NPs vs. MD's.

[Wordead]

Yeah, but most hospitals don't want the liability that comes with having midlevels operate under their protocols. That's the thing people frequently forget. A doctor misses something, his ass is on the line. A PA follows hospital protocol and misses something, the hospital is taking the hit, guaranteed.

Plenty of hospitals already are taking on the liability is what I'm saying. All they care about is moving the meat.

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[Wordead]

No way. Em has such potential for things to go bad quickly that there is always a role for em physicians. The knowledge base that you need is so broad that mid levels don't come close to being sufficient. We had a guy who came in with abdominal pain and flank pain and the np thought he had pyelonephritis despite no fever, no n/v, clean ua. Then he started hemorrhaging out his rear, turned out he had an aortoenteric fistula.

Sure, in the same way that there's always a role for anesthesia attendings. Turf the level 3s+4s to the midlevels with the attendings "staffing" them. I'm not saying I see Em being eliminated as a profession, I'm saying I can see it being eroded away much like gas.

 

[Mad Jack]

Plenty of hospitals already are taking on the liability is what I'm saying. All they care about is moving the meat.

The ones that do generally aren't doing it because they want to, they're doing it because they can't attract a physician to the area. We used PAs and NPs in our ED, but in a model where triage occurred and only the lowest two of five tiers were sent to them. If a patient became any more complicated, they would get bumped back up to a physician.

 

[Wordead]

The ones that do generally aren't doing it because they want to, they're doing it because they can't attract a physician to the area. We used PAs and NPs in our ED, but in a model where triage occurred and only the lowest two of five tiers were sent to them. If a patient became any more complicated, they would get bumped back up to a physician.

My school did it (major city). And yeah, it's akin to giving the easy cases to the CRNA and AA. And giving the ****ty stressful cirrhotics to the attendings.

 

[W19]

My school did it (major city). And yeah, it's akin to giving the easy cases to the CRNA and AA. And giving the ****ty stressful cirrhotics to the attendings.

Yet they claim equal or better outcomes... What a joke!

 

[Mad Jack]

My school did it (major city). And yeah, it's akin to giving the easy cases to the CRNA and AA. And giving the ****ty stressful cirrhotics to the attendings.

Yeah, but overall, we had six PAs working (two of which were in urgent care only), and we had over 140,000 ED visits per year in the busiest ED in the state. My point was that PAs won't be completely taking over EDs any time soon, and that there's more than enough room for both PAs/NPs and physicians in the ED, because they serve different functions.

 

[Wordead]

Yeah, but overall, we had six PAs working (two of which were in urgent care only), and we had over 140,000 ED visits per year in the busiest ED in the state. My point was that PAs won't be completely taking over EDs any time soon, and that there's more than enough room for both PAs/NPs and physicians in the ED, because they serve different functions.

Right, we agree on the facts we just disagree on the interpretation of what that means for the future.

CRNAs arent going to be taking over every OR either, just the surgicenters with the nice healthy outpatient surgeries.

You think the ED, with one of the highest burnout rates, will be better when all you get to see are the lvl 1s+2s with ****show crashing patients?

 

[Mad Jack]

Right, we agree on the facts we just disagree on the interpretation of what that means for the future.

CRNAs arent going to be taking over every OR either, just the surgicenters with the nice healthy outpatient surgeries.

You think the ED, with one of the highest burnout rates, will be better when all you get to see are the lvl 1s+2s with ****show crashing patients?

Oh, the ED will absolutely suck. There's many a reason why I'm not down with EM. But they won't be without jobs.

 

[pulmoblast]

NPs should absolutely be independent from day 1. They should carry their own malpractice insurance and liability independently.

 

[NaOH]

NPs should absolutely be independent from day 1. They should carry their own malpractice insurance and liability independently.

This is also why I'm okay with you guys being captain of the boat. I like my $100/year professional liability insurance just fine, thanks.

 

[ACSurgeon]

- note sure why this thread hasn't died yet. I'll contribute to that problem.
- EM is not safe. Some PAs are doing a year residency where they learn to intubate, put central lines, chest tubes, etc.
- Neurology is not safe. Most neurologists aren't reading EEGs or contributing a unique skill to better patient care. They can probably diagnose the patient without imaging, but the patient always gets an expensive workup with a diagnosis and no real options for treatment. Now, stroke/CC/epilepsy trained neurologists offer something unique.

- It's very interesting when a midlevel/physician extender starts to believe they've reached the point of knowledge/experience to replace an MD. Good combination of arrogance and ignorance. In general surgery (and subspecialties) you'll meet people training for 7-10 years and feeling nervous about running an OR independently. This is because we know what we don't know. On the other hand, show a midlevel how to do a procedure once or twice, and they become convinced that they know how to do it equally as well.

for what it's worth: all fields where MDs are being replaced with midlevels are doing patients a disservice. Not that hospital admins or extenders care about this problem much.

I've said this before on SDN: physicians have the training and knowledge to be irreplaceable in every field if we use our training to the max. However, when we degrade our value to what nurses can do, our jobs become individual tasks that a nurse can do…we can either protest online and demand that we are given our appropriate place in the "food chain" or we can stop being lazy and do a good job. I'm not suggesting we all become workaholics with no life, just that we use our training to perform at the appropriate level while at work.

 

[jw3600]

- note sure why this thread hasn't died yet. I'll contribute to that problem.
- EM is not safe. Some PAs are doing a year residency where they learn to intubate, put central lines, chest tubes, etc.
- Neurology is not safe. Most neurologists aren't reading EEGs or contributing a unique skill to better patient care. They can probably diagnose the patient without imaging, but the patient always gets an expensive workup with a diagnosis and no real options for treatment. Now, stroke/CC/epilepsy trained neurologists offer something unique.

- It's very interesting when a midlevel/physician extender starts to believe they've reached the point of knowledge/experience to replace an MD. Good combination of arrogance and ignorance. In general surgery (and subspecialties) you'll meet people training for 7-10 years and feeling nervous about running an OR independently. This is because we know what we don't know. On the other hand, show a midlevel how to do a procedure once or twice, and they become convinced that they know how to do it equally as well.

for what it's worth: all fields where MDs are being replaced with midlevels are doing patients a disservice. Not that hospital admins or extenders care about this problem much.

I've said this before on SDN: physicians have the training and knowledge to be irreplaceable in every field if we use our training to the max. However, when we degrade our value to what nurses can do, our jobs become individual tasks that a nurse can do…we can either protest online and demand that we are given our appropriate place in the "food chain" or we can stop being lazy and do a good job. I'm not suggesting we all become workaholics with no life, just that we use our training to perform at the appropriate level while at work.

I agree with your view but from a business sense it is just not what is going to happen because of the older physicians with all the leverage. They will continue to work less, make the same, sell out newer and future physicians for $$$. It happens in every industry, medicine is no excpetion. Sad but unfortunate truth.

 

[xanybar]

Bad care is no care no matter how cheap the upfront cost appears to be.

 

[Doctor Bagel]

Lolololol

Psych is probably the last thing you'd want to phase physicians out of- the enormous number of drug interactions and treatment strategies are beyond most nurses. Most psych NPs do wellness checks on your average lightly medicated patient, but psychiatrists are there to deal with for more difficult cases- suicidal patients, those with schizophrenia, bipolar, etc. These people absolutely will die or have poor quality of life with inadequate medical management.

This is 100% not true in my neck of the woods. NPs treat all of these types of patients independently here. NP work load and psychiatrist work loads are virtually indistinguishable in most employed settings where I am. Community MH is becoming dominated by NPs, so the majority of patients with severe/persistent mental illness are seeing NPs and not psychiatrists. Not that I disagree that psychiatrists shouldn't be entirely replaced, but I worry that the system is attempting to do so. NPs get paid maybe 50 to 60% of what we get paid, so it seems like winning to administrators to replace us with them.

 

[W19]

@Doctor Bagel The question is: Why should they get paid less (or why should a psych doc get paid more) in your neck of the woods if they are doing the same job?

 

[Doctor Bagel]

@Doctor Bagel The question is: Why should they get paid less (or why should a psych doc get paid more) in you neck of the woods if they are doing the same job?

I'm sure they are asking that question, and that makes me worried. Our state legislature also passed a parity bill not allowing insurance companies to pay less for mid-levels than for physicians in psychiatry and in primary care. Apparently that's not 100% how it works -- for example in my community job, they supposedly collect more for me than they do for the NPs from medicaid. I guess we might argue that we are doing a better quality job, but I don't think we have data to show that. It's worth worrying about even in a time when psychiatry salaries are going up. One thing I've noticed with work styles, though, is that NPs are maybe a group that's less likely (at least for now) to be assertive in asking for more money. NPs also seem less interested in working longer hours (full time, doing call, etc), and physicians in general are maybe more likely to be OK with spending more time at work.

Hopefully are psychiatry leaders are working on coming up with articulate answers for this question, but I don't think they have so far.

BTW, I think NPs probably should be paid more. Of course I also don't think I should be paid less, but who does.

 

[Mad Jack]

This is 100% not true in my neck of the woods. NPs treat all of these types of patients independently here. NP work load and psychiatrist work loads are virtually indistinguishable in most employed settings where I am. Community MH is becoming dominated by NPs, so the majority of patients with severe/persistent mental illness are seeing NPs and not psychiatrists. Not that I disagree that psychiatrists shouldn't be entirely replaced, but I worry that the system is attempting to do so. NPs get paid maybe 50 to 60% of what we get paid, so it seems like winning to administrators to replace us with them.

I'm really starting to feel like I should've gone into medmal so I could start suing the crap out of all these NPs and healthcare systems when things go bad. Maybe that'll be my post-med career lol.

 

[PathoTurnUp1865]

I'm sure they are asking that question, and that makes me worried. Our state legislature also passed a parity bill not allowing insurance companies to pay less for mid-levels than for physicians in psychiatry and in primary care. Apparently that's not 100% how it works -- for example in my community job, they supposedly collect more for me than they do for the NPs from medicaid. I guess we might argue that we are doing a better quality job, but I don't think we have data to show that. It's worth worrying about even in a time when psychiatry salaries are going up. One thing I've noticed with work styles, though, is that NPs are maybe a group that's less likely (at least for now) to be assertive in asking for more money. NPs also seem less interested in working longer hours (full time, doing call, etc), and physicians in general are maybe more likely to be OK with spending more time at work.

Hopefully are psychiatry leaders are working on coming up with articulate answers for this question, but I don't think they have so far.

BTW, I think NPs probably should be paid more. Of course I also don't think I should be paid less, but who does.

Are you from a more liberal state?

Obviously I wouldn't pick a medical specialty based off of this criteria alone, but I do think it is something medical students should look in to/consider when selecting a specialty, do you think most, if not all, fields outside of primary are generally safe?

 

[Mad Jack]

Are you from a more liberal state?

Obviously I wouldn't pick a medical specialty based off of this criteria alone, but I do think it is something medical students should look in to/consider when selecting a specialty, do you think most, if not all, fields outside of primary are generally safe?

I wouldn't even say primary care is unsafe- there's plenty of room for more people there. Hell, there's 17,400 listings for family practice physician jobs on Indeed right now. 17,400. Right now. There's just over 11,000 for FNPs. That clearly shows that there's more demand for physicians, of which there is a substantially smaller supply, than nurse practitioners, which can be hired for far cheaper and have a glut of supply.

Oh, just a thing below to show how nurses feel about NPs lol, just to back up my point that nurse practitioner quality control has some serious issues and there will be problems down the line:

http://allnurses.com/nurse-practitioners-np/glut-of-nps-983029-page4.html

"I am still waiting for a prospective NP to tell me they didn't get accepted to any school. Literally I don't think it's possible to get rejected from all. The online format is convenient so far but I do feel a little sheepish asking MDs to be my preceptor (most assume it's the schools job) or describing how all of my tests online with a couple campus visits a year. Most don't really comment but their reaction is a little surprised. Since after all they endured 4 years of medical school plus 4-6 years of residency and fellowship in a controlled and constantly proctored setting.
I have to agree with you. I go to a regular "brick and mortar" campus and I'm shocked every day at some of the people who are in my program. I don't even know if "online" vs. "campus" really makes that much of a difference (depending on reputation of program... I mean Vandy's program is online and probably more vigorous than the University of Phoenix... not trying to offend, but its my opinion).

Just some base examples of people in my program:

The nurse that never worked a day in psych says "I'm going to be a PMHNP! It's pointless to learn about all this medical stuff! Why do I even need to know it? I just want to do talk therapy for depressed housewives so I don't get it!" And then proceeds to do poorly on pathophys and assessment and then complains that "they didn't just give me a pass!".

The other nurse who never worked in psych that says, "I decided to switch to PsychNP cause it's less stressful [than area they work where patient are intubated and sedated] and I want to actually be appreciated by my patients".

The Masters Entry nurses (who just finished their masters degree) who are now on their 4th masters degree and haven't actually worked as a nurse - or in any field they have a degree in period (I admire the academic pursuit but the grumpy cat part of me wonders why they don't just pursue academic field at this point)."

"I went to a well known state university with an excellent reputation and there were more than a few dolts in my class as well as teaching classes. The thing with being a NP is that I think all areas will become saturated at the rate they are cranking them out now however in psych we have a bit of an advantage because so many can't stand what we do and those who think they can without any real knowledge of what it is will tire very quickly. Especially the chick who thinks she will be appreciated by her patients, lol. "

"My biggest concern as I added above is that there will be a significant number of sub par providers due to inexperience and poor education. As someone who has been the first NP on the behavioral health unit at 3 hospitals I can say the microscope is turned up. The physicians I work with expect me to know what I'm doing and pull my weight. One recently said one of the things he likes about me is that I'm not like many of the bleeding heart NPs who wear frumpy dresses and knee highs with their sandals. I guess the good news is now that we are graduating so many with no experience who are barely 19 years old we won't automatically be considered a profession of dowdy old women."

 

[Katie4594]

The knowledge is very important...it's important to stay up to date on the latest advances/medication. In the past when I'd go to the doctor & have my ekg read sinus tach 120-140 NP said I had "anxiety"....finally a cardiologist sent me to an electrophysiologist who inserted loop recorder to see what was going on. Turns out my average heart rate was 120-160's.Got diagnosed with a fairly new diagnosis "ist", underwent partial sinus node ablation, previous tried new medication called ivabradine...I saw that NP at my doctors office since all of this & she's never heard of IST or ivabradine. All the extra knowledge makes a difference....

 

[cbrons]

I saw that NP at my doctors office since all of this & she's never heard of IST or ivabradine. All the extra knowledge makes a difference....

Why's that a surprise? I heard of an NP this week that asked my attending what a nephrologist does.

 

[W19]

Why's that a surprise? I heard of an NP this week that asked my attending what a nephrologist does.

You can not be serious!

 

[criticalelement]

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 the point this poster was making is that interpersonal skill is a "soft skill". This is NOT as important as the hard skills physicians need which are critical thinking, decision making, diagonosis etc..

Would you rather a nice doctor or a doctor who actually knows what he is doing?

 

[jw3600]

The knowledge is very important...it's important to stay up to date on the latest advances/medication. In the past when I'd go to the doctor & have my ekg read sinus tach 120-140 NP said I had "anxiety"....finally a cardiologist sent me to an electrophysiologist who inserted loop recorder to see what was going on. Turns out my average heart rate was 120-160's.Got diagnosed with a fairly new diagnosis "ist", underwent partial sinus node ablation, previous tried new medication called ivabradine...I saw that NP at my doctors office since all of this & she's never heard of IST or ivabradine. All the extra knowledge makes a difference....

IST= Idiopathic Sinus Tachycardia? **** lady, most physicians are not gonna know that anyway.

Edit: INAPPROPRIATE sinus tachycardia, my bad. Although it just seems to be a subset of SVT.

 

[cbrons]

You can not be serious!

? why is this surprising

NP = Nursing school + a few classes on ethics and the equivalent of an extremely watered down M2 pharmacology course, what do you expect them know? They memorize protocols. That is all they can reasonably be expected to understand.

I've been studying human physiology/pathophysiology for nearly a decade, between my pre-med requirements, grad school, and med school. It's only because of that background that I can understand things like this: http://pulmccm.org/main/2016/cardio...-lactate-art-venous-blood-gas-interpretation/
(basic things any physician should understand)

A NP is never going to be able to understand the confluence of all of these complex components because they do not have the requisite understanding of the individual components.

 

[akwho]

NP who wanted to specialize in ortho had never looked at XR before in her entire training. First day on the job showed her an elbow XR and she couldn't even tell you what part of the body it was from. Scary, scary lack of knowledge. Oh yeah and she had prescription power.

 

[The Knife & Gun Club]

I had an NP managing my IBD for about 6 months and it was laughable. She told me with a straight face I should be taking 150 GRAMS/day of my usual med (she forgot a decimal when plugging my weight into her iPhone calculator).

By far the worst though was when she told me to discontinue my medication because "my Chacras had become unbalanced".

Better outcomes my ass...

 

[Kazaki]

When will doctors in the US stand up against this bs?
The US doesn't have the best healthcare system in the world, no doubt. But US physicians are by far the best in every medical speciality. The shear number of doctors, and money going into medical research are matched by no other country, even the UK with its (not-so-brilliant) NHS. It still puzzles me when I think about how a nurse can be given the same responsibilities as a doctor. I've seen a nurse discharge a patient from the ER with a a diastolic BP of 126! When asked about it, she said "it's probably their anxiety" A lowly pre-med knows better!
I guess the real question that needs to be asked here is, what can doctors do to stop this? Cuz so far all I've seen on this matter is doctors complaining on forums, but not much is being done in terms of, you know, telling them to eff off once and for all.

 

[el_duderino]

Doctors can't do much about it. There's a need for primary care providers and midlevels are filling the need. MDs and DOs don't really want to do the jobs, and the residency spots aren't really there anyway.

 

[sazerac]

Doctors can't do much about it. There's a need for primary care providers and midlevels are filling the need. MDs and DOs don't really want to do the jobs, and the residency spots aren't really there anyway.

Mid levels aren't doing primary care. They are specializing in greater numbers than the MDs.

What specialty has the majority of mid level billed procedures? It's dermatology, lol.

http://archderm.jamanetwork.com/mobile/article.aspx?articleid=1895673

 

[el_duderino]

Mid levels aren't doing primary care. They are specializing in greater numbers than the MDs.

What specialty has the majority of mid level billed procedures? It's dermatology, lol.

http://archderm.jamanetwork.com/mobile/article.aspx?articleid=1895673

Midlevels are most certainly doing primary care. They're doing a lot of primary care. It's no surprise that they're also picking up some of the excessive demand in what is perhaps the most exclusive and understaffed specialty.

 

[Kazaki]

How is that not a big middle finger to every doctor in the world when people say "This nurse, who knows less about hypertension than someone who's read a wiki page about hypertension, will be managing you. Oh and she's probably going to kill you in the process"
I was under the impression that you don't need a referral from a primary physician in the US if you have health insurance, correct me if I'm wrong. So why would anyone go to a nurse when they could see a doctor? Is it just waiting times?

 

[el_duderino]

They make an appointment at the office and they see who they see. If they specify a provider, they might have to wait much longer.

 

[musicalfeet]

They make an appointment at the office and they see who they see. If they specify a provider, they might have to wait much longer.

If I said I was okay with seeing a NP at the clinic I used to go to for checkups, I could usually get in that same week. If I wanted a physician....I had to wait 2 months.

That being said, I'm in a shortage area so it just sucks all around to get your health stuff together really. But the bonus of being in school is that now I get the awesome student health service which goes a lot faster! Yay.

 

[Taddy Mason]

I was under the impression that you don't need a referral from a primary physician in the US if you have health insurance, correct me if I'm wrong. So why would anyone go to a nurse when they could see a doctor? Is it just waiting times?

In many areas the difference in wait times to see a primary care "provider" as a new pt. is days/weeks v. months when looking at mid levels v. physicians. Also, it can be difficult to find primary care physicians who are even taking new pts. The last time I saw a primary care physician there were less than 10 physicians willing to take new, non-ob/gyn pts. in a community >200,000.

 

[chipwhitley]

In many areas the difference in wait times to see a primary care "provider" as a new pt. is days/weeks v. months when looking at mid levels v. physicians. Also, it can be difficult to find primary care physicians who are even taking new pts. The last time I saw a primary care physician there were less than 10 physicians willing to take new, non-ob/gyn pts. in a community >200,000.

How is it that our country's response to this problem is to fill the need with grossly undereducated providers when there are hundreds of thousands of people willing to become doctors and even more fully trained doctors from overseas dying to work here? Are we that stupid?

 

[deafdealer]

They make an appointment at the office and they see who they see. If they specify that they want to see a doctor instead of a provider, they might have to wait much longer.

FTFW. You're part of the problem

 

[el_duderino]

FTFW. You're part of the problem

I am? How so?

 

[precisiongraphic]

Doctors can't do much about it. There's a need for primary care providers and midlevels are filling the need. MDs and DOs don't really want to do the jobs, and the residency spots aren't really there anyway.

My opinion - there are not enough medical schools graduating enough doctors because of lack of residency spots. I think if the lack of sufficient residency spots had been fixed 10-15 years ago there wouldn't be this problem. (Further complicating it is that some of the cost of educating doctors is borne by the public via government funding of hospitals, which many could argue is inadequate.)

The standard supply and demand paradigm is not working because there is such a barrier to entry for doctors but there is not such a barrier for NPs, PAs and CRNAs. Many posts above talk about the lack of medical services in many areas. In opposition to some poster's opinion, I think a lot of PAs and NPs are smart and hardworking and may have been able to get into medical school had there been more spots and that they are indeed intelligent enough to have been competent physicians, had they been given a chance.

 

[deleted564680]

I just tried to search for a link to this information but couldn't find it (perhaps someone with more time can...) But, basically NPs have been using the "we do primary care in underserved/rural areas" line for a long time but it just isn't true. They want to work in the cities and suburbs too. A couple of years ago, the Ohio legislature was considering granting NP/APNs full practice rights in exchange for them to agree to work a minimum of 4 years (if I rememeber correctly) in a rural/underserved area. The NURSES refused.

It's obvious that the whole thing is just a power grab by nurse administrative types (who actually don't even practice medicine or nursing) and really doesn't even reflect the desires of most nurse practitioners, many of whom are perfectly fine working under a physician (and know they don't know each to work alone).

Things will not change in this arena until the nursing boards of each state are given more oversight. The fact that those boards are separate from the medical board is one thing, but to let them just run amok and willy nilly create new degrees/classes/training/etc. just to make themselves feel more important is certainly the opposite of good patient care (which they claim to want).

 

[W19]

The standard supply and demand paradigm is not working because there is such a barrier to entry for doctors but there is not such a barrier for NPs, PAs and CRNAs. Many posts above talk about the lack of medical services in many areas. In opposition to some poster's opinion, I think a lot of PAs and NPs are smart and hardworking and may have been able to get into medical school had there been more spots and that they are indeed intelligent enough to have been competent physicians, had they been given a chance.

PA probably! not many NP would be able to handle med school... I was (am) a RN and many of my former classmates who are NP now don't have the 'intellectual' capacity to even pass an organic chem class let alone handle the rigor of med school... I used to help some of these people with drug calculation problems (i.e. ProCalc), and it was kind of a source of 'torment' to think that some of these people are my classmates... Myself and another classmate were always talking about that... He bailed out as soon as he became a RN and got his PharmD. I had to work for a few years because I needed to make some money.

I am not a smart student by any means. In fact, I struggled in MS1, but did fine in MS2. I am attending a low tier MD school; the average MCAT of entering class is <30 on the old scale and the intellect (or smartness ) of my classmates are vastly superior than the ones I had in nursing school... They are not even comparable to be honest... I got my nursing degree at a state university--not Capella University or University of Phenix or the other diploma mills out there.

 

[wxman393]

PA probably! not many NP would be able to handle med school... I was (am) a RN and many of my former classmates who are NP now don't have the 'intellectual' capacity to even pass an organic chem class let alone handle the rigor of med school... I used to help some of these people with drug calculation problems (i.e. ProCalc), and it was kind of a source of 'torment' to think that some of these people are my classmates... Myself and another classmate were always talking about that... He bailed out as soon as he became a RN and got his PharmD. I had to work for a few years because I needed to make some money.

I am not a smart student by any means. In fact, I struggled in MS1, but did fine in MS2. I am attending a low tier MD school; the average MCAT of entering class is <30 on the old scale and the intellect (or smartness ) of my classmates are vastly superior than the ones I had in nursing school... They are not even comparable to be honest... I got my nursing degree at a state university--not Capella University or University of Phenix or the other diploma mills out there.

What's your opinion of the NCLEX in terms of difficulty? If someone failed it twice, would you trust them as your RN?


Sent from my iPhone using SDN mobile

 

[Instatewaiter]

IST= Idiopathic Sinus Tachycardia? **** lady, most physicians are not gonna know that anyway.

Edit: INAPPROPRIATE sinus tachycardia, my bad. Although it just seems to be a subset of SVT.

Um... Yes all doctors (especially IM and FM) will know what inappropriate sinus tach is. As it sounds, it is just sinus tach without an appropriate etiology. This isn't some esoteric diagnosis

PA probably! not many NP would be able to handle med school... I was (am) a RN and many of my former classmates who are NP now don't have the 'intellectual' capacity to even pass an organic chem class let alone handle the rigor of med school...

I am not a smart student by any means. In fact, I struggled in MS1, but did fine in MS2. I am attending a low tier MD school; the average MCAT of entering class is <30 on the old scale and the intellect (or smartness ) of my classmates are vastly superior than the ones I had in nursing school... They are not even comparable to be honest... I got my nursing degree at a state university--not Capella University or University of Phenix or the other diploma mills out there.

This is a common sentiment by the nurses who come on here that medical school was much harder and that most of their classmates could not have handled it.

I can say from my experience, NPs come in 2 varieties- those who are very capable and very likely could have done well in medical school and those who just don't have the skills.

I haven't encountered too many actual NPs who feel like they should be equivalent or autonomous but they are clearly out there. These people tend to either be NP students or NP leadership who is feeding this BS to the students.

 

[jw3600]

Um... Yes all doctors (especially IM and FM) will know what inappropriate sinus tach is. As it sounds, it is just sinus tach without an appropriate etiology. This isn't some esoteric diagnosis

Yeah that's what my edit implied. Just never heard the initialism. Didn't realize people didn't just say SVT for a dx.

 

[W19]

What's your opinion of the NCLEX in terms of difficulty? If someone failed it twice, would you trust them as your RN?


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The one thing I remember about the NCLEX is that it was much more about 'priority' (i.e. 'what would you do first ?') than content...

I think I would be ok with someone who failed it twice... Let's face it: Physicians call the shots and RN just follow orders. But the one thing I probably won't trust RN with is drug calculations... because I used to help some my classmates that are NP now and they were terrible.

I would be more wary about NP than RN since these people sometimes call the shots...

 

[67552931811]

The one thing I remember about the NCLEX is that it was much more about 'priority' (i.e. 'what would you do first ?') than content...

I think I would be ok with someone who failed it twice... Let's face it: Physicians call the shots and RN just follow orders. But the one thing I probably won't trust RN with is drug calculations... because I used to help some my classmates that are NP now and they were terrible.

I would be more wary about NP than RN since these people sometimes call the shots...

In my limited experiences, the vast majority of RNs (all) want to actually be nurses and, as a nurse, they are focused on nursing the patient (crazy idea, I know) rather than playing noctor. Contrast that to the vast majority of NPs I've worked with (all?) who want to play noctor and not nurse patients, as their field and training are designed for. It's like trying to fit that damn square peg in a round hole. I have family members who are nurses and I respect the hell out of them but this NP sh** is something else, man.

 

[Instatewaiter]

Yeah that's what my edit implied. Just never heard the initialism. Didn't realize people didn't just say SVT for a dx.

SVT and inappropriate sinus tach are two separate things

 

[niko327]

-

- It's very interesting when a midlevel/physician extender starts to believe they've reached the point of knowledge/experience to replace an MD. Good combination of arrogance and ignorance. In general surgery (and subspecialties) you'll meet people training for 7-10 years and feeling nervous about running an OR independently. This is because we know what we don't know. On the other hand, show a midlevel how to do a procedure once or twice, and they become convinced that they know how to do it equally as well.

Really? When does this happen to every PA exactly? Because I never felt this way, nor did any of the wonderful people I worked with as a PA. I'll also tell you what I never, ever, ever heard: "Please Niko, do less. My 9 admissions in the ER be damned. I'm coming up there to fix that guy's lower GI bleed. You've done enough." So imagine my confusion when I read your post and you go blowing up my entire sense of self.

 

[KnuxNole]

What's bad is they actually teach this **** in nursing school. We would spend a month on "socio-cultural" projects concerning people's social backgrounds and how it affect care. But when they would teach us that ACE inhibitors may cause a cough in some patients and we asked why, no one had a clue and it wasn't important to know why. This type of teaching style continues from bachelors-masters-doctorate. Sadly, growing up in a rural area many people choose to go to "Ms. Jodi" BSN-APRN-FNP-DNP-associate of arts in general studies, etc. because she is "nicer" than the mean MD who is just out for money. It's becomin a big issue in society as people don't know any better. I know this is true, especially in rural areas. Scary.

I see this too. I remember several patients tell me that they hated some of the MDs but only liked one NP cause she was the only one who knew what she was doing. Comments like "I always ask which providers are working, and make sure I get her, so I will actually get listened to and can get my medication I need." and "Dr. NP is the only person I trust! She should see patients in the hospital, she acts like a real human compared to these doctors in the hospital!"

Inb4ragingoverprovider

 

[evilbooyaa]

I see this too. I remember several patients tell me that they hated some of the MDs but only liked one NP cause she was the only one who knew what she was doing. Comments like "I always ask which providers are working, and make sure I get her, so I will actually get listened to and can get my medication I need." and "Dr. NP is the only person I trust! She should see patients in the hospital, she acts like a real human compared to these doctors in the hospital!"

Inb4ragingoverprovider

AKA "The NP fills my scripts for antibiotics, xanax, and narcotics without asking a bunch of questions or trying to convince me that they aren't necessary! I love having somebody just agree with my thoughts based on what I've diagnosed myself with!"