Your point is correct that there are many people doing primary care, but there is also the point that there are different levels of primary care.
I've thought about this thread more since I posted and I'll concede that the FNP should have known generally about lymphoma. But I still think that knowing about Hodgkin's versus non-Hodgkins isn't within the scope of an FNP.
This is where I have a problem. If you are seeing patients in a primary care setting you should at least be cognizant with disease processes that you are likely to see. You may not need to draw up a treatment regimen for NHL, but you should know what a disease with a 1:50 incidence looks like.
With midlevel providers there is a line that has to be drawn about how much they are trained to know and be able to treat. FNPs are not physicians. So where is the line? Everyone on this board is entitled to the opinion that FNPs should know more about oncology than is currently being taught. They are within their rights to write to the state legislative bodies that license FNPs and the national organization that accredits FNP programs and say that they think the current training isn't sufficient. But given that the programs are two years and are already very full, you have to ask what bumping another topic to include this education is going to accomplish.\
This is a non starter. If more information needs to be covered then the course needs to be longer. There are NP courses that cover this. Can they be done in 400 to 500 hours, no. Once again if you are working in a broad category you should have a working knowledge of the disease processes you are likely to see.
As a patient, I would feel like I would not want an FNP or a PA to order a fine needle aspiration of a lump or lymph node without my discussing it first with the physician they consulted with. If I had a suspected blood cancer, I would not want my generalist physician to start working it up, I would be on the phone to a hematologist/oncologist working to get myself into their office today if possible.
This does not describe the generalist model. If you are calling the oncologist to get someone in the office with every suspected blood disorder today, you are eventually going to have a hard time getting your calls returned. It is very helpful to get a workup started on the way to a specialist. If the labs are not available on the first specialist visit, you can have significant delays in treatment. Most primary care providers know enough about this to get basic labs or tests.
FNPs are midlevel providers. Basically, there is an algorithm that you are supposed to follow and it goes like this.
Patient presents with red flag symptoms (something highly unusual or potentially a safety concern) = consult an MD
Patient presents with no red flag symptoms but a common disorder does not match their presentation = consult an MD
Patient presents with no red flag symptoms, a presentation that matches a common disorder but then fails the approved treatment for that disorder = consult an MD.
Patient present with a presentation that matches a common disorder, but they have an unusual history that may broaden the differential = consult an MD.
Patients who have something going on that you are not comfortable with (i.e. a disorder you aren't familiar with) = consult an MD
You are making a big assumption here. You obviously work in a state that requires you to have a consulting or supervising physician. However, the hallmark of the NP profession is independent practice. There are a number of states that do not require any physician collaboration. In this case if you are in practice and you do not have a physician to turn to, what do you do? The other part of the equation is the danger of what you don't know. The real danger in medicine is not what you know, but not knowing what you don't know. If you don't have active collaboration with a physician how do you know this?
There are many people who post on SDN who do not like FNPs and feel that it is dangerous for them to be in practice. Of course I disagree with this position and feel that the health-care system benefits from FNPs being in practice and seeing mostly healthy patients. Does an OB/GYN need to do an annual pap smear on a healthy patient? Does an internist need to follow a patient with simple blood pressure problems and hyperlipidemia? Does a pediatrician need to do yearly developmental exams on a healthy kid?
The problem here is making sure that you see only healthy people or people with simple problems. Many patients that present with "common" complaints have anything but simple problems. Also, primary care providers have the hardest job in medicine. In a given encounter time you not only have to figure out the complaint that they came in with, but any problems that they aren't stating. Some one comes in with a common cold and is having a psychotic break. If you fail to pick up on this and the patient commits suicide you're still on the hook. What do you say, it wasn't in my scope of practice so I didn't have to notice it? A non starter for sure.
As for the OP's concern, could a clinic's patients benefit from having FNPs see people who call wanting a prompt visit who say they have a cold? I've worked in urgent care and many people come in with colds. Not many people come in with colds and lymphadenopathy who have had Hodgkins lymphoma.
I'll return to the statement that FNPs are not physicians. They do not have a residency where they are being exposed to the level of complexity of inpatients that physicians then have in their repertoire to apply to outpatients. They are doing outpatient primary care with healthy people. Or they are in specialty clinics performing a specific role in a team structure that they have been trained to do.
In a healthcare system that seems to be setting money on fire just for the hell of it, FNPs are a cost effective way to help more patients have access to primary care. I'll agree that primary care can be deceptively simple and that it isn't easy. But many patients in primary care do not have the kind of needs that necessitate seeing an MD. And there are requirements that FNPs work with physicians so they have the access in case the patient needs an MD opinion.
See above. You are making the assumption that every NP works with physicians and has access to a physician opinion. While I would agree that for dependent practice this is probably safe, I would maintain for independent practice it is not
