NPs vs. MD's.

[Bearcat74]

Not a "troll" here, just have plenty of years experience as an NP, from a "real university", not some on-line thing, and have some thoughts/comments, for you to consider:

1. There is no doubt that MD students have much deeper & broader basic science training than any NP I have every known.
2. Big question.... do you really need all that biochem, histology, anatomy to treat sinusitis or DMII?
3. Most NPs, after several years "on the job" training, are quite compentent to handle otitis media, HTN, and the other "common cold" problems most pt's have.
4. If there is something we can't handle, most certainly refer these patients onto the MD/DO.
5. I really resent NPs who get their training from on-line programs. My school required first year chemistry and real organic chemistry as prereqs. Most programs don't.
6. There should be NO automous practice for any NP until the NP has 3 years experience, working collaboratively with an MD/DO.
7. Medicine is changing so rapidly. I see patients, do the same thing as the one MD in our office, and make 1/2 as much. Much of the move to NPs is driven by the insurance companies, and the very powerful nurses lobbies and associations. Nurses lobbies are as powerful as the NRA.
8. The paperwork, especially prior authorizations, is just plain crazy. If there is a generic alternative, the insurance company will "fight you" until you feel like just saying, "I give up".... even if the newer drug is better for the patient.
9. Burnout is a factor for both MD and NPs. Most I know are happy, but many are not. When you take a 1 week vacation, it takes 2 weeks to catch up when you return.
10. Pt's are more demanding now than ever. Be sure you name/phone/email is not publicly listed, although w/ EMRs, many patients can reach you through your practice portal.
11. NPs have no interest in doing surgery (although some do basic stuff in derm clinics), and we are pretty much limited to FP, Psych, Peds, and Women's Health.
12. I see many CT scans and MRIs going to Australia and Israel for interpretation..... cheaper! Avoid radiology like the plague.... as this is getting more common.
13. Most hospitalists are foreign trained, here on work visas, and most (in my experience at least) are lacking in interpersonal skills, and most seem unhappy.
14. And yes, I was admitted to 2 public MD schools, and one public DO school. 15 years ago I couldn't prescribe an aspirin, now I can (idependently) prescribe Percocet..... Medicine is sure changing, and just like everything, these changes are "cost driven".

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[WingedOx]

 

[charmiedermie]

Not a "troll" here, just have plenty of years experience as an NP, from a "real university", not some on-line thing, and have some thoughts/comments, for you to consider:

1. There is no doubt that MD students have much deeper & broader basic science training than any NP I have every known.
2. Big question.... do you really need all that biochem, histology, anatomy to treat sinusitis or DMII?
3. Most NPs, after several years "on the job" training, are quite compentent to handle otitis media, HTN, and the other "common cold" problems most pt's have.
4. If there is something we can't handle, most certainly refer these patients onto the MD/DO.
5. I really resent NPs who get their training from on-line programs. My school required first year chemistry and real organic chemistry as prereqs. Most programs don't.
6. There should be NO automous practice for any NP until the NP has 3 years experience, working collaboratively with an MD/DO.
7. Medicine is changing so rapidly. I see patients, do the same thing as the one MD in our office, and make 1/2 as much. Much of the move to NPs is driven by the insurance companies, and the very powerful nurses lobbies and associations. Nurses lobbies are as powerful as the NRA.
8. The paperwork, especially prior authorizations, is just plain crazy. If there is a generic alternative, the insurance company will "fight you" until you feel like just saying, "I give up".... even if the newer drug is better for the patient.
9. Burnout is a factor for both MD and NPs. Most I know are happy, but many are not. When you take a 1 week vacation, it takes 2 weeks to catch up when you return.
10. Pt's are more demanding now than ever. Be sure you name/phone/email is not publicly listed, although w/ EMRs, many patients can reach you through your practice portal.
11. NPs have no interest in doing surgery (although some do basic stuff in derm clinics), and we are pretty much limited to FP, Psych, Peds, and Women's Health.
12. I see many CT scans and MRIs going to Australia and Israel for interpretation..... cheaper! Avoid radiology like the plague.... as this is getting more common.
13. Most hospitalists are foreign trained, here on work visas, and most (in my experience at least) are lacking in interpersonal skills, and most seem unhappy.
14. As yes, I was admitted to 2 public MD schools, and one public DO school. 15 years ago I couldn't prescribe an aspirin, now I can (idependently) prescribe Percocet..... Medicine is sure changing, and just like everything, these changes are "cost driven".

Is it National Nurse Practitioner Week or something?

 

[jeffk805dent]

Is it National Nurse Practitioner Week or something?

Ditto. wonder what next week's theme will be?

 

[FindMeOnTheLinks]

cue "dis' gon' be gud" meme

 

[chipwhitley]

Not a "troll" here, just have plenty of years experience as an NP, from a "real university", not some on-line thing, and have some thoughts/comments, for you to consider:

1. There is no doubt that MD students have much deeper & broader basic science training than any NP I have every known.
2. Big question.... do you really need all that biochem, histology, anatomy to treat sinusitis or DMII?

I'm told the extra knowledge matters because things that seem simple sometimes turn out to not be so simple at all.

 

[Mad Jack]

Not a "troll" here, just have plenty of years experience as an NP, from a "real university", not some on-line thing, and have some thoughts/comments, for you to consider:

1. There is no doubt that MD students have much deeper & broader basic science training than any NP I have every known. Obviously.

2. Big question.... do you really need all that biochem, histology, anatomy to treat sinusitis or DMII? No, but you need it to understand a lot of other things, and to know how to interpret research and determine the best course for your patients when you are at the edge of evidence based practice.

3. Most NPs, after several years "on the job" training, are quite compentent to handle otitis media, HTN, and the other "common cold" problems most pt's have. The problem is that they don't know what is common and what is uncommon. 95% of those things will be the typical presentation of the typical disease, but nurses DO NOT KNOW the atypical presentations of many typical diseases, nor do they know the zebras that present as horses.

4. If there is something we can't handle, most certainly refer these patients onto the MD/DO. A lot of the time you won't know what you can't handle. How can you know you have to refer something if you have no idea what it is and mistake it for something else? There's been more than a few cases of nurses treating "minor" illnesses that turned out to be major and didn't get caught until late, that were OBVIOUS to any physician looking at them, particularly amongst the oncology patients that would get antibiotic after antibiotic only to end up with cancer.

5. I really resent NPs who get their training from on-line programs. My school required first year chemistry and real organic chemistry as prereqs. Most programs don't. This is exactly why I am against independent NP practice. There are far more bad programs than good ones. I knew a lot of NPs that became midlevels and felt like they knew basically NOTHING more than they knew when they were a nurse after completion of their programs, and described their clinical rotations as glorified shadowing.

6. There should be NO automous practice for any NP until the NP has 3 years experience, working collaboratively with an MD/DO. There should be no autonomous practice for NPs period.

7. Medicine is changing so rapidly. I see patients, do the same thing as the one MD in our office, and make 1/2 as much. Much of the move to NPs is driven by the insurance companies, and the very powerful nurses lobbies and associations. Nurses lobbies are as powerful as the NRA. The nice thing about being a physician is that if things get bad enough, there's a good chance we'll be able to simply opt out of the system and take cash for whatever the market will bear. Nurses are generally employees, and not very entrepreneurial, so they'll probably stick to the system till it burns to the ground.

8. The paperwork, especially prior authorizations, is just plain crazy. If there is a generic alternative, the insurance company will "fight you" until you feel like just saying, "I give up".... even if the newer drug is better for the patient. Pre-auth sucks, I'll agree with you there. **** insurance companies.

9. Burnout is a factor for both MD and NPs. Most I know are happy, but many are not. When you take a 1 week vacation, it takes 2 weeks to catch up when you return. There's miserable people in every field of work.

10. Pt's are more demanding now than ever. Be sure you name/phone/email is not publicly listed, although w/ EMRs, many patients can reach you through your practice portal. Obviously.

11. NPs have no interest in doing surgery (although some do basic stuff in derm clinics), and we are pretty much limited to FP, Psych, Peds, and Women's Health. And allergy, IM, hospitalist work, critical care, EM, derm, etc etc...

12. I see many CT scans and MRIs going to Australia and Israel for interpretation..... cheaper! Avoid radiology like the plague.... as this is
getting more common. Cheaper =/= better. When these patients start having errors and can't track down the radiologist to sue, they'll come after the hospital. And when the hospitals start paying up, they'll switch back to US radiologists. Final reads CANNOT be done by a radiologist that is NOT licensed in the state in which they are read- it's straight up illegal. Initial reads can be, but a US-trained radiologist must look them over and approve the read to absorb the liability.

13. Most hospitalists are foreign trained, here on work visas, and most (in my experience at least) are lacking in interpersonal skills, and most seem unhappy. We care about medical skills, not interpersonal skills. In the future, most hospitalists will be US trained anyway, as the number of US students is rapidly approaching the number of residencies. And those hospitalists are NOT foreign trained- they have a foreign medical education and US graduate medical education.

14. And yes, I was admitted to 2 public MD schools, and one public DO school. 15 years ago I couldn't prescribe an aspirin, now I can (idependently) prescribe Percocet..... Medicine is sure changing, and just like everything, these changes are "cost driven". I'm sorry you made the wrong choice. Med school isn't nearly as bad as you would imagine, and residency can actually be pretty chill if you choose wisely. As to the "cost driven" nature of things, the ship sinks from the bottom up. The first people to take pay cuts at the hospitals near me were the people in basic functions- transport, food prep, janitorial, CNAs. The next to take a hit were the people a step up- nurses, respiratory therapists, radiation techs, etc. Then the cuts would hit the PAs, NPs, physical therapists, audiologists, etc. Never saw a pay cut hit the docs. Never saw pay cuts hit management. Get as high up the chain as you can, because medicine is going to sink, and the farther down you are, the worse things'll be. I've got a buffer- I'll go in making 250k-300k, if I sink to 200k, no big. You're starting at 100k, if you sink to 60k, that'll really hurt.

 

[Donald Juan]

How do you question if physicians need biochem, anatomy, and histology and then go on to praise your school for requiring ochem?

 

[chipwhitley]

Comparing NPs and MDs by itself makes no sense. One is a nurse and the other is a physician. There are separate careers...

 

[TaroBubbleTea]

Not a "troll" here, just have plenty of years experience as an NP, from a "real university", not some on-line thing, and have some thoughts/comments, for you to consider:

14. And yes, I was admitted to 2 public MD schools, and one public DO school. 15 years ago I couldn't prescribe an aspirin, now I can (idependently) prescribe Percocet..... Medicine is sure changing, and just like everything, these changes are "cost driven". I'm sorry you made the wrong choice. Med school isn't nearly as bad as you would imagine, and residency can actually be pretty chill if you choose wisely. As to the "cost driven" nature of things, the ship sinks from the bottom up. The first people to take pay cuts at the hospitals near me were the people in basic functions- transport, food prep, janitorial, CNAs. The next to take a hit were the people a step up- nurses, respiratory therapists, radiation techs, etc. Then the cuts would hit the PAs, NPs, physical therapists, audiologists, etc. Never saw a pay cut hit the docs. Never saw pay cuts hit management. Get as high up the chain as you can, because medicine is going to sink, and the farther down you are, the worse things'll be. I've got a buffer- I'll go in making 250k-300k, if I sink to 200k, no big. You're starting at 100k, if you sink to 60k, that'll really hurt.

Just had to quote this again because I cannot agree more. **** will hit the fan. It's only a matter of time.

 

[WingedOx]

We care about medical skills, not interpersonal skills.

Oh Mad Jack, you got about 90% of that post spot on, but holy crap is this part wrong.

This is the second post along these lines I've seen on this board in the last few days. @chipwhitley also made a post along these lines earlier this week. Good causes aren't helped by bad arguments, and this is about as bad of one as you can come up with.

Put bluntly, if your interpersonal skills suck, then you suck at an important part of being a physician. If you find yourself unable to communicate with a patient better than an NP, that's entirely on you, and it ain't something you should be proud of.

I really really don't get this attitude (particularly coming from students) that good counseling of patients is something that's someone else's problem. If you have **** counseling and communication skills, you're going to have **** patient adherence to treatment, which is going to lead to **** outcomes. And if you have **** outcomes, what does that say about you as a physician?

 

[Mad Jack]

Oh Mad Jack, you got about 90% of that post spot on, but holy crap is this part wrong.

This is the second post along these lines I've seen on this board in the last few days. @chipwhitley also made a post along these lines earlier this week. Good causes aren't helped by bad arguments, and this is about as bad of one as you can come up with.

Put bluntly, if your interpersonal skills suck, then you suck at an important part of being a physician. If you find yourself unable to communicate with a patient better than an NP, that's entirely on you, and it ain't something you should be proud of.

I really really don't get this attitude (particularly coming from students) that good counseling of patients is something that's someone else's problem. If you have **** counseling and communication skills, you're going to have **** patient adherence to treatment, which is going to lead to **** outcomes. And if you have **** outcomes, what does that say about you as a physician?

That was actually meant to rile OP up, not you While there is room in medicine for those lacking interpersonal skills (path, rads, etc), hospitalist medicine certainly isn't the place for it. Two of the best surgeons I've ever had the pleasure of working with had painfully bad interpersonal skills (and I mean like, autism spectrum levels of bad), but they were damn good at cutting people apart and putting them back together, so people didn't much make a fuss. I didn't mean to collaterally rustle your jimmies

 

[VA Hopeful Dr]

Oh Mad Jack, you got about 90% of that post spot on, but holy crap is this part wrong.

This is the second post along these lines I've seen on this board in the last few days. @chipwhitley also made a post along these lines earlier this week. Good causes aren't helped by bad arguments, and this is about as bad of one as you can come up with.

Put bluntly, if your interpersonal skills suck, then you suck at an important part of being a physician. If you find yourself unable to communicate with a patient better than an NP, that's entirely on you, and it ain't something you should be proud of.

I really really don't get this attitude (particularly coming from students) that good counseling of patients is something that's someone else's problem. If you have **** counseling and communication skills, you're going to have **** patient adherence to treatment, which is going to lead to **** outcomes. And if you have **** outcomes, what does that say about you as a physician?

I think its the next step from the argument that I'd rather have a really skilled doctor than a nice one. Ideally, and usually, you can find one who is both.

Here in town there is a just world class trauma surgeon, absolutely amazing guy. Huge huge huge jackass. He is one of the most unpleasant people I've ever met, but if I get hit by a bus you bet your ass I want him on call.

 

[WingedOx]

That was actually meant to rile up up, not you While there is room in medicine for those lacking interpersonal skills (path, rads, etc), hospitalist medicine certainly isn't the place for it. Two of the best surgeons I've ever had the pleasure of working with had painfully bad interpersonal skills (and I mean like, autism spectrum levels of bad), but they were damn good at cutting people apart and putting them back together, so people didn't much make a fuss. I didn't mean to collaterally rustle your jimmies

Sadly as I said, I've seen similar things said on the allo board as if interpersonal skills are somehow beyond the scope of an MD


if your life is procedural, you can get away with things, but even then inter-provider skills can get you in trouble too no matter how good you are in technical aspects or even patient communication. I saw an impressive downfall of a good surgeon who was loved by his/her patients because he/she basically crossed a line of pissing off his/her institution where even they couldn't tolerate it anymore.

 

[WingedOx]

I think its the next step from the argument that I'd rather have a really skilled doctor than a nice one. Ideally, and usually, you can find one who is both.

Here in town there is a just world class trauma surgeon, absolutely amazing guy. Huge huge huge jackass. He is one of the most unpleasant people I've ever met, but if I get hit by a bus you bet your ass I want him on call.

If you're cutting me open, I don't give a **** how good you are at talking to me. I also have an MD and generally know my way around medicine.

If I'm a guy with barely a high school education and you can't communicate to me the necessary steps to post-operative home care using language I can understand and I come back to you with an infection, a good amount of that blame for the poor outcome is on you.

 

[Mad Jack]

Sadly as I said, I've seen similar things said on the allo board as if interpersonal skills are somehow beyond the scope of an MD


if your life is procedural, you can get away with things, but even then inter-provider skills can get you in trouble too no matter how good you are in technical aspects or even patient communication. I saw an impressive downfall of a good surgeon who was loved by his/her patients because he/she basically crossed a line of pissing off his/her institution where even they couldn't tolerate it anymore.

Funny, similar happened to one of the ones I was talking about... He/she got the boot because they couldn't play politics for **** and was sent packing.

 

[VA Hopeful Dr]

If you're cutting me open, I don't give a **** how good you are at talking to me. I also have an MD and generally know my way around medicine.

If I'm a guy with barely a high school education and you can't communicate to me the necessary steps to post-operative home care using language I can understand and I come back to you with an infection, a good amount of that blame for the poor outcome is on you.

Surgeons give post-op instructions now? At my wife's c-section last week, the nurse did that. Same with my mother's recent mastectomy.

 

[VA Hopeful Dr]

Not a "troll" here, just have plenty of years experience as an NP, from a "real university", not some on-line thing, and have some thoughts/comments, for you to consider:

2. Big question.... do you really need all that biochem, histology, anatomy to treat sinusitis or DMII?
3. Most NPs, after several years "on the job" training, are quite compentent to handle otitis media, HTN, and the other "common cold" problems most pt's have.

These two really caught my attention.

2. You bet your ass you need all of that. Without biochem, how can you explain glycemic index to diabetic patients or explain why orange juice is bad for them? Without anatomy, how are you going to know the anatomy (see what I did there) of the sinuses and nasal cavity well enough to know if someone needs surgical intervention for sinus problems?

3. Anecdotal, but I have not found this to be true at all. If you give a z-pack for a sinus infection, you are not competent (I'm looking at you CVS Minute Clinic). If you use atenolol as first-line therapy in uncomplicated hypertension, you are not competent. I have seen multiple midlevels do both of these things in the last 2 weeks.

 

[Bearcat74]

How come virtually every doc I speak to says much of the basic science "stuff" they learned as a M1 and M2 was soon forgotten after Step 1? I don't see many primary care docs looking through a microscope at blood samples, or tissue samples.

I have seen many "stupid" mistakes by MDs too.... like an ER doc at my hospital telling a patient he had nothing but GERD, and then the pt died three hours later at home from a massive MI.

Not knocking MDs. Thank God for them. But the "pie is going to be split up even more", and the day of the omnipotent physician is over. 21 states now have autonomous practice for NPs, and more will be happening, as a way to control costs. As usual, "just follow the money".

I do enjoy reading your forum. Most topics are very good.

 

[Psai]

How come virtually every doc I speak to says much of the basic science "stuff" they learned as a M1 and M2 was soon forgotten after Step 1? I don't see many primary care docs looking through a microscope at blood samples, or tissue samples.

I have seen many "stupid" mistakes by MDs too.... like an ER doc at my hospital telling a patient he had nothing but GERD, and then the pt died three hours later at home from a massive MI.

Not knocking MDs. Thank God for them. But the "pie is going to be split up even more", and the day of the omnipotent physician is over. 21 states now have autonomous practice for NPs, and more will be happening, as a way to control costs. As usual, "just follow the money".

I do enjoy reading your forum. Most topics are very good.

Because you forget most things after you learn them. You act like this is something new and not just normal human nature. But if you learned more, you will know more than if you didn't learn more. Replacing an omnipotent physician with an impotent np is not exactly intelligent policy

 

[PL198]

images going to Israel and Australia to be read?

 

[maxxor]

images going to Israel and Australia to be read?

There was some experiments with off-shore outsourcing. They were mostly to board certified US MDs who relocated abroad to have a higher standard of living and handle night call. Australia had a few big nighthawk groups.

Problem is, final reads must be performed on US Soil. With the great slashing of 2007, radiology reimbursement fell to levels where this sort of "paying another group to do prelim reads" fell by the wayside, instead of just paying a US-based nighthawk for final reads.

 

[Mad Jack]

How come virtually every doc I speak to says much of the basic science "stuff" they learned as a M1 and M2 was soon forgotten after Step 1? I don't see many primary care docs looking through a microscope at blood samples, or tissue samples.

I have seen many "stupid" mistakes by MDs too.... like an ER doc at my hospital telling a patient he had nothing but GERD, and then the pt died three hours later at home from a massive MI.

Not knocking MDs. Thank God for them. But the "pie is going to be split up even more", and the day of the omnipotent physician is over. 21 states now have autonomous practice for NPs, and more will be happening, as a way to control costs. As usual, "just follow the money".

I do enjoy reading your forum. Most topics are very good.

Not all of us become primary care docs. And many of us that do enter FM or IM end up doing something that isn't straight primary care- hospitalist work (sometimes with open ICUs), urgent care, emergency med, international aid work, etc.

Now, as to NPs swooping in to "control costs," as I said before, physicians are going to be the last group to take real cuts. Nurses, at the end of the day, are in extremely high supply, have very little capital or entrepreneurial spirit to open their own businesses on average (some do, but the vast majority prefer to leave the business end to others), etc etc. Physicians have much more power to change their situation at the end of the day. We can leave the system and go cash only, we've got enough money to open a practice and hire multiple NPs and PAs to work beneath us for a fraction of our salary, and hospitals like to keep us around because unlike nurses, we make juicy, easy to sue targets that bleed money like pinatas. Not so with NPs, who typically get passed over and leave the hospital to blame when they make mistakes.

This isn't to say I don't believe NPs have no place in the system. They make great members of teams. They just shouldn't be autonomous, and I'm fairly certain that once some bodies start hitting the floor from these online DNP carrying NPs, the public/hospitals/insurance companies might wake up to realize that a bunch of half-assed practitioners operating on their own aren't the answer. Will the pie be split up even more? Sure. But it isn't a finite pie- it keeps getting bigger. Which is why, despite the influx of midlevels, physicians have managed to keep wages that have outpaced inflation for decades. Then there's the fact that we tend to hire midlevels, from whom we take a cut of their earnings. I was doing the math on running a psych practice with four midlevels working under me- each one of them essentially would increase my income by 50k, and it's easy to do psych cash only so I don't have to worry about EMR or any of that insurance nonsense. As an NP, options like that aren't exactly jumping out of the woodwork.

 

[PL198]

There was some experiments with off-shore outsourcing. They were mostly to board certified US MDs who relocated abroad to have a higher standard of living and handle night call. Australia had a few big nighthawk groups.

Problem is, final reads must be performed on US Soil. With the great slashing of 2007, radiology reimbursement fell to levels where this sort of "paying another group to do prelim reads" fell by the wayside, instead of just paying a US-based nighthawk for final reads.

I don't see the utility in prelim reads. Like are they making clinical decisions off them? If so what is the point of the final read. And if not, then what is the purpose of the prelim read

 

[W19]

These two really caught my attention.

2. You bet your ass you need all of that. Without biochem, how can you explain glycemic index to diabetic patients or explain why orange juice is bad for them? Without anatomy, how are you going to know the anatomy (see what I did there) of the sinuses and nasal cavity well enough to know if someone needs surgical intervention for sinus problems?

3. Anecdotal, but I have not found this to be true at all. If you give a z-pack for a sinus infection, you are not competent (I'm looking at you CVS Minute Clinic). If you use atenolol as first-line therapy in uncomplicated hypertension, you are not competent. I have seen multiple midlevels do both of these things in the last 2 weeks.

Can't be serious! Even a second year med student won't do something stupid like that. What do they freaking teach at these NP schools?

I had to explain to a nursing student the other what a proton pump inhibitor is... She is a nursing student, but... Geez!

 

[PL198]

Can't be serious! Even a second year med student won't do something stupid like that. What do they freaking teach at these NP schools?

I had to explain to a nursing student the other what a proton pump inhibitor is... She is a nursing student, but... Geez!

..why would she know what that is

 

[W19]

..why would she know what that is

What do you mean? She is about to graduate from nursing school in a little over a month... and she did not know what a proton is? She had trouble with the word 'proton'... I thought people took basic chemistry as a prereq for nursing school...

I also had to explain to her some simple drug calculation... She plan on becoming an NP... I am really scared for our profession...

 

[Instatewaiter]

images going to Israel and Australia to be read?

They are usually read by a board certified radiologist in australia or some other country at night because of different time zones. .. looks like someone beat me to it above.

 

[W19]

They are usually read by a board certified radiologist in australia or some other country at night because of different time zones.

Is that even legal?

 

[Instatewaiter]

Yes and commonly done. I mean what's the difference if they are US board certified. It's not like the image looks upside down in Australia

 

[PL198]

What do you mean? She is about to graduate from nursing school in a little bit over a month... and she did not know what a proton is? She had trouble with the word 'proton'... I thought people took basic chemistry as a prereq for nursing school...

I also had to explain to her some simple drug calculation... She plan on becoming an NP... I am really scared for our profession...

she's a nurse. are you disappointed when the social worker doesn't know what an SSRI is? your naivety continues to ooze like blood out of a DIC patient

 

[frenchyn]

What do you mean? She is about to graduate from nursing school in a little bit over a month... and she did not know what a proton is? She had trouble with the word 'proton'... I thought people took basic chemistry as a prereq for nursing school...

I also had to explain to her some simple drug calculation... She plan on becoming an NP... I am really scared for our profession...

Just FYI, to get into nursing program, you only need one year of basic chemistry. Second of all, you are expecting someone who has one to two classes of pharmacology or 4 years of education to yourself who have at least 8 years of education. I am a nurse myself and really...patients will be blah blah blah when you pull out the word proton pump inhibitor. However, if she/he did not know how to do simple math calculation then it is concerning.

 

[chipwhitley]

she's a nurse. are you disappointed when the social worker doesn't know what an SSRI is? your naivety continues to ooze like blood out of a DIC patient

Where I am, social workers are basically handling most of the psych visits and definitely know what SSRIs are...

 

[NYCGuy86]

Just FYI, to get into nursing program, you only need one year of basic chemistry. Second of all, you are expecting someone who has one to two classes of pharmacology or 4 years of education to yourself who have at least 8 years of education. I am a nurse myself and really...patients will be blah blah blah when you pull out the word proton pump inhibitor. However, if she/he did not know how to do simple math calculation then it is concerning.

Right, but you as a nurse know that nursing students take at least one pharmacology course (if it's two it's really just the one 4 credit course broken down into two 2 credit courses), plus the pharm content covered in the clinical nursing courses and texts (and no, none of this is to the depth that medical students learn pharmacology). The point is, a nursing student should know what a proton pump inhibitor is.

 

[PL198]

Where I am, social workers are basically handling most of the psych visits and definitely know what SSRIs are...

ok if they didn't know what a bisphosphonate was. do we really need to play this game or can you just play along and understand what I meant

 

[maxxor]

I don't see the utility in prelim reads. Like are they making clinical decisions off them? If so what is the point of the final read. And if not, then what is the purpose of the prelim read

Yes, these were mostly for overnight reads and to provide the mythical "radiology" lifestyle. Yes clinical decisions were made off the reports. The final read is because US law requires all final radiology interpretations be performed on US soil. It also establishes physician liability to a person in the USA. You overestimate your average physician's command of imaging if you expect community ED docs at night to be reading their scans while dealing with relentless patients per hour.

Is that even legal?

Prelim reads can be performed anywhere. They aren't billed to a 3rd party payer. Final reads must be performed on US soil.

 

[PL198]

Yes, these were mostly for overnight reads and to provide the mythical "radiology" lifestyle. Yes clinical decisions were made off the reports. The final read is because US law requires all final radiology interpretations be performed on US soil. It also establishes physician liability to a person in the USA. You overestimate your average physician's command of imaging if you expect community ED docs at night to be reading their scans while dealing with relentless patients per hour.



Prelim reads can be performed anywhere. They aren't billed to a 3rd party payer. Final reads must be performed on US soil.

so if US guy says its something different but decision has already been made and procedure occurs that isn't needed, who is responsible?

 

[chipwhitley]

Just FYI, to get into nursing program, you only need one year of basic chemistry. Second of all, you are expecting someone who has one to two classes of pharmacology or 4 years of education to yourself who have at least 8 years of education. I am a nurse myself and really...patients will be blah blah blah when you pull out the word proton pump inhibitor. However, if she/he did not know how to do simple math calculation then it is concerning.

Well if you're going to become an NP prescribing drugs someday and count your nursing degree as part of your clinical education, you should probably at least have learned what one of the most commonly prescribed classes of drugs is in nursing school.

 

[calvnandhobbs68]

How come virtually every doc I speak to says much of the basic science "stuff" they learned as a M1 and M2 was soon forgotten after Step 1? I don't see many primary care docs looking through a microscope at blood samples, or tissue samples.

I have seen many "stupid" mistakes by MDs too.... like an ER doc at my hospital telling a patient he had nothing but GERD, and then the pt died three hours later at home from a massive MI.

Not knocking MDs. Thank God for them. But the "pie is going to be split up even more", and the day of the omnipotent physician is over. 21 states now have autonomous practice for NPs, and more will be happening, as a way to control costs. As usual, "just follow the money".

I do enjoy reading your forum. Most topics are very good.

lol right...as if anybody over 18 years old who came into the ED with chest pain didnt get an EKG and troponin. Either 1) That's totally made up or 2) That doctor better have really deep malpractice insurance.

 

[WingedOx]

Surgeons give post-op instructions now? At my wife's c-section last week, the nurse did that. Same with my mother's recent mastectomy.

Even those in procedural specialties have office hours, pre-op consultations... though I hardly think that procedural specialists are worse than non-procedurists at having bad communication skills. Some psychiatrists I've worked with... jesus.

 

[racerwad]

so if US guy says its something different but decision has already been made and procedure occurs that isn't needed, who is responsible?

Idk what type of procedure would get done that didn't need to be done - most surgeons are probably as good as radiologists (within their specialty) and wouldn't do an appy just because that is how the study was read. They would confirm for themselves. If it's a CXR w/ a pneumonia that was missed, the pt gets a call back. The physician who makes a call based on the prelim read is responsible. Happens fairly regularly. In academic institutions, the overnight rads residents give a prelim read and the final comes in when the attendings arrive the next day.

The prelim vs final read phenomenon is why you have to be ok at making your own wet reads, if only to be able to look at a film and say, "this looks weird, but I'm not sure why." This is part of the reason why physicians spend so much time in training.

 

[W19]

Well if you're going to become an NP prescribing drugs someday and count your nursing degree as part of your clinical education, you should probably at least have learned what one of the most commonly prescribed classes of drugs is in nursing school.

In all fairness, she knows they use PPI for PUD etc... but she has trouble understanding why pH content in the stomach will increase... It was basically a chemistry issue.. But the thing that concerned me the most was her inability to do drug calculations that require 2+ steps...

 

[frenchyn]

Well if you're going to become an NP prescribing drugs someday and count your nursing degree as part of your clinical education, you should probably at least have learned what one of the most commonly prescribed classes of drugs is in nursing school.

I am not counting nursing experience as part of my clinical education. I am empathic for nursing students because really we learn nothing from nursing school. Nursing school alone is two years. One of those two years are on ethics and health care system. Only one year is on something relate to clinical. We learn mostly from our job. That is why I do not blame on them if they do not know drug class. I do not discredit medical school (I am planning on going to medical school myself), but I do see some special cases of residents (who spent 4 years undergrad and 4 years medical school) who said a SR rhythm with no pulse NSR. Now that is unacceptable...

 

[calvnandhobbs68]

I am not counting nursing experience as part of my clinical education. I am empathic for nursing students because really we learn nothing from nursing school. Nursing school alone is two years. One of those two years are on ethics and health care system. Only one year is on something relate to clinical. We learn mostly from our job. That is why I do not blame on them if they do not know drug class. I do not discredit medical school (I am planning on going to medical school myself), but I do see some special cases of residents (who spent 4 years undergrad and 4 years medical school) who said a SR rhythm with no pulse NSR. Now that is unacceptable...

I'm not even sure what you're trying to say in that last sentence.

 

[frenchyn]

I'm not even sure what you're trying to say in that last sentence.

My bad hehehe...I meant I heard a residency said PEA as NSR during a code. I guess his resident asked him what rhythm is this. He said NSR.

 

[NYCGuy86]

I am not counting nursing experience as part of my clinical education. I am empathic for nursing students because really we learn nothing from nursing school. Nursing school alone is two years. One of those two years are on ethics and health care system. Only one year is on something relate to clinical. We learn mostly from our job. That is why I do not blame on them if they do not know drug class. I do not discredit medical school (I am planning on going to medical school myself), but I do see some special cases of residents (who spent 4 years undergrad and 4 years medical school) who said a SR rhythm with no pulse NSR. Now that is unacceptable...

Huh? One year of nursing school is on ethics and health care system? What type of nursing school is this? Generally, the first year of an RN program (lets say upper division BSN program, since the first two years are the prerequisite courses/liberal arts and sciences) includes the fundamentals of nursing clinical course, the first medical/surgical nursing clinical course, pathophys, pharm, plus the BS fluffy courses. The second year typically includes the clinical courses for medical/surgical nursing II, psych, OB, peds, community, and your preceptorship/elective clinical course. I don't believe I've seen a program where the first of two years is on ethics and the health care system.

Also, yes, you should blame them if they do not know drug classes. What else would they be learning in the pharmacology course(s) that you brought up? Heck, I just opened up an NCLEX-RN review book, and what do you know, in the chapter on GI medications, there is a subsection on proton pump inhibitors (overview, common meds-generic/brand names, administration considerations, contraindications, side/adverse effects, nursing considerations, patient teaching). Again, nursing pharm is basic, certainly nothing like med school pharm, but lets not pretend that nursing students shouldn't be obtaining a basic understanding of the pharmacology of the medications they will be administering and monitoring. If they aren't, then that's a problem of the program/individual.

 

[chipwhitley]

I am not counting nursing experience as part of my clinical education. I am empathic for nursing students because really we learn nothing from nursing school. Nursing school alone is two years. One of those two years are on ethics and health care system. Only one year is on something relate to clinical. We learn mostly from our job. That is why I do not blame on them if they do not know drug class.

Well maybe you don't, but a lot of people do count their nursing education as clinical education when it comes to arguing that they have enough education to practice independently.

 

[frenchyn]

Huh? One year of nursing school is on ethics and health care system? What type of nursing school is this? Generally, the first year of an RN program (lets say upper division BSN program, since the first two years are the prerequisite courses/liberal arts and sciences) includes the fundamentals of nursing clinical course, the first medical/surgical nursing clinical course, pathophys, pharm, plus the BS fluffy courses. The second year typically includes the clinical courses for medical/surgical nursing II, psych, OB, peds, community, and your preceptorship/elective clinical course. I don't believe I've seen a program where the first of two years is on ethics and the health care system.

Also, yes, you should blame them if they do not know drug classes. What else would they be learning in the pharmacology course(s) that you brought up? Heck, I just opened up an NCLEX-RN review book, and what do you know, in the chapter on GI medications, there is a subsection on proton pump inhibitors (overview, common meds-generic/brand names, administration considerations, contraindications, side/adverse effects, nursing considerations, patient teaching). Again, nursing pharm is basic, certainly nothing like med school pharm, but lets not pretend that nursing students shouldn't be obtaining a basic understanding of the pharmacology of the medications they will be administering and monitoring. If they aren't, then that's a problem of the program/individual.

For the nursing program, they integrate the health care ethics and system with the clinical portion, so the first of two years was not completely on ethics and the health care system. However, half of what I learned from nursing school was useless. There was one class we even called it color class because it was so stupid.

I only had one class for pharmacology and there is no way one can remember the drug class due to the amount of information. Yes it is a common drug that we use for PUD, but remember a student nurse can have very little clinical exposure to really know it. NCLEX exam is useless. I passed it but I have not met a single person who walked out of that test 100% confidence that he or she passed it. Scary as it sounds but I half ass guessed most of them and I passed with 75 questions. As W19 mentioned, she knew PPI is used for PUD, she just did not know the chemistry behind it. How the hell she knows with one year of general chemistry?

Sorry, I just hate doctors for yelling at nurses for not knowing something when they have way more years of education and experience. I think they should approach it as an opportunity for education.

 

[chipwhitley]

Sorry, I just hate doctors for yelling at nurses for not knowing something when they have way more years of education and experience. I think they should approach it as an opportunity for education.

I've never seen a doctor yell at a nurse for not knowing details like this, but the thread here was started by a nurse who believed that the extra education/experience a doctor has isn't really important, hence the discussion.

 

[W19]

@frenchyn The problem is she is going to go NP school, and she probably will never have a chance to take chemistry again because most NP schools require just a BSN... I wonder how she is going to understand biochem, pharmacokinetics/pharmacodynamics etc...