"The GRE is no longer required for admission." NPs are making a farce out of us.

[deleted307836]

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Members do not see this ad.

Yet again the whole point is the issue of independently practicing NPs, not supervised ones

Although this is a common source of agitation for residents, more experienced doctors seem to think that this isn't much of an issue. I honestly can't see nurses taken too much business away from doctors -- at least, not enough for it to be a major concern.

Oh, and welcome to pseudo-capitalist America where consumers have the right to make decisions about who to patronize and the responsibility to know that they have to suffer the consequences or enjoy the results of those decisions, whatever they may be.

Why don't we let 4th year medical students practice independently as PCPs then? By the time a med student reaches M4, he/she has far greater basic science training as well as more clinical training than either NPs or DNPs get. So, let's be cost-effective and let M4s practice independently. I'm pretty sure the popularity of primary will increase pretty significantly: the med students will save on a year's tuition, not have to go through the rigors of residency, can start paying off loans sooner, etc.

Sounds like a great idea, doesn't it? But most people, when I bring this up, seem very against it. I don't understand the logic of letting NPs/DNPs, who receive less than 10% of the training a physician does, practice independently but not 4th year medical students.

PS. To clarify, I'm not actually supporting M4s practicing independently. I understand the value of education and was using that as an example.

You seem a little misguided here. I could be way off on this, but I would think that FNPs have more experience in the management of patient care than fourth year medical students. From what I know about the subject, I would MUCH rather see a FNP than an MS4 if forced to choose between the two.

 

[mspeedwagon]

I want to live where you live. The primary care doctors that I used to see at Kaiser (when I didn't have my current insurance) were crap. WebMD or medhelp were both more helpful than then primary care the MDs at Kaiser. Yes, I'm bitter about the inability of Kaiser to properly diagnosis me. I normally just go straight to specialists now.

I strongly disagree with this statement. Good primary care is very hard to provide. Poor/mediocre care is easy to provide and doesn't require you to be a rocket scientist. You need to know a lot about a lot of things. One can make the argument that primary is one of the hardest specialties out there. The breadth and depth of knowledge you need to have is pretty significant.

 

[mspeedwagon]

Not for nursing it's not. You can pop-up a lot of NP schools pretty quickly.

Haha enough top gun, this is different go find a continental forum.....you probability weren't a good business major as the market is totally rigged on the supply side and you are only allowed to utilize the demand in your network...

 

[Charles_Carmichael]

Some schools are moving in this direction. For example LECOM has cut med school to 3 yrs for those interested in primary care. Basically moving to the fact that 3 yrs of med school plus a residency is more than enough for primary care.

I'm actually all for it. M4 students should be able to take NP positions if they would like. They would of course, have to be compensated as NPs for the rest of their career.

Even with your LECOM example, you still have to do residency! One of the most important parts of medical education. All they're doing is shortening the training by one year, not by 90%.

Why should M4s be compensated the same as NPs/DNPs though? They have far superior training to NPs/DNPs.

 

[deleted307836]

I want to live where you live. The primary care doctors that I used to see at Kaiser (when I didn't have my current insurance) were crap. WebMD or medhelp were both more helpful than then primary care the MDs at Kaiser provided. Yes, I'm bitter about the inability of Kaiser to properly diagnosis me. I normally just go straight to specialists now.

This is really interesting to see this is your experience with Kaiser. I don't know a lot about their setup, but from my understanding ALL (or at least the vast majority) of their physicians are paid a flat yearly salary (which is lower than what they could reasonably expect to earn in PP). Some doctors may like that because it allows them to focus more on patient care.

OTOH, doctors who may have trouble attracting and maintaining a solid patient base may also be attracted to this setup. No incentive for quality involved.

 

[Charles_Carmichael]

You seem a little misguided here. I could be way off on this, but I would think that FNPs have more experience in the management of patient care than fourth year medical students. From what I know about the subject, I would MUCH rather see a FNP than an MS4 if forced to choose between the two.

Why? I don't get this. The M4 has better training in both the basic sciences and clinical sciences than the NP. And you'd still prefer the NP? There are direct-entry NP programs popping up left and right where you can graduate with an NP/DNP in 3 years without any prior nursing experience at all. In addition, the nursing community is very adamant about how completely different they are from medicine. So, using their own logic, you can't count any of their nursing years of training as being helpful in functioning as a mid-level.

 

[Charles_Carmichael]

I want to live where you live. The primary care doctors that I used to see at Kaiser (when I didn't have my current insurance) were crap. WebMD or medhelp were both more helpful than then primary care the MDs at Kaiser. Yes, I'm bitter about the inability of Kaiser to properly diagnosis me. I normally just go straight to specialists now.

Yes, you're letting your personal anecdote cloud your judgment and are making gross (wrongful, IMO) generalizations about an entire specialty.

 

[mspeedwagon]

Because in this model they would be accepting the NP position. They are compensated for the position they accept. They are offered two choices: as a graduated M4 take on an NP position and be exposed in clinic as most NPs are OR do a residency.

While their training may be superior, in this model they are filling the same role as the NP. I would have no problem with this model.

I can assure you that all M4s would opt for the residency though.

Even with your LECOM example, you still have to do residency! One of the most important parts of medical education. All they're doing is shortening the training by one year, not by 90%.

Why should M4s be compensated the same as NPs/DNPs though? They have far superior training to NPs/DNPs.

 

[Charles_Carmichael]

I can assure you that all M4s would opt for the residency though.

How can you assure me this? You don't think there would a single student looking at all the benefits of skipping out on a year of tuition, skipping out on the tough 80hr/week residency, paying loans earlier, etc? Do you really think that every single student will look at that and say "No, I need more training" and opt for residency? I would bet my left hand that you would be wrong.

 

[mspeedwagon]

I don't disagree. I have NEVER received EXCELLENT primary care from a primary care physician. The best primary care provider I ever had (back in the day when I had HMO insurance and had to choose one) was an oncologist. Every PCP I have had has been pretty crappy. This has lead me to certain assumptions about PCPs (probably unfairly).

Yes, you're letting your personal anecdote cloud your judgment and are making gross (wrongful, IMO) generalizations about an entire specialty.

 

[mspeedwagon]

I was going to edit this to say "most students." Make $100k now or $200k (on the lower end) three years from now. It doesn't take that long to make-up the salary difference, especially since residency positions are paid at around 40-50k.

How can you assure me this? You don't think there would a single student looking at all the benefits of skipping out on a year of tuition, skipping out on the tough 80hr/week residency, paying loans earlier, etc? Do you really think that every single student will look at that and say "No, I need more training" and opt for residency? I would bet my left hand that you would be wrong.

 

[Charles_Carmichael]

For those that are unfamiliar, here's an old post of mine regarding the (vast) differences between the training physicians and NPs/DNPs receive:

"Here's a sample curriculum from a BSN-DNP program (at Duke): http://nursing.duke.edu/wysiwyg/down...t_MAT_Plan.pdf

You need 73 credits to go from a college degree to a doctorate. That turns out to be less than 3 years.

Now, let's look at the fluff courses that aren't really clinically useful: Research Methods (3 credits), Health Services Program Planning and Outcomes Analysis (3 credits), Applied Statistics (2 credits), Research Utilization in Advanced Nursing Practice (3 credits), Data Driven Health Care Improvement (4 credits), Evidence Based Practice and Applied Statistics I & II (7 credits, since you told me medicine is not evidence based), Effective Leadership (2 credits), Transforming the Nation's Health (3 credits), DNP Capstone (6 credits), Health Systems Transformation (3 credits), Financial Management & Budget Planning (3 credits).

Here are the clinically useful courses: Population-Based Approach to Healthcare (3 credits), Clinical Pharmacology and Interventions for Advanced Practice Nursing (3 credits), Managing Common Acute and Chronic Health Problems I (3 credits), Selected Topics in Advanced Pathophysiology (3 credits), Diagnostic Reasoning & Physical Assessment in Advanced Nursing Practice (4 credits), Common Acute and Chronic Health Problems II (3 credits), Sexual and Reproductive Health (2 credits), Nurse Practitioner Residency: Adult Primary Care (3 credits), Electives (12 credits).

So, out of the 73 credits needed to go from BSN to DNP, 37 credits are not clinically useful. In addition, the number of required clinical hours is 612 hours (unless I miscounted something)!! Wow! And the NP program is designed the same way, with a bunch of fluff courses (11 credits out of 43 required are fluff) and requires 612 hours as well: http://nursing.duke.edu/wysiwyg/down...rriculum_2.pdf

Here are the curricula to several other programs:

• University of Arizona: http://www.nursing.arizona.edu/OSA/P...ndout_2008.pdf 31/74 credits are fluff.
• Loyola's MSN to DNP: http://www.luc.edu/nursing/dnp/curriculum.shtml (where are the basic science classes? They're all public health classes!!)
• MGH BSN to DNP: http://www.mghihp.edu/nursing/postpr...ulum.html?cw=1 (35/72 credits for Adult DNP are fluff while 46/83 credits for DNP in FM are fluff)

It's kinda scary how inadequate that training is in order to practice medicine independently. You can't really count prior nursing experience as time practicing medicine because you weren't practicing medicine during that time nor were you thinking in a medical manner (ie. the way a physician would). Nursing clinical hours might help you transition into medicine but they are NOT a replacement for medical clinical hours.

Now, just for comparison, let's look at a med school curriculum. I'll point out all the fluff courses here too. Here's an example from Baylor School of Medicine for M1/M2 (http://www.bcm.edu/osa/handbook/?PMID=5608) and for M3/M4 (http://www.bcm.edu/osa/handbook/?PMID=7463):

Fluff courses at Baylor School of Medicine during M1/M2 years ONLY: Patient, Physician, and Society-1 (4.5 credits), Patient, Physician, and Society-2 (6 credits), Bioethics (2.5 credits), Integrated Problem Solving 1 & 2 (10 credits).

Useful courses at Baylor School of Medicine during M1/M2 years ONLY: Foundations Basic to Science of Medicine: Core Concepts (14.5 credits), Cardiovascular-Renal-Resp (11.5 credits), GI-Met-Nut-Endo-Reproduction (14 credits), General Pathology & General Pharmacology (6.5 credits), Head & Neck Anatomy (4.5 credits), Immunology (5 credits), Behavioral Sciences (6.5 credits), Infectious Disease (13 credits), Nervous System (14 credits), Cardiology (4.5 credits), Respiratory (3.5 credits), Renal (4 credits), Hematology/Oncology (5 credits), Hard & Soft Tissues (3 credits), Gastroenterology (4 credits), Endocrinology (3.5 credits), GU/Gyn (3 credits), Genetics (3 credits), Age Related Topics (2.5 credits).

For only the M1/M2 years at Baylor, there's 162.5 total credits. Out of these 162.5 credits, 23 credits are fluff.

Core Clerkships during M3 (useful clinical training): Medicine (24 credits, 12 weeks), Surgery (16 credits, 8 weeks), Group A selective (8 credits, 4 weeks), Psychiatry (16 credits, 8 weeks), Neurology (8 credits, 4 weeks), Pediatrics (16 credits, 8 weeks), Ob/Gyn (16 credits, 8 weeks), Family & Community Medicine (8 credits, 4 weeks), Clinical Half-Day (includes Clincal Application of Radiology, Clinical Application of Pathology, Clinical Application of Nutrition, Clinical Evidence Based Medicine, Longitudinal Ambulatory Care Experience, and Apex -- 23 credits).

So, without even taking into consideration M4 electives and required subinternships (which are usually in Medicine and Surgery), medical students already have a far superior medical training than NPs or DNPs. Other examples of med school curricula:

• UMich M1/M2: http://www.med.umich.edu/lrc/medcurr...gram/m1m2.html
• UMich M3/M4: http://www.med.umich.edu/lrc/medcurr...gram/m3m4.html
• Duke: http://medschool.duke.edu/modules/so...index.php?id=2

You can get a BSN to DNP in about 3 years according to many programs I've looked at. Medicine involves 4 years of medical school and a minimum of 3 years of residency before allowing independent practice. Here's the math:

BSN to DNP: 2.5 - 3 years of training; longer if courses taken part-time; 600-1000 clinical hours!
BS/BA to MD/DO: 4 years med school + 3-5 years residency: 7-11 years of training; not possible part-time; clinical hours > 17000"

I also want to point out that there are really no valid studies suggesting that NP/DNP outcomes are equivalent to those of physicians. NPs/DNPs always mention that studies show that patients are more "satisfied" with the care/attention they receive from NPs/DNPs than from physicians. However, patient satisfaction =/= quality medical care. I talk to patients all the time when I'm volunteering in the ED, etc, and several have told me they feel much better after talking to someone. That does not mean I should be allowed to practice independently.

 

[morning]

Not for nursing it's not. You can pop-up a lot of NP schools pretty quickly.

Sounds like a good idea.

I honestly can't see nurses taken too much business away from doctors -- at least, not enough for it to be a major concern.

Yes, that's the major concern. Taking business away.

 

[deleted307836]

Sounds like a good idea.



Yes, that's the major concern. Taking business away.

To be honest, I think that IS the major concern for many of the posters on SDN who hide behind the veil of patient safety. That, and the perceived degradation of the prestige of the field. That's what I was responding to.

 

[mspeedwagon]

See... now we can all agree on go to bed (I know it was sarcasm). Alright, good night folks. USA vs Ghana tomorrow. Go USA!

Sounds like a good idea.



Yes, that's the major concern. Taking business away.

 

[FutureDoc4]

Although this is a common source of agitation for residents, more experienced doctors seem to think that this isn't much of an issue. I honestly can't see nurses taken too much business away from doctors -- at least, not enough for it to be a major concern.

Oh, and welcome to pseudo-capitalist America where consumers have the right to make decisions about who to patronize and the responsibility to know that they have to suffer the consequences or enjoy the results of those decisions, whatever they may be.



You seem a little misguided here. I could be way off on this, but I would think that FNPs have more experience in the management of patient care than fourth year medical students. From what I know about the subject, I would MUCH rather see a FNP than an MS4 if forced to choose between the two.

You are way off here. Granted I would never want to see either one for anything. But, if I was forced to make a decision. 4th year medical student hands down. Why? Cause they are trained in MEDICINE (unlike the 'Doctor Nurse"), who is trained in nursing (they went to NURSING school to get a BA/MSN, if they get a DNP, they get for little to almost zilch training in medicine--Look at some of the threads on here to find out about their curriculum). The curriculums aren't even a comparison.

I think this was already stated. But, everyone needs to ask themselves, if it was my "mother, father, sister/brother" that needed to manage a chronic condition such as heart disease, diabetes, PVD---wouldn't you want the physician who can understand and apply the medical literature? Who has the more in depth training.

Here is an important concept: It is HARD to be a good GP, but very, very, very easy to be a crappy one. Why? Cause most of these diseases have few immediate repercussions, more often its long term damange.

Everyone says we spend to much on healthcare. Well, what is it worth to you? People are going to have to make decisions. The problem is (as the research has shown over and over) that the average patient isn't a "smart" healthcare consumer and they dont know who they are getting their healthcare from. Please see the recent AAMC survey on this (I am to tired to link it myself--there are funny things in these surveys, like less than 20% of people realize that otolaryngologists are physicians---it really shows you how uninformed the public is).

http://www.ama-assn.org/ama/pub/news/news/healthcare-truth-transparency.shtml
(Here is how the AMA is responding to the research)

My philosophy in life and medicine:

If it is not good enough for my family members, its not good enough for my patients.

Finally, in terms of "filling a void" and cutting costs. These practitioners have no desire to do this. Pleases see the residency forums on the USF Derm Residency programs in Dermatology (built for DNPs) or the following:

http://video.foxnews.com/v/4161870/t...ll-see-you-now

Notice, in teh video that DNPs "should be compensated equally"

People need to pull the cotton out of their ears.

Finally, you can see how the AANP (the nurse lobbying organization) is against the "Truth and Tranparency" act. Is this someone you want taking care of you?

http://www.nursingworld.org/MainMenuCategories/ANAPoliticalPower/Federal/Issues/Healthcare.aspx

Quoted from their page:
"This bill would make it illegal for any licensed health care provider who is not a medical doctor (MD) or doctor of osteopathic medicine (DO) to make any statement or engage in any act that would lead patients or the public to believe that they have the same or equivalent education, skills, or training as an MD or DO."

They are actually against this and state it openly. They want equal recognition in skill set with less than have the work (see work hours in Taurus's signature)

Finally, CityLights, you try to come off as informed; but, you really seem to lack an understanding of what is going on.

 

[Charles_Carmichael]

To be honest, I think that IS the major concern for many of the posters on SDN who hide behind the veil of patient safety. That, and the perceived degradation of the prestige of the field. That's what I was responding to.

The patient safety issue is not a veil. There are currently no well-done studies that suggest NPs/DNPs provide care equivalent to that provided by board-certified attendings in a primary care setting. There are a ton of badly done studies (ie. measuring useless things like diastolic pressure only at the end of the study, patient satisfaction, etc) that keep being cited.

One reason for this is that it would be unethical for a double-blind, RCT to be done where patients are placed solely under the care of providers who have far less training than physicians.

 

[WDeagle]

NP's really are not that cost effective. They end up referring alot of cases to specialists that a PCP probably could have treated themselves. An NP visit + a specialist visit is going to cost way more than a single PCP visit. What about the cost of missing an early diagnosis. Its much cheaper to catch a disease early than to treat it later on.

NP's might end up increasing liability for physicians. They end up cherry-picking the easy cases and referring the more difficult(and litigious) cases to physicians. A good example is whats going on with nurse midwives and OB's. Similarly by cherry-picking easy cases they decrease physician income. While NP's can see 35 easy cough/cold "here are some antibiotics you dont need" cases physicians may get stuck with 15 complex cases a day that pay the same.

Does anyone else see this whole thing as unethical? Nursing school's are capitalizing on a perceived shortage and shoving as many students into schools as quickly as they can. Medicine is more complex now than ever before. Inundating the system with people who have less and less training is kind of a crappy thing to do to patients. Nobody wants to be treated by someone who doesnt have adequate training when their health is at stake. If the people in charge of nursing schools really cared about patients they would increase they length and quality of NP/DNP programs rather than make it easier and easier.

 

[deleted307836]

The patient safety issue is not a veil. There are currently no well-done studies that suggest NPs/DNPs provide care equivalent to that provided by board-certified attendings in a primary care setting. There are a ton of badly done studies (ie. measuring useless things like diastolic pressure only at the end of the study, patient satisfaction, etc) that keep being cited.

One reason for this is that it would be unethical for a double-blind, RCT to be done where patients are placed solely under the care of providers who have far less training than physicians.

I'm in total agreement with you here -- patient safety and the quality of care is a HUGE concern. My point was merely that, in my opinion, many of the posters on SDN use the "patient safety" argument to latently encompass the concerns I stated above. Sometimes it's blatantly obvious. I won't name any names as that's probably a TOS violation. But say, if you joined two days ago, have 60 posts, and all of them are about this issue in one facet or another, it may be likely you belong in this category.

 

[Charles_Carmichael]

I'm in total agreement with you here -- patient safety and the quality of care is a HUGE concern. My point was merely that, in my opinion, many of the posters on SDN use the "patient safety" argument to latently encompass the concerns I stated above. Sometimes it's blatantly obvious. I won't name any names as that's probably a TOS violation. But say, if you joined two days ago, have 60 posts, and all of them are about this issue in one facet or another, it may be likely you belong in this category.

While I do agree with you to a certain extent, to play devil's advocate here, what's wrong with wanting to protect one's turf? Every other profession does it so why should physicians be excluded from it? Why should NPs/DNPs be allowed to cherry-pick all the easy cases and leave physicians with only the complicated ones (which also means greater risk and liability) when they're both going to get compensated fairly similarly?

Edit: Just saw WDeagle's post. Spot on! 👍

 

[deleted307836]

You are way off here. Granted I would never want to see either one for anything. But, if I was forced to make a decision. 4th year medical student hands down. Why? Cause they are trained in MEDICINE (unlike the 'Doctor Nurse"), who is trained in nursing (they went to NURSING school to get a BA/MSN, if they get a DNP, they get for little to almost zilch training in medicine--Look at some of the threads on here to find out about their curriculum). The curriculums aren't even a comparison.

I think this was already stated. But, everyone needs to ask themselves, if it was my "mother, father, sister/brother" that needed to manage a chronic condition such as heart disease, diabetes, PVD---wouldn't you want the physician who can understand and apply the medical literature? Who has the more in depth training.

Here is an important concept: It is HARD to be a good GP, but very, very, very easy to be a crappy one. Why? Cause most of these diseases have few immediate repercussions, more often its long term damange.

Everyone says we spend to much on healthcare. Well, what is it worth to you? People are going to have to make decisions. The problem is (as the research has shown over and over) that the average patient isn't a "smart" healthcare consumer and they dont know who they are getting their healthcare from. Please see the recent AAMC survey on this (I am to tired to link it myself)

http://www.ama-assn.org/ama/pub/news/news/healthcare-truth-transparency.shtml
(Here is how the AMA is responding to the research)

My philosophy in life and medicine:

If it is not good enough for my family members, its not good enough for my patients.

Finally, in terms of "filling a void" and cutting costs. These practitioners have no desire to do this. Pleases see the residency forums on the USF Derm Residency programs in Dermatology (built for DNPs) or the following:

http://video.foxnews.com/v/4161870/t...ll-see-you-now

Notice, in teh video that DNPs "should be compensated equally"

People need to pull the cotton out of their ears.

That's a really good point in your first paragraph -- about the lack of a uniform education for NPs. Thank you for the correction.

If given the choice between a brand new NP and a MS4, I would place more confidence in the MS4. But I think some people here may be discounting the value of experience -- for an NP who has years of experience in primary care, I wouldn't go into her office with particularly low expectations.

One thing, though -- I don't think it's incredibly fair to portray a few deviants as the voice of the nursing profession. Both the nurse in that video and the USF Derm "Residency" are absolute jokes. However, my intuition tells me that the USF program and that nurse aren't particularly representative of the majority of nurse practitioners.

 

[Charles_Carmichael]

One thing, though -- I don't think it's incredibly fair to portray a few deviants as the voice of the nursing profession. Both the nurse in that video and the USF Derm "Residency" are absolute jokes. However, my intuition tells me that the USF program and that nurse aren't particularly representative of the majority of nurse practitioners.

Well, when the "silent majority" never speaks out against the vocal minority, it's kind of hard to keep thinking that most NPs/DNPs are against this current trend. By not speaking up, they're sending me the message that they either don't care about this issue or that they're okay with it. Both choices are scary.

My intuition has been trying to tell me for the last year and a half or so (ever since I first became aware of this issue and became outspoken against this), but I have never come across any NPs/DNPs speaking out against the vocal minority except on anonymous forums. And we all know how influential these anonymous forums are right?

 

[deleted307836]

While I do agree with you to a certain extent, to play devil's advocate here, what's wrong with wanting to protect one's turf? Every other profession does it so why should physicians be excluded from it? Why should NPs/DNPs be allowed to cherry-pick all the easy cases and leave physicians with only the complicated ones (which also means greater risk and liability) when they're both going to get compensated fairly similarly?

Edit: Just saw WDeagle's post. Spot on! 👍

I don't blame ANYONE for trying to protect their turf.

Personally, though, I tend to adopt a free-market philosophy in this debate. I myself wouldn't voluntarily see an NP for anything, but if a doctor deems it appropriate for my concerns then I will. However, if a NP does, for whatever reason, want to practice independently, I feel that he or she should have that right as long as their patients CLEARLY KNOW who they are being treated by.

I'll also add that some on SDN (particularly on the residency board) simply give me the impression of needing to "keep nurses in their place." It's that sentiment that I feel colors a lot of this debate and is nothing more than a tool for some to build up their own egos at the expense of those that they put down.

 

[FutureDoc4]

That's a really good point in your first paragraph -- about the lack of a uniform education for NPs. Thank you for the correction.

If given the choice between a brand new NP and a MS4, I would place more confidence in the MS4. But I think some people here may be discounting the value of experience -- for an NP who has years of experience in primary care, I wouldn't go into her office with particularly low expectations.

One thing, though -- I don't think it's incredibly fair to portray a few deviants as the voice of the nursing profession. Both the nurse in that video and the USF Derm "Residency" are absolute jokes. However, my intuition tells me that the USF program and that nurse aren't particularly representative of the majority of nurse practitioners.

That's like saying you can't "judge a country by its leader"... granted, its not entirely fair (but its how we do it).

For example, North Koreans as a people I'm sure are great people, but we all get stuck interacting with Kim Jon Il--we have to unfortunately judge North Korea by its leadership.

We judge those groups by those that claim to represent them--like it or not. The AMA does not speak for all physicians, (it has a very low enrollment actually), but it is assumed as the face of physicians regardless of the reality of how it operates in the real world.

Finally, and the most important concept:

Get ready for it.....

I AM GOING TO HAVE IT IN ALL CAPS FOR YOU


EXPERIENCE DOES NOT REPLACE A THEORETICAL UNDERSTANDING OF SCIENCE AND MEDICINE

THis is what is so hard to the average person to get across. People can see a procedure and repeat things over and over again (no problem). But, then they really dont have an understanding and cannot adapt or change to situations or new problems they have not encountered before.

 

[Charles_Carmichael]

Personally, though, I tend to adopt a free-market philosophy in this debate. I myself wouldn't voluntarily see an NP for anything, but if a doctor deems it appropriate for my concerns then I will. However, if a NP does, for whatever reason, want to practice independently, I feel that he or she should have that right as long as their patients CLEARLY KNOW who they are being treated by.

Don't get me wrong; I completely agree with you for the most part.

This part I've quoted though, I completely disagree with. Medicine is not a free market. Patients are not smart consumers when it comes to medical care. It's not like having to choose between Pepsi and Coke. Going with Pepsi is not going to kill you or cause significant harm that would've been prevented if you went with Coke. In the medical setting, the training you get can be absolutely critical in the delivery of competent care.

I also believe in the free-market philosophy for most things. However, in the arena of medicine, I absolutely think that there needs to be regulation in order to protect patients from quacks and lesser-trained individuals who are in over their heads.

Also, read the link Truth and Transparency Act link that FutureDoc provided. There's a survey in there showing how confused patients are about who's a doctor and who's not. Most patients will think whoever is wearing a white coat is a physician, even if they introduce themselves as otherwise.

 

[Charles_Carmichael]

EXPERIENCE DOES NOT REPLACE A THEORETICAL UNDERSTANDING OF SCIENCE AND MEDICINE

THis is what is so hard to the average person to get across. People can see a procedure and repeat things over and over again (no problem). But, then they really dont have an understanding and cannot adapt or change to situations or new problems they have not encountered before.

👍

This is an excellent point! Patients don't present just like a textbook describes them. If medicine was just following algorithms and nothing else, a high school student (heck, even a computer) can do it. The problem is, though, that when a patient deviates from the textbook presentation, the physician has that basic science and clinical background to adapt to the situation and make the right decision. You cannot say the same for NPs/DNPs because they don't receive the same in-depth training in physio/path/pathophys/pharm/etc that a physician does.

 

[morning]

I don't blame ANYONE for trying to protect their turf.

Personally, though, I tend to adopt a free-market philosophy in this debate. I myself wouldn't voluntarily see an NP for anything, but if a doctor deems it appropriate for my concerns then I will. However, if a NP does, for whatever reason, want to practice independently, I feel that he or she should have that right as long as their patients CLEARLY KNOW who they are being treated by.

I'll also add that some on SDN (particularly on the residency board) simply give me the impression of needing to "keep nurses in their place." It's that sentiment that I feel colors a lot of this debate and is nothing more than a tool for some to build up their own egos at the expense of those that they put down.

It doesn't matter why they feel that way if they are right. The residency forum could have an active, burning of hatred of all things nursing, a blazing pit of anger that consumes every waking moment, and the validity of the patient health argument would still stand.

Should patients be allowed to go to a BS healthcare provider? They already do - chiropractors, NDs. But those people don't get prescription rights, and nor should they or NPs. Nor should they be allowed to call themselves doctors. And NO pediatric patients or geriatric patients without the ability to consent. And when the NP screws up? The patient will get loaded back into the system at great cost.

 

[morning]

Don't get me wrong; I completely agree with you for the most part.

This part I've quoted though, I completely disagree with. Medicine is not a free market. Patients are not smart consumers when it comes to medical care.

I agree with you and that's really a good point. Patients don't know what is and isn't good care. They can usually tell when a doctor is an arsehole and feel more comfortable around a doctor who is friendly, but neither of those are actual medical care. The best they can do about their diagnosis and their Rx is take the doctor's word for it, get a second opinion, or Google it and argue about it (everyone's favorite patient!) This isn't like buying a car where you can know pretty much anything about it. There is a massive amount of trust that goes on between a patient and their physician because the patients are literally walking blind when it comes to medicine. I sure as heck wouldn't know if a doctor missed something subtle but major, nor would I know if I was being misdiagnosed.

 

[SoulinNeed]

Are you guys saying that I should no longer look forward to becoming an IM Physician?

I mean, seriously, there is HUGE demand in primary care, and someone has to do it. If there aren't enough doctors that will do it, then this is sadly what has to happen.

 

[Luke4202]

I hate to say it, but I think the profession has brought this upon itself. Years and years of union-like tactics by the AMA have lead to a shortage of physicians. These were aimed at protecting physician's pockets, but at a certain point it became absurd.

As late in the game as 2000, the AMA was still advocating against increasing med school enrollment. One of the big reasons you've seen the Osteopatic medical schools gain so much respect in the past 50 years is that there are many many quality applicants who make great doctors that are being turned away by the allopathic schools.

If there are no doctors, people must go somewhere for care, that's why the NP's have a niche to fill. If we were producing enough doctors, you wouldn't be seeing these new schools popping up. These policies lead to an abundance of high paying jobs in the profession, but at some point economics catches up to everyone.

 

[familyaerospace]

years ago it would be absurd to be dx and treated by a nurse with no doc involvement

In 1999, which isn't all that long ago, my primary care provider was a NP who diagnosed me and tried to treat me for a horrible infection for over a year (it never cleared because she apparently misidentified the body part that was infected or something). She refused to help me see a specialist until I threatened to sue for malpractice.

 

[familyaerospace]

I want to live where you live. The primary care doctors that I used to see at Kaiser (when I didn't have my current insurance) were crap. WebMD or medhelp were both more helpful than then primary care the MDs at Kaiser. Yes, I'm bitter about the inability of Kaiser to properly diagnosis me. I normally just go straight to specialists now.

I had this same problem with Kaiser where I live too. I was very happy when I had better insurance and I could actually pick my own doctors and I went straight to people who I trusted.

 

[Kaustikos]

Alright, fk it, I'm just going to become an NP. Less liability, less schooling, less debt. I can't wait until they just have you sign a form, get accepted, and they just throw you into practice.

 

[PR405]

Good. The easier it is to become an NP the better. docs legitimized their authority by raising the bar- requiring more years education, licensure, tests, etc. reducing the standards for NPs is a good thing as long as scope of practice doesn't broaden.

 

[NotAsking4Much]

👍

This is an excellent point! Patients don't present just like a textbook describes them. If medicine was just following algorithms and nothing else, a high school student (heck, even a computer) can do it. The problem is, though, that when a patient deviates from the textbook presentation, the physician has that basic science and clinical background to adapt to the situation and make the right decision. You cannot say the same for NPs/DNPs because they don't receive the same in-depth training in physio/path/pathophys/pharm/etc that a physician does.

I humbly disagree.

Ask any doctor if they remember all their biochem. Probably less than 10% do. No one cares how big a ribosome is nor is it clinically relevant.

As for a M4 vs NP with years of experience, I would stay as far away from the M4 as possible. Experience counts for everything. You see enough cases, you're going to see the entire spectrum of disease manifestations. I have relatives who are physicians as well as some who are PA/NPs. There is competency and incompetency in both.

Most importantly though, you have two alternatives right now in the healthcare market. Cut specialists' salary and raise PCP's. Or leave specialists' salary where it is and let other people fill the primary care void.

This whole debate about "oh I don't want to see a NP / they have no background" is completely useless.

The most important question you should think of addressing is how the primary care deficiency can be addressed, esp. in rural areas. PAs and NPs are just a marketforce response to the PCP void.

 

[morning]

PAs and NPs are just a marketforce response to the PCP void.

It's not like PAs or NPs sprung up spontaneously in the last decade. They've been around for a long and now they (NPs much more so than PAs) are using the PCP "void" (maldistribution?) to their advantage in an extremely calculated way. You're parroting propaganda.

I'd love to see anything that has shown NPs have genuinely reduced need for PCPs...and done so without sacrificing quality.

 

[FutureDoc4]

I humbly disagree.

Ask any doctor if they remember all their biochem. Probably less than 10% do. No one cares how big a ribosome is nor is it clinically relevant.

As for a M4 vs NP with years of experience, I would stay as far away from the M4 as possible. Experience counts for everything. You see enough cases, you're going to see the entire spectrum of disease manifestations. I have relatives who are physicians as well as some who are PA/NPs. There is competency and incompetency in both.

Most importantly though, you have two alternatives right now in the healthcare market. Cut specialists' salary and raise PCP's. Or leave specialists' salary where it is and let other people fill the primary care void.

This whole debate about "oh I don't want to see a NP / they have no background" is completely useless.

The most important question you should think of addressing is how the primary care deficiency can be addressed, esp. in rural areas. PAs and NPs are just a marketforce response to the PCP void.

I love how people know which things that are clinically relevant before starting medical school (granted, I am not far along in the process--M3). But, I have seen the "so useless basic sciences" used far more often that many would like to admit.

A quick jump over to the Residency forum, and people will have discussed this before. The overarching theme, yes---there is stuff you will learn and forget as useless (including the foramen in the skkull---unless you are a neurosurgeon)... but, what is relevant depends on your speciality a lot of the times.

The point is to get a BROAD based education, so if you encounter a new problem you know how to properly address it or refer properly.

Understanding the "why" of G6PD deficiency will allow you to understand why that patient is anemic after taking Bactrim (OMG, its biochemistry in action!) (people, they are not just trying to torture you in medical school for the first two years for no reason!)

The notion that I have even have to "fight" my future generation of colleagues to advocate that more education is frightening. Medicine is becoming more and more complicated, NOT less.

For the record, the comparison was a fresh NP to a brand new minted M4. Many NP programs now do NOT require previous experience (if you had been keeping up). Even so, I would take a freshly minted M4 who has a board based background then a freshly minted NP, who might have worked as a nurse in a Derm clinic for the last 10 years. How much do they remember about GI infections? (probably not much)

No one is expected to remember everything from biochem, but the boards (both internal medicine, and others, and your Steps will test you on it---so, it may be not as "irrelevant" as you think)

Btw, these new practioners are not going to address the maldistribution of physicians to rural areas.

These practioners are NOT going to give people more access... why would they want to go somewhere other people also don't want to go? Aka there is no incentive to go there. They will just complete "residencies" in Derm and set up shop in places near NYC etc and discuss their more "holistic" approach to the patient.

The incentives are not large enough, its a simple equation.... more $$$$ is needed to incentive people to these unpopular areas. The problem is no one wants to pay for it.

A growing problem in our country. We all want everything and want someone else to pay for it.

When did we decide as a profession that quantity>>>quality?