(Serious) Why do 4th year students need supervision but midlevels don't?

[MedicineZ0Z]

I can see now that debating you is a lost cause. But I want to respond for the sake of others. While I have other issues with NP education (and do not believe either is prepared to practice independently), no NP or PA programs are one year in length. The average PA program is 27 months long. And we refer to our schools without the use of quotation marks. For example, I go to the [my university] School of Medicine PA program, (not the “school” of medicine, you see), which is housed in the department of medical education alongside the MD program. I take pride in my school and training, after working for a decade as a paramedic in the field. It’s pretty terrible to hear a future MD colleague pointlessly bilittle the training of others, and it betrays a lack of maturity in your part.

I wouldn't be belittling one bit if I didn't keep hearing "we're just as good as MD/DOs" from midlevels and midlevel students.

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[RNtoMD87]

You're angry at many people. Midlevels, attendings, fellow med students. "pre med",

 

[NRP]

You're angry at many people. Midlevels, attendings, fellow med students. "pre med",

He's angry at their ideas and understandings. Their position comes second to their beliefs.

 

[Rendar5]

He's angry at their ideas and understandings. Their position comes second to their beliefs.

Yet time is still found to complain about their position. Sounds like anger lashing out.

 

[RNtoMD87]

And no one here disagrees with his opinion that midlevels, ESPECIALLY new midlevels should never practice independently.

 

[Instatewaiter]

For the 100th time, do you realize how ridiculous this statement is? You seriously must be trolling.
Like what sort of logic do you use to arrive at that conclusion? It's like saying someone who did 1 calculus course is better than someone who did 2 calculus courses. The 4th year student will be far more prepared to do the exact identical things the midlevel has been trained to do. That's the key part you keep missing.

Out of curiosity, why would you fight with someone who has actual real world experience with this? @DocEspana is an attending. He has gone through internship himself and has supervised many years of new interns. You haven't even been an intern yet. Perhaps, he has knowledge and experience that you dont?

To add upon what he says, I am an attending. I have supervised interns for 6 years during my training and also as an attending. I have also supervised new midlevels and experienced midlevels as well.

The thing you are not realizing is that the education pathways between physicians and midlevels are intentionally different. A midlevel is trained to practice the day after their school ends. A 4th year medical student is not. They are trained to be prepared for residency to then be prepared to practice. Hell, states realize this and won't allow you to practice without at least a year of internship.

You will realize, just as we all do, how little you know your first week of internship. You will not be ready to basically do anything on day 1 of your internship. It will probably feel as though you never went through medical schooling at all because you must learn in a vastly different way than you have been taught before. If you don't, you're probably what we would refer to as an assassin and are going to be killing patients with your hubris mixed with your incompetence.

 

[MedicineZ0Z]

Out of curiosity, why would you fight with someone who has actual real world experience with this? @DocEspana is an attending. He has gone through internship himself and has supervised many years of new interns. You haven't even been an intern yet. Perhaps, he has knowledge and experience that you dont?

To add upon what he says, I am an attending. I have supervised interns for 6 years during my training and also as an attending. I have also supervised new midlevels and experienced midlevels as well.

The thing you are not realizing is that the education pathways between physicians and midlevels are intentionally different. A midlevel is trained to practice the day after their school ends. A 4th year medical student is not. They are trained to be prepared for residency to then be prepared to practice. Hell, states realize this and won't allow you to practice without at least a year of internship.

You will realize, just as we all do, how little you know your first week of internship. You will not be ready to basically do anything on day 1 of your internship. It will probably feel as though you never went through medical schooling at all because you must learn in a vastly different way than you have been taught before. If you don't, you're probably what we would refer to as an assassin and are going to be killing patients with your hubris mixed with your incompetence.

Because what I'm saying is looking at things on a macro/national level. What you or any other attending is saying is based off of personal limited experience in a specific geographic area.

If you read the thread, I said of course 4th years should not have autonomy. It was making a case for how ridiculous autonomy for midlevels is. And no matter how many times you repeat the nonsense talking point of midlevels being "prepared" on day 1 from a couple months of shadowing... it doesn't change the fact that a majority of them are not that competent. I mean just the fact that I've seen them google stuff my grandma knows is enough proof (if you want to focus on personal experience ) .

 

[W19]

Because what I'm saying is looking at things on a macro/national level. What you or any other attending is saying is based off of personal limited experience in a specific geographic area.

If you read the thread, I said of course 4th years should not have autonomy. It was making a case for how ridiculous autonomy for midlevels is. And no matter how many times you repeat the nonsense talking point of midlevels being "prepared" on day 1 from a couple months of shadowing... it doesn't change the fact that a majority of them are not that competent. I mean just the fact that I've seen them google stuff my grandma knows is enough proof (if you want to focus on personal experience ) .

NP schools have a magic sauce that schools like Harvard/JHU should also use...

 

[MedicineZ0Z]

NP schools have a magic sauce that schools like Harvard/JHU should also use...

lol.

I love how a fresh midlevel can work up abdominal pain better than a 4th year student. Must be some sort of weird magic that lets you be more prepared by doing far less.

 

[Rendar5]

lol.

I love how a fresh midlevel can work up abdominal pain better than a 4th year student. Must be some sort of weird magic that lets you be more prepared by doing far less.

Better? No. More succinctly? Yes. With a more complete differential? No. With a more focused differential? yes.

Things start to change around pgy-2 for most ppl. Sometimes sooner. At that point the resident is usually better in all regards. Of course I’ve seen some awful mid levels and some fantastic med students and interns. I just speak on averages. Btw I wouldn’t trust a mid level to work independently either and doubt anyone is saying that.

 

[MedicineZ0Z]

Better? No. More succinctly? Yes. With a more complete differential? No. With a more focused differential? yes.

Things start to change around pgy-2 for most ppl. Sometimes sooner. At that point the resident is usually better in all regards. Of course I’ve seen some awful mid levels and some fantastic med students and interns. I just speak on averages. Btw I wouldn’t trust a mid level to work independently either and doubt anyone is saying that.

That's just simply not true. I can't understood how you come to such a conclusion when the 4th year has seen abdominal pain worked up 100x more than the midlevel has. A few online courses in ethics and shadowing an NP for 6 weeks prepare someone to work up X presentation better than someone who's done 1-2 years of rotations? Do you see how silly that sounds?

 

[W19]

Better? No. More succinctly? Yes. With a more complete differential? No. With a more focused differential? yes.

Things start to change around pgy-2 for most ppl. Sometimes sooner. At that point the resident is usually better in all regards. Of course I’ve seen some awful mid levels and some fantastic med students and interns. I just speak on averages. Btw I wouldn’t trust a mid level to work independently either and doubt anyone is saying that.

Having a broader differential is a bad thing in the world of medicine now... Where will this **** end? If you don't have a coherent argument, don't use silly things to try to prove a point... Succinct! Give me ONLY the f... impression-- stupid radiologists!

 

[DocEspana]

That's just simply not true. I can't understood how you come to such a conclusion when the 4th year has seen abdominal pain worked up 100x more than the midlevel has. A few online courses in ethics and shadowing an NP for 6 weeks prepare someone to work up X presentation better than someone who's done 1-2 years of rotations? Do you see how silly that sounds?

Having a broader differential is a bad thing in the world of medicine now... Where will this **** end? If you don't have a coherent argument, don't use silly things to try to prove a point... Succinct! Give me ONLY the f... impression-- stupid radiologists!

Just be aware that stomping your metaphoric feet and declaring you *must* be right based on your knowledge doesnt actually increase the top left box. It may increase the box within the top left box.

 

[MedicineZ0Z]

Having a broader differential is a bad thing in the world of medicine now... Where will this **** end? If you don't have a coherent argument, don't use silly things to try to prove a point... Succinct! Give me ONLY the f... impression-- stupid radiologists!

Isn't this the same person that sends PAs out to see patients but only lets med students shadow him? He/she does it the opposite of the rest of the country. Maybe if they gave some responsibility to the student they'd see how in 5 seconds they'd blow away a midlevel on just about any presentation.

Just be aware that stomping your metaphoric feet and declaring you *must* be right based on your knowledge doesnt actually increase the top left box. It may increase the box within the top left box.

 

[762513]

Just be aware that stomping your metaphoric feet and declaring you *must* be right based on your knowledge doesnt actually increase the top left box. It may increase the box within the top left box.

Love this. This is why I come to SDN.

 

[libertyyne]

Just be aware that stomping your metaphoric feet and declaring you *must* be right based on your knowledge doesnt actually increase the top left box. It may increase the box within the top left box.

What is funny is this is exactly what we have been complaining about in allowing NPs independent practice autonomy.

 

[jrlob91]

What is funny is this is exactly what we have been complaining about in allowing NPs independent practice autonomy.
View attachment 231672

Love this. This is why I come to sdn.

 

[762513]

What is funny is this is exactly what we have been complaining about in allowing NPs independent practice autonomy.
View attachment 231672

If I were a patient I would prefer my year in combat as a medic in a war zone plus my 10 on the ambulance and my 5 as an ICU RN over the chart of a medical student

 

[libertyyne]

If I were a patient I would prefer my year in combat as a medic in a war zone plus my 10 on the ambulance and my 5 as an ICU RN over the chart of a medical student

I am sure I would prefer the person with combat medic war zone emt with an MD degree over the NP. Lets not forget all the direct entry programs which approximately 30% of all NP schools are doing now where you can get a BS in archaeology and end up a DNP in all online and all self reported clinical hours.

 

[762513]

I am sure I would prefer the person with combat medic war zone emt with an MD degree over the NP. Lets not forget all the direct entry programs which approximately 30% of all NP schools are doing now where you can get a BS in archaeology and end up a DNP in all online and all self reported clinical hours.

Lets not forget most NP's have decades of experience and are far safer clinicians than medical students. It's not debatable.

 

[AsianPersuasion]

With the fact that I plan on doing FM, it's inevitable that I will be working with NP/PAs etc. But my biggest take from that is hopefully I can pick and chose a reliable midlevel who's willing to learn and practice safely in a collaborative level. We can't run the show without them, and frankly, I don't want to run the entire show myself.

My previous FM doctor has an NP who works with her and she's an absolute doll. I've been with that doctor for over 18 years and it's amazing to see the NP grow along side with my then freshly mint doctor.

The NP/PA, especially great ones, are worth their weight in gold. And I'm not sure who you guys are coming in contact with but majority of the NP/PA that I've ever worked with do not want total autonomy. A lot of them want their cushy hrs, nice vacation, low acuity and is more than willing to do a lot of stuff that the doctors just generally don't want to do.

 

[libertyyne]

Lets not forget most NP's have decades of experience and are far safer clinicians than medical students. It's not debatable.

Maybe a decade ago. Not today. Especially when there are a large number of programs that will take students with little to no nursing experience.

 

[FindMeOnTheLinks]

Lets not forget most NP's have decades of experience and are far safer clinicians than medical students. It's not debatable.

that's not at all the point of this thread. Of course NP's with decades of clinical practice are better than medical students, nobody is arguing that at all.

 

[762513]

Maybe a decade ago. Not today. Especially when there are a large number of programs that will take students with little to no nursing experience.

that's not at all the point of this thread. Of course NP's with decades of clinical practice are better than medical students, nobody is arguing that at all.

This guy literally is arguing that when he states "medical students" and "NP's". He draws those broad conclusions because he's a medical student and probably doesn't know any better.

 

[libertyyne]

This guy literally is arguing that when he states "medical students" and "NP's". He draws those broad conclusions because he's a medical student and probably doesn't know any better.

easy there tiger before assuming my background. There are plenty of nurses who go to medical school. There are also plenty of non nurses or nurses with no bedside experience that go to Direct NP school. Also the law doesnt differentiate between the NP who has 20 years of experience and the NP that has none and got the degree online with the clinical hours self reported.

 

[762513]

easy there tiger before assuming my background. There are plenty of nurses who go to medical school. There are also plenty of non nurses or nurses with no bedside experience that go to Direct NP school. Also the law doesnt differentiate between the NP who has 20 years of experience and the NP that has none and got the degree online with the clinical hours self reported.

Tell me your background so I can put you in context. I told you mine.

 

[NRP]

Why does this guy always act blind to all the online NP school degrees that have been posted on this and the two other threads? NPs should be mandated to have at least 5 years of experience instead of this fast track BS.

 

[libertyyne]

Tell me your background so I can put you in context. I told you mine.

Im a non trad who had a career before going to Medical school. I could have made excuses about my age and gone to direct NP school while working, but id rather not get an online degree in nursing theory and then claim equivalency to physicians. Because you know, I have to look at myself in the mirror every day.

 

[762513]

Im a non trad who had a career before going to Medical school. I could have made excuses about my age and gone to direct NP school while working, but id rather not get an online degree in nursing theory and then claim equivalency to physicians. Because you know, I have to look at myself in the mirror every day.

So were you in direct patient care before going to medical school? If so where, how long, what environment?

 

[jrlob91]

So were you in direct patient care before going to medical school? If so where, how long, what environment?

I don’t see why this matters to you. You’re wrong about this whole discussion. NP Education is extremely inferior to real physician training. Credentials before school don’t matter in the slightest. Know your role. I don’t care if you or any other midlevel has >1,000,000 clinical hours, you will still not be prepared to take care of patients the way that a physician can.

 

[libertyyne]

So were you in direct patient care before going to medical school? If so where, how long, what environment?

my career prior to this is of no consequence on the fact that 30% of NP schools now take students in the Direct to NP programs and that a Large portion of NP programs require little to no actual nursing experience. So if you are going to sit here and argue that a Majority of NPs have decades experience when the admission criteria for a majority of your schools do not require that I find that a hard to accept without any actual enrollment data from your accrediting bodies. You and I both know there are many diploma mills on the NP side of things and even NPs from years past are concerned about this trend. But do focus on my credentials prior to matriculation because that is clearly the key here.

 

[W19]

With the fact that I plan on doing FM, it's inevitable that I will be working with NP/PAs etc. But my biggest take from that is hopefully I can pick and chose a reliable midlevel who's willing to learn and practice safely in a collaborative level. We can't run the show without them, and frankly, I don't want to run the entire show myself.

My previous FM doctor has an NP who works with her and she's an absolute doll. I've been with that doctor for over 18 years and it's amazing to see the NP grow along side with my then freshly mint doctor.

The NP/PA, especially great ones, are worth their weight in gold. And I'm not sure who you guys are coming in contact with but majority of the NP/PA that I've ever worked with do not want total autonomy. A lot of them want their cushy hrs, nice vacation, low acuity and is more than willing to do a lot of stuff that the doctors just generally don't want to do.

You can hire PA only if you have your own practice.

 

[Rendar5]

Current NP mills are Why I prefer PA’s as my mid levels to NP. If they both have tons of experience than it doesn’t matter. But I do think it’s silly to rush through with virtual experience. I have a few nurses where I work that would make good midlevels in np school, but they already have many years of nursing experience and good clinical gestalt. They know what they don’t know, which is key to a good mid level or a good physician too for that matter.

 

[762513]

my career prior to this is of no consequence on the fact that 30% of NP schools now take students in the Direct to NP programs and that a Large portion of NP programs require little to no actual nursing experience. So if you are going to sit here and argue that a Majority of NPs have decades experience when the admission criteria for a majority of your schools do not require that I find that a hard to accept without any actual enrollment data from your accrediting bodies. You and I both know there are many diploma mills on the NP side of things and even NPs from years past are concerned about this trend. But do focus on my credentials prior to matriculation because that is clearly the key here.

I think you proved my point by your answer non-answer. When you start treating patients in a team environment, you may understand. Until then you'll continue the SDN salt competition.

 

[Rendar5]

That's just simply not true. I can't understood how you come to such a conclusion when the 4th year has seen abdominal pain worked up 100x more than the midlevel has. A few online courses in ethics and shadowing an NP for 6 weeks prepare someone to work up X presentation better than someone who's done 1-2 years of rotations? Do you see how silly that sounds?

4th years routinely take longer to tell me the work up they want and frequently get the work up wrong in terms of over ordering or not ordering basic things. This is to be expected. They’re not physicians and they don’t normally have enough clinical experience. I don’t work with junk midlevels. Nor nurse practitioners who do junk courses with junk school with no experience, so the ones I do work with know to order a few basic labs, not to overthink the case,

I realize you do not have much experience to work on, and have never supervised a typical mid-level, or a typical resident, or a typical medical student. So I realize you are completely blind to Reality that having more knowledge will slow you down and unfocus you until you have mastered the application of knowledge. A physician having completed residency will be light-years beyond a mid-level In terms of care they can provide. A physician who hasn’t completed their training and is at least 4 years away from it has not. It’s like comparing a senior in high school Who is planning on completing their engineering degree to an apartment buildings handyman. Or some other analogy. That said I don’t think anything will change your mind and you will likely be stuck until you get more life experience.

I don’t disagree with it being a bad idea for autonomous mid level practice. I agree with you on that. I just see you putting 4th year med students on too lofty a pedestal when they are years from nearing the end of their education

 

[libertyyne]

I think you proved my point by your answer non-answer. When you start treating patients in a team environment, you may understand. Until then you'll continue the SDN salt competition.

Once again, I would rather maintain the anonymity I do have as what I did is fairly identifiable. But your refusal to even acknowledge the diploma mills NPs have defeats your whole point of having "extensive" nursing background for a majority of NP graduates. So the point still stands. For what its worth all the NPs i encountered in inpatient did not think they were capable of replacing physicians or doing what physicians did without oversight, they had narrow scopes and stuck to them. But I would still take an MD graduate any day over a recent NP graduate.


Plus you are going to sit there and say a Direct entry program graduate is capable of hanging their own shingle in Primary care and an MD graduate who has had twice the amount of training has not?

 

[762513]

Once again, I would rather maintain the anonymity I do have as what I did is fairly identifiable. But your refusal to even acknowledge the diploma mills NPs have defeats your whole point of having "extensive" nursing background for a majority of NP graduates. So the point still stands. For what its worth all the NPs i encountered in inpatient did not think they were capable of replacing physicians or doing what physicians did without oversight, they had narrow scopes and stuck to them. But why would I would still take an MD graduate any day over a recent NP graduate.

You’re a Texas marksman, moving the target to fit the arrows. I never gave an opinion on a adequacy of the worst NP schools. I do know that July interns are unsafe to care for patients. I’ll take an NP over an intern. People with significant experience know it too, you are apparently not one of those people.

 

[libertyyne]

You’re a Texas marksman, moving the target to fit the arrows. I never gave an opinion on a adequacy of the worst NP schools. I do know that July interns are unsafe to care for patients. I’ll take an NP over an intern. People with significant experience know it too, you are apparently not one of those people.

perhaps you should reread what I wrote before accusing me of moving the goal post, but I will make this easy for you.

You and other posters defending NPs over MD state that the extensive decades long experience in nursing provides the diffreniation for NPs vs a new MD grad .
I simply stated that the "extensive" clinical experience requirements for NP programs is no longer true.
You then have a series of questions about my "clinical experience" but dont provide any data for the clinical experience of NP matriculants.

You seem to be missing the point, even if it was true in the past , your accrediting bodies have successfully diluted any credibility by allowing direct entry, lowering nursing experience requirements, and allowing diploma mills to thrive. So yes I would take a green MD over any green NP.

 

[NRP]

Would you take the worst intern or worst NP?

 

[VA Hopeful Dr]

You’re a Texas marksman, moving the target to fit the arrows. I never gave an opinion on a adequacy of the worst NP schools. I do know that July interns are unsafe to care for patients. I’ll take an NP over an intern. People with significant experience know it too, you are apparently not one of those people.

Depends on the NP.

Good background in a real school, yes. Direct from BSN in online school, nope.

 

[762513]

perhaps you should reread what I wrote before accusing me of moving the goal post, but I will make this easy for you.

You and other posters defending NPs over MD state that the extensive decades long experience in nursing provides the diffreniation for NPs vs a new MD grad .
I simply stated that the "extensive" clinical experience requirements for NP programs is no longer true.
You then have a series of questions about my "clinical experience" but dont provide any data for the clinical experience of NP matriculants.

You seem to be missing the point, even if it was true in the past , your accrediting bodies have successfully diluted any credibility by allowing direct entry, lowering nursing experience requirements, and allowing diploma mills to thrive. So yes I would take a green MD over any green NP.

This post is about how medical students are better than licensed and boarded NP’s and PA’s. Don’t pretend you were arguing any other point. You clearly won’t listen to me, which is fine, but you also won’t listen to the attendings posting here as well. You may want to rethink that decision, or you will hurt someone some day.

 

[libertyyne]

[QUOTE="IknowImnotadoctor, post: 19888717, member: 762513"]This post is about how medical students are better than licensed and boarded NP’s and PA’s. Don’t pretend you were arguing any other point. You clearly won’t listen to me, which is fine, but you also won’t listen to the attendings posting here as well. You may want to rethink that decision, or you will hurt someone some day.[/QUOTE]
Speaking of moving the goal posts. please show me where I have made this claim. Still avoiding answering the "extensive experience" question , who would have known.

Do you not see how it is weird that a direct entry NP is allowed to practice to the top of their license a day after graduation yet an MD holder isnt allowed to practice at that same level even with supervision.

Lol, burnetts law in the wild. Thanks.

There are also attendings agreeing with direct entry NPs being inferior to m4s.

 

[762513]

[QUOTE="IknowImnotadoctor, post: 19888717, member: 762513"]This post is about how medical students are better than licensed and boarded NP’s and PA’s. Don’t pretend you were arguing any other point. You clearly won’t listen to me, which is fine, but you also won’t listen to the attendings posting here as well. You may want to rethink that decision, or you will hurt someone some day.

Speaking of moving the goal posts. please show me where I have made this claim. Still avoiding answering the "extensive experience" question , who would have known.

Do you not see how it is weird that a direct entry NP is allowed to practice to the top of their license a day after graduation yet an MD holder isnt allowed to practice at that same level.[/QUOTE]

I’m not going to keep trying to fill a cup that’s already full. Good luck in your intern year, you’ll need it.

 

[Instatewaiter]

Just be aware that stomping your metaphoric feet and declaring you *must* be right based on your knowledge doesnt actually increase the top left box. It may increase the box within the top left box.

This is a wonderful chart.

 

[Instatewaiter]

Better? No. More succinctly? Yes. With a more complete differential? No. With a more focused differential? yes.

Things start to change around pgy-2 for most ppl. Sometimes sooner. At that point the resident is usually better in all regards. Of course I’ve seen some awful mid levels and some fantastic med students and interns. I just speak on averages. Btw I wouldn’t trust a mid level to work independently either and doubt anyone is saying that.

Hit the nail on the head. An early intern has all this knowledge and (despite what the med students think) essentially no experience to use it. Yes their differential is very broad but half of it is essentially worthless and impossible based upon the patient's presentation. By PGY2 people start to have enough experience from autonomy to actually use that knowledge. This is when you see the docs leapfrog the NPs and never look back.

I agree that NPs/PAs shouldn't be autonomous. This doesn't change the fact that interns suck until around January

 

[MedicineZ0Z]

4th years routinely take longer to tell me the work up they want and frequently get the work up wrong in terms of over ordering or not ordering basic things. This is to be expected. They’re not physicians and they don’t normally have enough clinical experience. I don’t work with junk midlevels. Nor nurse practitioners who do junk courses with junk school with no experience, so the ones I do work with know to order a few basic labs, not to overthink the case,

I realize you do not have much experience to work on, and have never supervised a typical mid-level, or a typical resident, or a typical medical student. So I realize you are completely blind to Reality that having more knowledge will slow you down and unfocus you until you have mastered the application of knowledge. A physician having completed residency will be light-years beyond a mid-level In terms of care they can provide. A physician who hasn’t completed their training and is at least 4 years away from it has not. It’s like comparing a senior in high school Who is planning on completing their engineering degree to an apartment buildings handyman. Or some other analogy. That said I don’t think anything will change your mind and you will likely be stuck until you get more life experience.

I don’t disagree with it being a bad idea for autonomous mid level practice. I agree with you on that. I just see you putting 4th year med students on too lofty a pedestal when they are years from nearing the end of their education

Problem is you've been working with poorly educated med students then. Even in my 2nd year we know the basic tests to order for common complaints. Another problem is that every attending I've talked to in real life (or 1 on 1 on SDN) says the exact opposite of what you're preaching.
It's the midlevels who routinely forget tests to order, or order useless ones. And the midlevel students who have no idea what's going on. The med students may not remember c-ANCA and ASCA every time but most of the time they absolutely do.

 

[MedicineZ0Z]

You’re a Texas marksman, moving the target to fit the arrows. I never gave an opinion on a adequacy of the worst NP schools. I do know that July interns are unsafe to care for patients. I’ll take an NP over an intern. People with significant experience know it too, you are apparently not one of those people.

I would rather drive my family member an hour away than have them seen by either of those two. But if I had to choose, I'd still go with the intern every time.

Hit the nail on the head. An early intern has all this knowledge and (despite what the med students think) essentially no experience to use it. Yes their differential is very broad but half of it is essentially worthless and impossible based upon the patient's presentation. By PGY2 people start to have enough experience from autonomy to actually use that knowledge. This is when you see the docs leapfrog the NPs and never look back.

I agree that NPs/PAs shouldn't be autonomous. This doesn't change the fact that interns suck until around January

You can't have double standards. The intern should be judged by the same standards the midlevel is for comparisons sake.

 

[762513]

I would rather drive my family member an hour away than have them seen by either of those two. But if I had to choose, I'd still go with the intern every time.

You can't have double standards. The intern should be judged by the same standards the midlevel is for comparisons sake.

If you think a July intern is safer than a NP, I’m sorry to say you have no idea what you’re talking about.

 

[DocEspana]

Problem is you've been working with poorly educated med students then. Even in my 2nd year we know the basic tests to order for common complaints. Another problem is that every attending I've talked to in real life (or 1 on 1 on SDN) says the exact opposite of what you're preaching.
It's the midlevels who routinely forget tests to order, or order useless ones. And the midlevel students who have no idea what's going on. The med students may not remember c-ANCA and ASCA every time but most of the time they absolutely do.

To be fair, by my count, its 6 attendings here to 0. Not exactly 1 to 1.

 

[Perrotfish]

Hit the nail on the head. An early intern has all this knowledge and (despite what the med students think) essentially no experience to use it. Yes their differential is very broad but half of it is essentially worthless and impossible based upon the patient's presentation. By PGY2 people start to have enough experience from autonomy to actually use that knowledge. This is when you see the docs leapfrog the NPs and never look back.

I agree that NPs/PAs shouldn't be autonomous. This doesn't change the fact that interns suck until around January

Again, I think this brings us back to the first question in the thread: why can't medical students write orders? Not why can new midlevels write orders, but rather why can't students write them? It would make their education so much higher yield, would make interns much less dangerous, and would make residents' lives better at no cost to anyone.