Psychiatrist or Psychiatric NP?

[DohAh]

Hi all. I have read many threads regarding the choice between doctor or nurse practitioner, and most people have said that there is no substitution for med school- that nurse practitioners simply do not know enough to be adequate by themselves. What I am wondering is whether you feel any differently about a psychiatric nurse practitioner. Do you think that the specificity of the work, and the fact that an NP can also do counseling (as well as prescribe meds) make a psychiatric NP's work a better, or at least equal choice to a psychiatrist? I am currently pre-med, and I need to make this decision before committing to my second semester of orgo (and to life in general!) Thanks a lot.

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[spicedmanna]

It's not an equal choice and I don't see how the field makes a difference here. The two are different and have different roles. NP/PA's are meant to assist physicians, not replace them. Physicians make the final and sometimes more difficult calls and review all cases. You will have the most autonomy and say as a physician as it is he/she that is ultimately responsible for the management of the patient/case. The buck stops with him/her, so to speak.

Psych illnesses/disorders may have an organic as well as a psychological etiology; sometimes both. Additionally, other systems can be and are involved as well. The in depth experience that a physician has accumulated through medical school and residency really make him or her the clear expert in the management of patients.

Do some shadowing of both and talk to them; ask questions...

 

[DohAh]

I know that it varies from state to state, but that nurse practitioners can work without the supervision of physician. You're right that they are not comparable. They are two completely different jobs, and I need to figure out whether I want more patient care, such as counseling, even if it means I do not get a med-school level education. I read, though, that lately, psychiatric nurse practitioners have been making almost the same medication decisions as psychiatrists, and how the treatment usually ends up being identical.

One question I had, which is very far off I know, has to do with time for a family. Do you know how common/easy it is for a doctor (psychiatrist specifically) to become part-time after a certain amount of time in the practice? I know of a part-time doctor, but I don't know how often it actually happens. I know it has to do with what setting you work in...

Thanks a lot for your response!

 

[OldFolkDoc]

I went through this very same dilemma a few years back. While I'm neither an NP nor an MD (or a trainee), I can relate to you my thought process for whatever its worth - YMMV.

I started by realizing that I was interested in caring for patients on a psychosocial axis in addition to the traditional biomedical duties inherent in the role of an advanced care provider. Family/free time is also important to me, as well as my overall level of life satisfaction in the work environment (which includes time spent in training.) With these considerations, I came to the following conclusions:

1) Both MD's and NP's (or PA's) are free to incorporate all types of care into their practice. However, an autonomous MD can prioritize psychosocial care more freely than, for example, an NP who works for an MD who only cares about the "patients per hour" ratio.

2) If free time is a priority, then you can structure your practice as such. Of course, this requires choosing the right specialty, but there are more options on the MD side. Also, the same theory as Point 1 applies here - if you are at the helm, nobody can demand that you to be in the office 9-5, M-F.

3) I like working with really smart, driven people. It keeps me on my toes and, well, its a lot of fun. There is no question that it takes brains to be an NP, a PA, or an MD. However, the MD's tend to be the most driven and academically oriented of the bunch and I can identify with that. As such, if I'm going to spend years in training and a lifetime working together with my peers, it might as well be with "my kind of people." Note that its is a fallacy to think that the NP or PA path is shorter than the MD for recent graduates. This isn't true if you've been out of school or don't have the pre-req's for MD admission, but if you're already close you might as well go all the way.

I think to sum it up, you can be an MD that has a career of an NP if that's the way you want to work it. You cannot be an NP that has the career of an MD however, so if you have the chance to keep your options open I'd go for the MD. Just my $0.02 (well maybe that was $0.03 but you can keep the change).

PS. A thought on Psychiatry NP vs. MD: This is way out of my true field of knowledge, but I would imagine that the Psych NP vs. MD is similar to the Family Practice NP vs. MD. The due to lack of truly specialized training, the NP's in family practice see the more routine cases (ear ache, stuffy nose, fever of unknown origin) and refer the more complex stuff to the MD in the office (multi-system malfunction, acute or emergent cases, etc). By the same token, an NP might be utilized in the Psych world to treat the worried well, med checks, routine depression or substance abuse, whereas an MD treats the whole range of patients including those with severe psych disorders or comorbidities. I your choice also depends on what scope of practice you're interested in. Think hard, and good luck.

 

[cliquesh]

My wife is currently studying for her master’s in nursing, and is planning on entering psyc nursing. When she graduates, she will be able to provide commutative therapy and drug therapy, similar to a physician. However, although she will be allowed to prescribe some meds, like anti-depressants, some hard-core anti-psychotics are out of her reach. Additionally, she will not be allowed to perform some more advance procedures like electroshock. So, as a NP, you are limited to the care you can provide, but it is more than sufficient to treat the most common mental-health disorders, like general anxiety and depression. However, if you are interested in the more severe mental disorders, like schizophrenia, you can provide basic communicative therapy but you would need a physicians help to fully threat the patient.

Anyway, to my knowledge, psychiatrists on average work 50 hrs/week, which is one of the shorts workweeks for all medical specialties. So if you want to have a family, psychiatry is one of the least demanding specialties, at least time wise.

 

[NPP1]

I accidentally stumbled upon this forum, and felt compelled to reply because I am a psychiatric RN and in the middle of my psych NP training. I would certainly urge you to seek input directly from nurses, because there is a bias of opinions on this board due to most people coming from the medical perspective. A few thoughts: 1. I absolutely love what I do, work closely with my psychiatric MD counterparts and our jobs have significant overlap and are often indistinguishable. 2. That said, look carefully into the laws in the state you would like to practice in because independent practice is not yet universal (it is quickly moving in that direction though). 3. Also, look carefully at the schools you are applying to, the entire field is very small and there is a large amount of variety between programs. 4. My program offers a truly unbeatable education, my professor is both a PHD psychologist and a psych DNP. My classmates are NPs, RNs, psychologists already by training. 5. It is exciting to be a part of a rapidly expanding field. 6. It is completely untrue to say that nurses are not taking care of the most complex clients. Frequently, we are the providers working in under-resourced settings, with chronically and persistently mentally ill that have been cut off from psychiatric care for years. 7. The path to be an NP takes you through RN training. Not only can you be well paid as an RN, there is no better way to expand your interpersonal skills of compassion and empathy that is most important to being an effective therapist. 8. Being an NP you can participate in almost all therapy training programs which you would attend as an MD. It is my understanding that MD training alone does not offer in-depth psychotherapy training. 9. In NP training you will NOT get the same depth of biomedical knowledge as in MD training. That does not feel like a problem at all for me though, much of this training - like a surgery rotation for example - is not relevant to my work.

All that said, do what feels right for you! Psychiatry (with any degree) is a highly rewarding field with unlimited need for caring and committed providers. Good luck!

 

[Funke]

I sure hope they've made a decision by now!

 

[Holmwood]

I accidentally stumbled upon this forum, and felt compelled to reply because I am a psychiatric RN and in the middle of my psych NP training. I would certainly urge you to seek input directly from nurses, because there is a bias of opinions on this board due to most people coming from the medical perspective. A few thoughts: 1. I absolutely love what I do, work closely with my psychiatric MD counterparts and our jobs have significant overlap and are often indistinguishable. 2. That said, look carefully into the laws in the state you would like to practice in because independent practice is not yet universal (it is quickly moving in that direction though). 3. Also, look carefully at the schools you are applying to, the entire field is very small and there is a large amount of variety between programs. 4. My program offers a truly unbeatable education, my professor is both a PHD psychologist and a psych DNP. My classmates are NPs, RNs, psychologists already by training. 5. It is exciting to be a part of a rapidly expanding field. 6. It is completely untrue to say that nurses are not taking care of the most complex clients. Frequently, we are the providers working in under-resourced settings, with chronically and persistently mentally ill that have been cut off from psychiatric care for years. 7. The path to be an NP takes you through RN training. Not only can you be well paid as an RN, there is no better way to expand your interpersonal skills of compassion and empathy that is most important to being an effective therapist. 8. Being an NP you can participate in almost all therapy training programs which you would attend as an MD. It is my understanding that MD training alone does not offer in-depth psychotherapy training. 9. In NP training you will NOT get the same depth of biomedical knowledge as in MD training. That does not feel like a problem at all for me though, much of this training - like a surgery rotation for example - is not relevant to my work.

All that said, do what feels right for you! Psychiatry (with any degree) is a highly rewarding field with unlimited need for caring and committed providers. Good luck!

It's not a matter of feeling... DO you need indepth knowledge to be a competent physician? I would say in most instances, no. From my understanding, medicine for most instances outside of the academic setting tends to be highly cookbook-oriented. NPs can perform on par with MDs if a cookbook is involved is the usual argument I hear.

For psychiatry, it's not an easy question to answer. No amount of positive psychology can aid severely disabled patients, and the focus in those instances would be to just manage the patient's condition. In this instance, NPs can do just as well as MDs... and perhaps even better, with their modest training in psychotherapy. However, that will not be the case forever. Currently, various new biology-based therapeutics developed for treatment resistant major depressive disorder, autism, and obsessive compulsive disorder. My concern is whether the lack of understanding in how the medicine works from a pharmacological/physiological/developmental perspective will endanger the lives of patients. However, this is a concern I extend to not only the NPs, but even the current MD psychiatrists.

In my opinion, both NP and MD training programs do a half-***ed job in training medical practitioners in the specialties. We need to bring aspects of nursing into physician-patient conduct training (which many MD schools are already doing), and we need to bring aspects of PhD training into the curriculum (which academic MD schools are already doing). Heck, let's just push all preclinical materials to college curriculum and create a truly "pre-med" major. That way we can focus on training in areas that really matter such as professionalism/ethics, legal savviness, diagnostics, scholarly requirements, etc.

 

[allantois]

No offense to anyone, but I encountered way too many subpar NPs

I want my healthcare provider to think, not go off a cookbook recipe.

 

[Holmwood]

No offense to anyone, but I encountered way too many subpar NPs

I want my physician to think, not go off a cookbook recipe.

If we set the standard for getting admitted to NP programs to be comparable to MD programs, do you think that's going to change?
Or do you attribute that discrepancy to be the NP program itself? And what specialty of NP if you don't mind me asking so much questions.

 

[allantois]

If we set the standard for getting admitted to NP programs to be comparable to MD programs, do you think that's going to change?
Or do you attribute that discrepancy to be the NP program itself? And what specialty of NP if you don't mind me asking so much questions.

Are there enough competent nurses to make NP programs high quality?

I think NPs do great in skill-based specialties such as assisting in surgeries, but when it's a medical specialty that relies on a great deal of critical thinking (medicine subspecialties or even primary care), they often times fall short. Or at least that has been the impression from my limited experience with them. I would love to see how many of them would pass medical boards, and I highly doubt it would be a high percentage at all. I have a more favorable opinion of PAs, though. But then again quality of their programs ranges widely.

My personal negative experiences with them were in primary care btw. I now specifically refuse to be seen by an APRN, and quite frankly I wouldn't want one for mental health care either. I would prefer pharmaceutical issues to be managed by a psychiatrist while non-pharmaceutical issues by a psychologist. NPs are just sort of in-between and are neither superior in the medical aspect nor the psychological aspect of mental health. But that's just my opinion.

Now it's a bit off topic, but I think our government should have opened more residencies and recruited foreign physicians than allow mid levels to expand their practice rights.

 

[Holmwood]

Are there enough competent nurses to make NP programs high quality?

I think NPs do great in skill-based specialties such as assisting in surgeries, but when it's a medical specialty that relies on a great deal of critical thinking (medicine subspecialties or even primary care), they often times fall short. Or at least that has been the impression from my limited experience with them. I would love to see how many of them would pass medical boards, and I highly doubt it would be a high percentage at all. I have a more favorable opinion of PAs, though. But then again quality of their programs ranges widely.

My personal negative experiences with them were in primary care btw. I now specifically refuse to be seen by an APRN, and quite frankly I wouldn't want one for mental health care either. I would prefer pharmaceutical issues to be managed by a psychiatrist while non-pharmaceutical issues by a psychologist. NPs are just sort of in-between and are neither superior in the medical aspect nor the psychological aspect of mental health. But that's just my opinion.

Now it's a bit off topic, but I think our government should have opened more residencies and recruited foreign physicians than allow mid levels to expand their practice rights.

I agree. I feel that psychological issues are better dealt with a fully licensed therapist or counselor rather than an NP or MD. If these psychological issues have a biological basis, I would talk to a MD for the neurophysio and my pharmacist for the drug interaction. I just don't see the logic in seeking an NP for a specialized medical problem.

Now for run of the mill problems, NPs and PAs are my go to. Heck, in other countries, pharmacists handle all the run of the mill problems... not doctors. So long as they are competent enough to spot when their expertise is limited, I don't have a problem with them being my PCP. I just don't know if many psychiatric problems are considered "run of the mill" and whether NPs should be able to practice independently in psychiatry. The brain is a complicated and paradoxical beast after all.

 

[NickNaylor]

Are there enough competent nurses to make NP programs high quality?

I think NPs do great in skill-based specialties such as assisting in surgeries, but when it's a medical specialty that relies on a great deal of critical thinking (medicine subspecialties or even primary care), they often times fall short. Or at least that has been the impression from my limited experience with them. I would love to see how many of them would pass medical boards, and I highly doubt it would be a high percentage at all. I have a more favorable opinion of PAs, though. But then again quality of their programs ranges widely.

My personal negative experiences with them were in primary care btw. I now specifically refuse to be seen by an APRN, and quite frankly I wouldn't want one for mental health care either. I would prefer pharmaceutical issues to be managed by a psychiatrist while non-pharmaceutical issues by a psychologist. NPs are just sort of in-between and are neither superior in the medical aspect nor the psychological aspect of mental health. But that's just my opinion.

Now it's a bit off topic, but I think our government should have opened more residencies and recruited foreign physicians than allow mid levels to expand their practice rights.

Ask and you shall receive. Here's the data for Columbia's DNP program, where they administer an optional, comprehensive exam that is essentially a modified version of step 3: http://nursing.columbia.edu/dnpcert/rates.shtml

For comparison, the pass rate for step 3 in 2013 was 96% for US MD/DOs (http://www.usmle.org/performance-data/default.aspx#2013_step-3).

 

[AspiringERMD]

Ask and you shall receive. Here's the data for Columbia's DNP program, where they administer an optional, comprehensive exam that is essentially a modified version of step 3: http://nursing.columbia.edu/dnpcert/rates.shtml

For comparison, the pass rate for step 3 in 2013 was 96% for US MD/DOs (http://www.usmle.org/performance-data/default.aspx#2013_step-3).

 

[NickNaylor]

Hey man, we're all on a team, NPs can manage BP and blood glucose levels just as well as physicians, therefore NP=MD/DO.

 

[NickNaylor]

I agree. I feel that psychological issues are better dealt with a fully licensed therapist or counselor rather than an NP or MD. If these psychological issues have a biological basis, I would talk to a MD for the neurophysio and my pharmacist for the drug interaction. I just don't see the logic in seeking an NP for a specialized medical problem.

Now for run of the mill problems, NPs and PAs are my go to. Heck, in other countries, pharmacists handle all the run of the mill problems... not doctors. So long as they are competent enough to spot when their expertise is limited, I don't have a problem with them being my PCP. I just don't know if many psychiatric problems are considered "run of the mill" and whether NPs should be able to practice independently in psychiatry. The brain is a complicated and paradoxical beast after all.

The worst part about poor psychiatric practice is that it is relatively difficult to actually "harm" a patient and easy to initiate a treatment plan that isn't very effective. Because individual responses to medications can vary widely - even among similar medication classes - it can be easy to chalk up poor management as little more than poor treatment response. I've seen people come into the hospital on completely wonky treatment regimens that really make no sense at all. That doesn't necessarily mean that they're poor practitioners - who knows, maybe the patient really is a case where first-line or "optimal" therapies haven't been effective - but the point remains that it is "easy" to treat psychiatric problems poorly and more difficult to treat them effectively.

This also assumes that the practitioner has done the work of actually investigating symptoms sufficiently to ensure that you aren't missing the diagnosis.

 

[WingedOx]

The worst part about poor psychiatric practice is that it is relatively difficult to actually "harm" a patient and easy to initiate a treatment plan that isn't very effective. Because individual responses to medications can vary widely - even among similar medication classes - it can be easy to chalk up poor management as little more than poor treatment response. I've seen people come into the hospital on completely wonky treatment regimens that really make no sense at all. That doesn't necessarily mean that they're poor practitioners - who knows, maybe the patient really is a case where first-line or "optimal" therapies haven't been effective - but the point remains that it is "easy" to treat psychiatric problems poorly and more difficult to treat them effectively.

This also assumes that the practitioner has done the work of actually investigating symptoms sufficiently to ensure that you aren't missing the diagnosis.

From what I've seen the wonky regimens are 2/2 the patient insisting that more sensible regimens "just don't work" or have "adverse reactions." If they're convinced enough of either, the patient will find a way to get themselves hosptalized if the MD changes anything. Oh, the delicate balancing act.

I have seen enough psychiatrists who are flat out awful at what they do though...

"I went to see an addition psychiatrist for my heroin addiction. She started me on suboxone, which was really making me anxious, so she also gave me xanax 3x/day"

 

[Psai]

From what I've seen the wonky regimens are 2/2 the patient insisting that more sensible regimens "just don't work" or have "adverse reactions." If they're convinced enough of either, the patient will find a way to get themselves hosptalized if the MD changes anything. Oh, the delicate balancing act.

I have seen enough psychiatrists who are flat out awful at what they do though...

"I went to see an addition psychiatrist for my heroin addiction. She started me on suboxone, which was really making me anxious, so she also gave me xanax 3x/day"

Really? My preceptors are all about benzos being short term stabilizers as you wait for ssris to work or something. I've seen some bad practices from family med and psych mid levels but not from psychiatrists.

 

[WingedOx]

Really? My preceptors are all about benzos being short term stabilizers as you wait for ssris to work or something. I've seen some bad practices from family med and psych mid levels but not from psychiatrists.

alprazolam is a special pain in the ass. Non-PRN multiple times per day prescribing is asking for problems down the road.

 

[NickNaylor]

Really? My preceptors are all about benzos being short term stabilizers as you wait for ssris to work or something. I've seen some bad practices from family med and psych mid levels but not from psychiatrists.

Psychiatrists (in my experience) are generally much more concerned about long-term use of benzos and almost always avoid alprazolam if at all possible. However, I've seen tons of people come in on alprazolam QID PRN for management of "anxiety" with no real work-up or referral to a psychiatrist. I have no idea why some providers do that.

Anecdotally, one of my family members saw a neurosurgeon for work-up of spinal root impingement. He/she was prescribed a couple of things but also alprazolam - for seemingly no reason - and a pretty hefty supply at that. There were no complaints of anxiety and I have no idea what it was prescribed for. I try to think the best of people, but the cynic in me thinks this was little more than a "goodie bag" of sorts. That kind of prescribing is completely inappropriate.

 

[Holmwood]

Psychiatrists (in my experience) are generally much more concerned about long-term use of benzos and almost always avoid alprazolam if at all possible. However, I've seen tons of people come in on alprazolam QID PRN for management of "anxiety" with no real work-up or referral to a psychiatrist. I have no idea why some providers do that.

Anecdotally, one of my family members saw a neurosurgeon for work-up of spinal root impingement. He/she was prescribed a couple of things but also alprazolam - for seemingly no reason - and a pretty hefty supply at that. There were no complaints of anxiety and I have no idea what it was prescribed for. I try to think the best of people, but the cynic in me thinks this was little more than a "goodie bag" of sorts. That kind of prescribing is completely inappropriate.

Hmm... That stereotype of psychiatrists as glorified drug salesman is not without reason. I can think of a similar situation with psychiatrists giving adderall to college students when their cognitive impairments are rooted in sleep deprivation. Hopefully these are the exceptions and not the norm.

As for the alprazolam, it doubles as a muscle relaxant I believe. But if the family member wasn't given an explanation for why he/she she needed to take the alprazolam, then I think that's inappropriate as well.

The psychiatric field seems to me a very underdeveloped and imprecise medicine. For instance, many commonly prescribed psychiatric meds have adverse paradoxical effects that we only later find out about with fervent research and case studies. Though I understand the need for more practitioners to handle the psychiatric needs of our growing population, I don't think the field is ready to start bringing independent practice NPs into the picture yet.

 

[WingedOx]

Hmm... That stereotype of psychiatrists as glorified drug salesman is not without reason.

Perhaps @NickNaylor is aware of this guy... http://www.chicagotribune.com/news/...tein-kickback-plea-20150213-story.html#page=1
(this particular article doesn't mention the fact that he also was paid hansdomly to give out Seroquel like candy.)

...and extreme example of course, but there's a reason why Abilify is the single most revenue producing drug in the country presently, and that reason isn't "good and proper prescribing."

 

[darklabel]

I accidentally stumbled upon this forum, and felt compelled to reply because I am a psychiatric RN and in the middle of my psych NP training. I would certainly urge you to seek input directly from nurses, because there is a bias of opinions on this board due to most people coming from the medical perspective. A few thoughts: 1. I absolutely love what I do, work closely with my psychiatric MD counterparts and our jobs have significant overlap and are often indistinguishable. 2. That said, look carefully into the laws in the state you would like to practice in because independent practice is not yet universal (it is quickly moving in that direction though). 3. Also, look carefully at the schools you are applying to, the entire field is very small and there is a large amount of variety between programs. 4. My program offers a truly unbeatable education, my professor is both a PHD psychologist and a psych DNP. My classmates are NPs, RNs, psychologists already by training. 5. It is exciting to be a part of a rapidly expanding field. 6. It is completely untrue to say that nurses are not taking care of the most complex clients. Frequently, we are the providers working in under-resourced settings, with chronically and persistently mentally ill that have been cut off from psychiatric care for years. 7. The path to be an NP takes you through RN training. Not only can you be well paid as an RN, there is no better way to expand your interpersonal skills of compassion and empathy that is most important to being an effective therapist. 8. Being an NP you can participate in almost all therapy training programs which you would attend as an MD. It is my understanding that MD training alone does not offer in-depth psychotherapy training. 9. In NP training you will NOT get the same depth of biomedical knowledge as in MD training. That does not feel like a problem at all for me though, much of this training - like a surgery rotation for example - is not relevant to my work.

All that said, do what feels right for you! Psychiatry (with any degree) is a highly rewarding field with unlimited need for caring and committed providers. Good luck!

This is disturbing to read. So you're "like a physician" except you don't need to go in-depth with all that messy stuff like "biochem" or "pharm" and silly stuff like "surgery" because none of those relate to psych. I am glad for your input because it's good to know what NPs are lobbying for and what they think. I can't really comprehend the argument for psych NP training since you're basically saying "we're indistinguishable from the MDs except we have less knowledge!".

 

[hopefuldoc97239]

This is disturbing to read. So you're "like a physician" except you don't need to go in-depth with all that messy stuff like "biochem" or "pharm" and silly stuff like "surgery" because none of those relate to psych. I am glad for your input because it's good to know what NPs are lobbying for and what they think. I can't really comprehend the argument for psych NP training since you're basically saying "we're indistinguishable from the MDs except we have less knowledge!".

I see you're a medical student, as am I (MS4). This isn't directed at you personally, but I'd like to share an anecdote that relates to this thread as well as your comments.

At my school we take neurology as fourth year students, and we have a required term paper in addition to ward duties and shelf exam. The assignment is to write a case report that highlights a disease mechanism or drug mechanism, or other basic-science aspect of a disease.

What's funny is that several of my classmates complained that this was not helpful education, saying things like, "What does it matter if I understand the molecular pathway of the drug? What's important is to know how to recognize conditions and select the right treatment."

In essence, and certainly without realizing it, they were actually arguing that their MD training should be more like the NP approach!

It's funny to me how often I hear med students complain that NP training doesn't have enough of X, Y, and Z. Meanwhile, X, Y, and Z are usually the things that med students complain most about in their own curriculum.

 

[allantois]

It's funny to me how often I hear med students complain that NP training doesn't have enough of X, Y, and Z. Meanwhile, X, Y, and Z are usually the things that med students complain most about in their own curriculum.

My university has a DNP program as well as all other levels of nursing. To get a BSN, they have to take one semester of General Chemistry, nothing else. Then you can go on to get your DNP, how can they even have a slightest idea of how things work on a cellular level?

 

[hopefuldoc97239]

My university has a DNP program as well as all other levels of nursing. To get a BSN, they have to take one semester of General Chemistry, nothing else. Then you can go on to get your DNP, how can they even have a slightest idea of how things work on a cellular level?

What school is this?

I'm not in an expert position to say how much of anything is necessary to do any job. All I can tell is my experience. This is my experience:

As a fourth-year medical student I do not feel that the amount of chemistry I took was in any way necessary or helpful for medical school. If you think about the actual topics--idea gas law, electron orbits, solubility products, synthesis of alcohols from alkyl halides from alkanes--I'm seriously trying to think how that is relevant to anything I saw as a third-year med student.

I say all this as a person who loved chemistry, got all A's in general chemistry and organic. Even then, I still don't think it was relevant to my medical school experience. Your experience may be different. But as for me, if asked honestly whether I think a year of gen chem plus a year of organic should be required for medical school admissions, I would say maybe just for the weeding-out factor, but not for the content itself.

Actually, if all that chemistry or physics was helpful for med school, I probably would have had a few more honors classes. Even as an undergrad I struggled with basic biology while breezing through organic chemistry and physics.

 

[Holmwood]

I see you're a medical student, as am I (MS4). This isn't directed at you personally, but I'd like to share an anecdote that relates to this thread as well as your comments.

At my school we take neurology as fourth year students, and we have a required term paper in addition to ward duties and shelf exam. The assignment is to write a case report that highlights a disease mechanism or drug mechanism, or other basic-science aspect of a disease.

What's funny is that several of my classmates complained that this was not helpful education, saying things like, "What does it matter if I understand the molecular pathway of the drug? What's important is to know how to recognize conditions and select the right treatment."

In essence, and certainly without realizing it, they were actually arguing that their MD training should be more like the NP approach!

It's funny to me how often I hear med students complain that NP training doesn't have enough of X, Y, and Z. Meanwhile, X, Y, and Z are usually the things that med students complain most about in their own curriculum.

I recently read a blog that was a rant about how pointless the non-clinical portion of medical school was and the wish that it be more practical and hands-on. I'm not sure how common this is among medical students. But certainly if salaries and public acknowledgement weren't a barrier, those students would have been more open to NP training as an alternative.

 

[Holmwood]

Perhaps @NickNaylor is aware of this guy... http://www.chicagotribune.com/news/...tein-kickback-plea-20150213-story.html#page=1
(this particular article doesn't mention the fact that he also was paid hansdomly to give out Seroquel like candy.)

...and extreme example of course, but there's a reason why Abilify is the single most revenue producing drug in the country presently, and that reason isn't "good and proper prescribing."

This is disturbing! But not super surprising I guess... which is a terrible thing to say. It really does put what @NickNaylor said into perspective though. The guy has been doing this for more than 20 years... Wowzers!

 

[WingedOx]

This is disturbing! But not super surprising I guess... which is a terrible thing to say. It really does put what @NickNaylor said into perspective though. The guy has been doing this for more than 20 years... Wowzers!

That's Chicago/Illinois for you. Guy had some connections, which shielded him from scrutiny for a long time. And connections trump everything over there.

 

[darklabel]

I see you're a medical student, as am I (MS4). This isn't directed at you personally, but I'd like to share an anecdote that relates to this thread as well as your comments.

At my school we take neurology as fourth year students, and we have a required term paper in addition to ward duties and shelf exam. The assignment is to write a case report that highlights a disease mechanism or drug mechanism, or other basic-science aspect of a disease.

What's funny is that several of my classmates complained that this was not helpful education, saying things like, "What does it matter if I understand the molecular pathway of the drug? What's important is to know how to recognize conditions and select the right treatment."

In essence, and certainly without realizing it, they were actually arguing that their MD training should be more like the NP approach!

It's funny to me how often I hear med students complain that NP training doesn't have enough of X, Y, and Z. Meanwhile, X, Y, and Z are usually the things that med students complain most about in their own curriculum.

Yeah, if there's one thing medical students are good at is complaining about everything.

The way I see it is we may think all of this is useless garbage, but I was shocked at how much of that "useless" garbage comes into play in most practices. I am working with an FM doctor and I was surprised how much stuff from MS1 he was using, especially when it came to drug pathways, immune stuff, why some receptors are important while others aren't, why certain microbes require certain antibiotics and when not to give any etc. Things like surgery can be important because for the patient, surgery can can cause a large mental strain. If you at least remember something from your 3rd year rotation on surgery about the procedure then maybe you can give individualized attention to the patient and it can all be connected. Maybe certain medications would aggravate his condition and you can think of alternatives.

You're right, depending on the specialty than a lot of information may be extraneous. But why do we even need to give independent practice to NPs? They fit a role into medicine, but they aren't indistinguishable from doctors. Compared to both their knowledge base that assertion is laughable. Besides, my fiancee is a nurse and you would be surprised at how much nursing students complain about their workload while she was in class.