Post to complement...why would anyone do an EM residency?

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Indebt4Life

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And here we have it.....residency in Emergency Medicine in 14 months all the while this person worked full time, took plenty of vacations and made more than double what EM residents make.

Did this person sacrifice their youth to attend medical school? No.
Did this person delay getting married and having children? No.
Did this person accrue 200-300K of debt? No.

Using the word "residency" here is so very wrong. But this is happening and we need to stop this.
 

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Disgusting to see three MDs from a highly touted academic institution put their names to this foolishness.

They don't give a *** though cause they ain't the one pulling shifts.
 
Indebt4Life said:
And here we have it.....residency in Emergency Medicine in 14 months all the while this person worked full time, took plenty of vacations and made more than double what EM residents make.

Did this person sacrifice their youth to attend medical school? No.
Did this person delay getting married and having children? No.
Did this person accrue 200-300K of debt? No.

Using the word "residency" here is so very wrong. But this is happening and we need to stop this.
Click to expand...

I like how they started in November and finished in January to make it look longer than the bull**** one year it actually took
 
Honest (non-rhetorical) question: what should these NP/PA "residencies" be called instead? "Certificate" seems like the obvious answer, but that also sounds like something you get over a weekend at a Holiday Inn.
 
I dont' get the big deal. Does doing a residency give them any more privileges compared to an NP/PA that works in the ER?

I know every hospital I worked at would not give them any extra privileges for this.
 
emergentmd said:
I dont' get the big deal. Does doing a residency give them any more privileges compared to an NP/PA that works in the ER?

I know every hospital I worked at would not give them any extra privileges for this.
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It's the fact that they are stealing our terminology to describe themselves. "Doctor" nurse practitioner, "residency trained" "board certified". Now people like podiatrists and chiropractors are insisting that they are physicians. People aren't satisfied with their station in life and want to try to bring more prestige into their career. That's why you have people calling themselves sandwich artists when they're actually a Burger King employee.
 
While I believe this NP even with an EM "Residency" is obviously not as competent as a physician in any respects, midlevel presence in the ED is kinda unavoidable.. so.. wouldn't you rather them be specifically trained to work in the ED? What is the alternative?

NP-independence is a whole other story - that 100% is inappropriate... but if you're gonna be a midlevel in the ED, I'd rather have someone with some level of competency than none?
 
Groove said:
The ABEM docs precepting these people are the ones to blame. We're going to end up copying anesthesia's mistakes and will have nobody to blame but ourselves. Monkey see, monkey do!
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Exactly.

I don't blame the midlevels for trying to accrue "residencies" and calling themselves doctor of NP etc. If I was in their situation, I would be doing the same trying to get ahead and make more money and get more respect/prestige.

I take issue with the selfish MDs who with open arms encourage this process, and the CMGs (who are staffed by MDs, and have MDs sit on their boards) along with ACEP that institute policies that allow for unregulated midlevel expansion.

It all boils down to the foolish EM docs currently in practice who believe that they can bill more and make more money with midlevels working under them, without any regard for the long term implications to the specialty. Their attitude is usually, "Oh well, at least I'll be retired by then!" Those physicians really make me sick, and I've met more than a handful of them.
 
I've heard many people in EM criticize PAs and NPs who work in emergency departments for "not doing additional training in EM, or a residency" like all the rest of us did. Now that they've come up with such a thing, the same people are up in arms that they're doing what they wanted them to do. We could stand to be a little more consistent.

That being said, you can put me in the camp that want PAs and NPs that work in EDs to be as well trained in all matters EM, as possible, and if they want to call that a "residency" then so be it. At the same time, I don't want them trying to pass that training off as equivalent to an MD degree, with EM residency and board certification, because it's not.

In theory, we should be able to accomplish the former, without the latter happening inevitably. The Law of Unintended Consequences says it will happen otherwise.
 
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The problem is that they are aping the name of the training and borrowing from the prestige of medicine to equivocate and give the impression of the same rigorous training and quality control process when in reality it doesn't even come close. It's nice that they are trying to get better training but it shouldn't be by medical doctors, taking away educational opportunities from medical doctors in training. It's obnoxious to use the same terminology for something that isn't the same thing. And the biggest problem is that it is all intentional obfuscation, playing dress up to beguile the suits and the patients to give the impression that they offer the same white coated medical expert.
 
Psai said:
It's the fact that they are stealing our terminology to describe themselves. "Doctor" nurse practitioner, "residency trained" "board certified". Now people like podiatrists and chiropractors are insisting that they are physicians. People aren't satisfied with their station in life and want to try to bring more prestige into their career. That's why you have people calling themselves sandwich artists when they're actually a Burger King employee.
Click to expand...

I get that but everyone who walks the hallways seems to be called doctors. Doctor of pharmacy, doctor of physical therapy. This is just another diploma mill so they can charge someone over 60K to take online courses.

Look at NP school now. You just have to do crap online and find yourself some preceptors.
 
Birdstrike said:
I've heard many people in EM criticize PAs and NPs who work in emergency departments for "not doing additional training in EM, or a residency" like all the rest of us did. Now that they've come up with such a thing, the same people are up in arms that they're doing what they wanted them to do. We could stand to be a little more consistent.

That being said, you can put me in the camp that want PAs and NPs that work in EDs to be as well trained in all matters EM, as possible, and if they want to call that a "residency" then so be it. At the same time, I don't want them trying to pass that training off as equivalent to an MD degree, with EM residency and board certification, because it's not.

In theory, we should be able to accomplish the former, without the latter happening inevitably. The Law of Unintended Consequences says it will happen otherwise.
Click to expand...

If I worked in an ED and an NP goes around calling themselves doctor, I will treat them like doctors when they have a question. I will be this will not last long.
 
It’s usually the worst nurses that g back to prack school too. Half the ones I used to work with on the floor back in the nursing days couldn’t even do their job as an RN following orders and now they are “providers”. At least the ones that got jobs.


Buyer beware
 
I see this in many different ways. 1) a way to try to build the field to equal the house of medicine, 2) a way for the NP/PA “educators” to create more degree creep in their field to suck from the student loan tit, 3) a way for old NP/PAs to be grandfathered in and prevent too high a supply of employable NPs/PAs

Any way you look at it, this is not good for anyone - including patients.
 
alprazoslam said:
It’s usually the worst nurses that g back to prack school too. Half the ones I used to work with on the floor back in the nursing days couldn’t even do their job as an RN following orders and now they are “providers”.
Click to expand...

Oh my God; so much this. I work with two right now that are in "NP School", and when I learned this, I was visibly upset and probably said something like: "NOOoooo...."

Yeah, that happened. I was embarrassed, but eff it. Its the truth.
The Emporer is naked, man.
 
Birdstrike said:
I've heard many people in EM criticize PAs and NPs who work in emergency departments for "not doing additional training in EM, or a residency" like all the rest of us did. Now that they've come up with such a thing, the same people are up in arms that they're doing what they wanted them to do. We could stand to be a little more consistent.

That being said, you can put me in the camp that want PAs and NPs that work in EDs to be as well trained in all matters EM, as possible, and if they want to call that a "residency" then so be it. At the same time, I don't want them trying to pass that training off as equivalent to an MD degree, with EM residency and board certification, because it's not.

In theory, we should be able to accomplish the former, without the latter happening inevitably. The Law of Unintended Consequences says it will happen otherwise.
Click to expand...

If NPs and CRNAs are sooooo amazing, why don't they just take the USMLE and their respective MD boards, including oral exams? I think that would level the playing field. If they can pass them, and prove they have the same number of clinical hours as MDs, then have at it, midlevels. Why don't they just offer to do this if their training is sooooooo amazing.

FYI I had a doctore-nurse (of oncology) call me and introduce herself as doctor. What a piece of trash. Docs never do that when they call about their family members. Never. Honestly, midlevels, especially NPs, are totally becoming uneducated garbage. D-K all day, every day.
 
miacomet said:
If NPs and CRNAs are sooooo amazing, why don't they just take the USMLE and their respective MD boards, including oral exams? I think that would level the playing field. If they can pass them, and prove they have the same number of clinical hours as MDs, then have at it, midlevels. Why don't they just offer to do this if their training is sooooooo amazing.

FYI I had a doctore-nurse (of oncology) call me and introduce herself as doctor. What a piece of trash. Docs never do that when they call about their family members. Never. Honestly, midlevels, especially NPs, are totally becoming uneducated garbage. D-K all day, every day.
Click to expand...


Part of me wants to just give nps their own hospital and see how patient outcomes end up. But then I realize that’s not ethical.

Even though pracks probably think they could run a hospital
 
Cryc_to_the_point said:
My ex got soooo offended when I suggested she get more than a year of experience as a RN before starting NP school...
Click to expand...
That’s the funny part is the midlevel independence movement always banks on “years of nursing experience” but then programs don’t even require experience and tons just go straight from nursing to NP or even worse do direct entry in like 1.5 years post basketweaving bachelors degree
 
alprazoslam said:
That’s the funny part is the midlevel independence movement always banks on “years of nursing experience” but then programs don’t even require experience and tons just go straight from nursing to NP or even worse do direct entry in like 1.5 years post basketweaving bachelors degree
Click to expand...

Exactly. The idea was you'd have YEARS of nursing experience to make up for your utter lack of didactic and clinical education in NP school... But no matter, "independence."
 
miacomet said:
If NPs and CRNAs are sooooo amazing, why don't they just take the USMLE and their respective MD boards, including oral exams? I think that would level the playing field. If they can pass them,
Click to expand...
I think that's a fabulous idea
 
alprazoslam said:
That’s the funny part is the midlevel independence movement always banks on “years of nursing experience” but then programs don’t even require experience and tons just go straight from nursing to NP or even worse do direct entry in like 1.5 years post basketweaving bachelors degree
Click to expand...
As a nurse myself I hate this BS. I recently had a coworker question me to the point of a debate on why I moved a patient from fast track to a room after she witnessed them have a seizure. She felt since they weren’t actively seizing now they could just sit in fast track for a few minutes. They were being seen for a headache, no seizure history, no CT and she was about to hand them discharge paperwork. She graduates NP school in May.
I also am really tired of hearing how many years of nursing experience a NP has. It is a completely different role and way of thinking. I certainly haven’t had much of an advantage when it comes to pathology and physiology from my nursing background, because you don’t need to know it to be a good nurse. I could go on but I know this topic is discussed ad-nauseum.

And for the record, I used to be one of the airheads who think that NP education is comparable and that NP’s with a DNP should be called doctor. That ended swiftly when I realized just how hard getting into and being in med school is.
 
jessasaurus said:
As a nurse myself I hate this BS. I recently had a coworker question me to the point of a debate on why I moved a patient from fast track to a room after she witnessed them have a seizure. She felt since they weren’t actively seizing now they could just sit in fast track for a few minutes. They were being seen for a headache, no seizure history, no CT and she was about to hand them discharge paperwork. She graduates NP school in May.
I also am really tired of hearing how many years of nursing experience a NP has. It is a completely different role and way of thinking. I certainly haven’t had much of an advantage when it comes to pathology and physiology from my nursing background, because you don’t need to know it to be a good nurse. I could go on but I know this topic is discussed ad-nauseum.

And for the record, I used to be one of the airheads who think that NP education is comparable and that NP’s with a DNP should be called doctor. That ended swiftly when I realized just how hard getting into and being in med school is.
Click to expand...

Exactly. I didn't think a paramedic background would "make up," for any part of the education required to be a physician. I knew it would help in certain areas, but prior experience of a different nature actually isn't applicable to being the lead clinician. Plus, we have and always will have NPs so I wish they'd tighten up on education so they could be respectable.
 
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Cryc_to_the_point said:
Exactly. I didn't think a paramedic background would "make up," for any part of the education required to be a physician. I knew it would help in certain areas, but prior experience of a different nature actually isn't applicable to being the lead clinician. Plus, we have an always will have NPs so I wish they'd tighten up on education so they could be respectable.
Click to expand...


I just don’t wanna supervise them or be forced to. Unless we get to pick which ones. One reason I’m not doing ER since you can’t really pick whose chart you sign
 
miacomet said:
If NPs and CRNAs are sooooo amazing, why don't they just take the USMLE and their respective MD boards, including oral exams? I think that would level the playing field. If they can pass them, and prove they have the same number of clinical hours as MDs, then have at it, midlevels. Why don't they just offer to do this if their training is sooooooo amazing.

FYI I had a doctore-nurse (of oncology) call me and introduce herself as doctor. What a piece of trash. Docs never do that when they call about their family members. Never. Honestly, midlevels, especially NPs, are totally becoming uneducated garbage. D-K all day, every day.
Click to expand...


I've said this for awhile now. I will concede that you are as good as me if you can pass STEP 1-2-3 and the respective board licensing exam. If you can do that, and you haven't completed a residency like the rest of us have... then eff-off... you're on your own.

As to your second point, I was seen by a PA at my GI doc's office (I have inflammatory bowel/ulcerative colitis-subtype). Not knowing that I was a physician, she tried to lie to me about basic scientific fact. Details can be had if you're interested. I had no choice but to drop the boom on her.

These MLPs... they don't actually understand the science behind the medicine. It's simply "monkey see, monkey do". That's as deep as it goes for them.

By the way, I got an e-mail from my medical director today letting us know that we're getting PA students rotating thru our department, and asking us to let him know if we would mind having them rotate with us on a doc-by-doc basis.

Seeing as how I was in-charge of our rotating medical students (DO) until our hospital and our local medical school "got mad and broke up with each other at prom", I guarantee I get asked to have the students rotate with me.

My answer is going to be a firm and impolite "no".
 
alprazoslam said:
I just don’t wanna supervise them or be forced to. Unless we get to pick which ones. One reason I’m not doing ER since you can’t really pick whose chart you sign
Click to expand...

Actually you can pick this as long as you refuse to work for a large CMG. In small democratic groups we hire, train, and (when necessary) fire our midlevels. To me that is the way it has to be for it to make sense.


Sent from my iPhone using SDN mobile
 
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Hercules said:
Actually you can pick this as long as you refuse to work for a large CMG. In a small democratic group. We hire, train, and (when necessary) fire our midlevel. To me that is the way it has to be for it to make sense.


Sent from my iPhone using SDN mobile
Click to expand...


Easy to say, but what's the ratio of jobs available at CMGs vs small democratic groups?
 
RustedFox said:
I've said this for awhile now. I will concede that you are as good as me if you can pass STEP 1-2-3 and the respective board licensing exam. If you can do that, and you haven't completed a residency like the rest of us have... then eff-off... you're on your own.

As to your second point, I was seen by a PA at my GI doc's office (I have inflammatory bowel/ulcerative colitis-subtype). Not knowing that I was a physician, she tried to lie to me about basic scientific fact. Details can be had if you're interested. I had no choice but to drop the boom on her.

These MLPs... they don't actually understand the science behind the medicine. It's simply "monkey see, monkey do". That's as deep as it goes for them.

By the way, I got an e-mail from my medical director today letting us know that we're getting PA students rotating thru our department, and asking us to let him know if we would mind having them rotate with us on a doc-by-doc basis.

Seeing as how I was in-charge of our rotating medical students (DO) until our hospital and our local medical school "got mad and broke up with each other at prom", I guarantee I get asked to have the students rotate with me.

My answer is going to be a firm and impolite "no".
Click to expand...
Uhh, yeah dude. We want details. Unless you are saving them for your book you’re writing.
 
Yesterday, saw a pt for post menopausal vag bleed. You know what this is (if you're a doc). I say this, b/c the NP, well, isn't a doc. I called her, and had a bad exchange, because I kinda said outright that she missed it. One month ago, she did order the ultrasound, which showed the beefy cervix, and thickened endometrium. However, this was just the exploration - there was no vag bleed, yet. Yesterday, pt says, "a lot of blood". I say my shpiel, "a lot of blood looks like a little blood, etc", but her Hb went from 14 to 10.9. I arrange to have her seen by OB/GYN today.

But, the NP calls back, and is incensed that she believes I dissed her. But, then, she tips her hand. She tells me she got the U/S report two weeks ago, but she took some time off, and was busy, and so on, and that the pt was scheduled to see her today - which would have delayed referral (status quo for mid levels). So, she knew about it 2 weeks ago.

And, as OB and I discussed, with cancer, every day counts. That's average mid level for you.
 
miacomet said:
If NPs and CRNAs are sooooo amazing, why don't they just take the USMLE and their respective MD boards, including oral exams? I think that would level the playing field. If they can pass them, and prove they have the same number of clinical hours as MDs, then have at it, midlevels. Why don't they just offer to do this if their training is sooooooo amazing.

FYI I had a doctore-nurse (of oncology) call me and introduce herself as doctor. What a piece of trash. Docs never do that when they call about their family members. Never. Honestly, midlevels, especially NPs, are totally becoming uneducated garbage. D-K all day, every day.
Click to expand...
LOL can only imagine the scores that would come out of this.

"Wait....you mean I need to know about the bacteria I'm trying to treat?"

Sent from my SM-G928V using SDN mobile
 
Didn't they try this at one point? Something like NPs taking a watered down version of step 3? With like a 50% pass rate?
 
NecFasc92 said:
One major thing I have noticed, both in my past career and especially now, as a med student is that mid-levels, uniformly, conflate familiarity with knowledge. It's sad to see doctors know this, yet continue to use them to fatten their pockets. Le sigh.
Click to expand...

You give them too much credit. They associate letters after their name with knowledge.
 
Psai said:
The problem is that they are aping the name of the training and borrowing from the prestige of medicine to equivocate and give the impression of the same rigorous training and quality control process when in reality it doesn't even come close. It's nice that they are trying to get better training but it shouldn't be by medical doctors, taking away educational opportunities from medical doctors in training. It's obnoxious to use the same terminology for something that isn't the same thing. And the biggest problem is that it is all intentional obfuscation, playing dress up to beguile the suits and the patients to give the impression that they offer the same white coated medical expert.
Click to expand...


THIS!!! 1000X. This is intentional ! All of this is meant to blur the lines. Why else would it be done?
 
alprazoslam said:
Part of me wants to just give nps their own hospital and see how patient outcomes end up. But then I realize that’s not ethical.

Even though pracks probably think they could run a hospital
Click to expand...

Look at the VA hospitals that is largely run by midlevels.
 
jessasaurus said:
As a nurse myself I hate this BS. I recently had a coworker question me to the point of a debate on why I moved a patient from fast track to a room after she witnessed them have a seizure. She felt since they weren’t actively seizing now they could just sit in fast track for a few minutes. They were being seen for a headache, no seizure history, no CT and she was about to hand them discharge paperwork. She graduates NP school in May.
I also am really tired of hearing how many years of nursing experience a NP has. It is a completely different role and way of thinking. I certainly haven’t had much of an advantage when it comes to pathology and physiology from my nursing background, because you don’t need to know it to be a good nurse. I could go on but I know this topic is discussed ad-nauseum.

And for the record, I used to be one of the airheads who think that NP education is comparable and that NP’s with a DNP should be called doctor. That ended swiftly when I realized just how hard getting into and being in med school is.
Click to expand...

Thank you so much for saying this. We have lots of nurses and midlevels who feel this way. They see that patient's are being harmed and won't stand for it. But I find that they are usually old school nurses...the ones that are amazing and super experienced and know their limitations.

What is more dangerous than ignorance? Answer: The illusion of knowledge.
 
I would like everyone to know on here that while you were all lamenting the midlevel scope of practice creep. A bill was trying to be passed in Indiana to make it an unsupervised state. Our group was there to "try* to educate legislators on the topic and stop this dangerous bill. You are welcome.
 
miacomet said:
If NPs and CRNAs are sooooo amazing, why don't they just take the USMLE and their respective MD boards, including oral exams? I think that would level the playing field. If they can pass them, and prove they have the same number of clinical hours as MDs, then have at it, midlevels. Why don't they just offer to do this if their training is sooooooo amazing.

FYI I had a doctore-nurse (of oncology) call me and introduce herself as doctor. What a piece of trash. Docs never do that when they call about their family members. Never. Honestly, midlevels, especially NPs, are totally becoming uneducated garbage. D-K all day, every day.
Click to expand...

I hasten to add that said doctor-nurse DEMANDED a head CT for her over 18 year old son, who was absolutely fine. I said, look, I'm not going to deny him a head CT, but there's no indication for one, he doesn't want one, and surely, as a doctor-nurse of oncology, you know EXACTLY how much radiation will be penetrating his skull. Then she yammers on about her other relative who is a TRAUMA NURSE (that takes two years of school, lady) at the big house and blah blah blah. Oh, and we have good insurance. Like the ER cares about insurance. Like I care about her opinion or that of her Dunning-Kruger family of *****s. I said okay, he's over 18, it's whatever he wants, but all you are doing is decreasing his IQ and increasing his cancer risk. Eventually she talks the poor kid into it. Clearly this is not a family that can handle losing IQ points lol. NEGATIVE CT. I know we are all shocked.

You should have seen my note. I noted this was only done for patient reassurance and they were warned of all radiation risks. Hope insurance forces them to pay. What a b***h. Doc families are NEVER like this.

What do they teach in nurse-doctor school that makes them think they know everything? And why do parents love their children so little?
 
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