Nurse Practitioners soon to take primary care physician role....

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demayette

demayette

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Why going to medical school to become primary doc if nurse practitioners will have the same privilege with less education, minimal amount of debt ect...I will not pursue my dream anymore, which is becoming a primary doc. I am a nurse who already got my prereq for med school and I am getting BS now so can apply to med school. I am so dismayed by that article and I dont know whether I should switch again and pursuing the nurse practitoner route or stick to medicine which is my dream. Advice please...
http://news.yahoo.com/s/ap/20100413/ap_on_he_me/us_med_dr_nurse
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sorry to break this to you but np's and pa's have been working as pcp's for decades in hmo's, va medical ctrs, all branches of the military and private practice..they have owned their own clinics for decades as well. the smart ones have physician partners/employees/collaborators.
now it's just finally being acknowledged.
we will always needs docs in primary care as team leaders. I wouldn't let this steer you away from a career as a primary care md/do.
 
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demayette said:
Why going to medical school to become primary doc if nurse practitioners will have the same privilege with less education, minimal amount of debt ect...I will not pursue my dream anymore, which is becoming a primary doc. I am a nurse who already got my prereq for med school and I am getting BS now so can apply to med school. I am so dismayed by that article and I dont know whether I should switch again and pursuing the nurse practitoner route or stick to medicine which is my dream. Advice please...
http://news.yahoo.com/s/ap/20100413/ap_on_he_me/us_med_dr_nurse
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fghgbngh
 
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emedpa said:
sorry to break this to you but np's and pa's have been working as pcp's for decades in hmo's, va medical ctrs, all branches of the military and private practice..they have owned their own clinics for decades as well. the smart ones have physician partners/employees/collaborators.
now it's just finally being acknowledged.
we will always needs docs in primary care as team leaders. I wouldn't let this steer you away from a career as a primary care md/do.
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I know that; however that article pointed out that they will be able to prescribe narcotics and have 100% medicaid and medicare reimbursement rate. I think it's crazy.
 
demayette said:
I know that; however that article pointed out that they will be able to prescribe narcotics and have 100% medicaid and medicare reimbursement rate. I think it's crazy.
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the dea/narcs thing isn't new. pa's/np's have had dea privileges forever.
the 100% reimbursement is.
 
100% of Medicare reimbursement is still crap.

If primary care isn't attractive to doctors, it's not going to be any more attractive to mid-levels.

There are so many threads here on this subject already...just use the search function.
 
Bring it on.

I would love to compete against nurse practitioners in what I do.
 
Why primary care? I've read the countless studies that show mid-levels heading into specialties at the same rate as physicians (BD is right). So why aren't all these Dr. Nurses and their arrogant lobbyists saying "I can be a cardiologist, neurologist, endocrinologist, etc.?" "I work side by side with these specialists, I ought to be paid like they do." If Dr. Nurses can learn a broad scope of medicine like primary care, what stops them from becoming practicing specialists in the future?

As someone who will be starting med school in july, reading this stuff makes me nervous and jaded. For what it's worth, psychiatrists are facing a similar issue with psychologists being able to prescribe. It just seems like everyone on this Earth can play doctor.
 
Zap Rowsdower said:
It just seems like everyone on this Earth can play doctor.
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not really. the more you specialize the more you separate yourself from anybody else but the specialists in your field from being able to do what you do. for example do you think anybody other than a pediatric heart surgeon will be allowed to independently perform heart surgery on kids? not a chance. a lot of places don't even allow an adult heart surgeon to scrub in on pediatric cardiac cases...it can only be the attending pediatric heart surgeon and the pediatric heart surgery fellow. the more you specialize the further you distance yourself from others wanting to encroach on your turf because it becomes too complex for them to do so.
 
PostCall said:
not really. the more you specialize the more you separate yourself from anybody else but the specialists in your field from being able to do what you do. for example do you think anybody other than a pediatric heart surgeon will be allowed to independently perform heart surgery on kids? not a chance. a lot of places don't even allow an adult heart surgeon to scrub in on pediatric cardiac cases...it can only be the attending pediatric heart surgeon and the pediatric heart surgery fellow. the more you specialize the further you distance yourself from others wanting to encroach on your turf because it becomes too complex for them to do so.
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I know I meant that in a sarcastic way. I must say as a libertarian, I'm all for nurses competing with doctors and allowing the patient to choose. The problem is that we just have not had a free market healthcare system since when, the 20's? If patients flock to NP's, then maybe costs would decrease bc primary care providers would make less (although that would probably effect like 2.5% of healthcare costs). It just isn't an equal playing field in terms of length of education and educational debt, or malpractice I'd assume. If the insurance companies and government do not value primary care doctors, then why wouldn't all doctors go cash only? It's probably just easier said than done.
 
Very few mid-levels practice independently. This isn't likely to change.

The growth in mid-level jobs is in specialties, not primary care. This isn't likely to change, either.

Being a super-sub-specialist only guarantees that you'll have relatively few employment opportunities to choose from. It doesn't guarantee income or job security, and it sure as hell doesn't guarantee happiness.
 
>>I wouldn't let this steer you away from a career as a primary care

Really, when are you people going to wake up? While MLPs might have been slowly and gradually making inroads into primary care we have a perfect storm - not enough primary care docs and about another 30 million people looking for care. Quite frankly, there is no other solution. People who go to medical school will become specialists and primary care will be from MLPs - all called Dr. It will simply be a different model of medical care.

At this point the only responsible approach is to ensure that new med school grads do not apply to family medicine programs. Then the fam med programs will either close or adapt to educating MLPs. There is no point in fighting this any longer. It's time to accept change and adapt accordingly.
 
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George85 said:
At this point the only responsible approach is to ensure that new med school grads do not apply to family medicine programs. Then the fam med programs will either close or adapt to educating MLPs. There is no point in fighting this any longer. It's time to accept change and adapt accordingly.
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Fortunately for everyone, your opinion is not widely held.
 
Blue Dog said:
100% of Medicare reimbursement is still crap.

If primary care isn't attractive to doctors, it's not going to be any more attractive to mid-levels.

There are so many threads here on this subject already...just use the search function.
Click to expand...

Don't take this wrong, I'm in FM and perfectly happy. I think its not attractive to docs because of the high level of debt, possible lack of prestige and chance to make bank in other specialties.

Mid-levels on the other hand, don't have the same debt, see this as a step up and don't have quite the same ability to specialize.
 
>>Fortunately for everyone, your opinion is not widely held.

Isn't that what Galileo was told when he suggested the world was flat? Anyway, you're wrong - I go to enough conferences and interact with enough administrators, both hospital and insurance, to know that my view is widely held and accepted as inevitable. It's not if, it's when.

I don't understand why everyone seems to get so bent out of shape on this issue. Things change and medicine is no different. People seem to want to compare our educational path to that of MLPs and use that to justify our "superior" position. Well, medical education isn't really up to much. The system could be changed enabling most of the pre-clinical years to be completed in an undergrad degree - as for the 2 clinical years, that could be cut down to one year as in many places the second year is low key (not everywhere). So, my point is that changes can be made and that our view of our own education doesn't mean that it's the only way, or indeed the best way.

If someone wants to go into primary care after med school and they're happy with their choice then that's great. But if you choose fam med over internal med and do change your mind at a later date then you're screwed - there are no real followship opportunities - sports med, geriatrics - it's a joke. Even the so called EM fellowships are not recognized. In fact, so much of what we used to do has been taken away from us, leaving us with jobs that are easily done by MLPs.

I cannot support your approach of burying your head in the sand. You seem to want to encourage new med school grads to climb on board your sinking ship. I believe we have a responsibility to ensure that anyone considering family medicine knows the truth and understands what will happen to primary care in this country. How many people are now "stuck" in primary care because they made uninformed decisions? And even though the same might be true for many specialists they at least don't have same financial pressures that we often have to endure.
 
And to the original poster, "demayette" - don't be dismayed or put off primary care. Just ensure that you make informed decisions along the way. You may well find that your views and goals change as time goes on. And if you're set on primary care and have concerns about future changes then you could do internal medicine which would give you future fellowship options. You could also consider dual programs such as FM/EM, IM/Peds. Medicine has countless opportunities and if your goal is to be a doctor then go for it.
 
George85, sorry to be blunt, and I don't know what you are a resident in, but you are really ignorant. Internal med training w or w/o peds is pretty different from family med. IM training is not as focused generally on outpatient care. It's just not the same.

I'm finishing my second year as a fam med resident and know, from speaking to many practicing physicians and reading a lot about our current state of affairs, that money is out there to be made, but we must love our craft. It will evolve in some way. But a smart business person can and will find a niche in FM and do fine. Most recent grads from our program are not complaining about starting contracts and reasonable perks/performance requirements.
 
I love how this thread pretty much just *died* now that there's a thread going in General Residency called "NPs can now do residencies in dermatology".
 
lowbudget said:
I love how this thread pretty much just *died* now that there's a thread going in General Residency called "NPs can now do residencies in dermatology".
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There are two in TIH, plus similar threads in some of the other residency forums. The discussion is all pretty much the same.
 
Here is my two cents on this NP Vs MD. When your in a position to choose, ie Beamer, Bently, or Benz, which would you choose ? Patients will over time in the primary care world want to go with an MD just because most of them won't know anything else except that the MD represents the Bently of care and a NP might be a Toyota Avalon without a recall.


No pun intended but, these threads are striking fear in med students - some are wondering if its better to be a NP and forgo med school. What I wrote above is going to wind up being the case in alot of the areas in the US. NP's aren't held to the same CME's standards we are. We read the New England Journal of Med - not sure what they read or use; seen some rely on epocrates - how sad that is.

If you love primary care, your good at it, and love what outpatient medicine is - go for it. If you have lots of debt, then sign up for IBR during residency and then work in an undeserved area or hospital - then your loans are forgiven after 10 years(includes residency). If this option isn't cool, many employers are actually paying off your loans so long as you work for them. I've seen places pay 40k a year directly to your loan companies and still pay a nice 200k a year.


Specialists have what I call job security in a state of job obscurity. Is a NP going to do Cardio, Pulm, GI, Neuro, Surgery, Optho, - of course not. Many of the fields of medicine are already being back filled with NP's simply because of the shortage and costs. If your worried, then go into IM and get into something that you can't see an NP with a master's degree doing. This will indeed give you security which isn't false but will take many more years of your life to get done - sigh


Bottom line: we shouldn't blame NP's. Med schools need to change the way things work- from MCAT's to the 'do I really need a 4th year of med school.' the 4th year could very well serve as an intern year instead of what it is to most - a one year slack era till you are on the clock for your PGy1.
 
It's not only primary care they are after it's EVERYTHING.

Clinical Residency Concentrations


The USF College of Nursing has established selected, broad, supervised residency concentrations designed to meet each resident’s individualized professional and clinical practice goals. Each clinical residency concentration is a variable credit tract with a minimum requirement of 500 clinical hours beyond the Master’s level clinical hours. The Dermatology and Cardiovascular residency concentrations require a minimum of 1000 hours beyond the Master’s level clinical hours. Residency concentrations are broadly defined by the following clinical specialties:

Dermatology*
Cardiovascular
Family Practice
Occupational Health *
Internal Medicine
Endocrinology
Neurology/Pain Management
Psychiatry
Pediatrics
Neonatology
Emergency Medicine
Acute Care

* Additional criteria may be required for admission
 
Well the question is now, why go to medical school - short cuts are now abound which cost less and allow you into areas which aren't that bad? Med schools along with boards need to see this as a problem and fix it or face less and less students choosing the traditional path of medical school.
 
I'm not the moderator, but unless you guys can keep this on-topic to the FM forum, why not take this discussion to one of the many other threads already in progress in TIH and General Residency?

I won't be adding to this thread myself. I'm certainly not about to repeat everything that I've posted there over here.
 
i did an internship for 7 months at a local family practice program about 3 years ago. i quit because the stress and workload were too much for my aging body and mind. i would not try to do it again.

as i slaved as an intern, i watch how easy the nurses jobs were. hours were fixed. pay and benefits were much better.

anyway, i'm back as a prison doc...and happy.
 
billsguy,

>>I don't know what you are a resident in
Nothing anymore.

>>but you are really ignorant.
Impressive display of wit and sharp repartee.

>>I'm finishing my second year as a fam med resident and reading a lot
Read all you want - unfortunately, the real world awaits - in that real world you will find real student debt, real mortgages, real college funds, real pension funds, and some very real opportunities to work very hard to generate down stream revenue for hospitals and specialists. Hopefully, I don't come across as too cynical, after all, I understand that many of my specialist collegues need to earn twice as much as primary care docs because they have much more free time that needs fully funding.

>>IM/Peds training is pretty different from family med.
>>It's just not the same.
I never implied that they were the same. I was simply offereing the original poster some suggestions for pursuing primary care but with a "get out of jail free" card if they changed their mind at a later date.
 
.
 
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M.Furfur said:
This is what dr nurse thinks of the difference between them and a family physician.

http://www.cnn.com/video/#/video/health/2010/04/17/nr.velshi.nurses.power.cnn

Ali Velshi: ....
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What... you so excited your double posting... in the same forum for that matter!
http://forums.studentdoctor.net/showthread.php?t=720518
M.Furfur said:
...This is getting beyong ridiculous

http://www.cnn.com/video/#/video/health/2010/04/17/nr.velshi.nurses.power.cnn

Ali Velshi:...
Click to expand...
 
You know medicine is challenging enough for MDs. Let's just remember we're talking 9 months maybe clinical experience. Veterinarians get more than that. Anything can and does walk in that door. Giving nps narcotic prescription power is just going to turn them into prescription Pain pill mills with otherwise healthy patients just as they do with antibiotics for people with colds to push up their numbers. They don't have the training to deal with the scope of real human disease. It's just stupid and people need to know that.
 
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Does anybody have data comparing outcomes and COST/referral levels of NP managed versus MD managed clinics, for anything other than single chronic disease patients and focused procedures? I ask this not to be provocative, but because these are the only studies (rather one underpowered JAMA study) I can find, and this obviously does not represent the average primary care practice.
 
Just wanted to throw this out there..

Does it occur to anyone here that patients still have a choice? All I ever read on mid-level encroachment threads is that, if given the power, mid-levels will take over healthcare in <insert specialty>. I can tell you I will never see an np, would have to seriously think about a PA, and I will make sure a crna is not ever working on me or my family.

I had an np assess me during a recent ED visit for a reaction to meds, I was NOT impressed. Fortunately the attending came in and finished without me requesting, but I can say I would have requested it anyhow. Ironically, this particular np is one I recognized from my years working in EMS in this area, he's been an ER nurse for at least 11 years, but still.....

Relax docs, there are still plenty of patients out there that prefer the expertise..
 
FiremedicMike said:
Just wanted to throw this out there..

Does it occur to anyone here that patients still have a choice? All I ever read on mid-level encroachment threads is that, if given the power, mid-levels will take over healthcare in <insert specialty>. I can tell you I will never see an np, would have to seriously think about a PA, and I will make sure a crna is not ever working on me or my family.

I had an np assess me during a recent ED visit for a reaction to meds, I was NOT impressed. Fortunately the attending came in and finished without me requesting, but I can say I would have requested it anyhow. Ironically, this particular np is one I recognized from my years working in EMS in this area, he's been an ER nurse for at least 11 years, but still.....

Relax docs, there are still plenty of patients out there that prefer the expertise..
Click to expand...

1. Most patients don't know the difference. Some midlevel providers try hard to downplay their midlevelness.
2. When you go to the ER, you don't have a choice. If you ask for an attending, you will be forced to wait for a long time. That's hardly a choice, especially if you are sick, worried that the midlevel provider is missing something, and in need of a physician evaluation.
3. When you go to an urgent care that's staffed only by a midlevel, I suppose you can chose to leave. But, if you're there and you don't know, that's not a choice.
4. You may have a choice now, but there's nothing that compels your insurance company to force you to see a midlevel first, much like how HMO's force you to see a PCP before you are allowed to see a specialist. That's hardly choice. You can choose to not buy an insurance that has an HMO option, but if your employer only allows you to have HMO insurance, that's not a choice. If your employer offers only HMO insurance, and if the HMO insurance forces you to see a midlevel, it's not like you can opt out and choose the public option. Lastly, if you can't afford anything but to see a midlevel, that's hardly a choice.

The whole idea of having choice is a luxury that only some people can enjoy. For everyone else, you're subjected to the whim of the "system".
 
I would say its rather rare that people are without a choice and at the whim of the system. If people choose to stay uneducated, that is not my responsibility, it is their choice to be uneducated. In the case of the ED visit, i would have requested a physician, that's my choice. I used the word attending because it's not a teaching hospital and there are no residents available, so I'm not sure of that created some confusion in my post.

In the end, I was trying to interject some positive energy into a perpetually negative topic on these forums. I was trying to convey the perspective of a patient who chooses physicians to midlevels for myself and my family. I'm sorry that perspective is invalid to you.
 
MedicineDoc said:
You know medicine is challenging enough for MDs. Let's just remember we're talking 9 months maybe clinical experience. Veterinarians get more than that. Anything can and does walk in that door. Giving nps narcotic prescription power is just going to turn them into prescription Pain pill mills with otherwise healthy patients just as they do with antibiotics for people with colds to push up their numbers. They don't have the training to deal with the scope of real human disease. It's just stupid and people need to know that.
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You have any facts here? In 2007 there were 4 pain clinics in Broward County, Fl. Now there are 150. I'll bet these clinics weren't started by NP's.
 
zenman said:
You have any facts here? In 2007 there were 4 pain clinics in Broward County, Fl. Now there are 150. I'll bet these clinics weren't started by NP's.
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Pain clinics are run by those trained in pain management for patients with recalcitrant pain. It's not necessarily a bad thing. Giving generalist nurse practitioners narcotic prescription power on the other hand will just incentivize them to hand out narcotics to anybody who says ouch. Doesnt take much training to become a narcotic source after all. Right down their alley.
 
MedicineDoc said:
Pain clinics are run by those trained in pain management for patients with recalcitrant pain. It's not necessarily a bad thing. Giving generalist nurse practitioners narcotic prescription power on the other hand will just incentivize them to hand out narcotics to anybody who says ouch. Doesnt take much training to become a narcotic source after all. Right down their alley.
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So you still just have an opinion and no facts.
 
As an aside. I admitted a patient the other day. The Er nurse practitioner offered to write some preliminary orders on the patient as I had 2 other simultaneous admits. The patient had a sodium of 124. What fluids did the nurse practitioner "Er doc" order? D5 1/2 normal saline with 20 millieq of potassium. Why? Because that's what he always orders. Same guy months before. "it doesn't matter that much which antibiotic. They all seem to work about equally as well". For what? "For anything".
 
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JaggerPlate said:
Choking on the irony.
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Ironic when you insist on fact in order to make a medical decision, yet here opinions seem to work for you. Well my opinion is that I have a lot of trouble getting patients straightened out after their PCP just handed out benzos or narcs like they were M&M's.
 
zenman said:
Ironic when you insist on fact in order to make a medical decision, yet here opinions seem to work for you. Well my opinion is that I have a lot of trouble getting patients straightened out after their PCP just handed out benzos or narcs like they were M&M's.
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No, ironic because when someone has an argument against NPs, you suddenly become a strict scientist and demand objective proof, but I literally cannot count the number of times you've "proven" NP worth on these boards with ridiculous anecdotal stories, n=1 scenarios, personal beliefs, and baseless opinions.
 
I think we could agree that there are an abundance of physicians who have started up clinics that are nothing more than narcotic resupply depots? If that's the case, I'm not sure how letting a much less educated provider give it a go will help the situation? :scared:
 
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