Second look at primary care?

[kansaskid]

I know most of us aren't anywhere near picking a specialty, but this keeps primary care as an option for me. I just wish there was better compensation...

http://thehealthcareblog.com/blog/2011/04/04/why-primary-care-parity-matters/

Reprinted for lazy bums like me who don't like to click random links:

Why Primary Care Parity Matters

By PAUL FISCHER, MD



Thoughts?

 

[kcin]

Good post, but nothing really new..

 

[drizzt3117]

The issue is that FM is a 3 year residency, in which you're supposed to learn to diagnose every problem in any patient. How they're supposed to do that, I have no idea.

The article borderline disparages NPs but a NP will have more training in the care of patients than a newly minted FM attending.

 

[BigRedBeta]

a NP will have more training in the care of patients than a newly minted FM attending.

I'd like to see your source (or even just your thought process) for this actually being true.

 

[drizzt3117]

I'd like to see your source (or even just your thought process) for this actually being true.

I guess it depends on the path you take, but nursing school + DNP program is roughly equivalent in terms of years (not hours in patient care) to med school + FM residency and the vast majority of DNP applicants have intervening experience and/or additional training in between.

 

[BadHorse]

I guess it depends on the path you take, but nursing school + DNP program is roughly equivalent in terms of years (not hours in patient care) to med school + FM residency and the vast majority of DNP applicants have intervening experience and/or additional training in between.

Let's just take a look at your average DNP program:

http://www.lasalle.edu/grad/index.php?section=snhs&group=dnp&page=courses

They don't learn medicine... they hardly learn any science. Even their genetics course reads like a freshman philosophy seminar. Something to keep in mind when claiming that NPs receive superior training to physicians.

 

[UbuntuGM]

it doesn't matter. No one is going to go into FM in 4 years. chillax. this info is irrelevant.

 

[Narmerguy]

I guess it depends on the path you take, but nursing school + DNP program is roughly equivalent in terms of years (not hours in patient care) to med school + FM residency and the vast majority of DNP applicants have intervening experience and/or additional training in between.

First of all you didn't start by saying DNP programs.

Second, saying 3 years training from this discipline = 3 years of training from that discipline is a little absurd.

 

[kcin]

DNP

 

[Hoody]

Let's just take a look at your average DNP program:

http://www.lasalle.edu/grad/index.php?section=snhs&group=dnp&page=courses

They don't learn medicine... they hardly learn any science. Even their genetics course reads like a freshman philosophy seminar. Something to keep in mind when claiming that NPs receive superior training to physicians.

There is a difference between NP's and DnP's. The program you list above is candidates who already have a masters. Also, I wouldn't say La Salle is "average". I've never even heard of the school (oh hai, found you, ranked # 193 out of nursing graduate programs). We learned science way back in undergrad, and more in masters school. How often are you using physics to treat patients on a daily basis? Oh, you mean you aren't? Oh, your not even a doctor or a med student? Wait, you've never completed a DnP program?

...well that explains why are so gosh darn informed bout everything. you were saying...?

 

[Hoody]

The issue is that FM is a 3 year residency, in which you're supposed to learn to diagnose every problem in any patient. How they're supposed to do that, I have no idea.

yeah, one of the most imporant (and busy) job's gets the least compensation and respect. The AMA works an awful lot like the government, has little support and generally makes no sense, yet still sits high on a pedestal. Does that mean most doctors are like most Americans who are so apathetic and submissive to the government? Yeah. Sad world.

 

[drizzt3117]

First of all you didn't start by saying DNP programs.

Second, saying 3 years training from this discipline = 3 years of training from that discipline is a little absurd.

Honestly, the better comparison would be a woman choosing a family physician vs a OB/GYN NP for her primary care/gynecologic health. Do you honestly think she's better off with the brand new FP?

 

[Hoody]

Honestly, the better comparison would be a woman choosing a family physician vs a OB/GYN NP for her primary care/gynecologic health. Do you honestly think she's better off with the brand new FP?

sorta off topic, but I HATE when women use thier Ob/Gyn as a primary. It shouldn't be allowed. You wouldnt go to orthopedic surgeon to have your vision managed so why go to a Ob/Gyn to get your pimple cream? stupid.


and isn't is true, the more specializes care, the WORSE the patients outcomes?


end hijack/, Time for pizza and NUGGETS game. Birdmannnn, bacaaaaaa.

 

[BadHorse]

There is a difference between NP's and DnP's. The program you list above is candidates who already have a masters. Also, I wouldn't say La Salle is "average". I've never even heard of the school (oh hai, found you, ranked # 193 out of nursing graduate programs). We learned science way back in undergrad, and more in masters school. How often are you using physics to treat patients on a daily basis? Oh, you mean you aren't? Oh, your not even a doctor or a med student? Wait, you've never completed a DnP program?

...well that explains why are so gosh darn informed bout everything. you were saying...?

Defensive much? The guy said something about DNPs being better trained than physicians and I provided a link to a DNP curriculum. Didn't know I had to be a med student for that to be valid, but if you want I'll check back in four months and post it again.

y u mad? 😀

 

[drizzt3117]

Defensive much? The guy said something about DNPs being better trained than physicians and I provided a link to a DNP curriculum. Didn't know I had to be a med student for that to be valid, but if you want I'll check back in four months and post it again.

y u mad? 😀

try something like Duke's nursing school, which also has a DNP program...

 

[coldweatherblue]

The article borderline disparages NPs but a NP will have more training in the care of patients than a newly minted FM attending.

http://www.aafp.org/online/etc/medialib/aafp_org/documents/press/nurse-practicioners/nurse-practicioners-training.Par.0001.File.tmp/NP-Kit-FP-NP-UPDATED.pdf

 

[drizzt3117]

Until a couple years ago, ACOG was pushing primary care.

Now, they aren't so much because a lot of insurances aren't paying for it anymore.

Honestly, I'm ok with it, why should women have to see multiple doctors a year?

When I was on OB, I'd done more deliveries than the FM intern that was trying to deliver (it was like her 2nd one), so me and my intern were giving her tips... FM doctors don't get very much exposure to OB during their residency. An OB resident gets more deliveries in one month of OB than a FM resident during all of residency, easily.

sorta off topic, but I HATE when women use thier Ob/Gyn as a primary. It shouldn't be allowed. You wouldnt go to orthopedic surgeon to have your vision managed so why go to a Ob/Gyn to get your pimple cream? stupid.


and isn't is true, the more specializes care, the WORSE the patients outcomes?


end hijack/, Time for pizza and NUGGETS game. Birdmannnn, bacaaaaaa.

 

[coldweatherblue]

Honestly, the better comparison would be a woman choosing a family physician vs a OB/GYN NP for her primary care/gynecologic health. Do you honestly think she's better off with the brand new FP?

I would intrust my wife's primary care to a board-certified physician over a nurse-practitioner every time.

 

[drizzt3117]

http://www.aafp.org/online/etc/medialib/aafp_org/documents/press/nurse-practicioners/nurse-practicioners-training.Par.0001.File.tmp/NP-Kit-FP-NP-UPDATED.pdf

Their estimates are such crap. I'm not going to comment on the quality of the training and I do think that medical students spend much more hours in "training" but a huge portion of it is empty time. Also, 60-65 hours a week during residency for FP? yeah right.

 

[smq123]

Also, 60-65 hours a week during residency for FP? yeah right.

Do you think that they usually work less?

 

[smq123]

When I was on OB, I'd done more deliveries than the FM intern that was trying to deliver (it was like her 2nd one), so me and my intern were giving her tips... FM doctors don't get very much exposure to OB during their residency. An OB resident gets more deliveries in one month of OB than a FM resident during all of residency, easily.

"Not getting very much exposure to OB during their residency" is program dependent. There are some programs where you do A LOT of OB, and others where you do less. <shrug> If it interests you, then you go to the programs that do a lot of OB; if it doesn't, then you go to the ones that do less.

Honestly, the better comparison would be a woman choosing a family physician vs a OB/GYN NP for her primary care/gynecologic health. Do you honestly think she's better off with the brand new FP?

In some ways, yes.

An OB/gyn NP does a lot of OB/gyn. That's ALL they do. I've seen OB/gyns (physicians; not even talking about NPs) mismanage asthma and sinus infections. I mean, REALLY mismanage. I've seen OBs give patients questionable advice on cholesterol medication, and I've seen OBs not treat the non-GYN parts of menopause. And I'm a RESIDENT, correcting ATTENDINGS.

 

[BadHorse]

try something like Duke's nursing school, which also has a DNP program...

I could (and looking at their DNP program, which is essentially a research based degree culminating in a capstone project in medical administration with almost no clinical or scientific focus it would be a very poignant analysis), but the fact that you have me shopping around for different DNP programs is itself an indication of a much greater problem- there's no standardization to their education.

NPs do get scientifically trained, but it's not in the DNP part of their education, and it's not as extensive as any medical school. I don't think what I'm saying is very radical, and I'm sure most NPs would agree with this assessment.

 

[JimmyShakerDay]

I guess it depends on the path you take, but nursing school + DNP program is roughly equivalent in terms of years (not hours in patient care) to med school + FM residency and the vast majority of DNP applicants have intervening experience and/or additional training in between.

So in the learning of the art of diagnosis, treatment, and patient management,
nursing school + DNP school = medical school and residency?

Great, what's next, online DNP school = residency? Yikes.

 

[coldweatherblue]

Their estimates are such crap. I'm not going to comment on the quality of the training and I do think that medical students spend much more hours in "training" but a huge portion of it is empty time. Also, 60-65 hours a week during residency for FP? yeah right.

Not an adequate critique of the article. If you disagree, please offer published evidence to support your argument. You claimed that NPs have more clinical training than family medicine attendings. Offer published evidence to support this, keeping in mind that working as an RN is job experience, not clinical training.

 

[JimmyShakerDay]

Their estimates are such crap. I'm not going to comment on the quality of the training and I do think that medical students spend much more hours in "training" but a huge portion of it is empty time. Also, 60-65 hours a week during residency for FP? yeah right.

Having worked with many NP and DNP students, the level of patient care they participate in is equivalent to being a medical student. So where in the DNP curriculum does a DNP participate on the level as a resident?

 

[Hoody]

Defensive much? y u mad? 😀

cause what you say is wrong. and unfounded? you preach it like you've had experience with it other than looking a few sites online. fail, try again.

I could (and looking at their DNP program, which is essentially a research based degree culminating in a capstone project in medical administration with almost no clinical or scientific focus it would be a very poignant analysis), but the fact that you have me shopping around for different DNP programs is itself an indication of a much greater problem- there's no standardization to their education.
why would a DnP who already has a masters need to be retrained and retaught shizz they learned in the masters portion? makes no sense.
and I'm sure most NPs would agree with this assessment.

no, no they wouldn't. and in four months, you will be no more qualified to speak of NP/DnP training than you are now.

babble on....

 

[BadHorse]

cause what you say is wrong. and unfounded? you preach it like you've had experience with it other than looking a few sites online. fail, try again.

no, no they wouldn't. and in four months, you will be no more qualified to speak of NP/DnP training than you are now.

babble on....

There's an adage about arguing with somebody like you, I've made my point, I bear you no ill will, and for every second you spend hating me I'll love you even more. I love you, Hoody.

 

[drizzt3117]

Not an adequate critique of the article. If you disagree, please offer published evidence to support your argument. You claimed that NPs have more clinical training than family medicine attendings. Offer published evidence to support this, keeping in mind that working as an RN is job experience, not clinical training.

I said in my previous post that I was talking about years of training, not hours.

Honestly I don't care enough to do research on this topic.

I understand people in various primary care fields are concerned about midlevels taking their jobs, and I can appreciate that to a certain degree but honestly I think many of their problems are self-inflicted. In my experience the participation of NPs and other midlevels in patient care has been generally positive for everyone involved, and for the most part, midlevels have done a good job of practicing within their level of training.

Save your argument for someone who cares.

 

[Charles_Carmichael]

There is a difference between NP's and DnP's. The program you list above is candidates who already have a masters. Also, I wouldn't say La Salle is "average". I've never even heard of the school (oh hai, found you, ranked # 193 out of nursing graduate programs). We learned science way back in undergrad, and more in masters school. How often are you using physics to treat patients on a daily basis? Oh, you mean you aren't? Oh, your not even a doctor or a med student? Wait, you've never completed a DnP program?

...well that explains why are so gosh darn informed bout everything. you were saying...?

If you wanted to talk about a top program, the DNPs at Columbia had a 50% fail rate on a watered-down version of Step 3. It speaks volumes that Mary Mundinger's own students did that poorly.

The fact is that the basic science curriculum of any NP/DNP program is nowhere close to that of medical school (or PA school, for that matter). In addition to that, NP/DNP programs require between 500 and 1000 hours of clinical training on average (the longest I've seen is the Vandy program that requires 1400 hours, but IIRC, it combines 2 NP programs in one). The 3rd year of medical school alone likely provides more clinical hours than any NP/DNP program in the country.

Most importantly, IMO, there aren't any well-designed studies comparing patient outcomes between residency-trained physicians and NPs/DNPs. So drizzt, you can't really say that it's better for a woman to choose an Ob/Gyn NP rather than a family medicine physician.

 

[Hoody]

If you wanted to talk about a top program, the DNPs at Columbia had a 50% fail rate on a watered-down version of Step 3. It speaks volumes that Mary Mundinger's own students did that poorly.

And if NPs needed to pass step 3 to practice, they would. End of story.

Im not arguing that NP = FP or that NP >> MD. What I am arguing is that you shouldn't speak to the depth or training of an NP/DNP if all you can do is look up a few sites online and regurgitate some stats you heard another poster say.

The fact is that the basic science curriculum of any NP/DNP program is nowhere close to that of medical school (or PA school, for that matter).

point? where is the study that says hard science = better patient outcomes when your in practice? just because MDs and PAs do it a certain way, doesn't mean that its the RIGHT way, the BEST way, or the ONLY way.

NP/DNP programs require between 500 and 1000 hours of clinical training on average (the longest I've seen is the Vandy program that requires 1400 hours, but IIRC, it combines 2 NP programs in one). The 3rd year of medical school alone likely provides more clinical hours than any NP/DNP program in the country.

Most importantly, IMO, there aren't any well-desiagned studies comparing patient outcomes between residency-trained physicians and NPs/DNPs. So drizzt, you can't really say that it's better for a woman to choose an Ob/Gyn NP rather than a family medicine physician.

actually, there was a HUGE (n = 200,000+) study just realeased that showed no difference in outcomes of patients with the same acuity (in other words, they arent taking docs who have super complex cases and nurses who have fluff and buff patients - do some googling, Im sure you can find it). So you can't really say that the lesser training hours or the inability of group of nurses from Columbia to pass step 3 means that they have poor(er) patient outcomes. Cause they don't. 🙂

 

[Hoody]

There's an adage about arguing with somebody like you, I've made my point, I bear you no ill will, and for every second you spend hating me I'll love you even more. I love you, Hoody.

I am a very lovable person, thanks. You made a point with no basis. It was (very) easy for me to rip apart, so no hate. 🙂

 

[Charles_Carmichael]

actually, there was a HUGE (n = 200,000+) study just realeased that showed no difference in outcomes of patients with the same acuity (in other words, they arent taking docs who have super complex cases and nurses who have fluff and buff patients - do some googling, Im sure you can find it). So you can't really say that the lesser training hours or the inability of group of nurses from Columbia to pass step 3 means that they have poor(er) patient outcomes. Cause they don't. 🙂

Citation please. Because a quick PubMed search didn't yield anything for me.

Unless you're talking about the CRNA study that was released last year? If that's the case, in addition to methodological flaws, there was a statistically significant difference in the difficulty of cases undertaken by CRNAs and anesthesiologists (the anesthesiologists tended to be involved in more difficult cases than the CRNAs).

 

[Narmerguy]

actually, there was a HUGE (n = 200,000+) study just realeased that showed no difference in outcomes of patients with the same acuity (in other words, they arent taking docs who have super complex cases and nurses who have fluff and buff patients - do some googling, Im sure you can find it). So you can't really say that the lesser training hours or the inability of group of nurses from Columbia to pass step 3 means that they have poor(er) patient outcomes. Cause they don't. 🙂

Googled for about 10min and couldn't find it. You sure you got this correct?

Plus, I want to clear what you're asserting. Are you asserting that a NP can do an attending's job just as well? If you aren't, then what are you arguing exactly? Either you do or you don't believe they can do that job.

 

[Charles_Carmichael]

And if NPs needed to pass step 3 to practice, they would. End of story.

Im not arguing that NP = FP or that NP >> MD. What I am arguing is that you shouldn't speak to the depth or training of an NP/DNP if all you can do is look up a few sites online and regurgitate some stats you heard another poster say.

From what I understand, you're not an NP either (correct me if I'm wrong). So if I can't critique the NP/DNP training model, then it doesn't make sense for you to defend it either.

point? where is the study that says hard science = better patient outcomes when your in practice? just because MDs and PAs do it a certain way, doesn't mean that its the RIGHT way, the BEST way, or the ONLY way.

Notice that I never said "hard science = better patient outcomes." What I did imply was that the basic sciences provide a better understanding of phys/pathophys/whatever so that when a patient deviates from textbook presentations, there's an understanding of the underlying pathology to guide the treatment plan. The more important part though, IMO, is that nursing midlevels receive only a fraction of the clinical hours of training that a board-certified physician gets. Until clinical data suggests otherwise and since the diagnosis/treatment of patients is based on both pattern recognition and analytical reasoning, logic dictates that more clinical hours of training = better patient outcomes.

 

[Hoody]

From what I understand, you're not an NP either (correct me if I'm wrong). So if I can't critique the NP/DNP training model, then it doesn't make sense for you to defend it either.

because I am a baccalaureate nurse thats worked alongside several students and graduates from NP programs? Because I heavily researched, applied to and was accepted to several NP programs?

Its pretty much the same thing as you all trying to tell me that because I was a "nursing" major that I took "nursing theory" science classes that were "easier" which is total BS. The seince classes that were required as PRE reqs for my nursing program were the same stupid science classes that the pre-meds, pre-dent, and pre-pharm students were taking.

I have waaaaay more experience with NP/DNP programs than you do an it goes waaaaay beyond regurgitating stats or simply looking up curricula online.

(this reminds of the time someone asked people if they would do a "distance" medical program and people shot back and were like, "no way, this isn't nursing, blah, blah, blah".....until someone came in and said that they were actually in such a program. Then everyone was cool with it. 🙄

My guess is that you would say any study that doesn't clearly state MD >>>>>>>> NP, you would find some statistical/methodology error.

Until clinical data suggests otherwise and since the diagnosis/treatment of patients is based on both pattern recognition and analytical reasoning, logic dictates that more clinical hours of training = better patient outcomes.

Clinical data hasn't suggested anything, one way or the other. Believe whatever makes you feel better, bro.

 

[Hoody]

Plus, I want to clear what you're asserting. Are you asserting that a NP can do an attending's job just as well? If you aren't, then what are you arguing exactly? Either you do or you don't believe they can do that job.

No, not at all. I am not arguing if they can or can't do a certain job. I hijacked the thread to tell the knowitall that he doesn't in fact know it all when it comes to the training of NPs/DnPs and that he should keep his incorrect information to himself.

 

[MilkmanAl]

where is the study that says hard science = better patient outcomes when your in practice?

Unintentional humor is always the best kind.

 

[smq123]

The issue is that FM is a 3 year residency, in which you're supposed to learn to diagnose every problem in any patient. How they're supposed to do that, I have no idea.

The purpose of residency is to teach you how to THINK like a primary care doctor. Not to learn how to solve every single problem, not to learn how to diagnose every single patient. To learn how to think through the steps needed to get your patients the care that they need.

Also, 60-65 hours a week during residency for FP? yeah right.

I'm an FM resident. I'm usually at 70 hours a week during residency; more if you factor in studying and catching up on articles. Depending on the rotation, I have topped out at 85 hours a week (I think...I fudged some of my hours so that I stayed under 80....). Due to "continuity of care" and whatnot, I have done 36 hour long shifts and stayed up for nearly 48 hours at a time.

A lot of med students think that it's an easy residency....because they get sent home a good 3 hours before the resident actually goes home or finishes their work. They also don't see us as we go from inpatient to outpatient to L&D to the ED back to outpatient.

I understand people in various primary care fields are concerned about midlevels taking their jobs, and I can appreciate that to a certain degree but honestly I think many of their problems are self-inflicted. In my experience the participation of NPs and other midlevels in patient care has been generally positive for everyone involved, and for the most part, midlevels have done a good job of practicing within their level of training.

Same could be said for dermatologists and DNPs.

Same could be said for anesthesiologists and CRNAs.

Same could be said for radiologists and teleradiologists. Why bother having radiologists in your building when you could send your images to a radiologist in India, who probably has more experience than a newly minted US radiology grad?

 

[Charles_Carmichael]

because I am a baccalaureate nurse thats worked alongside several students and graduates from NP programs? Because I heavily researched, applied to and was accepted to several NP programs?

I've researched the programs pretty well too. And I've had quite a few interactions with them too (there were several NPs who worked in the ER I used to volunteer in). For what it's worth, they seemed to agree with my views.

Congrats on your acceptances.

Its pretty much the same thing as you all trying to tell me that because I was a "nursing" major that I took "nursing theory" science classes that were "easier" which is total BS. The seince classes that were required as PRE reqs for my nursing program were the same stupid science classes that the pre-meds, pre-dent, and pre-pharm students were taking.

Except no one here said that...

I have waaaaay more experience with NP/DNP programs than you do an it goes waaaaay beyond regurgitating stats or simply looking up curricula online.

If you're already in NP/DNP school, then yes, you do have way more experience than the rest of us. If not, you don't have that much more experience (like you suggested) than the rest of us do. I'll definitely give you that your nursing experience with NPs/DNPs is definitely superior to what I have.

(this reminds of the time someone asked people if they would do a "distance" medical program and people shot back and were like, "no way, this isn't nursing, blah, blah, blah".....until someone came in and said that they were actually in such a program. Then everyone was cool with it. 🙄

My guess is that you would say any study that doesn't clearly state MD >>>>>>>> NP, you would find some statistical/methodology error.

Why would I say that? If a well-done prospective trial found no difference, I'd be more than happy to eat my words. The methodological flaws that exist in current NP/DNP studies aren't minor ones that can be overlooked. They're actually pretty huge flaws, especially in the JAMA Mundinger study that NPs love to cite so often, and sometimes I even feel like the PI purposefully designed the study in a flawed way to produce favorable outcomes.

If a medical study had big methodological flaws, I would be just as critical against it.

Clinical data hasn't suggested anything, one way or the other. Believe whatever makes you feel better, bro.

Wait. Didn't you just say in a previous post that a HUGE recent study (that a couple of us couldn't find) found no differences in outcomes even after accounting for difficulty of cases, etc? Now you're saying that clinical data hasn't suggested anything. I'm confused. And I'm still waiting for the citation to that study you mentioned.

 

[Hoody]

Unintentional humor is always the best kind.

prove me wrong, yo.

now that would be real funny...watching all you SDN'ers crap your pants when you find how overtained you are.

MD: the best way, the right way, the only way!!

 

[smq123]

prove me wrong, yo.

now that would be real funny...watching all you SDN'ers crap your pants when you find how overtained you are.

MD: the best way, the right way, the only way!!

Why do you like to make so much fun of MDs/DOs? Aren't you applying to med school? 😕 Why apply to be something that you make fun of so readily?

 

[Charles_Carmichael]

No, not at all. I am not arguing if they can or can't do a certain job. I hijacked the thread to tell the knowitall that he doesn't in fact know it all when it comes to the training of NPs/DnPs and that he should keep his incorrect information to himself.

Assuming you're referring to me, what have I said so far that's incorrect? I've said that NPs/DNPs receive less basic science training than physicians do. That's pretty well established. I've also said that NPs/DNPs receive less clinical hours of training than physicians do. Can't really see how you'd argue against that. And I've also said that there are no well-designed studies providing evidence that patient outcomes for NPs/DNPs practicing independently are equivalent to that of attending physicians. You mentioned that there was a recent study that suggested otherwise. A couple of us couldn't find it and then you said that "clinical data hasn't suggested anything."

Sooooo, what exactly did I say that was incorrect? 😕

prove me wrong, yo.

now that would be real funny...watching all you SDN'ers crap your pants when you find how overtained you are.

MD: the best way, the right way, the only way!!

And the evidence suggesting that physicians are overtrained exists where? Or are you just flinging insults now without any actual evidence to support your statements? And I'm also curious as to why you're pursuing medicine if you think physicians are overtrained and that NPs/DNPs can provide equivalent care. Seems like an awful waste of time and money, especially considering that you've gotten accepted to NP school.

 

[Hoody]

end hijack/, Time for pizza and NUGGETS game. Birdmannnn, bacaaaaaa.

In your face, Kobe. Its the Ty Lawson show tonight, baby!!! New record for consectuive 3's. The little man, holla!!!!!!!!!!!!

/back to thread.

 

[MilkmanAl]

prove me wrong, yo.

now that would be real funny...watching all you SDN'ers crap your pants when you find how overtained you are.

MD: the best way, the right way, the only way!!

You really want someone to do a study on whether or not learning, say, pathology helps treating patients with pathologies?

 

[Hoody]

You really want someone to do a study on whether or not learning, say, pathology is beneficial to treating patients with pathologies?

no. I want you to find some study out there that proves that more hard science training = better patient outcomes overall (not in a particular subject, like the pathology you mention - duh). pretty easy to comprehend, eh?

And you act like medical school is standardized or something.

Let me guess, your one block of pharmacology definitely makes you >>>> then a pharmacist because it was "medical school pharmacology" and "very intensive, much more than what a pharmacists would be subject to."

 

[Hoody]

In your face, Kobe. Its the Ty Lawson show tonight, baby!!! New record for consectuive 3's. The little man, holla!!!!!!!!!!!!

/back to thread.

well shizzz, now I'm confused. 😕

 

[coldweatherblue]

now that would be real funny...watching all you SDN'ers crap your pants when you find how overtained you are.

This post highlights a consistent difference I've observed between physicians and mid-levels.

I repeatedly hear the idea from nurses that it is somehow possible to be "overtrained" when taking ultimate responsibility for someone's health. I disagree. I want all the training I can get before having that responsibility. I do not think residency should be shorter, nor have I considered my education to this point to be superfluous. Most of the attendings I speak with highlight the amount of learning that takes place during the first few years after residency, and remark that they continue to learn every day in order to stay current. Many nurses and mid-levels, like yourself, consider continuing education and comprehensive medical training to be overkill. They have the luxury of holding this opinion because they will never have ultimate medical and legal responsibility for their patient's health. It is a luxury; be glad that you can sit back and critique physicians as being "overtrained." Personally, as someone who will very soon be responsible for making decisions which will directly affect my patient's outcomes, I'll take all the training I can get.

 

[Hoody]

Assuming you're referring to me

I was actually referring to the BigHorse dude poster thats in love with me.

And the evidence suggesting that physicians are overtrained exists where?

The same place that your evidence that suggest nurse practitioners are under trained. 😉

And I'm also curious as to why you're pursuing medicine if you think...

I can't do transplants as a NP...although I could still be highly involved in the whole process.

Seems like an awful waste of time and money, especially considering that you've gotten accepted to NP school.

Its not about money....and I will age no matter what choice I make.

 

[MilkmanAl]

no. I want you to find some study out there that proves that more hard science training = better patient outcomes overall (not in a particular subject, like the pathology you mention - duh). pretty easy to comprehend, eh?

More training in a particular subject is more hard science training. Nobody will do a study on whether or not getting trained in the nuts and bolts of something makes you better at that thing because the answer is obvious...to most people. Pretty easy to comprehend, eh?

And you act like medical school is standardized or something.

It's not? Better let the LCGME know.

Let me guess, your one block of pharmacology definitely makes you >>>> then a pharmacist because it was "medical school pharmacology" and "very intensive, much more than what a pharmacists would be subject to."

That actually sounds quite a lot like your argument. 😕

 

[Charles_Carmichael]

no. I want you to find some study out there that proves that more hard science training = better patient outcomes overall (not in a particular subject, like the pathology you mention - duh). pretty easy to comprehend, eh?

And you act like medical school is standardized or something.

Let me guess, your one block of pharmacology definitely makes you >>>> then a pharmacist because it was "medical school pharmacology" and "very intensive, much more than what a pharmacists would be subject to."

Medical school is standardized. The LCME (?) is pretty strict regarding what medical curricula should be like. And I understand that the ACGME sets minimum requirements for the completion of residency. Others can correct me if I'm wrong about that last part. Can't say the same for NP/DNP schools though.

And no one has said the physicians >>> pharmacists in terms of understanding pharmacology. In fact, it's the opposite. I've often had physicians say how much they love having a clinical pharmacist around.

Now you're just making up arguments.

The same place that your evidence that suggest nurse practitioners are under trained. 😉

In the absence of evidence, the best we can really do is make rational decisions based on logic. And, like I mentioned earlier, logic indicates that NP/DNP do not have equivalent outcomes as physicians do considering the vast difference in training. If future studies suggest otherwise, I'd be more than happy to admit I was wrong.