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Second look at primary care?
Started by kansaskid
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I can say whatever, this isn't a journal article, I dont need to cite sources to back up my opinion. Interestingly enough, most of my med student female friends go to NPs for their PC
Truth. A good pharmacist is an amazing resource, to say the least.
You're more than free to express your opinion; I didn't mean to suggest otherwise.
Just be aware that your opinion isn't supported by existing evidence. That's all I'm saying.
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deleted212936
That's exactly my reaction when I heard Derm was competitive And in all 4 years of med school, you only take ONE Pharmacology course.
I disagree. If you look at two different curicula, you will notice that they are completely different. You will also notice that some schools teach to the boards, and some don't. I wouldn't call that "standardized" in the traditional sense. You might have a student form school A who had a month more training of XXXX and student B who from a different school who had two months training of XXXX. Does that mean student B is going to have better patient outcomes because he had more training? Um, no. not even close.
It was a dig at SDN's hollier than tho attitude. That no matter what, docotrs are the best and they had it harder. Ya know, walking both ways uphill, naked and in a blizzard? "If you didnt study anatomy at medical school, then you couldn't possibly know as much about anatomy." So not true....just more SDN rhetoric.
you make them up too. see the post where you said "until studies prove otherwise" when they haven't even proved your point in the first place?
who's logic? your logic? SDN's logic?
Hoody, I'm pretty sure by your own logic that you have no standing to discuss MD/DO training.
"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. "
You're also making BSNs and NP students look like a bunch of tools. You should take a break from posting.
and my SO's reaction when he heard that radiology was competitive.
👍
Wait until the malpractice lawyers start hunting down NPs/DNPs. Suddenly everyone wants more training!
Um, again, medical school is standardized. Even with slight variations (ex. PBL vs. traditional vs. integrated curricula), you still learn the same information. Not only that, you have Step 1 after the basic sciences ensuring that everyone ends up learning the same information. And in the clinical years, from what I understand, you have standardized shelf exams, etc, built in to establish minimum competency.
Additionally, even with the variances in curricula, there's actually literature that shows no difference in board scores, etc, between PBL and traditional, etc.
Here's a link to the accreditation standards set by the LCME: http://www.lcme.org/functions2010jun.pdf
Except it's pretty rare to see such a sentiment on SDN...the only time when I see SDN'ers saying "doctors are the best" is when the topic is related to the practice of medicine. I've never seen anyone saying doctors are better at law than lawyers are or that doctors are better at business than businessmen are, etc.
Except I didn't make up anything. In the absence of evidence, I made a rational conclusion based on the fact that physicians receive far more training than nursing midlevels do. If you want me to put it another way, I basically said that chemists are better at chemistry than biologists are since chemists receive far more training in chemistry. So, where exactly did I make something up? 😕
oh, you mean they arent already? perhaps you should tell that to the two NP's I work with who are currently under the gun.
(not to be limiting, I also work with a DO who is going for her 3 suit and an MD for her first).
D
deleted307836
This is what I don't understand about Hoody's postings.
IMO, I still see them as non-standardized because they each have different curricula and spend different amount of time on different subject. If I were making a rational, logical decision based off this information, I would say that the amount of in depth science training doesn't really correlate to better patient outcomes. You could spend 3 years learning organic chem, and still have ****ty patient outcomes compared to the guy that took it for one semester, or the guy how didn't take it at all.
I wholeheartedly disagree. It is all over the place. SDN is filthy with it. And if its not explicitly spelled out, its obviously distinguishable from the tone of the post.
Okay, so you made an opinion. Doesn't mean that its in any way close to the truth.
I was arguing with AL who said that it was funny that I said that hard science traning doesnt equal better patient outcomes. It doesnt - show me a study that says the amount of time you spent in organic makes a difference in your patient outcomes. It doesnt. Then Al tries to come back with some pathology anaology where someone who is specializing in patholoy is obviously going to benefit from extra training in...pathology. Um, DUH?
Not nearly at the same rate. Between 1990 and 2004 (14 years!) only 350 suits were filed against NPs. 25% of MDs/DOs are sued ANNUALLY. Additionally, 80% of all malpractice suits are against MDs/DOs. NPs/DNPs, as it stands right now, are pretty effectively shielded against malpractice, especially in states like California where physician oversight is pretty much required.
I know its hard to understand that I am interested in being a doctor but that at the same time I highly disagree with the way most posters on SDN generalize nurses and the training of nurses.
...tough subjects we are tackling today.
So they are still getting sued and have to be fearful of such. That's what I thought....
Did you miss the first sentence? It's EXTREMELY rare for an NP to be sued. If you look at what they were sued for, it's usually some stupid equipment/billing problem. This is because most of the clinical judgement they make are under physician oversight (at least legally).
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deleted307836
I wasn't referring to the subject matter of your posts but rather the unnecessary antagonism that is a hallmark of many discussions you becoming involved in -- as evidenced by the bolded.
For the record I think you do have some legitimate points, particularly when it comes to premeds thinking that they know all about nursing based on what they've read on SDN. But the level of emotionality that you bring to these arguments is puzzling, and the insults are off-putting and heavily detract from any point that you may be trying to make.
no, I read it. It said that like MDs, NPs are too being sued. lame sauce.
oh, is that whats is usually for? well who care then, its like they really aren't even being sued.
um, yeah, sure, whatever you say......
Let's not make this personal, okay? This isn't about me, or about medical school being too good or nursing school not being good enough. My original argument is about the fact that in general, most SDN'ers have NOT A FREAKING clue what goes into NP/DnP training other than what they looked up on a few random web sites (if they even did that) and what they can regurgitate from other posters who obviously feel extremely threatened and insecure by their presence. bink!
My favorite one was the last one: "Um, yeah, sure, whatever. Like the law? Who cares, you know?"
In other words, you were wrong, and NPs are not legally liable for clinical judgements as it stands.
And you'd be wrong.
You need to stop jumping from pre-reqs to medical school and actual medical education. Medical education, you know, the things you learn in medical school, is standardized. We're discussing medical education, which doesn't teach or emphasize organic chemistry. Not the pre-reqs. So your bolded statement is irrelevant to this discussion.
Tone is hard to pick-up when you're looking at an online post. You have your opinion on this matter and I have mine. Either way, neither of our opinions on this issue is relevant to the topic at hand.
Considering that there's no convincing evidence suggesting otherwise, my conclusion is likely the most reasonable one to come to rather than assuming that there's parity between NP/DNP and physician outcomes.
Again, you're not distinguishing between pre-reqs to med school, which don't really have any direct bearing medical practice, and actual medical training. No one has said that there's a correlation between the amount of organic chemistry training you get and patient outcomes.
And Al's comment was pretty relevant to the discussion. He wasn't talking about pathologists. You do realize that all medical specialties treat pathologies right? How about this instead: you really want someone to do a study that whether or not learning about diseases actually helps in treating patients with diseases?
ha, please. like all of SDN isn't overly emotional?
and sometimes you have to be a bitch to get your point across. Just like one of the attendings around here said you have to be a dick sometimes to get the nurses to listen.
fixed. for accuracy.
Okay, now I'm pretty sure we are arguing different things at this point...and the OP is MIA (love when they do that).
Hmm... I figured you were the one making it personal delving into the details of your own training.
Is it safe to say that you don't REALLY know what goes into MD training?
I'm not downplaying the role of NPs in a clinical setting. In fact, I think they can provide adequate care and help cut down on costs for clinics and healthcare in general.
However, the people I know who have gone through nursing or NP and then pursued MD have said that medical is a different beast in and of itself. JMO
pretty much so, along with all other pre-meds in here. I work with doctors daily (for years) and have dated a doctor (for years) but I still probably be very surprised when I'm in the mix.
it may be. but that still doesn't change the fact that good chunk of posters around here have no clue what they are talking about when they discuss nurse training. At one of the NP schools I applied to and interviewed at, I was told that I would be doing year long rotation with internal medicine residents. Not saying thats something to brag about, but how many SDN posters really would think that an NP would spend a whole year alongside residents when they don't even get any "medical training"? What else do they do that SDN'ers dong know about? Lots.
Furthermore, the beastly difference between NP and MD school may be notable, but that still doesn't significantly change patient outcomes. NPs are not killing patients left an right with their inadequate science/medicine training.
I haven't seen many (errr, any) NPs go MD, you?
I had a classmate who was an NP, but went back to med school (for increased autonomy, etc.)
She said med school was a WHOLE different beast. She had just as much stuff to learn as any of us did.
For what it's worth, my information isn't from random sites. I've actually spent a lot of time not only looking at the actual websites of NP/DNP programs to see what their curricula is like, but also reading the existing body of literature. I'm sure you've seen my curricular analysis several times so I won't waste your time by posting it here again.
And please, please, please don't think that physicians/physicians-in-training are threatened by NPs/DNPs! 🙂laugh🙂 Physicians will continue to be the "top dogs" (or whatever you want to call it) in terms of delivery of medical care by the sheer fact that they receive the most training in the practice of medicine. With the severe lack of patient outcome data, it should really be the patients who should be worried. I just find it a bit ironic that nurses, who pride themselves in being patient advocates, continue to push for full independence without convincing evidence supporting them.
Except even you admitted that the clinical data doesn't suggest that...
If I remember correctly, there actually used to be several NP-turned-physician posters who used to post in the Clinicans forums here on SDN. I don't think they're active anymore but, like smq mentioned, they mentioned that NP school didn't make medical school any easier for them compared to their classmates. You can probably find their posts in the old NP/DNP threads in the Clinicians forums if you wanted.
A good chunk of posters don't know what they are talking in discussion of many things.
You don't. But you also don't see a lot of family practice docs go around killing a bunch of patients (or bringing patients from the brink of death for that matter) because it's not within the scope of patients they see on a daily basis. Patient outcomes in a general clinic setting is iffy anyway. From the rural clinics that I was involved in, the NPs handled the majority of case loads and referred those cases they felt as out of their scope (mainly procedural type cases) to the family doc. At the end of the day (or week rather) the family doc signed off on all the charts.
I've always figured what scared most people about NPs are people who think that some NPs won't recognize their boundaries of care (same goes for doctors in general) or those doctors who feel like their livelihood is threatened if NPs gain more autonomy in various states.
Not close friends. But friends of friends, you know how that is. But most looking for something outside of the scope of general medicine.
Physician oversight isn't required in every state, or every setting, but I've seen this. I've seen doctors whip through about 90-100 charts that were handled over the week. For Lucious to insinuate that doctors actually sit down and read each individual chart is completely false (and goes back to SDN'ers generalizing and making assumptions). They are supposed to, yes, do they, not always.
One of the doctors being sued that I mentioned was due to a NP not running a pregnancy test on someone whom the doctor signed the chart off on. They both went to court. Doctor oversight doesn't mean that NPs are being safer or making better decisions or that the NP is less likely to be sued, etc. I mean, he (Lucious) is insinuating that the doctor, who is supposedly more competent, is being sued more often....so why, if MDs were that much into mirco managing NPs, wouldn't NPs be sued more often too? Consider me confuzzled.
And isnt it true that FPs in general are the least sued of all specialities? Not sure but I think that had to do something with Patient report. Which could be why NPs are sued less (not to mention that there are less practicing NPs than there are MDs?)
I said that the clinical date doesn't say that NPs have lower patient outcomes when compared to physicians. Which is exactly what I am saying when I say, med school and nursing school are different, however, clinical data shows that there isn't a difference in the outcomes of their patients so it doesn't really matter if they are different. Again, I'm not one of the lemmings who think med school is the best and the only way. Until its proven to be, I wont believe that it is. Until its proven not to be, you wont believe that its not.
So med school is hard, who woulda thought? I bet NP school is a walk in the park. Getting back to training and patient outcomes...
First of all. LUCIUS. IT'S LUCIUS. How dare you not recognize the name of the hero of the 13th legion.
Secondly, you missed my point. I know that doctor's don't actually go through the charts line by line. The clinic I've been at for a year has 1 MD and 4 NPs+1 PA, and the MD just kind of skims the more at risk charts then calls it a day.
The point is that, as it stands, NPs will either go to court with the MD, as you mentioned, or not at all (the MD is liable, after all he's the one who signed off on it). You're looking at this from a clinical viewpoint and not a legal one. As a malpractice attorney, which is the better target?
When NPs actually get full practice rights and there isn't an MD to blame anymore, I can almost guarantee you NP malpractice premiums will skyrocket. Then, everyone will want more clinical hours, more coursework, more standardization across schools, etc etc.
Just curious, how many practicing NPs are there? 400? cause 350 out of 400 would be a lot. And out of that, how many of those are FNP's? And out of that 350, how many had physician oversight?
Stats like those would be a lot more insightful into your thoughts.
And if you honestly think that NPs aren't legally liable, then you don't even deserve a real response.
Just curious, how many practicing NPs are there? 400? cause 350 out of 400 would be a lot. And out of that, how many of those are FNP's? And out of that 350, how many had physician oversight?
Stats like those would be a lot more insightful into your thoughts.
And if you honestly think that NPs aren't legally liable, then you don't even deserve a real response.
400? Are you serious? You think there are only 400 NPs/DNPs in the entire country?
"According to the "National Sample Survey of Registered Nurses 2008:Initial Findings" (Health Resources Services Administration, 2010), in 2008, there were an estimated 158,348 nurse practitioners with credentials as NPs in the United States, an estimated increase from 141,209 in 2004."
"There are 10,959 nurse practitioners in California." Since I'm only familiar with California laws, I can say that at least 11,000 of the NPs in the United States have physician oversight (most states have laws similar to, or stricter than, California regarding scope of practice, so this number is probably higher). Also, 90% of NPs in California practice primary care.
Does 350 still sound like a large incidence rate to you?
NPs already are practicing independently. In 2007, there were 10 states in which NPs could practice fully independently, only 11 states in which they had to have physician oversight, and 27 states were MD collaboration was required.
http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf
A newer site indicates more independence...
http://timeswampland.files.wordpress.com/2009/05/nncc-guide-to-np-practice-regulations-2008.pdf
No, I didnt think so, I just didnt know how many. When you say things like "only 350", you should include 350 out of how many.... Now that were staring to get somehwere, how many physiancs are there? and how many in FP?
So, since physicians are being sued so often (at a much higher rate than NPs), how would physician oversight make them less likely to be sued? Your statements are, like, contradictory.
This thread is out of control. Someone insert bored person (Hoody) turned troll is unsuccessful meem already.
He's obviously just bored on a sat night.
He's obviously just bored on a sat night.
no one else is posting citations either. do you own work. 🙂
MD collaboration = MD oversight in nicer terms. Look up the wording of the laws themselves, the MD is still liable for mistakes the NP makes. As far as I'm concerned, 38/50 states is a majority, not taking into effect the fact that the states where NPs can practice independently tend to be the less populous states.
You're not listening! Being sued has nothing to do with how competent you are. Physican oversight would not make NPs more likely to be sued, it would make them LESS likely. The key word here is liability. Physicians are sued more often than NPs because they are usually the ones held liable by plaintiffs/malpractice lawyers. Once NPs gain full, independent practice rights nationwide their malpractice will go up.
maybe so, but not exactly. if it were the same, they would call is "MD oversight requires" - ya know, the other category they already have.
And it still doesn't answer my question - If MDs are sued so often (so much more than NPs) than how come all these NPs who have MD oversight aren't sued as much?
Still off topic, NPs get sued and have to worry about liability - even if its less often than physicians and even if you don't want to believe they do. Denial doesnt make things nonexistent.
See above post. You probably missed it.
I don't follow your logic. You need stats that say how many of the 350 NPs that were sued had physician oversight - then you could better make such correlations
And its 2011. Where are your stats from 2004-2011? My guess is that the numbers have changed a bit, as you say, as NP as profession grows.
How many practicing physicians are there? How many were sued? How many are in FP? How many of those that were sued were FP....?
peace out. 👍
oh, and thanks for the two post contribution. good work tonight!
Oh wait, make it three posts!
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