Should NP Programs be More Selective / Increasing Prestige for Mid-Level Providers

[rdonahue87]

This is probably discussed somewhere else, but lately I've been at a crossroads in my career where I'm just sort of frustrated with my profession and the lack of respect we get from physicians. Unfortunately, I think a lot of that may be earned.

Case in point...

I am currently an FNP enrolled in a PMHNP program at a relatively prestigious university (US News has it top 5 in America). This is a post-master's certificate program that is only open to currently licensed, practicing NPs. I have no idea if this program is very selected because I did not ask anyone at the university about the admissions acceptance rate and this was the only program I applied to.

We just had our psychopharmacology midterm. A lot of my classmates were stressed out because this class is traditionally regarded as "hard" and the most difficult class in the program. As someone working multiple jobs I didn't have much time to put any effort into prep for this class and figured as a practicing NP I already know a lot of psychopharm even though I work in family practice. I watched the lectures (at 1.5 speed) and did little else. The exam was proctored via video. I suppose you could cheat, but I didn't want to figure out a way to do this so I took it the way we are supposed to. The exam was multiple choice (4 choices per question) and I ended up with an A on what I thought was a pretty simple exam.

Now that the exam is over I just looked at the class average was 79.4% with low of 32%. That low F is clearly pretty bad especially considering random guessing would yield 25%. The part that scares me is this isn't just some random person way over their heads. He/she is currently a practicing provider. What's even scarier, is I looked at our syllabus and assumed that this person gets a 32% on the final exam but completes all the other coursework with 100% (which is pretty likely since class average is 90-95%+ on these exercises). If this person does that they will just barely pass. But it gets worse - the instructor also offers extra credit which will provide further breathing room. Based on the way the course is graded, if you get 100% on all the fluff assignments and do the extra credit, you only need to score 19.3% on the exams to pass the course.

Obviously this is just one example, but this is quite appalling. Maybe med school is the same way and med students just like to hype how stressful everything is, but I can't imagine this is the case. If you score 32% on pharmacology tests in an online class, you should not be prescribing these medications. Period.

I realize there is a huge lack of providers in this country, but pumping out providers this way does not seem to be the solution. This system can't possibly sustain itself.

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[shevchenko277]

Congrats on getting an A on the exam! You seem like a good provider. However, I agree with you this is appalling since in medical/dental/optometry/PA/podiatry/veterinary/pharmacy school, there’s no way someone can pass a class with a 19.3 % on their exams. Exams usually make up all or most of the grade and there sometimes may be quizzes etc. worth a small amount. Minimal extra credit and no fluff assignments at all especially in a class like that. I understand that most people are working as well in a PMHNP program but the academic rigor doesn’t compare at all to any of the health professional schools I listed above. I do agree that students like to hype the stress in general but your comparison to med school is apples to oranges. Continue to do well in your program so you can become the best nurse practitioner you can be to serve your patients.

 

[Noisewater-TDX]

As a RN that went the med school route I can tell you written exams are pretty much it as far as grades go. We had some fluff grades, but they were few and far between.

And yes. NP entrance requirements need to be similar to CRNA ones. 2-3 years in ICU or high acuity units. Or 5-6 years in general med floors.

 

[deleted941485]

There is no quality control anymore. Hospitals/Clinics need cheap warm bodies to churn through patients and schools are glad to take students and push them through so long as they pay tuition. Any attempt at slowing this system down will be met with derision and hand waving about free markets and antitrust issues while employers simply respond by paying you less and less.

 

[rdonahue87]

The thing is I don't really care about the grades necessarily. I mean NPs don't need residencies so as long as you pass your boars, nobody will ever know. But I mean I put close to 0 effort into this test and found it quite simply. I would assume most any family practice physician would have easily passed this exam even though they (almost certainly) never prescribe antipsychotics.

While I'm also nitpicking, I find it incredibly obnoxious that my instructor feels compelled to have every single degree he's ever earned next to his name - even his multiple degrees in divinity studies which obviously have nothing to do with nursing. He even feels compelled to list his DNP, MSN, BSN, and ADN all as part of his signature even though each of those degrees implies the next one.

I guess I should start signing my name Ryan Donahue, MSN, BSN, BA, ADN, AS, AA, FNP-C, APRN, PHN, RN just so I can look cool too

 

[shevchenko277]

LOL I don’t think the alphabet soup thing looks cool. The MSN or DNP implies the rest were done to me but maybe some people have their reasons for this.

 

[deleted6669]

If you have a masters in a relevant field and a doctorate I could see listing both like PA, MPH, PhD but if one has a masters in the same field as their doctorate or if their primary title implies a masters just the doctorate should suffice. I sign PA, DHSc

 

[shevchenko277]

If you have a masters in a relevant field and a doctorate I could see listing both like PA, MPH, PhD but if one has a masters in the same field as their doctorate or if their primary title implies a masters just the doctorate should suffice. I sign PA, DHSc

Yes, in cases like that, I agree Emedpa.

 

[rdonahue87]

If you have a masters in a relevant field and a doctorate I could see listing both like PA, MPH, PhD but if one has a masters in the same field as their doctorate or if their primary title implies a masters just the doctorate should suffice. I sign PA, DHSc

See, that makes sense to me. My collaborating physician puts MD, MPH on her business cards. She also has a degree in nutrition sciences but she does not mention that. She also doesn't list her board certification on her business cards either despite the fact she is board certified in family practice.

The problem is, my particular professor writes DNP, DMin, MSN, MDiv, BSN, BA, ARPN-CNP, PMHNP-BC, ANP-BC, CARN-AP, FIAAN and that's just crazy to me. For one, the DNP is basically a higher version of the MSN and BSN so those two can go. The DMin is higher than the MDiv so you can lose the MDiv (and really DMin has nothing to do with medicine so it should go, too). I have no idea what his BA is in but it's irrelevant because it's either related two his DNP or it's in something like public health which is theoretically interesting but it's such a lower degree that nobody cares. His a PMNHP and ANP so the APRN-CNP can go away. I suppose the CARN-AP is allowable as it's an addiction board certification and being a fellow (FIAAN) is somewhat relevant. But realistically this is a PMHNP program so those other certifications are irrelevant. I have a PHN which is something extra I chose to add, but I've never once signed PHN after my name.

Back to my initial topic, I think NPs like to add an alphabet soup after their name to further "prove" they're relevant compared to MD/DOs because physicians always have fewer letters after their name. A better solution would be to add some prestige to these programs and stop letting people that get 32% on tests try to pretend they're equivalent to psychiatrists. Even scarier, the test was already a dumbed down version of what we had to learn. The instructor made it very clear that learning specific receptors was beyond the scope of the course and not to bother. As long as we knew what serotonin, dopamine, and norepinephrine do that's good enough.

 

[Ho0v-man]

So in first semester of med school, they let us retake one exam if we failed but our max score was a 70 on that test. That’s about the only part we got treated with any mercy. While med students live to complain, you can’t just wing our exams like this.

So even though there’s little incentive to try, please crush your curriculum and try to go beyond it. Peoples lives will depend on it very soon and it sounds like your school doesn’t care.

 

[rdonahue87]

Probably the wrong place to ask this, but this got me to thinking...


So I know med students are quite motivated and invest a TON of time outside of school studying and all that. But is this because med students are, by nature, really devoted students or simply because they have no choice? Basically, is it that 100% of med students devote hours and hours of study time because it's the only way to get through or are there a few exceptions?

I don't mean to compare RN/NP school to med school, but in my RN or NP programs I felt like most of my classmates spent tons of time outside class and stressed how difficult it was. I was never this type of student and mostly go to class, spend a small amount of time at home studying and pretty much call it good. This has pretty much been my academic model my entire life and outside of a few years at a major university where it didn't work out at all (i.e. I got a lot of C's) I have pretty much been a 4.0 student my whole life. Are there any med students that have this type of study habit, or even somewhat similar? For example, are there med students that basically show up, spend an hour or two a day studying, and at least do average in their class? (Note: I'm not trying to say I could be that type of student or plan on doing anything like that, I'm just genuinely curious). Perhaps any wasn't the best choice as I'm sure nationwide there is at least 1 student that does this, but you get my idea.

 

[Ho0v-man]

It’s not because we’re super motivated or so hyper competitive that we just want to be the best. It’s genuinely so ridiculous that you just have to put in the time. Ask any NP who went to med school. The two really don’t compare at all. You’re just a big fish in a small pond.

 

[shevchenko277]

Probably the wrong place to ask this, but this got me to thinking...


So I know med students are quite motivated and invest a TON of time outside of school studying and all that. But is this because med students are, by nature, really devoted students or simply because they have no choice? Basically, is it that 100% of med students devote hours and hours of study time because it's the only way to get through or are there a few exceptions?

I don't mean to compare RN/NP school to med school, but in my RN or NP programs I felt like most of my classmates spent tons of time outside class and stressed how difficult it was. I was never this type of student and mostly go to class, spend a small amount of time at home studying and pretty much call it good. This has pretty much been my academic model my entire life and outside of a few years at a major university where it didn't work out at all (i.e. I got a lot of C's) I have pretty much been a 4.0 student my whole life. Are there any med students that have this type of study habit, or even somewhat similar? For example, are there med students that basically show up, spend an hour or two a day studying, and at least do average in their class? (Note: I'm not trying to say I could be that type of student or plan on doing anything like that, I'm just genuinely curious). Perhaps any wasn't the best choice as I'm sure nationwide there is at least 1 student that does this, but you get my idea.

I agree with the big fish in a small pond analogy. The first two years of Optometry school, we shared the same basic science classes with the dental/med students. An hour or two of studying a day wouldn’t be enough to survive let alone be average. However, dedicated students such as yourself would succeed wherever as long as they put in the work.

 

[RomeoNP]

These posts are always built on massive blanket statements like every NP student is exactly the same. At the end of the day we are adults responsible for ensuring that we get the best possible education. I went to a well known and respectable program, and I am about to take a job at nationally known teaching hospital working alongside addiction fellows and great attendings as well as experienced Pmhnps, my program opened doors for me but I am the one choosing to use my first two years of work experience to get as much experience and education as I can. NP schools would benefit from having a universal standard and eliminating diploma mills but I feel like at this point you are beating a dead horse. And especially here, these discussions often devolve into unproductive NP bashing sessions.

 

[Splenda88]

It's one of the reasons i left nursing and went to MD school. I had my AS at a CC and I thought the program was pretty good.

Then I went on to get my BSN at a state university while I was working 24 hrs/wk. I was taking a class called 'health assessment'. Prof was an older NP (probably >65 y/o) and I thought she was great. The class required some reading in order to do well. I heard people complaining how hard the class was. This class was not hard nor easy; it just required some reading in order to do well. I saw the prof after the class was over and she told me she will no longer teach the class because people went to administration and complained about her, administration decided to pull her out.

That was when I realized this profession is ok with mediocrity (and even promote it TBH), and I started looking into medicine. Took med school prereqs while I was completing my BSN.

Looking at these NP programs, I am having a hard time believing there are good ones out there.

 

[Splenda88]

The thing is I don't really care about the grades necessarily. I mean NPs don't need residencies so as long as you pass your boars, nobody will ever know. But I mean I put close to 0 effort into this test and found it quite simply. I would assume most any family practice physician would have easily passed this exam even though they (almost certainly) never prescribe antipsychotics.

While I'm also nitpicking, I find it incredibly obnoxious that my instructor feels compelled to have every single degree he's ever earned next to his name - even his multiple degrees in divinity studies which obviously have nothing to do with nursing. He even feels compelled to list his DNP, MSN, BSN, and ADN all as part of his signature even though each of those degrees implies the next one.

I guess I should start signing my name Ryan Donahue, MSN, BSN, BA, ADN, AS, AA, FNP-C, APRN, PHN, RN just so I can look cool too

My first pharm test in med school was like a p-chem test and I attended probably a bottom 25 med school.

While there are a lot smart nurses, I can tell you that the two cohorts (nursing and med students) are completely different in term of IQ and work ethic.

True story: I had a guy in my class in med school who went to administration complaining that our anatomy professor should not have a 2-hr review session before exams because the professor was telling us the topics to spend most our times on, and he studies too hard to get his grades... The school made the professor stop these reviews and I believe close to 25% of the class failed and had to repeat it.

Most people hated the guy after that and he did not seem to care. He is a PGY3 neurosurgery...

 

[Splenda88]

As a RN that went the med school route I can tell you written exams are pretty much it as far as grades go. We had some fluff grades, but they were few and far between.

And yes. NP entrance requirements need to be similar to CRNA ones. 2-3 years in ICU or high acuity units. Or 5-6 years in general med floors.

Med schools seem to pay lip service to extra credits... We had a few extra credit that were 3-5% for many of our classes, but they can only be counted after your average is 70%+ in all exams...

Writing papers, which is a big thing in nursing school was non existent in med school. I only wrote 1 paper (out of 2 research papers) of < 2 pages during MS1 for a B$ professionalism class.

 

[pamac]

My first pharm test in med school was like a p-chem test and I attended probably a bottom 25 med school.

While there are a lot smart nurses, I can tell you the that the two cohorts (nursing and med students) are completely different in term of IQ and work ethic.

True story: I had a guy in my class in med school that went to administration complaining that our anatomy professor should not have a 2-hr review session before exams because the professor was telling us the topics to spend most our times on, and he studies too hard to get his grade... The school made the professor stop these reviews and I believe close to 25% of the class failed and had to repeat it.

Most people hated the guy after that and he did not seem to care. He is a PGY3 neurosurgery...

For anatomy? 25% of the class failed anatomy? What did those that failed do in undergrad while all of the other premeds were boning up on anatomy in all its forms?

Sounds like that dude was a former anatomy TA with maybe a little bit of savant in him from being on the spectrum. Probably his best chance to bust the curve to level things out for a bunch of folks he didn’t care a bit about throwing under the bus.

While we are on the subject of folks that seem to be a bit lacking in self awareness, you single handedly came in and fulfilled the prophecy that RomeoNP made regarding this conversation devolving into an NP bash session.

 

[Splenda88]

Probably the wrong place to ask this, but this got me to thinking...


So I know med students are quite motivated and invest a TON of time outside of school studying and all that. But is this because med students are, by nature, really devoted students or simply because they have no choice? Basically, is it that 100% of med students devote hours and hours of study time because it's the only way to get through or are there a few exceptions?

I don't mean to compare RN/NP school to med school, but in my RN or NP programs I felt like most of my classmates spent tons of time outside class and stressed how difficult it was. I was never this type of student and mostly go to class, spend a small amount of time at home studying and pretty much call it good. This has pretty much been my academic model my entire life and outside of a few years at a major university where it didn't work out at all (i.e. I got a lot of C's) I have pretty much been a 4.0 student my whole life. Are there any med students that have this type of study habit, or even somewhat similar? For example, are there med students that basically show up, spend an hour or two a day studying, and at least do average in their class? (Note: I'm not trying to say I could be that type of student or plan on doing anything like that, I'm just genuinely curious). Perhaps any wasn't the best choice as I'm sure nationwide there is at least 1 student that does this, but you get my idea.

There will always be some people with photographic memory in any field that do not have to study a lot. I don't remember if there was one like that in my class. I was one of the lay back person and still I was studying 6+ hrs day in MS1 and 8+ in MS2 since attending classes was not mandatory in MS2.

 

[Splenda88]

For anatomy? 25% of the class failed anatomy? What did those that failed do in undergrad while all of the other premeds were boning up on anatomy in all its forms?

Sounds like that dude was a former anatomy TA with maybe a little bit of savant in him from being on the spectrum. Probably his best chance to bust the curve to level things out for a bunch of folks he didn’t care a bit about throwing under the bus.

While we are on the subject of folks that seem to be a bit lacking in self awareness, you single handedly came in and fulfilled the prophecy that RomeoNP made regarding this conversation devolving into an NP bash session.

Most of the 25% passed on repeat . I struggled in the class as well even if I was a nurse. That class almost drove me into clinical depression because it would have been the first class that I failed in my life.

Now looking back at everything, I think my school promoted "uncooperative" behavior. in the way they reported grades:

Our grades for every single test were reported ike that:

Your score: 72
Class rank: 63
Class average: 80
Standard deviation: 10
Highest score: 95
Lowest score: 49


It is not NP bashing. My spouse is about to start NP school.

 

[pamac]

It is not NP bashing. My spouse is about to start NP school.

You can have friends of a different race and still be bigoted towards that race.

At this point, it’s apparent that you have no respect for NP education, so you are quite the sellout by not convincing your wife to go to medical school. She certainly isn’t going to “go the extra mile” to obtain gold standard education at the level that would satisfy you. Is she going to be one of the good NPs that stays in her lane and collaborates with no daylight between her and her supervising physician? Sure she will.

Nah, she will do just what you think the majority of NPs do, because why not? If she was going to put in all the extra work and time to meet your standards, she’d just go to medical school, wouldn’t she? Or maybe she’d go be a PA and stick to the medical model.

Your buddy the curve buster was just a guy who wanted to ice the competition, maybe even for sport. He figured since he knew the material, he’d use that to his advantage. And it worked to get all of you situationally depressed, so he could get ahead for whatever purpose he wanted to glean from doing that. It probably carried forward to the other courses. While everyone was playing catch up, he was already a week ahead in his studies. Then he’s pulling ahead in the next class.

 

[rdonahue87]

Med schools seem to pay lip service to extra credits... We had a few extra credit that were 3-5% for many of our classes, but they can only be counted after your average is 70%+ in all exams...

Writing papers, which is a big thing in nursing school was non existent in med school. I only wrote 1 paper (out of 2 research papers) of < 2 pages during MS1 for a B$ professionalism class.

The lack of papers sounds great. I'm pretty good at papers and can throw one together pretty rapidly, but they're just so awful.

Don't get me wrong, knowing how to put a piece of writing together is important. I believe most medical schools require 1 year of college level English as a prerequisite. For those that don't, this should be added. I have an RN job at a government forensic hospital and most of administration has an associate's degree or less and the memos/emails they send out are truly appalling. Even though clinicians use a ton of shorthand, the ability to put together a well-constructed sentence or paragraph is important and anyone in a professional job should have this ability.

I think this is one area where a nurse is "better" than a doctor - nurses are much more well-versed on the history of nursing than doctors are on the history of medicine (at least I think?). I have taken at least 3 classes (ADN, BSN, and MSN level) on nursing theorists which is just ridiculous in my opinion. I suppose if I was an orthopedic surgeon it wouldn't be bad to know who Dr. James Andrews or Dr. Frank Jobe are but I think you can still be a great orthopedic surgeon without knowing these doctors by name (sorry...these were the two most famous doctors outside of Dr. Fauci that I could quickly come up with).

 

[rdonahue87]

As long as I'm complaining, in addition to the psychopharmacology course mentioned earlier, we are also taking a course that explores psychiatric illnesses. One of the components of this course is to film ourselves performing an ~45 minute psychiatric H&P on a volunteer based on a clinical scenario we were given. As this program is entirely online, our training on how to do this was pretty much nonexistent as we have not yet started our clinical hours. I have worked as a psychiatric RN at an inpatient forensic hospital for the past 7 years so I have watched numerous psychiatrists perform literally hundreds of these so I like to think I did a fairly good job. I received 100% on the assignment which is all well and good except for two major problems:

1. The class average was 98% so basically everyone got a perfect score so it's hard to say if mine was actually all that good based on the score alone
2. No feedback was given other than my grade. While I like to think I did pretty good the fact that I was given no feedback whatsoever is not particularly helpful. Many of my classmates have little, if any, background working in a psychiatric setting so I am sure this assignment was somewhat difficult for them. Giving no feedback whatsoever is not particularly helpful. We also had to write up the H&P as part of the assignment and once again I was given no feedback here either.

If a program is going to be essentially entirely online, the instructors really should put at least some effort into reaching out the students to let them know how they did. I think our cohort is about 60 students so I wonder how much time the instructor even spent watching these videos and reading the reports because he had them graded within a week of turning them in and if you figure about an hour each that's a 60 hour workweek for a guy that takes pride in mentioning to us that he is a full-time psychiatric provider in addition to being an instructor.

We haven't started our clinical hours yet but since there is no oversight as to wear we do them, this is literally our one shot at having the instructor critique our ability as a provider and that is a scary thought. Our clinical hours are only 500 total hours and I know many people choose to do them at poor sites. The PMHNPs at the psych facility I work with often happily take on PMHNP students even though the facility forbids PMHNPs to prescribe medication and the vast majority of their job entails auditing charts.

 

[Splenda88]

As long as I'm complaining, in addition to the psychopharmacology course mentioned earlier, we are also taking a course that explores psychiatric illnesses. One of the components of this course is to film ourselves performing an ~45 minute psychiatric H&P on a volunteer based on a clinical scenario we were given. As this program is entirely online, our training on how to do this was pretty much nonexistent as we have not yet started our clinical hours. I have worked as a psychiatric RN at an inpatient forensic hospital for the past 7 years so I have watched numerous psychiatrists perform literally hundreds of these so I like to think I did a fairly good job. I received 100% on the assignment which is all well and good except for two major problems:

1. The class average was 98% so basically everyone got a perfect score so it's hard to say if mine was actually all that good based on the score alone
2. No feedback was given other than my grade. While I like to think I did pretty good the fact that I was given no feedback whatsoever is not particularly helpful. Many of my classmates have little, if any, background working in a psychiatric setting so I am sure this assignment was somewhat difficult for them. Giving no feedback whatsoever is not particularly helpful. We also had to write up the H&P as part of the assignment and once again I was given no feedback here either.

If a program is going to be essentially entirely online, the instructors really should put at least some effort into reaching out the students to let them know how they did. I think our cohort is about 60 students so I wonder how much time the instructor even spent watching these videos and reading the reports because he had them graded within a week of turning them in and if you figure about an hour each that's a 60 hour workweek for a guy that takes pride in mentioning to us that he is a full-time psychiatric provider in addition to being an instructor.

We haven't started our clinical hours yet but since there is no oversight as to wear we do them, this is literally our one shot at having the instructor critique our ability as a provider and that is a scary thought. Our clinical hours are only 500 total hours and I know many people choose to do them at poor sites. The PMHNPs at the psych facility I work with often happily take on PMHNP students even though the facility forbids PMHNPs to prescribe medication and the vast majority of their job entails auditing charts.

Just do your best to learn what you need to know to be competent. You should try to find a psychiatrist or a good psych NP to be your mentor.

 

[pamac]

The PMHNPs at the psych facility I work with often happily take on PMHNP students even though the facility forbids PMHNPs to prescribe medication and the vast majority of their job entails auditing charts.

Why would a psyche NP work there? Why would they even need a psyche NP to work when they can’t prescribe? They pay $150k for chart auditing?

Since you think your training is so poor, drop out, or get a job where you are at and audit charts. Nobody is making you do what you are doing.

 

[PikminOC]

You can have friends of a different race and still be bigoted towards that race.

At this point, it’s apparent that you have no respect for NP education, so you are quite the sellout by not convincing your wife to go to medical school. She certainly isn’t going to “go the extra mile” to obtain gold standard education at the level that would satisfy you. Is she going to be one of the good NPs that stays in her lane and collaborates with no daylight between her and her supervising physician? Sure she will.

Nah, she will do just what you think the majority of NPs do, because why not? If she was going to put in all the extra work and time to meet your standards, she’d just go to medical school, wouldn’t she? Or maybe she’d go be a PA and stick to the medical model.

Your buddy the curve buster was just a guy who wanted to ice the competition, maybe even for sport. He figured since he knew the material, he’d use that to his advantage. And it worked to get all of you situationally depressed, so he could get ahead for whatever purpose he wanted to glean from doing that. It probably carried forward to the other courses. While everyone was playing catch up, he was already a week ahead in his studies. Then he’s pulling ahead in the next class.

Yep quite easy to get in and thru med school and residency and board certs.

 

[Ho0v-man]

For anatomy? 25% of the class failed anatomy? What did those that failed do in undergrad while all of the other premeds were boning up on anatomy in all its forms?

This really shows that you don’t know what you’re talking about and don’t comprehend the rigor of medical school. I had arguably one of the best anatomy backgrounds in my class, probably second only to a literal masters level anatomist. That knowledge base saved me at best 2 hours per month. There’s a reason anatomy isn’t a premed requirement. It’s because 99% of undergrad anatomy courses barely scratch the surface of what we do.

 

[rdonahue87]

Why would a psyche NP work there? Why would they even need a psyche NP to work when they can’t prescribe? They pay $150k for chart auditing?

Since you think your training is so poor, drop out, or get a job where you are at and audit charts. Nobody is making you do what you are doing.

They don't hire many PMHNPs but the ones that they hire tend to like it because it's a really easy job and it pays fairly decent. They work for the state of California so they get nice benefits and a good pension which is also nice. I've been an employee there as an RN (and janitor, food service worker, etc) for 11 years so I have some incentive to continue doing something there. I also work in a private clinic as an FNP which is a far more rewarding job in terms of pay and job satisfaction, but it has no benefits so I have incentive to continue working for the state.

I've been bashing my program quite a bit but I think that's not completely fair. I don't want to call them out by name on here (if someone is really interested they can PM me and I will tell them which program it is) but my concern is it's actually relatively well-regarded according to the US News. I think they educational structure they have is decent and I do think I'm learning a fair amount, but my concern with this program (and many/most NP programs) is it's quite easy to get a really bad education and still pass. Your clinical site is of tremendous importance and if you get a bad one that's going to really cause problems moving forward.

My FNP program was mostly in person and was at moderately well-respected university as part of the Cal State system. The in person education was decent but they relied heavily on us learning through our clinical site. I ended up with a really bad clinical site (the NP moved to another country, one MD had her licensed revoked, another MD thought 120 norco and 90 soma a month cures everything, and the only good MD would only let me shadow her). I realized my site was bad but I live in a relatively small town and finding a site is quite difficult so I ended up doing almost all of my hours there. It took me years of practicing on my own before I felt like I actually was competent enough to where I should have been allowed to do so. I think I'm a pretty decent provider now, but this lack of oversight is what worries me.

 

[pamac]

This really shows that you don’t know what you’re talking about and don’t comprehend the rigor of medical school. I had arguably one of the best anatomy backgrounds in my class, probably second only to a literal masters level anatomist. That knowledge base saved me at best 2 hours per month. There’s a reason anatomy isn’t a premed requirement. It’s because 99% of undergrad anatomy courses barely scratch the surface of what we do.

Let’s break this down. One guy came along, according to that account of a med school anatomy class, and he single handedly made it impossible for 25% of that class to even pass. Sounds like it might not have been that rigorous in the first place. All these smart kids were all good to go until a guy who had anatomy down pat screwed them and made it into a class that would cause even you, with your mad anatomy skills, to break a sweat. Lot of variability I guess.

 

[pamac]

Yep quite easy to get in and thru med school and residency and board certs.

So you now advocate that folks forgo medical school, and instead are dangerously inept because they don’t want to go through the rigor of med school? Ok.

 

[pamac]

They don't hire many PMHNPs but the ones that they hire tend to like it because it's a really easy job and it pays fairly decent. They work for the state of California so they get nice benefits and a good pension which is also nice. I've been an employee there as an RN (and janitor, food service worker, etc) for 11 years so I have some incentive to continue doing something there. I also work in a private clinic as an FNP which is a far more rewarding job in terms of pay and job satisfaction, but it has no benefits so I have incentive to continue working for the state.

I've been bashing my program quite a bit but I think that's not completely fair. I don't want to call them out by name on here (if someone is really interested they can PM me and I will tell them which program it is) but my concern is it's actually relatively well-regarded according to the US News. I think they educational structure they have is decent and I do think I'm learning a fair amount, but my concern with this program (and many/most NP programs) is it's quite easy to get a really bad education and still pass. Your clinical site is of tremendous importance and if you get a bad one that's going to really cause problems moving forward.

My FNP program was mostly in person and was at moderately well-respected university as part of the Cal State system. The in person education was decent but they relied heavily on us learning through our clinical site. I ended up with a really bad clinical site (the NP moved to another country, one MD had her licensed revoked, another MD thought 120 norco and 90 soma a month cures everything, and the only good MD would only let me shadow her). I realized my site was bad but I live in a relatively small town and finding a site is quite difficult so I ended up doing almost all of my hours there. It took me years of practicing on my own before I felt like I actually was competent enough to where I should have been allowed to do so. I think I'm a pretty decent provider now, but this lack of oversight is what worries me.

I don’t believe you, because only NPs do poorly enough to need to get their licenses revoked, and certainly only NPs would think that 120 norco, and 90 soma per month, solves everything. Not buying it. All your new friends you made here bashing NPs would politely let you know that doctors don’t have those problems. Their anatomy classes are so hard that you never see physicians screwing up like that.

 

[PikminOC]

So you now advocate that folks forgo medical school, and instead are dangerously inept because they don’t want to go through the rigor of med school? Ok.

You're so angry all the time. Adorable

 

[RomeoNP]

Not surprised to see that this conversation devolved exactly into what I predicted it would be.

 

[sylvanthus]

Itll continue to happen so long as those with faaaaarr less training are a direct threat to physicians job prospects and patient safety. Like it or not, there are a lot of really pissed off physicians and while we as a group put up with alot, things are gonna boil over.

 

[pamac]

You're so angry all the time. Adorable

You’re projecting. Who’s hobby is it to tear down another profession? You guys show up to do just that.....Adorable.

 

[pamac]

Itll continue to happen so long as those with faaaaarr less training are a direct threat to physicians job prospects and patient safety. Like it or not, there are a lot of really pissed off physicians and while we as a group put up with alot, things are gonna boil over.

But what does it look like when things “boil over?” How many physicians are employees now vs 10 years ago? From 2012 to 2018, physicians as employees went from 25% of your workforce up to 40%. In 2019, more new docs became employees than owners of their own practice. I know an NP in a different health system that requires supervision of NPs by physicians, and the supervising physician was simply told they were going to be in that role by the employer, and given a modest bonus to do so. Sure, they could go through the hassle of walking, but most of the other appealing options out there also involve being an employee. As employees, doctors are very influential, if not the most influential employees any entity is likely to have outside of the C-suite. For every doc that is frustrated, there is a doc who is a medical director looking for a payday by hiring more PAs and NPs, or a doc who wants to utilize them in their own practice vs hiring another doctor or taking on another physician partner. So it’s canabalism amongst yourselves that has helped get you guys here to some kind of boiling point.

Anyone who feels invincible should look at pharmacy or optometry to see what saturation does. Saturation for physicians looks a bit different because it arrives at the hands of NPs as PAs to some extent. Currently, as many NPs are cranked out each year vs physicians. While a PA or NP can’t replace a surgeon, I don’t think it’s in anyone’s best interest to have doctors relegated to the surgical realm, or simply the high level specialties to become essentially brain trusts for legions of non physician providers to bounce questions off of.

For a glimpse of how vulnerability emerges for physicians, imagine a scenario where “Midlevel” saturation runs unabated. Practices start to hire NPs and PAs in lieu of doctors when they get the chance. They keep a few docs around for image purposes (after all, who wants to be known as the facility that only has “midlevels” around?). So that means more docs freed up to go into higher demand specialties that have a lot of vacancies.... until there are plenty of doctor folks to fill the demand there. Then admin throws a party (or goes on vacations, or hires more admin, or simply passes the savings to shareholders) with the excess revenue that is freed up when wages go down for physicians. Think it can’t happen? It’s already happening in psychiatry. Yes, if a physician wants to walk, they can go just about anywhere, or they can take on the headache of opening a practice of their own. But in the past, they could stay where they are at geographically, and find any job, and name a price. Now it’s not so simple. And that’s how it started with PAs. In years past, you graduated PA school to 6 job offers. You could pick your location, specialty, and salary. Then it went to picking 2 of the 3 categories, with complete confidence that you’d get any 2. Now? The PA forums now say “take any job you can get so that you can get experience to hopefully get something better late and become more marketable”. That’s happened in just the last 5 years or so.

I sat on a plane and overheard an ER doctor talking to another passenger about what that doc does. The doc flew to another state because ER jobs were tight in our city, and they didn’t want to relocate their family to the other location. Maybe the pay was out of sight, and it was a saavy financial decision, but even then, it stood out to me that one would have to chase that money outside of where one wanted to live.

 

[DentGent13]

This really shows that you don’t know what you’re talking about and don’t comprehend the rigor of medical school. I had arguably one of the best anatomy backgrounds in my class, probably second only to a literal masters level anatomist. That knowledge base saved me at best 2 hours per month. There’s a reason anatomy isn’t a premed requirement. It’s because 99% of undergrad anatomy courses barely scratch the surface of what we do.

Let’s break this down. One guy came along, according to that account of a med school anatomy class, and he single handedly made it impossible for 25% of that class to even pass. Sounds like it might not have been that rigorous in the first place. All these smart kids were all good to go until a guy who had anatomy down pat screwed them and made it into a class that would cause even you, with your mad anatomy skills, to break a sweat. Lot of variability I guess.

No offense but he's right. You're thinking, "I took anatomy. Yea it was hard, but how much harder could med school anatomy be than my nursing anatomy." Well, I have experienced both. I went to an undergrad that had a pretty prestigious nursing program. I, as a bio major, was free to take the nursing anatomy class as an elective. I enjoyed the anatomy I learned in Bio and wanted to supplement my knowledge with nursing A&P which was said to be one of the hardest classes in the college. Let me tell you, it was true. It was one of the hardest classes there probably next to organic chemistry. I remember needing to memorize a majority of the 600 muscles and the origins and insertions for that class spend at least like 10+ hours a week just to get caught up in this one class. In the end, I got barely edged an A- and I missed an A by very literally 0.05 points out of 100. I ended up getting an A for A&P II because it was less memorization and more understanding physiology, mechanisms, and pathways. This was what I thought of my undergrad nursing A&P.

Fast forward a few years, I took anatomy in dental school and it really is on a whole other level. I thought all 600 muscles, insertions and origins, an extensive set of VANs were tough to rote memorize in nursing anatomy. Oh boy, in dental school, we had to learn that and every VAN that had a name, what muscles they innervate and supply/drain, and what type of fibers they were. It was so much more in depth than the undergrad nursing A&P that I already felt was hard. I studied probably twice as hard as the undergrad class and got a high B narrowly missing a B+. I also felt that if I didn't already take A&P, I would have done a bit worse, perhaps a low B or a B- (the class average is a C+). Yes, nursing A&P was hard. Dental school A&P was just harder, and I imagine the same could be said of medical school A&P. Hopefully you can take my anecdotal experience not as an attack on nursing, but confirmation that med students just learn more in depth with the schooling they are required to undergo.

 

[scoopdaboop]

Yes they should be more selective. Will they be? No. Because, 90 percent of the nursing workforce can be NP's currently, and if they are more selective, probably only 70 percent can do it- thus cutting down profits based of application fees alone. Yet NP's think that earning a doctorate through that route is still prestigious and go championing it to patients "not to confuse them, but just because I earned a doctorate in a different field!!" Hilarious. Idk how these people aren't ashamed of themselves - people that call them selves doctors in a setting where that actually means something and is obviously misleading to the hoi polloi.

The problem in the physician world is this: It has gotten to the point now where NP's now learn from physicians in a version that is basically a weak watered down "residency" for a few years in some specialty then they can have the option to practice independently after a few years under supervision (in a lot of states). This impowers them to think they are equivalent to a physician and they go championing it around. Could you imagine a NP exclusively learning from a NP? Blind leading the blind - they would be no where near as confident as they are now- thus I blame all the old physicians and hospital admins for making this happen.

 

[doyinDO]

This is probably discussed somewhere else, but lately I've been at a crossroads in my career where I'm just sort of frustrated with my profession and the lack of respect we get from physicians. Unfortunately, I think a lot of that may be earned.

Case in point...

I am currently an FNP enrolled in a PMHNP program at a relatively prestigious university (US News has it top 5 in America). This is a post-master's certificate program that is only open to currently licensed, practicing NPs. I have no idea if this program is very selected because I did not ask anyone at the university about the admissions acceptance rate and this was the only program I applied to.

We just had our psychopharmacology midterm. A lot of my classmates were stressed out because this class is traditionally regarded as "hard" and the most difficult class in the program. As someone working multiple jobs I didn't have much time to put any effort into prep for this class and figured as a practicing NP I already know a lot of psychopharm even though I work in family practice. I watched the lectures (at 1.5 speed) and did little else. The exam was proctored via video. I suppose you could cheat, but I didn't want to figure out a way to do this so I took it the way we are supposed to. The exam was multiple choice (4 choices per question) and I ended up with an A on what I thought was a pretty simple exam.

Now that the exam is over I just looked at the class average was 79.4% with low of 32%. That low F is clearly pretty bad especially considering random guessing would yield 25%. The part that scares me is this isn't just some random person way over their heads. He/she is currently a practicing provider. What's even scarier, is I looked at our syllabus and assumed that this person gets a 32% on the final exam but completes all the other coursework with 100% (which is pretty likely since class average is 90-95%+ on these exercises). If this person does that they will just barely pass. But it gets worse - the instructor also offers extra credit which will provide further breathing room. Based on the way the course is graded, if you get 100% on all the fluff assignments and do the extra credit, you only need to score 19.3% on the exams to pass the course.

Obviously this is just one example, but this is quite appalling. Maybe med school is the same way and med students just like to hype how stressful everything is, but I can't imagine this is the case. If you score 32% on pharmacology tests in an online class, you should not be prescribing these medications. Period.

I realize there is a huge lack of providers in this country, but pumping out providers this way does not seem to be the solution. This system can't possibly sustain itself.

My med school isn't the same way. We need at least a 70% avg on exams to pass the course. We also don't have all the easy homework/quiz buffer to your school's extent. Even if we did, it doesn't matter because still need the 70% avg on exams.

Overall, I agree that NP programs should be more selective. It would decrease the potential of upcoming saturation, make the field more respectable, and probably increase patient safety.

 

[PikminOC]

Yes they should be more selective. Will they be? No. Because, 90 percent of the nursing workforce can be NP's currently, and if they are more selective, probably only 70 percent can do it- thus cutting down profits based of application fees alone. Yet NP's think that earning a doctorate through that route is still prestigious and go championing it to patients "not to confuse them, but just because I earned a doctorate in a different field!!" Hilarious. Idk how these people aren't ashamed of themselves - people that call them selves doctors in a setting where that actually means something and is obviously misleading to the hoi polloi.

The problem in the physician world is this: It has gotten to the point now where NP's now learn from physicians in a version that is basically a weak watered down "residency" for a few years in some specialty then they can have the option to practice independently after a few years under supervision (in a lot of states). This impowers them to think they are equivalent to a physician and they go championing it around. Could you imagine a NP exclusively learning from a NP? Blind leading the blind - they would be no where near as confident as they are now- thus I blame all the old physicians and hospital admins for making this happen.

This is their residency

My name is XXX RN-BC. I am looking for a Psychiatrist that is open to working with me for a semester starting in late August/September as a Mental Health NP student. I currently go to Walden University and I have a 4.0 GPA. I have read your practice description on your website and what intrigued me is that you are one of very few providers that do have some evening and weekend hours. In addition, patients are able to have more direct contact with you which is wonderful.
My time commitment is 160 hours/80 encounters over the span of 11 weeks.
Please let me know if you are willing to take me as a student.
I appreciate your time.

 

[scoopdaboop]

This is their residency

🤣🤣🤣🤣

 

[scoopdaboop]

This is their residency

Honestly, all that just makes me realize medical school needs to change the way they do things. There should be 2 routes. The traditional route, offered to people interested in research who need a backbone of fundamental knowledge.

Then, there should be a route that basically is 1 year pre-clinical, 2 years of rotations, then residency for maybe more 1 extra year added to every specialty. I do not understand the need to have such a long drawn out process. Also, college degrees shouldn't be necessary. They are not even in other countries. after high school, 2 years of college pre reqs, 1 year pre-clinical, 1 third year rotations, boards, then fourth year + apps.

How much of a better clinician will you become with extra college, 1 extra year of pre-clinical? That type of stuff doesn't determine that anyways.

 

[pamac]

The way for physicians to put NPs in the ground is to simply to do things like: skunk us through cranking out massive production numbers (you guys can do that because you are so much more capable, right?), lower your costs and become more appealing, and increase your number of graduates (thereby reducing physician wages). Quality speaks for itself. We are in a capitalist society, and the free market should be making physicians shine. THERE SHOULD BE NO NEED FOR NP’s BECAUSE YOU GUY’S ARE SO RAD.... right?!!! Nobody is arguing that physicians aren’t trained to the hilt.



In any event, there’s a bill in congress to expand physician residencies considerably. I look forward to what physicians will be saying about the field being awash in new docs when that days comes. It’s not NPs and PAs that put a stranglehold on physician residencies. In 1997, physician groups like the AMA lobbied to have the supply of residency slots reduced, and the government did their bidding. Around that time, PA and NP emerged to fill the gap that the industry wasn’t willing to put up with. Blame someone else for your misfortune. You guys made a power play, and the industry adapted.



The system won’t tolerate business as usual with wages, though. Expect that at some point in the future, there are conditions placed on just about anything wage related. When the government expands residency slots, be ready for them to decide exactly what specialties will see all the new grads. It will be a tool for reducing your wages. Think nobody will do cardiology for $250k per year? Nobody will do anesthesia for $200k? Wanna bet? Hint: There already are providers doing anesthesia for less than $200k per year. Imagine what the government can do with 1200-4000 new residency slots. Does anyone expect they will all go to primary care? My hunch is they will be assigned to plenty of other specialties where the docs have a stranglehold. Once those are good and saturated, it will be on to the next specialty.



The market stepped in and compensated for docs strangling the supply. The market is now used to the savings an NP or PA provides. At the hospital I worked at as a nurse, COVID forced significant belt tightening due to fears of what the future held. Those fears weren’t realized, but once the belt is tightened, that becomes the new standard. “Midlevels” are here to stay. If “midlevels” aren’t here to stay, it means that you guys stepped in and filled the void.... not with bodies, but with low salaries. So pick your poison....tolerating the presence of decently paid “midlevels” and a shot at a great wage for yourselves as docs... or else settle in with lots of docs and terrible pay, because even the well paid NPs and PAs are still so much cheaper than you guys ever would work for. Think about the places in Europe where physicians are paid in respect vs money. Maybe a better parking spot, some more vacation time, free admiration to museums, free public transportation... but not money. Also, look at what PAs are doing in literally every state nationwide. Nobody is ratcheting down on their scope, in fact they are setting up your new $75k per year replacement provider.



My office has psychiatrists and PMHNPs. Guess who the suits now plan to hire exclusively from now on to expand? They will keep a minimal number of psychiatrists onboard to have their names on the marquee. A few docs and a lot of “midlevels”.....that’s the new hot business plan. And it works. So it works for psychiatry and primary care. We can step in and “relieve the burden” in many other specialties. You guys already have EM on the way to saturation already, but we are also there to help. I see plenty of fresh NPs bebopping around the hospital working as hospitalists. I’d invite physicians to go back to Congress and ask them to restrict residency spots again to restrict supply, and see how that works out.



BUT SPECIALTIES!!! “A midlevel won’t be doing surgery!” True. In the US, 2/3 of docs are specialists. In the rest of the world, 2/3 of the docs are not. And the ones that are not, are not making the big bucks, they pull the equivalent of $110k to $130k here.

 

[PikminOC]

Honestly, all that just makes me realize medical school needs to change the way they do things. There should be 2 routes. The traditional route, offered to people interested in research who need a backbone of fundamental knowledge.

Then, there should be a route that basically is 1 year pre-clinical, 2 years of rotations, then residency for maybe more 1 extra year added to every specialty. I do not understand the need to have such a long drawn out process. Also, college degrees shouldn't be necessary. They are not even in other countries. after high school, 2 years of college pre reqs, 1 year pre-clinical, 1 third year rotations, boards, then fourth year + apps.

How much of a better clinician will you become with extra college, 1 extra year of pre-clinical? That type of stuff doesn't determine that anyways.

IMO, I am glad with the traditional way. So many cases that seem easy or routine end up not being that way and my thorough training helps with that.

 

[pamac]

Honestly, all that just makes me realize medical school needs to change the way they do things. There should be 2 routes. The traditional route, offered to people interested in research who need a backbone of fundamental knowledge.

Then, there should be a route that basically is 1 year pre-clinical, 2 years of rotations, then residency for maybe more 1 extra year added to every specialty. I do not understand the need to have such a long drawn out process. Also, college degrees shouldn't be necessary. They are not even in other countries. after high school, 2 years of college pre reqs, 1 year pre-clinical, 1 third year rotations, boards, then fourth year + apps.

How much of a better clinician will you become with extra college, 1 extra year of pre-clinical? That type of stuff doesn't determine that anyways.

In a lot of places, medicine is some form of direct entry after high school.

 

[doyinDO]

Honestly, all that just makes me realize medical school needs to change the way they do things. There should be 2 routes. The traditional route, offered to people interested in research who need a backbone of fundamental knowledge.

Then, there should be a route that basically is 1 year pre-clinical, 2 years of rotations, then residency for maybe more 1 extra year added to every specialty. I do not understand the need to have such a long drawn out process. Also, college degrees shouldn't be necessary. They are not even in other countries. after high school, 2 years of college pre reqs, 1 year pre-clinical, 1 third year rotations, boards, then fourth year + apps.

How much of a better clinician will you become with extra college, 1 extra year of pre-clinical? That type of stuff doesn't determine that anyways.

my thoughts are similar. Current medical training is too outdated

 

[deleted6669]

my thoughts are similar. Current medical training is too outdated

Indeed. I trained alongside a bunch of visiting medical students from the UK on one rotation. They were all younger than me, all under 25, and almost done with medschool. 18 months of classroom, 18 months of clinicals, and on to residency would work just fine. There are already several 3 yr US medschools.

 

[deleted6669]

IMO, I am glad with the traditional way. So many cases that seem easy or routine end up not being that way and my thorough training helps with that.

But is it your clinical training or your intense knowledge of histology, the krebs cycle, and biochemistry?

 

[PikminOC]

But is it your clinical training or your intense knowledge of histology, the krebs cycle, and biochemistry?

All of it. It's layered knowledge.

 

[deleted6669]

All of it. It's layered knowledge.

So what do you see as the differences between attending a current 3 yr vs 4 yr MD program? Are grads of 3 year programs lesser physicians?

Member Schools — Consortium of Accelerated Medical Pathway Programs

www.acceleratedmdpathways.org