How do we stop nurse practitioners?

[Carbocation1]

The "health care team" propaganda being spewed by medical school is purposefully done to undermine the autonomy and status of the modern physician. My friend's school ("top-tier") invited a hospital admin to speak about cost cutting/improving outcomes. The entire mandatory attendance lecture was a complete dumping on physicians. My friend had questions about this "lecture" on his exam.

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[ACSurgeon]

I actually shadowed a group of 2 general surgeons and 2 mid-levels in a rural setting and one of the PAs use to take call before she had a baby. The PA said that if there was a call at like 2am she would come in and determine if surgery was needed or if the pt could just come in in the morning.

In the OR the PA was pretty much just retracting which looks ridiculously easy. Couldn't you just train a regular RN, getting paid less than a NP/PA, to execute orders, write notes, retract, etc.? Also do surgeons that supervise a PA get paid more for this?

Disclaimer: I only know the 7-8 hospitals that I've worked at as a resident. I'm sure there are many setups out there, especially in rural areas.

In the scenario you describe, I wouldn't be surprised if the PA was routinely calling the surgeon to present the patient and "determine" if the patient needs surgery. I wouldn't be surprised if the surgeon reviewed images from home.

An experienced PA, much like an experienced intern, should be able to identify the handful of conditions that needs emergent surgery (compromised bowel, perforated viscous, hemorrhage, necrotizing infections, ischemic limb, etc). Even then, the surgeon still serves as a safety net if its not a straight forward case and can be called at home at 2 am to come see the patient or give an opinion.

It might seem like the PA is just retracting. In reality, they know the flow of the operation and can anticipate steps and help things go smoothly. While you could train a nurse or scrub tech to do the same, our system currently allows to bill for an NP or PA but not RN as a surgical assist. The surgeon doesn't make more money, but the hospital or practice (whoever is paying the assistants salary) will make money to offset the cost of the NP/PA.

 

[TaroBubbleTea]

The "health care team" propaganda being spewed by medical school is purposefully done to undermine the autonomy and status of the modern physician. My friend's school ("top-tier") invited a hospital admin to speak about cost cutting/improving outcomes. The entire mandatory attendance lecture was a complete dumping on physicians. My friend had questions about this "lecture" on his exam.

Either I go to your friend's school or this phenomenon is extremely widespread because I had the SAME exact experience. I don't know why med schools are so keen on castrating the profession and indoctrinating us with this "health care team" and "professionalism" bullcrap.

 

[ArkansasMed]

Either I go to your friend's school or this phenomenon is extremely widespread because I had the SAME exact experience. I don't know why med schools are so keen on castrating the profession and indoctrinating us with this "health care team" and "professionalism" bullcrap.

It's an interesting point you guys bring up. I think one thing med students, residents and attendings alike are not trained in is the money of medicine. I'd like to think that most of us have the mindset of provide the best care for our patients. Hospital admin, especially those with business backgrounds (aka no medicine background at all), tend to be more about money. If it makes the hospital money, they'll do it. Regardless if it is better for the patient or not.

Ever wonder why you drive on the highway there are signs for coming to x hospitals ED but rarely a primary care office? Ever wonder why all these hospitals have programs to keep heart failure pts out of the ED after a hospitalization that generally last 30 days (you get paid again at 31 days)? It's all about money. Hospitals make 3-4 times the money seeing an average Joe in the ED for their primary care (hence why there is no mass movement for PC by most hospitals). This may all change once we move from fee-for-service to high value care. I have seen some excellent health care models get dissolved because it doesn't make the hospital money.

What you are describing is the same thing. Why have anesthesiologist when you can have a NP do it for the third of the cost (hence the movement we are seeing now)? Same is happening with PC and some fields of surgery with PAs. Unfortunately, money has taken over a field which should probably never been a "for profit" corporation.

 

[NickNaylor]

Disclaimer: I only know the 7-8 hospitals that I've worked at as a resident. I'm sure there are many setups out there, especially in rural areas.

In the scenario you describe, I wouldn't be surprised if the PA was routinely calling the surgeon to present the patient and "determine" if the patient needs surgery. I wouldn't be surprised if the surgeon reviewed images from home.

An experienced PA, much like an experienced intern, should be able to identify the handful of conditions that needs emergent surgery (compromised bowel, perforated viscous, hemorrhage, necrotizing infections, ischemic limb, etc). Even then, the surgeon still serves as a safety net if its not a straight forward case and can be called at home at 2 am to come see the patient or give an opinion.

It might seem like the PA is just retracting. In reality, they know the flow of the operation and can anticipate steps and help things go smoothly. While you could train a nurse or scrub tech to do the same, our system currently allows to bill for an NP or PA but not RN as a surgical assist. The surgeon doesn't make more money, but the hospital or practice (whoever is paying the assistants salary) will make money to offset the cost of the NP/PA.

Hell, I did my general surgery rotation at community hospital that utilized PAs extensively (always 2 on the general surgery service during the day, one at night), and they would close up after the procedure if the surgeon was comfortable with it. They would essentially function as resident: seeing consults, seeing patients in the ED, writing notes, and discussing the cases with the attendings. And they were all very good at what they did.

 

[anaesthetic]

.

 

[eye love lamp]

Hell, I did my general surgery rotation at community hospital that utilized PAs extensively (always 2 on the general surgery service during the day, one at night), and they would close up after the procedure if the surgeon was comfortable with it. They would essentially function as resident: seeing consults, seeing patients in the ED, writing notes, and discussing the cases with the attendings. And they were all very good at what they did.

The PAs I've seen work function like they're a permanent part-time resident.

 

[NickNaylor]

The PAs I've seen work function like they're a permanent part-time resident.

That is effectively what they are. And, frankly, IMO that's exactly how NPs should operate as well.

 

[TwinsFan]

Only problem is PAs have a standardized curriculum that teaches medicine and science, NPs, not so much...

 

[eye love lamp]

That is effectively what they are. And, frankly, IMO that's exactly how NPs should operate as well.

Can you imagine though? Being a permanent resident?

That's the very definition of purgatory.

 

[sureitis]

So how do we undo the wrong?

It's too late. The extenders are prescribers. In the US, the pharmaceutical-insurance industries will continue to increase folks who can Rx.

 

[Wordead]

Can you imagine though? Being a permanent resident?

That's the very definition of purgatory.

Not really, because it's a permanent resident that works 40-60 hrs a week and can quit whenever the **** they want

 

[Cyberdyne 101]

Not really, because it's a permanent resident that works 40-60 hrs a week and can quit whenever the **** they want

Sounds like a pretty sweet gig.

 

[TwinsFan]

Getting paid twice as much as a resident to do 1/2-2/3 the work hrs while having limited liability is a pretty decent gig.

 

[sureitis]

The extenders—in the US—are here to stay. They'll remain as folks who prescribe (to the delight of Big Pharma) as algorithm following drones. Sadly this is what healthcare in the US has become. However, an extender can make your life easier screening patients, but a recurring problem in private practice is they're often preferred—they can be incredibly personable salaried help—to having to see the MD. We're living in odd times for private practice. I have faith specialists will regain their ground.

 

[NickNaylor]

Can you imagine though? Being a permanent resident?

That's the very definition of purgatory.

Sure, except for the part where you work 40-50 hours/week and take home twice the salary, not to mention being done with the training and out working by the time the typical physician has graduated medical school.

 

[eye love lamp]

Sure, except for the part where you work 40-50 hours/week and take home twice the salary, not to mention being done with the training and out working by the time the typical physician has graduated medical school.

....and then 20 years later when you're still stuck in that part time hell....

 

[Cyberdyne 101]

....and then 20 years later when you're still stuck in that part time hell....

Not everyone wants to be the QB, though.

 

[sureitis]

We all need help, and extenders provided it until they assumed the role as "physicians" rather than assistants. An incredible evolution of "minor" anomalies turfed to our helpers, but then the "helpers" played the part as primaries, and purported some expertise ultimately fouling up. There is a place for helpers, but under the current system they're faster at prescribing, remarkably "nice" to the needy, and spend time holding hands. Ultimately the most inexpensive caretaker (provider) will be favored by the gentle, salaried, nice person. Sadly your patients will succumb to the lack of knowledge, and complications arise. There's no answer to this now, but folks with little understanding, grand bank deposits, and little responsibility will ultimately assume the same, or similar consequences of practicing medicine. A quick and easy paycheck for an extender may extend into a quick and dire level of responsibility—that time in coming.

 

[kbeitz]

The students running away from primary care and creating a more fragmented and less teamwork driven health environment are more problematic than the presence of nps in this health "system".

I enrolled in medical school to become fearless not spineless.

Sent from my XT1092 using Tapatalk

 

[NickNaylor]

....and then 20 years later when you're still stuck in that part time hell....

As @Cyberdyne 101 said, the fallacy is in thinking that everyone wants to be the head honcho or that the increased responsibility is worth the risk of increased "power," so to speak. Not everyone has those goals, and not everyone wants that responsibility. There are plenty of people who are more than happy coasting with their solid salary and lower stress work even if it means they aren't at the top of the totem pole.

 

[Dr_lost]

Guys we really need to step it up and take ownership of medicine and ALL specialties. The previous generation of greedy fat cats have really screwed us over by selling out to the people in suits who have no understanding of medicine.

Read this "entrepreneur's" future vision of turning medicine into fast-food healthcare. This will be the future unless we take action.

"By 2030, just 15 years from today, there will be ~70 million Americans over 65yo. Today, there are ~30 million. Coupled with a predicted physician shortage, I believe this calls for disruptive innovation from entrepreneurs. Given that the entire healthcare sector is performance based.. My business model seeks to have high accountability (outcomes in real time/costs in real time).

My employees which constitute my brand, my franchise, will be adeptly trained in one to three outpatient surgical procedures. The inspiration for this came from military medics, in which low income retail and part time restaurant workers enter 6-8 week boot camps and are capable of handling trauma scenarios on the battle field similar to what a trauma surgeon would encounter here. By employing these training tactics onto the general population, I will fuel job promotion.

By creating a new class of caretakers that have been extensively trained in just 1-3 surgeries, we will reduce the cost curve by being able to offer a menu of care, in a retail clinic franchise format. Keep in mind that the training protocols will always be aware of the limitations posed by such a model. And our employees will have to endure sustained and prolonged training to be considered ready to enter the workforce."

I am very disturbed that some people treat medicine as a joke, especially not understanding how two people with the same illness will not manifest exactly the same. During my 9 month practicum at a local hospital, I witnessed the turf war between nurses, and physicians. I can understand both aspects of the turf war, as my mother has been a RN for 25 years (I've heard so many stories from her). On the other side of the turf war, my supervising Psychiatrist, and PharmD consistently provided me with the reality of being a "doctor". I do not want to start a turf war in this thread, so I will ask my question and leave.

Question: Maybe the big pharmaceutical companies are behind this push for more Nurse Practitioner autonomy. The more drugs that are being prescribed, the more money they make.
My supervising doctors were very honest about their support of prescription medication for treating mental illness (and other alignments). I was constantly reminded that a Clinical Psychologist (even one that took 2 years Post-Doc in Pharmacology just to be able to prescribe psycho-tropic medications), needs 12+ sessions to achieve results with a patient. In a hospital setting, a 1 hour long therapy session is not possible with each patient. Every day I slid my ID badge through the scanner to clock in, I had no less than 15 patients to see before I could clock-out. The nurses on the various floors I attended, would ask me to periodically hold a quick session with a patient (I noticed that most of the patients I visited were Pre-Op and/or suffering GAD). After my first week I wasn't able to see a patient for more than 20 minutes, that wen I understood the hardships of an attending physician.

In closing, I think the Pharmaceutical companies are the real puppet masters. I've noticed that every turf war within medicine revolves around having the label doctor, and having the authority to prescribe medications. Turf wars such as:

• NP vs MD
• NP vs Clinical Psychologists ( Clinical Psychologists that have prescription privilege)
  
• Clinical Psychologists vs Psychiatry (Clinical Psychologists that have prescription privilege)
  
• DO vs MD (this turf war is pointless in my opinion, as both are highly trained)
• LCSW vs Clinical Psychologists
  
• RN vs MD
• RN vs DO
• PharmD vs MD

While the turf war escalates insurance companies, and pharmaceutical companies continue to earn record breaking profits. This Modern Healthcare article entitled, "Global prescription drug use to increase 24% over next five years" illustrates my point. http://www.modernhealthcare.com/article/20151119/NEWS/151119856

 

[Psai]

I am very disturbed that some people treat medicine as a joke, especially not understanding how two people with the same illness will not manifest exactly the same. During my 9 month practicum at a local hospital, I witnessed the turf war between nurses, and physicians. I can understand both aspects of the turf war, as my mother has been a RN for 25 years (I've heard so many stories from her). On the other side of the turf war, my supervising Psychiatrist, and PharmD consistently provided me with the reality of being a "doctor". I do not want to start a turf war in this thread, so I will ask my question and leave.

Question: Maybe the big pharmaceutical companies are behind this push for more Nurse Practitioner autonomy. The more drugs that are being prescribed, the more money they make.
My supervising doctors were very honest about their support of prescription medication for treating mental illness (and other alignments). I was constantly reminded that a Clinical Psychologist (even one that took 2 years Post-Doc in Pharmacology just to be able to prescribe psycho-tropic medications), needs 12+ sessions to achieve results with a patient. In a hospital setting, a 1 hour long therapy session is not possible with each patient. Every day I slid my ID badge through the scanner to clock in, I had no less than 15 patients to see before I could clock-out. The nurses on the various floors I attended, would ask me to periodically hold a quick session with a patient (I noticed that most of the patients I visited were Pre-Op and/or suffering GAD). After my first week I wasn't able to see a patient for more than 20 minutes, that wen I understood the hardships of an attending physician.

In closing, I think the Pharmaceutical companies are the real puppet masters. I've noticed that every turf war within medicine revolves around having the label doctor, and having the authority to prescribe medications. Turf wars such as:

• NP vs MD
• NP vs Clinical Psychologists ( Clinical Psychologists that have prescription privilege)
  
• Clinical Psychologists vs Psychiatry (Clinical Psychologists that have prescription privilege)
  
• DO vs MD (this turf war is pointless in my opinion, as both are highly trained)
• LCSW vs Clinical Psychologists
  
• RN vs MD
• RN vs DO
• PharmD vs MD

While the turf war escalates insurance companies, and pharmaceutical companies continue to earn record breaking profits. This Modern Healthcare article entitled, "Global prescription drug use to increase 24% over next five years" illustrates my point. http://www.modernhealthcare.com/article/20151119/NEWS/151119856

There is no turf war between do and md. They are functionally equivalent and work together as colleagues. There is no turf war between rns and mds, the jobs are fundamentally different and complementary. There is no turf war between pharmds and mds, there are only a small minority of pharmacists who are trying to push the idea that flooding the market with pharmacists was a good idea and want to turn pharmacists into healthcare providers to ameliorate that mistake. Nps and clinical psychologists are attempting to muscle into physician territory through legislation because they want to earn more money without putting in the time and effort that it takes to become a real doctor. Pharmaceutical companies are only capitalizing on the fact that lesser trained providers don't know as much about the medications that are being peddled and that the sunshine act is limited to physicians.

 

[FlowRate]

Ask them basic science questions.

Too bad I'd probably also miss those questions these days.

There is no turf war between do and md. They are functionally equivalent and work together as colleagues. There is no turf war between rns and mds, the jobs are fundamentally different and complementary. There is no turf war between pharmds and mds, there are only a small minority of pharmacists who are trying to push the idea that flooding the market with pharmacists was a good idea and want to turn pharmacists into healthcare providers to ameliorate that mistake. Nps and clinical psychologists are attempting to muscle into physician territory through legislation because they want to earn more money without putting in the time and effort that it takes to become a real doctor. Pharmaceutical companies are only capitalizing on the fact that lesser trained providers don't know as much about the medications that are being peddled and that the sunshine act is limited to physicians.

Hard to have a tuft war when you're playing on the same team.


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Did you know you could become a FNP 5 years after graduating high school?

http://www.simmons.edu/academics/accelerated-and-dual-degree/nursing-bs-nursing-ms

 

[iqe2010]

PAs are trained alongside medical students and are taught how to practice clinical medicine.

It sucks that PAs are still fighting an uphill battle and are viewed less than NPs when NP education is far less superior.

I heard that NPs aren't trained to suture, put in central lines, intubate, etc.

Maybe that's why they're basically nonexistent outside of FM, Women's health & Psychiatry.

 

[DNM]

As a nurse going into medicine I work closely with a group of Cardiologist's with a few NP/PA's in the group as well.

I have asked almost all of the MD's I work with how they feel about mid-level encroachment and the response is almost unanimous. Keeping in mind we only represent one practice in the Midwest..

The physicians state that the mid-level usage is for the patients that already have a plan set in place by one of our MD's. Example, Heart failure patient has an acute on chronic exacerbation and is admitted to the hospital. The physician sets up a plan and medication regime. The patient will follow up with the mid-level over the course of the next month or two due to the physician's schedule being booked up. If our mid-levels get over their head perse, they consult the physician.

Thoughts on this model guys?

I think that is a good model and is what we should be doing. I'm also in the midwest. Some states in the midwest, NP's have full autonomy and can practice 100% independently from a physician, which is where I have a problem.

 

[Psai]

I think that is a good model and is what we should be doing. I'm also in the midwest. Some states in the midwest, NP's have full autonomy and can practice 100% independently from a physician, which is where I have a problem.

It sounds like a good idea until they start thinking that spending a little time following the plan makes them qualified to start making the pan themselves. Then they do whatever they want, under your license with you taking all of the responsibility, even if you had nothing to do with the adverse outcome

 

[cbrons]

The "health care team" propaganda being spewed by medical school is purposefully done to undermine the autonomy and status of the modern physician. My friend's school ("top-tier") invited a hospital admin to speak about cost cutting/improving outcomes. The entire mandatory attendance lecture was a complete dumping on physicians. My friend had questions about this "lecture" on his exam.

Either I go to your friend's school or this phenomenon is extremely widespread because I had the SAME exact experience. I don't know why med schools are so keen on castrating the profession and indoctrinating us with this "health care team" and "professionalism" bullcrap.

My school does this as well. They love also putting us on rotations with NP students and NP preceptors.

 

[cbrons]

Hell, I did my general surgery rotation at community hospital that utilized PAs extensively (always 2 on the general surgery service during the day, one at night), and they would close up after the procedure if the surgeon was comfortable with it. They would essentially function as resident: seeing consults, seeing patients in the ED, writing notes, and discussing the cases with the attendings. And they were all very good at what they did.

Goood to know medical school is not needed to function as a surgeon. Always love hearing stuff like this. There was an intensevist on ERCAST recently who stated that NPs in the ICU were "a cut above" the residents. So that's nice too.

It's a great feeling knowing that you spend a decade or more of your life in school/training to do the exact same thing as people who didn't spend half the time, effort, or money.

 

[cbrons]

Same here. The PA that I worked with did a critical care fellowship at a high volume hospital and put in 10-20 central lines every day for a year. He was good, and everyone knew it. Nice guy too.

That's good. I'm sure the vast majority of critical care fellows who are already MDs don't get this much experience.

PAs are trained alongside medical students and are taught how to practice clinical medicine.

It sucks that PAs are still fighting an uphill battle and are viewed less than NPs when NP education is far less superior.

I heard that NPs aren't trained to suture, put in central lines, intubate, etc.

Maybe that's why they're basically nonexistent outside of FM, Women's health & Psychiatry.

Not a single thing you said is true. Lol.

 

[Psai]

My school does this as well. They love also putting us on rotations with NP students and NP preceptors.

That is pathetic. If your school doesn't have enough physicians to teach future physicians, they need to shut down. The worst thing that my school has done is one time the attending was at a meeting so they wanted us to spend a day with the np in surgery clinic which I refused and spent the day in the OR but that was a complete anomaly.

 

[TaroBubbleTea]

My school does this as well. They love also putting us on rotations with NP students and NP preceptors.

That sounds awful. That NP could be the sweetest person in the world, but no way in hell would I let an NP be my preceptor. I would complain to the administration if that ever happened to me. I am not taking out $200k+ in loans to be taught by a noctor with half the education as me. It just doesn't sit well with me.

 

[cbrons]

That sounds awful. That NP could be the sweetest person in the world, but no way in hell would I let an NP be my preceptor. I would complain to the administration if that ever happened to me. I am not taking out $200k+ in loans to be taught by a noctor with half the education as me. It just doesn't sit well with me.

Today I had to sit in the OR and get lectured by a student CRNA about the "planes of anesthesia". She has been in training for 9 months and can already do various procedures better than most residents. Made me incredibly depressed and butt hurt the entire day, in case you couldnt tell from my earlier whining. I cant help but shake the feeling that all this med school stuff is a huge scam and 99% irrelevant in the modern day when were all just "providers."

 

[iqe2010]

Not a single thing you said is true. Lol.

So PAs aren't trained similarly to physicians?

NPs don't have more autonomy than PAs?

NP education isn't inferior to PA education?

Elaborate please.

 

[Dranger]

Jeez look at this pump up of PAs just because you have your thumbs over them. I work in a MICU and we only have physicians and NPs. The physicians do most of the admits and plans of care, however the NPs do admits as well albeit less complicated. Furthermore, in my experience the ACNPs at many hospitals do many of the chest tubes, central lines, art lines and a good amount of bronchs and intubations.

At least in my experience, the PAs I have worked with were mostly poor to average at best. Many come from the cardio/GI/OR services and are usually fresh faced 24-27 year olds who couldn't even address basic questions or do routine procedures. We had a few hospitalist PAs who tripped over a H/P and admit unless they were given 2 hours to do it...

The biases are strong here, I get anecdotes are pervasive everywhere but seriously....?

 

[W19]

PA is legit

NP is a joke... You can do your NP online and some schools require only 500 hours preceptorship... A resident in FM complete 500 hrs in less than two months and yet some states allow NP to have the same scope with FM/IM docs... This is insane!

 

[allantois]

I think the fault of AMA was their focus on absorbing DO residencies with that merger which btw will shut down many residency programs. This only creates a vacuum that NPs will gladly fill. The AMA should have focused on containing the nursing profession instead.

In Europe, medical schools enroll classes that are a lot larger than the ones in US (perhaps sacrificing some of the quality of education). I never quite understood what the point of creating a bottleneck in the production of number of physicians in the US was, because the result is the massive projected shortage of healthcare providers, that NPs were called on to fill. Perhaps it is time to rethink medical education.

On a side note, it makes no sense to me as to why clinical psychologists should not be able to prescribe medications while inferiority trained NPs can.

 

[TaroBubbleTea]

Today I had to sit in the OR and get lectured by a student CRNA about the "planes of anesthesia". She has been in training for 9 months and can already do various procedures better than most residents. Made me incredibly depressed and butt hurt the entire day, in case you couldnt tell from my earlier whining. I cant help but shake the feeling that all this med school stuff is a huge scam and 99% irrelevant in the modern day when were all just "providers."

No, I get exactly what you mean. It's like, what am I doing with my life if I can easily be replaced by someone with half the education and training? I'm only an M1, so I might be naive, but I truly believe that the grueling journey I am embarking on will ultimately be for the benefit of the patient. Even if that's not true, I need to believe it for the sake of my sanity.

 

[iqe2010]

Jeez look at this pump up of PAs just because you have your thumbs over them. I work in a MICU and we only have physicians and NPs. The physicians do most of the admits and plans of care, however the NPs do admits as well albeit less complicated. Furthermore, in my experience the ACNPs at many hospitals do many of the chest tubes, central lines, art lines and a good amount of bronchs and intubations.

At least in my experience, the PAs I have worked with were mostly poor to average at best. Many come from the cardio/GI/OR services and are usually fresh faced 24-27 year olds who couldn't even address basic questions or do routine procedures. We had a few hospitalist PAs who tripped over a H/P and admit unless they were given 2 hours to do it...

The biases are strong here, I get anecdotes are pervasive everywhere but seriously....?

This is a damn lie and you know it.

 

[67552931811]

Jeez look at this pump up of PAs just because you have your thumbs over them. I work in a MICU and we only have physicians and NPs. The physicians do most of the admits and plans of care, however the NPs do admits as well albeit less complicated. Furthermore, in my experience the ACNPs at many hospitals do many of the chest tubes, central lines, art lines and a good amount of bronchs and intubations.

At least in my experience, the PAs I have worked with were mostly poor to average at best. Many come from the cardio/GI/OR services and are usually fresh faced 24-27 year olds who couldn't even address basic questions or do routine procedures. We had a few hospitalist PAs who tripped over a H/P and admit unless they were given 2 hours to do it...

The biases are strong here, I get anecdotes are pervasive everywhere but seriously....?

 

[ACSurgeon]

This is a damn lie and you know it.

View attachment 198361

I'm sure exceptions exist. An NP who was an ICU nurse for 5-10 years before becoming an NP would be far ahead a fresh PA grad. The PA might have more theoretical knowledge but much less experience.

The problem is, it is becoming more common tbat NPs don't have extensive nursing experience. Combine a weaker curriculum and no clinical training, and on average, PAs are much more capable than NPs.

Also, just because a nurse can correctly guess how to manage a condition from noticing trends, this doesn't mean they know why or how that treatment works. That's where a more thorough basic science and clinical training curriculum makes sense.

 

[Dranger]

View attachment 198361

Yes, I am totally making it up on an anonymous forum for my own personal gain, oh wait.

I am not suggesting NPs> or equal to Physicians, but there are NP programs out there (ACNP/Acute not FNP) that teach all of these skills. I don't know if you are actually "pre-med" or a "med-student" but how about you get your feet wet before denouncing something you know nothing about.

As for NP education I feel it should be elevated to be more stringent, but the blanket notion that PAs are simply better than NPs across the board is simply laughable and frankly, uninformed. Too many NPs and PAs do jump right into school without experience, the hallmark advantage of "mid-levels" before was their seasoned medical experience.

 

[NickNaylor]

Goood to know medical school is not needed to function as a surgeon. Always love hearing stuff like this. There was an intensevist on ERCAST recently who stated that NPs in the ICU were "a cut above" the residents. So that's nice too.

It's a great feeling knowing that you spend a decade or more of your life in school/training to do the exact same thing as people who didn't spend half the time, effort, or money.

I wouldn't agree with that. Just that PAs in this particular context functioned well, contributed to the team, and weren't incompetent in the setting of oversight. I don't think anyone is arguing that PAs are "functioning as surgeons" as you say. At best they are functioning at the level of an intern or sub-I.

 

[Carbocation1]

"Was told by a physician that pharmacists are not doctors." https://www.reddit.com/r/pharmacy/comments/2z3now/was_told_by_a_physician_that_pharmacists_are_not/

"First year residents get a bit of this out of their system early on. The rigors of residency beats it out of them. I've worked with several physicians who said they came around when a pharmacist "caught a mistake and saved my ass." So let them talk for now. They'll figure it out eventually that we are a team."

"I had a doctor go ape**** over me requesting chart notes to get a prior authorization. He threatened to get me fired and report me for trying to obtain confidential information. I tried to explain how the health plan needs chart notes otherwise the clinical staff won't approve paying for someone's Invega and he goes "do you even have an experience dealing with psychotics!?" I wanted to say "I do now""

 

[Carbocation1]

PharmDs, NPs, DNPs, DNAPs, CRNAs, etc are all taking a dump on our profession every single day. They think they can do our job better than us. They are being trained to do every part of a physician's job until the physician is not needed anymore. Sad times.

I know a friend who sat down with his school's dean out of concern for the future of physicians. His response was that "physicians will always be the head of the healthcare team" and " an MD is the powerful degree in the world and opens so many doors." Bullcrap. Mind you this dean only work as a physician 3-4 weeks per year. He is profiting off students - basically smiling at us while putting his foot down on our throats.

 

[67552931811]

Yes, I am totally making it up on an anonymous forum for my own personal gain, oh wait.

I am not suggesting NPs> or equal to Physicians, but there are NP programs out there (ACNP/Acute not FNP) that teach all of these skills. I don't know if you are actually "pre-med" or a "med-student" but how about you get your feet wet before denouncing something you know nothing about.

As for NP education I feel it should be elevated to be more stringent, but the blanket notion that PAs are simply better than NPs across the board is simply laughable and frankly, uninformed. Too many NPs and PAs do jump right into school without experience, the hallmark advantage of "mid-levels" before was their seasoned medical experience.

K, bud-- There's a solid chance that I've been around medicine longer than you've been alive.

Let me guess, you're a nurse? Lol.

 

[iqe2010]

Yes, I am totally making it up on an anonymous forum for my own personal gain, oh wait.

I am not suggesting NPs> or equal to Physicians, but there are NP programs out there (ACNP/Acute not FNP) that teach all of these skills. I don't know if you are actually "pre-med" or a "med-student" but how about you get your feet wet before denouncing something you know nothing about.

As for NP education I feel it should be elevated to be more stringent, but the blanket notion that PAs are simply better than NPs across the board is simply laughable and frankly, uninformed. Too many NPs and PAs do jump right into school without experience, the hallmark advantage of "mid-levels" before was their seasoned medical experience.

None of the new RN grads I know plan on just being an RN for the rest of their lives. They all want to be an NP, CRNA, etc.

This one girl I know was "accepted" into an NP program before she even took her RN boards. So after 1-2 years of taking fluff classes, she's gonna be handing out meds like candy in a white coat probably calling herself a doctor.

I have to give it to the nursing lobby. They have really out done themselves.

 

[iqe2010]

Are all these new "mid-levels" driving down physician salaries?

I was talking with someone the other day, and they were saying how hospitalists were only making 120k-130k in certain places.

That's very low for an MD/DO. But an NP/PA who make that would be more than happy.

 

[67552931811]

Are all these new "mid-levels" driving down physician salaries?

I was talking with someone the other day, and they were saying how hospitalists were only making 120k-130k in certain places.

That's very low for an MD/DO. But an NP/PA who make that would be more than happy.

I live in a major market (hint: look at handle) and hospitalists here make double that. I even know a few who make more.

 

[cbrons]

PAs are trained alongside medical students and are taught how to practice clinical medicine.

It sucks that PAs are still fighting an uphill battle and are viewed less than NPs when NP education is far less superior.

I heard that NPs aren't trained to suture, put in central lines, intubate, etc.

Maybe that's why they're basically nonexistent outside of FM, Women's health & Psychiatry.

So PAs aren't trained similarly to physicians?

NPs don't have more autonomy than PAs?

NP education isn't inferior to PA education?

Elaborate please.

Read your original post kid. You said various idiotic things such as, "NPs aren't taught how to intubate, central lines" etc. All those little statements you made were inaccurate. Please go back to pre-allo where your ignorance is welcomed and celebrated.