why dont you all go to nursing school instead?

[niranjan162]

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I haven't heard of many unemployed anethesiologists.

Im not saying that NP/PA won't make certain specialties less lucrative, im saying they likely arent going to take over the whole specialty.

And if they do manage to incringe on a specialty its going to be because they are capable of doing the job.

(For example, my friend's dad who is a plastic surgeon has a nurse anthesticist (spelling??) because he feels she is completly capable of doing the required job).

I mean do you really need an anthesiologist in every OR when a whole pack of them are just a code button away? (Obviously it would be most safe to have an anethesiologist in every room, but there is no point in providing only infintesimely safer care if it doubles the cost of every procedure).

I read it like I saw it, some guy claimed to be orders of magnitude (a highly specific term) smarter than most the world.

This stuff angers me because people like him damage the reputation of MDs everywhere. People hear stuff like that and think that all MD's are incredibly arrogant, have massive egos and god complexes.

Im trying to defend my future profession here (MD), its no wonder im a little worked up.

This whole thread is about protecting the profession, which I don't thin u understand, as well as my last post. It was basically satirical but a corollary to the to future of medicine if nurses are not properly regulated and stopped from trying to practice medicine. There r bigger threats to medicine than arrogance. If you really wanted to defend medicine you would open your eyes to them

 

[cbrons]

These clinicians are peerless prevention specialists and coordinators of complex care. In other words, as a patient, you get the medical knowledge of a physician, with the added skills of a nursing professional.

lolwut

 

[Kaustikos]

This whole thread is about protecting the profession, which I don't thin u understand, as well as my last post. It was basically satirical but a corollary to the to future of medicine if nurses are not properly regulated and stopped from trying to practice medicine. There r bigger threats to medicine than arrogance. If you really wanted to defend medicine you would open your eyes to them

Unless you can cite evidence for your claim that nurses need to be regulated in what they can/can't do, I tend to believe that we should let them do this. Hell, if MD's aren't going to do their job and start reaching for specialized medicine, why should patients suffer this sprawled out approach to healthcare? NP/PAs are doing what, apparently, MD's don't want to do.

 

[tennisball80]

I'm assuming you're still in high school (hSDN) and so would recommend you talk less and listen more. The argument you present is so outlandish and ignorant that it begs the question of whether or not you really know what you're talking about.

This is ageism, a form of discrination. So you are saying high school students have to talk less and listen more ? So you are saying high school studednts can't detabate sometimes then ? You are going into medicine and discriminate against high school students ? What's your moral standards ? Did you parents educate you that way to discriminate against those who are younger ?

If my argument present outlandish and ignorant, would you point out where is outlandish and ignorant with evidences, not your personal examples ? And what's your evidence that I don't know what I am talking about ? Do you know my medical condition ? I don't have a mental disease.

 

[cbrons]

This is ageism, a form of discrination. So you are saying high school students have to talk less and listen more ? So you are saying high school studednts can't detabate sometimes then ? You are going into medicine and discriminate against high school students ? What's your moral standards ? Did you parents educate you that way to discriminate against those who are younger ?

If my argument present outlandish and ignorant, would you point out where is outlandish and ignorant with evidences, not your personal examples ? And what's your evidence that I don't know what I am talking about ? Do you know my medical condition ? I don't have a mental disease.

Ageism is only a concern for how people treat senior citizens. No one gives two ****s about some whiney teenage kid with pent up angst. Age discrimination against teenagers and kids has and always will be acceptable (for good reason).

 

[besmart]

This is ageism, a form of discrination. So you are saying high school students have to talk less and listen more ? So you are saying high school studednts can't detabate sometimes then ? You are going into medicine and discriminate against high school students ? What's your moral standards ? Did you parents educate you that way to discriminate against those who are younger ?

If my argument present outlandish and ignorant, would you point out where is outlandish and ignorant with evidences, not your personal examples ? And what's your evidence that I don't know what I am talking about ? Do you know my medical condition ? I don't have a mental disease.

What experience do you have in the health care setting? How many hours of health care experience do you have? If you have zero, then shut up and learn. Even most pre-meds don't have a clue what the hell they are talking about. You can clearly see which pre-meds know how things really work and the ones who have no clue.

The pure fact that you said PAs don't learn about pharmacology, pathology, and anatomy shows that you have a lot to learn. Just so you know, at the local PA program, students taken ANATOMY DURING THE SUMMER ALONE.

Edit: I have over 6,000 hours of health care experience. The mere fact that you discount PAs and NPs shows that you don't know just how important they really are.

 

[Kaustikos]

This is ageism, a form of discrination. So you are saying high school students have to talk less and listen more ? So you are saying high school studednts can't detabate sometimes then ? You are going into medicine and discriminate against high school students ? What's your moral standards ? Did you parents educate you that way to discriminate against those who are younger ?

If my argument present outlandish and ignorant, would you point out where is outlandish and ignorant with evidences, not your personal examples ? And what's your evidence that I don't know what I am talking about ? Do you know my medical condition ? I don't have a mental disease.

I only say this because I was a teenager and I was told exactly that. More often than not, they were right. I'm not going to reiterate what I have already said. What I quoted was referenced and my counter argument presented.

Unless you really, honestly, believe that NP's are some of the most terrible people on the planet and want to remove them of their rights because you don't really understand how critical and helpful NPs are to healthcare.

 

[niranjan162]

Unless you can cite evidence for your claim that nurses need to be regulated in what they can/can't do, I tend to believe that we should let them do this. Hell, if MD's aren't going to do their job and start reaching for specialized medicine, why should patients suffer this sprawled out approach to healthcare? NP/PAs are doing what, apparently, MD's don't want to do.

I already posted an article written by the leader of the dnp movement cbrons quoted right above ur post. Nps aRen't the answer to the of shortage. They will leave it for specialized medicine too and we will still have a shortage and now lesser trained people in posititons they shouldn't be. Y is medical education is so long? Y is it so highly regulated? You don't think if a medical education could be done in a shorter time it would be? So y do u think someone with significantly less education can do the same jobs? They will say they are equal cuz of their new degree, i also posted that if u wanna look at the classes they take but hopefully u can c those classes are a joke. They are not science clases nor anything that will help with patient care.

Now would u care to post something that refutes what I have said?

 

[Kaustikos]

I already posted an article written by the leader of the dnp movement cbrons quoted right above ur post. Nps aRen't the answer to the of shortage. They will leave it for specialized medicine too and we will still have a shortage and now lesser trained people in posititons they shouldn't be. Y is medical education is so long? Y is it so highly regulated? You don't think if a medical education could be done in a shorter time it would be? So y do u think someone with significantly less education can do the same jobs? They will say they are equal cuz of their new degree, i also posted that if u wanna look at the classes they take but hopefully u can c those classes are a joke. They are not science clases nor anything that will help with patient care.

Now would u care to post something that refutes what I have said?

That's definitely a possibility. But in the end, if they are able to do their job right for the most part, then NPs are qualified to do their jobs. Believe it or not, but Nursing isn't easy and you do learn a lot about healthcare. It may be insubstantial to an MD and I am not saying they're in the same light as MDs. They are there to help provide better healthcare. Same with DOs and increasing medical school spots. I don't have a solution, but it just seems wrong to try and say NPs aren't qualified to do what they do. They acquire the acreditation and practice their jobs and they're obviously not doing anything wrong because then there would be a HUGE uproar to remove them. From speaking to MDs, they haven't offered any complaints aside from those thinking that they are equal to MDs.

 

[tennisball80]

What experience do you have in the health care setting? How many hours of health care experience do you have? If you have zero, then shut up and learn. Even most pre-meds don't have a clue what the hell they are talking about. You can clearly see which pre-meds know how things really work and the ones who have no clue.

The pure fact that you said PAs don't learn about pharmacology, pathology, and anatomy shows that you have a lot to learn. Just so you know, at the local PA program, students taken ANATOMY DURING THE SUMMER ALONE.

Edit: I have over 6,000 hours of health care experience. The mere fact that you discount PAs and NPs shows that you don't know just how important they really are.

Can you pass all the USMLE if you take the exam ? Do the patients really satisfy your diagnose and prescription ? Don't they go ask a M.D to seek the satisfaction ? Is your PA education the same with a M.D education ?

Go on the street and ask how many people would choose when a M.D and P.A. to see them when they are sick.

Your 6000 hours of clinical experience does not make up a M.D's clinical hours. An M.D has about 12.000 hours by the time they graduate. And their clinical hours are more valuable than your clinical hours because they know more about all the anatomy, physiology,...etc.

Are you saying that American medical association has 3 years residency period because they are nuts ? No. They want to ensure the quality for patients and provide the best health care for every American. That's why they have such a long training period even for a family physician. PAs have shorter clinical hours and less clinical knowledge.

Your help is greatly appreciated by the people. But you are nurse, not a doctor.

By the way, Happy st patrick's day. I am gonna go to study.

 

[niranjan162]

When I get home from work I will post somemore links on how's cRnas are trying to move into pain medicine. It's to hard from my phone. U can also google it I believe the bill was proposed in louissiana

 

[tennisball80]

Ageism is only a concern for how people treat senior citizens. No one gives two ****s about some whiney teenage kid with pent up angst. Age discrimination against teenagers and kids has and always will be acceptable (for good reason).

What experience do you have in the health care setting? How many hours of health care experience do you have? If you have zero, then shut up and learn. Even most pre-meds don't have a clue what the hell they are talking about. You can clearly see which pre-meds know how things really work and the ones who have no clue.

The pure fact that you said PAs don't learn about pharmacology, pathology, and anatomy shows that you have a lot to learn. Just so you know, at the local PA program, students taken ANATOMY DURING THE SUMMER ALONE.

Edit: I have over 6,000 hours of health care experience. The mere fact that you discount PAs and NPs shows that you don't know just how important they really are.

I only say this because I was a teenager and I was told exactly that. More often than not, they were right. I'm not going to reiterate what I have already said. What I quoted was referenced and my counter argument presented.

Unless you really, honestly, believe that NP's are some of the most terrible people on the planet and want to remove them of their rights because you don't really understand how critical and helpful NPs are to healthcare.

Thank you for your comments.

I want to withdraw this argument from this thread now.

However, it was nice to hear other people's thoughts on health care. I appologize if my comments were too harsh, I did not mean anything personal.

Good luck !

 

[besmart]

When I get home from work I will post somemore links on how's cRnas are trying to move into pain medicine. It's to hard from my phone. U can also google it I believe the bill was proposed in louissiana

Please do share the links for this when you have time.

 

[besmart]

Can you pass all the USMLE if you take the exam ?

I'm not in medical school yet. I'm also not a nurse.

Do the patients really satisfy your diagnose and prescription ? Don't they go ask a M.D to seek the satisfaction ? Is your PA education the same with a M.D education ?

No, most patients don't ask to see the M.D. for minor things. Generally a person from outside of the clinic comes in to get medication to do away with what is bothering them. Most of the simple things (infections, coughs, ear aches, etc) can be done by a NP with no problem.

My PA education? Huh? You clearly don't know what role the PA has nor the purpose of being a PA.

Go on the street and ask how many people would choose when a M.D and P.A. to see them when they are sick.

Your 6000 hours of clinical experience does not make up a M.D's clinical hours. An M.D has about 12.000 hours by the time they graduate. And their clinical hours are more valuable than your clinical hours because they know more about all the anatomy, physiology,...etc.

You mist the point. When you have zero experience with at topic, you have NO credibility on the subject. A person with zero medical experience saying PAs and NPs are useless is like me saying that all accountants do is tax work during tax season..so they is useless as well (which is clearly not the case)

Are you saying that American medical association has 3 years residency period because they are nuts ? No. They want to ensure the quality for patients and provide the best health care for every American. That's why they have such a long training period even for a family physician. PAs have shorter clinical hours and less clinical knowledge.

Your help is greatly appreciated by the people. But you are nurse, not a doctor.

By the way, Happy st patrick's day. I am gonna go to study.

Read the above. Please do us a favor and spend some time in the local hospital/clinic and learn how the health care system works.

 

[87138]

Can you pass all the USMLE if you take the exam ? Do the patients really satisfy your diagnose and prescription ? Don't they go ask a M.D to seek the satisfaction ? Is your PA education the same with a M.D education ?

Go on the street and ask how many people would choose when a M.D and P.A. to see them when they are sick.

Your 6000 hours of clinical experience does not make up a M.D's clinical hours. An M.D has about 12.000 hours by the time they graduate. And their clinical hours are more valuable than your clinical hours because they know more about all the anatomy, physiology,...etc.

Are you saying that American medical association has 3 years residency period because they are nuts ? No. They want to ensure the quality for patients and provide the best health care for every American. That's why they have such a long training period even for a family physician. PAs have shorter clinical hours and less clinical knowledge.

Your help is greatly appreciated by the people. But you are nurse, not a doctor.

By the way, Happy st patrick's day. I am gonna go to study.

1. A PA is nothing like a nurse
2. St. Patrick's day was two days ago.
3. Many of your sentences are confusing due to your poor grasp on the English Language
4. Ending with a cutesy faux olive branch of peace after picking someone apart is pretty juvenile

 

[NotAndrew]

1. A PA is nothing like a nurse
2. St. Patrick's day was two days ago.
3. Many of your sentences are confusing due to your poor grasp on the English Language
4. Ending with a cutesy faux olive branch of peace after picking someone apart is pretty juvenile

RogerWilco rules.

Additionally: I agree with cbrons, nothing in this world is more acceptable than "discriminating" against high school kids due to their age.

 

[melanoleuca]

...But like I said earlier, I like the fact I can go to the clinic to get a physical and the NP can sign it instead of making me wait a week to see an MD so he can tell me that its safe for me to volunteer at a hospital...

This is only because the majority of all medical care is completely unnecessary from a medical point of view and the money spent on it is completely and utterly wasted. And I'm not just talking about unnecessary physical exams on young healthy pre-meds to protect the hospital legally against the one-in-a-million chance that they will spontaneously drop dead but almost every aspect of medical care from unnecessary surgeries to futile care to completely worthless Emergency Department visits. I would say that seventy percent of the money that passes through my hands is totally wasted and may as well be flushed down a crapper for all the good it does but, of course, this will vary by specialty. I'd say the money wasted on pediatrics is probably in the high eighties while hand surgery might be in the low twenties (because the more specialized specialties tend to have their patients filtered for them at a lower level of care).

In other words, you love your NP because she was able to help you with a bureaucratic problem, not a medical one, which is the job description of most mid-levels.

 

[Kaustikos]

1. A PA is nothing like a nurse
2. St. Patrick's day was two days ago.
3. Many of your sentences are confusing due to your poor grasp on the English Language
4. Ending with a cutesy faux olive branch of peace after picking someone apart is pretty juvenile

THANK YOU👍

 

[Moebius]

Lol

 

[circulus vitios]

Consider that 49.99% of people are smarter than the majority of people.

Consider that people of 110 IQ, which is presumably surpassed by the majority of people here, are smarter than 75% of people.

Etc.

QED

You are the personification of

 

[starfishprime]

You are the personification of

True but irrelevant.

 

[millepora]

I guess my post is a little off the topic of people arguing who is better, but...

I like this article. I think they should increase the ratio of nurse practioners practicing into the primary care area. The primary care area is becoming more undesirable to a growing number of physicians. I even read an article where 60% of primary care physicians wished they were practicing in another profession. I do not know how accurate my opinion is, but while I agree that can be a lot of trivial knowledge involved in practicing as a primary care physician, I believe a lot of the job just deals with how well you can deal with people; anyone with a good personality is suited to do that job.

I have to comment of the NP curriculum though. It seems like most of the classes just have to do with theory, and I really do not see many of the classes in the curriculum dealing with core medical knowledge, I do have to agree it it seems like a pretty fluffy degree.

 

[niranjan162]

As promised...

The CRNAs proposed a bill to allow them to do pain management independently

The judgement was that pain medicine was just that, medicine, not nursing.

The important point though is that they are trying, and while that this will slow them down it wont stop them, so as future doctors you have to be aware and ready to protect medicine.

http://www.asahq.org/news/news011508.htm

A Louisiana court recently held that the Louisiana State Board of Nursing’s advisory opinion substantively expanded the scope of practice of a nurse anesthetist into an area where they have not traditionally practiced (i.e. - chronic or interventional pain management). The advisory opinion was issued in 2005 in response to a nurse anesthetist’s request for clarification on this issue. Subsequently, Spine Diagnostics Center of Baton Rouge, Inc brought a lawsuit against the nursing board that, among other things, sought an injunction to prevent the nurse anesthetist who requested the opinion from continuing to perform pain management procedures. Moreover, Spine Diagnostics Center sought a declaratory statement that interventional pain management procedures constitute the practice of medicine and that the nursing board exceeded its authority in authorizing nurse anesthetists to practice these procedures.

In 2006, the Court of Appeal ruled that the “opinion” was in fact a regulation and required compliance with the Louisiana Administrative Procedures Act. Additionally, the appellate court ordered a preliminary injunction prohibiting the nursing board from enforcing the statement. The Louisiana Society of Anesthesiologists and ASA filed amicus briefs in support of Spine Diagnostics Center. The Louisiana Supreme Court affirmed the court’s decision. In November, the parties returned to the trial court concerning several remaining issues. Last week, the court’s decision included:

* The practice of interventional pain management is not the scope of practice of a nurse anesthetist.
* The practice of interventional pain management is solely the practice of medicine.
* The advisory opinion issued by the nursing board is an effort to substantively expand nurse anesthetist scope of practice and is an improper attempt at rule making.
* A permanent injunction issue prohibiting the nursing board from enforcing the statement.

 

[besmart]

As promised...

The CRNAs proposed a bill to allow them to do pain management independently

The judgement was that pain medicine was just that, medicine, not nursing.

The important point though is that they are trying, and while that this will slow them down it wont stop them, so as future doctors you have to be aware and ready to protect medicine.

http://www.asahq.org/news/news011508.htm

A Louisiana court recently held that the Louisiana State Board of Nursing’s advisory opinion substantively expanded the scope of practice of a nurse anesthetist into an area where they have not traditionally practiced (i.e. - chronic or interventional pain management). The advisory opinion was issued in 2005 in response to a nurse anesthetist’s request for clarification on this issue. Subsequently, Spine Diagnostics Center of Baton Rouge, Inc brought a lawsuit against the nursing board that, among other things, sought an injunction to prevent the nurse anesthetist who requested the opinion from continuing to perform pain management procedures. Moreover, Spine Diagnostics Center sought a declaratory statement that interventional pain management procedures constitute the practice of medicine and that the nursing board exceeded its authority in authorizing nurse anesthetists to practice these procedures.

In 2006, the Court of Appeal ruled that the “opinion” was in fact a regulation and required compliance with the Louisiana Administrative Procedures Act. Additionally, the appellate court ordered a preliminary injunction prohibiting the nursing board from enforcing the statement. The Louisiana Society of Anesthesiologists and ASA filed amicus briefs in support of Spine Diagnostics Center. The Louisiana Supreme Court affirmed the court’s decision. In November, the parties returned to the trial court concerning several remaining issues. Last week, the court’s decision included:

* The practice of interventional pain management is not the scope of practice of a nurse anesthetist.
* The practice of interventional pain management is solely the practice of medicine.
* The advisory opinion issued by the nursing board is an effort to substantively expand nurse anesthetist scope of practice and is an improper attempt at rule making.
* A permanent injunction issue prohibiting the nursing board from enforcing the statement.

This is a serious issue for a few reasons:

1: People not fully trained in the medical model performing medicine (beyond the scope of basic care)

2: Safety of patients...protecting the general public from receiving medical care from non trained medical specialists.

I'm all for nurses wanting to practice medicine if there was a way to allow nurses to gain medical training, but that is not possible.

 

[niranjan162]

That's definitely a possibility. But in the end, if they are able to do their job right for the most part, then NPs are qualified to do their jobs. Believe it or not, but Nursing isn't easy and you do learn a lot about healthcare. It may be insubstantial to an MD and I am not saying they're in the same light as MDs. They are there to help provide better healthcare. Same with DOs and increasing medical school spots. I don't have a solution, but it just seems wrong to try and say NPs aren't qualified to do what they do. They acquire the acreditation and practice their jobs and they're obviously not doing anything wrong because then there would be a HUGE uproar to remove them. From speaking to MDs, they haven't offered any complaints aside from those thinking that they are equal to MDs.

Never did i say that nursing was easy or that they werent important to healthcare. Never. I think they deserve every penny they earn.

However, I dont think that justifies, them being allowed to practice medicine.

But your right, if they competent, they should be allowed to do it. There should be some sort of test to see if these people are competent to practice independently.....O wait! There are tests like these! If they wanna practice independently, let them take the USMLEs and Comlex steps, the same ones required of physicians to practice independently. Why should they be held to a lesser standard?

You bring up an interesting point about D.O.s, In order to get the practice rights of medicine, they matched the allopathic curriculum, 4 years med school, residency, and boards of 3 steps. This shows it isnt about simply protecting medicine, but rather the standards of medicine.

Again I ask, why should nurses be allowed to be held to a different and lesser standard?

If they want to practice independently I have no problem with it as long as they can prove it. But doing it through the garbage DNP degree is unacceptable. Its unacceptable to physicians and especially to patients.

DNP's were given an easier version of step three (which physicians dont even study for) and half of them failed, I wonder how many just barely passed? Nurses practice nursing and physicians practice medicine. Theres nothing wrong with either, but there is something wrong with one trying to do the other, by circumventing established standards.

 

[starfishprime]

* The practice of interventional pain management is not the scope of practice of a nurse anesthetist.
* The practice of interventional pain management is solely the practice of medicine.

Note how easily this could be amended, e.g.
*The practice of screening colonoscopy is solely the practice of medicine.
*The practice of cryosurgery is solely the practice of medicine.
*The practice of surgical abortion (!) is solely the practice of medicine.

The latter leads me to believe it's time to draw a very thick line in the sand. I mean, come on. (If it is not obvious, I'm making a slippery slope argument.)

 

[starfishprime]

I'm all for nurses wanting to practice medicine if there was a way to allow nurses to gain medical training, but that is not possible.

They're more than welcome to attend medical school.

 

[niranjan162]

I guess my post is a little off the topic of people arguing who is better, but...

I like this article. I think they should increase the ratio of nurse practioners practicing into the primary care area. The primary care area is becoming more undesirable to a growing number of physicians. I even read an article where 60% of primary care physicians wished they were practicing in another profession. I do not know how accurate my opinion is, but while I agree that can be a lot of trivial knowledge involved in practicing as a primary care physician, I believe a lot of the job just deals with how well you can deal with people; anyone with a good personality is suited to do that job.

I have to comment of the NP curriculum though. It seems like most of the classes just have to do with theory, and I really do not see many of the classes in the curriculum dealing with core medical knowledge, I do have to agree it it seems like a pretty fluffy degree.

Your opinion can never be wrong, but the assumptions on which you base your opinion can be faulty.

Theres no reason for nurses to stick to primary care. Its all part of their game plan. nursing->primary care-> other specialties->$$$.

Honestly we are all pre-meds, we dont know how hard or easy it is to practice primary care. Someone on this board said, its easy be a crappy family care doc, but hard to be a great one.

If we are happy, with "just good enough" then sure let them have primary care and while we're at it lets lessen medical education too.

What i think is hanging people up is that its all about baby steps.

If it sounds like a duck ("im a doctor, Im a doctor, I have a doctorate degree"), it looks like a duck("I wear a long white coat") and its in a pond like a duck (hospital ), its must be a duck (doctor), wrong! its a DNP.

Genius in its simplicity. No this isnt gonna happen tomorrow, but the best thing for the DNP degree is if physicians dont know about it until its too late, until they have chipped away so much that they are practicing medicine.

 

[circulus vitios]

True but irrelevant.

 

[highvoltage]

The hilarity of this post just hit me. Sure, during residency and whatnot, when I'm a peon, I'll probably have some insane long shifts. But no doctors I know work 30 hours regularly, or don't ever get to step around the block for lunch. If you're in that high of a demand, you've got to be pretty damn special.

whatever you say

 

[AldousHux]

I keep hearing people talking about their personal experiences with NP's, or DNP's and how the can get everything right most of the time. Well, I've had my physicals done by NP's for the last few years, because my doctor decided he was too busy/needed help/wanted more money/ whatever. I had a number of symptoms which both I and my NP thought were unrelated. 2 years later I go to an actual doctor for a physical checkup, and he feels my thyroid. It's enlarged. I get an ultrasound, I have multi-nodular goiter. I get a biopsy, it's cancerous. Was this present before? yes. Did my symptoms match my disease? Yes, however it did not present in the most obvious way, it was slightly different. Did I get a bad NP? maybe. Would any doctor have realized earlier? maybe.

The point is this is a PERSONAL story, and is really not representative of all NP's. Or of all doctors. I may have had a bad experience, but personal experiences with a n=1 doesn't really mean **** does it? Neither does an experience of n=one hospitals worth. We're all pre-med, why do we think we have any real understanding of what NP's are like across the country?

to those of you who are fellows and residents, and even 3-4th years, I give you the benefit of the doubt that you know what you're talking about. I admit, I probably don't.

As to the point of this original post, I want to do surgery. I don't really like to be touchy feely with the patients. Can't wait to treat them and work 100 hours a week (so sad attendings don't have weekly hour limits) and to be honest, I'm a typical type A, always reaching for the stars type of person, and if MD is the highest degree for the specialty I'm interested in, by god I'm going for it.

 

[Kaustikos]

I keep hearing people talking about their personal experiences with NP's, or DNP's and how the can get everything right most of the time. Well, I've had my physicals done by NP's for the last few years, because my doctor decided he was too busy/needed help/wanted more money/ whatever. I had a number of symptoms which both I and my NP thought were unrelated. 2 years later I go to an actual doctor for a physical checkup, and he feels my thyroid. It's enlarged. I get an ultrasound, I have multi-nodular goiter. I get a biopsy, it's cancerous. Was this present before? yes. Did my symptoms match my disease? Yes, however it did not present in the most obvious way, it was slightly different. Did I get a bad NP? maybe. Would any doctor have realized earlier? maybe.

The point is this is a PERSONAL story, and is really not representative of all NP's. Or of all doctors. I may have had a bad experience, but personal experiences with a n=1 doesn't really mean **** does it? Neither does an experience of n=one hospitals worth. We're all pre-med, why do we think we have any real understanding of what NP's are like across the country?

to those of you who are fellows and residents, and even 3-4th years, I give you the benefit of the doubt that you know what you're talking about. I admit, I probably don't.

As to the point of this original post, I want to do surgery. I don't really like to be touchy feely with the patients. Can't wait to treat them and work 100 hours a week (so sad attendings don't have weekly hour limits) and to be honest, I'm a typical type A, always reaching for the stars type of person, and if MD is the highest degree for the specialty I'm interested in, by god I'm going for it.

You're relying on one experience. My situation was derived from multiple patient contacts and my own interaction with NPs. I don't know how many NP's and PA's I need to see or how many opinions I need from MD's about how helpful they are to healthcare, but I think I understand their role and how beneficial they have been.

Also, physicians miss things too. No one is perfect.

They're more than welcome to attend medical school.

🙄 That's not the answer, at ALL.

But your right, if they competent, they should be allowed to do it. There should be some sort of test to see if these people are competent to practice independently.....O wait! There are tests like these! If they wanna practice independently, let them take the USMLEs and Comlex steps, the same ones required of physicians to practice independently. Why should they be held to a lesser standard?

That could work, in theory. But then, what's to stop me from doing the same thing? I'll just go ahead and say screw Medical School and instead homeschool myself to take the USMLE Step 1, 2 3. If I pass, does it mean I should become a physician? (Realize that I do not think I could even remotely do this but that it is just a hypothetical. I am not dismissing the medical school curriculum or putting myself on a pedestal) But I believe that some standard test akin to the USMLE would definitely help further solidify the idea that they are qualified and remove NP's that are not. The point isn't to intrude on physicians jobs and take them away (Hell, they don't even want them, remember?) but to help. I'm no historian, but I don't think Nurses in the past had nearly the same job qualifications that they do now. Is it really an intrusion or a saving grace for doctors?

If someone wants to become a physician by first getting a BSN and then going through another few years of acreditation and taking more tests to do tasks similiar to a physician and are able to do so competently, then why not?

 

[niranjan162]

You're relying on one experience. My situation was derived from multiple patient contacts and my own interaction with NPs. I don't know how many NP's and PA's I need to see or how many opinions I need from MD's about how helpful they are to healthcare, but I think I understand their role and how beneficial they have been.

Also, physicians miss things too. No one is perfect.

🙄 That's not the answer, at ALL.




That could work, in theory. But then, what's to stop me from doing the same thing? I'll just go ahead and say screw Medical School and instead homeschool myself to take the USMLE Step 1, 2 3. If I pass, does it mean I should become a physician? (Realize that I do not think I could even remotely do this but that it is just a hypothetical. I am not dismissing the medical school curriculum or putting myself on a pedestal) But I believe that some standard test akin to the USMLE would definitely help further solidify the idea that they are qualified and remove NP's that are not. The point isn't to intrude on physicians jobs and take them away (Hell, they don't even want them, remember?) but to help. I'm no historian, but I don't think Nurses in the past had nearly the same job qualifications that they do now. Is it really an intrusion or a saving grace for doctors?

If someone wants to become a physician by first getting a BSN and then going through another few years of acreditation and taking more tests to do tasks similiar to a physician and are able to do so competently, then why not?

Well cannot say how hard the usmle and comlex are but there a big thingyour forgetting, getting into med school is a pain in the ass. Getting into nursing school isn't as difficult. Right there by allowing someone to bridge from nursing school to med school your losing quality applicants. Secondly standards for he dnp degree differ greatly. Some schools only require 500 clinical hours while others require 1000(which is still very little). There's no standardzation Or regulation that's y it's dangerous to allow this. As for a test I already said they got the nbme to make an easier watered down version of step 3 which physicians don't study for and pass with a 96 percent rate while the dnps had 50percent passing rate for the easier version. Y would should they get an easier test to be able to do the same thing? It lowers the standards of medicine.

You say bsn to md after few years of accrditation but that's not equal to physician training. Why would u be ok holdig them to a lower standard. As for your claim they don't want physician jobs I posted a link proving otherwise. Please back up your cla with some data. Every one in this thread is screaming about data but I'm the only one providing any links

Add a clause that says you need 12500+ clinical hours in an accredited institution while 'practicing medicine' under supervision and retain the testing requirements.

Agreed. I also think that physicians will have more than this by the end of their training

 

[Kaustikos]

Add a clause that says you need 12500+ clinical hours in an accredited institution while 'practicing medicine' under supervision and retain the testing requirements.

That wouldn't hurt either.

Well cannot say how hard the usmle and comlex are but there a big thingyour forgetting, getting into med school is a pain in the ass. Getting into nursing school isn't as difficult. Right there by allowing someone to bridge from nursing school to med school your losing quality applicants. Secondly standards for he dnp degree differ greatly. Some schools only require 500 clinical hours while others require 1000(which is still very little). There's no standardzation Or regulation that's y it's dangerous to allow this. As for a test I already said they got the nbme to make an easier watered down version of step 3 which physicians don't study for and pass with a 96 percent rate while the dnps had 50percent passing rate for the easier version. Y would should they get an easier test to be able to do the same thing? It lowers the standards of medicine.

You say bsn to md after few years of accrditation but that's not equal to physician training. Why would u be ok holdig them to a lower standard. As for your claim they don't want physician jobs I posted a link proving otherwise. Please back up your cla with some data. Every one in this thread is screaming about data but I'm the only one providing any links



Agreed. I also think that physicians will have more than this by the end of their training

No, I realize that getting into nursing school requires a significantly less amount of work than getting into medical school. My general idea is that I believe if Nurses honestly and truely think they are cut out to practice medicine, there should be a gateway that allows them. I use the term gateway loosely as they should have to suffer through some difficult process so that the ones that really want it/are able to can cut it out. Maybe the answer is Medical School. But to me, that would be somewhat of a slap in the face to nurses. Maybe I'm biased because all the Nurses I have met are intelligent, competent nurses (granted, they work in specialized areas of care that I don't think ANY RN can get into - oncology/nicu, etc) so I would think that what they learn and know is hugely beneficial and should be taken into consideration for the education to "move up" in healthcare.

I don't disagree with you, I don't think. I just think there should be some way instead of closing doors in their face. NP is a right start.

 

[besmart]

That wouldn't hurt either.


No, I realize that getting into nursing school requires a significantly less amount of work than getting into medical school. My general idea is that I believe if Nurses honestly and truely think they are cut out to practice medicine, there should be a gateway that allows them. I use the term gateway loosely as they should have to suffer through some difficult process so that the ones that really want it/are able to can cut it out. Maybe the answer is Medical School. But to me, that would be somewhat of a slap in the face to nurses. Maybe I'm biased because all the Nurses I have met are intelligent, competent nurses (granted, they work in specialized areas of care that I don't think ANY RN can get into - oncology/nicu, etc) so I would think that what they learn and know is hugely beneficial and should be taken into consideration for the education to "move up" in healthcare.

I don't disagree with you, I don't think. I just think there should be some way instead of closing doors in their face. NP is a right start.

I feel that there is no possible way to make a bridge program. If there was one, the nurse would miss out on some important basics of medical education (organic chemistry ---- that watered down biochemical/chemistry course they take is a complete joke).

I could see medical school being cut down to three years for nurses. These nurses have not taken that in depth anatomy class, nor an in depth pharmacology, immunology, etc, etc, courses. Sure they may have the basic clinical skills down, but not the basic medical knowledge.

 

[Slack3r]

...there should be a gateway that allows them.

There is. They're called "allopathic or osteopathic medical schools". We shouldn't compromise care because people believe they're more important than they are and want to have all the perks without putting in the work.

 

[Kaustikos]

I feel that there is no possible way to make a bridge program. If there was one, the nurse would miss out on some important basics of medical education (organic chemistry ---- that watered down biochemical/chemistry course they take is a complete joke).

I could see medical school being cut down to three years for nurses. These nurses have not taken that in depth anatomy class, nor an in depth pharmacology, immunology, etc, etc, courses. Sure they may have the basic clinical skills down, but not the basic medical knowledge.

They haven't, true, but we're not trying to replace physicians. We're offering Nurses more responsibility. And how do we qualify them? The same medical school curriculum? Then they would become physicians. NP programs are designed to see if they can do the work in a primary care setting.
You guys need to get off medical school being the cut and dry end-all for letting someone be able to prescribe, because that's not the only way. Now people are contesting allowing pharmacists prescribe maintenance medication for repeat patients/customers that come to their pharmacies. Are we going to say no? You can't because you didn't go to medical school? Medical School is for becoming a physician. While we work on chipping away at what a physician is and his/her responsibilities are, we find out that there are things a physician shouldn't have to do that a Nurse/Pharmacist/etc could do. That's what these programs are for. We shouldn't slam the door with this attitude of "OMG, they'll take our jobs away!". This approach has worked successfully in the past and, imo, will continue to be successful. More and more, we deligate tasks that can and inevitably should be given to those helping a physician. We just test them to make sure they're up to the task. Who gives a damn if the title is different. If it's a NNPPNLWKDKJ, it'll make no difference to a patient who wants care. I may have outlandish ideals/opinions because I'm no physician myself, but I would like to think that history does tend to repeat itself and that like Nurses taking bigger tasks/responsiblities from their first jobs in the 1900s to now, we will see more specialization, not just in physician's jobs, but in healthcare jobs.

There is. They're called "allopathic or osteopathic medical schools". We shouldn't compromise care because people believe they're more important than they are and want to have all the perks without putting in the work.

We're not compromising care here. Not in the least bit, if you understand that schools like NP schools are meant to see if they are cut out to even provide primary care. Which, for the most part, they do a damn fine job of doing and their previous knowledge probably has a lot of help in. If you're arguing that NP school isn't cutting it and that we're having some of the worst NP's and PAs, then I would just say we need to employ a different curriculum altogether and harsher standards for admittance to the programs so that graduates come out prepared.



- and please don't flame me Med Students/Residents/Attendings. If I am wrong, please feel free to chime in. I realize that some have differing opinions and would be more than willing to put me in my place.

 

[millepora]

Your opinion can never be wrong, but the assumptions on which you base your opinion can be faulty.

Theres no reason for nurses to stick to primary care. Its all part of their game plan. nursing->primary care-> other specialties->$$$.

Honestly we are all pre-meds, we dont know how hard or easy it is to practice primary care. Someone on this board said, its easy be a crappy family care doc, but hard to be a great one.

If we are happy, with "just good enough" then sure let them have primary care and while we're at it lets lessen medical education too.

What i think is hanging people up is that its all about baby steps.

If it sounds like a duck ("im a doctor, Im a doctor, I have a doctorate degree"), it looks like a duck("I wear a long white coat") and its in a pond like a duck (hospital ), its must be a duck (doctor), wrong! its a DNP.

Genius in its simplicity. No this isnt gonna happen tomorrow, but the best thing for the DNP degree is if physicians dont know about it until its too late, until they have chipped away so much that they are practicing medicine.

Primary Care is the growing "problem" area in medicine, and so far the only the thing medical schools have done is create more state medical schools that put emphasis on primary care, such as BSOM (ECU). This unfortunately does not guarantee that the people they admit, will not change their mind and go into a speciality. If you were to create another school (such as DNP), and limit their area of practice, then there would be no chance for applicants to change their mind after the state has spent a great deal of money training them.

If you feel that the DNP should have full right to go into any residency, they why even open a DNP school (then we have medical school that lacks a residency program)? Why not just open another medical school? A medical school/residency process seems to be a perfected form of creating great physicians, so why change the process?

 

[45408]

Tell that to the Anesthesiologists.

More and more things are being done under sedation these days - things like colonoscopies are a big one - and there's a need for more anesthesiologists than there is supply. Like it or not, the CRNAs are just filling a void.

 

[45408]

Your credibility is questionable,

Looking at PA curriculum from MUSC


Anatomy including lab with cadaver dissection? Yes
Pathology? Yes
Physiology? Yes
Pharmacology? Yes
Clinical Diagnosis? Yes
Pharmacotheraputics? Yes

Clinical Education/Clerkships?

General Surgery? Yes
Family Medicine? Yes
Emergency Medicine? Yes
Peds? Yes
Women's Health? Yes
Mental Health? Yes
General Medicine? Yes

Hmmm, 2 years of school versus 4 years of school.

 

[surftheiop]

Hmmm, 2 years of school versus 4 years of school.

I didnt claim they were MD's, somebody just listed stuff and said PA's dont learn about about all these topics which just isnt true.

 

[melanoleuca]

...You guys need to get off medical school being the cut and dry end-all for letting someone be able to prescribe, because that's not the only way. Now people are contesting allowing pharmacists prescribe maintenance medication for repeat patients/customers that come to their pharmacies. Are we going to say no? You can't because you didn't go to medical school?

In the case of prescription medications, most physicians write for refills, usually enough to hold the patient through their next doctor visit which may be every six months, every two months, or every month depending on the severity of the patient's condition. No responsible physician will write a "bottomless" prescription good for as long as the patient thinks he can stay away from his doctor. Things change, after all, and part of a good doctor-patient relationship is a periodic reevaluation of the patient, something that most pharmacists, by virtue of the limits of their training, are not, repeat not qualified to do. This is not a dig at pharmacists and I confess myself to be perplexed why they would want to mess up a perfectly decent career by taking on the responsibility for non-compliant, entitled, and often-times crazy patients. Not that I don't love the squirrelly mother****ers, you understand, just that I can't fathom what the pharmacists think they will gain by assuming responsibility for them.

More money? Hah. Not hardly. More respect? Not too many people doctors respect more than a good clinical pharmacist. Better hours? Come on.

I want to reiterate that most of American Medicine is unnecessary, totally wasted, oftentimes harmful, and always ruinously expensive. Mid-levels fill a niche in this system because their lack of training is either harmless or the effects of their screw-ups are not immediately obvious and can always be addressed at a later at a higher level of care.

 

[niranjan162]

I don't disagree with you, I don't think. I just think there should be some way instead of closing doors in their face. NP is a right start.

Why? Can you justify or explain why you feel this way?

They haven't, true, but we're not trying to replace physicians. We're offering Nurses more responsibility. And how do we qualify them? The same medical school curriculum? Then they would become physicians. NP programs are designed to see if they can do the work in a primary care setting.
You guys need to get off medical school being the cut and dry end-all for letting someone be able to prescribe, because that's not the only way. Now people are contesting allowing pharmacists prescribe maintenance medication for repeat patients/customers that come to their pharmacies. Are we going to say no? You can't because you didn't go to medical school? Medical School is for becoming a physician. While we work on chipping away at what a physician is and his/her responsibilities are, we find out that there are things a physician shouldn't have to do that a Nurse/Pharmacist/etc could do. That's what these programs are for. We shouldn't slam the door with this attitude of "OMG, they'll take our jobs away!". This approach has worked successfully in the past and, imo, will continue to be successful. More and more, we deligate tasks that can and inevitably should be given to those helping a physician. We just test them to make sure they're up to the task. Who gives a damn if the title is different. If it's a NNPPNLWKDKJ, it'll make no difference to a patient who wants care. I may have outlandish ideals/opinions because I'm no physician myself, but I would like to think that history does tend to repeat itself and that like Nurses taking bigger tasks/responsiblities from their first jobs in the 1900s to now, we will see more specialization, not just in physician's jobs, but in healthcare jobs.

We're not compromising care here. Not in the least bit, if you understand that schools like NP schools are meant to see if they are cut out to even provide primary care. Which, for the most part, they do a damn fine job of doing and their previous knowledge probably has a lot of help in. If you're arguing that NP school isn't cutting it and that we're having some of the worst NP's and PAs, then I would just say we need to employ a different curriculum altogether and harsher standards for admittance to the programs so that graduates come out prepared.



- and please don't flame me Med Students/Residents/Attendings. If I am wrong, please feel free to chime in. I realize that some have differing opinions and would be more than willing to put me in my place.

Your missing big part of the problem. NP programs arent actually designed for primary care. They are designed to be aides to physicians and train people to be part of a healthcare team.

NPs are trying to replace physicians. For prestige, money, etc., mostly money.

Im pretty certain you havent read all the posts in this thread cuz ive posted a decent amount of links supporting my position.

http://www.forbes.com/2007/11/27/nurses-doctors-practice-oped-cx_mom_1128nurses.html

Here is what the creator/leader of the DNP degree says about her new breed:

Rather than a physician, that comprehensive-care provider may very well be a nurse--who also happens to be a doctor.

In other words, as a patient, you get the medical knowledge of a physician, with the added skills of a nursing professional.

this one is the most misleading garbage every presented. Ive posted the DNP curriculum in the thread page 3, i think check it out, none of those classes would can even be compared to what you take in med school.

DNPs are the ideal candidates to fill the primary-care void and deliver a new, more comprehensive brand of care that starts with but goes well beyond conventional medical practice. In addition to expert diagnosis and treatment,

More comprehensive, with less education huh?

Skilled at identifying nuanced changes of condition, and intervening early in a patient's illness, these clinicians are also expert at utilizing community and family resources

I took the liberty of pointing out the garbage they are spewing that proves they are trying to replace physicians

Primary Care is the growing "problem" area in medicine, and so far the only the thing medical schools have done is create more state medical schools that put emphasis on primary care, such as BSOM (ECU). This unfortunately does not guarantee that the people they admit, will not change their mind and go into a speciality. If you were to create another school (such as DNP), and limit their area of practice, then there would be no chance for applicants to change their mind after the state has spent a great deal of money training them.

If you feel that the DNP should have full right to go into any residency, they why even open a DNP school (then we have medical school that lacks a residency program)? Why not just open another medical school? A medical school/residency process seems to be a perfected form of creating great physicians, so why change the process?

Well limiting nurses to simply primary care will be difficult if not impossible. They arent even supposed to be practicing medicine, but they are; theyre also in other specialties already, so this will be near impossible.

I posted a link that showing the bill they tried to get passed allowing them to invade pain medicine. Luckily it was shot down.

Heres the thing, they are organized, unionized, and they spend lots of money lobbying (part of NP's tuition every year goes to funds for such things, whether you choose to contribute or not). Politicians dont know what the hell theyre doing when it comes to anything, bailout is evidence. They know even less about healthcare.

If they read that o nurses now have medical education of a physician but the bedside skills of a nurse, they must be good lets give them more latitude. But this is simply not true, any of you who have looked at the curriculum know that is complete garbage.

I think the DNP degree is worthless and should be shut down, its not and will never be equal to med school. If nurses want to be doctors or want to practice independently go med school.

They may have clinical experience but thats not a substitute for the hardcore science education gained in medschool. It doesnt afford them special treatment, when it comes to practicing medicine, because practicing nursing is not medicine. THATS WHY THERE SHOULD BE NO BRIDGE.

 

[niranjan162]

This will help you understand, Read the whole quote

I have a unique perspective on this. I am a physician (i.e. I actually went to medical school). I was also a nurse and took NP classes.

There is absolutely NO comparison between the two. ZERO. Most NP programs contain less actual "medical" classes than you get in one semester of real medical school. Mine was 15 credit hours. The rest is nursing theory, research, nurse political activism and such. It is so unbelievably different, you can't compare the two. The truly scary thing is that they don't how much they don't know.

NPs, DNPs have absolutely NO right to independent practice. I think there is a role for them such as running coumadin clinics, helping with post-op evals, vaccinations and other such limited practice.

They simply do not have a fraction of the knowledge that the worst FM physician has. Not even close.

Imagine this. Would you let a fourth year medical student open up a clinic and do primary care? H@(( no! And the fourth year medical student already has VAST more medical education than an NP or DNP.

If this does not bother you, it should. I've seen the inside politics of this debate. These people want your job. They hate, resent and envy you. They are cunning and very political active. If we don't stop them, it will negatively affect us all. And their pathway to "independence" will be littered with the dead bodies from their blissful ignorance and pride.

http://forums.studentdoctor.net/showthread.php?t=605130
post number 40

 

[pietachok]

I know quite a bit about what I am talking about.
1) There are only 10 states where NP's can practice autonomously.
2) I work with them in a meaninfuly capacity considering I am a research coordinator to their patients.
3) When I said ER docs aren't specialists, I didn't mean ER medicine isn't a specialty, I meant it doesn't substitute for a physician who is a specialist in the field in which you need longer-term care. If I may re-phrase it to clarify what I meant: ER docs are excellent at giving life-saving and life-sustaining care, but they are not specialized to give disease-specific, healing care that is not of that emergent nature. When you present to the ER with something out of the scope of emergency medicine, you are not seeing a physician in the proper specialty, however many Americans use the ER as their GP and/or treating physician for their chronic ailments. With rare exception, if your Crohn's disease or diverticulosis flares, you should see a GI, not the ER...if you have tonsilitis you should see an ENT not the ER...if you have endometriosis you get the best care from a GYN. The ER is for emergencies, but logistics send many people to the ER even for far less urgent situations. It is not ideal.

4) With regards to the disparity in education...I think a proper board exam could weed out those who have had a superior education from others. The NPs I've worked with have been exceptionally brilliant. They have also been older. I assume this may have something to do with their accumulation of skill and knowledge. I will be honest that I do not really feel comfy with the autonomous practice of NPs in the states that permit it except for things like treating ear infections, administering vaccines, etc. in independent clinics. With rigorous examinations, I think you can ensure that only the best are afforded further autonomy and credentials. Afterall, that is the point--is to identify who has the knowledge to safely practice. And to a certain extent, I don't care how they got there. Hell, I don't care if you got your M.D. equivalent by self education if you actually manged to do it! Just find a way that you can actually prove it, and I'd be happy.

Not trying to be a dick, but you dont know what youre talking about.

from american academy of NP's


http://www.aanp.org/NR/rdonlyres/FCA07860-3DA1-46F9-80E6-E93A0972FB0D/0/Scope_of_Practice.pdf

There are several states where nurses can practice without physician supervision.

Hell they sound better than physicians, except for that little bit of training they are missing, and by little bit I mean 2-6 years.

You call out people on ever having worked with them, but you dont know anything about them and probably have not worked with them in a meaningful capacity either.

I dont hate nurses, nobody here was asserting that. My gripe is that they were trained to do nursing, the DNP degree is a joke and is not equal to the training of a physician which many nursing lobbying groups are claiming.

Hmmm the AMA seems to think emergency medicine is a specialty. But you dont, wonder whose right?

http://www.ama-assn.org/ama/pub/education-careers/becoming-physician/choosing-specialty.shtml

Dont let the fact that its first on the list fool you. Keep living in ignorance.

 

[niranjan162]

I wonder if any of the NP and DNP hating people on this thread have actually worked with NPs substantially. The DNP still does not have exactly the same skills as a physician, cannot practice in any state (as far as I know) without some oversight of a physician, and is OF GREAT ASSISTANCE TO PHYSICIANS. The existence of DNPs and NPs does not hinder MD's or DO's or jeopardize our positions as such, it assists us in the treatment of patients.

I work in one of the best medical school-affiliated treatment centers for GI issues, particularly inflammatory bowel diseases (IBD). Some of the physicians have affiliated, off-campus private practices. One such practice has 4 MD's + one NP. Of course, the MD's are the ones who primarily follow/treat the patients, however, b/c of their prestige, they are often booked. When any patient in the practice has a non-emergent issue, but their physician can't see them soon enough, that NP (who is specially focused in IBD) sees that patient in the interim. It keeps the patient more comfortable, healthier, and happier than waiting for an appointment. NP's can get extremely knowledgable about their field due to their well-honed focus. I also know DNP's who basically oversee hospital-based NP's who serve the same function at hospitals. This keeps patients from (1) needlessly going to the emergency room, and (2) getting care that is specialized to their issue.

Studies have shown that patients are using the ER for their general care, rather than simply for emergencies. ER docs are not specialists, so you don't get the best care there for many internal medicine cases. Providing NP's with the potential to get further credentials so that we can qualify that they particularly excel in a certain field will provide a better, safer, healthier alternative for everyone. A patient who knows he/she is having a flare of a chronic condition that is non-emergent should se a credentialed DNP when they can't get an appointment with their doc; right now they are going to the ER...and often that means the doc seeing them has no medical history and has to play it safe which could mean a drastically different course of action! (I just saw a patient today who got 160mg of corticosteroids who should have gotten none due exactly to this type of situation).

I know quite a bit about what I am talking about.
1) There are only 10 states where NP's can practice autonomously.
2) I work with them in a meaninfuly capacity considering I am a research coordinator to their patients.
3) When I said ER docs aren't specialists, I didn't mean ER medicine isn't a specialty, I meant it doesn't substitute for a physician who is a specialist in the field in which you need longer-term care. If I may re-phrase it to clarify what I meant: ER docs are excellent at giving life-saving and life-sustaining care, but they are not specialized to give disease-specific, healing care that is not of that emergent nature. When you present to the ER with something out of the scope of emergency medicine, you are not seeing a physician in the proper specialty, however many Americans use the ER as their GP and/or treating physician for their chronic ailments. With rare exception, if your Crohn's disease or diverticulosis flares, you should see a GI, not the ER...if you have tonsilitis you should see an ENT not the ER...if you have endometriosis you get the best care from a GYN. The ER is for emergencies, but logistics send many people to the ER even for far less urgent situations. It is not ideal.

4) With regards to the disparity in education...I think a proper board exam could weed out those who have had a superior education from others. The NPs I've worked with have been exceptionally brilliant. They have also been older. I assume this may have something to do with their accumulation of skill and knowledge. I will be honest that I do not really feel comfy with the autonomous practice of NPs in the states that permit it except for things like treating ear infections, administering vaccines, etc. in independent clinics. With rigorous examinations, I think you can ensure that only the best are afforded further autonomy and credentials. Afterall, that is the point--is to identify who has the knowledge to safely practice. And to a certain extent, I don't care how they got there. Hell, I don't care if you got your M.D. equivalent by self education if you actually manged to do it! Just find a way that you can actually prove it, and I'd be happy.

Hmm am I seeing discrepancies or am I just crazy??

Im sure your research position gives you great insight into what nurses know/dont know.

I never said nurses werent smart. I believe you when you say u know some very intelligent NP's, in which case they should do well in med school if they want to practice independently.

It would be nice if we didnt have to worry about how people were trained, but these arent cars we're fixing, its people. The lengths of schooling and regulations are put in place to protect people. Thats why you should care, because pathways to becoming these things have the proof that they can do their job built into them, i.e. licensing requirements.

Nurses are lobbying to circumvent these requirements for the sole purpose of gaining more market share. DANGEROUS!

Your amalgamating education and clinical skills, in such a way that its confusing the issue.

The education learned in the basic sciences of med school is applied to the clinical setting. And While you can learn things in the clinical setting, you are most likely not learning the scientific basis of the underlying ailments.

Now, lets look at the example of the interns vs the nurse with experience. The nurse claims that the intern is incompetent and knows nothing, which in turn we can assume that the nurse knows more than the intern. This is true and false.

The intern is still in the learning stages, learning to navigate the hospital procedural bs, doing other work etc. The nurse certainly knows more about this than the intern, however the intern has more science knowledge.

Then theres also the fact that residency is about learning as well. The residents have to go home and read up on cases etc. to and learn things they dont know.

We already have proper board exams to weed people out. If nurses want to take them then let them. But then we should also implement a certain amount of clinical hours, like a residency, so they can truley be prepared.

With regards to referrals, yes ER docs make referrals, ALL doctors make referrals. Im not pointing you out, but people here seem to think once a specialist is seen thats the end all be all. Specialist refer out too. However, without the scientific bank of knowledge, how do you know who to refer to? How do you coordinate with that doctor about what they're doing and what you're doing if you dont have the preclinical knowledge of med school to fall back on?

This creates and extremely dangerous situation. Nurses may know how many mgs of a drug to push, but do they know the basis of how that drug works? its effects when combined with such other drugs? etc.

 

[tennisball80]

lol this thread is still going 😀

 

[Californian]

Nurse doctor! does not sound right but interesting.

 

[cbrons]

wow this trainwreck of a pissing match is still going?

Bah, you all sound like *****s to me... getting too emotional and becoming completely irrational in your arguments.
I agree with melanoleuca, he is the only one who knows what in the hell he is talking about. Also, the prowlers input is great because its never more than one sentence and it cuts right to the chase.

Just because your mom is an NP doesnt mean you have to be a whiney bitch over the internet trying to convince us that they should get any of the autonomy they aspire to.

As a side note, I was interest to find out that there was a point in medicine when people thought doctors would lose prescriptive authority. There was a time when people thought doctors would do the diagnosing and pharmacists would do the prescribing. I wonder why that model didn't pick up more steam, it seems to make more sense to me. Maybe someone (like a current physician or pharmacist) could shed some light on this for me

Oh and here is a funny little rant by a pharmacist about NPs: http://www.theangrypharmacist.com/archives/2006/07/cnmpanp_home_he.htmlhttp:// www.theangrypharmacist.com/archives/2006/07/cnmpanp_home_he.html

From my experience in retail pharmacy, having heard my own boss bitch and complain everyday, I think the general consesus among pharmacists is more autonomy for NPs = nightmare for them.

 

[melanoleuca]

The other thing you folks have to realize is that there is a tremendous amount of "Degree Inflation" out there. Any idiot can get a Masters nowadays and doctorates are not that hard to come by. The fact that anybody has a "Masters" in anything does not impress me in the slightest. Universities are mostly now nothing but diploma mills and federal student aid farms where anybody who qualifies for student loans will be fed into the pipeline to emerge at the other end with as much money squeezed out of them as possible. If you think it is otherwise you are sadly deluded.

Just like most of medicine is absolutely wasted, most of higher education is a joke. The price keeps going up because there is so much federal money available to pay for it and suckers keep lining up to waste four or five years of their lives for easy, meaningless degrees that give them something to put on their resume when they apply for a job at Starbucks.

Higher education as it is structured in the United States is one of the biggest scams in history.