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.
I actually had a FNP post-master's psych student in class who didn't believe mental illness was a real thing. My question was "so what are you doing here?" It's the lifestyle specialty. I don't think there's an actual lack of providers. What is lacking is the desire to work in/among the populations people don't desire to treat. I grew up in the suburbs. That's how I was socialized. That's where I want to live and work, and I suspect the majority of healthcare providers want to live how they know. If your dad was a country doctor maybe you'd like that to. I like having more options than a Dollar General. I also appreciate not having to pay to park somewhere and not having demonstrators block main thoroughfares.
Re: admissions. There's no standard across the board. Med/dent/etc school has "standards" going for them. Even when I went through a public U NP program (that I was later faculty at) I would say if you could pay the tuition, you could be a student. I think now they do some interviews and require the GRE or MAT. I don't know what the GPA requirements are, but I also "grew up" assuming most people that went to college all had good grades. Naive, eh? All of healthcare is a second career for me. I enjoy it, but I often regret it (60:40).
It seems the CRNA programs have historically been more robust, but now many of them are even becoming largely online. The DNP rather than adding value to advanced nursing turned into more of a millstone. Loss of time, money, and for those that know what a DNP is loss of prestige. I see a DNP and think "what a sucker." But I'd get one if I could do so at no financial cost and am convinced I could accomplish the majority of the work with limited distress. Why? Because someday when all the tadpoles have DNPs the old bullfrogs are going to be critiqued by young HR and kid doctors about not having one.
We have the three advanced P's of NP training - advanced physicals, advanced pharm, and advanced physio/patho. Frankly, they weren't advanced at all. Same I had in BSN training (one used same book) although we were expected to have more competency in those subjects. I bet we could poll NPs in advanced physio/patho and find most feel very weak in that category. IDK how PAs do. They seem somewhat more informed in the sciences, generally speaking, and the docs and dents clearly are (assuming they retain it post-graduation) although we understand that all humans have memory decay; "use or lose."
From a university perspective, there is ZERO incentive to make school admissions requirements more stringent or coursework more difficult. Law school and pharmacy school have already experienced this growth and over saturation. Within 30 minutes driving of my home there are three programs producing master's trained counselors, marriage/family therapists, social workers, and clinical psychologist. Expand the box another 60 minutes drive time and you can add 8 other therapist producing programs. Most master's trained therapists I've worked with have multiple jobs as new grads until they can establish enough clientele through longevity to reduce their hours and office space. NPs will be the same way. On top of this, insurance companies are reimbursing us reasonably well somewhere between 80-100% of what physicians make. From a financial standpoint, my MSN cost $12,000 (which it did), and if I made 80% of what physicians made it would take them a long time to catch up and then exceed me. I believe in the future we'll all get reimbursed the same particularly as medicine becomes more socialized and society becomes more liberalized. Obviously, telehealth is here to stay as well reducing the need for clinic time and expense. I was talking to a new NP who received over $80,000 in loan reimbursement from an employer and was glad to have it but lamented he still have over $50,000 left to pay. I almost spilled my drink! Why would any element of nursing EVER cost that much, and if it did why choose this career. I had a patient that was an elementary teacher with over a hundred grand in student loans and always stressed and depressed because of it and working after hours at CVS as a checker. Why would her college decrease the cost? It won't because the .gov will give you all the loaned money you want to go to school knowing they'll get it back with interest. This is the singular difficulty with healthcare costs. It's expensive to become someone who can sign prescriptions, it takes time, and you want to be reimbursed to assuage the lost time, added stress, and financial cost.
For most of nursing, a bedside nurse makes what? 40-60 grand/yr? A NP effectually twice that (if not more)? NPs don't want to be bedside nurses so some loan or debt is worthwhile to get away from that environment, but aspiring APRNs need to moderate their choices on career. Heathcare is increasingly not the luxurious profession it once was. Adding in the fact that graduate nursing programs want to throw in a bunch of arcane, trivial coursework to make themselves seem like an entirely separate body of knowledge. Who really cares about nursing theory? What kind of autism is required to do doctoral work in that field and teach it for a career? Community health let alone advanced community health? What was that even about? Multiple research methods courses that could more effectively be given as a series of seminars.... All of this obfuscates our clinical education the sole thing all of us became NPs to obtain and will be assessed, reimbursed, and judged by for the remainder of our work lives.
Much could be done to improve the profession, but I think we'll only see it become more dilute.
www.acceleratedmdpathways.org
