But, you see, they have taken those classes. Ask any BSN student and they'll say, "We took organic chemistry, too!" It turns out to be a chemistry course for non-science majors where they learn vocabulary words and some basic structures, but hey, there was some organic chemistry involved so it counts. They take a watered down pathophysiology course in nursing school armed with an undergraduate level physiology course as foundation for "normal" and claim to have a similar background as a graduating medical student. The false equivalence has been around since I was in undergrad which was...sadly over 10 years ago now. None of this is new. The NP craze has just taken it to a higher level. You look at DNP curricula from even top rated schools and its filled with fluff about nursing theory and education, lobbying, and health policy. There is usually a credit hour or two to "advanced pathophysiology" and then community health/family health/global health/whatever. This gets topped off with 700 or so hours of clinical exposure of varying in quality, and now you get a false equivalency that someone with this level of education is as qualified to provide primary care as someone who has finished an IM or FP residency.
The outcomes studies for both NPs and CRNAs have been ripped apart for poor methodology and so on multiple times in multiple subforums here, so I won't belabor that point.
Dunning-Kruger effect (
Dunning–Kruger effect - Wikipedia) has been exhibited perfectly in the whole advanced practice nursing area, hell, even med/surg nursing, for a long time. I saw it personally when my sister and friends were in nursing school (these doctors are idiots! Listen to this story where the doctor did something that I thought was wrong because I don't have the necessary background to understand the decision making process in this patient! We know more than they do AND we take care of the patient!), saw it in medical school, and continue to see it in residency.
Unless something changes with the healthcare system here they are not going anywhere, though. The need for primary care is present, and DNP programs shoot up faster than medical schools. The only group really interested in doing outcomes studies are the nursing organizations. Maybe if the AAFP had a fire lit under them they could pursue a study, but if you think about it this is a difficult study to pull off and would require long term follow up. Imaging and referral differences have been explored in a small amount of studies, which did show increased imaging use and referral patterns for advanced practice nurses, however it is again difficult to draw conclusions based on methodology and certain unknowns. The best thing we can do as physicians is try and educate and close the education gap somewhat for the sake of patients. I frequently get inappropriate referrals from NPs (and to a much lesser extent physicians), and I make it a point to call or email them to discuss the patient and decision making process. I do this in a non-judgmental manner and phrase it around "closing the loop" so they know what's going on with the patient. I do this in hopes that it will change their practice patterns, but also ensure they aren't afraid to refer a patient that actually does need evaluation.
I certainly don't hate nurses, don't get me wrong. A good floor or OR nurse makes my life much, much easier when I'm not constantly having to double check that a med was given on time, vitals or I/Os have been charted, etc. I don't hate NPs, either, as long as they understand the limitations of their training- in the same way an intern needs to understand their limitations as well. They can play a critical role as physician extender.
For us the situation stings. We spend 4 years in undergrad, 4 years slaving away in medical school, and then 3+ years in residency to have someone with a lot less training and experience say they do the job just as well. In a lot of clinical situations that may be true, but those usually aren't the ones that are life/limb/eyesight threatening.