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There will be lots of magical thinking until about half way through MS3.
The Advanced Nurse Practitioner Provider Specialists Experiment
- Thread starter LiamNeesons
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Yes, very much so. Miss the days that I could go back to magical thinking during MS-1/MS-2. We all were much happier back then.
I have been reading a lot of these threads about NP and MD and honestly I'm baffled. Before going back to school so I could work more on the patient care side, I worked in hospital admin for several year and have my MPH. I chose my NP school based on a collaborative curriculum with other health professions. I had MDs teach large sections of our classes and I worked with many of them during clinicals. I loved going to an NP school that was attached to a medical school because it reminded me each and every day that NPs are not MDs. I hate reading all of these threads that blast NPs for asserting that they are equal to doctors or have better patient outcomes. I think NPs serve a specific purpose, and when they are used effectively they can be an integral part of the healthcare team. I love what I do, and I think for the most part I do it well, but I don't think mid-levels should ever be able to practice on their own. ( I guess now I'm going to get flamed from NPs and PAs for saying midlevels... which is ridiculous..) No amount of bedside experience as a nurse can amount to what med students have to go through during school and residency. I believe that I am a competent clinician, but I think being able to collaborate with my attending and ask questions/check on diagnosis helps provide the best care possible for my patients. I think if NPs would let their egos go for a bit, they would see that in order for us to do our jobs as midlevels, we need to know when to let go and admit we don't have enough knowledge and experience to deal with certain cases. It seems fairly simple to me. The healthcare system cannot survive on NP and PAs-- so why alienate MDs?
There are a few younger NPs (late 20s like myself) that I work with that feel the same way I do. Unfortunately, most of the new MDs and residents have the same bad taste in their mouths for midlevels that I see on these forums. I love my job, but I feel backed into a corner. The older NPs flame the younger NPs for not treating them like they are the same as the doctors. Yet, the younger doctors think NPs are *****s.
There is certainly middle ground. For those of you that have worked with NPs, what areas did they work in and did they help relieve some of the patient burden?
Brief sidenote: for the PA and NPs that may read this, try to actually READ my post before telling me that I make you mad, or that im a disgrace to the profession, or that im letting the doctors win... I've heard it all before and am not impressed.
There are a few younger NPs (late 20s like myself) that I work with that feel the same way I do. Unfortunately, most of the new MDs and residents have the same bad taste in their mouths for midlevels that I see on these forums. I love my job, but I feel backed into a corner. The older NPs flame the younger NPs for not treating them like they are the same as the doctors. Yet, the younger doctors think NPs are *****s.
There is certainly middle ground. For those of you that have worked with NPs, what areas did they work in and did they help relieve some of the patient burden?
Brief sidenote: for the PA and NPs that may read this, try to actually READ my post before telling me that I make you mad, or that im a disgrace to the profession, or that im letting the doctors win... I've heard it all before and am not impressed.
You seem to be one of the very few NPs I've met that doesn't have an ego and think they can do everything. This is a good thing and you will be very successful in your career and do very well for your patients as a result.
I had an NP as a preceptor once and the lady was telling me things that even as a beginning 3rd year medical student, I knew were completely wrong. These included basic points of physiology and pharmacology that she just didn't understand. Initially I tried to be respectful and not say anything but eventually I decided to show her some evidence that she was wrong, and she just ignored me completely. She was also teaching the NP student wrong things. This lady was a perfect example of the Dunning-Kruger effect.
The fact is, no doctor with this poor of a knowledge base would make it through medical school and residency. If she was in medical school, she wouldn't have even passed first year. But here she is practicing independently in our state. That scares me. There is a problem with the training and licensing system when a person who is struggling with the basics of medical science is working unsupervised with no one to turn for guidance. There is a bigger problem when the person is unwilling to accept that she is wrong in spite of evidence, though that is likely her personality trait and not an issue with NPs as a whole.
I have no problem with NPs at all, I think they can definitely take a lot of the load off of the system, but the idea of them practicing on their own with no guidance from a physician is reckless. Also, this lady would introduce herself as 'dr. so and so' to the patients, which certainly confused many of them into believing that they were receiving care from a physician. Most of the patients were poor, uneducated folks who are only familiar with the term doctor being used in the healthcare setting to mean an MD. Once a patient asked, "are you a doctor" and she responded indignantly, "yes I have a doctorate" and gave the patient a look as if he had just used a racial slur or something. I think this was quite deceitful on her part. It was a legitimate question and she should have explained what her training was.
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That's what happens when you have no quality control like residency. And yet even some big wig thought leaders, hold NPs and PAs as the solution.
I completely agree with you. I have worked a few NPs that introduce themselves as "doctor" and it has always driven me crazy. I actually thought NPs were not allowed to do so in a medical setting. Not only is it deceitful, but when the demographics of your patient population are uneducated folks that dont visit the clinic very often, it can be really dangerous. Even if that patient has something simple and easy to treat, its important for patients to know who is providing their care so that they can also make an informed decision later down the line if another issue comes up and they want a second opinion. I think its the burden of the NPs and PAs to make sure patients understand that they are midlevels. I make it very clear to my patients that I am an NP- and most of the time patients dont have any problem seeing me for basic visits. If later down the line my patient asks to see a doc because they are having a more complex issue, I think midlevels need to be ok with that and not throw a fit about how they could probably take care of the issue themselves...
I think the NP curriculum needs to change. More science, less theory. I like a lot of things about the nursing model, but more pharmacology etc would be helpful. New MDs should be thankful for the new direct entry programs in my opinion. These programs are often associated with good schools and have a lot of science pre-reqs for a good foundation. Also, in my experience, these direct entry NPs have way less of an attitude about thinking they know it all. Probably because they havent been bedside nurses for 15 years...
I think the NP curriculum needs to change. More science, less theory. I like a lot of things about the nursing model, but more pharmacology etc would be helpful. New MDs should be thankful for the new direct entry programs in my opinion. These programs are often associated with good schools and have a lot of science pre-reqs for a good foundation. Also, in my experience, these direct entry NPs have way less of an attitude about thinking they know it all. Probably because they havent been bedside nurses for 15 years...
You are clearly a very well-informed, logically thinking NP. If only all the other NPs could have the insight you do.
This is because the big wig thought leaders only engage in thought and don't actually witness the reality of what is going on as a result of the lack of quality control in NP education.
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That's bc for the NP bigwig establishment (i.e. Mary Mundinger - former dean of Columbia's Nursing Schoool), this has more to do with a power grab and having tons of tuition fork over student loan money than what's actually good for patient care. Hence the hubris of having "earned" being called Doctor, just bc your profession decided to degree creep from a masters to a doctorate, patients be damned. Puts a big dent in your motives, when you offer online DNP programs.
That's bc for the NP bigwig establishment (i.e. Mary Mundinger - former dean of Columbia's Nursing Schoool), this has more to do with a power grab and having tons of tuition fork over student loan money than what's actually good for patient care. Hence the hubris of having "earned" being called Doctor, just bc your profession decided to degree creep from a masters to a doctorate, patients be damned. Puts a big dent in your motives, when you offer online DNP programs.
Yeah it's mostly about money for the nursing schools. I have heard from multiple NPs that getting the DNP was not really neccessary or helpful for them at all. Just something the nursing schools came up with for more $$. Now they're working on requiring all the new NPs to have DNP (if not the case already) so they can basically just mint money.
The big wigs don't give a damn about patients and never did.
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Of course not. A masters NP degree (the ones that have this will likely be grandfathered in) was perfectly fine. It's well known when you "professionalize" a degree you make it more expensive - which brings in more tuition money. The same with the lies of saying that NPs can do primary care, when you see all these NPs going into specialist care.
http://allnurses.com/doctor-nursing-practice/doctoral-degree-become-160044-page5.html
Yeah it's all about money. But it only works in the short term. Eventually the market is gonna be super saturated with NPs and the value of the degree is going to plummet like crazy. The question is whether they are gonna drag us down with them, which is happening in places like Oregon.
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Some of the nurses on that link were against that whole DNP stuff, but it was in 2006... Their attitude might have changed by now...
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I doubt they'll see them for their own care.
Maybe not now, but I feel like 10-20 years from now if things go as they are, DNPs will be so widespread people won't even think twice, including other nurses. It'll just be normal. They won't even remember what going to an actual doctor was like.
If you grew up with everyone in your family going to a DNP, and your parents taking you to a DNP, that would be your concept of a 'doctor'. The MD would be strange to you, not the DNP. Your childhood pediatric DNP certainly isn't going to tell you MDs are the real doctors.
The whole DNP thing is a crock. If they changed the curriculum to add more clinical hours, add specialty training or something it could be a decent way to weed out NPs. The way it is currently though, a bunch of for-profit degree mills are pumping out DNPs left and right. I would seriously love to read their dissertations... I think I will be grandfathered into the new DNP craze, but if not, I'm definitely not going to waste my time getting a DNP- I'd rather get a PhD in genetics or public health or something useful.. Even if I did choose a good school where the curriculum strong, there will be 50 other online schools that will call our degree "the same". Clearly MDs are having this same issue with NPs.
I unfortunately don't think the market saturation will happen (although sometimes I wish it would-- I know some pretty terrible NPs that I wonder some days how they made it through undergrad...). The average age of an NP is something like 57. In the next few years demand will rise from obamacare and we will have the older generation begin to retire. Also, even though you have these diploma mills pumping out NPs at an astounding pace, not all of them pass their board exams and get hired on somewhere. I also think NP residencies will become pretty common. Problem is, most of the residencies aren't in primary care where we need them. Its pretty hard out there right now to get a job as a green NP. Places like JHU, Emory, and Lahey are opening residencies for NPs to specialize. If places begin doing that with primary care, I think you'll see a much better crop of NPs in local clinics.
The prevalence of NPs will hurt doctors in the long run if big wigs continue to believe that the two are equal. If thats the mindset, sure, hire an NP at half the price and watch those patient satisfaction scores come down when we start seeing twice as many patients as we do now...
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Yeah, as a rule, I try to give nurses the benefit of the doubt-many of them deserve it. However, to give an example, there are the nurses who think they walk on water. When I shadowed in undergrad, I met this nurse who always called herself doctor and acted like she knew everything there is to know about medicine. She'd refer to herself as Dr. So and so to me and to the patients. They crazy part was even when a doctor was in the room with her, she still had the balls to call herself Dr. The Doctor I was shadowing exchange a few looks with me of anger and disbelief. Finally, he said to the patient, "and I'm the real doctor. Dr. So and so." I thought that was funny.
Thats really too bad. I know a lot of NPs that I work with (mostly younger) that would never ever do that. I think its a generational thing. The NPs that spent a decade at the bedside think they are owed more respect and will pretend to know everything now that they are "in charge". Either way, hope some of you on this forum recognize that not all of us are like that. I certainly love the doctors I work with and I think they enjoy working with me and respect my skill set as long as I respect my scope of practice. This is often confused with being a pushover- but honestly outside the hospital I am pretty abrasive, I just know my role I guess and like learning from the people around me.
Good for you, you have the right attitude.
You're right about the NPs who have been bedside nurses for 10+ years. Many of them think they are the queens of the place. There were a couple I ran into on the wards that were actually pretty rude and arrogant to the RNs, moreso than any of the docs. You'd think a person who was an RN for a couple decades would treat other RNs with respect, but it's not always the case.
I think if NPs had to re-certify, just like many other health profession, this would solve a lot of problems. Weed out the ones that got to take NP exams because they were bedside nurses for years. Bedside RN and NP are completely different. I spent almost no time in bedside nursing because I never used my brain. Simple math for dosages and reporting to the docs when problems came up. I love being an NP because I can work through cases and every day brings new challenges to HELP solve. Unfortunately, because the skill set is so different between NP and bedside RN, the same people who wanted to be RNs, arent usually the same people that make good NPs. You need to be able to think critically and have a willingness to learn more.
Ugh... this is kind of depressing. So many new NPs have great skills to offer MDs and patients but are being grouped in with the hard-headed idiot NPs that think they can do it all on their own and become a doctor with an online degree.
If/when PAs have the opportunity to get a doctorate degree in Physician Assistant studies, do you think MDs will experience the same problem with them?
Do NPs that are practicing independently have to recertify?
It depends on which governing body they are certified with, but every five years they just have show that they've worked x number of hours in their specialty and do some CME. No re-cert exam like PA. Now I'm not sure if thats different if you're practicing independently, but I doubt it. Thats part of the NP hype... "be an NP and you only have to take your boards once. Not every 6 years like PA"
Another excuse for laziness...
Another excuse for laziness...
Wow.. I didn't know this. I don't think anyone knows this. How's this even allowed?
The nursing lobby is mighty strong...
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DNPs are even against taking a certifying exam. They took a modified version of USMLE Step 3 and 50% failed.
Ha. No kidding.
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A good portion of NPs are employed by physicians, and I think physicians should stop hiring them--they should hire PAs. @DermViser @tdram and others, hire PAs when you open up your practice.
Shouldn't it be more about the person and less about whether they are a PA or NP? I know plenty of bad PAs too. This is kind of my point and why I finally created an account to post on here. I would happily take a re-cert exam or spend more time on CME. Grouping all NPs together as worse than PAs is a shame. There are plenty of us that know our scope of practice and are competent.
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You are right that it should be more about the person, but in my 7+ years working as a RN, I met more NPs that have doctor's envy than PAs...
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@DermViser was being nice when s/he said a 'modified' step 3... It's more like a 'watered down' step 3...
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More like completely diluted. I was actually surprised the failure rate wasn't higher.
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I think that's why a lot of physicians are starting to hire PA's instead.
Overall, I probably have too. Again, like I said earlier, I think its a generational thing. Many young NPs can put the doctor's envy aside and have no trouble fitting in and being a part of the team.
Also- the PAs that practice for 10-15 years and then realize they can't really go into management or hospital admin because the nursing lobby is so strong end up having another type of envy for nurses too.
Whats the passage rate for PAs taking the "watered down" step 3?
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@BestDoctorEver, so you were an RN before but now you're in med school? If so, good for you.
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Apparently 50%. I would have expected a much lower passage rate though.
Edit: Never mind. My bad, I thought you said DNP's.
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I am not sure that PAs took it since they are not claiming that they are equal to PCP...
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Depends on the year: http://www.cumc.columbia.edu/nursing/dnpcert/rates.shtml
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Oh, PA's. Sorry I thought you said DNP's. My bad, lol.
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Made some money as a RN for almost 8 years... Now I am a MS-I trying to become a psychiatrist or neurologist...
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They have their own exam - the PANCE. But they have no desire for independent practice.
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Good luck. I think that's great.
NPs have their own board exam too. Also, a lot of PAs are lobbying for independent practice, a name change to associate instead of assistant, and 1/2 the CME they have now.
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The only reason they haven't gotten farther is bc they fall under the Board of Medicine.
Overall, I just think its more about the person. I dislike the "new docs should only hire PAs and not NPs". I dont think thats very helpful and it only adds fuel to the fire. There are plenty of NPs that wouldnt practice on their own, even if they were given the chance. Myself included.
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My post about hiring PAs instead of NPs was kind of a hyperbole... I am sure most physicians will look at this stuff on case by case basis... However, I remember reading a post in SDN by an attending (I think it is @Winged Scapula ) who advised a colleague to hire a PA instead when s/he was going to hire a NP... So these stuff happen...
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If you're going to call out someone, like Winged Scapula, you should realize the circumstances and the why behind the case.
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That's bc for the NP bigwig establishment (i.e. Mary Mundinger - former dean of Columbia's Nursing Schoool), this has more to do with a power grab and having tons of tuition fork over student loan money than what's actually good for patient care. Hence the hubris of having "earned" being called Doctor, just bc your profession decided to degree creep from a masters to a doctorate, patients be damned. Puts a big dent in your motives, when you offer online DNP programs.
It's not really fair for us to criticize nurses for being educated online when medical students by and large watch lectures online and disdain coming to school, wishing they could do everything online.
It's more accurate to criticize lack of standardization in NP curriculums.
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There's a HUGE difference between basic science lectures that are recorded and available online, and which you can go anytime to your instructor and ask questions and an entire NP curriculum being online.
Your MS-3 clinical clerkship year in your medical education is not online.
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