"The NP Education Disaster"

[Splenda88]

Finally someone is starting to address this issue.

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[IMG69]

I was speaking to a PA turned M1 about a Radiology rotation (he asked me and said he wouldn't learn anything) and he was saying how easy it is doing standard X-ray reads etc and how when he was a PA all he ever saw was obvious fractures etc and he didn't understand how Radiologists got paid so much. I had to explain to him that it's completely different when you have the final word on an image and the whole hospital relies on your judgement rather than you just attempting a read without any consequences. Also had to explain that they wouldn't even show them anything other than obvious imaging because they've had 0 training in it so what good would it be to even try get them to attempt a read. I asked him why he thought Radiology was 5 years, he said he had no idea.

It's shocking how naïve other professionals within the medical field are.

 

[Lawpy]

Finally someone is starting to address this issue.

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Hopefully this new channel gains a lot of popularity

 

[BidingMyTime]

I had heard this story before, completely heartbreaking. Working as a pharmacist in both hospital and retail, and as a parent of many, I have had many experiences with NP's in the course of my job and as a parent, and it is really hit or miss. Scarily hit or miss. There have been a couple of times when I was with a NP, and the NP is telling me what her diagnosis is, and I'm thinking how I as a pharmacist really don't know anything about diagnosis, but I know what the NP is telling me is nonsensical.

In the sad case of Betty, if I had been working retail and her parents came in and asked me what to do for their daughter, looking at her I would have said, I would take her to the ER (and if they balked at the price of the ER, I'd have told them to call her pediatrician immediately).... but even if her parents had taken her to an ER, she likely would have been seen by an NP.

This video sums it up nicely, the complete lack of standardization of the training, is the primary problems (other problems as well, but without a solid educational foundation, it's impossible to even work on the other problems.)

 

[Matthew9Thirtyfive]

Recently came off a rotation where I worked side-by-side with a NP student. The student had worked as a nurse in a different field for many years and I thought "probably knows a lot!". I was wrong.

The student couldn't ramble off a 1 liner, couldn't come up with a differential (looked at me cross-eyed when I had mentioned SIADH, like "WTH is that?"), and had to look at my notes for structure. The kicker? Said student blatantly bragged about how she will be independent in less than a year. Meanwhile, the residents and I are signed up for the long haul. What really kicked me in the gut was when she told me her fiancé failed out of medical school and is now working as a APN.

I'm thankful to be where I am and to have the opportunity to do what I love for a living. I wanted the best training available and wanted to provide all that I could to patients. But the utility of going to medical school is quickly fading, and this phenomenon seems to strictly reside within the US healthcare system. We spend more than anyone, have poor outcomes, and the answer is to fill our system with midlevels who have less training and standards?

The only possible hope I have is that A) lawyers smell blood in the water, B) the proliferation of shoddy NP programs leads to the profession's demise, or C) people actually begin to advocate for us (laughable).

They won’t be advocating for us, but when the right people are dying or being hurt by these charlatans, the patients will start advocating for themselves. I’m rotating with two PA students, and they can’t even write their own notes or participate in any meaningful way in the OR. And they graduate in like 3 months.

There are two NPs on this service I’m on. They were both nurses for years first, and they work in a narrow area of the specialty and only see low acuity, routine patients for established care. They both have very low thresholds for escalating care or bringing in a physician for clarification of anything. If anyone is even remotely higher risk, they bump them up to a physician. They are basically the ideal set up for an NP, and it makes it so horrifying seeing how many NPs are being misused or are taking positions they shouldn’t be in, because there is a role for them on the healthcare team. But they just want our position without any of the work it takes to get there.

 

[Natremia]

Recently came off a rotation where I worked side-by-side with a NP student. The student had worked as a nurse in a different field for many years and I thought "probably knows a lot!". I was wrong.

The student couldn't ramble off a 1 liner, couldn't come up with a differential (looked at me cross-eyed when I had mentioned SIADH, like "WTH is that?"), and had to look at my notes for structure. The kicker? Said student blatantly bragged about how she will be independent in less than a year. Meanwhile, the residents and I are signed up for the long haul. What really kicked me in the gut was when she told me her fiancé failed out of medical school and is now working as a APN.

I'm thankful to be where I am and to have the opportunity to do what I love for a living. I wanted the best training available and wanted to provide all that I could to patients. But the utility of going to medical school is quickly fading, and this phenomenon seems to strictly reside within the US healthcare system. We spend more than anyone, have poor outcomes, and the answer is to fill our system with midlevels who have less training and standards? What I am dumbfounded by, however, is that medical schools keep raising tuition and students remain silent and play along, even though they are training side-by-side with NP students who pay less for a shorter duration (and do the same job, apparently).

The only possible hope I have is that A) lawyers smell blood in the water, B) the proliferation of shoddy NP programs leads to the profession's demise, or C) people actually begin to advocate for us (laughable).

Why is your school having np students on rotations with med students? Disgraceful. You should put your school so future Med students can avoid it/ not apply

 

[Matthew9Thirtyfive]

Why is your school having np students on rotations with med students? Disgraceful. You should put your school so future Med students can avoid it/ not apply

I mean, they also need to rotate places. I rotated with PA students. As long as they aren’t taking learning opportunities from med students, who cares?

 

[Fatalis]

Not surprised with these stories. As my dad always says “every job is easy when you work under someone because in the end the responsibility is never on you and you never have to sweat”
Of course reading a chest X-ray is easy for the PA. If they are wrong, it’s not on them. Mid level arrogance is at an all time high because they lack the formal training that we all go through but have the confidence that they know medicine because their school says so.

 

[deleted966164]

Not surprised with these stories. As my dad always says “every job is easy when you work under someone because in the end the responsibility is never on you and you never have to sweat”
Of course reading a chest X-ray is easy for the PA. If they are wrong, it’s not on them. Mid level arrogance is at an all time high because they lack the formal training that we all go through but have the confidence that they know medicine because their school says so.

I will one-up you if I may… the PA/NP students are overconfident while my school destroyed any confidence I ever had…

 

[Fatalis]

I will one-up you if I may… the PA/NP students are overconfident while my school destroyed any confidence I ever had…

It is part of a doctors training; bleed out the confidence😂

 

[InFreudWeTrust]

Mid level arrogance is at an all time high because they lack the formal training that we all go through but have the confidence that they know medicine because their school says so.

This is probably why I've heard several NPs refer to residents as "the students" over the past year. I had to turn my head a couple of times to see if my fellow medical student colleagues were in the room with me. But "go with the student" meant 'residents'. It makes me wonder if the new MO in NP school is to brainwash their students into thinking residents aren't doctors, but mere students.

I just sit in disbelief. And this happens in no other profession because we somehow allowed it to happen. Every physician I encounter, save for 1, refers to us as "providers". The profession gave no push back, and this is where we are now.

 

[deleted966164]

This is probably why I've heard several NPs refer to residents as "the students" over the past year. I had to turn my head a couple of times to see if my fellow medical student colleagues were in the room with me. But "go with the student" meant 'residents'. It makes me wonder if the new MO in NP school is to brainwash their students into thinking residents aren't doctors, but mere students.

I just sit in disbelief. And this happens in no other profession because we somehow allowed it to happen. Every physician I encounter, save for 1, refers to us as "providers". The profession gave no push back, and this is where we are now.

sadly, this is because if you try to say anything it will make you sound like a d-bag...

 

[Matthew9Thirtyfive]

Every physician I encounter, save for 1, refers to us as "providers".

I’m just an MS3, but I have told several residents why they shouldn’t call themselves providers. None of them knew the history of the word or why it’s being used today.

 

[Fatalis]

This is probably why I've heard several NPs refer to residents as "the students" over the past year. I had to turn my head a couple of times to see if my fellow medical student colleagues were in the room with me. But "go with the student" meant 'residents'. It makes me wonder if the new MO in NP school is to brainwash their students into thinking residents aren't doctors, but mere students.

I just sit in disbelief. And this happens in no other profession because we somehow allowed it to happen. Every physician I encounter, save for 1, refers to us as "providers". The profession gave no push back, and this is where we are now.

Some of the ones I have encountered have a serious complex about them not being a physician and bring it up at every point that they can "outdo any doctor any day of the week".

 

[GoSpursGo]

A particularly aggressive and rude response has been deleted from this thread. While these discussions invariably can get heated, let's please remember to refrain from personal attacks.

 

[stickgirl390]

I was prerounding on an ICU patient the other day, and overheard the CRNA student (STUDENT) telling the bedside family member that he was “basically an anesthesiologist” when questioned what a CRNA was. If I was a resident already, I would have taken him outside the room and told him how dangerous it can be to misinform family members like that.

 

[Espressso]

One of the big issues that I don't think many young nurses or want to be NPs understand is that the nursing profession by definition was never meant to overstep into the physician profession. It's a care-model based profession. As a PGY1 in IM I actually see this play out all the time when talking to nurses. They notice a problem with the patient in the room, be that vitals, be that this or that. And page me about holding a med for example. They're caring for the patient, yes. But they have never learned the diagnostic model of medicine. It's two completely different careers. They work together. But different. I have all the respect for the career nurses. But the young nurses who plan on going straight to NP school, that's the problem.

IDK how we fix it honestly. Been thinking a lot about this over the past year or so. The public seems to be completely on the nurses side. They believe Drs are overpaid. They see us less compared to nurses while in the hospital, and to top it all off, the privatization of HC and the buy outs by PE firms make the bottom line more important that quality and standards. We obviously need a strong PR campaign, such as this channel and similar videos/articles, but we also need much more help on the legislative and policy side. And we also need doctors to refuse to allow NPs or PAs to work independently. I have more tolerance for PAs though. They tend to have a better understanding of their role in the healthcare team.

 

[Ganon]

One of the big issues that I don't think many young nurses or want to be NPs understand is that the nursing profession by definition was never meant to overstep into the physician profession. It's a care-model based profession. As a PGY1 in IM I actually see this play out all the time when talking to nurses. They notice a problem with the patient in the room, be that vitals, be that this or that. And page me about holding a med for example. They're caring for the patient, yes. But they have never learned the diagnostic model of medicine. It's two completely different careers. They work together. But different. I have all the respect for the career nurses. But the young nurses who plan on going straight to NP school, that's the problem.

IDK how we fix it honestly. Been thinking a lot about this over the past year or so. The public seems to be completely on the nurses side. They believe Drs are overpaid. They see us less compared to nurses while in the hospital, and to top it all off, the privatization of HC and the buy outs by PE firms make the bottom line more important that quality and standards. We obviously need a strong PR campaign, such as this channel and similar videos/articles, but we also need much more help on the legislative and policy side. And we also need doctors to refuse to allow NPs or PAs to work independently. I have more tolerance for PAs though. They tend to have a better understanding of their role in the healthcare team.

In general I agree with you, but this "alternate model of care delivery" is completely overstated.

Do you think that DO physicians "treat the whole patient" whereas MD physicians do not?
I think these care models are 90% BS that exists only because some pHDs needed to publish.

(Speaking as someone who had to invent a care model for nursing school. I got an A.)

 

[deleted1100659]

I personally want midlevels to have great training. The thing is, I have some under me, and I am liable for any gaps in knowledge they have. That can be very nerve wracking at times, but in my field many of the jobs out there, you will have to work with them. Some are very teachable, others are a bit more arrogant. I don't mind someone that's teachable, but I think my young appearance (i probably look like im in my 20s) makes it a little harder for me at times to instill that sense of staff hierarchy.

Most of you likely will be liable for them at some point, so pray you get well trained ones.

 

[operaman]

I’m hopeful that the boards of nursing will ultimately step in and try to come up with some minimum standards. They’re the ones most being hurt under the current system of churning out online “degrees” such that many entry level NP jobs at desirable places get >100 applications. At some point the ones with experience and legit schooling will want to gain a leg up on the rest.

As for the student attitudes I never really encountered those and definitely worked with some midlevel trainees along the way. The programs were some of the more competitive ones so maybe that’s purely a selection bias, but most of the midlevels I’ve worked with have been humble and eager to learn and generally quite competent.

Whether they know it or not, their residency training comes when they start practice. They get paid better than MD residents, but on the flip side they’re sorta residents for life.

 

[Ho0v-man]

Just to throw some positivity into the thread: I just wanna thank whatever deity is deemed appropriate for this forum for the NP that helped me do my first central line today. I wish I got that level of instruction and patience in med school.

 

[Matthew9Thirtyfive]

Just to throw some positivity into the thread: I just wanna thank whatever deity is deemed appropriate for this forum for the NP that helped me do my first central line today. I wish I got that level of instruction and patience in med school.

Yep. The NP that showed me how to insert an IUD was awesome.

 

[Angus Avagadro]

Just to throw some positivity into the thread: I just wanna thank whatever deity is deemed appropriate for this forum for the NP that helped me do my first central line today. I wish I got that level of instruction and patience in med school.

All true and I'm glad you had a good experience. I believe you should not be doing procedures unless you can treat any complications that arise. As a trainer, I have to be able to undo anything you do, or I shouldn't be supervising. If the NP is facile enough with rescusitating a patient with a tension pneumothorax and inserting a chest tube, then ok. That is no time for contacting your supervising physician.

 

[Matthew9Thirtyfive]

All true and I'm glad you had a good experience. I believe you should not be doing procedures unless you can treat any complications that arise. As a trainer, I have to be able to undo anything you do, or I shouldn't be supervising. If the NP is facile enough with rescusitating a patient with a tension pneumothorax and inserting a chest tube, then ok. That is no time for contacting your supervising physician.

Agreed. I think we can all learn things from midlevels and nurses, but I don’t think anyone but a physician should be doing something like a central line.

 

[Wordead]

All true and I'm glad you had a good experience. I believe you should not be doing procedures unless you can treat any complications that arise. As a trainer, I have to be able to undo anything you do, or I shouldn't be supervising. If the NP is facile enough with rescusitating a patient with a tension pneumothorax and inserting a chest tube, then ok. That is no time for contacting your supervising physician.

I hope this means general surgery will stop doing trachs and thyroids

 

[Ganon]

All true and I'm glad you had a good experience. I believe you should not be doing procedures unless you can treat any complications that arise. As a trainer, I have to be able to undo anything you do, or I shouldn't be supervising. If the NP is facile enough with rescusitating a patient with a tension pneumothorax and inserting a chest tube, then ok. That is no time for contacting your supervising physician.

Guess no more subscap injections by family med, then.

Or, even better: no more heart paths by interventional cardiologists.

No more endoscopy by GI.

Shall I go on?

 

[Matthew9Thirtyfive]

Guess no more subscap injections by family med, then.

Or, even better: no more heart paths by interventional cardiologists.

No more endoscopy by GI.

Shall I go on?

There’s a difference between a physician doing a procedure they are trained in residency or fellowship to do with plenty of reps to learn when to not do it or how to mitigate risk and recognize complications and a midlevel doing a procedure they are not equipped to handle or even recognize when things might go wrong.

 

[Angus Avagadro]

Guess no more subscap injections by family med, then.

Or, even better: no more heart paths by interventional cardiologists.

No more endoscopy by GI.

Shall I go on?

If you can't treat the complication of a procedure, then you have no business doing the procedure. Can't put in a chest tube? Don't do central lines. Interventional cardiologist place a catheter below the dissection and infuse oxygenated blood if perf the artery.. What subscap complications are you referring to? Perf the gut with an endoscopy? It's on you. But please go on.

 

[Angus Avagadro]

I hope this means general surgery will stop doing trachs and thyroids

What complications not treatable by a general surgeon are you referring to?

 

[LimpSpatula]

The student couldn't ramble off a 1 liner, couldn't come up with a differential (looked at me cross-eyed when I had mentioned SIADH, like "WTH is that?"), and had to look at my notes for structure. The kicker? Said student blatantly bragged about how she will be independent in less than a year. Meanwhile, the residents and I are signed up for the long haul. What really kicked me in the gut was when she told me her fiancé failed out of medical school and is now working as a APN.

You post that like its an affront to NPs. I see it as them absolutely winning, because she will be practicing in a year. You will be treated as a subhuman for the next 5-7 years depending on where you are in training. It all comes down to leadership and the amount of terrible leaders we have in our craft. Its almost ironic that a profession first looked at as feminine has taken the balls out of the one that was traditionally masculine.

 

[operaman]

What complications not treatable by a general surgeon are you referring to?

The ones thsend to me tend to be vocal fold paralysis for thyroids and tracheal stenosis & TE fistulas after trachs.

I personally don’t have a problem with people doing something they can’t manage the complications for so long as they have a plan for doing so. Sometimes that plan involves other physicians.

 

[Ganon]

If you can't treat the complication of a procedure, then you have no business doing the procedure. Can't put in a chest tube? Don't do central lines. Interventional cardiologist place a catheter below the dissection and infuse oxygenated blood if perf the artery.. What subscap complications are you referring to? Perf the gut with an endoscopy? It's on you. But please go on.

So when GI perfs a gut they don't call surgery for help with the repair where you practice?
Your cards don't ever call vascular for help?

 

[Angus Avagadro]

The ones thsend to me tend to be vocal fold paralysis for thyroids and tracheal stenosis & TE fistulas after trachs.

I personally don’t have a problem with people doing something they can’t manage the complications for so long as they have a plan for doing so. Sometimes that plan involves other physicians.

Nor do I when there is time to refer to a specialist as you point out. My point, which was not well articulated by me, is if you can't manage an emergent complication from the procedure, like a tension pneumo or lacerated coronary artery, then you shouldn't be doing it. An example would be a case I'm aware of involving a radiologist performing a pleural biopsy, who encountered a pneumothorax in the patients only remaining lung following the biopsy. They had never inserted a chest tube before. A colleague inserted a chest tube shortly thereafter only to lose the patient. Did the short delay matter? I can't say, but it looks bad for the radiologist.

 

[VA Hopeful Dr]

If you can't treat the complication of a procedure, then you have no business doing the procedure. Can't put in a chest tube? Don't do central lines. Interventional cardiologist place a catheter below the dissection and infuse oxygenated blood if perf the artery.. What subscap complications are you referring to? Perf the gut with an endoscopy? It's on you. But please go on.

So as an FP since I can't wash out a septic joint, I should never inject one?

 

[Angus Avagadro]

So as an FP since I can't wash out a septic joint, I should never inject one?

Please see my reply to @operman above clarifying my point. It should make more sense now.

 

[operaman]

Nor do I when there is time to refer to a specialist as you point out. My point, which was not well articulated by me, is if you can't manage an emergent complication from the procedure, like a tension pneumo or lacerated coronary artery, then you shouldn't be doing it. An example would be a case I'm aware of involving a radiologist performing a pleural biopsy, who encountered a pneumothorax in the patients only remaining lung following the biopsy. They had never inserted a chest tube before. A colleague inserted a chest tube shortly thereafter only to lose the patient. Did the short delay matter? I can't say, but it looks bad for the radiologist.

Yikes! I think we in ent tend to mitigate this kind of thing by partnering with other specialties. Being the only field of medicine defined by a region rather than a system, we share a lot of real estate with others (Neuro, ophtho, spine, pulm, thoracic, vascular, etc) and tend to enlist help if there’s a potential emergent complication that would be outside our scope.

 

[Lem0nz]

One of the big issues that I don't think many young nurses or want to be NPs understand is that the nursing profession by definition was never meant to overstep into the physician profession. It's a care-model based profession. As a PGY1 in IM I actually see this play out all the time when talking to nurses. They notice a problem with the patient in the room, be that vitals, be that this or that. And page me about holding a med for example. They're caring for the patient, yes. But they have never learned the diagnostic model of medicine. It's two completely different careers. They work together. But different. I have all the respect for the career nurses. But the young nurses who plan on going straight to NP school, that's the problem.

IDK how we fix it honestly. Been thinking a lot about this over the past year or so. The public seems to be completely on the nurses side. They believe Drs are overpaid. They see us less compared to nurses while in the hospital, and to top it all off, the privatization of HC and the buy outs by PE firms make the bottom line more important that quality and standards. We obviously need a strong PR campaign, such as this channel and similar videos/articles, but we also need much more help on the legislative and policy side. And we also need doctors to refuse to allow NPs or PAs to work independently. I have more tolerance for PAs though. They tend to have a better understanding of their role in the healthcare team.

The NP problem will solve itself. I have moved to a place somewhat off the beaten path and in a spot that physician recruitment can be a little challenging. Honestly the ideal place to *be* an NP. But the job market is completely saturated. There are ten applications for every position and no reason to take someone who doesn't already have ample experience. Most NP candidates are currently holding regular nursing jobs because there's nothing else to do. It's kind of wild. The PA job market seems even worse.

And many of cities have insurance dynasties set up where its next to impossible for an NP to just go out and practice independently in the wind. There's no reason for them to pay midlevels for that. They can pay physicians or NPs working under physicians for better quality care that costs them less. None of the three health systems here use free standing independent midlevels. At this point what I'm seeing is NPs working for a salary that is better than a nurses, but certainly not orders of magnitude better. What they do get is much improved quality of life and a more rewarding job - but they're all under physicians here. They were in my last city too which was much larger.

What isn't changing is the demand for physicians.

There will always be people who want to strike out on their own and try to earn a quick buck but these young kids going straight through a diploma mill or even a traditional school without actual nursing experience and a realistic goal other than to make a ton of money independently practicing... the vast majority of them are going to be sorely disappointed. It is not that easy. In a weird twist of irony, somehow capitalism and market forces are the things actually preventing them from doing the high paying independent job in their heads instead of licensing, laws, and medicine as a society.

Was an interesting video, at least. The part about NP certification is spot on but also ignores the actual utility of an NP - their experience. Ignoring the very young adults going straight through school with $$$ as the only motivation, the actual nurses who bring some really valuable stuff to the table who then go back to NP school would be completely lost to us if we gated them behind needing specific certifications from specific schools. I'm not saying that the FNP-->Anything model is good or works, but for me, I needed a first assist NP in the OR who could also assist in the clinic, rounds, etc. The OR piece was the most important part though and I found someone in school for FNP who had been an RNFA for 10+ years who is completely rooted in the community. Really worked out brilliantly. Not sure that would have ever been a possibility if she had had to go to surgery NP school of which there are only a handful scattered across the country. Very difficult problem to fix.

 

[Beerus]

Amazing YouTube channel
I love it.

 

[Splenda88]

it's coming guys/gals

 

[percyeye]

Who is really to blame for all of this?

Meds students/ Residents complain about it all through training. Then get out as an attending and realize they don't want to do all the scut work or see every single post-op patient. So they get out and hire 2-3 NPs to work under them.

Or all over the country right now private practice groups are selling out to PE for the all mighty dollar and they just hire more NPs because they are cheaper.

If it is so bad I'd say stop hiring them or quit selling out your practices.

 

[Matthew9Thirtyfive]

it's coming guys/gals

I mean…they’d still have to match and do residency to practice as a physician. And I seriously doubt any place would let them refer to themselves as physicians if they’re working as an NP.

 

[Matthew9Thirtyfive]

Who is really to blame for all of this?

Yeah, it’s not a problem with only one person to blame. Yes, physicians who are helping midlevels expand are to blame. That doesn’t absolve anyone else that is involved. It is still on the lobbying bodies, the politicians who are passing these laws, the midlevels who claim to be against it but remain silent and reap the benefits of expansion, etc.

 

[Matthew9Thirtyfive]

I needed a first assist NP in the OR who could also assist in the clinic, rounds, etc.

That’s a PA. You could have hired a PA, where the education is much more standardized and at least for now they are stuck working under physicians in 49 states.

 

[PA_2_MD]

it's coming guys/gals

Seems like a worse deal than LECOMS PA-DO bridge.

 

[Splenda88]

I mean…they’d still have to match and do residency to practice as a physician. And I seriously doubt any place would let them refer to themselves as physicians if they’re working as an NP.

True. But the fact that it's being advertised show how low we have gone.

 

[Matthew9Thirtyfive]

True. But the fact that it's being advertised show how low we have gone.

I’m only surprised it hasn’t been announced sooner. Those Carib schools will do anything to prey on people willing to part with their money.

 

[Gambino.]

it's coming guys/gals

Don't see how this is legal as other Carib programs have tried remote learning to the US in the past and got in some serious hot water. Regardless, IUHS is a joke even amongst Carib programs and they don't have CAAM-HP or ACCM accreditation so hopefully their program will be dead in the water come the 2024 ECFMG requirement changes.

 

[Lem0nz]

That’s a PA. You could have hired a PA, where the education is much more standardized and at least for now they are stuck working under physicians in 49 states.

I would have taken either. To be perfectly honest their education base is not particularly relevant to me and my practice (and I imagine many other surgeons). That does not at all reflect on what I feel their education SHOULD be in general, but specific to the issue of running a surgical practice, very little taught in PA school or NP school are relevant to pre-operative, intra-operative, or post-operative patient management. Its all far to superficial and you have to teach them everything and micromanage all of it anyway. A month or two rotating with surgery in PA school is woefully inadequate, the same as it is for an NP. It's not worthless, but it is such a small drop in the bucket that I don't find the difference particularly meaningful.

What ends up mattering more than the credentials is the quality of the person and their past experience. I now have two NPs since I last posted in this thread (sorta, they're both still in school) and one had 3+ years in outpatient oncology as her previous nursing experience and the other has 15+ years as a surgical assist. Both extremely valuable for their experience but even that pales compared to their work ethic which is definitely the most important thing. They're extremely dedicated, willing to go way above and beyond. Love 'em to death. Could literally not function without them, though that is an issue secondary to volume more than anything. I need a partner very badly, we're just off cycle and to get another surgeon boots on the ground is going to take ~1.5 years at this point.

Interestingly, both this institution and my previous institution also don't recognize a difference when it comes to their salaries. Its standard for surgical services. Its much higher compared to the medical counterparts but there is just a single surgical APP scale that is based on time and experience. Guess I'm not the only one who feels like that.

 

[guytakingboards]

Who is really to blame for all of this?

Meds students/ Residents complain about it all through training. Then get out as an attending and realize they don't want to do all the scut work or see every single post-op patient. So they get out and hire 2-3 NPs to work under them.

Or all over the country right now private practice groups are selling out to PE for the all mighty dollar and they just hire more NPs because they are cheaper.

If it is so bad I'd say stop hiring them or quit selling out your practices.

There's nothing wrong with the concept of a mid-level provider. An NP rounding on post-op patients and then presenting to a surgeon is little different than an intern doing it. The key in both cases is that its heavily supervised.

The distinction is when NP/PAs want full independent privileges and are no longer "mid-level" but the final say on decision-making. That's the dangerous part because their training paradigm isn't set up for that.

 

[Splenda88]