PAs/NPs attempting to "cancel culture" the AMA

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Chibucks15 said:
Yes I am as well. But framing it as “scope creep” instead of “patient safety” is allowing for the messaging to get off target.
Things will swing back the other way it’s all
Cyclical
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It's cyclical, that's true. But what causes that pendulum to swing back to sanity? Patient harm.

If we do nothing, then enough patients will die and the problem will "solve itself", with mid-levels no longer being seen as equivalent. However, knowing this will happen, and that patients will suffer for it, aren't we obliged to try and prevent it?
 
IsleyOfTheNorth said:
It's cyclical, that's true. But what causes that pendulum to swing back to sanity? Patient harm.

If we do nothing, then enough patients will die and the problem will "solve itself", with mid-levels no longer being seen as equivalent. However, knowing this will happen, and that patients will suffer for it, aren't we obliged to try and prevent it?
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Consider getting a JD and being the change you want to see in the world
 
Y'all my attending today randomly goes "so I'm going to give you some advice, not related to this specialty....don't ever be dependent on midlevels, you're just so much smarter than them at the end of the day". She's like we keep giving them an inch and they take a mile. It was lowkey super refreshing to hear from a doc, the group keeps hiring midlevels and she said she's against the number of midlevels they are hiring. Was just super interesting to hear finally-- she wasn't bashing them, she agreed they have their place but she was basically like they don't know a lot of stuff lol.
 
fldoctorgirl said:
Y'all my attending today randomly goes "so I'm going to give you some advice, not related to this specialty....don't ever be dependent on midlevels, you're just so much smarter than them at the end of the day". She's like we keep giving them an inch and they take a mile. It was lowkey super refreshing to hear from a doc, the group keeps hiring midlevels and she said she's against the number of midlevels they are hiring. Was just super interesting to hear finally-- she wasn't bashing them, she agreed they have their place but she was basically like they don't know a lot of stuff lol.
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Two of the local practices have to keep firing them or having them quit because they're either incompetent or can't handle a workload that is already almost half of what a physician would see
 
Which part of the AMA cheers/jeers rollercoaster on we on now?
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Matthew9Thirtyfive said:
Betting it skews heavily toward anti.
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SurfingDoctor said:
Someone needs to do a study how many pro- and anti-AMA posts there are on this forum. I would like to know the numbers.
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More anti AMA than r/Residency and much less than Facebook. I guess that also tells a little about who is using those... hint: much more nurses on Facebook haha
 
Eye-eye said:
Umm... what? What field are you looking into, where salaries have actually been trending up over time?
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In almost every MGMA released data set...almost every specialty all over the country the averages have been going up? Why is this such a revelation what data have you looked at?
 
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Chibucks15 said:
In almost every MGMA released data set...almost every specialty all over the country the averages have been going up? Why is this such a revelation what data have you looked at?
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While this is true, they have not kept up with inflation, like not even close. It's extremely unfortunate, but the golden age of medicine is long over. I believe we've skipped the silver age and we are now in the bronze age, heading precipitously into whatever is two steps below bronze (dirt?). I was definitely born several decades too late. Really not looking forward to telling my kids that medicine is no longer worth it, and I'm a "medicine is my calling" person.
 
slowthai said:
While this is true, they have not kept up with inflation, like not even close. It's extremely unfortunate, but the golden age of medicine is long over. I believe we've skipped the silver age and we are now in the bronze age, heading precipitously into whatever is two steps below bronze (dirt?). I was definitely born several decades too late. Really not looking forward to telling my kids that medicine is no longer worth it, and I'm a "medicine is my calling" person.
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Eh now that depends where you live. Where I’m at in the Midwest it’s still pretty darn golden. Like new grads able to pay off private DO school tuition in 3 years good.

If you feel the need to only live in the big coastal cities you better not have debt or work like mad. In those situations the finances don’t work as well but it’s still the most stable job in the world and a heck of a lot more respected than almost anything else
 
I mean, I wasn't saying it's not a very well paying profession; it is. But the trend does not appear to be going up. Reimbursements for just about everything are slowly being cut, is my understanding. Increases in reimbursement, while they do occur, appear rare and do not balance out cuts. Perhaps the survey data indicates an increase, but there are a lot of factors that go into who responds to such surveys, so I always take those with a large grain of salt. Maybe this is more noticeable in the field I'm going into than others (ophtho), but I don't think it's exclusive to us. There's no way cataracts are the only thing that pay about 1/10 of what they used to.

Again, not saying it's a bad deal right now, but the trend is pushing toward Medicine being a horrible career choice, financially, in another 25 or 50 years, if not sooner.
 
Eye-eye said:
I mean, I wasn't saying it's not a very well paying profession; it is. But the trend does not appear to be going up. Reimbursements for just about everything are slowly being cut, is my understanding. Increases in reimbursement, while they do occur, appear rare and do not balance out cuts. Perhaps the survey data indicates an increase, but there are a lot of factors that go into who responds to such surveys, so I always take those with a large grain of salt. Maybe this is more noticeable in the field I'm going into than others (ophtho), but I don't think it's exclusive to us. There's no way cataracts are the only thing that pay about 1/10 of what they used to.

Again, not saying it's a bad deal right now, but the trend is pushing toward Medicine being a horrible career choice, financially, in another 25 or 50 years, if not sooner.
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MGMA isn’t a survey like Medscape. It’s legit data. I see your point but the trend is still there for most specialties. Surgical specialties are gonna start seeing a cut in order to adequately pay for some of the more cerebral specialties. The new payment structure is geared towards actually paying for complex medical care and the time spent on the patient, rather than just procedures. I know I’m gonna get skewered on this surgery-heavy sub but the payment structure was wayyyyy too heavily shifted to procedurists. They should make more but the split was too big, and is getting fixed accordingly.

All this was explained to me by one of my attendings. It’s obviously framed as a large positive for me (non surgical), but definitely can make a large difference
 
Chibucks15 said:
MGMA isn’t a survey like Medscape. It’s legit data. I see your point but the trend is still there for most specialties. Surgical specialties are gonna start seeing a cut in order to adequately pay for some of the more cerebral specialties. The new payment structure is geared towards actually paying for complex medical care and the time spent on the patient, rather than just procedures. I know I’m gonna get skewered on this surgery-heavy sub but the payment structure was wayyyyy too heavily shifted to procedurists. They should make more but the split was too big, and is getting fixed accordingly.

All this was explained to me by one of my attendings. It’s obviously framed as a large positive for me (non surgical), but definitely can make a large difference
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Yup and my understanding is that there isnt ever straight cuts in reimbursement from Medicare. The cuts seen (e.g. colonoscopies, cataract surgery, whatever) are placed towards reimbursing something else at a higher rate (e.g. wellness visits, whatever)
 
Chibucks15 said:
Eh now that depends where you live. Where I’m at in the Midwest it’s still pretty darn golden. Like new grads able to pay off private DO school tuition in 3 years good.

If you feel the need to only live in the big coastal cities you better not have debt or work like mad. In those situations the finances don’t work as well but it’s still the most stable job in the world and a heck of a lot more respected than almost anything else
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It’s pretty golden here in coastal CA too if you work for yourself.

Part of the reason docs‘ salaries are lower than what people want is so many are now employees of the hospital/group instead of owners/partners. That, and these days everyone complains. Me included. Maybe we’re working harder for the same pay, but we still do well. I don’t have to check my bank account when I go grocery shopping. When my wife wants to go shopping at Lululemon and spend hundreds on a pair of pants/jacket, I can say “if it makes you happy sweetie.” (While that did happen last week, she thankfully isn’t a shopaholic).
 
A-Fib said:
View attachment 322770View attachment 322770I can’t stop shaking my head...
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I have some memes too:
If students began teaching other students: "Brain like a teacher to the infinity power, heart of a struggling student"
If airline hostesses became pilot: "Brain like a pilot, complimentary service, while plane is on autopilot, of an airline hostess"
If waiters became chef: "Cooks like gordon ramsey but also brings your drinks like a waiter"
If grass became tree: "shade like a tree, but nymph height of a grass blade"
If electrician became an engineering profession: "sophisticated bow tie academician, but rugged and authentic like an electrician"
If a potato was a potato: "life would actually be simple and less confusing"

Respect nurses and appreciate their efforts but I can't help but think we as physicians are and continue to be so under-appreciated. Practicing at the top of their license used to be a phrase to respect roles...nurse lobby became sneaky and raised the top roof of what that licence covers. I don't really expect ppl who take a shortcut to education to really think about lawsuits if they can get a higher pay...and behind the line there are many more to replace them after those who got burned leave. Chances of that happening anyways is pretty slim (i'd actually like to see data where NPs/PAs try to recede after repercussions). Also with more physicians becoming employees, more and more institutes impose rules on how many NPs/PAs a physician must supervise. On the second thought, a lot of NPs don't even really ask a physician on management/diagnosis.
 
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RangerBob said:
When my wife wants to go shopping at Lululemon and spend hundreds on a pair of pants/jacket, I can say “if it makes you happy sweetie.”).
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Can't wait to be at that stage in our life...

At the moment we’re at the “that **** better be a gift or your ass better of stole them” stage...
 
Look folks, just my 2 cents. And if you want to flame me fine. I am an RN applying for med school. There is is reason I am not going to NP school, even though I have known some excellent NPs. I don't love the training programs and I don't welcome the limits on my scope of practice. My best friend is a hospitalist and she and I have compared bad nurse/bad doc stories for years to our mutual benefit.

Many of you have met clueless, lazy, or shallow nurses. So have I. So have most nurses. I guarantee you have also met brilliant (really), committed caring nurses, whether or not you know it. Most nurses have met arrogant, irresponsible, insulting docs, some of whom care more about making sure that the nurse knows she is beneath them than their patient's safety (I could absolutely tell you stories). All of this hurts patients.

Some of you have asked how docs are (apparently) losing the messaging/ public opinion battle. This is part of how:

Feel free to say MD/DO have more training than mid-levels or nurses, have better scientific preparation, are rigorously evaluated and tested, demonstrate their commitment by their long hours of training, face financial pressures due to malpractice exposure and insurance etc. Feel free to cite research about referrals, patient outcomes etc. All of this is true.

Put please, please, do not say that doctors are smarter than nurses and midlevels. Even if this is true on average (and I have no data here), most people will read it (and many will mean it) as a doctor is automatically smarter than a nurse, and that is demonstrably not true (not how statistics work). Do not conflate intelligence and training. And just as it is ridiculous for an RN to say he or she could do a resident's job, don't imply you could do theirs. The roles overlap but are substantially different. Don't say they care about their patients less because they chose not to put themselves (or their families) through the ringer that is med school and residency. They don't.

Here's the dirty little secret. Every nurse, and most members of the public have met a doc who appears to be an arrogant a$$. They may have met crummy nurses too, but they play into a different stereotype. If you talk in the above ways, it doesn't matter what you say or how well meaning you are. You will already have lost the argument, and the public's good will.
 
atnightingale said:
just as it is ridiculous for an RN to say he or she could do a resident's job, don't imply you could do theirs. The roles overlap but are substantially different.
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Now, I actually agree with your statements that it is not fair (and is even harmful to the cause) to suggest that doctors are smarter than nurses, regardless of whether or not it is true on average. However, I do not think you can reasonably draw the conclusion that a MD/DO cannot do the job of a RN. I have the utmost respect for nurses, have several in my family (including my mother and have no physicians in my family), and worked as a nursing assistant for three years as an undergrad so I have plenty of exposure to the field outside of a physician role and I think your argument needs a slight adjustment.

While a nurse is certainly better at completing the job of a nurse than a physician is, there is nothing about a nurse's job that a physician would be unable to do (but the reverse is not true). It is not unreasonable to say that a physician can do the job of a nurse. It is unreasonable to say that a physician can do the job of a nurse better or even at the same competency as a well-trained nurse.

They are different skill sets which are reinforced by different experiences from the day-to-day and most physicians I have met readily acknowledge this fact and may rely on the skills of a nurse over their own. For example, I've met several physicians who would rather give the job of an IV placement to the nurse but this is because the nurse is more experienced and skillful in this regard--not because the physician is not trained or able to do it themselves.

Also, the argument here in this thread is not against the bread and butter RN at all. It's about a population of NP's and PA's wanting a higher level of autonomy--nothing more.
 
Deltasidearm said:
Now, I actually agree with your statements that it is not fair (and is even harmful to the cause) to suggest that doctors are smarter than nurses, regardless of whether or not it is true on average. However, I do not think you can reasonably draw the conclusion that a MD/DO cannot do the job of a RN. I have the utmost respect for nurses, have several in my family (including my mother and have no physicians in my family), and worked as a nursing assistant for three years as an undergrad so I have plenty of exposure to the field outside of a physician role and I think your argument needs a slight adjustment.

While a nurse is certainly better at completing the job of a nurse than a physician is, there is nothing about a nurse's job that a physician would be unable to do (but the reverse is not true). It is not unreasonable to say that a physician can do the job of a nurse. It is unreasonable to say that a physician can do the job of a nurse better or even at the same competency as a well-trained nurse.
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Your response if fair, but I would like to clarify in return. I understand that this thread is not intended to be against the bread and butter RN. However, as an RN who WANTED to be sympathetic to the argument and the thread and who agrees with many of the points, I saw a lot of creep of the language I have heard about RNs into language about NPs and PAs (especially NPs). That language and argument is equally damaging in that context. Many people commented about the power of lobbies and whose voices are listened to or heard. It can be valuable to have a reality and tone check, and that is what I was attempting to provide.

Now regarding your other quibble, which we both realize is outside the scope of the larger discussion:

Can a physician do the job of a nurse?? If you worked as a nursing assistant, you are probably more prepared than most, because, at minimum you have skill at moving and caring for people most docs don't. I teach CNA students, so I know what it takes to learn it. It is not my argument that a physician could not do the job of a nurse with the appropriate supplemental training and experience. (Though frankly the same is true of nurses becoming doctors which is the point of nurses going to med school). It is not my argument that there are no physicians trained and experienced in many of the things nurses may excel in, but the majority are not and are not expected to be. I have been in many situations where I have been working one on one with physicians on a typically nursing problem and I am asked to lead the encounter because it is more clearly in my training and experience, not theirs. And I am not talking about IVs (which, frankly, you are probably as good at as I am).

Some actual examples. How many physicians (think percentages here, from medical training, not I know one guy who.....) do you know who could do a really good job of teaching a family to care for a bedbound patient, including a full suite of non pharmacological pain relief, because that person wants to be alert? To be good at teaching that, you have to have done it, and have to have done it a lot. Most physicians don't. Could they learn, sure, and so can the lay family member, but not in a day or 2.

How many typical MDs (outside of urology) are experienced with difficult catheterizations? Can they learn, sure. How long would it take?

How many physicians (outside of vascular surgeons and some ID docs) are truly skilled in wound care, including selecting the appropriate dressings for a given situation, applying and managing wound vac dressings? I have spent years on this and it took a long time to get good at it. It took a while to get minimally competent at it. Can you learn it? Sure. I could teach you. How much time can you give me?

Other nurses in other specialties will have different examples than I have. I couldn't do their jobs without a lot of time in, even though we start off with more similar training.

And then there is simply the skill that any professional develops in managing the workflow of their job. It takes a while to get competent (often months not days for competence, years for excellence). Meds at the right time, IVs, transfering, toileting, teaching, etc. Is is learnable? Sure, but how long would it take to get to do it at a level that patients won't suffer?

No one honest says that doctors can't learn to be nurses, or visa versa. No one honest says that some doctors or nurses shouldn't, because frankly, they would suck at it. The difference of opinion is in what it takes to learn those skills and what expertise represents. You know what that looks like for docs. Frankly, you don't for nurses. There is no reason you should. The only error is in assuming you know, when you don't.
 
atnightingale said:
Your response if fair, but I would like to clarify in return. I understand that this thread is not intended to be against the bread and butter RN. However, as an RN who WANTED to be sympathetic to the argument and the thread and who agrees with many of the points, I saw a lot of creep of the language I have heard about RNs into language about NPs and PAs (especially NPs). That language and argument is equally damaging in that context. Many people commented about the power of lobbies and whose voices are listened to or heard. It can be valuable to have a reality and tone check, and that is what I was attempting to provide.
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I will just take your word on this. It's been a while since I've read every message on this thread and, while I didn't get this feeling, you are likely more sensitive to it since you are a RN yourself. I also believe that perception matters a whole lot more than reality because if you perceived it this way then it is real to you and may come across that way to others, too. So there's a lesson there to be learned about how to communicate this issue for broader appeal and less misinterpretation.

atnightingale said:
How many physicians do you know who could do a really good job of teaching a family to care for a bedbound patient, including a full suite of non pharmacological pain relief, because that person wants to be alert? To be good at teaching that, you have to have done it

How many typical MDs (outside of urology) are experienced with difficult catheterizations?

How many physicians (outside of vascular surgeons and some ID docs) are truly skilled in wound care, including selecting the appropriate dressings for a given situation, applying and managing wound vac dressings?

Other nurses in other specialties will have different examples than I have. I couldn't do their jobs without a lot of time in, even though we start off with more similar training.

And then there is simply the skill that any professional develops in managing the workflow of their job. It takes a while to get competent (often months not days for competence, years for excellence). Meds at the right time, IVs, transfering, toileting, teaching, etc. Is is learnable? Sure, but how long would it take to get to do it at a level that patients won't suffer?

No one honest says that doctors can't learn to be nurses, or visa versa. No one honest says that some doctors or nurses shouldn't, because frankly, they would suck at it. The difference of opinion is in what it takes to learn those skills and what expertise represents. You know what that looks like for docs. Frankly, you don't for nurses. There is no reason you should. The only error is in assuming you know, when you don't.
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You have done a good job articulating skills that most physicians would readily leave to more competent nurses but, at the end of the day, if no nurse is available then a doctor could still do all of these things. The result may not be as smooth as if a well-trained nurse had done it but the doctor's training and experience still covers these skills even if they are seldom practiced.

atnightingale said:
It is not my argument that there are no physicians trained and experienced in many of the things nurses may excel in, but the majority are not and are not expected to be. I have been in many situations where I have been working one on one with physicians on a typically nursing problem and I am asked to lead the encounter because it is more clearly in my training and experience, not theirs.
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You are asked to lead the encounter because you are the best one suited for the task and your skills and experience gained from practicing your nursing skills is valued. Make no mistake about that. You and your skills are valued. The physician steps aside not because they aren't qualified and couldn't do the work but because you and your experience makes you the better team member to care for the patient in that manner.

This argument actually mirrors the issue in this thread. Much like a physician should recognize the skill and experience deficit and step aside for RN's when it comes to nursing activities, midlevel practitioners should recognize their training still falls short of a physician's and should not try to practice in the same role as a physician. Why? Because it will harm the outcome of the patient, just like if a physician gave subpar mobility and homecare instructions or caused a patient fall due to an improper patient transfer that a nurse would have avoided.
 
Deltasidearm said:
I will just take your word on this. It's been a while since I've read every message on this thread and, while I didn't get this feeling, you are likely more sensitive to it since you are a RN yourself. I also believe that perception matters a whole lot more than reality because if you perceived it this way then it is real to you and may come across that way to others, too. So there's a lesson there to be learned about how to communicate this issue for broader appeal and less misinterpretation.

You have done a good job articulating skills that most physicians would readily leave to more competent nurses but, at the end of the day, if no nurse is available then a doctor could still do all of these things. The result may not be as smooth as if a well-trained nurse had done it but the doctor's training and experience still covers these skills even if they are seldom practiced.

You are asked to lead the encounter because you are the best one suited for the task and your skills and experience gained from practicing your nursing skills is valued. Make no mistake about that. You and your skills are valued. The physician steps aside not because they aren't qualified and couldn't do the work but because you and your experience makes you the better team member to care for the patient in that manner.
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We largely agree here. Thank you for the discussion. I suppose I will reserve judgement on whether all of my skills are actually taught in medical education until I have completed both. However I will note that in a number of situations my physician colleagues have told me that they actually did not know how to do what we discussed, not that I was more experienced at it, but that isn't really a point we need to argue about. It gets into meaningless quibbling and solves nothing.

The larger point is the one we agree on. Providers at all levels working together SHOULD defer to the most experienced and skilled team member for that issue because we are all there for the patients. I am genuinely saddened to hear some of the stories about midlevels who think they know more than they do and behave arrogantly. That would concern me and helps no one. But responding to that lack of knowledge and respect with a similar lack of respect (not always for the training, but certainly for the person) will only compound the problem in interprofessional relationships and cruicially, in the court of public opinion.

EDIT: I walked away from this but came back because I am dissatisfied with my above response.

I asked myself, if I picked 2 roles where I have substantial training and skill overlap, say social work and PT, would I say I could do their job, just not as well? Even though I have worked closely with them and performed some of the same tasks? I wouldn't. It would be ignorant and arrogant for me to make that claim. What about doctors? Honestly, if a doctor made that claim, I would also judge it ignorant and arrogant, even though some specialties (Physical medicine, psychiatry) would have more overlap than others. Would you make that claim, or is it just nursing you feel good about saying that about? Why is that?

Crucially, here is why this matters. Many people object that NPs in particular are trying to shortcut medical education and claim similar stature and skill as MDs. I want to emphasize, I am really sympathetic with this argument. NP would be a much shorter road for me, but I am not doing it because I am not comfortable with the level of training I would have.

Many people who have posted here object to the characterization that NPs have a leg up because they are RNs and therefore need less training than other to function safely independently. Again. I don't really disagree. This argument thinks of nursing as "medicine light" or beginning medicine, and honestly, it isn't. That point is important to your argument. You don't want NPs to lean on "medicine light." But you have to be really careful looking at roles and training which are not medicine and assuming that just because you work with them, like them, respect them, or are related to them, and went to school a lot longer than them that you even know the scope of their training or jobs. Folks on this thread are complaining that "people" including the public, nurses, NPs and PAs don't know or acknowledge the scope of their extensive training in medicine. And again, you are right. But you get nowhere if you assume that you have some superset of the training of all healthcare roles. There isn't time nor reason for you to do so, even in 7-10 years. Honestly that includes nursing. Your argument against NP independant practice is stronger, not weaker when you acknowledge this. Nursing isn't medicine light where RNs get advanced placement in medicine. It is a different role.

Case in point. You claimed above that you had been taught all the things I mentioned. I buy that is at least a statement in good faith right up until the wound vac. Have you ever been trained in changing such a dressing? Do you even know the procedure or how it can go wrong? Wound care in particular is an area where the nurses typically write the suggested order and send to the MD for signiature, because it really isn't in medical training beyond a basic level. I have been told this by MANY MDs. The true specialists here (not me) are WOCNs or Wound Ostomy and Continence nurse, who write would care orders after MD referrals.

My dad has a PhD in Political Science, particularly polling behavior. Now I have had a lot more statistical training than most nurses or doctors (MPHs, PhD, and bioinformaticists being the exceptions). He spent most of professional life designing and analyzing surveys and survey data. Including in health research. He knows way more than I do. But in his research capacity, he frequently encountered MDs who thought they knew more, and were real barriers to health research. They knew only their own training which, while extensive, lacked the specific focus and depth of his. They looked like idiots to every research trained person in the room.

No one who cares about patient safety should want to make that mistake. If detracts from your credibility.
 
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atnightingale said:
We largely agree here. Thank you for the discussion. I suppose I will reserve judgement on whether all of my skills are actually taught in medical education until I have completed both. However I will note that in a number of situations my physician colleagues have told me that they actually did not know how to do what we discussed, not that I was more experienced at it, but that isn't really a point we need to argue about. It gets into meaningless quibbling and solves nothing.

The larger point is the one we agree on. Providers at all levels working together SHOULD defer to the most experienced and skilled team member for that issue because we are all there for the patients. I am genuinely saddened to hear some of the stories about midlevels who think they know more than they do and behave arrogantly. That would concern me and helps no one. But responding to that lack of knowledge and respect with a similar lack of respect (not always for the training, but certainly for the person) will only compound the problem in interprofessional relationships and cruicially, in the court of public opinion.

EDIT: I walked away from this but came back because I am dissatisfied with my above response.

I asked myself, if I picked 2 roles where I have substantial training and skill overlap, say social work and PT, would I say I could do their job, just not as well? Even though I have worked closely with them and performed some of the same tasks? I wouldn't. It would be ignorant and arrogant for me to make that claim. What about doctors? Honestly, if a doctor made that claim, I would also judge it ignorant and arrogant, even though some specialties (Physical medicine, psychiatry) would have more overlap than others. Would you make that claim, or is it just nursing you feel good about saying that about? Why is that?

Crucially, here is why this matters. Many people object that NPs in particular are trying to shortcut medical education and claim similar stature and skill as MDs. I want to emphasize, I am really sympathetic with this argument. NP would be a much shorter road for me, but I am not doing it because I am not comfortable with the level of training I would have.

Many people who have posted here object to the characterization that NPs have a leg up because they are RNs and therefore need less training than other to function safely independently. Again. I don't really disagree. This argument thinks of nursing as "medicine light" or beginning medicine, and honestly, it isn't. That point is important to your argument. You don't want NPs to lean on "medicine light." But you have to be really careful looking at roles and training which are not medicine and assuming that just because you work with them, like them, respect them, or are related to them, and went to school a lot longer than them that you even know the scope of their training or jobs. Folks on this thread are complaining that "people" including the public, nurses, NPs and PAs don't know or acknowledge the scope of their extensive training in medicine. And again, you are right. But you get nowhere if you assume that you have some superset of the training of all healthcare roles. There isn't time nor reason for you to do so, even in 7-10 years. Honestly that includes nursing. Your argument against NP independant practice is stronger, not weaker when you acknowledge this. Nursing isn't medicine light where RNs get advanced placement in medicine. It is a different role.

Case in point. You claimed above that you had been taught all the things I mentioned. I buy that is at least a statement in good faith right up until the wound vac. Have you ever been trained in changing such a dressing? Do you even know the procedure or how it can go wrong? Wound care in particular is an area where the nurses typically write the suggested order and send to the MD for signiature, because it really isn't in medical training beyond a basic level. I have been told this by MANY MDs. The true specialists here (not me) are WOCNs or Wound Ostomy and Continence nurse, who write would care orders after MD referrals.

My dad has a PhD in Political Science, particularly polling behavior. Now I have had a lot more statistical training than most nurses or doctors (MPHs, PhD, and bioinformaticists being the exceptions). He spent most of professional life designing and analyzing surveys and survey data. Including in health research. He knows way more than I do. But in his research capacity, he frequently encountered MDs who thought they knew more, and were real barriers to health research. They knew only their own training which, while extensive, lacked the specific focus and depth of his. They looked like idiots to every research trained person in the room.

No one who cares about patient safety should want to make that mistake. If detracts from your credibility.
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I agree they are very different roles. I was an RN before going to medical school. It didn’t help me much to learn to be a physician, nor does medical school teach you to be a nurse or any other role. And I agree that this actually strengthens the argument against NPs trying to claim equivalency. Now as I’m interviewing for residency, I also find it interesting that when I ask about if the hospital has good and adequate staffing for all health care roles, everyone assumes I’m trying to ask about nursing scut work. A: I’m actually not using that as a workaround for asking about scut, but rather trying to see what patient care is like at that hospital. B: we can’t fill the role of a nurse C: there are several other services we couldn’t fill either like pharmacy, PT, Speech therapy, Cardiovascular imaging tech, etc. D: in regard to “scutwork” it’s not that we as a human are above doing other tasks, it’s that we have another different role to fill.
 
atnightingale said:
Feel free to say MD/DO have more training than mid-levels or nurses, have better scientific preparation, are rigorously evaluated and tested, demonstrate their commitment by their long hours of training, face financial pressures due to malpractice exposure and insurance etc. Feel free to cite research about referrals, patient outcomes etc. All of this is true.
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It's unfortunate that physicians (and likewise, medical students like me) actually can't speak up about this in fear of retribution from our employers.
 
I agree that we should focus on the actual training differences; realistically, there are obviously many nurses who could go through medical school if they wanted to, but if they didn't, they didn't. That includes NPs.

However, I think it's a shame that because we don't want to sound condescending we can't discuss the fact that the academic standards required to even start medical school are far higher than those required to start nursing school, and maybe the fact that you have two unequal inputs going in means you'd have unequal outputs. I'd prefer to see an average physician over Albert Einstein NP, because again the training just isn't there; but it's not like your average NP is "smarter" than your average physician, as well all know the standards are far lower, and that makes it even more ridiculous that the actual training is such a joke.

Again, not a point I'd make for my side of the argument, but something I hope everyone can agree with nonetheless.

Also, @atnightingale, would you agree that a higher percentage of physicians could get through nursing school to become competent nurses than vice versa?
 
jambro said:
I'd prefer to see an average physician over Albert Einstein NP, because again the training just isn't there
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This. It doesn’t matter how smart you are. If you haven’t had the education and training, you just don’t know what you don’t know.
 
jambro said:
I agree that we should focus on the actual training differences; realistically, there are obviously many nurses who could go through medical school if they wanted to, but if they didn't, they didn't. That includes NPs.

However, I think it's a shame that because we don't want to sound condescending we can't discuss the fact that the academic standards required to even start medical school are far higher than those required to start nursing school, and maybe the fact that you have two unequal inputs going in means you'd have unequal outputs. I'd prefer to see an average physician over Albert Einstein NP, because again the training just isn't there; but it's not like your average NP is "smarter" than your average physician, as well all know the standards are far lower, and that makes it even more ridiculous that the actual training is such a joke.

Again, not a point I'd make for my side of the argument, but something I hope everyone can agree with nonetheless.

Also, @atnightingale, would you agree that a higher percentage of physicians could get through nursing school to become competent nurses than vice versa?
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Intellectually, yes, a high percentage of MDs could certainly get through nursing school without difficulty. I dont think that was ever at issue. However, and this is critical, a lot might make crummy nurses for reasons OTHER than their intelligence, and because of that might not have done well in nursing school. You really have to want to be there, doing that job, or patients suffer. I really wanted to be the person there at 2 am when someone had to go to the bathroom. Those moments matter and a lot of concerns about pain, fear of death etc come out then. It wasnt scut work, it was the calling. Same with bathing. My desires for the role I want have changed, but I chose my role for a reason and don't regret it.

I don't know that majority of nurses would make it in med school. I do know that the majority wouldn't want to. I know plenty of folks who had the grades and smarts for both and chose nursing.

I do think that it is unfortunate that the prereqs diverge as early as they do because they force unnecessary choices. Case in point. I had to take a year of chemistry for my nursing school. But they didn't want (and mostly wouldn't take) majors level Gen Chem. I, on the other hand wasnt interested in wasting a year of my life for the sequence they did want. I took Gen chem ( and was a top student) with the majors and premed , and with my professor identified the one term of the other sequence that WASN'T duplicated in Gen Chem and took that term in addition to Gen Chem (basic orgo and biochem). It was a stupid way to go about it, but it was the only way not to stab my pen into my eye with boredom. (Also, if I had taken that class all year I wouldn't have done well because I showed up every monday at 9 Am after working a night shift) and had a really hard time staying awake.)
 
atnightingale said:
Intellectually, yes, a high percentage of MDs could certainly get through nursing school without difficulty. I dont think that was ever at issue. However, and this is critical, a lot might make crummy nurses for reasons OTHER than their intelligence, and because of that might not have done well in nursing school. You really have to want to be there, doing that job, or patients suffer. I really wanted to be the person there at 2 am when someone had to go to the bathroom. Those moments matter and a lot of concerns about pain, fear of death etc come out then. It wasnt scut work, it was the calling. Same with bathing. My desires for the role I want have changed, but I chose my role for a reason and don't regret it.

I don't know that majority of nurses would make it in med school. I do know that the majority wouldn't want to. I know plenty of folks who had the grades and smarts for both and chose nursing.

I do think that it is unfortunate that the prereqs diverge as early as they do because they force unnecessary choices. Case in point. I had to take a year of chemistry for my nursing school. But they didn't want (and mostly wouldn't take) majors level Gen Chem. I, on the other hand wasnt interested in wasting a year of my life for the sequence they did want. I took Gen chem ( and was a top student) with the majors and premed , and with my professor identified the one term of the other sequence that WASN'T duplicated in Gen Chem and took that term in addition to Gen Chem (basic orgo and biochem). It was a stupid way to go about it, but it was the only way not to stab my pen into my eye with boredom. (Also, if I had taken that class all year I wouldn't have done well because I showed up every monday at 9 Am after working a night shift) and had a really hard time staying awake.)
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and I guess the is is the whole point of the thread and similar threads. If you want to be a physician then go to med school. If you want to be a nurse then go to nursing school. If I wanted to become a nurse after getting an MD/DO I would have to go to nursing school. There isn’t a shortcut! And there shouldn’t be the other way around.
 
At this point, arguing over "intelligence vs. smart" is getting into semantics. Which doesn't do anything but piss both sides off and further divide physicians and nurses, when we need to be allies. The nursing pre-reqs get people prepped for nursing school, so that future nurses can practice the art of NURSING. Nursing has a huge emphasis on being more personal with patients: making sure they meet individual goals, healing better, and so on. I'm not saying physicians DON'T do this (one semester in and we've had a ton of lectures on patient safety, patient autonomy, and mitigating/avoiding potential unwanted adverse events during treatment.) However, nursing takes a bigger approach on the individual.

The issue, beyond who has more pathophys/anatomy/pharmacology/biochem knowledge (physicians, obviously), is that NP's will always be trained to practice through the NURSING model of healthcare. This isn't an issue until you push them into independent roles, sans oversight from a physician. I read "Patients at Risk" over Thanksgiving. It provides so much more input that I won't get into because the authors do it so damn well; however, they explain how the nursing model of healthcare and the training it provides does NOT adequately prepare NP's to practice without physician oversight.

I am not trained to be a nurse. I would look stupid compared to an RN/NP if I tried to do their job just because I'm going to medical school. Likewise, an NP who is NOT trained as a physician will be way less prepared to practice like a physician. You can have 30 years of experience working with a physician; but, unless you have the necessary background information and training medical school provides, the on-the-job training won't do you much good. An NP stating "I'm essentially a physician!" when they've worked with doctors in the wards is like saying "I'm just like a nurse!" because I followed NP's and CRNAs around during my clinical rotations. It's an insult to both fields to be honest.

Which brings me to my last point - why are people ashamed to be floor nurses? I'm genuinely curious because EVERY nursing student/floor nurse I've talked to has always told me they've "been pushed to get a master's/DNP so they can further their education." The conversations have always led to "we/the administrators/the educators think we can be more than just a floor nurse/RN." A floor nurse is arguably one of the most important jobs when treating patients. I've always had deep respect for them because they are the eyes and ears of the wards. If the MD/DO tells them to do something a patient doesn't like? The nurse gets to be chewed out/hurt physically mentally (or heaven forbid, physically) by the patient. They are literally needed to keep hospitals running. I don't hate nurses whatsoever, and people need to realize that when physicians say "NP's should not practice independently."
 
Cornfed101 said:
and I guess the is is the whole point of the thread and similar threads. If you want to be a physician then go to med school. If you want to be a nurse then go to nursing school. If I wanted to become a nurse after getting an MD/DO I would have to go to nursing school. There isn’t a shortcut! And there shouldn’t be the other way around.
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Physicians cannot do the job of a RN. I’ve never met a physician who could prone a morbidly obese patient on CVVH while administering 9 IV infusions through limited ports with most of them incompatible with each other, while ensuring the patient on paralytics remains intubated during all phases of movement and the pressor lines never kink. You provide all this when at the same time thinking about what your other patient needs after you finish the prone. If you had the experience and training to do these things, you’d be a nurse. The hubris of medical students on full display here.
 
FutureSurgical said:
Which brings me to my last point - why are people ashamed to be floor nurses? I'm genuinely curious because EVERY nursing student/floor nurse I've talked to has always told me they've "been pushed to get a master's/DNP so they can further their education." The conversations have always led to "we/the administrators/the educators think we can be more than just a floor nurse/RN." A floor nurse is arguably one of the most important jobs when treating patients. I've always had deep respect for them because they are the eyes and ears of the wards.
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You've hit on an excellent point, and the truth is... Because bedside nursing is a dying field. Many nurse jobs require nurses to participate in awful patient care conditions, and the amount of stress in a nursing job=/=more money. Nurses realize there are greener pastures and simply head for them. There are so many options for nurses to leave those tough situations (Case management, insurance, outpatient, home health, CRNA, NP, clinical specialist, management, academics) that it really has to be your only love to stay at a certain bedside role.

And let's be clear: money plays a role. It absolutely does.

I've worked more hours with more stress than some of my CRNA friends and made a third the pay at that time, so why wouldn't a nurse go to CRNA or NP school?

And to be clear, I am not advocating for independent practice or whatever. I made the choice to attend MD school, so my opinion is obvious.

I feel that the best nurses to work with are the ones who love the role they have and don't have that "I'm really just a junior doctor in disguise" chip on their shoulder. They are golden, and you probably know the ones I'm talking about.
 
DrNotaDr said:
Physicians cannot do the job of a RN. I’ve never met a physician who could prone a morbidly obese patient on CVVH while administering 9 IV infusions through limited ports with most of them incompatible with each other, while ensuring the patient on paralytics remains intubated during all phases of movement and the pressor lines never kink. You provide all this when at the same time thinking about what your other patient needs after you finish the prone. If you had the experience and training to do these things, you’d be a nurse. The hubris of medical students on full display here.
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I'm a student physician and I can do all of those things, and I could train any one of my medical student classmates how to do them as well. (I've trained new grad nurses... I could train my classmates. Promise)

Hubris is imagining that programming a pump and doing a sheet-roll couldn't be taught to a group of intelligent humans. 🙄
 
Ganon said:
I'm a student physician and I can do all of those things, and I could train any one of my medical student classmates how to do them as well. (I've trained new grad nurses... I could train my classmates. Promise)

Hubris is imagining that programming a pump and doing a sheet-roll couldn't be taught to a group of intelligent humans. 🙄
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I think you don’t know what you don’t know. Have you ever done what I just described?

EDIT: you do know it takes 5 years of full time ICU RN nursing to be considered “competent” in the role.
 
Ganon said:
I have and do. ICU RN here.
I don't think YOU know what you don't know.

Last week I proned a patient with no roto-bed. Because I never skip arm day. 😏
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Which way to the gym? 😜

Although seriously, competence in critical care nursing does require about 5 years according to the AACN. If they had that much time working in the role of an ICU nurse than they would be an ICU nurse. Any less is getting substandard care, and I do recall you guys seem to have a problem with that.
 
DrNotaDr said:
Which way to the gym? 😜

Although seriously, competence in critical care nursing does require about 5 years according to the AACN. If they had that much time working in the role of an ICU nurse than they would be an ICU nurse. Any less is getting substandard care, and I do recall you guys seem to have a problem with that.
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I think most med students who have spent any time on the wards and most physicians would agree that a nurse with a few years of experience can be a huge asset (and I only say can because we’ve all met the nurse that’s been at it for 20 years and still sucks because it’s just a paycheck for them). I think it’s a little much to say that you couldn’t teach med students to do any of what you said. I get that you haven’t gone to medical school, but if we can learn what we learn in med school, we can learn that stuff. (And just to head it off, no I’m not saying nurses couldn’t learn medicine—there are prior nurses in my class and they are crushing it. Being a nurse instead of a physician doesn’t mean you’re less intelligent or couldn’t handle medical school in and of itself.)

I’m not a nurse, but I was a tech and a medic for a very long time and my wife has been a nurse for like 12 years and completely agrees.

That said, like I have said a number of times, that whole argument is pointless. Nurses have a role on the healthcare team because physicians can’t do everything, nor should they. Medicine is a team sport and works best when everyone is doing their job and has the patient at the center.
 
Matthew9Thirtyfive said:
I think most med students who have spent any time on the wards and most physicians would agree that a nurse with a few years of experience can be a huge asset (and I only say can because we’ve all met the nurse that’s been at it for 20 years and still sucks because it’s just a paycheck for them). I think it’s a little much to say that you couldn’t teach med students to do any of what you said. I get that you haven’t gone to medical school, but if we can learn what we learn in med school, we can learn that stuff. (And just to head it off, no I’m not saying nurses couldn’t learn medicine—there are prior nurses in my class and they are crushing it. Being a nurse instead of a physician doesn’t mean you’re less intelligent or couldn’t handle medical school in and of itself.)

I’m not a nurse, but I was a tech and a medic for a very long time and my wife has been a nurse for like 12 years and completely agrees.

That said, like I have said a number of times, that whole argument is pointless. Nurses have a role on the healthcare team because physicians can’t do everything, nor should they. Medicine is a team sport and works best when everyone is doing their job and has the patient at the center.
Click to expand...

They could learn it, but it would take years, at which point why not just take NCLEX and be a nurse.

One could say that a medical student caring for a ICU patient may be capable of providing some care as a novice in the exact same way a unsupervised NP is capable of working in primary care. They both might be fine for awhile but eventually something would go wrong that they don’t have sufficient training for. See what I did there?
 
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