On the topic of calling NPs 'doctor'

[deleted87716]

I dunno. I would be fine with NPs managing chronic patients with straight-forward medical conditions (DM, HTN, etc), as long as they are appropriately, and extensively, trained in it.

Trouble is, there are increasingly fewer "straightforward" medical conditions. Patients, both in and out of the hospital, are becoming sicker, with more co-morbid conditions now than ever before, along with increased potential for polypharmacy and interrelated symptoms and side effects.

I never see a patient with hypertension, or diabetes, or dyslipidemia, or coronary artery disease. I see patients with hypertension, AND diabetes, AND dyslipidemia, AND coronary artery disease (AND COPD, AND depression, AND restless leg syndrome, AND...you get the idea). These are run of the mill patients. Most of them don't need specialty consultation. Not in my practice, anyway.

The average number of problems I address during a typical 15-min. office visit these days is four. The majority of my patients are on at least four medications, not counting OTC stuff. That's the average...many are far more complex than that.

Anyone who thinks they can do my job with a fraction of my training is welcome to try. Good luck.

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[unhappyrnstudnt]

What concerns me is the fact that these midlevels are not managing
pre-specified "straight-forward" problems ( although the above medical issues you allude to have their own complications I would not be comfortable having a mid level manage - eg : a female diabetic pt presenting in the office with acute coronary syndrome in an atypical fashion - it happens).

For example, a patient comes with fatigue; this could be any number of underlying problems.

Another example that comes to mind is chronic cough.

Both of these have a huge differential, some not benign. Of course, most of these are benign. However, family MDs are paid for catching the malignant or life-threatening problems. I have serious doubts that a noctor, with the amount of training, listed here, has the capacity to manage such problems independently.

You get what you pay for.

I have a hard time seeing these noctors being nothing other than referral machines.

I wouldn't even call them referral machines. When I kept having throat issues, I couldn't get any immediate appointments with my PCP, but was experiencing enough pain and swelling to need immediate treatment and thus agreed to appointments with the PA or NP. I don't know that my PCP had my ER/ENT records from my throat nearly swelling shut hardly a year prior, but I did inform them of the incident (the hospital was very apprehensive to release me...I got the impression they wanted to keep me until the tonsillitis was controlled enough to take them out before actually discharging me).

Since a bit of time had passed after my throat nearly swelling shut (it had been minimum a few months) and it was the first time I was being seen at my PCP for my throat issues, I could understand running a strep test once. But after the first time or two (my throat kept swelling up A LOT) with negative strep tests, I would have thought it should dawn on the NPs/PAs that the issue ISN'T strep throat, even if that was going around at the time. I started to refuse the tests after a while and the mid-levels never referred me to any physician, even my own (who worked in the same facility!). I had to set an appointment for him at some random date a month in the future, only to have him refer me to an ENT on the first visit, thinking I would need my tonsils out.

Sore throat issues are supposed to be some of the more straight-forward problems. The NP/PA treating me couldn't even figure out that is was beyond them. I wonder if I would've had my tonsils yanked out faster if it weren't for the NPs/PAs trying to hold me with their stupid strep test theory.

 

[Boatswain2PA]

Valadi/Ghost/Blue/Unhappy - Please be careful not to lump PAs and NPs into the same category here. Besides the huge differences in education (medical vs nursing, clinical hours, etc), please remember that PAs work FOR you, and under your supervision. A PA is not a doctor, nor do (should) we try to be one. However, a PA, when used appropriately, certainly can allow their supervising physician to practice better and more efficient medicine...which makes you more money!

NPs are also effective when they stick to the same construct, however some of them have decided to use their immense political power to change the rules so that they can practice medicine (nursing?!?) independently -- without your physician level oversight. THAT is what is scary, and THAT is what, in my opinion, you physicians should be fighting about and not whether or not your PA, who you are responsible for training, can manage chronic comorbidities.

 

[zenman]

I wouldn't even call them referral machines. When I kept having throat issues, I couldn't get any immediate appointments with my PCP, but was experiencing enough pain and swelling to need immediate treatment and thus agreed to appointments with the PA or NP. I don't know that my PCP had my ER/ENT records from my throat nearly swelling shut hardly a year prior, but I did inform them of the incident (the hospital was very apprehensive to release me...I got the impression they wanted to keep me until the tonsillitis was controlled enough to take them out before actually discharging me).

Since a bit of time had passed after my throat nearly swelling shut (it had been minimum a few months) and it was the first time I was being seen at my PCP for my throat issues, I could understand running a strep test once. But after the first time or two (my throat kept swelling up A LOT) with negative strep tests, I would have thought it should dawn on the NPs/PAs that the issue ISN'T strep throat, even if that was going around at the time. I started to refuse the tests after a while and the mid-levels never referred me to any physician, even my own (who worked in the same facility!). I had to set an appointment for him at some random date a month in the future, only to have him refer me to an ENT on the first visit, thinking I would need my tonsils out.

Sore throat issues are supposed to be some of the more straight-forward problems. The NP/PA treating me couldn't even figure out that is was beyond them. I wonder if I would've had my tonsils yanked out faster if it weren't for the NPs/PAs trying to hold me with their stupid strep test theory.

Did you have any symptoms suggestive of strep throat every time? If so, I'd probably do one every visit. Just cause you were clear one visit doesn't mean you might not have strep and/or something else next time. You are aware that someone showing up in the ER multiple times with gas pains might show up with an MI the next visit even though an MI has been ruled out all the other visits.

 

[unhappyrnstudnt]

Valadi/Ghost/Blue/Unhappy - Please be careful not to lump PAs and NPs into the same category here. Besides the huge differences in education (medical vs nursing, clinical hours, etc), please remember that PAs work FOR you, and under your supervision. A PA is not a doctor, nor do (should) we try to be one. However, a PA, when used appropriately, certainly can allow their supervising physician to practice better and more efficient medicine...which makes you more money!

NPs are also effective when they stick to the same construct, however some of them have decided to use their immense political power to change the rules so that they can practice medicine (nursing?!?) independently -- without your physician level oversight. THAT is what is scary, and THAT is what, in my opinion, you physicians should be fighting about and not whether or not your PA, who you are responsible for training, can manage chronic comorbidities.

The only reason I lumped PA/NP together in my last post is because I had both looking at my throat wanting to do strep tests instead of consulting the doctor about my case. The other aspect (complication? layer?) of this is that a lot of nurses become PAs. So while the scope/education may be different, I would imagine the political power struggle probably floods over into the PA field to some extent.

The power struggle b.s. certainly floods over into the education. Our teacher again gave us crap about dissatisfied students and had us do a group "teach ourselves" in class assignment. Apparently students in the past complained on teacher evaluations about having to teach themselves because the professors don't teach in class, so assigning this in class group assignment was a way to back her ass up when the department head evaluates her. Meanwhile, I've failed yet ANOTHER assignment due to having absolutely NO direction in terms of what to study. This is pop quiz #4 in a period of 3 weeks...each quiz being over something we haven't gone over in class and at a time when we have multiple tests either the same day or the following day. And though we may be upset and they want us to talk with them, they won't help us/work with us when we do try to talk with them. It's a lose-lose situation. And despite expecting it, each b.s. action/concurrent bad grade shocks me.

 

[Boatswain2PA]

The other aspect (complication? layer?) of this is that a lot of nurses become PAs. So while the scope/education may be different, I would imagine the political power struggle probably floods over into the PA field to some extent.

Not that I have seen. Again, PAs are Physician Assistant's. The Physician is the leader of our health care team. Period. In my (still limited) experience, nurses who choose to go PA over NP do so because they like the superior educational model AND the superior clinical model (ie: medical model with a (real) Doctor in charge).

 

[Valadi]

Valadi/Ghost/Blue/Unhappy - Please be careful not to lump PAs and NPs into the same category here. Besides the huge differences in education (medical vs nursing, clinical hours, etc), please remember that PAs work FOR you, and under your supervision. A PA is not a doctor, nor do (should) we try to be one. However, a PA, when used appropriately, certainly can allow their supervising physician to practice better and more efficient medicine...which makes you more money!

NPs are also effective when they stick to the same construct, however some of them have decided to use their immense political power to change the rules so that they can practice medicine (nursing?!?) independently -- without your physician level oversight. THAT is what is scary, and THAT is what, in my opinion, you physicians should be fighting about and not whether or not your PA, who you are responsible for training, can manage chronic comorbidities.

Looked over my posts and I haven't mentioned PAs at all, but regardless, I know what you mean. I think the PA model is excellent and support it wholeheartedly. If I had to choose, I would quickly pick multiple PAs in an MD team to help fill the healthcare gap vs. filling it in with NPs/DNPs.

To the independent practice of D/NPs, I agree that they would obviously be limited in diagnosis making capacity. It's why I said I would be wary of having them see every patient that comes in from the ED. Now for a patient who's been diagnosed with HTN, is started on medications, etc and needs routine follow-up, I think they that would be a good role for follow-up.

To Zenman, I fully trust that you are excellent in what you do. However, your individual experience is not representative of the whole population. Moreover, outpatient psychiatry tends to be one of the more algorithmic fields, where you have a DSM checklist to guide you and the opportunities for acute travesty are minimal and in such cases (suicide or homicide being the most imminent dangers in psychiatry, and antipsychotic med adverse effects I am sure you are well aware of and can manage) the guidelines are more straightforward. If you feel comfortable practicing independently in a consult-liason service managing neuroleptic malignant syndrome and other acute problems, then I would be very impressed. It is very likely that you are as good as anyone else at dx'ing and treating psychiatric conditions; education is what you put into it, afterall. Now, should you also be as comfortable treating a pneumothorax? Probably not. But I would also argue that any psychiatrist out of medical school likely has forgotten to do so as well! What I'm trying to say is, that because of your years of specialty training I trust you are performing superiorly and, like your boss, I wouldn't mind patients calling you doc. Afterall, in the truest sense of the word, doctor means teacher, and this is what you are to them. The issue is with newly minted D/NPs who have a sense of entitlement for the title, but do not posses any of the relevant experience or training; whereas their trust in you is well-founded given your experience, the title may inspire confidence in patients for fresh-faced D/NPs that deters them from a healthy dose of skepticism that should be encouraged in all patients in order for them to receive the best care.

If a patient wants to go ahead and call someone doctor, by all means they should go for it and no one should stop them. However, I would say that this should be their choice. I think that rule is good for MDs, DNPs, PhDs. Hours of course work should not beget the respect of a patient in clinic, but you should strive to earn it continually. I get incredibly frustrated when I hear people correcting patients to call them 'doctor' from all levels.

 

[chimichanga]

...If a patient wants to go ahead and call someone doctor, by all means they should go for it and no one should stop them. However, I would say that this should be their choice. I think that rule is good for MDs, DNPs, PhDs. Hours of course work should not beget the respect of a patient in clinic, but you should strive to earn it continually. I get incredibly frustrated when I hear people correcting patients to call them 'doctor' from all levels.

Nice post dude!

Reminds me a bit of a scene from 'Patch Adams'

Just saw the movie again last week.

Still can't get with a nurse 'allowing' the pt to (continue to) use (at the bedside.)
Hell, as a guy, it's happened countless times to me (staff RN) and I'm happy to correct them.

 

[zenman]

Not that I have seen. Again, PAs are Physician Assistant's. The Physician is the leader of our health care team. Period. In my (still limited) experience, nurses who choose to go PA over NP do so because they like the superior educational model AND the superior clinical model (ie: medical model with a (real) Doctor in charge).

I'm calling BS on this post Navy boy! It's a "different" educational model. And I'd be lacking in clinical psych experience if I went the PA route. And doing those pelvics really helped me a lot in psych! Waste of time and money!

 

[chrish0204]

I think it will definitely make me a better NP... Being the best NP I can be is the goal, and I'm very pleased with my education so far.

Nice to see someone being reasonable!

 

[zenman]

To Zenman, I fully trust that you are excellent in what you do. However, your individual experience is not representative of the whole population. Moreover, outpatient psychiatry tends to be one of the more algorithmic fields, where you have a DSM checklist to guide you and the opportunities for acute travesty are minimal and in such cases (suicide or homicide being the most imminent dangers in psychiatry, and antipsychotic med adverse effects I am sure you are well aware of and can manage) the guidelines are more straightforward. If you feel comfortable practicing independently in a consult-liason service managing neuroleptic malignant syndrome and other acute problems, then I would be very impressed. It is very likely that you are as good as anyone else at dx'ing and treating psychiatric conditions; education is what you put into it, afterall. Now, should you also be as comfortable treating a pneumothorax? Probably not. But I would also argue that any psychiatrist out of medical school likely has forgotten to do so as well! What I'm trying to say is, that because of your years of specialty training I trust you are performing superiorly and, like your boss, I wouldn't mind patients calling you doc. Afterall, in the truest sense of the word, doctor means teacher, and this is what you are to them. The issue is with newly minted D/NPs who have a sense of entitlement for the title, but do not posses any of the relevant experience or training; whereas their trust in you is well-founded given your experience, the title may inspire confidence in patients for fresh-faced D/NPs that deters them from a healthy dose of skepticism that should be encouraged in all patients in order for them to receive the best care.

I’ve been practicing as an NP 9 months. Kinda gives one pregnant pause. However, I might be a poster boy for the benefits of prior experience before becoming an NP...37 years. In my opinion, and others, the DSM is a guide and should only be followed strictly if doing research. I’m very likely to “forget” to label a young person as borderline and mess up their entire lives. Or like a young girl recently who wanted to join the military but some idiot had labelled her as Bipolar...and she’s not. Military doesn’t want another opinion now. What I like most about psych is that you’re more successful if you approach it as an art rather than a science. (Prozac may work great for one and kill another.) You basically have to as we barely have an idea how the brain/mind works or how the drugs even work. Algorithmic fields? Try that with a patient with ADHD, PTSD, BPD, Bipolar Disorder! We have to be familiar with NMS (rare) and Serotonin syndrome (not so rare.) I’d be comfortable treating a pneumothorax but only because of prior experience...even in the dark ages where our local general surgeon would use a foley cath midclavicular line. Remember the old glass bottles. I’ve even had my hand in a person’s chest doing heart massage. All that is boring now compared to the complexities of each patient’s experiences. But I do get what you’re saying about newly minted DNPs and I agree. I'm around a therapist who has a new doctorate and wants you to call her "doctor."

 

[ghost dog]

Looked over my posts and I haven't mentioned PAs at all, but regardless, I know what you mean. I think the PA model is excellent and support it wholeheartedly. If I had to choose, I would quickly pick multiple PAs in an MD team to help fill the healthcare gap vs. filling it in with NPs/DNPs.

To the independent practice of D/NPs, I agree that they would obviously be limited in diagnosis making capacity. It's why I said I would be wary of having them see every patient that comes in from the ED. Now for a patient who's been diagnosed with HTN, is started on medications, etc and needs routine follow-up, I think they that would be a good role for follow-up.

To Zenman, I fully trust that you are excellent in what you do. However, your individual experience is not representative of the whole population. Moreover, outpatient psychiatry tends to be one of the more algorithmic fields, where you have a DSM checklist to guide you and the opportunities for acute travesty are minimal and in such cases (suicide or homicide being the most imminent dangers in psychiatry, and antipsychotic med adverse effects I am sure you are well aware of and can manage) the guidelines are more straightforward. If you feel comfortable practicing independently in a consult-liason service managing neuroleptic malignant syndrome and other acute problems, then I would be very impressed. It is very likely that you are as good as anyone else at dx'ing and treating psychiatric conditions; education is what you put into it, afterall. Now, should you also be as comfortable treating a pneumothorax? Probably not. But I would also argue that any psychiatrist out of medical school likely has forgotten to do so as well! What I'm trying to say is, that because of your years of specialty training I trust you are performing superiorly and, like your boss, I wouldn't mind patients calling you doc. Afterall, in the truest sense of the word, doctor means teacher, and this is what you are to them. The issue is with newly minted D/NPs who have a sense of entitlement for the title, but do not posses any of the relevant experience or training; whereas their trust in you is well-founded given your experience, the title may inspire confidence in patients for fresh-faced D/NPs that deters them from a healthy dose of skepticism that should be encouraged in all patients in order for them to receive the best care.

If a patient wants to go ahead and call someone doctor, by all means they should go for it and no one should stop them. However, I would say that this should be their choice. I think that rule is good for MDs, DNPs, PhDs. Hours of course work should not beget the respect of a patient in clinic, but you should strive to earn it continually. I get incredibly frustrated when I hear people correcting patients to call them 'doctor' from all levels.

You need to think about this.

Even an algorithmic "simple" issue, such as evaluating a patient for hypertension may seem straight-forward, this is not always the case.

For example, differentiating primary versus secondary hypertension. Yes, the vast majority of people will have a primary case of HTN, but there are a few peeps with secondary causes of HTN out there. This does require a careful considered approach, with specialized testing indicated.

 

[Makati2008]

You need to think about this.

Even an algorithmic "simple" issue, such as evaluating a patient for hypertension may seem straight-forward, this is not always the case.

For example, differentiating primary versus secondary hypertension. Yes, the vast majority of people will have a primary case of HTN, but there are a few peeps with secondary causes of HTN out there. This does require a careful considered approach, with specialized testing indicated.

Sir you are wasting your breath with that person. For him to call another provider an idiot and yet be only out for 9 months should show you that. Also he thinks that independent practice is okay for him which I feel is very very inappopriate for a provider that is a MLP(whether they have 30years of experience or not.)

I challenge those that want to go to an independent model to go onto medical school. It's all sunny until you learn what you DON'T know.

 

[Boatswain2PA]

Zen - if you're a poster boy for anything, it is for being completely wrong on at least 95% of your posts here. Furthermore, if you're going to throw the BS flag it's because you are perpetually swimming in it.

How many clinical hours did you have in your psych NP program? IF you had decided to go to a PA program (you know, one of those ones where you learn how to practice general medicine, and THEN possibly specialize) you could have done 1-3 rotations, 4-6 weeks in length, in psych. That's 200-300 hours per rotation, so you could have had from 200-900 clinical hours of psych in a PA program. I'm guessing that is more clinical hours than most psych NP programs give you. Oh, and you still have all of those other rotations, which is what makes PA programs much BETTER than NP programs.

Oh, and just to show you that you are, indeed, nearly always wrong....I'm not a Navy boy. Some day you may realize you don't know nearly as much as you think you know, and THAT is when your learning will start.

 

[Makati2008]

Zen - if you're a poster boy for anything, it is for being completely wrong on at least 95% of your posts here. Furthermore, if you're going to throw the BS flag it's because you are perpetually swimming in it.

How many clinical hours did you have in your psych NP program? IF you had decided to go to a PA program (you know, one of those ones where you learn how to practice general medicine, and THEN possibly specialize) you could have done 1-3 rotations, 4-6 weeks in length, in psych. That's 200-300 hours per rotation, so you could have had from 200-900 clinical hours of psych in a PA program. I'm guessing that is more clinical hours than most psych NP programs give you. Oh, and you still have all of those other rotations, which is what makes PA programs much BETTER than NP programs.

Not going to pile on Zen here but I do have to agree. I was in a certain state in the South and when I went to get my DEA number by sitting in on a taped course for two days(which I thought was stupid since I literally had three semesters of Pharm. taughter by a PharmD/PA.) there were sooo many things that NPs were miseducated on about PA education as well as many things I am/was miseducated about theirs. Also the Pysch. NP's that were there told me they were able to get this degree by working online and the course work took about two days a week. I have another friend that is currently working on her NP and she has been in school since I applied to med. school and started(about 4 years ago) and due to letting her go part time to her program me and her will probably graduate at the same time and I can say she will probably learn about 50% of what I have maybe more.

To zen- I had several RN's that went to PA school in my class because they felt that the training was stronger in that route and they are all specialized like yourself. Their big issue was the poor standardization of the programs in the area as well as wanting a generalist education. Also I have nurses where I am in medical school and one of them said he wouldn't have went the NP route but instead the PA one for similar reasons. I just hope you don't hurt someone with your "independence" because to me it seems purely like hubris and the want to be more like a Physician. I personally have no ill will toward NPs or PAs because I know that we have a niche in the market and we are very very safe as long as we are effectively used(ie supervised.)

I didn't ever think I would agree more with the conservative bunch(in real life I am somewhere between a liberal-moderate area) on this board but as I log on and see more and more people thinking like this I have no other choice for myself as well as my patients to be safe.

Sorry if there are typos in class and should be listening lol.

 

[TheEarDoc]

Ok coming from a field that throws the doctor title out rather freely I must agree somewhat that PA's and NP's should not be allowed to function independently. Yes they should be able to see patients without a physician in the room but they should not be able to open up their own private practice with no physician assistance.

Now yes I do like the PA model, but it still bothers me when someone dogs on NP's. Yes PA school is demanding, but most NP's spent many years working med surge or ICU or ER. They have watched patients circle the drain before. They have had the experience before getting the NP education. So yes you can say a PA is better trained and I'll say yes they are better trained because they crammed years of work into a really short period of time. Most of the NP's I know have spent about 10 years doing real nursing work before going back to get their NP. They aren't idiot nurses with a script pad.

I am an audiologist and an RN. I've done both for a decent number of years. As a pa or np I wouldn't have missed your tonsil issues, but I also worked in an ENT office for several years too. I see primary care docs that miss chronic otitis media, cholesteatomas, chronic mastoiditis, and glomulus tumors all the time does that make them idiots? Nope. Sometimes you don't see something without a second glance or thinking outside the box. I'm heading back to become an NP. I chose it over PA because I have a family and have to work while I do it. Do that threw out PA school right away. My employer also is paying my tuition so I'd be crazy to go the pa route. Yes it would be nice to shave a couple years off my program time, but not at the financial impact on my family. When I'm done I have no desire to work independently, I want to work with physicians. I don't back the independent mid level private practitioner lobby crap. If I wanted to be a physician I would have went to medical school. I want a 40-50 hour work week with no on call hours.

Also patients can call me doctor if they want and several do when I'm their audiologist. When I'm an NP I won't allow that. And I have no desire to become a DNP. That is a feel good title degree with no substance! It doesn't nothing to improve the quality of care for patients. I saw that cluster f&$:; with audiology.

 

[Therapist4Chnge]

Now yes I do like the PA model, but it still bothers me when someone dogs on NP's. Yes PA school is demanding, but most NP's spent many years working med surge or ICU or ER. They have watched patients circle the drain before. They have had the experience before getting the NP education. So yes you can say a PA is better trained and I'll say yes they are better trained because they crammed years of work into a really short period of time. Most of the NP's I know have spent about 10 years doing real nursing work before going back to get their NP. They aren't idiot nurses with a script pad.

My gripe is the proliferation of bridge programs and programs that allow Random non-nursing BA--> NP--> DNP. Those programs maximize the billable credits while minimizing any actual "experience" that was implied when the NP and DNP were each first proposed. It is possible to do an online BSN and then enroll in an online MSN + DNP program. There will be clinical hours, but they aren't comparable to either the PA or the NP who put in 10+ years of experience before going back for NP training.

I know some great clinicans who had 10+ years experience before going back for their NP, but I'm not worried about them. I'm worried about the straight through school NPs who have the minimum # of hours possible, and yet can practice/prescribe with 100% autonomy. The latter is becoming more and more popular because it ends up being quicker and easier than going to medical school....and the end result is still 100% independant practice.

 

[unhappyrnstudnt]

Most of the NP's I know have spent about 10 years doing real nursing work before going back to get their NP. They aren't idiot nurses with a script pad.

This is true and is definitely something I've considered. But the NPs that are my instructors can't explain the why behind anything I ask them. They can explain (to a limited extent) point A, explain (also limited) point B, know that they are connected and that these two points call for intervention C, but they can't explain how point A lead to point B (which, in my mind, better explains why intervention C is used). They aren't idiots (not all of them, though definitely some of them), but they also aren't as qualified as they are trying to make themselves out to be.

I am an audiologist and an RN. I've done both for a decent number of years. As a pa or np I wouldn't have missed your tonsil issues, but I also worked in an ENT office for several years too. I see primary care docs that miss chronic otitis media, cholesteatomas, chronic mastoiditis, and glomulus tumors all the time does that make them idiots? Nope. Sometimes you don't see something without a second glance or thinking outside the box.

I would argue that this is definitely related to your ENT experience. More than their inability to figure out the problem was their inability to look at the history, at least know it was something beyond them, and thus refer me either to the PCP (if they can't directly refer me to an ENT) or to an ENT. Doctors definitely won't always catch everything. Health care professionals have to work as a team for this reason. But that also doesn't make a nurse equivalent, regardless of their experience or education level (unless they become an MD).

 

[zenman]

Sir you are wasting your breath with that person. For him to call another provider an idiot and yet be only out for 9 months should show you that. Also he thinks that independent practice is okay for him which I feel is very very inappopriate for a provider that is a MLP(whether they have 30years of experience or not.)

I challenge those that want to go to an independent model to go onto medical school. It's all sunny until you learn what you DON'T know.

I'm free to call someone out if they are wrong no matter how much experience I have. I like independent practice because I don't want to be required to pay a physician to review charts after the fact, or have them change their mind or die and I immediately have to close my practice. I'm free to step across the hall and consult with a psychiatrist all I want when I want, not because I have to.

I didn't want to go to medical school because I wanted a different focus, that of healing vs curing. Once you spend a lot of money and time in medical school you might rank at the top in curing, but do you know where you rank in healing? At the very bottom...the lowest level.

 

[zenman]

Zen - if you're a poster boy for anything, it is for being completely wrong on at least 95% of your posts here. Furthermore, if you're going to throw the BS flag it's because you are perpetually swimming in it.

Prove it.

How many clinical hours did you have in your psych NP program? IF you had decided to go to a PA program (you know, one of those ones where you learn how to practice general medicine, and THEN possibly specialize) you could have done 1-3 rotations, 4-6 weeks in length, in psych. That's 200-300 hours per rotation, so you could have had from 200-900 clinical hours of psych in a PA program. I'm guessing that is more clinical hours than most psych NP programs give you. Oh, and you still have all of those other rotations, which is what makes PA programs much BETTER than NP programs.

I actually did 2 years of an advanced nursing master program in psych, then did 2 years post-masters program as psych NP. I did clinical at a university hospital, with a psychologist in private practice, a Navy hospital on a Marine base in Okinawa, and a VA outpatient mental health clinic. I've also done 4 years training with a medical anthropologist and psychologist. That's not including earlier medical and psych experience.

Oh, and just to show you that you are, indeed, nearly always wrong....I'm not a Navy boy. Some day you may realize you don't know nearly as much as you think you know, and THAT is when your learning will start.

Ok merchant marine, you're on a boat/ship in the ocean.

 

[zenman]

Not going to pile on Zen here but I do have to agree. I was in a certain state in the South and when I went to get my DEA number by sitting in on a taped course for two days(which I thought was stupid since I literally had three semesters of Pharm. taughter by a PharmD/PA.) there were sooo many things that NPs were miseducated on about PA education as well as many things I am/was miseducated about theirs. Also the Pysch. NP's that were there told me they were able to get this degree by working online and the course work took about two days a week. I have another friend that is currently working on her NP and she has been in school since I applied to med. school and started(about 4 years ago) and due to letting her go part time to her program me and her will probably graduate at the same time and I can say she will probably learn about 50% of what I have maybe more.

I have no beef whatsoever with PA's or their education. I almost went that route as a medic myself. I was just drawn to another direction. Granted some of the general med stuff you learn might help me in psych but I got it in actual experience, plus why the heck would I want to do a surgical rotation (spent 6 months in OR with Denton Cooley as pump tech student) or waste time doing OD-GYN rotation? I got the hormonal changes, post partum depression, dyspareunia, etc., etc..

Why does anyone in their right mind have a problem with distance education? I quess you haven't checked on the research about it or checked out all the online course material available in medical schools. The fact that you might have spent 40 hrs a week in school while I might have spent 20 just means I have more time to study and really soak up the material in a manner that lends itself to better retention.

To zen- I had several RN's that went to PA school in my class because they felt that the training was stronger in that route and they are all specialized like yourself. Their big issue was the poor standardization of the programs in the area as well as wanting a generalist education. Also I have nurses where I am in medical school and one of them said he wouldn't have went the NP route but instead the PA one for similar reasons. I just hope you don't hurt someone with your "independence" because to me it seems purely like hubris and the want to be more like a Physician. I personally have no ill will toward NPs or PAs because I know that we have a niche in the market and we are very very safe as long as we are effectively used(ie supervised.)

Like I said I had plenty of the "general" but I can certainly see someone without that experience wanting to go that route. Regarding my independence I can consult anytime I want. I'm not an idiot that goes off half-cocked and think I know everything. The patients will teach you differently! I'm continually reading and keeping up in the field. Three physicians here that I've worked with all vouch for me. One's a D.O., an M.D., and an M.D., Ph.D.. One's in his 40's; others late 50-early 60's so they have plenty experience.

Sorry if there are typos in class and should be listening lol.

You're paying good money for that class. You better listen up! Ops, my crisis hour is over. Back to work.

 

[deleted87716]

I didn't want to go to medical school because I wanted a different focus, that of healing vs curing. Once you spend a lot of money and time in medical school you might rank at the top in curing, but do you know where you rank in healing? At the very bottom...the lowest level.

Why don't you try that comment out on your psychiatry colleagues?

Let us know how that works out for you.

 

[Boatswain2PA]

Prove it .

I already did, but you just can't see it.

I actually did 2 years of an advanced nursing master program in psych, then did 2 years post-masters program as psych NP. I did clinical at a university hospital, with a psychologist in private practice, a Navy hospital on a Marine base in Okinawa, and a VA outpatient mental health clinic. I've also done 4 years training with a medical anthropologist and psychologist. That's not including earlier medical and psych experience.

That's all great, and I'm sure that experience helps make you a better clinician....but how many clinical hours did you have in your NP program?

Ok merchant marine, you're on a boat/ship in the ocean.

Darn Zenman...you can't get ANYTHING right today! Not a navy boy, and not a merchie. Maybe you will get it right on your third try?

 

[deleted87716]

Not a navy boy, and not a merchie. Maybe you will get it right on your third try?

Coast Guard.

Making the right diagnosis is always easier when you're the second (or third) person seeing the patient.

 

[Boatswain2PA]

Coast Guard.

Making the right diagnosis is always easier when you're the second (or third) person seeing the patient.

AND when you don't walk into the room with an ENORMOUS ego that makes you think you already know everything.

 

[zenman]

My gripe is the proliferation of bridge programs and programs that allow Random non-nursing BA--> NP--> DNP. Those programs maximize the billable credits while minimizing any actual "experience" that was implied when the NP and DNP were each first proposed. It is possible to do an online BSN and then enroll in an online MSN + DNP program. There will be clinical hours, but they aren't comparable to either the PA or the NP who put in 10+ years of experience before going back for NP training.

I know some great clinicans who had 10+ years experience before going back for their NP, but I'm not worried about them. I'm worried about the straight through school NPs who have the minimum # of hours possible, and yet can practice/prescribe with 100% autonomy. The latter is becoming more and more popular because it ends up being quicker and easier than going to medical school....and the end result is still 100% independant practice.

These programs bother me also.

 

[zenman]

Why don't you try that comment out on your psychiatry colleagues?

Let us know how that works out for you.

I asked one older psychiatrist training with me in shamanism why he was there and his answer was, "So I can finally help my patients." That's an exact quote, btw.

I don't know about my clinic supervisor. I'll ask him when I see him in a few weeks. Of the other 2 psychistrists, one has trained with the anthropologist Michael Harner in shamanism and the other is very interested in it. Another psychiatrist in addictions here is very interested in how a physician in the Amazon has triple + the success rates with addictions with shamanisn and Ayahuasca. So, you really want me to ask your question?

When I run into someone that is a "medical failure" with either medical or psych problems, I pull out the shamanism card. Please don't try to baffle me with what you don't know. I'll be back in the Amazon in December if you want to meet me there.

 

[zenman]

I already did, but you just can't see it.





That's all great, and I'm sure that experience helps make you a better clinician....but how many clinical hours did you have in your NP program?

In actual NP class over 700 hours.

Darn Zenman...you can't get ANYTHING right today! Not a navy boy, and not a merchie. Maybe you will get it right on your third try?

You're arguing a minor useless point. A boatswain is a crewman on a merchant ship. What kind of critter are you?

 

[zenman]

AND when you don't walk into the room with an ENORMOUS ego that makes you think you already know everything.

If you met me in person you'd change your mind, considering you're talking about me. However, I am confident about what I know and I have good ego strength. (I'm frickin brave too as I've been in tiger cages with non-drugged tigers...and you think I can't handle you )

And if you think you always need a physician nearby, I don't want you working on me...no offense.

 

[jwk]

I didn't want to go to medical school because I wanted a different focus, that of healing vs curing. Once you spend a lot of money and time in medical school you might rank at the top in curing, but do you know where you rank in healing? At the very bottom...the lowest level.

Oh puhleeeeeeeeeeeze. I get SOOOOOO irritated at all this touchy-feely "nurses are the only ones that care" crap I could just puke. It is absolute total BS!!!

 

[Boatswain2PA]

In actual NP class over 700 hours.

Thank you for proving my point that PA programs are (generally) MUCH better than NP programs. I'm just finishing my 3rd rotation (5 more to go, plus preceptorship) and I already have more clinical hours than you did in your entire NP class. Better yet, if one of my classmates wanted to focus on psych they could probably get all of their elective rotations in psych and have more CLINICAL PSYCH HOURS than you got, in addition to their mandatory surgery, cardiology, FP (X2), and ER rotations. So, thank you for proving my point that PA programs are generally much better than NP programs.

You're arguing a minor useless point.

Who's arguing? You called me a Navy boy, and you were wrong. Then you called me a merchant, and you were wrong. Again.

A boatswain is a crewman on a merchant ship.

You are wrong AGAIN! A boatswain is not "a crewman", although they are part of a crew (just as the Captain, the First Mate, Gunner, or Cook are). Haven't you seen Pirates of the Caribbean?? If you call a Boatswain a "crewman" you may get hauled off to the Boatswain's Locker, which could be a bit dicier than getting locked in a cage with someone's pet kitty-cat.

.....considering you're talking about me....

THANK YOU Zenman. And here I was wondering if I overestimated when I said you were actually right 5% of the time. It was looking like you weren't going to be right about a single thing on today's thread, but then you pulled it off and got one right. Good job!!

And now back to our regularly scheduled program of everyone (but Zenman) saying that DNPs shouldn't call themselves Doctor.

 

[zenman]

Oh puhleeeeeeeeeeeze. I get SOOOOOO irritated at all this touchy-feely "nurses are the only ones that care" crap I could just puke. It is absolute total BS!!!

Anyone can "care." Doesn't mean you know, or were trained, in healing.

 

[zenman]

Thank you for proving my point that PA programs are (generally) MUCH better than NP programs. I'm just finishing my 3rd rotation (5 more to go, plus preceptorship) and I already have more clinical hours than you did in your entire NP class. Better yet, if one of my classmates wanted to focus on psych they could probably get all of their elective rotations in psych and have more CLINICAL PSYCH HOURS than you got, in addition to their mandatory surgery, cardiology, FP (X2), and ER rotations. So, thank you for proving my point that PA programs are generally much better than NP programs.

You really haven't proven any point. PA programs are more standardized which means, IMO, they are cranking out the identical, or close, mini-clones of physicians. I didn't know you were trying to prove that PA schools are better. I thought they were DIFFERENT from NP schools which is why I chose NP school over PA school. Will you ever get that? Understand again please that I also didn't want PA school and waste my time and money because I've already got extensive experience. Are you capable of getting this point? And don't forget I had 2 years more of didactic experience than PA programs.

Who's arguing? You called me a Navy boy, and you were wrong. Then you called me a merchant, and you were wrong. Again.


You are wrong AGAIN! A boatswain is not "a crewman", although they are part of a crew (just as the Captain, the First Mate, Gunner, or Cook are). Haven't you seen Pirates of the Caribbean?? If you call a Boatswain a "crewman" you may get hauled off to the Boatswain's Locker, which could be a bit dicier than getting locked in a cage with someone's pet kitty-cat.

A boatswain formerly and dialectically also, bo's'n, bos'n, or bosun is an unlicensed member of the deck department of a merchant ship. The boatswain supervises the other unlicensed members of the ship's deck department, and typically is not a watchstander, except on vessels with small crews. Other duties vary depending on the type of ship, her crewing, and other factors.

The word boatswain has been in the English language since approximately 1450. It is derived from late Old English batswegen, from bat (boat) concatenated with Old Norse sveinn (swain), meaning a young man, a follower, retainer or servant. The phonetic spelling bosun has been observed since 1868. Interestingly, this spelling was used in Shakespeare's The Tempest written in 1611, and as Bos'n in later editions.

The rank of boatswain was until recently the oldest rank in the ROYAL NAVY, and its origins can be traced back to the year 1040. The Royal Navy's last official boatswain, Commander E W Andrew OBE, retired in 1990.

Guess I'm smarter than you thought.

THANK YOU Zenman. And here I was wondering if I overestimated when I said you were actually right 5% of the time. It was looking like you weren't going to be right about a single thing on today's thread, but then you pulled it off and got one right. Good job!!

And now back to our regularly scheduled program of everyone (but Zenman) saying that DNPs shouldn't call themselves Doctor.

And you got this where?

 

[zenman]

Right now I'm laughing my head off. My last patient of the day, a psych eval, has spirits in her house. I made a full page of notes of things the spirit has done, such as unhooking shower curtain in front of witnesses, picking up a ball and throwing it at the cat, feet appearing under curtains, a black cloud floating around the house, a yellow light floating around, kid's toys being knocked across the room, sounds of dishes being broken in the kitchen while multiple people are in the kitchen, occupants of the house waking up with perfectly round bruises on their bodies, etc.. A priest blessed the house Monday but that didn't work (and hardly ever does). The patient has lived in this family home all her life and the activity has increased lately and it's bothering one son but not the other. Apparently a great great uncle was a curandera and rumor has it he sometimes crossed over to the other side.

I'm going over Sunday to clear the house out...hopefully. Guess who's going with me? My good psychiatrist buddy! He's ecstatic! Maybe he can write another article.

In the SPIRIT of good medicine, we must clear this house out in order to make a proper diagnosis of the patient's condition. I guess you guys would just pump her full of antipsychotics. I hesitate to call you guys impotent in this situation, but sometimes you just don't know what you don't know. I'll get back to you Sunday or later. God, I love my job!

 

[Boatswain2PA]

You really haven't proven any point. PA programs are more standardized which means, IMO, they are cranking out the identical, or close, mini-clones of physicians. I didn't know you were trying to prove that PA schools are better. I thought they were DIFFERENT from NP schools which is why I chose NP school over PA school. Will you ever get that?

Yeah, I said PA schools are better, and at 7:49 pm last night you threw the BS flag. Remember? Okay, you think they are DIFFERENT. Pretty much everyone agrees with you that they are DIFFERENT. I agree with you, they are DIFFERENT. Of course, you are pretty much the only one who doesn't agree that PA programs are better (standardized, more didactic hours, more clinical hours, etc ad nauseum) than NP programs.

Understand again please that I also didn't want PA school and waste my time and money because I've already got extensive experience. Are you capable of getting this point?

Hmmm....like I said before, I'm sure your previous experience has made you a better clinician. Just like my previous experience has made me better. But, like many others have pointed out, both the NP and PA programs are taking green kids right out of undergrad with no experience. So our "previous experience" arguments really are not generalizable to our perspective populations are they? (you might need to wiki some of those last terms).

And don't forget I had 2 years more of didactic experience than PA programs.

Okay, seriously.....I missed this. Where did you get 2 more years of didactic experience than PA programs?? Are you talking about 2 more years of part-time, (in some cases) online didactic experience? Are you talking about nursing school?? Or are you saying your NP program gave you three years of butt-in-seat, firehose velocity learning in comparison to the 1 year of butt-in-seat, firehose velocity learning that PA programs give??

A boatswain formerly and dialectically also, bo's'n, bos'n, or bosun is an unlicensed member of the deck department of a merchant ship. The boatswain supervises the other unlicensed members of the ship's deck department, and typically is not a watchstander, except on vessels with small crews. Other duties vary depending on the type of ship, her crewing, and other factors.

The word boatswain has been in the English language since approximately 1450. It is derived from late Old English batswegen, from bat (boat) concatenated with Old Norse sveinn (swain), meaning a young man, a follower, retainer or servant. The phonetic spelling bosun has been observed since 1868. Interestingly, this spelling was used in Shakespeare's The Tempest written in 1611, and as Bos'n in later editions.

The rank of boatswain was until recently the oldest rank in the ROYAL NAVY, and its origins can be traced back to the year 1040. The Royal Navy's last official boatswain, Commander E W Andrew OBE, retired in 1990.

OH MY GAWD. Would you care to cite the resource you cut-and-pasted for this?? If you don't, I will....because it pretty much proves EVERYTHING I have insinuated about you today. I do hope you don't rely on this resource too much when you are treating REAL PATIENTS, because this website is has notoriously shallow content.

BTW, the boatswain, bosun, or bos'n, has MANY more meanings than what Wikipedia states (bwaaaahahahahahahahahahahah!!!!!)

Guess I'm smarter than you thought.

That wouldn't be too hard

And you got this where?

Okay, perhaps I was wrong with this......

Getting back to the purpose of this thread. Zenman (prove me wrong), Do YOU think DNPs should refer to themselves, or be called, "Doctor" in clinical settings??

 

[jwk]

Right now I'm laughing my head off. My last patient of the day, a psych eval, has spirits in her house. I made a full page of notes of things the spirit has done, such as unhooking shower curtain in front of witnesses, picking up a ball and throwing it at the cat, feet appearing under curtains, a black cloud floating around the house, a yellow light floating around, kid's toys being knocked across the room, sounds of dishes being broken in the kitchen while multiple people are in the kitchen, occupants of the house waking up with perfectly round bruises on their bodies, etc.. A priest blessed the house Monday but that didn't work (and hardly ever does). The patient has lived in this family home all her life and the activity has increased lately and it's bothering one son but not the other. Apparently a great great uncle was a curandera and rumor has it he sometimes crossed over to the other side.

I'm going over Sunday to clear the house out...hopefully. Guess who's going with me? My good psychiatrist buddy! He's ecstatic! Maybe he can write another article.

In the SPIRIT of good medicine, we must clear this house out in order to make a proper diagnosis of the patient's condition. I guess you guys would just pump her full of antipsychotics. I hesitate to call you guys impotent in this situation, but sometimes you just don't know what you don't know. I'll get back to you Sunday or later. God, I love my job!

I don't think he's writing the article about your "patient"...

 

[Makati2008]

I'm free to call someone out if they are wrong no matter how much experience I have. I like independent practice because I don't want to be required to pay a physician to review charts after the fact, or have them change their mind or die and I immediately have to close my practice. I'm free to step across the hall and consult with a psychiatrist all I want when I want, not because I have to.

I didn't want to go to medical school because I wanted a different focus, that of healing vs curing. Once you spend a lot of money and time in medical school you might rank at the top in curing, but do you know where you rank in healing? At the very bottom...the lowest level.

See the first two areas. Don't you think your a tad blinded by arrogance? As a MLP someone should be reviewing your charts(especially dealing with homicidal and suicidal patients but I guess the SW is so desperate for providers they don't care....).

I personally think the two are intertwined but that would be a little above your scope.....

 

[zenman]

I don't think he's writing the article about your "patient"...

Actually she was his patient last year which is one reason he's interested. As of right now, I think she's BPD and Schizoaffective. But I'm going to certainly collaborate with other family members. She might be the one "possessed."

 

[zenman]

[/B]

See the first two areas. Don't you think your a tad blinded by arrogance? As a MLP someone should be reviewing your charts(especially dealing with homicidal and suicidal patients but I guess the SW is so desperate for providers they don't care....).

I personally think the two are intertwined but that would be a little above your scope.....

I have a clinic supervisor who has access to all my charts, as do the all the locums psychiatrists as we take turns seeing most of the patients. So all of them (total of 5) see what I have done and vice versa.

 

[zenman]

Yeah, I said PA schools are better, and at 7:49 pm last night you threw the BS flag. Remember? Okay, you think they are DIFFERENT. Pretty much everyone agrees with you that they are DIFFERENT. I agree with you, they are DIFFERENT. Of course, you are pretty much the only one who doesn't agree that PA programs are better (standardized, more didactic hours, more clinical hours, etc ad nauseum) than NP programs.

You can't make a blanket statement that they are better. Yes, they are more standardized. That's good in some respects, but not all...unless you strictly want to follow the medical model. (Read my former post closely where I already said PA programs were standardized.) Again PA program was not better for me. Glad I had a choice. On the other hand, I've suggested PA school to my son after he completes a PT assistant program.

Hmmm....like I said before, I'm sure your previous experience has made you a better clinician. Just like my previous experience has made me better. But, like many others have pointed out, both the NP and PA programs are taking green kids right out of undergrad with no experience. So our "previous experience" arguments really are not generalizable to our perspective populations are they? (you might need to wiki some of those last terms).

That's correct for some programs

Okay, seriously.....I missed this. Where did you get 2 more years of didactic experience than PA programs?? Are you talking about 2 more years of part-time, (in some cases) online didactic experience? Are you talking about nursing school?? Or are you saying your NP program gave you three years of butt-in-seat, firehose velocity learning in comparison to the 1 year of butt-in-seat, firehose velocity learning that PA programs give??

I was an ARMY medic. Challenged Nursing state board successfully, then went to nursing school while working as charge and then nurse manager of a Level 1 trauma center. Got my BSN, then full time brick and mortar masters in advanced practice psych program. Then got MBA in part-time brick and mortar program. Then 2 years post-masters, mostly distance ed from Bangladesh (picking up experiences few get in the states) and Thailand. Your butt-in-the seat firehouse velocity is a poor way to learn. Good luck on retaining 25% of the material. My experience as an assistant professor and my teacher wife who is an expert on learning disagrees with anything you have to say about the efficiency of that method. BTW rote memorization uses only a fraction of your brain. Go check out the studies. Storying telling, on the other hand for example, lights up your entire brain like a Christmas tree.

OH MY GAWD. Would you care to cite the resource you cut-and-pasted for this?? If you don't, I will....because it pretty much proves EVERYTHING I have insinuated about you today. I do hope you don't rely on this resource too much when you are treating REAL PATIENTS, because this website is has notoriously shallow content.

BTW, the boatswain, bosun, or bos'n, has MANY more meanings than what Wikipedia states (bwaaaahahahahahahahahahahah!!!!!)

You know which one it is ..the one outlawed by most universities as a source. However, it was appropriate for you and this shallow argument. Here's another if you want. http://www.merriam-webster.com/dictionary/boatswain

Okay, perhaps I was wrong with this......

Getting back to the purpose of this thread. Zenman (prove me wrong), Do YOU think DNPs should refer to themselves, or be called, "Doctor" in clinical settings??

I really don't give a rat's hinny. You and many others are being flanked while you are arguing about who is owner of the title "doctor" and don't even realize it. I have worked areas where there were psychologists and they were called doctor but they also informed the patient they were psychologists. Never a problem. I've been called "doctor" since I was a nurse's aid in 1970. I still introduce myself by my first and last name and that I'm a psych NP. Ninety-nine percent of patients respond, "Nice to meet you doctor."

 

[TheEarDoc]

I work with PA's and NP's all the time and it baffles me the animosity one group has for the other. Is it truly a question of patient care or is it jealousy?

I see no difference in a PA program taking a pre med student fresh out of college into a program and a fast track BSN to CNP program. I don't agree with it no matter which route people take. The mid level was made for people who had experience in healthcare and wanted to grow their knowledge whether it's having been a medic, RN, PT, OT etc. This whole fast track crap needs to stop. Schools should only be allowing people to become mid level practitioners if they have previous medical experience.


I will say from my previous experience that an RN with two years med surge experience has a better right to be in that pa or np school lecture than a pre med 4.0 student. I was close to a 4.0 pre med student and I had no illusions stepping into audiology grad school or nursing school that I knew anything! I learned more about healthcare in 1 year of nursing school than I ever learned in 5 years of pre med!

I mean I don't get the hatred. If you stick the mid level programs to what they were made to be which was take experience providers and train them to become mid levels then there isn't a whole lot of difference other than theory. Now if you want to go fast track route then yes pa probably edges NP due to clinical hours but that's about it. I know I chose NP because I know the nursing board and although misguided and militant at times, at least they have an interest in keeping my scope of practice and expanding it while the PA's have the medical board watching their back. Yeah I've seen how physicians care about anyone else's scope of practice or reimbursement first hand multiple times. You decided to take PA school over NP so you take the good with the bad.

What I'm hoping is none of these fast track program students are getting jobs out of school. Complete independent mid level practitioners scare the hell out of me! It was made to be a collaborative team not a backdoor to medical school.

 

[unhappyrnstudnt]

I work with PA's and NP's all the time and it baffles me the animosity one group has for the other. Is it truly a question of patient care or is it jealousy?

That does sound odd. I had the idea that nurses will often go the PA route instead of DNP. But, then again, I also was under the impression that these two routes were pretty similar in terms of scope of practice. I thought both were required to practice under an MD and had the same limits (ie, I thought a PA wasn't a step up from a DNP in terms of what they could do). But it does sound like a lot of the animosity reflects the animosity between RNs and MDs in terms of the nursing model/scope being different and nurses constantly pushing for more rights/responsibilities.

I see no difference in a PA program taking a pre med student fresh out of college into a program and a fast track BSN to CNP program. I don't agree with it no matter which route people take. The mid level was made for people who had experience in healthcare and wanted to grow their knowledge whether it's having been a medic, RN, PT, OT etc. This whole fast track crap needs to stop. Schools should only be allowing people to become mid level practitioners if they have previous medical experience.

I do agree that nurses should have clinical experience before furthering their degree beyond a BSN. A lot of nurses do, but it's not an absolute requirement. Programs often will say they require work experience before admitting students into an NP/DNP program, but I don't know if this is a hard and fast rule. If it's not (and even more so if there is a large number of nurses going straight through without getting any work experience outside of school clinicals), then it sounds like the PA track would give these future providers more preparation.

I do think it could be difficult for people wanting to be a PA to get the same kind of experience an RN does before they are able to go into their graduate program. This is in the case someone graduates with a premed Bachelor's...a nurse to PA could obviously have more clinical experience. Graduating premed, you'd only be able to volunteer/shadow or do clerical work in a clinical setting (from what I understand...correct me if I'm wrong) without getting other degrees/certifications. It's exposure, but clerical isn't treatment (just like nursing is different from being an MD). So if PA school does have more clinical hour requirements than NP/DNP school, I can agree with admitting students straight from undergrad school (but not nurses into NP/DNP school without work experience).

What I'm hoping is none of these fast track program students are getting jobs out of school. Complete independent mid level practitioners scare the hell out of me! It was made to be a collaborative team not a backdoor to medical school.

I think this is the point a lot of MDs are trying to make. Whether a person has been in the field for years or are fresh grads, mid levels don't have the knowledge to practice independently. And NP/DNPs may have seen a lot (primarily the ones who have a decade or more of work experience), but that doesn't mean they are qualified to anything/everything they've seen.

 

[ghost dog]

In actual NP class over 700 hours.




You're arguing a minor useless point. A boatswain is a crewman on a merchant ship. What kind of critter are you?

Correct me if I'm wrong on the math here: 700 hours / 8 hours per day

= 87.5 days / 5 days per week
= 17.5 weeks / 4 weeks / month
= 4.4 months of clinical exposure ?

Is my math off here ?

Is this why you phrase it as " 700 hours " , as 4 1 / 2 months sounds completely pathetic ?

WTF ?

Comparing this to a family medicine resident's training:

8 hours / day x 5 days / week x 48 weeks x 3 years =

5760 hours.

This is being extremely conservative, as on call time is not included here.

How can a mid level be expected to manage patients independently with this level of training and patient exposure ?

As can be seen from the above, family physicians receive at least 8 (eight) times the amount of patient exposure and training
compared to that of noctors.

Of course, Zenman would have you believe he is the bees knees. He has seen and done it all; he's zip lined through Madonna's panty drawer and
juggled angry tiger balls in the darkest jungles of Africa. This must count for something.

Right ?

 

[deleted87716]

Comparing this to a family medicine resident's training:

8 hours / day x 5 days / week x 48 weeks x 3 years =

5760 hours.

This is being extremely conservative, as on call time is not included here.

Most FM residencies are closer to 10,000 hours.

http://www.tafp.org/advocacy/resources/PCCIssueBriefScopeEdu.pdf

 

[zenman]

Correct me if I'm wrong on the math here: 700 hours / 8 hours per day

= 87.5 days / 5 days per week
= 17.5 weeks / 4 weeks / month
= 4.4 months of clinical exposure ?

Is my math off here ?

Is this why you phrase it as " 700 hours " , as 4 1 / 2 months sounds completely pathetic ?

WTF ?

WTF is correct. I didn't know you desired anything other than hours, which is why I used hours, which seems to be common. None of my clinical was done 40 hrs a week. I tried to do that but the university response was that they wanted us to be able to follow patients on more of a long term basis. Another advantage of "part-time" clinical vs cramming patients in all week long is that I could go home, look up every frickin thing about my patients, comorbid medical conditions, meds, etc., and retain it.

Comparing this to a family medicine resident's training:

8 hours / day x 5 days / week x 48 weeks x 3 years =

5760 hours.

This is being extremely conservative, as on call time is not included here.

How can a mid level be expected to manage patients independently with this level of training and patient exposure?

Well, I'm sitting here doing it. Maybe we also need to increase the training of Special Forces medics. Those guys do all kinds of crazy stuff on their own.

As can be seen from the above, family physicians receive at least 8 (eight) times the amount of patient exposure and training compared to that of noctors.

And the USA still ranks far behind other countries ...

Of course, Zenman would have you believe he is the bees knees. He has seen and done it all; he's zip lined through Madonna's panty drawer and
juggled angry tiger balls in the darkest jungles of Africa. This must count for something.

Right ?

Pretty much. It's like having a bear chase you. All I have to do is be ahead of you. I value all my experience btw. The reason I started looking at the older systems of healing was due to the ineffectiveness of current medical care, especially for chronic conditions. It is the "bees knees" when everything else has failed. I will never touch a Tiger's balls but I would love to zip line through Madonna's panty drawer. I have, however, zip lined through a rain forest.

You have anything else? I'm a little busy right now as my wife is evacuating our place in Bangkok due to the flooding.

 

[fab4fan]

The difference is that those other professions have almost always been referred to as "doctor". It's only the nurses who are making the new move and squealing about it. PharmD, AuD, DPT, etc., seem not to care about it.

IOW, times can't change. We have to keep doing things exactly as we did 100y ago. Man, with that philosophy, we'd have never moved from smoke signals to the modern communication we have today.

What kind of horse do you ride to work?

 

[FiremedicMike]

When you take a step back from this forum and look at it with a fresh set of eyes, and interesting trend emerges. On one hand, a large chunk of the physicians here condemn current medical eduction, insisting they wished they had gone in to business or law or who cares what else. On the other hand, they fervently denounce and belittle any other form of medical education out there.

 

[Therapist4Chnge]

When you take a step back from this forum and look at it with a fresh set of eyes, and interesting trend emerges. On one hand, a large chunk of the physicians here condemn current medical eduction, insisting they wished they had gone in to business or law or who cares what else. On the other hand, they fervently denounce and belittle any other form of medical education out there.

These are two independant issues.

Issue #1: The diminishing returns when Time Invested v. Future Earnings is considered. Other paths require far few years of training and have a higher earning potential, such as Investment Banking.

Issue #2: Other healthcare professions have a number of "alternative paths" for training. Online training, condensed training programs, etc. I think the biggest issue is the emergence of quasi-fulltime online training circumventing residential training requirements and quality control.

 

[Dranger]

Sorry to bring this thread back from the dead, but I would like to toss in my humble 2 cents as a 4th year BSN student.

I think the idea of DNP is largely a con/scandal for lobbyist groups and schools to churn out profit parallel to the rising rates of tuition. I have looked over a number of course loads and the curriculum is more akin to a health administration/MPH master rather than a CLINICAL doctorate. In no way shape or form should a NP refer to themselves as "Dr." within a clinical setting as this ushers in a unethical pretense.

I live in a state where NPs have pretty much full scrip rights along with independent practice. Most of the docs I work with in clinical up here push me to go NP rather than PA because of my nursing background. Its odd coming on here and seeing NP bashing when almost every PCP/IM doc I meet says nothing but good things about the NPs they work with in the everyday outpatient setting. That being said I think there should be a minimum of 5 years working as an RN (preferably with a CCRN or trauma identifier) before going into a NP program.This whole straight into ARNP school after an abridged MSN is cheap and I feel that an experienced ICU/ER RN can bring a lot to the table after years of experience. I have personally witnessed experienced RNs school MSIIIs in some situations and the value of RN experience and continuing education/certs far outweighs whatever random BS/BA an undergrad received.

A little rant if you will. I have lurked for a bit and often see people bashing nursing undergrad patho physiology, A&P and microbiology and med/surg courses as being watered down. I disagree ( as evidenced by discussing curriculum with providers). In respect to undergraduate education nursing is probably best preparation for further medical endeavors. Pre-med courses in chem, physics and calculus are important and provide a basis for critical thinking but how do they prepare one for med school besides the MCAT? (Keep in mind I have taken these courses) Even the bio classes rarely pertain to actual HUMAN physiology. Anthropods, Botany and Orinthology? Really? Sure there are some exceptions such as genetics and molecular bio, but the vast majority of pre-med bio courses seem non-relevant. My pre-med buddies always liked flipping through my texts books because the bio/med-surg/pharm classes I took only pertained to human physiology, the disease process, assessments, lab interpretation etc (Some of them are in med school now). End rant DISCLAIMER: Just my opinion after seeing many people bash what they often glaze over or have not experienced.

Back to the original point, I do not believe the term doctor should be used in the clinical practice for NPs. In addition I feel as though independent practice should be done away with in favor of collaboration with on site physician in a hospital or out patient setting. NPs simply do not have the differential diagnostic knowledge nor clinical time to sufficiently practice on their own right from the get-go. However, I do believe NPs act as great managers for chronic problems such as DM, COPD, CHF, primary HTN and more straight forward medical problems (strep, cellulitis, asthma management...I realize these are not always straight forward) semi-independently. NPs do and will always have their place as mid-level providers (same with situations like military's wide-spread use of PAs, CRNAs etc).

 

[chimichanga]

...That being said I think there should be a minimum of 5 years working as an RN (preferably with a CCRN or trauma identifier) before going into a NP program.This whole straight into ARNP school after an abridged MSN is cheap and I feel that an experienced ICU/ER RN can bring a lot to the table after years of experience...

Good post!

Just wanted to comment on the above referenced part.

Do you really think 5 years is enough?

I think 10 years should be the minimum, and collaboration with on site physicians is key