I have nothing against NP... I was (or I am) a nurse and some of my friends are NP. So naturally I should be more open to the idea of working alongside NP, but it's hard for me to close my eyes when the barrier to entry into NP is nonexistent.
The way I put it: If I hire a PA when I become a doc, I will assume he/she has a minimum competency until proven otherwise... For NP, I will assume that he/she is incompetent until he/she shows me s/he isn't...[
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This is probably the most accurate comparison of NP vs. PA education in regards to mid-level degrees and I'd second that it reflects my experience working alongside NPs and PAs.
I personally feel that if physicians are concerned of NP encroachment, then they need to stop training and hiring them. I understand that physicians are increasingly making fewer of the hiring decisions, however I think if more and more refused to work with NPs, in preference of PAs, then medical groups would listen. After all, most hospital administrators know nothing of the difference in our training, and frequently interview individuals that represent both professions for employment. Although PAs tend to make more than NPs, the difference is drastically marginal when you consider physician salaries. The AMA needs to know that PAs are on their side, and the few malcontents that push for independent practice are few and far between. The PA profession is ultimately governed by the AMA and our training exceeds that of NPs. We take an almost identical pre-med pathway as med students. Our formal education follows the medical model, with many of our classes being taught alongside medical students. Our board exams are patterned after the USMLE, and our review material for said exam is the same. We recertify just like physicians, and because of our generalist education we are able to move around specialties much more easily than an NP. Our profession would not exist without the MD/DO professions, and we in no way wish to usurp the role of the physician/surgeon. PAs come to you with a standardized training model (that the AMA helps dictate) and with an understanding that most days we will see the "easier" patients and you will see the "harder" patients. If you expect that we do see the "harder" patients as well, you better believe that we are going to be consulting you regularly, even after we have years of experience under our belts.
It goes even farther than this. There have been threads recently in the residency sub-forums in which physicians did not even know they'd have mid-levels working under them. Wasn't mentioned in the contract or anything. The most egregious example was where a new attending found out they'd have an NP working under them when the NP introduced herself on the first day of work. The question was could the attending refuse to oversee the NP since the NP had already been hired and actually started working the same day as the attending. Just really shady stuff.
I certainly haven't read through all the posts here. However, even with what I've skimmed over, I'd be completely fine with an NP for primary care. From what I understand, NPs can do 90% of what primary care physicians do. Pediatrics and family practices see a lot of the same chief complaints on a day to day basis; strep throat, stitches, etc. and anything truly complex is likely to be referred to a specialist. By all means, let the nurse practitioners take care of immunizations, flu shots, basic health care.
The problem is that when NPs practice independently, they often don't know how to identify when it's not a basic case. Worked with an NP on my peds rotation who would regularly come ask me if her diagnosis was right or if I thought she should order a test. She literally asked me (as a 3rd year medical student) 3 times in the same day if different kids had impetigo. On the other side, there were multiple times when she'd see a patient for something 'benign', then we'd see them with the physician a few days later and find she missed something that I would have caught as a med student. Had a similar issue with the NP who rotated with me during FM. Some of the things she was missing would have been more excusable, but she had been a nurse for 20+ years and an NP for 5 years and was about to start seeing patients on her own at the county health department (ie, where all the sick high-acuity patients who need better care but can't afford it go).
Okay, that's interesting. I guess what I'm wondering is if the certifying bodies will except those statuses? Not sure if they would, but to honest this is an area I haven't really looked into. I'm also wondering how many of these providers exist at this point in time. Can't imagine that any of them are practicing independently
Idk about people with no degree at all, but I've worked with a few NPs whose only degree was an associates degree. Ironically, the best NP I've worked with (and the only one I've worked with that I'd trust to see any patients independently) only had an associate's degree. However, she's definitely gone out of her way significantly to really educate herself on the field of psychology/psychiatry and knew more about a lot of the drugs than the drug reps we met who were selling them.
Take care.
