Why MD/DO and not PA/NP

[heartsink]

The last thread on this topic was back in May, it was about 9 posts long and was mostly about applying to PA programs (generalization). It was a boring uninformative read. Before that, its at least a couple years before a good discussion has happened about why students choose to go MD or DO instead of PA or NP.

My mind frequently visits this question when I play out interview scenarios in my head and the inevitable question comes up "Why become a doctor and not x y or z?". I'm curious how others have approached this question that have decided on med school over PA or NP.

I'm especially interested in exploring the question of what exactly can an MD do that a PA can't, and vice versa. What autonomy does an MD allow that you truly cannot get as a PA?

If someone asked you right now, what would you tell them the reasons are that you are pursuing med school and not just become a nurse, or a PA?

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[IslandStyle808]

What have you gotten thus far from your search? It may help us guide you with your response.

 

[Dr. Retractor]

I want to have in depth knowledge in my specialty, to the degree where I can be responsible for making the decisions that determines the livelihood of my patients. I wouldn't want to be a PA or NP working with a doctor who can make these decisions and I don't fully understand why or not be able to make the same decisions.

TL;DR: My ego.

 

[karayaa]

Autonomy depends on the state you work in. NPs at least can be fully autonomous in some states.

generic reasons for MD/DO:
- leadership in the healthcare system and in academia
- sub-specialities
- opportunity to do research
- career options beyond clinical care, incl medical education
- greater knowledge/understanding of pathophysiology and basic/clinical science
- more responsibility, authority, autonomy
- surgery
- higher income ceiling

generic reasons for PA/NP
- female
- older
- unable to handle debt
- don't want to delay full-time practice/don't want so much training time (eg for family/financial reasons)
- want less responsibility, decision-making
- don't want to study so much
- don't want to feel financial pressures
- don't want to work so much
- already have an RN/LVN
- Military medic/corpsman experience

DO/PA seem to have fewer international opportunities, if that matters.


Both can run their own businesses, do admin, etc, but MD/DO has a slight edge in authority

Any others?

 

[BestDoctorEver]

@karayaa I don't know if most states will allow PA/NP to open their own practice if this is what you are talking out. I don't see many NP/PA in administration either...

 

[heartsink]

Better answers in this thread already. In the past I'd read the vague notion of 'autonomy' doctors have, but there's also been debate in the past how much autonomy PAs actually have on their own. Past threads have argued you could never have your own practice as a PA but some are vehement that you can.

 

[IslandStyle808]

@karayaa I don't know if most states will allow PA/NP to open their own practice if this is what you are talking out. I don't see many NP/PA in administration either...

NPs have autonomy (within those states that granted them) within the realm of their training, if it goes beyond that then a physician is needed (meaning it's the NPs patient until the problem is beyond their expertise). I was not sure if this translated to opening up practice, so I looked into it, and found actually it does in Nevada (not sure if other states have followed). However, the NP needs to have practiced for a few years in order to do so.

Here is an article explaining more detail about it.

http://www.kaiserhealthnews.org/sto...ne-nurse-practitioners-scope-of-practice.aspx

 

[ems2doc]

MD/DO because...
- Leadership
- Ability to sub-specialize
- Role in academia/teaching
- Research


I just like the whole "sciency" feel of it—I know that's not a word in the dictionary.

 

[karayaa]

@karayaa I don't know if most states will allow PA/NP to open their own practice if this is what you are talking out. I don't see many NP/PA in administration either...

The admin that NP/PA do might be less than what you see a MD/DO do - eg MD could be chief of staff, chief medical officer at a hospital, chair of department, while NP/PA could be clinic director, coordinator/supervisor, etc.
Both have admin as an option in their careers, but MDs/DOs seem to be able to go further/higher.
Between NP and PA, I suspect that NPs have more admin options than PAs, because they can manage nurses (RNs, LVNs, etc), whereas a PA might not be as suited for that role. NPs could manage nursing units (ICU, CC, PICU, ICN, etc), or SNFs, or other places where nurses work.

 

[karayaa]

MD/DO because...
- Leadership
- Ability to sub-specialize
- Role in academia/teaching
- Research


I just like the whole "sciency" feel of it—I know that's not a word in the dictionary.

You are aware that clinical doctors don't really use/consider basic science, right? 🙂
edit: noticed you're a MS, so maybe you know more than me haha

 

[hoihaie]

cause if you NP/PA, you can't slice dudes open and hold their brains like Simba was held in Lion King 1

 

[dbeast]

I never understood the purpose of interviewers asking this question.

 

[IslandStyle808]

cause if you NP/PA, you can't slice dudes open and hold their brains like Simba was held in Lion King 1

It's the circle of....... willis!

Sorry I will stop now.

 

[ButImLETired]

I answered this question a couple of days ago on here, not sure why it doesn't automatically come up, but I can try to explain some of the differences.

First of all, you absolutely can own your own practice as a PA, but you have to hire an MD (I say this generically, but it applies to DO's as well, MD's just what I've got) to go through your charts (and assume the liability thereof). Technically when you're a PA you're always under MD supervision, while as an NP you're not. The reason you don't see many PA or NP run practices is that it's often not worth it from a financial standpoint. It's extremely difficult for an MD to run a solo practice nowadays, because overhead (especially with EMR) just keeps growing while reimbursements shrink. As an NP/PA, your reimbursement is lower than an MD's at baseline, so you're in trouble from the get-go. It makes way more sense to be a part of an already-present MD group and see the doctors' patients. This allows the doctors to take time off when needed knowing their patients still have a provider they can see, it allows them to see essentially twice as many patients because they technically "own" the NP/PA's patients as well, and if they stop by and see the NP/PA's patient for 5 minutes they can still reimburse at the MD rate (otherwise they get 80% of their rate for someone else having seen the patient). Meanwhile the NP/PA gets a steady salary not tied to reimbursements, they see fewer patients a day, and they don't have to deal with the nonsense of owning a practice. Win/win for all. This is an extremely common model nowadays.

As for why one vs the other, I'll touch on the main difference re: patients. Imagine you're in a busy ER. At the same time that you get a 6 year old with an ear infection, a 20yr old with a laceration on his arm and a 25 year old pregnant woman likely having a miscarriage, you get a 21yo who OD'd on heroin and keeps trying not to breathe on you, an 85yo septic patient with pneumonia and sketchy vitals at best, and a guy clutching his chest, sweaty and breathing fast. If you're the PA/NP, you can see the first three basically on your own, you can kinda sorta mention them to the MD if you think there's something special about the patient, but if you've been working in the ER longer than a month, you've seen 8 billion of each of those. In teaching hospitals, it's unlikely the PA/NP will go anywhere near the next 3- the residents will take those. In a small community ER, where you don't have more than 1 or 2 MD's on at any one point, it's extremely unlikely that you'll have more than 1 potentially critical patient at the same time, but if for some reason you did, the PA's job there would be to kind of stabilize while the MD makes the decisions. On medicine floors, the PA will take the easy admissions that just require pain meds/IV antibiotics but not the complex ones that'll likely crap out at some point. In the OR, the PA can be first assist, but they can't operate. On anesthesia, the CRNA will take the healthy young appendectomy but not the liver transplant case or the big heart case or the guy with bad lung disease. Etc etc. That's where the patient population differs.

There's a popular belief that PA's and NP's function at the level of a 1st-2nd year resident forever, and I'd say that only really applies to surgery. In reality, there's a big difference between the way residents function and PA's/NP's do. We often see the sickest patients because we have to learn how to take care of them, but are always carefully supervised because we're not supposed to function independently at all. So that same basic ear infection or small laceration, the attending still has to see it and technically be there for any procedure that's done if they are going to bill for it. If a PA/NP takes care of it, the MD really doesn't have to be in the room or care about it one way or the other because it'll be billed as a NP/PA procedure (residents can't bill).

I think the biggest benefit of becoming an NP/PA is the significantly lesser time commitment (both in terms of schooling and work hours), lesser financial commitment, lesser liability- because they take care of more stable, less sick patients- and greater flexibility in terms of switching specialties. The benefits of becoming an MD/DO are pretty obvious to everyone on this site.

 

[DermViser]

MD/DO because...
- Leadership
- Ability to sub-specialize
- Role in academia/teaching
- Research


I just like the whole "sciency" feel of it—I know that's not a word in the dictionary.

PAs can specialize as well. Also "sciency" feel is not a good reason to shell out 6 figures in loans.

 

[DermViser]

I want to have in depth knowledge in my specialty, to the degree where I can be responsible for making the decisions that determines the livelihood of my patients. I wouldn't want to be a PA or NP working with a doctor who can make these decisions and I don't fully understand why or not be able to make the same decisions.

TL;DR: My ego.

What is stopping an NP/PA to have in-depth knowledge of their specialty? PAs/NPs also make medical decisions for patients as well. NPs work independently and even PAs aren't in the patient room with a physician hovering over their shoulder. For some people, their ego isn't worth 6 figures in non-dischargeable debt.

 

[Lamel]

What is stopping an NP/PA to have in-depth knowledge of their specialty? PAs/NPs also make medical decisions for patients as well. NPs work independently and even PAs aren't in the patient room with a physician hovering over their shoulder. For some people, their ego isn't worth 6 figures in non-dischargeable debt.

Out of curiosity, what would you say to the question in the title? Or better put, why did you choose MD over PA/NP?

 

[DermViser]

Out of curiosity, what would you say to the question in the title? Or better put, why did you choose MD over PA/NP?

Honestly, I never explored PA/NP as an option. I had the viewpoint at the time that only physicians practice medicine, and that's the only route you can do to achieve it. Not even close to true. You have no idea the level of time and money sacrifice you will be making in medicine, vs. PA/NP, at the age of 22.

 

[Lamel]

Honestly, I never explored PA/NP as an option. I had the viewpoint at the time that only physicians practice medicine, and that's the only route you can do to achieve it. Not even close to true. You have no idea the level of time and money sacrifice you will be making in medicine, vs. PA/NP, at the age of 22.

So what are some legitimate reasons that people should pick MD over PA/NP?

Surgery and academia come to mind.

 

[DermViser]

So what are some legitimate reasons that people should pick MD over PA/NP?

Surgery and academia come to mind.

Yeah, that's probably about it. Also if you wanted to do Radiology, Path, maybe PM&R, etc.

 

[ASD2019]

People have already noted that some cases might be beyond the reach of NP/PA, but I believe the biggest limitation to be the confidence patients have in NPs and PAs. Do you personally feel comfortable with being treated by NP/PA? Do you have confidence in their ability? or is your confidence in the MD behind them?

Personally I feel it is a matter of how much impact one wants to have. If one basically just wants to treat patients and is ok with working under someone then NP/PA would work just fine. But with a MD one is making a much more commitment in improving the human condition through medicine and the opportunities are endless.

 

[DermViser]

People have already noted that some cases might be beyond the reach of NP/PA, but I believe the biggest limitation to be the confidence patients have in NPs and PAs. Do you personally feel comfortable with being treated by NP/PA? Do you have confidence in their ability? or is your confidence in the MD behind them?

Personally I feel it is a matter of how much impact one wants to have. If one basically just wants to treat patients and is ok with working under someone then NP/PA would work just fine. But with a MD one is making a much more commitment in improving the human condition through medicine and the opportunities are endless.

😆😆😆 That last sentence doesn't make a lick of sense. Are you saying tht PAs/NPs don't improve the human condition thru medicine?

 

[ASD2019]

They do! I didn't say they didn't! But MDs make much more of a commitment to be able to do this. Whether it is the educational, financial, work hours, personal sacrifice, etc.. Thus the impact they have is greater!

 

[mimelim]

I should note that the vast majority of my experience with NPs/PAs is in the hospital, not in the outpatient setting....

The way that I see NPs/PAs are professional residents. They get paid 4 times the resident salary (twice as much pay and half the hours), but otherwise they function intellectually the same as a junior/mid-level resident would. As residents, we get a fair bit of autonomy as we go up the food chain. But, at the end of the day, the attending is 'responsible'. Talk to ANY recent residency graduate. It is downright scary when you look across the table and realize that YOU are the most experienced person in the room and that there isn't immediate backup for you to fall on. The difference between taking Junior trauma surgery call and Chief trauma surgery call is HUGE and the gap between Chief and attending is night and day. You could easily replace that Junior resident with a PA/NP. They have the background, they have the physical abilities, but they (in general) don't want to take that extra step and take on the autonomy and responsibility of being the chief or being the attending.

I have said this before, but a good chunk (if I had to put a number on it, 10-25%) of my medical school class would have been better off doing NP/PA. This isn't judgement, this isn't being condescending. This is what they say, or they imply. There are HUGE perks to being either of those. HUGE. Lifestyle, well paid, really make a real and lasting impact on people's health. How much people respect them or you is by your actions, not the two letters that follow your name. The main point is, being an MD is NOT the pinnacle of occupations. It is a niche. It fulfills certain kinds of people. It is NOT for everyone. It is NOT for all or even most pre-meds.

Do NOT misinterpret. You don't have to work 80 hours a week for the rest of your life to be a successful MD. But, you do need to get through 3-9 years of residency/fellowship. You do need to keep up with the field on a much higher level than NPs/PAs because you are always functioning at a higher level within the system. That is a burden.

 

[DermViser]

They do! I didn't say they didn't! But MDs make much more of a commitment to be able to do this. Whether it is the educational, financial, work hours, personal sacrifice, etc.. Thus the impact they have is greater!

So because they sacrifice more to be able to practice their impact is greater? You really believe that?

 

[DermViser]

I have said this before, but a good chunk (if I had to put a number on it, 10-25%) of my medical school class would have been better off doing NP/PA. This isn't judgement, this isn't being condescending. This is what they say, or they imply. There are HUGE perks to being either of those. HUGE. Lifestyle, well paid, really make a real and lasting impact on people's health. How much people respect them or you is by your actions, not the two letters that follow your name. The main point is, being an MD is NOT the pinnacle of occupations. It is a niche. It fulfills certain kinds of people. It is NOT for everyone. It is NOT for all or even most pre-meds.

Do NOT misinterpret. You don't have to work 80 hours a week for the rest of your life to be a successful MD. But, you do need to get through 3-9 years of residency/fellowship. You do need to keep up with the field on a much higher level than NPs/PAs because you are always functioning at a higher level within the system. That is a burden.

 

[stickshifthonda]

This is definitely a question I asked myself as well, especially with the "what-if" about not getting into medical school. I work directly with an NP in outpatient settings, granted a pretty unique one- based at a homeless shelter for teens and within a network of homeless providers.

Google isn't providing much help here either. It seems from basic research of mine that PAs level off (reach a peak and cannot move up the ladder anymore), must work with an MD who precepts, and cannot prescribe specific drugs. NPs on the other hand seem to be able to work more independently and use the "nursing model"- honestly it seems like there are minor differences between the models.

What really seems to be the difference is the time spent training between PA/NP and MD/DO. There's a leadership aspect, there's the ability to run your own practice, and work in any specialty/sub-specialty.

Tell me if I'm way off course here!

 

[DermViser]

This is definitely a question I asked myself as well, especially with the "what-if" about not getting into medical school. I work directly with an NP in outpatient settings, granted a pretty unique one- based at a homeless shelter for teens and within a network of homeless providers.

Google isn't providing much help here either. It seems from basic research of mine that PAs level off (reach a peak and cannot move up the ladder anymore), must work with an MD who precepts, and cannot prescribe specific drugs. NPs on the other hand seem to be able to work more independently and use the "nursing model"- honestly it seems like there are minor differences between the models.

What really seems to be the difference is the time spent training between PA/NP and MD/DO. There's a leadership aspect, there's the ability to run your own practice, and work in any specialty/sub-specialty.

Tell me if I'm way off course here!

leadership aspect --> well medicine is more going to "team-based" care so that's out.
run your own practice --> private practices are consolidating and docs are becoming hospital employees
PAs/NPs can work in almost any specialty/subspecialty - besides Rads/Path.

 

[stickshifthonda]

leadership aspect --> well medicine is more going to "team-based" care so that's out.
run your own practice --> private practices are consolidating and docs are becoming hospital employees
PAs/NPs can work in almost any specialty/subspecialty - besides Rads/Path.

So in your opinion what differentiates them?

I know I work on a team with PAs, NPs, DOs and MDs in addition to social workers, counselors, and clinical psychologists. Everybody has their role in my clinic, but I'm wondering what nationally it looks like.

 

[DermViser]

So in your opinion what differentiates them?

I know I work on a team with PAs, NPs, DOs and MDs in addition to social workers, counselors, and clinical psychologists. Everybody has their role in my clinic, but I'm wondering what nationally it looks like.

liability, mainly.

I'll say it again. Scope of practice in state law is what defines a physician as a physician.

 

[ems2doc]

You are aware that clinical doctors don't really use/consider basic science, right? 🙂
edit: noticed you're a MS, so maybe you know more than me haha

1. "Basic" Science is the core of all of medicine. Your statement is completely ridiculous.
2. You can still go into research for the science. You don't see too many NPs doing that.

PAs can specialize as well. Also "sciency" feel is not a good reason to shell out 6 figures in loans.

True on the PA. The level of academic research is much higher in medicine than PA.

 

[DermViser]

You are aware that clinical doctors don't really use/consider basic science, right? 🙂
edit: noticed you're a MS, so maybe you know more than me haha

I really hope you're truly joking.

 

[BestDoctorEver]

I should note that the vast majority of my experience with NPs/PAs is in the hospital, not in the outpatient setting....

The way that I see NPs/PAs are professional residents. They get paid 4 times the resident salary (twice as much pay and half the hours), but otherwise they function intellectually the same as a junior/mid-level resident would. As residents, we get a fair bit of autonomy as we go up the food chain. But, at the end of the day, the attending is 'responsible'. Talk to ANY recent residency graduate. It is downright scary when you look across the table and realize that YOU are the most experienced person in the room and that there isn't immediate backup for you to fall on. The difference between taking Junior trauma surgery call and Chief trauma surgery call is HUGE and the gap between Chief and attending is night and day. You could easily replace that Junior resident with a PA/NP. They have the background, they have the physical abilities, but they (in general) don't want to take that extra step and take on the autonomy and responsibility of being the chief or being the attending.

I have said this before, but a good chunk (if I had to put a number on it, 10-25%) of my medical school class would have been better off doing NP/PA. This isn't judgement, this isn't being condescending. This is what they say, or they imply. There are HUGE perks to being either of those. HUGE. Lifestyle, well paid, really make a real and lasting impact on people's health. How much people respect them or you is by your actions, not the two letters that follow your name. The main point is, being an MD is NOT the pinnacle of occupations. It is a niche. It fulfills certain kinds of people. It is NOT for everyone. It is NOT for all or even most pre-meds.

Do NOT misinterpret. You don't have to work 80 hours a week for the rest of your life to be a successful MD. But, you do need to get through 3-9 years of residency/fellowship. You do need to keep up with the field on a much higher level than NPs/PAs because you are always functioning at a higher level within the system. That is a burden.

Honestly, I never explored PA/NP as an option. I had the viewpoint at the time that only physicians practice medicine, and that's the only route you can do to achieve it. Not even close to true. You have no idea the level of time and money sacrifice you will be making in medicine, vs. PA/NP, at the age of 22.

 

[karayaa]

I really hope you're truly joking.

Can you elaborate?
All the doctors I've shadowed have moved far away from basic science.

 

[ems2doc]

Can you elaborate?
All the doctors I've shadowed have moved far away from basic science.

You've shadowed doctors? For real?

Well people, this guy is clearly an expert.

 

[DermViser]

Can you elaborate?
All the doctors I've shadowed have moved far away from basic science.

When you practice you use basic science all the time. It may not be nitty gritty minutiae but you use it. For example, changing someone from a ACE inhibitor to a Angiotensin II receptor blocker due to cough, which occurs secondary to accumulation of bradykinin.

 

[karayaa]

When you practice you use basic science all the time. It may not be nitty gritty minutiae but you use it. For example, changing someone from a ACE inhibitor to a Angiotensin II receptor blocker due to cough, which occurs secondary to accumulation of bradykinin.

Maybe I was limiting basic science to the minutiae...
Do doctors actually think about this level of detail when they change a med? Do they consider what's actually happening - oh too much bradykinin, better switch? Or do they think on a more clinical level - oh, cough, better change from x to y?

I didn't mean that basic science doesn't matter, or that doctors don't know it, they just don't seem to utilize it on a daily basis. The fundamental knowledge seems to be supplanted by clinical knowledge.

Eg in microbiology vs ID, do MDs consider the different mechanisms of different bacterial secretion systems, or do they think: symptoms, bug, antibiotic?
For an anemic patient, do MDs consider the molecular, biochemical mechanism for RBC destruction, or do they just know that RBCs are being degraded?

Maybe my concept of "basic science" if off? I think of biological mechanisms on the cellular level and below.

How would experienced doctors score on Step 1? Do they continue to use all that info - or at least what's relevant to their specialty?

MD/PhDs would obviously have a more sciency perspective.

 

[DermViser]

Maybe I was limiting basic science to the minutiae...
Do doctors actually think about this level of detail when they change a med? Do they consider what's actually happening - oh too much bradykinin, better switch? Or do they think on a more clinical level - oh, cough, better change from x to y?

I didn't mean that basic science doesn't matter, or that doctors don't know it, they just don't seem to utilize it on a daily basis. The fundamental knowledge seems to be supplanted by clinical knowledge.

Eg in microbiology vs ID, do MDs consider the different mechanisms of different bacterial secretion systems, or do they think: symptoms, bug, antibiotic?
For an anemic patient, do MDs consider the molecular, biochemical mechanism for RBC destruction, or do they just know that RBCs are being degraded?

Maybe my concept of "basic science" if off? I think of biological mechanisms on the cellular level and below.

How would experienced doctors score on Step 1? Do they continue to use all that info - or at least what's relevant to their specialty?

MD/PhDs would obviously have a more sciency perspective.

As a premed, you have NO standing to decide what is minutiae and what isn't. One specialty's minutiae is another specialty's you really need to know this. As far at the example I gave, knowing why the cough is happening is important, or you end up like the PA/NP who gives a cough suppressant (Guiafenesin) to someone who's coughing from an ACE inhibitor.

 

[Osteoth]

leadership aspect --> well medicine is more going to "team-based" care so that's out.
run your own practice --> private practices are consolidating and docs are becoming hospital employees
PAs/NPs can work in almost any specialty/subspecialty - besides Rads/Path.

Yes, medicine is by its nature team based, but at the end of the day the doctor is the team-leader, bar none.

 

[DermViser]

Yes, medicine is by its nature team based, but at the end of the day the doctor is the team-leader, bar none.

Try again:
http://www.medscape.com/viewarticle/772300_2

http://www.beckershospitalreview.co...-and-nurse-practitioners-a-perfect-match.html

 

[Osteoth]

Try again:
http://www.medscape.com/viewarticle/772300_2

http://www.beckershospitalreview.co...-and-nurse-practitioners-a-perfect-match.html

First link requires a login so I couldn't look at it.

Second one, from that article:

"The vast majority of care in a medical home model is basic care",

"[...]there are not many PCMHs led solely by nurse practitioners across the country, in part because of certain limitations they face from the state and federal government. For instance, many states do not allow nurse practitioners to prescribe or diagnose without physician involvement. In fact, 32 states require a degree of physician involvement for NPs to diagnose and treat or prescribe medication"

As a result, your point about NP being able to function as "leaders" based on autonomous patient-care within the healthcare industry seems to be a very niche observation, which is hamstrung in 32 states, including the top 10 most populated states. As a result, in most of the United States, NPs are mid-level healthcare providers who require, by federal regulations, the expertise and legal liability coverage of a physician to see patients.

Furthermore, even in these extremely specific care situations where NPs have autonomy, they only serve patients at the lowest acuity levels. These patients in a hospitals largely "leave follow-up calls and care coordination to nurses to begin with", so this patient model is not that novel altogether from nurses seeing patients in a hospital.

Sources:
Nurse Practitioner State-by-State Practice Rights
US Populations by State

 

[DermViser]

First link requires a login so I couldn't look at it.

Second one, from that article:

"The vast majority of care in a medical home model is basic care",

"[...]there are not many PCMHs led solely by nurse practitioners across the country, in part because of certain limitations they face from the state and federal government. For instance, many states do not allow nurse practitioners to prescribe or diagnose without physician involvement. In fact, 32 states require a degree of physician involvement for NPs to diagnose and treat or prescribe medication"

As a result, your point about NP being able to function as "leaders" based on autonomous patient-care within the healthcare industry seems to be a very niche observation, which is hamstrung in 32 states, including the top 10 most populated states. As a result, in most of the United States, NPs are mid-level healthcare providers who require, by federal regulations, the expertise and legal liability coverage of a physician to see patients.

Sources:
Nurse Practitioner State-by-State Practice Rights
US Populations by State

http://dhhs.ne.gov/publichealth/licensure/documents/MedicalHomes.pdf

Scope of practice is at the state level - it's 18 states and rising in which NPs are fully independent.

 

[Osteoth]

http://dhhs.ne.gov/publichealth/licensure/documents/MedicalHomes.pdf

Scope of practice is at the state level - it's 18 states and rising in which NPs are fully independent.

Yes, and those 18 states comprise a whopping 13% of the US population.

Source: US Population by State

Alaska 0.23%
Arizona 2.04%
Colorado 1.61%
Hawaii 0.43%
Idaho 0.51%
Iowa 0.97%
Maine 0.42%
Montana 0.32%
Nevada 0.86%
New Hamphire 0.42%
New Mexico 0.66%
North Dakota 0.21%
Oregon 1.21%
Rhode Island 0.34%
Vermont 0.20%
Washington 2.15%
Wyoming 0.18%
District of Columbia 0.19%
= 12.95%

 

[fellowstudent92]

So what are some legitimate reasons that people should pick MD over PA/NP?

Surgery and academia come to mind.

yea but honestly if you want to do surgery, go for oral surgery. Better return on investment if you ask me (assuming you also have an interest in dentistry).

not to mention OMFS is the #2 highest paying job in the country above mostly all other surgeons.

 

[DermViser]

Yes, and those 18 states comprise a whopping 13% of the US population.

Source: US Population by State

Alaska 0.23%
Arizona 2.04%
Colorado 1.61%
Hawaii 0.43%
Idaho 0.51%
Iowa 0.97%
Maine 0.42%
Montana 0.32%
Nevada 0.86%
New Hamphire 0.42%
New Mexico 0.66%
North Dakota 0.21%
Oregon 1.21%
Rhode Island 0.34%
Vermont 0.20%
Washington 2.15%
Wyoming 0.18%
District of Columbia 0.19%
= 12.95%

Your list is definitely wrong bc New York allows NPs to practice independently.

 

[Osteoth]

Your list is definitely wrong bc New York allows NPs to practice independently.

According to the Nurse Practitioners Modernization Act, which is the state law in NY which governs the requirements of NPs, "shall maintain collaborative relationships", which are defined as "communicates with licensed physician(s) as needed OR a Hospital that provides services through licensed physicians qualified to collaborate in the specialty involved and having privileges at such institution"

As a result, when a case is out of the scope of an NPs training, and there are sure to be some, then they seek the help of a physician, similar to the relationship between a resident and an attending. As a result, they do not have total authoritative practice rights, NY is considered a "Reduced Practice" state, whereas CA, TX, and FL are "Restricted Practice" where NPs have much stricter regulations than in NY.

In addition you did not address my point that the 18 states where NPs have full practice rights make up less than 15% of the US population. This shows that while NPs do have autonomy in some cases, these are few and far between, and largely in states where the physician need is at a desperate level.

Furthermore, even in the states that are "Reduced Practice", physicians are still leaders in the healthcare realm in that they "oversee" the work of NPs via consultation.

Source:
NY State NP Law

 

[DermViser]

According to the Nurse Practitioners Modernization Act, which is the state law in NY which governs the requirements of NPs, "shall maintain collaborative relationships", which are defined as "communicates with licensed physician(s) as needed OR a Hospital that provides services through licensed physicians qualified to collaborate in the specialty involved and having privileges at such institution"

As a result, when a case is out of the scope of an NPs training, and there are sure to be some, then they seek the help of a physician, similar to the relationship between a resident and an attending. As a result, they do not have total authoritative practice rights, NY is considered a "Reduced Practice" state, whereas CA, TX, and FL are "Restricted Practice" where NPs have much stricter regulations than in NY.

In addition you did not address my point that the 18 states where NPs have full practice rights make up less than 15% of the US population. This shows that while NPs do have autonomy in some cases, these are few and far between, and largely in states where the physician need is at a desperate level.

Furthermore, even in the states that are "Reduced Practice", physicians are still leaders in the healthcare realm in that they "oversee" the work of NPs via consultation.

Source:
NY State NP Law

Yeah, if it's out of scope of the NP (AS DETERMINED BY THE NP) they would refer the person to a specialist. Just like a PCP.

 

[Osteoth]

Yeah, if it's out of scope of the NP (AS DETERMINED BY THE NP) they would refer the person to a specialist. Just like a PCP.

Except that PCPs are inherently trained to handle more diverse cases, due to medical school + residency. If a NP were to treat a patient out of their scope, the NP would open themselves up to increased liability, so it would behoove them to seek out additional help, possibly even from a PCP.

 

[FutureOncologist]

I'm seeing these kinds of threads all the time. Many people will try talking you out of medical school for NP and PA school.

OP stop drinking the kool aid and do your research. If you wanna be a PA, then do it. Wanna get an MD? Do that. Simple as that.

 

[DermViser]

Except that PCPs are inherently trained to handle more diverse cases, due to medical school + residency. If a NP were to treat a patient out of their scope, the NP would open themselves up to increased liability, so it would behoove them to seek out additional help, possibly even from a PCP.

Sorry, but NPs believe that they have outcomes equal to PCPs and they have "studies" to prove it.