PA vs NP

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Yes, I'm aware they do...unfortunately.

I feel the same about the FNPs I have to baby sit fresh out of school especially those pesky Direct Entry ones......and EMEDPA brings up the best point as usual. I didn't think about that sub-group of Psych PAs.

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with 2000-3000 hrs of training available a pa with a plan can really specialize in anything they want.
I ended up with 27 weeks out of 54 in em, peds em, and trauma surgery but also did 12 weeks of fp and 5 weeks each of psych, IM, and OB...folks I went to school did similar things for peds(peds surgery, etc), gyn, ortho, etc
 
I didn't think about that sub-group of Psych PAs.
there was a guy in my class with a prior 4 yr degree + experience as a mental health tech for example.
of course there are also psych nurses and social workers who choose the pa school route.
 
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someone with a prior job in psych(tech, msw, etc) who does a strong psych rotation and elective will do quite well practicing in the specialty right out of school. 1 rotation + 1 elective can sometimes be 16+ weeks of psych training....

Good chance but that 1 rotation plus 1 elective could also be 7 weeks.
 
Good chance but that 1 rotation plus 1 elective could also be 7 weeks.
most pa school rotations are 4-6 weeks each. some places allow electives up to 12 weeks so I will grant you a range of 8-18 weeks.
 
most pa school rotations are 4-6 weeks each. some places allow electives up to 12 weeks so I will grant you a range of 8-18 weeks.

The reality is that most PAs do not get near the same training in psych that psych NPs get.
 
The reality is that most PAs do not get near the same training in psych that psych NPs get.
True in most cases.
what is the min hrs for a psych np program? I know of some 500 hr fnp programs. that's 12.5 weeks of clinicals, about 1/4 what most pa students get. I had some electives that were 12 weeks long.
 
Oh?

Oh well.

Psych NPs do not get near the same training in psych that Psychiatrists get.

:idea:

What about FP doc's? I don't know, but I would wager that ANY (real) Doctor gets more training in psych than Psych NPs get.
 
Oh?

Oh well.

Psych NPs do not get near the same training in psych that Psychiatrists get.

:idea:

But we're not talking about psychiatrists are we??

What didactic coursework do PA's get in psych? Just wondering. I forgot to ask the last one here and now they are on break till January...slaggards...
 
But we're not talking about psychiatrists are we??
No, but it is ironic when NPs like yourself try to show how much better you are than PAs in specialty care because of "all of your specialized training", yet you constantly say that you are just as good (or, in your case Zenman, much better :love: ) as the specialist (real) Doctors who not only receive ten times the specialty training, but the complete spectrum of medical training as well.

Oh, and if you don't think that is ironic, then I suggest you consult Wiki again! :laugh:
 
But we're not talking about psychiatrists are we??
No, but it is ironic when NPs like yourself try to show how much better you are than PAs in specialty care because of "all of your specialized training", yet you constantly say that you are just as good (or, in your case Zenman, much better :love: ) as the specialist (real) Doctors who not only receive ten times the specialty training, but the complete spectrum of medical training as well.

Oh, and if you don't think that is ironic, then I suggest you consult Wiki again! :laugh:

You seem to have an unnatural fascination with my abilities, but let me inform you I'm not your daddy and I don't treat kids so find another adult leg to hump.

I'm not pointing out that I'm better than anyone (you are projecting) nor do I say how much better I am. I like PAs as they are in a similar boat that NPs are. Remind me how useful all that speciality training is when you forget half of it or it doesn't apply to your current speciality. Was it a waste of time and money?
 
You seem to have an unnatural fascination with my abilities, but let me inform you I'm not your daddy and I don't treat kids so find another adult leg to hump.

Nope, don't know anything about your actual abilities. But I am amazed at how good you seem to think you are in your posts here, especially in relation to the "everyone else" strawman. I think the term for this duck is "Malignant egophrenia", and you sure quack a lot. :D

I'm not pointing out that I'm better than anyone (you are projecting) nor do I say how much better I am.

Oh, really? What about

every damn time (so far) I consult a psychiatrist they wouldn't do anything different,

Don't worry about my documentation as it's available to military providers all over the world and you can be sure plenty of people are looking at it.

If I needed to be spoon feed by you I wouldn't have been placed by the chief of psychiatry to be the only prescriber in a 13 member team embedded in an Army brigade. The other teams here have psychiatrists.


A lot of quacking going on there....
 
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True in most cases.
what is the min hrs for a psych np program? I know of some 500 hr fnp programs. that's 12.5 weeks of clinicals, about 1/4 what most pa students get. I had some electives that were 12 weeks long.

Not sure. I think it depends. I'm all for more clinical hours and fewer papers, frankly. I went this route not because I love the idea of care plans and nursing diagnoses, but because the NP license confers significant advantages.
 
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Not sure. I think it depends. I'm all for more clinical hours and fewer papers, frankly. I went this route not because I love the idea of care plans and nursing diagnoses, but because the NP license confers significant advantages.

What besides "independent practice" which you know my feelings about.
 
What besides "independent practice" which you know my feelings about.

In the areas where I'm interested, NPs have a significant advantage over PAs in getting employed in psych, I even spoke with a PA who wanted to practice in psych but had a hard time getting hired because of billing problems. This could be region specific.

Plus, I do want to be trained in providing therapy, which NPs are licensed to provide, and PAs get virtually no structured training in whatsoever. I know the NP training is minimal, but my program does teach us individual, group, and family therapy, and we have to get a minimum number of supervised hours. I know of no PA programs that do this. Plus, I want the psych specific training and coursework, not general training. I'm also interested in teaching and research, and opportunities abound in nursing for that kind of work.

I think the pissing match between PAs and NPs should end, as there are viable reasons to choose either field, which was the entire point of my first post. You can say that independent practice is a stupid reason to pursue NP, but the psych NPs I knew who had their own practices did very well (both of them are not taking new patients because they are inundated) and it's a compelling career opportunity for someone like myself, later down the line.
 
A lot of quacking going on there....

You might think so but I already told you "it's just facts." Same as you telling me you're a PA and what you do. How else do you want me to relate this to appease you? (not that I care one whit)
 
In the areas where I'm interested, NPs have a significant advantage over PAs in getting employed in psych, I even spoke with a PA who wanted to practice in psych but had a hard time getting hired because of billing problems. This could be region specific.

Plus, I do want to be trained in providing therapy, which NPs are licensed to provide, and PAs get virtually no structured training in whatsoever. I know the NP training is minimal, but my program does teach us individual, group, and family therapy, and we have to get a minimum number of supervised hours. I know of no PA programs that do this. Plus, I want the psych specific training and coursework, not general training. I'm also interested in teaching and research, and opportunities abound in nursing for that kind of work.

I think the pissing match between PAs and NPs should end, as there are viable reasons to choose either field, which was the entire point of my first post. You can say that independent practice is a stupid reason to pursue NP, but the psych NPs I knew who had their own practices did very well (both of them are not taking new patients because they are inundated) and it's a compelling career opportunity for someone like myself, later down the line.

I originally thought about going the PA route but everything just fell into place for nursing. I did the Psych CNS route first which focused on therapy then went the NP route. I will only wind up in an independent practice state, maybe back in NM where NPs have had independent practice rights for 20 years. The reason? I've seen NPs with private practices which had to be closed down immediately due to their collaborating physician dying, changing his mind, moving, etc..
 
In the areas where I'm interested, NPs have a significant advantage over PAs in getting employed in psych, I even spoke with a PA who wanted to practice in psych but had a hard time getting hired because of billing problems. This could be region specific.

Plus, I do want to be trained in providing therapy, which NPs are licensed to provide, and PAs get virtually no structured training in whatsoever. I know the NP training is minimal, but my program does teach us individual, group, and family therapy, and we have to get a minimum number of supervised hours. I know of no PA programs that do this. Plus, I want the psych specific training and coursework, not general training. I'm also interested in teaching and research, and opportunities abound in nursing for that kind of work.

I think the pissing match between PAs and NPs should end, as there are viable reasons to choose either field, which was the entire point of my first post. You can say that independent practice is a stupid reason to pursue NP, but the psych NPs I knew who had their own practices did very well (both of them are not taking new patients because they are inundated) and it's a compelling career opportunity for someone like myself, later down the line.

I am saying its dangerous for patient safety. That is why I am anti independent practice for mid levels. Hell I did well as a PA(made over 180k and slept the majority of the time)
So there is money in both fields.
 
I originally thought about going the PA route but everything just fell into place for nursing. I did the Psych CNS route first which focused on therapy then went the NP route. I will only wind up in an independent practice state, maybe back in NM where NPs have had independent practice rights for 20 years. The reason? I've seen NPs with private practices which had to be closed down immediately due to their collaborating physician dying, changing his mind, moving, etc..

That's horrible. I heard about that happening to a PA who had 20+ years of experience. Ridiculous.
 
I am saying its dangerous for patient safety. That is why I am anti independent practice for mid levels. Hell I did well as a PA(made over 180k and slept the majority of the time)
So there is money in both fields.

Agreed about the money. Regarding your first point, I just don't see it. I mean, NPs have had independent practice in some states for quite a while, and they're not inundated with lawsuits, their insurance remains very reasonable, etc. I don't know if there's really any evidence that they're as dangerous as you believe. Nobody practices in a vacuum, people know to refer out, etc.
 
You might think so but I already told you "it's just facts." Same as you telling me you're a PA and what you do. How else do you want me to relate this to appease you? (not that I care one whit)

No Zen, it's not "just the facts". It's the way you self-aggrandize yourself here while belittling everyone else who hasn't learned the mystical Hopi-art of spiritual wholeness and etheral well-being that you always say is so important.

You are no better than anyone else. Perhaps you really don't think you are better, but the way you come across on these boards make you look like you do, indeed, suffer from malignant egophrenia. And, as you know, most people with huge ego's just get laughed at by all of the other regular people! :laugh:
 
No Zen, it's not "just the facts". It's the way you self-aggrandize yourself here while belittling everyone else who hasn't learned the mystical Hopi-art of spiritual wholeness and etheral well-being that you always say is so important.

You are no better than anyone else. Perhaps you really don't think you are better, but the way you come across on these boards make you look like you do, indeed, suffer from malignant egophrenia. And, as you know, most people with huge ego's just get laughed at by all of the other regular people! :laugh:

You realize of course that you're making a judgement call based on inadequate information. God help your patients if you treat them the same. Perhaps you'd like to see some of my recommendations for a second opinion. Or would you be afraid of that? Or would you consider that grandstanding on my part? You think I'm in my position or any other one I've been in because I'm an idiot? I've got experience many people might love to have. Why don't you pay for a psych eval for me? Maybe that would shut you up. I see your adolescent behavior got you kicked off allnurses. No one can role model adult behavior for you with your personality, you can only drop to your adolescent level and hope someday you catch on. :D
 
Agreed about the money. Regarding your first point, I just don't see it. I mean, NPs have had independent practice in some states for quite a while, and they're not inundated with lawsuits, their insurance remains very reasonable, etc. I don't know if there's really any evidence that they're as dangerous as you believe. Nobody practices in a vacuum, people know to refer out, etc.

Yes, we need the facts. Like I mentioned earlier, NPs in New Mexico have had independent practice for 20 years. My insurance was less than $900 a month and you know the insurance companies are on top of any risk factors.
 
No Zen, it's not "just the facts". It's the way you self-aggrandize yourself here while belittling everyone else who hasn't learned the mystical Hopi-art of spiritual wholeness and etheral well-being that you always say is so important.

You are no better than anyone else. Perhaps you really don't think you are better, but the way you come across on these boards make you look like you do, indeed, suffer from malignant egophrenia. And, as you know, most people with huge ego's just get laughed at by all of the other regular people! :laugh:

I'm not belittling anyone...but your behavior. The training is available for you if you want.
 
Agreed about the money. Regarding your first point, I just don't see it. I mean, NPs have had independent practice in some states for quite a while, and they're not inundated with lawsuits, their insurance remains very reasonable, etc. I don't know if there's really any evidence that they're as dangerous as you believe. Nobody practices in a vacuum, people know to refer out, etc.

That is true but I get into trouble when I base my attitudes on past experiences. For example, I worked with a NP (either PhD or DNP) that got pissed because a Physician wanted to talk to his peer instead of her. Instead of taking it in stride, I'll never forget her saying and I quote- I know more than a Physician because I had to write a thesis and they just study and take test in medical school. That person teaches for a NP program so how am I supposed to not think she is not instilling that same dangerous logic and hubris into her young NPs?

I have heard a PA say something similar(only one in my years of practice) say that she didn't need a SP and guess what a few weeks later she had to call the SP to intubate a difficult airway.

So I have seen in it on both sides of the fence but much much more greatly on the NP side.
 
That is true but I get into trouble when I base my attitudes on past experiences. For example, I worked with a NP (either PhD or DNP) that got pissed because a Physician wanted to talk to his peer instead of her. Instead of taking it in stride, I'll never forget her saying and I quote- I know more than a Physician because I had to write a thesis and they just study and take test in medical school. That person teaches for a NP program so how am I supposed to not think she is not instilling that same dangerous logic and hubris into her young NPs?

I have heard a PA say something similar(only one in my years of practice) say that she didn't need a SP and guess what a few weeks later she had to call the SP to intubate a difficult airway.

So I have seen in it on both sides of the fence but much much more greatly on the NP side.

But that's just one NP. Really. I know people on SDN love to take one experience they had with a NP/PA/whatever and use it to write off the entire profession, but let's be reasonable. I understand that you're worried she's a prof, but I think you believe NP professors have more influence over their students than they actually do. Do you hang on to your profs' every word? I doubt it.

I also doubt that this professor spends her time ranting about docs and inundates her students with anything other than nursing. That never happens in my program, at least. We're all kind of busy, learning how to be nurses and NPs. When would they even find the time? So far the only time we have talked about docs has been during exercises for clear communication (discussions about not taking verbal orders, when to call the doc/provider, what info to provide, etc). I'm in the RN portion of my program, for what it's worth. Maybe the anti-physician propaganda portion of the program starts next year. ;)
 
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Not sure. I think it depends. I'm all for more clinical hours and fewer papers, frankly. I went this route not because I love the idea of care plans and nursing diagnoses, but because the NP license confers significant advantages.
fair enough. best of luck in your studies.
 
But that's just one NP. Really. I know people on SDN love to take one experience they had with a NP/PA/whatever and use it to write off the entire profession, but let's be reasonable. I understand that you're worried she's a prof, but I think you believe NP professors have more influence over their students than they actually do. Do you hang on to your profs' every word? I doubt it.

I also doubt that this professor spends her time ranting about docs and inundates her students with anything other than nursing. That never happens in my program, at least. We're all kind of busy, learning how to be nurses and NPs. When would they even find the time? So far the only time we have talked about docs has been during exercises for clear communication (discussions about not taking verbal orders, when to call the doc/provider, what info to provide, etc). I'm in the RN portion of my program, for what it's worth. Maybe the anti-physician propaganda portion of the program starts next year. ;)

I base my feelings on that example and others so its not a "single bad" situation. If that were true I would have written off the PA profession a long time ago...

Anyway good luck.
 
You think I'm in my position or any other one I've been in because I'm an idiot? I've got experience many people might love to have.

Okay, I didn't think it would work, but I tried. I'll revert back at laughing at your malignant egophrenia because laughing keeps me youthful in my old age! :laugh:

Annoyed/Makati: We all know a few PA/NPs who think they are equal or better than board certified Doctors (insert Zenman joke of choice here). And we also know that most of us understand and operate within our established role in the system.

Two of my preceptors were NPs, and they were terrific. The first was during my general surgery rotation. She used to teach at a NP program and was just a fantastic teacher with incredibly high standards, and she fully understood that the Doc was the head of the team. The second was at a (extremely rural) medicine rotation where he was practicing medicine practically unsupervised....yet we were always discussing "when to pick up the phone and call the boss". I thank both of them for all that they taught me!
 
Okay, I didn't think it would work, but I tried. I'll revert back at laughing at your malignant egophrenia because laughing keeps me youthful in my old age! :laugh:

I agree with laughing. It has certainly help me survive 40 + years in this business. Only 20 more to go...
 
But we're not talking about psychiatrists are we??

What didactic coursework do PA's get in psych? Just wondering. I forgot to ask the last one here and now they are on break till January...slaggards...

Aside from pre-reqs needed to get into PA school, ARC-PA has the following standards:

B2.08 The program curriculum must include instruction in the social and behavioral sciences as
well as normal and abnormal development across the life span.
ANNOTATION: Social and behavioral sciences prepare students for primary care
practice. Instruction includes detection and treatment of substance abuse; human
sexuality; issues of death, dying and loss; response to illness, injury and stress;
principles of violence identification and prevention; and psychiatric/behavioral conditions.
B2.09 The program curriculum must include instruction in basic counseling and patient
education skills.
ANNOTATION: Instruction in counseling and patient education skills is patient centered,
culturally sensitive and focused on helping patients cope with illness, injury and stress,
adhere to prescribed treatment plans and modify their behaviors to more healthful
patterns.

This will obviously come in the form of didactic coursework. Additionally, a psych rotation is required, and that doesn't count the management of mental health issues required during other rotations(FP/EM/etc.).

I think the implication that a new grad NP is far more prepared to work in psych than a new grad PA is inaccurate at best.
 
Aside from pre-reqs needed to get into PA school, ARC-PA has the following standards:



This will obviously come in the form of didactic coursework. Additionally, a psych rotation is required, and that doesn't count the management of mental health issues required during other rotations(FP/EM/etc.).

I think the implication that a new grad NP is far more prepared to work in psych than a new grad PA is inaccurate at best.

What makes you think so? Just how much mental health do you get in other rotations? I only see one behavioral health course listed in the Army program but I'll look again. I'm just curious as I forgot to ask the last PA through here and there won't be another till January. I'll put up the psych courses in my program:

Group therapy
Major Psychopathology Disorders
Family therapy
Applied Pharmacotherapeutics: Psychopharmacology
Neuroscience
Diagnosis and management I: Assessment and planning
Diagnosis and management II: Evidence based treatment
Psych mental health NP-Adult I
Psych mental health NP-Adult II

I also did two semesters community mental health in another program which was more therapy-oriented. I don't know how much community mental health there is in NP programs now.
 
What makes you think so? Just how much mental health do you get in other rotations? I only see one behavioral health course listed in the Army program but I'll look again. I'm just curious as I forgot to ask the last PA through here and there won't be another till January. I'll put up the psych courses in my program:

Group therapy
Major Psychopathology Disorders
Family therapy
Applied Pharmacotherapeutics: Psychopharmacology
Neuroscience
Diagnosis and management I: Assessment and planning
Diagnosis and management II: Evidence based treatment
Psych mental health NP-Adult I
Psych mental health NP-Adult II

I also did two semesters community mental health in another program which was more therapy-oriented. I don't know how much community mental health there is in NP programs now.

Everything you mentioned is covered in the PA curriculum but not necessarily under the same course names or with a separate course for every aspect of psych. Speaking of my program specifically, we cover drug therapy in our two semesters of pharm, take a course in neuroscience, and the rest of that is covered in our psych coursework(as outlined by the ARC-PA standards I pasted above).
 
I think the implication that a new grad NP is far more prepared to work in psych than a new grad PA is inaccurate at best.

hahahaha. Maybe if you're comparing a FNP to a PA. Psych NPs clearly get more education in psych. PAs receive no structured therapy training, for one, unlike psych NPs. Psychotherapy isn't something you pick up on the fly while you're on other rotations.
 
Everything you mentioned is covered in the PA curriculum but not necessarily under the same course names or with a separate course for every aspect of psych. Speaking of my program specifically, we cover drug therapy in our two semesters of pharm, take a course in neuroscience, and the rest of that is covered in our psych coursework(as outlined by the ARC-PA standards I pasted above).

I really doubt that as you'd be taking away content in the specific course. I just don't see it. You can't for example cover a semester course in group therapy as part of FP. Or 13 weeks of interviewing.
 
I really doubt that as you'd be taking away content in the specific course. I just don't see it. You can't for example cover a semester course in group therapy as part of FP. Or 13 weeks of interviewing.

Interviewing and assessment for PA school is three semesters long(Summer/Fall/Spring in year 1.) but we don't have a Psych focus on it if that is what you mean. Also our Pharmacology is the same length and was taught by a PharmD PA. Also our Neuroscience was 12 weeks long(all fall) and taught by two PhDs. That was harder than my med. school neuroscience because it was so esoteric from those two(that changed after my class though so I don't know about how tough it is now.)

Also we are not taught any group therapy in PA school, I will definitely agree with you on that.
 
Interviewing and assessment for PA school is three semesters long(Summer/Fall/Spring in year 1.) but we don't have a Psych focus on it if that is what you mean. Also our Pharmacology is the same length and was taught by a PharmD PA. Also our Neuroscience was 12 weeks long(all fall) and taught by two PhDs. That was harder than my med. school neuroscience because it was so esoteric from those two(that changed after my class though so I don't know about how tough it is now.)

Also we are not taught any group therapy in PA school, I will definitely agree with you on that.

Thanks. I know if I wanted to do primary care I'd go the PA route or if already a nurse, might just keep repeating clinical till I had many more hours. However, I'd volunteer to go to Afghanistan as a contractor before doing primary care.:laugh:
 
I think it is fair to say that in most cases a psych np gets more psych training than a typical pa student.
I had a 5 week rotation in a lock down psych facility in addition to the didactic coursework. psych wasn't my focus in school so I didn't do electives in psych.
when we look at other specialties it becomes a bit more cloudy.
fnp's can become certified for example with as little as 500 hrs of fp clinical training.
I had more fp than this in addition to another 42 weeks of rotations in other specialties.
ditto acnp. I did 27 weeks of em/peds em/trauma/icu and most of those were 50-60 hr weeks, more on surg.
ditto rnfa. my trauma surgery rotation was well over 600 hrs.
pa programs don't cover psych counseling per se but do cover a lot of the disease processes, medications, etc...more of what a pcp would need to treat anxiety and depression without referral but in most cases pa pcp's are likely referring out those with schizophrenia, bipolar, etc to psych folks( I know I would).
 
As I sit at the bottom of the sheer vertical wall of experiemtially based knowledge and decision making capability that has to be overcome by the time I achieve independence in practice. As I see the vast difference between me and the senior medical student. Her and the intern. The intern and the 2nd year. The 2nd year and the 3rd year running the team. Her and the journeyman attending. Them and the fellows they consult for specific areas of management. They and their attendings. Here at the bottom. Looking to my right and seeing a mid level student who nears practice before I will passed one step above me. Who lacks the ability to come up with half the differentials I can.

It boggles my f'n mind. That that student would be wanting the right to practice independently. That's what you're advocating for. The law doesn't specify levels of discretionary experience. It simply confers rights of practice for specific levels of training. If you're wanting independence at that level, by law. You're insane. You're irresponsible. And you have no idea what your asking for. You don't even want to know what you don't know. It'd be a character assassination.
 
The other thing I think we need is to really find out if NP education is sufficient and safe for independent practice out of the box. Could be that it is. The trouble is that we're evaluating NP's for poorer outcomes without refining and isolating the real question. We're also not evaluating efficiency. For instance every ED that I've seen has NP's or PA's in the fast track with md/do's with the more complicated patients. Are we to assume the NP's can't breeze over and ask a question on an unclear issue. What about the culture of the MD's affecting friendly professional opinion sharing. All sorts of muddy, confounding issues.

The only real test seems the eventual totally independent NP's en masse and vs physicians in a huge prospective analysis with very similar populations and practice conditions.

For now. I'll trust my loved ones and myself to the instinct that every physician feels at every step. Some foreboding trepidation of not knowing enough. After many years of having someone on hand that did to count on. Am I ready? Even after all those years. Attending feeling like an unworthy title.

Such that yes. Some group organizing aggressively around seizing these rights is an affront, to civility and common sense.

Could be the data will show all of this caution is not necessary. But saying this caution is wasteful with the data that we have. Without clear comparison's is a gambler's proposition. Worthwhile only when access is the rate limiting step.
 
Lol, I never said or advocated i would open my own practice. I just said they can open their own practice. So can DPT's and PharmD's, and OD's ect..It's no different for a DNP. A DNP will collaborate with the patients primary care physician in regards to care. If a patient needs to see a higher authority aka specialist, NP's can refer that patient to the proper specialist. When an OD sees that a patient needs surgery for his eye, he refers the patient to an opthomologist.When a PT finds out the patient has fractured a bone he refers the patient to a orthopedic surgeon. So how are these fields different form NP, their all midlevel and can practice independently. But each midlevel provider will discuss the treatment plan and its progress with the primary physician. If a patient needs special services, or beyond the scope of the provider, then they get referred to a specialist. An NP will only practice based on his or her level of training, anything beyond that scope will be seen by the proper healthcare provider.

There's nothing lol about it. You clearly don't understand what a PCP is. That would be the NP. Or whoever is seeing an undifferentiated complaint. Those other professions are not practicing medicine. An NP will.

You've done a great job summarizing the differences. I wasn't responding to you. Just in general. But since you posted the above. I will say that now you must charge yourself with understanding what independent practice of medicine means.

This will take years. Read your post years hence. And see if you can understand the dilemma of me trying to make sense of it to your 2013 self. I've only just begun to get an inkling after 5 years of study and now my clinical rotations.
 
As I sit at the bottom of the sheer vertical wall of experiemtially based knowledge and decision making capability that has to be overcome by the time I achieve independence in practice. As I see the vast difference between me and the senior medical student. Her and the intern. The intern and the 2nd year. The 2nd year and the 3rd year running the team. Her and the journeyman attending. Them and the fellows they consult for specific areas of management. They and their attendings. Here at the bottom. Looking to my right and seeing a mid level student who nears practice before I will passed one step above me. Who lacks the ability to come up with half the differentials I can. It boggles my f'n mind.

That that student would be wanting the right to practice independently. That's what you're advocating for. The law doesn't specify levels of discretionary experience. It simply confers rights of practice for specific levels of training. If you're wanting independence at that level, by law. You're insane. You're irresponsible. And you have no idea what your asking for. You don't even want to know what you don't know. It'd be a character assassination.


Highly doubt the bolded. Medical students are not good with Ddx until 3rd year(mid to late). You might come up with the zebras(which areimportant to know) but the MLP will more than likely come up with the correct diagnosis more than yourself. Plus how are you doing all of this if you haven't passed Step 1......

PS- I have been a PA for a while and now a medical student. I personally feel from a clinical standpoint I was more ahead as a PA then I am as a Medical student at a similar point of my schooling if that makes sense?
 
NPs have had "independent practice" in New Mexico for about 20 years. The world has yet to end. Malpractice rates have not gone up. Lawsuits have not gone up. Responsible people know when to refer out and repeating the phrase "you don't know what you don't know" is not the equivalent of a logical argument.
 
OH i see what your saying. Your worried that instead of the PCP, the DNP will be the primary care provider. I don't think the nursing association is pushing for this at all. I think your over reacting to the DNP.

What else is to be understood by independent practice. What possible meaning is there besides patient comes in with XYZ...ready, set, go. If you make the referral you are the PCP. You are the the one who decides whether to refer. No different than a board certified family practice doc.

Look. We're far from overreacting. We're underreacting. And worse reacting stupidly by curmudgeonly clinging to narcotics perscription rights as if aspirin couldn't kill you first. We've lost the public. I mean, your interested, a professional, and I'm having a hard time explaining it. That's why NP's are shoving the agendas through. Everybody understands cheaper white coat person. Nobody understands physician training but physicians or physicians in training. Which is what endows all those without it with the brazen, and cavalier attitude towards its fundamental tenets.

Keep in mind I'm not saying mid levels can't achieve parity in practice. That's not the goal of licensure. The goal of licensure is minimum safety standards. We, like the FAA for pilots, make sure somebody watches you doing it for years before giving you the go ahead for yourself independently.

But I guess we're just the worrying type.

Personally. Go ahead. Just don't expect me to sign off on your work. I'll go somewhere else or hang my own shingle before I do that. The only way I'm doing that is if you work for me. And my time in cross-checking your management is also making me money for my time.
 
Highly doubt the bolded. Medical students are not good with Ddx until 3rd year(mid to late). You might come up with the zebras(which areimportant to know) but the MLP will more than likely come up with the correct diagnosis more than yourself. Plus how are you doing all of this if you haven't passed Step 1......

PS- I have been a PA for a while and now a medical student. I personally feel from a clinical standpoint I was more ahead as a PA then I am as a Medical student at a similar point of my schooling if that makes sense?

Wtf are you talking about. I'm half way through my 3rd year. And of course if your a PA you'd have been further ahead than me. I was talking about a PA student who will enter practice before I graduate.

And annoyedbyfreud....I don't need to convince you of anything. What I can say emphatically is I can't believe someone with my approximate level of experience considers themselves fit for Independent practice. If you feel dandy about it. Thanks. And I won't be referring or asking your input on my patients. Just because anyone who thinks that is scary to me. Yeah...pretty much that's it.
 
Addendum:

The referring has to stop somewhere. The refered to cannot keep referring. Hence, you all are piggy backing on our system of training whether Independent or not. That's part of the slickness in the sleight of hand. It's also the means, I believe, by which much of the parity in outcomes in the preliminary data come from. A willingness by NP's to refer cautiously. Which is a good thing. I want to emulate it actually. But systemically someone has to both be there to be referred to and be willing to make the decision for that to work. The tough decisions are the ones that have potentially bad outcomes. Which is why they're tough.

The confidence to overcome this comes from residency training. Where you've seen more clinical failures and successes.

So. As markets tighten. And the labor pool gets crowded--because let's be real, y'all don't want to be in South Dakota anymore than we do--don't expect the free ride on our training to always be there. Your referral might become my patient.

Maybe not. But if it comes to it. Count on it. Cause I'm half a mil in the hole for this ****. And will be burning the midnight oil in my specialty long after you've laid your pretty head to sleep that night and all the thousands of nights.
 
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