Study says NPs provide better care than MDs

[Charles_Carmichael]

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I'm not sure I understand why this whole NP thing is a big deal. I see an NP for most of my primary care needs and I think she does a good job. I'm sure if I presented with anything really complex she wouldn't try to overreach the scope of her training. For patients with typical illnesses and few comorbidities research does indicate that NPs do a good job. The only thing I do worry about is that an increase in the number of NPs will spell the end for primary care physicians (especially if more states allow independent billing). But as things stand right now with the lack of primary care physciains these NPs seem to be helping people gain access to some form of care that perhaps they may not have been able to get otherwise.

From what I understand, a lot of complex things present as common things. So how will someone know that the disease process they're seeing is a complex one disguised as common one if they've never learned about the complex stuff (due to less training)? How will they know when something is really out of their scope if they think it's just a common pathology they see everyday?

Nursing midlevels get reimbursed at 85% of the rate that Medicare reimburses physicians (IIRC). Also, they're heavily pushing toward equal reimbursement rates as physicians using the whole "we're equal/superior to physicians so we deserve to be paid equally" argument. Not really cost-effective.

I would be surprised if any physician is worried about him/herself regarding NPs/DNPs. No matter what, physicians will always have a job and patients prefer physicians over midlevels (according to various surveys conducted by the AMA). Honestly, it's the patients that should be more worried. They're essentially seeing someone with less training than a 3rd year medical student has, but are paying the same as if they saw an attending physician.

 

[bluejay0428]

While I'm willing to concede the breadth of training students receive in medical school is extensive; it's both inaccurate and ignorant to suggest people go to NP school because they couldn't get accepted to medical school (or couldn't hack it).

For me it's simply a game of numbers:
I have been accepted to NP school and can finish by my 27th birthday. I plan on applying to an NP fellowship, which means I will have completed my training by 28.

In my state NP's practice autonomously in primary care settings (meaning no MD supervision at all). That being said, I don't think it's appropriate to eliminate a checks and balance system for any profession. I have caught countless MD/DO errors, as well as, NP and PA errors. I have encountered incompetent physicians, as well as, NP's and PA's. There are good and bad apples in every group. Instead of pissing and moaning at each other why don't we start working together toward what should be a shared goal...improved patient outcomes and safety.

Currently I am contemplating medical school (simply because I love surgery) but am unsure if I'm willing to be in school/residency until I'm 36 years old. Not to mention the debt I must incur to obtain my goal.

Intellectually I'm more than capable of pursuing an MD. No I haven't taken the MCAT but I have rocked every standardized test I've ever taken.

SAT: 1560 (out of 1600) Never picked up a test prep book nor did I take the PSAT. Went in blind and took with a hangover (no exaggeration).
LSAT: 176/180 (Yes I did consider law school)
GRE: 1540

While the prospect of studying medicine excites me, I don't look forward to the egotistical attitudes I often find on here.

Between the whining nurses, arrogant docs, disgruntled PA's, and insecure NP's, I'm thinking about redirecting my career path toward underwater basket weaving.

 

[banner18]

^^ lol, real talk.

 

[CodeBlu]

While I'm willing to concede the breadth of training students receive in medical school is extensive; it's both inaccurate and ignorant to suggest people go to NP school because they couldn't get accepted to medical school (or couldn't hack it).

For me it's simply a game of numbers:
I have been accepted to NP school and can finish by my 27th birthday. I plan on applying to an NP fellowship, which means I will have completed my training by 28.

In my state NP's practice autonomously in primary care settings (meaning no MD supervision at all). That being said, I don't think it's appropriate to eliminate a checks and balance system for any profession. I have caught countless MD/DO errors, as well as, NP and PA errors. I have encountered incompetent physicians, as well as, NP's and PA's. There are good and bad apples in every group. Instead of pissing and moaning at each other why don't we start working together toward what should be a shared goal...improved patient outcomes and safety.

Currently I am contemplating medical school (simply because I love surgery) but am unsure if I'm willing to be in school/residency until I'm 36 years old. Not to mention the debt I must incur to obtain my goal.

Intellectually I'm more than capable of pursuing an MD. No I haven't taken the MCAT but I have rocked every standardized test I've ever taken.

SAT: 1560 (out of 1600) Never picked up a test prep book nor did I take the PSAT. Went in blind and took with a hangover (no exaggeration).
LSAT: 176/180 (Yes I did consider law school)
GRE: 1540

While the prospect of studying medicine excites me, I don't look forward to the egotistical attitudes I often find on here.

Between the whining nurses, arrogant docs, disgruntled PA's, and insecure NP's, I'm thinking about redirecting my career path toward underwater basket weaving.

Yes!

And you most certainly are capable/intelligent enough. Nice LSAT! Beat me by 3 points.

Allied Health Professionals... work as a TEAM. Lots of arrogance floating around, but the MD/DO is nothing without his/her healthcare TEAM. I don't see the MD changing foley bags, or actually dispensing medication. The nurses take care of that. Without nurses the whole system falls apart. Eliminate nurses and you'll see how quickly the docs will be begging for them to come back.

 

[Tourmaline]

It's simple...PAs take the same biology/chem classes we do in pre-med....nurses take well...nursing chemistry

Meh, wrong. In my nursing school, we take quite a few classes with the premeds. A year of chem (including ochem) and bio, along with our other nursing prereqs. The only thing we really cut out is physics. The other schools in the area are like this as well, I believe. Perhaps it's a regional thing? But I know at my undergrad, nursing is one of the most competitive majors to get into, and it's definitely challenging.

Woo, first post! And for the record, I lurk here because my boyfriend is premed. I'm not a total weirdo. 🙂

 

[Narmerguy]

Well I think most of us would agree that a year of chemistry and a year of biology are two years short of the basic science pre-req's expected of premeds, which isn't saying much.

But anyway, I think us lambasting all the nurses here on the internetz doesn't do much good. The better question is what realistically can be done by the physician population to respond to this growing movement?

By restricting the #'s of doctors and thus maintaining a shortage of primary care physicians, we've really opened the door for this.

 

[Deathstar]

😍

 

[postbacpremed87]

I'm sure they separate nursing chem and pre-med chem. Ignorance is bliss for you I guess.

Meh, wrong. In my nursing school, we take quite a few classes with the premeds. A year of chem (including ochem) and bio, along with our other nursing prereqs. The only thing we really cut out is physics. The other schools in the area are like this as well, I believe. Perhaps it's a regional thing? But I know at my undergrad, nursing is one of the most competitive majors to get into, and it's definitely challenging.

Woo, first post! And for the record, I lurk here because my boyfriend is premed. I'm not a total weirdo. 🙂

 

[isoquin]

i love the stereotypes. high yield discussion.

 

[FlowRate]

BSN nurses at most schools are required to take the same biology, chemistry etc as pre-meds, plus many are required to take microbiology, anatomy/physiology before starting their nursing curriculum. This is not "nursing chemistry", this is the same exact class any undergrad would take (this is bachelor level nursing, not associate level).

And as for the number of clinical hours for a DNP, they might only get 1000 in grad school, but what about the hours they got in undergrad and the 1500-2000hrs per year they got working as an RN before going to DNP school? Many of these places require 2 years of clinical experience before you can start - that is 3000-4000 of pure clinical hours before even beginning school.

And in case you were wondering, not all nurses chose their path because they could not get into med school. That is an unbelievable statement. I went to nursing school because I had bad experiences with physicians and I wanted a healthcare profession that emphasized holistic and empathetic care. Now that I have been a nurse for a while I realized that I can still do this as a physician, but I am looking for more autonomy and a bigger scope of practice (thus applying to med school).

That being said...DNP does not equal MD/DO. They are different jobs with different philosophies and responsibilities. DNP has some of the same scope of practice as a physician, but not nearly as much. But they each have the same ultimate goal which is a positive patient outcome. I do agree, however, that believing this "study" at face value is like listening to the cigarette companies tell you that smoking is not bad for you.

Wrong

I'm gonna go be a CNA for a few years so that I can skip my first year of radiation oncology training. Clinical hours are clinical hours.

Patients of advanced practice registered nurses have similar or better results in many outcome measurements compared with physicians and other healthcare teams without APRNs, according to a new study.Published in Nursing Economics,
the report reinforces that APRNs provide effective, high-quality patient care and play an important role in improving the quality of care in the United States according to a news release.,
Robin P. Newhouse, RN, PhD, NEA-BC, associate professor at the University of Maryland School of Nursing and assistant dean for the Doctor of Nursing Practice Program, and co-authors conducted a systematic review comparing APRN processes and outcomes to those of physician providers. They analyzed 69 studies published between 1990 and 2008 and summarized 28 outcomes for nurses in APRN roles.,
The authors described patient outcomes for each of three patient groups — nurse practitioners, certified nurse-midwives and clinical nurse specialists. ,
Outcomes with similar or better grades than those of physician comparison groups included:,
• Nurse practitioners: glucose control, lipid control, patient satisfaction, functional status, mortality.,
• Certified nurse-midwives: cesarean, low APGAR score, episiotomy, labor analgesia, perineal lacerations.,

• Clinical nurse specialists: Satisfaction, length of stay, cost.,,The authors wrote that the results could help address concerns about whether care provided by APRNs can safely augment the physician supply to support reform efforts aimed at expanding access to care.The complete article is available as a PDF at http://bit.ly/oeFILW.</p>

Only in nursing do you see this crap. (I've seen nurses with easily 6 different "qualifications" listed after their name). The rule is to list your most advanced degree, unless you have essentially equivalent or relevant terminal degrees in different fields (MD/JD, MD/PhD, MD/MBA). In this case, the RN and PhD are in essentially the same thing. The other alphabet soup is like saying you're CPR trained (or FACS, which also imo sounds kinda douchey to always list behind your name).

Alphabet soup =/= advanced clinical qualification.


Most nurses are awesome people. Practicing nurses are usually humble, competent clinicians, often knowledgeable beyond their clinical role. Specific, highly vocal academic nurses are the ones who make it sound like nurses think they're more qualified, smarter, and better than other MD's and PhD's.


Physicians need better representation than we get from the AMA. Doctors no longer benefit from an overall highly positive public perception or respect. We need to change that; this is an advertising problem. We want to change consumer opinion. This is one of the directions I am thinking of heading, should I get enough connections during my training. Maybe a name like "Physicians for Cooperative Medicine" Who's going to try and mess with a name like that?

 

[TheMightySmiter]

Even if patients do statistically have "better outcomes" under NPs than under MD/DOs, wouldn't a large part of that be due to the fact that more complicated patients require a physician as opposed to an NP? If physicians are seeing sicker patients, of course it's going to look like NP patients have better outcomes. NPs see the healthy ones, and physicians see the ones who have a higher risk of dying in the first place. I wonder if the study controlled for this--I'm too lazy to actually read the whole thing.

 

[Web MD]

Even if patients do statistically have "better outcomes" under NPs than under MD/DOs, wouldn't a large part of that be due to the fact that more complicated patients require a physician as opposed to an NP? If physicians are seeing sicker patients, of course it's going to look like NP patients have better outcomes. NPs see the healthy ones, and physicians see the ones who have a higher risk of dying in the first place. I wonder if the study controlled for this--I'm too lazy to actually read the whole thing.

Yeah pretty much. Btw how do you control for things in a study? I didn't learn anything about it in gen chem

 

[Tourmaline]

I'm sure they separate nursing chem and pre-med chem. Ignorance is bliss for you I guess.

Haha, you're either extremely ignorant, incredibly biased, or just trolling. I have many premed friends, and I've sat next to them in lecture halls. I think I would know what I'm talking about.

 

[Tourmaline]

Well I think most of us would agree that a year of chemistry and a year of biology are two years short of the basic science pre-req's expected of premeds, which isn't saying much.

Really? I was under the impression that the basic requirements are a year of each with labs, math, and english. Obviously a heavier science load might help, but I can't imagine non-science majors applying to med school take as many science classes as science majors, and many still get in. I could be wrong though.

 

[Instatewaiter]

The best provider actually listens to the patients needs, and I think however biased the journal is, NP's might spend more time actually talking to the patients and so the patients feel that their care is more personalized. I think that your utter disrespect for NP's, and other nurses are the reason why the public despises physicians as cocky, unreasonable, elitists that earn too much money.

No the best providers actually know what to do to provide good care. You can listen to your patients all you want to but if you don't know what the hell to do next it doesn't matter one bit.

In part, NPs spend so much time for their patients for 2 reasons:
- it takes them longer to get the needed info from patients 2/2 less education
- they tend to be salaried so don't have to worry about seeing enough patients to pay for overhead, staffing costs etc.

oh and just a little tidbit for all those elitist DO's out there. Patients dont think your an equivalent to an MD so try to wrap that around your egos. Go outside the Americas and see how well received your DO is then youll know what its like to be an NP and get no respect.

Seriously people, please learn the difference between your and you're and their, they're and there.

Your and idiot if don't know they're is a difference between the to examples above.

Thank you. a voice of reason. mds are freaking out that their roles as pcp's is vanishing. welcome to the 21st century, you are replaceable when it comes to basic primary care.

An MD's role as a PCP is not going anywhere anytime soon. The issue is that few med students want to be PCPs because of the hassles and relatively low pay when they could specialize for just a few extra years. There is a PCP shortage that could easily be filled with MDs if they wanted. The issue is that the gov't has created so much red tape and insurance/medicare has reduced reimbursement so much that people who may have gone into primary care are diverted elsewhere. I was one of those people.

Intellectually I'm more than capable of pursuing an MD. No I haven't taken the MCAT but I have rocked every standardized test I've ever taken.

SAT: 1560 (out of 1600) Never picked up a test prep book nor did I take the PSAT. Went in blind and took with a hangover (no exaggeration).
LSAT: 176/180 (Yes I did consider law school)
GRE: 1540

Without the training, it doesn't matter how good your scores are; you will never have the appropriate clinical skill sets to be a great clinician.

 

[bluejay0428]

Without the training, it doesn't matter how good your scores are; you will never have the appropriate clinical skill sets to be a great clinician.

You took my statement out of context. First of all, I understand the importance of developing solid clinical skills. That being said, clinical skills are developed with experience in clinical settings, not medical school classrooms. I have spent significant time in the hospital and while my title is RN and I'm not allowed to provide diagnoses, that doesn't change my thought process. All that statement was meant to imply is not all nurses/NP's lack the intellectual capacity to become physicians. I have many other things I'd like to achieve in my life and medical school would put many of those things on hold far longer than I may be willing to sacrifice.

I have great relationships with my physician/mid level associates, voice my opinion within reason, and have spent a significant amount of time going through medical textbooks on my own. If I choose NP school over medical school, I will continue to build my knowledge base, increase my professional responsibility and continue my progression toward competent clinical practice. Which NP's are more than capable of providing, in spite of what many insecure people on this board suggest.

Call me cocky or confident, I don't particularly care which sentiment you choose, medicine is more than memorization and even experience for that matter (no doubt you do need experience). To be a great provider you must have good instincts and a certain degree of talent. I have honestly been told by several MD's that I should have went to medical school (I still may).

Like I implied before, NP's shouldn't be a replacement for physicians but rather an extension within a healthcare team. If you are sitting behind your computer rolling your eyes, do me a favor ask yourself, who are you to judge me? Have we ever discussed disease processes together? Did you take any chemistry/biology classes with me? Have we done clinical rotations together? Then who are you to tell me I'll "never have the appropriate clinical skill sets to be a great clinician?"

 

[theseeker4]

Really? I was under the impression that the basic requirements are a year of each with labs, math, and english. Obviously a heavier science load might help, but I can't imagine non-science majors applying to med school take as many science classes as science majors, and many still get in. I could be wrong though.

Med schools require a year gen chem, a year organic chem, a year biology, and a year physics, all with labs. So yes, one year chem and one year bio is 2 years of science short. To get a science degree, a lot of upper level courses are required, so non-science majors who fulfill the med school requirements are still short of the requirements for a BS degree in that subject.

 

[Tourmaline]

Med schools require a year gen chem, a year organic chem, a year biology, and a year physics, all with labs. So yes, one year chem and one year bio is 2 years of science short. To get a science degree, a lot of upper level courses are required, so non-science majors who fulfill the med school requirements are still short of the requirements for a BS degree in that subject.

Oh okay. I think that's what I was trying to say, but I got a bit confused because my school is on quarter system. And I wasn't trying to claim that I take all the same prereqs as premeds. I was responding specifically to the post that nursing schools provide dumbed down versions of chem and bio, which in my experience, is not the case. Thanks for your response though, I enjoy learning about the medical side of health care and education.

And Tired, I wasn't jumping in to defend NP programs, I was jumping in to respond to an insulting comment in regards to nursing education. I mostly lurk here, but I don't see the harm in responding to a false claim about one's future profession. I'm here to learn about medical school, since I'll be dating a med student in the future. If I can dispel a few myths about the nursing side of things, then great! Everyone benefits. 🙂

 

[235788]

no way. The same crappy studies show that DO's > MD, Community Colleges are just as good as state universities, and walmart is a beacon of equality.

 

[getright]

Yeah, I stopped reading at "Published in Nursing Economics..."

Same /thread.

 

[arfc6]

Same /thread.

Ok this is off topic but what the hell does the / thing mean on the internet? I see it all the time and find it confusing. While we're on the subject what does the # thing mean? Is it just to classify something?

 

[45408]

Ok this is off topic but what the hell does the / thing mean on the internet? I see it all the time and find it confusing. While we're on the subject what does the # thing mean? Is it just to classify something?

You used it in your own post, actually.

see how the

tag has a / in the [ /quote] part to close out the tag? they're pretending to type in a command that would end the thread, because the issue has been dealt with decisively.

# is a hash tag for Twitter. it's a keyword.

 

[Narmerguy]

For the hash mark (#) http://answers.yahoo.com/question/index?qid=20090523150909AANqVEa

The /thread and things of that nature are references to html code. For example, in html, if I wanted to make a word bold, I would surround it like this:

•Word's that I want bold•

And that entire sentence would be bold. Much pseudo-programming code on the internet uses the same kind of structure (for example, on this forum if you want something to be bold, you surround it like this: Words that I want bold[/b ]

 

[Tourmaline]

Sure, you have four posts, all of them just happen to be in this thread, but you've been "lurking" for a while and never had anything to say before now? And you want to understand med school, but you just happened to post only in the pre-med section? And of all the nursing/ancillary staff sections on this board, you never decided to contribute now until this thread came up in pre-allo?

Give me a break. I've been on this board on-and-off for five years, this thread has reincarnated a dozen times since then. It always end up the same. Someone just like you always claims to have "stumbled across" the thread and wanted "dispel myths."

Just fyi, I've also been a member at allnurses, so I actually understand what's going on here. Run back to your nursing sites and tell everyone how mean the doctors are...

Um, wow. Not sure how to respond. I normally appreciate the things you post, and I'm sorry you're so jaded that you assume I am lying. I don't need to prove myself to you though. But realize, I never said anything about NP programs. Anything. I responded to a statement about undergrad nursing programs, and that was it.

Just fyi, I'm not a member of allnurses, although I lurk there on occasion too. So no, I won't run back and tell everyone how mean doctors are. I'll continue to read the pre-allo, mcat, and allo threads, and hopefully gain a greater understanding of the medical profession and training.

 

[FlowRate]

Oh okay. I think that's what I was trying to say, but I got a bit confused because my school is on quarter system. And I wasn't trying to claim that I take all the same prereqs as premeds. I was responding specifically to the post that nursing schools provide dumbed down versions of chem and bio, which in my experience, is not the case. Thanks for your response though, I enjoy learning about the medical side of health care and education.

And Tired, I wasn't jumping in to defend NP programs, I was jumping in to respond to an insulting comment in regards to nursing education. I mostly lurk here, but I don't see the harm in responding to a false claim about one's future profession. I'm here to learn about medical school, since I'll be dating a med student in the future. If I can dispel a few myths about the nursing side of things, then great! Everyone benefits. 🙂

In my experience, nurses at my school took the same bio, but vastly easier and shorter chemistry courses.

It's not insulting to say that nurses don't take basic science courses that are as rigorous, it's true.

You took my statement out of context. First of all, I understand the importance of developing solid clinical skills. That being said, clinical skills are developed with experience in clinical settings, not medical school classrooms. I have spent significant time in the hospital and while my title is RN and I'm not allowed to provide diagnoses, that doesn't change my thought process. All that statement was meant to imply is not all nurses/NP's lack the intellectual capacity to become physicians. I have many other things I'd like to achieve in my life and medical school would put many of those things on hold far longer than I may be willing to sacrifice.

I have great relationships with my physician/mid level associates, voice my opinion within reason, and have spent a significant amount of time going through medical textbooks on my own. If I choose NP school over medical school, I will continue to build my knowledge base, increase my professional responsibility and continue my progression toward competent clinical practice. Which NP's are more than capable of providing, in spite of what many insecure people on this board suggest.

Call me cocky or confident, I don't particularly care which sentiment you choose, medicine is more than memorization and even experience for that matter (no doubt you do need experience). To be a great provider you must have good instincts and a certain degree of talent. I have honestly been told by several MD's that I should have went to medical school (I still may).

Like I implied before, NP's shouldn't be a replacement for physicians but rather an extension within a healthcare team. If you are sitting behind your computer rolling your eyes, do me a favor ask yourself, who are you to judge me? Have we ever discussed disease processes together? Did you take any chemistry/biology classes with me? Have we done clinical rotations together? Then who are you to tell me I'll "never have the appropriate clinical skill sets to be a great clinician?"

You seem to imagine that if you weren't legally limited to be a nurse, then you could practice as a doctor, even though you have never been through medical school or residency.

That may even be true, but you must understand that it's a dangerously arrogant sounding attitude. I would not trust the vast majority of nurses that I know to do my medical care--I would trust them to do my nursing care. They are not trained to take care of my medical needs.

 

[Tourmaline]

I'm sure they separate nursing chem and pre-med chem. Ignorance is bliss for you I guess.

Flowrate, I find the above comment insulting. Along with another one stating that people go to nursing school because they wouldn't cut it as a doctor. That is insulting, and in many cases, not true. I understand nursing schools have different practices, but at mine (and others in the area) I take the same chemistry series (3 out of the 4 quarters) as the premeds. That's all I was saying. Really.

 

[Little Justice]

lol at this thread

i made a graph to share with you all that i'm sure will make you all really love me!

 

[postbacpremed87]

One the average, at most institutions, nurses take a different set of pre-requisites(lesser ones) than pre-meds/pre-PA students do. I don't know why you are arguing this or making a big point out of it. My only mistake was that I did not say on the average. Your school may be different, but ON THE AVERAGE...nurses take less rigorous pre-reqs. The case is closed.

Flowrate, I find the above comment insulting. Along with another one stating that people go to nursing school because they wouldn't cut it as a doctor. That is insulting, and in many cases, not true. I understand nursing schools have different practices, but at mine (and others in the area) I take the same chemistry series (3 out of the 4 quarters) as the premeds. That's all I was saying. Really.

 

[bluejay0428]

In my experience, nurses at my school took the same bio, but vastly easier and shorter chemistry courses.

It's not insulting to say that nurses don't take basic science courses that are as rigorous, it's true.



You seem to imagine that if you weren't legally limited to be a nurse, then you could practice as a doctor, even though you have never been through medical school or residency.

That may even be true, but you must understand that it's a dangerously arrogant sounding attitude. I would not trust the vast majority of nurses that I know to do my medical care--I would trust them to do my nursing care. They are not trained to take care of my medical needs.

I'm simply implying that I believe NP school in addition to my clinical experience as an RN, will provide a sufficient foundation to provide competent practice in a primary care setting. My point of the entire post is that I'm intellectually capable of handling medical school but am leaning toward NP because of the time and my age.

This all started because people within this thread suggested the only individuals who become NP's are the ones who couldn't be physicians, which is nonsense.

 

[Ortho Guy]

I think America wants NP to take over the primary care role.

Whether or not that is good, I do not know. Undoubtedly, it is the direction we are headed.

 

[Instatewaiter]

That being said, clinical skills are developed with experience in clinical settings, not medical school classrooms. I have spent significant time in the hospital and while my title is RN and I'm not allowed to provide diagnoses, that doesn't change my thought process. All that statement was meant to imply is not all nurses/NP's lack the intellectual capacity to become physicians. I have many other things I'd like to achieve in my life and medical school would put many of those things on hold far longer than I may be willing to sacrifice.

Experience as a nurse is not the same as experience as a doctor. The "experience" you get as a nurse is learned in the first few months of intern year. You get experience from the combination of adequate training (med school AND residency) and years in the hospital as a doctor. Looking on as an observer who is not making any of the decisions doesn't give you anything resembling experience as a decision maker. Anyone can play monday morning quarterback. It doesn't get you clinical experience, or at least anything that can't be gained with a few months as an intern.

I have great relationships with my physician/mid level associates, voice my opinion within reason, and have spent a significant amount of time going through medical textbooks on my own. If I choose NP school over medical school, I will continue to build my knowledge base, increase my professional responsibility and continue my progression toward competent clinical practice. Which NP's are more than capable of providing, in spite of what many insecure people on this board suggest.

Reading a few snipits of a medical textbook =/= medical training.

The training of an NP + some extra reading =/= physician. I cannot tell you how many times in the last year I have gotten a patient from the ED midlevel with completely improper care. For instance, a little while ago we had an elderly patient with n/v and a massive history of atypical MIs. They didn't even have an EKG after almost a day.

To be a great provider you must have good instincts and a certain degree of talent. I have honestly been told by several MD's that I should have went to medical school (I still may).

Where do you think those instincts come from? They come from solid training and a solid fund of knowledge. Go to med school if you want to maximize your chances of having good clinical acumen.

 

[Instatewaiter]

The following is from an SDN poster who was a nurse, went to NP school and then later went to med school:

"Again, I think there is a place for NPs. I think NPs can eventually learn a niche area of medicine... They can be useful in routine tasks and in patient education. The problem is they do not have close to the same level of baseline education to be making independent clinical decisions.

Argue away but until you've done both you argument is all conjecture. Every midlevel I know that later went to medical school will tell you they are amazed and frightened about how little they knew and how much they thought they did."

 

[postbacpremed87]

👍 Epic

The following is from an SDN poster who was a nurse, went to NP school and then later went to med school:

"Again, I think there is a place for NPs. I think NPs can eventually learn a niche area of medicine... They can be useful in routine tasks and in patient education. The problem is they do not have close to the same level of baseline education to be making independent clinical decisions.

Argue away but until you've done both you argument is all conjecture. Every midlevel I know that later went to medical school will tell you they are amazed and frightened about how little they knew and how much they thought they did."

 

[Instatewaiter]

More from that same poster:

Listen [poster's name removed], you don't seem to understand. Have you been to medical school? No, right? I HAVE BEEN TO BOTH!! THERE IS A HUGE DIFFERENCE!!! The fact that you continue to argue this point is a bit ridiculous don't you think?

I feel for you. I really do. I spent many years spouting off the same stuff that's said here by many of the midlevels "experience matters more" "I can do the same thing as a doctor" "I spent X years doing Y and that makes me the same as a doctor." It's simply not true. You simply can't understand the HUGE difference unless you've done both. Sorry...

The problem is you don't know what you don't know. The vast majority of medicine is pretty straight forward, easy in fact. It's the 5% that will get you. You can't diagnose a problem if you have never even heard of it. That's the problem. That's why I've seen bad mistakes made by NPs. Innocuous rash or life-threatening Kawasaki's disease. Get it?

 

[Instatewaiter]

Another Gem from the same guy


I will call your "covered all this also in nursing school and as an NP student" and "We might understand pathology because we take courses called 'pathophysiology'."

I'M A NURSE. I've taken both undergraduate and graduate (NP) "pathophysiology." I was a tenured track full time faculty at a school where I taught nursing classes. I also went to medical school. THERE IS NO COMPARISON IN THE LEVEL OR DEPTH BETWEEN THE TWO!!!!!

You think you understand the difference but you cannot. Talk to me when you finish medical school and tell me they are even close to the same. Every NP I know will tell you the same thing. They are the biggest critics of the expansion of midlevels (particularly NPs) because they realize, in hindsight, how little they knew and how much they thought they knew. Scary.

I am not against midlevels and certainly not against nurses. In fact, I probably value a good nurse MORE than most because I've been there. I am against under qualified people trying to play doctor without undergoing the equivalent education.

 

[Instatewaiter]

/thread

 

[bluejay0428]

Experience as a nurse is not the same as experience as a doctor. The "experience" you get as a nurse is learned in the first few months of intern year. You get experience from the combination of adequate training (med school AND residency) and years in the hospital as a doctor. Looking on as an observer who is not making any of the decisions doesn't give you anything resembling experience as a decision maker. Anyone can play monday morning quarterback. It doesn't get you clinical experience, or at least anything that can't be gained with a few months as an intern.

I have great relationships with my physician/mid level associates, voice my opinion within reason, and have spent a significant amount of time going through medical textbooks on my own. If I choose NP school over medical school, I will continue to build my knowledge base, increase my professional responsibility and continue my progression toward competent clinical practice. Which NP's are more than capable of providing, in spite of what many insecure people on this board suggest.

Reading a few snipits of a medical textbook =/= medical training.

The training of an NP + some extra reading =/= physician. I cannot tell you how many times in the last year I have gotten a patient from the ED midlevel with completely improper care. For instance, a little while ago we had an elderly patient with n/v and a massive history of atypical MIs. They didn't even have an EKG after almost a day.



Where do you think those instincts come from? They come from solid training and a solid fund of knowledge. Go to med school if you want to maximize your chances of having good clinical acumen.

Clearly neither of us is going to budge; therefore this is my last response on this thread. I can point out poor care by several physicians as well. For example, a patient presented to the ED c/o a terrible HA. To make a long story short I felt she had a subdural hematoma. I consulted the physician, they disregarded my suggestion and wrote her up for Compazine and called it day. I mentioned to someone else she may need a CT, once again I got ignored. Two hours later, she finally got a CT and sure enough she had a subdural hematoma. A lot of things happened in between but you get the just of it.

My point is, there are examples of poor care from both sides. For every one story you tell me, I'm sure I can come up with something to refute it. But it doesn't matter; neither of us is going to change our opinion.

I don't believe NP's should be neurologist, cardiologist, etc. But management of illness, knowing when to refer, and diagnosing strep throat doesn't take a brain surgeon.

I still might go to medical school; I have two weeks to make a decision and I can't honestly make up my mind. One minute I think NP the next physician.

 

[gettheleadout]

^ And there's even a tutorial posted halfway up the page on how to format quotes...

 

[FlowRate]

^ And there's even a tutorial posted halfway up the page on how to format quotes...

his/her quotes were improperly formatted because the other person messed it up first, to be fair.

 

[Instatewaiter]

I still might go to medical school; I have two weeks to make a decision and I can't honestly make up my mind. One minute I think NP the next physician.

If you want to be the best provider you can be, go to medical school. If you want to take a shortcut, go to NP school.

 

[NYRN]

I thought this topic has been beaten to death already, but here is my input on it in a nutshell.

1) I have never met or seen any NP's who are looking to take over medicine. Every NP I know or who is in school for NP now, enjoys working with and learning from physicians. They are not looking to be the boss, and they embrace their role as an advance practice nurse, not as an MD/DO equivelant. None of them think by any stretch of the imagination that the education is the same or that years of nursing experience = MD/DO training. That being said, I don't deny that there are some NP's out there who do, but I know they are the minority and not the majority.

2) As far as prereqs for nursing school goes, the vast majority of schools require the bios and chems to be for science majors, the same as the premeds take. I know this is not the case for associates degrees, and some 4 year schools will take non-science major classes, but this is not as common. It really surprises me that many premeds think that we don't take the same classes, we do. The only difference is many schools don't require orgo or physics, which is why I am taking those two classes now for premed. My bios and chems fulfill the requirments already so no need to retake those thank goodness.

3) I don't think its fair to say that NP's or nurses are med school rejects. This is simply not true. Many people who are in late 20's early 30's just cannot justify taking out hundreds and thousands of dollars in loans and another 10 years in school if they have a family. I don't know anyone who went to nursing school because they couldn't get into med school. For myself, I wanted to be a nurse, and this medicine thing came later.

4) I don't think NP's will really ever be a threat to MD/DO's. There are people out there who seek NP's for primary care or for womens issues, and that is their choice. There are many more people who will prefer a physician and that is also their choice.

 

[paul411]

I'm gonna go be a CNA for a few years so that I can skip my first year of radiation oncology training. Clinical hours are clinical hours.

Wait, what? 😕 How does this work?

 

[deleted307836]

Wait, what? 😕 How does this work?

He was being sarcastic... showing that clinical hours in one capacity aren't comparable to clinical hours in another, very different capacity.

 

[TedStark]

BSN nurses at most schools are required to take the same biology, chemistry etc as pre-meds, plus many are required to take microbiology, anatomy/physiology before starting their nursing curriculum. This is not "nursing chemistry", this is the same exact class any undergrad would take (this is bachelor level nursing, not associate level).

And as for the number of clinical hours for a DNP, they might only get 1000 in grad school, but what about the hours they got in undergrad and the 1500-2000hrs per year they got working as an RN before going to DNP school? Many of these places require 2 years of clinical experience before you can start - that is 3000-4000 of pure clinical hours before even beginning school.

At my undergraduate institution the nurses do not take the same classes as the pre-meds. They take the general education version which historically hands out A's if you show up.

"3,000 hours" watching a monitor, following instructions, and taking business classes does not equal 30,000 hours of learning how to diagnose and manage patients from hundreds of MD's/PhD's.

 

[Matthew9Thirtyfive]

At my undergraduate institution the nurses do not take the same classes as the pre-meds. They take the general education version which historically hands out A's if you show up.

"3,000 hours" watching a monitor, following instructions, and taking business classes does not equal 30,000 hours of learning how to diagnose and manage patients from hundreds of MD's/PhD's.

 

[TheBiologist]

but do they make better diagnoses?

 

[WedgeDawg]

Please don't bump old threads without a good reason