NYT Today: "Nurses are Not Doctors"

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Mr. Hat said:
I'm over the NP vs MD argument. Any time it comes up now (usually with an NP), I tell them that I fully support independent NP practice rights in every field in medicine. And I really do. But I mean INDEPENDENT. I do not support NP's practicing "independently", but having an MD as part of their "team" who is going to get sued when the crap hits the fan. No, I support them practicing entirely independently including being 100% responsible for their own outcomes, malpractice coverage, how much they cost the hospital system in tests and referrals, etc.

As far as I'm concerned, granting NP's completely independent practice rights is the only way this thing is going to get solved. If they truly are equivalent to MD's, then society will save a bunch of money and we can end the medical school and residency training model as well. If it turns out that going through years of indentured servitude gets you to the exact same level of training and competence as someone who goes to school 1 day a week for a couple years while working full time, then things SHOULD change. On the other hand, if truly independent practice for NP's turns out to be a complete cluster, then their malpractice rates will go through the roof (or they will be totally unable to obtain it), hospitals will absolutely refuse to hire them, and the problem will solve itself quite nicely.
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Great post!
 
Mr. Hat said:
I'm over the NP vs MD argument. Any time it comes up now (usually with an NP), I tell them that I fully support independent NP practice rights in every field in medicine. And I really do. But I mean INDEPENDENT. I do not support NP's practicing "independently", but having an MD as part of their "team" who is going to get sued when the crap hits the fan. No, I support them practicing entirely independently including being 100% responsible for their own outcomes, malpractice coverage, how much they cost the hospital system in tests and referrals, etc.

As far as I'm concerned, granting NP's completely independent practice rights is the only way this thing is going to get solved. If they truly are equivalent to MD's, then society will save a bunch of money and we can end the medical school and residency training model as well. If it turns out that going through years of indentured servitude gets you to the exact same level of training and competence as someone who goes to school 1 day a week for a couple years while working full time, then things SHOULD change. On the other hand, if truly independent practice for NP's turns out to be a complete cluster, then their malpractice rates will go through the roof (or they will be totally unable to obtain it), hospitals will absolutely refuse to hire them, and the problem will solve itself quite nicely.
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This is the solution. Stop fighting the inevitable, let it take its course.
This, this, this.
 
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Siggy said:
Sigh, I love how the AllNurse gang (mafia?) has moved onto the "we save residents, therefore we can be attendings!" angle. As well as the, "Well, then we won't help residents out" line. The militant NP wing... so professional.
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Make no mistake though, they need us, we don't need them.
Residents without NPs, not exactly a huge problem.
NPs without attendings? Good luck. The blind leading the blind.
 
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Doudline said:
On another note, I clearly remember at least two attendings on this very forum stating that NPs generally work on the level of second or third year residents. Considering that FM is 3 years in length...
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Considering that FM 3rd years are only 3rd years for exactly 1 year, and then do not continue functioning at 3rd year resident levels for the rest of their careers......?
 
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Just throwing my two cents in. I was in a top-ranked DNP program last year. In my class there were some vastly intelligent people who will make excellent NP's, and there were many I wouldn't trust to pass meds on the floor let alone be an independent practitioner. I chose to leave because I came to find out that the profession wasn't what I had thought it would be. That being said, the course content was easier than my undergrad work (biology/chemistry major). I did not purchase textbooks my second semester and still finished with A's. That was said to illustrate the level of difficulty not to try and pat myself on the back.

I think if the general public knew the VAST difference in time/rigor/competition/training this conversation would never need to take place.
 
I usually skim these threads for a laugh or two, but I've been inclined to chime in on this debate after spending a good chunk of time going through 10+ pages, as well as other random NP articles (with some truly cringe-worthy comments). The cynic (or maybe pragmatist) in me wants to say "F it, let's just watch the problem solve itself as the public image of NP's inevitably deteriorates and the massive legal vulnerabilities of independent practice effectively drive them into oblivion." Of course, a few generations of PCP's will likely continue to suffer until that reality comes about. At the same time, I do think there is opportunity for damage control, and potentially even a partial reversal of the rapid progress currently being made by the nursing lobby and their supporters (Big pharma, corporate interests). I read some great ideas going though this thread, one of which is a strong push for a massive, nationwide PR campaign (delicately designed to show that cheap alternatives can mean e.g. jeopardizing your or your family's health, without really referring to NP's specifically.) It wouldn't be unlike some of the tactics used by our defense department on our politicians to fund billions in seemingly unnecessary costs (which could swiftly justify themselves the moment they are needed, as is a physician in the potential scenario when that flu wasn't just the flu, etc), although that is a whole different debate. So why isn't the AMA working harder on this? (As a sidenote- increasing residency spots in primary care probably won't help much if there are no PCP roles to fill after those residencies).
 
Siggy said:
Med schools getting us to mobilize? ROFL. Sorry, but we can't do that, it's contrary to the interprofessional harmony that we're supposed to be taught.
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The sort of apologetic drivel I hear from some people - "We should all try to get along, what matters is the patient (true) etc." Politically correct has some place in society. Not here.
 
KnuxNole said:
Maybe i'm missing something, but I think doctors connect with people just as much as nurses can. I mean, when I talk to patients, I almost never use medical jargon
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Yeah, you make a good point. There was a doctor who discarded the medical jargon of "lumbar lordosis" to explain to the patient her Dx was "ghetto booty".
 
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Anastomoses said:
Yeah, you make a good point. There was a doctor who discarded the medical squack of "lumbar lordosis" to explain to the patient her Dx was "ghetto booty".
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Holy crap what an idiot. I definitely think there's a PC excess in medical culture that teaches white people to try to ebonicize their speech to grossly inappropriate effect. Even when not derogatory or a slur I still get offended by the absurdity of trying so hard not to offend that you end up sounding like a tool.

Bearing this out to the thread topic-- I've seen a southern bell of an NP try this out on her African American patients to painful awkwardness for all involved. She proceeded gleefully oblivious. Convinced she was treating the whole person by adopting their cultural norms.
 
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That's why you gotta be a white person who has perfected their Ebonics to a T 😛
 
To whoever MD2BE is, over on that other site, a quick note. A lot of MD schools only "require" 90 semester hours of course work and not a degree for admission. Now the competition for medical school is such that a degree is pretty much required, but on paper it isn't.
 
Siggy said:
To whoever MD2BE is, over on that other site, a quick note. A lot of MD schools only "require" 90 semester hours of course work and not a degree for admission. Now the competition for medical school is such that a degree is pretty much required, but on paper it isn't.
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Admission != matriculation. Need the bachelor's or a combined degree program to matriculate anywhere.
 
KinasePro said:
Admission != matriculation. Need the bachelor's or a combined degree program to matriculate anywhere.
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http://www.meded.uci.edu/admissions/admissions_information.asp
Only mentions 90 hours, not a degree

From what I remember, when I applied years ago, very few schools actually listed a degree as being mandatory to matriculate. Again, granting that the admission rate is about 50% and 30% of admitted students had graduate degrees, an undergrad degree is an unwritten requirements. It's just that there are plenty of schools that don't put that into writing.
 
BurghStudent said:
So, I didn't know this, but the Institute of Medicine isn't exactly on our side:

"No studies suggest that APRNs are less able than physicians to deliver care that is safe, effective, and efficient or that care is better in states with more restrictive scope of practice regulations for APRNs"

www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Report-Brief-Scope-of-Practice.aspx?page=2
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Finally something interesting. So now what? Should we begin supporting our nurses to practice independently?
 
Siggy said:
http://www.meded.uci.edu/admissions/admissions_information.asp
Only mentions 90 hours, not a degree

From what I remember, when I applied years ago, very few schools actually listed a degree as being mandatory to matriculate. Again, granting that the admission rate is about 50% and 30% of admitted students had graduate degrees, an undergrad degree is an unwritten requirements. It's just that there are plenty of schools that don't put that into writing.
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I'm guessing those websites just aren't comprehensive. I'm sure if you looked into the registrar manual or student handbook the bachelor's requirement is there with exceptions for combined programs.
 
BurghStudent said:
So, I didn't know this, but the Institute of Medicine isn't exactly on our side:

"No studies suggest that APRNs are less able than physicians to deliver care that is safe, effective, and efficient or that care is better in states with more restrictive scope of practice regulations for APRNs"

www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Report-Brief-Scope-of-Practice.aspx?page=2
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The IOM also is not fully comprised of physicians (much less those that actively practice medicine): http://www.iom.edu/About-IOM/Leadership-Staff/Council.aspx
 
BurghStudent said:
So, I didn't know this, but the Institute of Medicine isn't exactly on our side:

"No studies suggest that APRNs are less able than physicians to deliver care that is safe, effective, and efficient or that care is better in states with more restrictive scope of practice regulations for APRNs"

www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Report-Brief-Scope-of-Practice.aspx?page=2
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Do we know what these studies are? It's a common mantra among the pro-independent nurses crowd that all studies show they are just as good (or better) than physicians, but I don't often see these studies cited. The few I have looked at have glaring flaws that compromise the statistical power of the study, including but not limited to: low number of participants, limited time frame of study (prevents study of long-term outcomes), and inconsistent or meaningless measures of 'outcome', like BP or patient satisfaction. If all these studies 'prove' is that nurses can manage chronic HTN as well as physicians, well, I don't think that is grounds to give them independent practice rights.
 
tarheel1408 said:
Do we know what these studies are? It's a common mantra among the pro-independent nurses crowd that all studies show they are just as good (or better) than physicians, but I don't often see these studies cited. The few I have looked at have glaring flaws that compromise the statistical power of the study, including but not limited to: low number of participants, limited time frame of study (prevents study of long-term outcomes), and inconsistent or meaningless measures of 'outcome', like BP or patient satisfaction. If all these studies 'prove' is that nurses can manage chronic HTN as well as physicians, well, I don't think that is grounds to give them independent practice rights.
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I think @Instatewaiter explains it quite well here: http://forums.studentdoctor.net/thr...-are-not-doctors.1068469/page-9#post-15193729

These studies happen to be funded by nurses themselves.
 
Siggy said:
Sigh, I love how the AllNurse gang (mafia?) has moved onto the "we save residents, therefore we can be attendings!" angle. As well as the, "Well, then we won't help residents out" line. The militant NP wing... so professional.
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They know how to game the system quite well. They've had practice in this for years: http://www.medscape.com/viewarticle/464663_2
(even pharmacists have taken note)
 
tarheel1408 said:
Would it be immature to just repeat these reasons each time someone brings the issue up? I feel like this is something that ought to have been addressed but hasn't. Regardless, legislators are forging ahead with the pro-nursing lobby.
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They're politicians. By definition they are behold to specific interest groups. They could care less about the facts on the ground as you can bet when THEY need a provider, it will be with an MD. The rest of the unwashed masses can see a PA/NP, and if it "brings down costs", without huge collateral damage (many deaths and public outcry) then it's worth it.

Why do you think they're already backing off certain Obamacare features already? If they believed that the actual legislation worked - they'd hold to it. Look how much Howard Dean, MD (a noted liberal) was attacked by his own side for saying the IPAB is effectively a govt. rationing body.
 
BurghStudent said:
So, I didn't know this, but the Institute of Medicine isn't exactly on our side:

"No studies suggest that APRNs are less able than physicians to deliver care that is safe, effective, and efficient or that care is better in states with more restrictive scope of practice regulations for APRNs"

www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Report-Brief-Scope-of-Practice.aspx?page=2
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I bet there are also no studies suggesting custodial staff are less able to deliver care equal to that of physicians. It doesn't tell you much if you haven't looked at long-term outcomes of APRNs practicing truly independently. But should any grop who claims to be on par with physicians be granted equal independent practice rights and we can wait and see how it turns out? What if massage therapists claimed they could provide just as good care (hell, for the stuff that gets referenced, with a good flow chart and a bit of experience maybe they could)

tarheel1408 said:
Do we know what these studies are? It's a common mantra among the pro-independent nurses crowd that all studies show they are just as good (or better) than physicians, but I don't often see these studies cited. The few I have looked at have glaring flaws that compromise the statistical power of the study, including but not limited to: low number of participants, limited time frame of study (prevents study of long-term outcomes), and inconsistent or meaningless measures of 'outcome', like BP or patient satisfaction. If all these studies 'prove' is that nurses can manage chronic HTN as well as physicians, well, I don't think that is grounds to give them independent practice rights.
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BurghStudent said:
So, I didn't know this, but the Institute of Medicine isn't exactly on our side:

"No studies suggest that APRNs are less able than physicians to deliver care that is safe, effective, and efficient or that care is better in states with more restrictive scope of practice regulations for APRNs"

www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Report-Brief-Scope-of-Practice.aspx?page=2
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Bc that's the standard we should use. No studies suggest that they are "less able than physicians" to do the job, so it's A-OK to release them on the public.
 
DermViser said:
The IOM also is not fully comprised of physicians (much less those that actively practice medicine): http://www.iom.edu/About-IOM/Leadership-Staff/Council.aspx
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Every major medical organization I can think of has the problem of misrepresentation. Either it's non-MDs telling MD what's what, or MDs that lived the glory days and are assuming to understand the plight of today's medical student. Look at the AMA. Even the AOA- most DOs and DO students would do away with the 'osteopathic distinctiveness' bit.
 
tarheel1408 said:
Do we know what these studies are? It's a common mantra among the pro-independent nurses crowd that all studies show they are just as good (or better) than physicians, but I don't often see these studies cited. The few I have looked at have glaring flaws that compromise the statistical power of the study, including but not limited to: low number of participants, limited time frame of study (prevents study of long-term outcomes), and inconsistent or meaningless measures of 'outcome', like BP or patient satisfaction. If all these studies 'prove' is that nurses can manage chronic HTN as well as physicians, well, I don't think that is grounds to give them independent practice rights.
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Patient satisfaction is a strong predictor of treatment adherence and a valid measure to use in a quality study (separate to the link to treatment adherence, many would argue patient satisfaction as an independent factor in quality, but that's going off on a tangent). BP is a valid measure as well - I don't have to list the risk factors of unmanaged hypertension in allo forum. Your last statement is where the real argument is - what factors need to be measured in a study to determine if a group is qualified to provide independent / unsupervised care to patients? I think it would be reasonable to argue that long term outcomes, referral and lab/test utilization, cumulative cost with the aforementioned factors accounted for, and missed diagnosis rates are all things that should be looked at. The problem is the majority of these factors take long and both financially and resource intensive studies to reasonably measure, and there's a huge push from the nursing lobby for independent practice now that's easy for many politicians to get behind from an access to care standpoint.

Sephiroth said:
I bet there are also no studies suggesting custodial staff are less able to deliver care equal to that of physicians. It doesn't tell you much if you haven't looked at long-term outcomes of APRNs practicing truly independently. But should any grop who claims to be on par with physicians be granted equal independent practice rights and we can wait and see how it turns out? What if massage therapists claimed they could provide just as good care (hell, for the stuff that gets referenced, with a good flow chart and a bit of experience maybe they could)
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The thing is, there ARE studies that show nurses deliver comparable care to physicians. The studies may have significant validity issues as well as dubious construction from the get go given the vast majority are funded by nursing organizations that champion independent practice for nurses, but when the nursing groups lobby for independent practice, they're not making an argument of lack of evidence - they can provide positive evidence based on the studies that they've conducted
 
BurghStudent said:
Every major medical organization I can think of has the problem of misrepresentation. Either it's non-MDs telling MD what's what, or MDs that lived the glory days and are assuming to understand the plight of today's medical student. Look at the AMA. Even the AOA- most DOs and DO students would do away with the 'osteopathic distinctiveness' bit.
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Those MDs in leadership positions enjoyed the glory days of medicine many of whom could open up a shingle without even completing a residency. They have absolutely nothing in common with those graduating now or even those graduating within the last 2 decades.
 
Cytarabine said:
Patient satisfaction is a strong predictor of treatment adherence and a valid measure to use in a quality study (separate to the link to treatment adherence, many would argue patient satisfaction as an independent factor in quality, but that's going off on a tangent). BP is a valid measure as well - I don't have to list the risk factors of unmanaged hypertension in allo forum. Your last statement is where the real argument is - what factors need to be measured in a study to determine if a group is qualified to provide independent / unsupervised care to patients? I think it would be reasonable to argue that long term outcomes, referral and lab/test utilization, cumulative cost with the aforementioned factors accounted for, and missed diagnosis rates are all things that should be looked at. The problem is the majority of these factors take long and both financially and resource intensive studies to reasonably measure, and there's a huge push from the nursing lobby for independent practice now that's easy for many politicians to get behind from an access to care standpoint.



The thing is, there ARE studies that show nurses deliver comparable care to physicians. The studies may have significant validity issues as well as dubious construction from the get go given the vast majority are funded by nursing organizations that champion independent practice for nurses, but when the nursing groups lobby for independent practice, they're not making an argument of lack of evidence - they can provide positive evidence based on the studies that they've conducted
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I would argue that patient satisfaction is not a quality measure of outcome.
http://archinte.jamanetwork.com/article.aspx?articleid=1108766&resultClick=3

I agree with you that BP is something that needs to be managed - and uncontrolled HTN obviously causes a lot of problems - but the ability to manage HTN does not a provider make.
 
For all practical purposes, medical education needs to change...to adapt.

We learn a lot of material that just isn't useful for becoming a competent physician during the current 4-year education model.

"Yeah yeah yeah, wise words, MS1. How do you know med school education should change?"

We only need look to our friends at Duke.

They finish their preclinical material in 1 year. Essentially, they complete their MD education in 3 years (however, are forced to do a research/additional year -- that's a beef for another day).

Point is that Duke students can absorb the [academic] material to be an MD in 3 years. The school trimmed the fat off the curriculum.

I think NYU has a 3-year program, too. Vandy is also doing preclinicals in 1 year, iirc.

These schools are the pioneers, perhaps NYU more than Vandy/Duke (as the latter 2 still drag things out for 4 years anyway).

These schools have set precedent. 3 years of intense medical education is enough to make excellent graduates prepared for residency -- where the real learning takes place, so I hear.

Cutting the path to an MD would do a lot of good for future students...besides saving a year of your life in the books and a year of tuition (well, theoretically), it might also lessen the hurt that is inevitably going to be felt by many fresh PCP's in the future (as midlevels infiltrate more and more into their field).
 
tarheel1408 said:
I would argue that patient satisfaction is not a quality measure of outcome.
http://archinte.jamanetwork.com/article.aspx?articleid=1108766&resultClick=3

I agree with you that BP is something that needs to be managed - and uncontrolled HTN obviously causes a lot of problems - but the ability to manage HTN does not a provider make.
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http://archinte.jamanetwork.com/article.aspx?articleid=1108763

I thought that was an insightful response to the article you referenced. It doesn't disagree with you, but does highlight the same thing I would point out - the likelihood of unmeasured confounding variables. Another point I would make is that it matters the context in which satisfaction is measured. My background in the literature is in doctor-patient communication, and in that area, patient satisfaction can be looked at as an outcome variable subsequent to randomization - a different context from the use of patient satisfaction as a reimbursement incentive for example. In kind, there may be different settings in which satisfaction is a valid measure of quality, e.g. primary care vs the emergency room (the latter of which is simply the most inane area to me - it kills me that this is where the major push has been for satisfaction being tied to reimbursement)
 
Frazier said:
For all practical purposes, medical education needs to change...to adapt...

...(as midlevels infiltrate more and more into their field).
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Agree with this entirely. Medical education has been so slow to change, we've almost brought it upon ourselves. The bloat in our education is painful
 
Frazier said:
For all practical purposes, medical education needs to change...to adapt...3 years...
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That won't help us much if residencies all become longer, which has been the trend in recent years.
 
GUH said:
That won't help us much if residencies all become longer, which has been the trend in recent years.
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Sure, it would.

If your residency is going to be longer regardless (as you say it is already a trend) -- a year saved anywhere (whether undergrad or med school) is going to save the student, period, during the overall timeline.

If residencies extend their length as a direct result of med school shortening -- that would be rather ridiculous, IMO. Nevertheless, certainly ridiculous things happen all the time.

Between those choices, I would argue in favor of longer residency, as at least during residency you are not paying tuition and instead making an income (big money when you add the two together) while learning the actual field that interests you most.
 
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Frazier said:
For all practical purposes, medical education needs to change...to adapt.

We learn a lot of material that just isn't useful for becoming a competent physician during the current 4-year education model.

"Yeah yeah yeah, wise words, MS1. How do you know med school education should change?"

We only need look to our friends at Duke.

They finish their preclinical material in 1 year. Essentially, they complete their MD education in 3 years (however, are forced to do a research/additional year -- that's a beef for another day).

Point is that Duke students can absorb the [academic] material to be an MD in 3 years. The school trimmed the fat off the curriculum.

I think NYU has a 3-year program, too. Vandy is also doing preclinicals in 1 year, iirc.

These schools are the pioneers, perhaps NYU more than Vandy/Duke (as the latter 2 still drag things out for 4 years anyway).

These schools have set precedent. 3 years of intense medical education is enough to make excellent graduates prepared for residency -- where the real learning takes place, so I hear.

Cutting the path to an MD would do a lot of good for future students...besides saving a year of your life in the books and a year of tuition (well, theoretically), it might also lessen the hurt that is inevitably going to be felt by many fresh PCP's in the future (as midlevels infiltrate more and more into their field).
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I agree, we can definitely squeeze an intense 3 year programs. Like you mentioned too, residency is where you REALLY learn to be a doctor....hell I feel like I learned nothing in med school compared to 10 months of internship training :O
 
maxxor said:
Be careful what you wish for in lengthened residency. You don't want to end up like Dentistry where students pay tuition...
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Good point.

That said, definitely not wishing for longer residencies to become a reality.

Simply saying between these hypotheticals in a vacuum:

3 years medical school + 4 years residency =7 years
3 years medical school + 5 years residency = 8 years
4 years medical school + 4 years residency = 8 years

My preference would be: 1, 2, 3
 
WhippleWhileWeWork said:
Considering that FM 3rd years are only 3rd years for exactly 1 year, and then do not continue functioning at 3rd year resident levels for the rest of their careers......?
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From my understanding, senior residents (3rd year FM) need very little supervising and are trusted to make most decisions by themselves. Plus it means that NPs have virtually the same skill level has FM attendings fresh out of residency. I don't see much of a crusade going against that group, however.

@DermViser No idea.

@Psai I realize that the quality of training varies strongly, but the same can be said for MDs. There is a significant amount of absolutely gross medical mistakes going on every year, plus medical schools being put on probation for bad standards, or new ones opening left and right.

You're right in that it's probably more recurrent in the nursing world though.
 
Doudline said:
From my understanding, senior residents (3rd year FM) need very little supervising and are trusted to make most decisions by themselves. Plus it means that NPs have virtually the same skill level has FM attendings fresh out of residency. I don't see much of a crusade going against that group, however.

@DermViser No idea.

@Psai I realize that the quality of training varies strongly, but the same can be said for MDs. There is a significant amount of absolutely gross medical mistakes going on every year, plus medical schools being put on probation for bad standards, or new ones opening left and right.

You're right in that it's probably more recurrent in the nursing world though.
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Chances are those NPs that function at 2/3rd year resident level, are that way after many years of actual practice, even then they're still at 2nd/3rd year resident level.

The problem is even if they worked 40 years, and were at attending level status, we have no proof of that bc their education pathway is not standardized at all, and when you try to standardize it, nearly 50% fail the certification exam.
 
Mad Jack said:
:bored:*clicks link*
HTNbleed_cerebellum_2.jpg
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Seriously? I can't even....
 
Cytarabine said:
The thing is, there ARE studies that show nurses deliver comparable care to physicians. The studies may have significant validity issues as well as dubious construction from the get go given the vast majority are funded by nursing organizations that champion independent practice for nurses, but when the nursing groups lobby for independent practice, they're not making an argument of lack of evidence - they can provide positive evidence based on the studies that they've conducted
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Which is why bad data are worse than no data...
 
I don't get the whole argument of NP functioning as a 3rd year resident. Like yes, totally buy that if they have a decent amount of experience, yet a 3rd year resident still gets paid 60k a year for a reason. If they are a fresh out of school NP, they have less training than an M3, so why would they be 4 years superior in performance? Seems pretty obvious as to the meanings of those anecdotes to me.

obviously a NP that has some experience is going to have at least some idea how to do their job (like a 3rd year resident). It's the ones fresh out of school that we are worried about. If you function as well as a 26-30 year old resident when you are 40, how good are you going to be when you are 26 and have full legal ability to practice? Probably not too well.
 
Doudline said:
I realize that the quality of training varies strongly, but the same can be said for MDs. There is a significant amount of absolutely gross medical mistakes going on every year, plus medical schools being put on probation for bad standards, or new ones opening left and right.

You're right in that it's probably more recurrent in the nursing world though.
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Actually, no it can't. Even from one the "low tier" med schools you are on similar footing with your peers from the top school. The product those low tier med schools put out is similar to that put out by the top tier schools. I can attest to this as I did my med school at a "low tier" school and went to residency and fellowship at a tippy top tier programs surrounded by mainly people from Hopkins/Harvard/Colubia/Penn/Duke etc.

The standardization in medical education actually belies your point. It is one of the few places where there is a close to uniform product put out. There is not even close to uniformity or standardization in NP and DNP education. Most NP programs have to find their own clinicals!
 
PL198 said:
I don't get the whole argument of NP functioning as a 3rd year resident. Like yes, totally buy that if they have a decent amount of experience, yet a 3rd year resident still gets paid 60k a year for a reason. If they are a fresh out of school NP, they have less training than an M3, so why would they be 4 years superior in performance? Seems pretty obvious as to the meanings of those anecdotes to me.

obviously a NP that has some experience is going to have at least some idea how to do their job (like a 3rd year resident). It's the ones fresh out of school that we are worried about. If you function as well as a 26-30 year old resident when you are 40, how good are you going to be when you are 26 and have full legal ability to practice? Probably not too well.
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This comparison is usually for senior NPs who have been around the block. I have been around some incredibly good NPs who did function like senior residents in their little niche. Outside of their wheelhouse however, watch out. It could get pretty scarry
 
Doudline said:
From my understanding, senior residents (3rd year FM) need very little supervising and are trusted to make most decisions by themselves. Plus it means that NPs have virtually the same skill level has FM attendings fresh out of residency. I don't see much of a crusade going against that group, however.
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There's some sloppy reasoning happening here. You seem to be suggesting that FM 3rd year residents should be receiving the same criticism as NPs because they "function" at the same level.

Why would anyone question a 3rd year FM residents semi-autonomy? He's been trained under the medical model: 4 years of medical school, multistep board exams and a residency training program. That's the standard. Of course there's no crusade going against it, it's the highest form of medical education in the world.

Also, like I said, FM docs only function at a 3rd year resident level for one year, in theory. They actually have the knowledge bank and experience to grow into incredibly competent practitioners of medicine there after.

Nothing I said above applies to NPs. In other words, take away the entire foundation for the FM residents knowledge, experience, and training, let him practice with absolute autonomy, no board exams, and let him remain at roughly the same level (3rd of residency) for the rest of his career.

To risk cliché, you're trying to compare an apple to an orange but failing to see the differences.
 
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If we let this people invade our career, expect the worst in less than 20 years.
 
darksurg said:
If we let this people invade our career, expect the worst in less than 20 years.
Click to expand...

I'm firmly convinced that they'll ruin their own careers. I honestly don't even see what the threat is, if they are as incompetent as the medical model practictioners suggest then they'll dig their own graves. If they can truly provide equivalent health care then the rest of us are getting ripped off and the entire medical education system as we know it will collapse, as it should.
 
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