NPs vs. MD's.

[jqueb29]

Why are we in medical school?

Heart of a hustla
Mind of a G
N.P.-hating M.D.'s can't overprescribe like me

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[username456789]

P.S. I am outa here!

Thank goodness.

You literally start a thread called "NPs vs MD's [sic]", then bitch and moan when it becomes you (the NP) versus us (the MDs).

Hilarious.

 

[VA Hopeful Dr]

I'm assuming you're referring to the accelerated BS/MD programs? They still require 2-3 years of college (the BS part). There aren't any US medical schools that allow directly entry without a college education of some sort.

True, but countries that allow direct entry have a 5-6 year program as well so you're not really losing any time.

 

[VA Hopeful Dr]

And you, and the rest of the student doctors/residents/attendings have generally been very rude and mean spirited to my honest comments. If I wanted to be inflammatory, I would have told you from the get-go that in five years, all 50 states (21 right now), will have independent practice, and NPs will be putting FP and IM docs out of business. My hospital owned PCP charges $175 for an office visit. NPs I work with in Kentucky, who have independent practice, charge $75. They can handle your HTN, DMII, sinusitis, otitis media, strep, etc.... very well.

I will take that bet right the hell now. I'm in South Carolina. Let's talk again in 2020. I'm in private practice, DPC specifically, and I do way too much that is beyond 99% of midlevels to worry about getting replaced. If I were hospital employed, then yeah I"d worry.

I guarantee you could go to a NP Forum, and you would be treated very kindly. Perhaps that is why patients, at least at my community mental center of over 1000 patients, well they voted 2 to 1 via an agency survey, that they would rather see any of the NPs over any of the MDs. Your bedside manners already suck, and that is a fact, Jack!

allnurses begs to differ.

 

[akwho]

Speaking of (in)adequate training. I saw an NP fresh out of her online degree program try to read an x-ray of a Monteggia fracture. She couldn't identify any of the three bones in the x-ray (humerus, radius or ulna) or the fracture line itself. I'm pretty sure my patients could pick out which bone is broken at a minimum.

 

[giantswing]

Fact: 95 percent of nurses are various combinations of mean, lazy, and rude. You want those people taking care of your mother?

 

[Mad Jack]

And you, and the rest of the student doctors/residents/attendings have generally been very rude and mean spirited to my honest comments. If I wanted to be inflammatory, I would have told you from the get-go that in five years, all 50 states (21 right now), will have independent practice, and NPs will be putting FP and IM docs out of business. My hospital owned PCP charges $175 for an office visit. NPs I work with in Kentucky, who have independent practice, charge $75. They can handle your HTN, DMII, sinusitis, otitis media, strep, etc.... very well.

I guarantee you could go to a NP Forum, and you would be treated very kindly. Perhaps that is why patients, at least at my community mental center of over 1000 patients, well they voted 2 to 1 via an agency survey, that they would rather see any of the NPs over any of the MDs. Your bedside manners already suck, and that is a fact, Jack!

We're just having a bit of fun Don't take SDN so seriously.

 

[giantswing]

Speaking of (in)adequate training. I saw an NP fresh out of her online degree program try to read an x-ray of a Monteggia fracture. She couldn't identify any of the three bones in the x-ray (humerus, radius or ulna) or the fracture line itself. I'm pretty sure my patients could pick out which bone is broken at a minimum.

I'd make her cry.

 

[Mad Jack]

Speaking of (in)adequate training. I saw an NP fresh out of her online degree program try to read an x-ray of a Monteggia fracture. She couldn't identify any of the three bones in the x-ray (humerus, radius or ulna) or the fracture line itself. I'm pretty sure my patients could pick out which bone is broken at a minimum.

How the actual **** could you not recognize a Monteggia? I mean, not being able to name it I could see, but not being able to recognize somethin' ain't right?

 

[Mad Jack]

Thank goodness.

You literally start a thread called "NPs vs MD's [sic]", then bitch and moan when it becomes you (the NP) versus us (the MDs).

Hilarious.

I mean, this was never my fight to begin with, what with being an apprentice bone wizard and all...

Seriously though, what the actual **** did they expect? I'm going on Allnurses and posting... Oh god... I tried... Never mind... Just seeing how outdated their software is made me throw up in my mouth, I can't...

 

[WedgeDawg]

I mean, this was never my fight to begin with, what with being an apprentice bone wizard and all...

Seriously though, what the actual **** did they expect? I'm going on Allnurses and posting... Oh god... I tried... Never mind... Just seeing how outdated their software is made me throw up in my mouth, I can't...

I remember a couple months ago I somehow navigated to an allnurses thread that was titled something to the effect of "is nursing school harder than medical school?" and initially had an aneurysm because a lot of people were saying it was a lot harder (lol) until several pages in (yeah I read through the whole thread..) where someone posted some questions about anatomy. They were very easy questions (one I remember was like "which muscle is not a part of the rotator cuff" and one of the answer choices was like brachialis or something that obviously wasn't) so I was like wow these are pretty easy compared to my anatomy questions, guess nurses don't have to know that much about these things ... then I realized these were questions that someone posted that were supposed to be questions a medical student would have to answer (i wish lol). After that post, people posting seemed to understand that there's a lot they didn't know because they couldn't answer these (imo as an M1 very simple) questions.

Granted, I think this was RN not NP (not 100% sure) and I don't know how much more anatomy an NP learns over an RN, but if it's not enough to answer basic questions like this, I question whether they have to knowledge to truly function effectively independently in situations where an at least semi-detailed knowledge of anatomy is required.

If you google "is nursing school harder than medical school" I think the thread is the first result, for anyone who is interested in reading (it's several years old).

 

[FindMeOnTheLinks]

I remember a couple months ago I somehow navigated to an allnurses thread that was titled something to the effect of "is nursing school harder than medical school?" and initially had an aneurysm because a lot of people were saying it was a lot harder (lol) until several pages in (yeah I read through the whole thread..) where someone posted some questions about anatomy. They were very easy questions (one I remember was like "which muscle is not a part of the rotator cuff" and one of the answer choices was like brachialis or something that obviously wasn't) so I was like wow these are pretty easy compared to my anatomy questions, guess nurses don't have to know that much about these things ... then I realized these were questions that someone posted that were supposed to be questions a medical student would have to answer (i wish lol). After that post, people posting seemed to understand that there's a lot they didn't know because they couldn't answer these (imo as an M1 very simple) questions.

Granted, I think this was RN not NP (not 100% sure) and I don't know how much more anatomy an NP learns over an RN, but if it's not enough to answer basic questions like this, I question whether they have to knowledge to truly function effectively independently in situations where an at least semi-detailed knowledge of anatomy is required.

If you google "is nursing school harder than medical school" I think the thread is the first result, for anyone who is interested in reading (it's several years old).

I looked it up just for fun. One of the first few posts is talking about how they knew someone who flunked out of nursing school because they were working 12-16 hours a week, and that you will sometimes have to spend at least 12-16 hours per week studying (as if that is a lot). I lol'd. Granted I know there are people in medical school who do well only studying 15-20 hours per week or less, but I think the vast majority of people study greater than 30 hours per week.

 

[WedgeDawg]

I looked it up just for fun. One of the first few posts is talking about how they knew someone who flunked out of nursing school because they were studying 12-16 hours a week, and that you will sometimes have to spend at least 12-16 hours per week studying (as if that is a lot). I lol'd. Granted I know there are people in medical school who do well only studying 15-20 hours per week or less, but I think the vast majority of people study greater than 30 hours per week.

Yeah that was something that caught my eye lol. The first week of medical school, I was definitely studying like 12/hours a day on average (including class), so the idea that 12 hours a week was a lot was laughable (though I'm definitely not studying anywhere near that much now - I've figured out how to be far more efficient than I was at the beginning).

 

[chipwhitley]

True, but countries that allow direct entry have a 5-6 year program as well so you're not really losing any time.

Are the extra years in those countries equally unnecessary, as you previously stated? Or are the medical students spending those years learning actual medicine?

 

[chipwhitley]

How the actual **** could you not recognize a Monteggia? I mean, not being able to name it I could see, but not being able to recognize somethin' ain't right?

I saw an NP frantically googling broken arm x-rays and comparing them one after another lol.

 

[FindMeOnTheLinks]

Yeah that was something that caught my eye lol. The first week of medical school, I was definitely studying like 12/hours a day on average (including class), so the idea that 12 hours a week was a lot was laughable (though I'm definitely not studying anywhere near that much now - I've figured out how to be far more efficient than I was at the beginning).

Yeah efficiency is key.

To be fair, most of the responses in that allnurses thread are pretty tame. Most of them realize that medical school is much harder. A lot of them say that they've never been to medical school so they don't know which is harder, and I think that is definitely a reasonable response. I remember my freshmen year of college, I thought all I had to do was get into med school and then it would be a breeze. I guess it's just an example of "you don't even know what you don't know" in action. They don't even realize just how much there is to learn.

 

[WedgeDawg]

Yeah efficiency is key.

To be fair, most of the responses in that allnurses thread are pretty tame. Most of them realize that medical school is much harder. A lot of them say that they've never been to medical school so they don't know which is harder, and I think that is definitely a reasonable response. I remember my freshmen year of college, I thought all I had to do was get into med school and then it would be a breeze. I guess it's just an example of "you don't even know what you don't know" in action. They don't even realize just how much there is to learn.

This is why socrates was such a wise man.

Yeah most of the responses were not out of left field, but the couple that were definitely left me thinking "are these people for real...?"

 

[petrosgp]

Are the extra years in those countries equally unnecessary, as you previously stated? Or are the medical students spending those years learning actual medicine?

In my country (Greece), medicine is a direct entry (you start just after highschool) program that lasts six years. Two and a half of these are proclinical (biochemistry, physiology, anatomy, histology, microbiology, pathophysiology, etc.), two and a half are clinical (internal medicine, OB/GYN, surgery, various other medical specialties), and the sixth is like an intern year where you spend most of your time in the hospital working with patients in internal medicine, surgery, OB/GYN and neurology for three months each, and take final exams at the end of each three month block. So as a whole I'd say we spent more time learning medicine.

 

[Perrotfish]

Its important to recognize how much the midlevel training pathways have changed over just the last decade

I actually do agree with the original premise of the NP and PA degrees. It takes 7 years to turn a completely inexperienced college graduate into a functioning doctor. It should NOT take 7 years to get an experienced nurse, Paramedic, or independent duty corpsman to the same place. If you have spent 10+ years seeing case after case after case on the wards or in the clinic you should be more than halfway to being a doctor already. Its perfectly reasonable to create a training pathway that is only 3 years long for students with that kind of experience, especially if they spend their first few years out of the program under a physicians direct supervision.

However the clinical experience requirement has continued to decrease since these programs were founded, and for the NP degree is actually now non-existent. There are combined RN/NP programs now. That's not a doctor, and its not really a nurse either. That's, at best, a 3rd year medical student who somehow stole a prescription pad. The midlevels I have worked with who came through combined programs were flat out terrifying. Screwing up very basic medicine and not having a clue that they were doing anything wrong.

I have met a few NPs and PAs who I trust as much as a physicians, and who were functioning with complete independence. I know that some physicians take offense to people saying that but its true. However they were always the ones who used the programs as the were originally intended to work, with 10+ years experience before making the switch. A midlevel degree should mean taking the long road to become a provider, not taking a shortcut.

 

[Psai]

Its important to recognize how much the midlevel training pathways have changed over just the last decade

I actually do agree with the original premise of the NP and PA degrees. It takes 7 years to turn a completely inexperienced college graduate into a functioning doctor. It should NOT take 7 years to get an experienced nurse, Paramedic, or independent duty corpsman to the same place. If you have spent 10+ years seeing case after case after case on the wards or in the clinic you should be more than halfway to being a doctor already. Its perfectly reasonable to create a training pathway that is only 3 years long for students with that kind of experience, especially if they spend their first few years out of the program under a physicians direct supervision.

However the clinical experience requirement has continued to decrease since these programs were founded, and for the NP degree is actually now non-existent. There are combined RN/NP programs now. That's not a doctor, and its not really a nurse either. That's, at best, a 3rd year medical student who somehow stole a prescription pad. The midlevels I have worked with who came through combined programs were flat out terrifying. Screwing up very basic medicine and not having a clue that they were doing anything wrong.

I have met a few NPs and PAs who I trust as much as a physicians, and who were functioning with complete independence. I know that some physicians take offense to people saying that but its true. However they were always the ones who used the programs as the were originally intended to work, with 10+ years experience before making the switch. A midlevel degree should mean taking the long road to become a provider, not taking a shortcut.

Let's be real, the amount of knowledge and quality between any 3rd year medical student and any np student is vast. I'm frequently shocked at how little nps know about very basic topics

 

[deleted407021]

Let's be real, the amount of knowledge and quality between any 3rd year medical student and any np student is vast. I'm frequently shocked at how little nps know about very basic topics

I mean, looking at their curriculum, even a senior pre-med student has a deeper basic science background than an NP.

 

[medic86]

I mean, looking at their curriculum, even a senior pre-med student has a deeper basic science background than an NP.

Well, that's 100% true.

 

[Mad Jack]

Its important to recognize how much the midlevel training pathways have changed over just the last decade

I actually do agree with the original premise of the NP and PA degrees. It takes 7 years to turn a completely inexperienced college graduate into a functioning doctor. It should NOT take 7 years to get an experienced nurse, Paramedic, or independent duty corpsman to the same place. If you have spent 10+ years seeing case after case after case on the wards or in the clinic you should be more than halfway to being a doctor already. Its perfectly reasonable to create a training pathway that is only 3 years long for students with that kind of experience, especially if they spend their first few years out of the program under a physicians direct supervision.

However the clinical experience requirement has continued to decrease since these programs were founded, and for the NP degree is actually now non-existent. There are combined RN/NP programs now. That's not a doctor, and its not really a nurse either. That's, at best, a 3rd year medical student who somehow stole a prescription pad. The midlevels I have worked with who came through combined programs were flat out terrifying. Screwing up very basic medicine and not having a clue that they were doing anything wrong.

I have met a few NPs and PAs who I trust as much as a physicians, and who were functioning with complete independence. I know that some physicians take offense to people saying that but its true. However they were always the ones who used the programs as the were originally intended to work, with 10+ years experience before making the switch. A midlevel degree should mean taking the long road to become a provider, not taking a shortcut.

The problem isn't that NPs and PAs exist or that they are, by their nature, incompetent. The problem is quality control. The nurse with 10 years of experience that completes a rigorous in-person NP program at one of the better schools has the same practice rights as the BS to RN graduate that got their RN in a year then hopped right into an online DNP program.

 

[deleted407021]

Well, that's 100% true.

Ochem, biochem, genetics, physics, etc. As opposed to intro chem and microbiology for a BSN and -- looking at NP curricula -- they don't take further basic science courses to get a DNP.

 

[Straw Hat]

As a current RN who wants to go MD/DO all I can say is y'all need to step up your game. Nurses out lobby and out image the hell out of you guys. I don't wanna hear the we're too busy busting our butts and grinding it out to help patients schtick either. I hope there's a job for me by the time I get into and out of school/residency because doctors are simply losing the PR game and that's all that matters.

 

[wjs010]

I don't know why anyone would ever take anything said on SDN seriously.

Haha. I would agree, but I can honestly say if it weren't for sdn, I wouldn't be in Med school

 

[Mad Jack]

Haha. I would agree, but I can honestly say if it weren't for sdn, I wouldn't be in Med school

Shhhhh, don't reveal our secret...

 

[WingedOx]

 

[el_duderino]

"We're not non-physicians"

What?

 

[FindMeOnTheLinks]

Those cant be real

 

[chipwhitley]

"We're not non-physicians"

What?

Basically they're saying that they are physicians, but used the double negative there because actually straight out saying "we are physicians" would be illegal as physician is a protected title.

 

[chipwhitley]

As a current RN who wants to go MD/DO all I can say is y'all need to step up your game. Nurses out lobby and out image the hell out of you guys. I don't wanna hear the we're too busy busting our butts and grinding it out to help patients schtick either. I hope there's a job for me by the time I get into and out of school/residency because doctors are simply losing the PR game and that's all that matters.

Actually if NPs want to have full autonomy, they should go for it - but they can't hide behind a physician when it comes to malpractice. If they screw up, their assess should be on the line and no one else's.

 

[W19]

Is that freaking real?

Some stupid premed or med students will come here and say 'they will never replace physicians'... Now all these people have to do is to create 1-2 years of residency in most specialties and everything will turn up on its head... Once they do that, physicians won't be able to use that residency weapon against them anymore... and most specialties will be in big trouble... Some surgical ones might be spared...

 

[WingedOx]

source: https://twitter.com/melissadecapua

submitted without comment. I only saw the above because David Gorski retweeted it this afternoon. The blog is blocked as "unknown content" at work so I haven't had a chance to read it.

 

[dwgrubbs1s]

Even though they have gained autonomy in several states, I think at the end of the day physicians shouldn't have too much to worry about.....I don't think. If the knowledge gap between MD/DO and NP is really that large, then this new wave of autonomy will eventually start showing the knowledge gaps and differences in quality of care. However it may not. Obviously a well trained MD/DO is a hell of a lot more compentent than an NP in a primary care setting. But the lack of knowledge from an NP will be more likely to slide in the primary care setting because many cases they see aren't too complex (Although several are and are beyond the scope of NP knowledge). This is not belittling primary care MD's in any way, just saying that they are probably getting "soft toss" cases that probably are fairly simple to treat. I commented earlier saying that an in depth science knowledge is needed to adequately treat primary care patients and giving NPs autonomy is dangerous since they lack this. The sad reality is these autonomous NP's have probably had fairly simple cases for the most part in the short time they have been independent (Ive read on here horror stories about them though) and their lack of knowledge isn't showing up on a large scale. If you started having them do "residencies" and go into speciality areas, this lack of knowledge would show up much faster and be more apparent for everyone. Nursing isn't going to change their cirriculum to actually teach science so they will continue to lack the knowledge. I may be wrong but I do not beleive physicians are in any danger of being replaced, especially in speciality areas. I could be wrong though as many of you probably have more knowledge about this subject than I.

 

[calvnandhobbs68]

whatever she got 7 whole retweets on the pic? wow really getting out to the masses there

 

[calvnandhobbs68]

lololol some more gems from her site
"Malpractice rates remain low; only 2% have been named as primary defendant in a malpractice case "
Wonder why that is?

"The majority (69.5%) of NPs see three or more patients per hour"
Wat? Isn't like half their argument about how they spend more time with patients?

"97.2% of NPs prescribe medications, averaging 19 prescriptions per day"
Since when did the number of prescriptions you write become a benchmark of anything? I could write amoxicillin for every patient that comes in with a cold all day and average 30 prescriptions a day.

 

[Mad Jack]

Is that freaking real?

Some stupid premed or med students will come here and say 'they will never replace physicians'... Now all these people have to do is to create 1-2 years of residency in most specialties and everything will turn up on its head... Once they do that, physicians won't be able to use that residency weapon against them anymore... and most specialties will be in big trouble... Some surgical ones might be spared...

They're already doing minor surgical procedures in the UK... How much longer before someone here tries the same thing?
http://news.bbc.co.uk/2/hi/health/3580453.stm
https://www.kch.nhs.uk/news/media/press-releases/view/8003

 

[Psai]

They're already doing minor surgical procedures in the UK... How much longer before someone here tries the same thing?
http://news.bbc.co.uk/2/hi/health/3580453.stm
https://www.kch.nhs.uk/news/media/press-releases/view/8003

This is shocking and demoralizing. Do they not have enough surgeons to perform surgery? They already treat their doctors so poorly that the doctors are on strike. The worst thing is that it is surgeons training these undereducated people to replace them instead of people who went through all of the education and training of medical school and surgical residency. There's no such thing as a minor procedure and why would you settle for less than the best?

 

[Mad Jack]

This is shocking and demoralizing. Do they not have enough surgeons to perform surgery? They already treat their doctors so poorly that the doctors are on strike. The worst thing is that it is surgeons training these undereducated people to replace them instead of people who went through all of the education and training of medical school and surgical residency. There's no such thing as a minor procedure and why would you settle for less than the best?

Because monies. They don't care about patients, they just want the cheapest care possible with a moderately acceptable mortality rate.

 

[W19]

They're already doing minor surgical procedures in the UK... How much longer before someone here tries the same thing?
http://news.bbc.co.uk/2/hi/health/3580453.stm
https://www.kch.nhs.uk/news/media/press-releases/view/8003

Wow! For the people who always say it will NEVER happen, that is a clear example. It can happen guys/gals... Don't think you are exempt because you will be a surgeon (especially general surgeons)...

 

[Mad Jack]

Wow! For the people who always say it will NEVER happen, that is a clear example. It can happen guys/gals... Don't think you are exempt because you will be a surgeon (especially general surgeons)...

But wait, there's more!

http://www.bbc.com/news/health-20629396
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1557893/
http://careers.bmj.com/careers/advice/view-article.html?id=1299

They're essentially PAs that are trained in two years total to operate independently.

 

[W19]

But wait, there's more!

http://www.bbc.com/news/health-20629396
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1557893/
http://careers.bmj.com/careers/advice/view-article.html?id=1299

They're essentially PAs that are trained in two years total to operate independently.

If they introduce that SCP in here or using PA/NP and train them to do cholecystectomy, I wonder what kind of impact that will have on general surgeons...

 

[Straw Hat]

One of my coworkers posted this on Facebook

http://www.nbcnews.com/health/midwives-nurses-are-good-docs-sometimes-better-who-finds-8C11506820

Like I said you need to learn to protect yourselves. While I don't think physicians will totally disappear, if you guys don't stand your ground you will lose a lot.

 

[W19]

One of my coworkers posted this on Facebook

http://www.nbcnews.com/health/midwives-nurses-are-good-docs-sometimes-better-who-finds-8C11506820

Like I said you need to learn to protect yourselves. While I don't think physicians will totally disappear, if you guys don't stand your ground you will lose a lot.

We can become better if they add more years to our training. I think adding one more year to med school and another year residency to every specialty will certainly do it. Lol...

 

[funk74]

If you feel real strongly against independent medical practice by nurses. look at this: www.safevacare.org
then tell your friends and family to submit on there also.
When we don't speak out, things get passed in congress without your voice being heard!

 

[Lord Humongus]

But wait, there's more!

http://www.bbc.com/news/health-20629396
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1557893/
http://careers.bmj.com/careers/advice/view-article.html?id=1299

They're essentially PAs that are trained in two years total to operate independently.

Mr Nicholas performs the operation which is carried out under local anaesthetic, and involves delicately cutting into the wrist to cut the ligament that is pressing on a nerve and producing the numbness and pain that goes with this common condition.

I can't believe people knowingly allow a glorified tech to mess with the ligaments and nerves that control their hand. When I saw the headline I thought it would have something to do with suturing or cleaning out wounds, but no. Mind boggling and depressing. I got my med school acceptance not so long ago but am becoming increasingly neurotic about pulling the trigger on devoting ~$300k and 7+ years of my life to a journey whose destination is becoming increasingly fuzzy.

I was never particularly keen on surgery but I imagined that if 5 years from now as an M4 I saw that my non-surgical specialties of interest were becoming obviously untenable due to midlevel assault, I'd at least have the option to bite the bullet and salvage my professional life by going into surgery. Now even that route seems to no longer be sacrosant. FML.

 

[dermforlife2016]

"It says the initiative is necessary to meet the demands of European limits on working hours, but has concerns that the practitioners are not subject to regulation in the way that either surgeons or nurses are."

Since when did surgeons start heeding to work hour regulations? Surgical residents rarely do that in the U.S. and I could hardly imagine an attending surgeon refusing to perform a life saving procedure due to some arbitrary work hour regulation by handing the procedure over to a "surgical assistant." I have a child who needs an emergency surgery, but I cannot perform it because I have already hit my quota this week sorry guys

 

[Psai]

"It says the initiative is necessary to meet the demands of European limits on working hours, but has concerns that the practitioners are not subject to regulation in the way that either surgeons or nurses are."

Since when did surgeons start heeding to work hour regulations? Surgical residents rarely do that in the U.S. and I could hardly imagine an attending surgeon refusing to perform a life saving procedure due to some arbitrary work hour regulation by handing the procedure over to a "surgical assistant." I have a child who needs an emergency surgery, but I cannot perform it because I have already hit my quota this week sorry guys

Wtf work hour restrictions do nurses have? Can't do more than their rigorous 3 x 12 hour shifts a week with multiple breaks in between?

 

[chipwhitley]

If we want to maintain our ground as physicians, we need to start talking. We need to start making our own infographics. We need to start shouting back at them and putting them in their place.