PA vs NP

[AnnoyedByFreud]

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So you don't think patients are fit to decide who they want to see for their own healthcare needs? They should have others deciding for them? Seems kind of nanny-state to me. Especially in light of research finding equivalent outcomes between physicians and NPs (yes people on SDN love to argue that every single study is flawed, I am aware). It's not like we're comparing holistic healer mumbo jumbo to a neurosurgeon. NPs carry their own insurance and can be sued, just like MDs. New Mexico has had independent practice for NPs for 20 years... they have yet to be sued into oblivion. If they were a fraction as incompetent as people on this forum make them out to be, don't you think we'd see higher malpractice rates?

Just wanted to add, I have a lot of respect for the med students and docs (and PAs, PTs, pharmacists, MSWs, etc.) I work with and will train with (gasp) during my clinical rotations. The physicians have sacrificed a lot more than I would be willing to. They are clearly experts. I think all for profit NP programs should be shut down. The psych NP route carries a lot of bang for its buck, so I'm pleased with my pathway. Nursing as a field has a ton to offer. Different strokes for different folks and all that.

 

[SpecterGT260]

So you don't think patients are fit to decide who they want to see for their own healthcare needs? They should have others deciding for them? Seems kind of nanny-state to me. Especially in light of research finding equivalent outcomes between physicians and NPs (yes people on SDN love to argue that every single study is flawed, I am aware). It's not like we're comparing holistic healer mumbo jumbo to a neurosurgeon. NPs carry their own insurance and can be sued, just like MDs. New Mexico has had independent practice for NPs for 20 years... they have yet to be sued into oblivion. If they were a fraction as incompetent as people on this forum make them out to be, don't you think we'd see higher malpractice rates?

Just wanted to add, I have a lot of respect for the med students and docs (and PAs, PTs, pharmacists, MSWs, etc.) I work with and will train with (gasp) during my clinical rotations. The physicians have sacrificed a lot more than I would be willing to. They are clearly experts. I think all for profit NP programs should be shut down. The psych NP route carries a lot of bang for its buck, so I'm pleased with my pathway. Nursing as a field has a ton to offer. Different strokes for different folks and all that.

Honestly, no. Patients are not fit to judge the quality of the care they get. They often make decisions based on emotional reactions to things and the way they and their provider interact. Obviously cordiality and rapport are incredibly important, but they have nothing to do with the skill level of the provider.

The papers put out by the nursing association (like there isn't bias there 🙄 ) have looked at total outcomes for a narrow scope of uncomplicated patients and have used the results to argue for expansion of scope. This is utterly insane. They claim that the studies show equivalency, when in fact they speak to no regard what so ever on the nurse's ability to handle complex cases in any capacity. Even if complex cases were included in the studies (which I have yet to see a paper which doesn't include this overwhelmingly obvious bias), the washout due to including the vast majority of patients who are uncomplicated and wouldn't experience a negative outcome even if the doctor sucker-punched each one at the end of the session would mathematically hide a difference between the two even if the DNPs were ritualistically killing each complicated case that walked in.

Performing such a poor study design and reporting as they do is either, at best, indicative of the ignorance that we object to or, at worst, representative of intentionally misleading the lawmakers and patients for their own benefit. There is no 3rd option here.

I don't want my statements here misrepresented or misinterpreted as nurse-bashing or even DNP bashing. My statement is only that they are not equivalent to, nor are they capable of providing equivalent care as physicians. My argument is against expansion, not against the existence of nurse practitioners all together.

On the other subject - malpractice rates are only loosely related to actual rates of malpractice. They relate more to probability of being sued (which again is only loosely correlated with actual rates of malpractice) and the amount of money that stands to be changed hands. People don't sue nurses for a few reasons. Primarily because they are not viewed as being worthwhile to sue (shallow pockets) and hospitals will often be sued in their place if at all. Another major factor is that sh** rolls uphill in this case. A patient who is going to have a negative outcome and sue is very likely to have had a physician at some point in his or her care, and usually towards the end when things go from bad to worse. Lawsuits don't happen in the outpatient setting nearly as often as they occur in inpatient. Basically, relating competency to malpractice rates is just inappropriate.

 

[dudestheman90]

l

 

[AnnoyedByFreud]

SpecterG - I think we'll have to agree to disagree when it comes to whether or not people should be allowed to make their own decisions based on who they want to see. I'm curious - do you have any evidence that NPs are unsafe providers or that they practice in unsafe ways when not collaborating with a physician? I also know that not all the outcomes-based research studies are conducted by nurses only (often I see both RNs and MDs as authors), though I'll have to look through the literature more closely.

 

[SpecterGT260]

SpecterG - I think we'll have to agree to disagree when it comes to whether or not people should be allowed to make their own decisions based on who they want to see. I'm curious - do you have any evidence that NPs are unsafe providers or that they practice in unsafe ways when not collaborating with a physician? I also know that not all the outcomes-based research studies are conducted by nurses only, though I'll have to look through the literature more closely.

Anecdotal only, unfortunately. This isn't to imply that I think NPs are a danger to patients or that they are incompetent. I only mean to imply that I think expansion is ill advised.

Out of curiosity, how do you feel about patients with acute illness or in dire need of management for chronic illness going to see alternative sham practitioners (acupuncture for cancer, hypothetically)? Do you honestly think that healthcare should be unregulated in terms of patient access or do you just think the bar belongs beneath your rung?

 

[deleted87716]

We are simply car mechanics that possess a lot of information.

Speak for yourself.

Become an astronaut, the next bill gates, the next president even, now that's someone that's special.

You forgot actors, athletes, and rap stars. 🙄

 

[SpecterGT260]

Speak for yourself.



You forgot actors, athletes, and rap stars. 🙄

Rap stars, obviously. Apparently you havent heard one of the 5 word repetitive symphonies that Beyonce has put out recently which oh so obviously deserves several million dollars.

 

[deleted87716]

I had to read "dude's" post twice to convince myself that he wasn't being sarcastic. I don't think he was.

Sounds like the beginning of a really excellent personal statement, there.

 

[JoBreeze]

So you don't think patients are fit to decide who they want to see for their own healthcare needs? They should have others deciding for them? Seems kind of nanny-state to me. Especially in light of research finding equivalent outcomes between physicians and NPs (yes people on SDN love to argue that every single study is flawed, I am aware). It's not like we're comparing holistic healer mumbo jumbo to a neurosurgeon. NPs carry their own insurance and can be sued, just like MDs. New Mexico has had independent practice for NPs for 20 years... they have yet to be sued into oblivion. If they were a fraction as incompetent as people on this forum make them out to be, don't you think we'd see higher malpractice rates?

Just wanted to add, I have a lot of respect for the med students and docs (and PAs, PTs, pharmacists, MSWs, etc.) I work with and will train with (gasp) during my clinical rotations. The physicians have sacrificed a lot more than I would be willing to. They are clearly experts. I think all for profit NP programs should be shut down. The psych NP route carries a lot of bang for its buck, so I'm pleased with my pathway. Nursing as a field has a ton to offer. Different strokes for different folks and all that.

Am I correct that the holder of a BSN can do a 2 year NP and needs ~500 clinical hours to graduate?

 

[dudestheman90]

-

 

[SpecterGT260]

Just trying to help you guys out. Your obv. in this field for all the wrong reasons. If you were to take my advice, then this world would be a much better place to live in. Not every1 has the luxury of going to med school. Some people are broke, some are homeless, some are disabled, some have families to tend for, believe me being a physician isn't anything special, a homeless man with the resources could go to school and become a physician. Some people just don't want to go into serious financial ruin/debt and don't want to spend so much time in school. Some want to start a family early, some just aren't interested in science. Some find other ways to make good money with a lot less stress than being a physician. As I;m typing your starting to see that, being a physician isn't anything major. Being the president, or a top actor/actress, or an astronaut, or an NFL player, now that requires perserverance, and determination, b/c only a few can get into those kind of positions. I'm just trying to teach you a hard lesson on "Life" and "Respect". But I honestly don't blame people, it;s the way you were raised, spoiled, i'm going to be better than every1 sort of attitude. A lot of youth today, aren't taught respect, morals, and the fear of god, Again this goes back to morals and ethics, but it's certainly not an easy problem to fix.

Your right their. Two true. I here what your sayin.

 

[facetguy]

Your right their. Two true. I here what your sayin.

 

[deleted307836]

Your right their. Two true. I here what your sayin.

Someone needed to point it out. How can you consistently misspell "there" or "they're" so many times??

I hate picking on people's grammar and spelling on the internet, but... dude... people will take you much more seriously if you improve your spelling, grammar, and sentence construction. Otherwise you look like a young child IMing to their friends.

 

[deleted307836]

Anecdotal only, unfortunately. This isn't to imply that I think NPs are a danger to patients or that they are incompetent. I only mean to imply that I think expansion is ill advised.

Out of curiosity, how do you feel about patients with acute illness or in dire need of management for chronic illness going to see alternative sham practitioners (acupuncture for cancer, hypothetically)? Do you honestly think that healthcare should be unregulated in terms of patient access or do you just think the bar belongs beneath your rung?

In this example, are you implying that the acupuncturist is advertising their services as curative? Otherwise, I wouldn't put them in the "sham" category as cancer patients do often derive a perceived benefit from this alternative therapy.

 

[SpecterGT260]

In this example, are you implying that the acupuncturist is advertising their services as curative? Otherwise, I wouldn't put them in the "sham" category as cancer patients do often derive a perceived benefit from this alternative therapy.

Yes. It was just a hypothetical to establish a "same page" for us to work from. Essentially, people claiming to cure a condition who cannot, who also pull patient time and resources away from legitimate treatments.

I won't get too involved in your use of "perceived benefit"... that is kind of a different matter. We could go to psychic healers if you'd like. I am just trying to establish where the limits of Annoyed's stance lay.

 

[SpecterGT260]

Someone needed to point it out. How can you consistently misspell "there" or "they're" so many times??

I hate picking on people's grammar and spelling on the internet, but... dude... people will take you much more seriously if you improve your spelling, grammar, and sentence construction. Otherwise you look like a young child IMing to their friends.

You didn't seem to pick up the fact that I was criticizing the grammar in the poster who was telling the attending here about how s/he is in the field for the wrong reasons. This person used the wrong "you're" and my subconscious always trips on that every time because I actually say "yoo-er" for "you're" and "yoar" for "your" I also missed much more than "their" 😕

However, the chiropractor got it 👍

 

[deleted307836]

Benefit, perceived benefit, whatever. I do think it's distinct from true shams such as "psychic healers" but that wasn't the point of your question. Carry on.

 

[NYCGuy86]

Your right their. Two true. I here what your sayin.

 

[NYCGuy86]

Just trying to help you guys out. Your obv. in this field for all the wrong reasons. If you were to take my advice, then this world would be a much better place to live in. Not every1 has the luxury of going to med school. Some people are broke, some are homeless, some are disabled, some have families to tend for, believe me being a physician isn't anything special, a homeless man with the resources could go to school and become a physician. Some people just don't want to go into serious financial ruin/debt and don't want to spend so much time in school. Some want to start a family early, some just aren't interested in science. Some find other ways to make good money with a lot less stress than being a physician. As I;m typing your starting to see that, being a physician isn't anything major. Being the president, or a top actor/actress, or an astronaut, or an NFL player, now that requires perserverance, and determination, b/c only a few can get into those kind of positions. I'm just trying to teach you a hard lesson on "Life" and "Respect". But I honestly don't blame people, it;s the way you were raised, spoiled, i'm going to be better than every1 sort of attitude. A lot of youth today, aren't taught respect, morals, and the fear of god, Again this goes back to morals and ethics, but it's certainly not an easy problem to fix.

You sound like you're trying to convince yourself (since no one has implied anything of the sort that you're talking about ). Perhaps this is why you deleted your podiatry posts from a month ago?

 

[deleted307836]

You didn't seem to pick up the fact that I was criticizing the grammar in the poster who was telling the attending here about how s/he is in the field for the wrong reasons. This person used the wrong "you're" and my subconscious always trips on that every time because I actually say "yoo-er" for "you're" and "yoar" for "your" I also missed much more than "their" 😕

However, the chiropractor got it 👍

Maybe you misunderstood my post, but I knew that's who you were referring to... that's who I was referring to also. That's why I called him "dude"... that's the first four letters of his username anyway. The same poster has consistently misspelt "there" throughout this entire thread. Maybe it's late and I'm missing something. 😕

 

[SpecterGT260]

Maybe you misunderstood my post, but I knew that's who you were referring to... that's who I was referring to also. That's why I called him "dude"... that's the first four letters of his username anyway. The same poster has consistently misspelt "there" throughout this entire thread. Maybe it's late and I'm missing something. 😕

oh yeah, then I did misunderstand. I am also a dude 😛

 

[deleted87716]

Your obv. in this field for all the wrong reasons.

You don't know squat about me.

You're completely missing the point. If you're going into any field in healthcare, and think that you're nothing more than a mechanic fixing broken bodies, you're going into it for the wrong reasons.

Medicine is a very special field, and it takes a special person to do it, whether you're a doctor, nurse, or whatever. We don't need "mechanics."

Done here. Carry on.

 

[Shinken]

Just trying to help you guys out. Your obv. in this field for all the wrong reasons. If you were to take my advice, then this world would be a much better place to live in. Not every1 has the luxury of going to med school. Some people are broke, some are homeless, some are disabled, some have families to tend for, believe me being a physician isn't anything special, a homeless man with the resources could go to school and become a physician. Some people just don't want to go into serious financial ruin/debt and don't want to spend so much time in school. Some want to start a family early, some just aren't interested in science. Some find other ways to make good money with a lot less stress than being a physician. As I;m typing your starting to see that, being a physician isn't anything major. Being the president, or a top actor/actress, or an astronaut, or an NFL player, now that requires perserverance, and determination, b/c only a few can get into those kind of positions. I'm just trying to teach you a hard lesson on "Life" and "Respect". But I honestly don't blame people, it;s the way you were raised, spoiled, i'm going to be better than every1 sort of attitude. A lot of youth today, aren't taught respect, morals, and the fear of god, Again this goes back to morals and ethics, but it's certainly not an easy problem to fix.

 

[AnnoyedByFreud]

You don't know squat about me.

You're completely missing the point. If you're going into any field in healthcare, and think that you're nothing more than a mechanic fixing broken bodies, you're going into it for the wrong reasons.

Medicine is a very special field, and it takes a special person to do it, whether you're a doctor, nurse, or whatever. We don't need "mechanics."

Done here. Carry on.

I wish more people had this attitude. Maybe I've just seen a lot of burnt out physicians and nurses lately, but yikes.

 

[dudestheman90]

;

 

[pamac]

Well Let's try to dissect this. It takes about 4-5 Years to obtain your BSN. The BSN includes 2 years of clinical training. You then have to take the NCLEX and pass the exam in order to get licensed. Most RN's will practice 2+ years before applying to a DNP program. Most RN's if not all work while they are in the Program. The DNP includes a 1 year residency training program as well as didactic clinical training in the first 2 years. The DNP can take from 3-6 years to complete depending if you go as a full-time or part time student. This will largely depend on your work schedule. You then have to take a licensing and certification exam depending on your specialty. So that's 2 licensing exams you will have to take overall and I believe you will also have to take a certification exam based on your specialty in addition. There are also 12 month residency programs for NP's, I believe this will eventually become the norm, where NP's will train under the supervision of other NP's and MD's and alongside PA's in the hospital setting. I believe that NP post-graduate residency programs will eventually become the norm and it may even expand to 2 years instead of 1 down the road There may already be 18-24 month post graduate residency programs. I think this is a great Idea overall. So as you can see, the NP education is long and rigorous. I have heard foreign trained doctors that can be as incompetent as incompetency gets, since they dont't even have to attend undergrad in some countries and compromise 25% of physicians practicing in the U.S. And i'm sure some countries don't train their physicians to the caliber as expected here.

foreign docs take the usmle if they want to practice medicine. thats the standard. granted, thier individual training may vary, but if they manage to acquire the knowlege to pass, they have options in the states. if im not mistaken, foreign grads have a higher bar to clear on that exam in order to be considered to have passed (med school folks correct me if im wrong). if DNPs were passing that test, we probably wouldnt be arguing this. but they arent. the education is different.

 

[pamac]

i guesse over time ive forgotten the point you are trying to make about DNPs, or NPs in general. personally, im onboard with becoming an NP or DNP (whichever the university of my choice has in place by the time i get there). my personal perspective as someone who works full time in healthcare, and as an occasional patient, i definately don't see nonphysician providers and physicians as equivalent. im not going to seek equivalence as an NP. im one of those folks that see's firsthand what many doctors do and are responsible for, and what it took to get there, and think that often they are underpaid for what id be willing to do that for. thats not to say that i want to be taken advantage of by a physician or group that wants me to work for them for less than what i think im worth, but im not looking to be anything more or less than a valuable addition to a practice.... and for that reason, i see how i benefit from folks in the NP world making headway. it unlocks some leverage. in every company, there are different levels on the pecking order, and it seems that in conversations like this, there are folks insisting that a medical practice needs to operate different than most every organization out there. at the end of the day, if you want parity, you need to prove you deserve it. acquire skills and abilities that allow you to function beyond the folks at the top, and you will have made a case for yourself. just compare what you are saying about DNPs to a hypothetical example in the business world:
john and tim both went to school for 6 years. john is an engineer, and tim is an architect. they both run a business where they do interior design. they both use drafting software, and find themselves working on how to arrange the layouts on new buildings in ways that don't require them to delve into using thier individual lisences. then one day a client approaches them and wants them to not only arrange the interior layout, but make structural changes to the building. guess who is then more valuable to the project? the guy that has more skills and background, and can crunch the numbers to make the project safe. its nice both the architect and the engineer operate as peers, but its clear that the skill set the engineer carries gives him an edge. thats just the nature of qualifications. if it wasnt that way, you wouldnt have folks going the extra mile. in places where those qualifications aren't being properly utilized, the folks with less qualifications that are competant are then substituted in for cheaper. you can argue whether or not its overkill to have a doctor looking every patient at an urgent care clinic, and you may be right in many circumstances. however, one thing that wont happen is for a provider with LESS qualifications coming in and performing the same work for the same amount of money. theres no escaping how qualifications fit into the dynamic.

 

[JourneyAgent]

Well Let's try to dissect this. It takes about 4-5 Years to obtain your BSN. The BSN includes 2 years of clinical training. You then have to take the NCLEX and pass the exam in order to get licensed. Most RN's will practice 2+ years before applying to a DNP program. Most RN's if not all work while they are in the Program. The DNP includes a 1 year residency training program as well as didactic clinical training in the first 2 years. The DNP can take from 3-6 years to complete depending if you go as a full-time or part time student. This will largely depend on your work schedule. You then have to take a licensing and certification exam depending on your specialty. So that's 2 licensing exams you will have to take overall and I believe you will also have to take a certification exam based on your specialty in addition. There are also 12 month residency programs for NP's, I believe this will eventually become the norm, where NP's will train under the supervision of other NP's and MD's and alongside PA's in the hospital setting. I believe that NP post-graduate residency programs will eventually become the norm and it may even expand to 2 years instead of 1 down the road There may already be 18-24 month post graduate residency programs. I think this is a great Idea overall. So as you can see, the NP education is long and rigorous. I have heard foreign trained doctors that can be as incompetent as incompetency gets, since they dont't even have to attend undergrad in some countries and compromise 25% of physicians practicing in the U.S. And i'm sure some countries don't train their physicians to the caliber as expected here.

Foreign docs who make it to the states are usually already fully trained and will then have to retrain in a US residency. They're extremely knowledgeable. They are often the brightest and/or the most ambitious of their respective cohorts. Often a lack of English proficiency and/or their lack of facility with American cultural currency can make them appear as you say. But you're probably getting that from nurse's who have to follow their orders despite a lack of social grace in some of the more paternalistic culturally oriented among them.

Know this. Patients and nurses don't know the first thing about what makes a competent clinician. Now if you're making the argument that American cultural fluency is an important characteristic in a provider then, yes, I agree. But saying they don't have clinical skill or knowledge just makes you look ignorant, because some of them are the most trained among us.

Regarding curriculum and licensure, what is, is more important that what might be. Secondly nursing training is not clinical training so hours towards it means little towards being a clinician. You can be a nurse for 30 years and have very little gained in terms of becoming a clinician. That part of it is very individual. Some will benefit a great deal towards becoming a clinician. But not because of the training. Anyone who is really curious, observant, and imaginative will benefit from a ring side clinical seat.

 

[Boatswain2PA]

Well Let's try to dissect this. It takes about 4-5 Years to obtain your BSN. The BSN includes 2 years of clinical training. You then have to take the NCLEX and pass the exam in order to get licensed. Most RN's will practice 2+ years before applying to a DNP program. Most RN's if not all work while they are in the Program. The DNP includes a 1 year residency training program as well as didactic clinical training in the first 2 years. The DNP can take from 3-6 years to complete depending if you go as a full-time or part time student.....blah blah blah blah

Someday, if you ever make it into the medical field, reality is going to bite you in your arse and you will realize how clueless you are.

I will try to soften that bite for you now. I doubt it will work because you have obviously drunk too much kool-aid and think you already know everything, but I'll try to help you out.

Nurses are incredibly important, and my nurses keep me out of trouble all the time. But there is a huge difference between what they do and what I do. The 2 years of "clinical training" a BSN gets has very little in common with the "clinical training" a PA or doctor gets.

Yes, most NP/DNP students have some good nursing experience, and I'm sure that helps them be better medical providers....but not all NP/DNP programs require this.

However NP/DNP education today consists of about half (give or take some) of the medical education that a PA gets, and is only a very small fraction of what a board certified (real) doctor gets. Yes, there are now some DNP "residencies" but these are laughable when you compare the education/hours of one of these with a true physician residency.

You think DNP is great. We got you, and you are entitled to your opinion. But when you come on here and spew your kool-aid to those of us who are in the field and know what it REALLY is like, you just don't look too bright. You might want to apply just a bit of critical thinking with all of the pro-DNP literature you have memorized, because if you ever get around to practicing medicine you will need it.

Disclaimer: I think nurses are awesome. I had two amazing NP preceptors, and I have several very good NP friends (and every NP I know agrees that their NP education was a joke compared to PA and MD education). I am not nurse bashing nor NP bashing, so lets not start a flame war.

 

[SpecterGT260]

Someday, if you ever make it into the medical field, reality is going to bite you in your arse and you will realize how clueless you are.

I will try to soften that bite for you now. I doubt it will work because you have obviously drunk too much kool-aid and think you already know everything, but I'll try to help you out.

Nurses are incredibly important, and my nurses keep me out of trouble all the time. But there is a huge difference between what they do and what I do. The 2 years of "clinical training" a BSN gets has very little in common with the "clinical training" a PA or doctor gets.

Yes, most NP/DNP students have some good nursing experience, and I'm sure that helps them be better medical providers....but not all NP/DNP programs require this.

However NP/DNP education today consists of about half (give or take some) of the medical education that a PA gets, and is only a very small fraction of what a board certified (real) doctor gets. Yes, there are now some DNP "residencies" but these are laughable when you compare the education/hours of one of these with a true physician residency.

You think DNP is great. We got you, and you are entitled to your opinion. But when you come on here and spew your kool-aid to those of us who are in the field and know what it REALLY is like, you just don't look too bright. You might want to apply just a bit of critical thinking with all of the pro-DNP literature you have memorized, because if you ever get around to practicing medicine you will need it.

Disclaimer: I think nurses are awesome. I had two amazing NP preceptors, and I have several very good NP friends (and every NP I know agrees that their NP education was a joke compared to PA and MD education). I am not nurse bashing nor NP bashing, so lets not start a flame war.

I like nurses and even the NP masters. It is DNP that I think is absurd. IMO it is not doctorate level training. "Doctor" isn't just a word that signifies a terminal degree. More and more mid-level providers are attaching "doctor" to their title with no real change in training for no reason other than there isn't a higher degree.

 

[AnnoyedByFreud]

I like nurses and even the NP masters. It is DNP that I think is absurd. IMO it is not doctorate level training. "Doctor" isn't just a word that signifies a terminal degree. More and more mid-level providers are attaching "doctor" to their title with no real change in training for no reason other than there isn't a higher degree.

Agreed. I think the DNP as entry to the field is utterly ridiculous.

 

[joeDO2]

Medicine is a very special field, and it takes a special person to do it, whether you're a doctor, nurse, or whatever. We don't need "mechanics."

Thank you for this comment blue dog. Its something we should all take to heart. The idea of practitioners, whether they be MDs, DOs, PAs, or NPs being reduced to "mechanics" really gets my blood boiling. This is precisely the problem with the progressive dumbing down of medical education that many have discussed before on this and other forums.

The practice of medicine is an awesome responsibility. It is not to be taken lightly. Although the climate we are living in, with all its algorithms, procedures, administration, and oversight may give the illusion that we are simply highly trained technicians, I assure you this is not the case. When you take that knowledge to the bedside you become something more. There is literally no greater responsibility than being entrusted with another person's life.

From my favorite article on the purposes of medicine, lancet 1965: "For it is not true that the doctor is simply a man among men: when his patients turn to him in affliction he becomes something more. With all its faults the profession to which he belongs is not a body of technologists interested solely in the means by which physical and mental processes can be restored to normal: it is a body of doctors seeking to use these means to an end- to help patients cope with their lives."

I must second blue dogs comment. If your goal is to be a mechanic, we have no use for you here.

 

[dudestheman90]

/

 

[deleted87716]

You are a middle class worker, blah, blah, blah...

🙄

 

[SpecterGT260]

You are a middle class worker, like everyone else, this includes car mechanics. Nothing special. Anyone can sit down and memorize information. Whether your a md, pa, np ect. But not everyone wants to spend years in debt, and years memorizing a bunch of info or may even lack an interest in science all together. You go into this field b/c you want to help people, but so do firefighters, which i technically have more respect for. In regards to the medical profession, whether your a PT, RN, MD,ect. I look at everyone at the same level with the same level of respect. I don't picture a ladder, and say this person is better than this person.

🙄

I can assure you that not a single person here cares who you respect.

 

[joeDO2]

You are a middle class worker, like everyone else, this includes car mechanics. Nothing special. Anyone can sit down and memorize information. Whether your a md, pa, np ect. But not everyone wants to spend years in debt, and years memorizing a bunch of info or may even lack an interest in science all together. You go into this field b/c you want to help people, but so do firefighters, which i technically have more respect for. In regards to the medical profession, whether your a PT, RN, MD,ect. I look at everyone at the same level with the same level of respect. I don't picture a ladder, and say this person is better than this person.

I respect everyone who strives to be the best at what they do, regardless of the profession. To say however that everyone is on the same level / there is no ladder is just not possible. Although a patient may encounter many team members, someone is ultimately calling the shots. That person is the one with the broadest knowledge base and experience. When there is a disagreement between the MD and the CNA nobody goes to the PT for the tie breaker. Thats just not how it works. This doesn't mean that any of them are any less valuable, but at the end of the day there needs to be a decision maker and someone who will take overall responsibility for the patient's care. The relationship between doctor and patient (or even NP/PA and patient) IS SPECIAL. I'm sorry you are not able to see that.
I don't "want" to spend years in debt and years memorizing a bunch of info....but I will. This has nothing to do with money, gaining the respect of others, or even a desire to help people. I'm doing it because I love medicine and I want to be the best at what I do. I want to be more than a mechanic to my patients.

 

[Boatswain2PA]

I knew it wouldn't work.

And just think......he votes!

We're screwed.

 

[JourneyAgent]

I knew it wouldn't work.

And just think......he votes!

We're screwed.

It's an extremely powerful ideology. Bolstered by nightingale hero mythology, hardball union driven politics, shrewd public relations, and a guevarian iconological historical narrative.

You take that and feed it to fed up nurse's, shamed premed dropouts, and the generally easily persuaded and you have a densely concentrated political force. One that capitalizes on economic forces moving in their direction.

And they're making us too much money for us to cut them off from our umbilical cord.

I really think that in the decades it will take to play out to achieve clarity in the public imagination we'll be so broke and overspent on healthcare that it won't matter. The cheaper script writer will be better for those that don't have any choice. Medicine will be an archaic art. Practiced crudely by necessity sooner than later.

This devolution happening in all spheres not just ours.

I put no more effort into this banter. The public will get what it wants. Cheaper, faster, now.

 

[dudestheman90]

.

 

[SpecterGT260]

Why won't physicians see medicare and medicaid patients if this isn't about money. I though you went into this field to help people. O that's right, your expecting lot's of money for all your schooling. See, this goes back to the, "I went into this field for all the wrong reasons". Why won't most med students not want to go into primary care if this isn't about money. O, this goes back to, "I went into this field, so I can make lot's of money". How can the public hate on NP's if they are trying to alleviate the shortage, that's b/c people remember nurses as the ones who took care of them while they were sick in the hospital by their bedside. I can see that their training is expanding, more schooling and I believe post-graduate residencies will become a requirement in the near future. This whole tug of war is about money and turf in my humble opinion.

So... in your particular reality, who do you THINK sees medicare patients?

plumbers? 🙄

You aren't even a medical student and you have no idea what medical practice of ANY type is like. So why don't some want to go into primary care? Because not everyone likes primary care. Should we generate a specialist shortage and allow people to die just to satisfy your arbitrary sense of duty? no. we shouldnt. please go get back in your box now.

 

[Boatswain2PA]

Why won't physicians see medicare and medicaid patients if this isn't about money. I though you went into this field to help people. O that's right, your expecting lot's of money for all your schooling. See, this goes back to the, "I went into this field for all the wrong reasons". Why won't most med students not want to go into primary care if this isn't about money. O, this goes back to, "I went into this field, so I can make lot's of money". How can the public hate on NP's if they are trying to alleviate the shortage, that's b/c people remember nurses as the ones who took care of them while they were sick in the hospital by their bedside. I can see that their training is expanding, more schooling and I believe post-graduate residencies will become a requirement in the near future. This whole tug of war is about money and turf in my humble opinion.

It isn't JUST about the money, although it is a part of it, and you are a fool (and an even bigger fool than you have already made yourself out to be) if you don't think it is, always has been, and always will be a PART of the issue. Just like all of the PAs and NPs who tell the admissions committee's that they want to work in primary care, but then take the better paying specialty jobs. It's just what happens, and it will probably happen to you if you ever get to enter the real world.

And nobody here is hating on NPs. The vast majority of NPs are great, and part of what makes them great is that they realize that THEY ARE NOT DOCTORS! They are not EQUAL to DOCTORS in any type of medical setting because they only have a FRACTION of the medical education of doctors. Yes, there are now DNP residencies, but if you compare them to REAL medical residencies they are an absolute JOKE!

Yes, you have "humbly" stated your opinion here over and over. But the old adage about opinions apply here, and you smell like C.Diff. Worse yet, you keep bloviating....

You are young, and you know very little. It's okay to express your opinion, but if you want to have a chance at doing well in the real life, then sit back and LISTEN to those who are out there and know a hell of a lot more about this profession than you do.

 

[deleted87716]

l

-

;

/

You are young, and you know very little.

Apparently, he doesn't know that it doesn't do any good to delete his posts after people have already quoted them in replies.

 

[pamac]

Double post removed.

 

[pamac]

"Why won't physicians see medicare and medicaid patients if this isn't about money. I though you went into this field to help people. O that's right, your expecting lot's of money for all your schooling. See, this goes back to the, "I went into this field for all the wrong reasons". Why won't most med students not want to go into primary care if this isn't about money. O, this goes back to, "I went into this field, so I can make lot's of money". How can the public hate on NP's if they are trying to alleviate the shortage, that's b/c people remember nurses as the ones who took care of them while they were sick in the hospital by their bedside. I can see that their training is expanding, more schooling and I believe post-graduate residencies will become a requirement in the near future. This whole tug of war is about money and turf in my humble opinion."

You are making these kinds of comments without any understanding of overhead involved in becoming and being a physician and running a practice. In addition, you aren't considering the high financial price of schooling and living expenses (it's not about them "expecting lots of money for their schooling"). Doctors tend to make excellent wages, but a lot goes back into paying down loans that can cost more than a nice home. A new physician with a spouse and kids (medical education can take up some prime child rearing years) had to find a way to support them durring school. The other day in my ER a physician was talking to me and another nurse about their spouse (another physician), and how they have to be careful about money. At first I was thinking "why?", but on second thought, their spouse being a physician meant that they had two educations to pay down, and probably requires both of them to work full time when they probably don't want to. And who is the one grubbing money? The physician who takes out a literal boatload in loans to become trained, or the student who is stoked about going the easier route to NP or PA school sees it as the faster, easier, route that also provides a way to undercut physicians. You carried on all excited about cost savings and the appeal provided by DNPs, which would care inroads into untapped markets, but somehow YOU are the noble one for wanting to pick a career like NP to serve the "underserved"? Well maybe you have that luxury to do that because you got there on the cheap. Congrats. In addition to that, you would have managed to break into a potentially lucrative market because it is untapped by physicians.

As a nursing student I managed to work full time through nursing school. My previous degree took 4 years to obtain, but aside from that, my community college RN was fairly inexpensive. So that means that every almost every moment of my time spent in healthcare has been pure profit at a decent wage (my lab scientist wages started higher than medical residency wages). If you add up the hourly wage I've made in healthcare and divided it by the hours I've put into training, specifically for nursing, I have a fairly high return. The physician spends enormous amounts of time and effort into their craft. I bet if you calculated out what kind of return they made per hour of time spent, along with debt, it would come out to a fairly meager number. In my case, after four semesters of RN training, I'm drawing a very decent paycheck. After no less than 9 years of school, physicians start to make decent money, and then get to start paying down huge loans. That's what hit me when I heard that physician talking about being careful with money.... My wife (also in healthcare) and I have no debt, nice brand new cars that are paid for, healthy savings, good bennefits plenty of time off (never forced to work over 36 hours, and If we do it's overtime)... We worked hard to get where we are, but we also have been able to live life along the way. I dont think physicians are gods, but I respect their training and what they give up. The folks who want to be "associates" (PAs) or "doctors" (DNPs) knew that their path was going to yield less money, less training, and less "respect", but they took that path because it cost less money, took less time, or required less responsibility overall. At times they face up to challenges that match a physician, and they make decisions that are just as vital, but the job required less of them.... and they got less out of it in return. Just because one day they are putting in stitches just like a physician would, or managing a chest pain like a physician doesn't mean they are one. Conversely, the physician that i watched set up suction and made a bed in a patient room to get it ready for an ems patient to come in shouldn't take a pay cut for the time he spent doing that, even though that was the job of an ER tech or cna.

 

[joeDO2]

After no less than 9 years of school, physicians start to make decent money, and then get to start paying down huge loans.

correction: after no less than 11 years they make decent money: college = 4, med = 4, minimum residency = 3. total = 11. upper end would be 15.

unless you count residency as decent money....then its 8. but 40k/80hrs wk - 2 weeks vacation = $10/hr for a doctor. i don't consider that decent.

but i'm not here to start yet another pa/np vs. md/do debate. i don't think the majority of midlevels are trying to "undercut" physicians. i was just disturbed by someone reducing the profession to less than it is. if you're going to be a player in this game, you need to give the field and the people in it the respect they/it deserves.

 

[pamac]

correction: after no less than 11 years they make decent money: college = 4, med = 4, minimum residency = 3. total = 11. upper end would be 15.

unless you count residency as decent money....then its 8. but 40k/80hrs wk - 2 weeks vacation = $10/hr for a doctor. i don't consider that decent.

i knew it was 11 at minimum. i just wanted to shave off some of the pre-med undergrad to compare with some of the prereqs to get into a nursing program and allow for a more across the board comparison, because its not like you can just go to nursing school without some prior coursework. but even nursing prereqs dont compare to premed... i know because i got a biology degree. and i know of some nursing programs that have something like 5 prereqs (none of them hard sciences) and a few corequisites. but yeah, you do the math and MD/DO compensation doesnt look so hot considering what it took to get to that point, even at 200k+ per year.

i knew a kid who financed his college education with couple characters on world of warcraft that he developed and sold to some asian guy. i was like "dude thats awesome! thats a good way to make money doing what you love". he replied, "yeah, it came out to $1.38 and hour for all the time i put into it". so the final payday didn't tell the whole story, and its the same for physicians.

 

[Shinken]

I serve the "underserved" by donating free time to see uninsured patients at a local free clinic. However, in real life, I have to balance the amount of Medicare/Medicaid patients I see in my practice, not because I'm a greedy, arrogant doctor but because I have bills to pay and ultimately medicine is also a business, and you need your revenue to cover expenses. Seeing too many Medicaid patients is not economically feasible.

Although it's cute to see an idealistic pre-med (we all were like that to some extent, no?), to basically insult and criticize practicing physicians without having any idea of what the career actually entails, it's uncalled for and rather immature.

 

[dudestheman90]

k

 

[ChillyRN]

The self actualized adults in the group know that the uninformed opinions of those whom do not yet fully understand the culture of the professional world in which the rest of us really work are not worth taking to heart and we don't take offense to the bitter words and over dramatized blather that is so often seen in these threads. Once upon a time I used to get all "het up" about defending my profession and life's choices, but now I just scroll on by. I must admit a bit of chagrin to posts like those by dudestheman, so full of bravado, arrogance and inaccuracies. It can still be a bit embarrassing, but of course he doesn't speak for me or the APN profession and I trust everyone realizes that.

I'll finish my DNP in just a few months. I have worked very hard for it. I can't really estimate how many thousands of hours I have invested. I smile inwardly when I hear it referred to as "fluff." I don't get defensive on the point, because it just makes me aware that a person suggesting thus has no idea what they are talking about. The world is full of ignorance and I don't have the time nor the inclination to go about correcting all of it. I've loved the DNP experience and taken a lot away from it. My chair said something to me the other day about "saying goodbye to Duke" this year, and it made me a little sad to realize it will be over. I don't know what I'll do with my time! I have done nothing else but read, study, work, live and breathe this work for so long I'll be lost, lol.

Frankly, I am not the least bit interested in how other people perceive the DNP, I didn't earn it for (the collective) you, I earned it for the purpose of learning/knowing more than I did before. I have done something really extraordinary with my capstone project. I can't tell you about it because it is a public (a "goggleable",) performance improvement project that was implemented in this state and it would identify me, but I'm extremely proud of it. Patients have, and will continue, to benefit from my efforts. I'm pleased by that knowledge, and that's enough. I do not care a whit if the members of SDN respect or laugh at "Chilly" for the fact that I will have earned a DNP. I have quantitative data that demonstrates improved patient outcomes. The powers that be in this state were impressed enough to take it from county wide to state wide in less than 18 months. That along with the respect and support of people that I admire is what is important to me. Isn't that what should be important to all of you, regardless of your own credentials and educational background and goals?

Isn't all of this really a pointless argument? Are the people opposing you in your argument going to be convinced? I'm taking the time to type this not to convince the naysayers, but to reassure the hopeful lurking PA and NP students and those considering entering PA or NP school that they should not doubt their choice because of what they read on the internet. It is a great career. It isn't not the same as medicine, and if being a physician is what you want to do, I think you should pursue that. However, don't let negativity on the internet convince you that being a non-physician provider is some kind of second rate option and that you will be disrespected at the workplace and made to feel as small there as you might be here, lol. It simply doesn't happen.

Ask yourself, do you enjoy what you do? Do you feel fulfilled? Do you have regrets about your path, and if so can you redress them so that you do not? Are you living the life and lifestyle that you desire?

Do you feel it matters to the patients you work with, that you have a positive impact in those you treat? Enjoy the people you work with and have positive, collegial relationships? Have you set additional goals and enjoy working toward them?

IME, all of us work together to do our best for patients, and then go home to our families and the truly important issues in our lives!. The titles and the office stuff is just what we do during the day; it isn't who we are, it doesn't define us. I don't know anyone who gets as passionate about any of these issues as SDN members! My friends and colleagues care a great deal more about the office basketball pool and the fact that their next door neighbor is flaunting the covenant association bylaws. That's a true story. One of them is obsessed with HOA issues, lol. All of this is manufactured drama about the DNP and conflict between NPs and PAs seems IME to exist only in cyberspace. In the real world, everyone laughs at the notion of the idea of entertaining this sort of argument. I don't know any PAs who dislike NPs or vice versa, I don't know any DNPs who want to take over medicine (and I'm acquainted with more DNPs than any of you, I'm absolutely certain, so my anecdotal evidence has greater power) and I don't know any physicians that have a problem with either group, or are interested in the alleged conflict. The only DNP feedback I have ever gotten from NPs, PAs or MDs/DOs is either something along the lines of "What's that?" or "Good for you." It is just such a non-issue.

In short, you are all making mountains out of molehills. I think you should get off the computer and go spy on your neighbor to make certain they have not broken any HOA rules, those are far more serious problems IMO. 😉

Best~

 

[JourneyAgent]

The self actualized adults in the group know that the uninformed opinions of those whom do not yet fully understand the culture of the professional world in which the rest of us really work are not worth taking to heart and we don't take offense to the bitter words and over dramatized blather that is so often seen in these threads. Once upon a time I used to get all "het up" about defending my profession and life's choices, but now I just scroll on by. I must admit a bit of chagrin to posts like those by dudestheman, so full of bravado, arrogance and inaccuracies. It can still be a bit embarrassing, but of course he doesn't speak for me or the APN profession and I trust everyone realizes that.

I'll finish my DNP in just a few months. I have worked very hard for it. I can't really estimate how many thousands of hours I have invested. I smile inwardly when I hear it referred to as "fluff." I don't get defensive on the point, because it just makes me aware that a person suggesting thus has no idea what they are talking about. The world is full of ignorance and I don't have the time nor the inclination to go about correcting all of it. I've loved the DNP experience and taken a lot away from it. My chair said something to me the other day about "saying goodbye to Duke" this year, and it made me a little sad to realize it will be over. I don't know what I'll do with my time! I have done nothing else but read, study, work, live and breathe this work for so long I'll be lost, lol.

Frankly, I am not the least bit interested in how other people perceive the DNP, I didn't earn it for (the collective) you, I earned it for the purpose of learning/knowing more than I did before. I have done something really extraordinary with my capstone project. I can't tell you about it because it is a public (a "goggleable",) performance improvement project that was implemented in this state and it would identify me, but I'm extremely proud of it. Patients have, and will continue, to benefit from my efforts. I'm pleased by that knowledge, and that's enough. I do not care a whit if the members of SDN respect or laugh at "Chilly" for the fact that I will have earned a DNP. I have quantitative data that demonstrates improved patient outcomes. The powers that be in this state were impressed enough to take it from county wide to state wide in less than 18 months. That along with the respect and support of people that I admire is what is important to me. Isn't that what should be important to all of you, regardless of your own credentials and educational background and goals?

Isn't all of this really a pointless argument? Are the people opposing you in your argument going to be convinced? I'm taking the time to type this not to convince the naysayers, but to reassure the hopeful lurking PA and NP students and those considering entering PA or NP school that they should not doubt their choice because of what they read on the internet. It is a great career. It isn't not the same as medicine, and if being a physician is what you want to do, I think you should pursue that. However, don't let negativity on the internet convince you that being a non-physician provider is some kind of second rate option and that you will be disrespected at the workplace and made to feel as small there as you might be here, lol. It simply doesn't happen.

Ask yourself, do you enjoy what you do? Do you feel fulfilled? Do you have regrets about your path, and if so can you redress them so that you do not? Are you living the life and lifestyle that you desire?

Do you feel it matters to the patients you work with, that you have a positive impact in those you treat? Enjoy the people you work with and have positive, collegial relationships? Have you set additional goals and enjoy working toward them?

IME, all of us work together to do our best for patients, and then go home to our families and the truly important issues in our lives!. The titles and the office stuff is just what we do during the day; it isn't who we are, it doesn't define us. I don't know anyone who gets as passionate about any of these issues as SDN members! My friends and colleagues care a great deal more about the office basketball pool and the fact that their next door neighbor is flaunting the covenant association bylaws. That's a true story. One of them is obsessed with HOA issues, lol. All of this is manufactured drama about the DNP and conflict between NPs and PAs seems IME to exist only in cyberspace. In the real world, everyone laughs at the notion of the idea of entertaining this sort of argument. I don't know any PAs who dislike NPs or vice versa, I don't know any DNPs who want to take over medicine (and I'm acquainted with more DNPs than any of you, I'm absolutely certain, so my anecdotal evidence has greater power) and I don't know any physicians that have a problem with either group, or are interested in the alleged conflict. The only DNP feedback I have ever gotten from NPs, PAs or MDs/DOs is either something along the lines of "What's that?" or "Good for you." It is just such a non-issue.

In short, you are all making mountains out of molehills. I think you should get off the computer and go spy on your neighbor to make certain they have not broken any HOA rules, those are far more serious problems IMO. 😉

Best~

Of course you're interested in the perception of the degree, hence the lobbying and the research directed at outcome parity--if I take your implications correctly.

Of course you should be proud of yourself for working really hard and achieving the pinnacle of your profession.

Of course once doc's are established and making money--many of them off of you...for now--they don't see the problem with a Balkanized labor force competing for the same jobs.

Of course anyone interested in these careers should derive their satisfaction internally.

Still...what exists now...will not always. There's not an unlimited amount of resources to go around. Just because the patient demand is there doesn't mean the economics of employment will be.

It's very possible that we could see a time of direct competition for provider roles in the near future. So that those of us laying out the largest bets with worst foreseeable return since the middle of the last century on our investment have every right, every correct impulse, every reason to be concerned.

I'm congratulatory of your efforts and accomplishments but am not buying the sheep's clothing routine. You're starting to believe the internal groupthink of your professional bodies is the real world as you call it. Well...we're all living in very separate, very real worlds. And the style of the NP body politic does not have sole dominion on what constitutes that reality.