When a nurse is your health-care provider, you’re at risk

[Sirach38]

If the mob "asks" you for "protection money," the smart thing to do is to give them the money. If you told me that what they were doing was wrong, how would you react if someone told you "LOL just try to give them the finger and keep your moneyrofl"?

Not sure what you're talking about their buddy...then again, I have no experience with the mob. Just CT surgeons.

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[studenthealth12]

I wonder how deluded you have to be to think that you can get equivalent outcomes from a CRNA and a residency trained anesthesiologist? The depth of knowledge and training rigor are on totally different levels. It is such common sense to me that I can't even fathom why anyone would need to do a research study on it. I would also venture to bet that these CRNA's would deep down underneath rather a doc do their anesthesia than a nurse.

I think there needs to be a distinction between outcomes and preferences. For example several studies have shown that the outcomes are the same for both types of professionals. However, some argue that the outcomes are the same because physicians are supervising the nurse anesthetist. I have worked in hospitals for years and the level of supervision is not enough to where it impacts the outcomes on a regular basis. Now, from a patient choice perspective I agree with you that most people would prefer a physician but that is largely because the typical person is uneducated on the quality outcomes issue.

 

[studenthealth12]

I'm an NP who thinks this is ridiculous. Independent practice is a terrible idea. Yes, send me the simple cases -- the UTIs, ankle sprains, PAP smears, lacerations, etc. I'll take those and leave the complex patients to my physician colleagues.

Shh... don't tell my fellow NPs I feel this way.

I am NOT saying that I disagree with your own personal opinion about your own personal skills. However, in hundreds of clinics throughout the United States nurse practitioners provide care without a physician even at the site. For example, many rural health clinics are staffed by nurse practitioners alone. in addition, many physician groups set up multiple sites and allowed nurse practitioners to practice at other office locations by themselves. Nobody is arguing that a nurse practitioner has more education than a physician. However, many people on this board ignore the reality of what is actually occurring in health care. For example in many emergency rooms the nurse practitioner sees the patients and confirms the diagnosis and treatment with the emergency physician. In primary care, nurse practitioners regularly work independent of a physician at sites where physician is not even practicing. Above all, there is not one study that states the quality of care is worse. If someone can find one, please send it to me. This is not to say, once again, that physicians aren't more highly educated because they are. With that being said, the reality is that physicians across the country have allowed nurse practitioners to work independent from the position and now people are getting mad about it because the nurse practitioners want true independence.

 

[W19]

I am NOT saying that I disagree with your own personal opinion about your own personal skills. However, in hundreds of clinics throughout the United States nurse practitioners provide care without a physician even at the site. For example, many rural health clinics are staffed by nurse practitioners alone. in addition, many physician groups set up multiple sites and allowed nurse practitioners to practice at other office locations by themselves. Nobody is arguing that a nurse practitioner has more education than a physician. However, many people on this board ignore the reality of what is actually occurring in health care. For example in many emergency rooms the nurse practitioner sees the patients and confirms the diagnosis and treatment with the emergency physician. In primary care, nurse practitioners regularly work independent of a physician at sites where physician is not even practicing. Above all, there is not one study that states the quality of care is worse. If someone can find one, please send it to me. This is not to say, once again, that physicians aren't more highly educated because they are. With that being said, the reality is that physicians across the country have allowed nurse practitioners to work independent from the position and now people are getting mad about it because the nurse practitioners want true independence.

There is a study that shows they order almost 30% more test than physicians...

 

[TraumaLlamaMD]

I don't think anyone here is denying that this is reality - but just because it happens doesn't mean it's a great idea.

 

[Psai]

I think there needs to be a distinction between outcomes and preferences. For example several studies have shown that the outcomes are the same for both types of professionals. However, some argue that the outcomes are the same because physicians are supervising the nurse anesthetist. I have worked in hospitals for years and the level of supervision is not enough to where it impacts the outcomes on a regular basis. Now, from a patient choice perspective I agree with you that most people would prefer a physician but that is largely because the typical person is uneducated on the quality outcomes issue.

I'm guessing that your years in the hospital were as an anesthesiologist since you seem so qualified to be judging their work. Supervision doesn't mean sitting in the room 24/7 micromanaging every single thing the nurse does. It means coming up with a plan for the anesthetics, what drugs in what amounts and being there for induction, extubation. Also being available if there are problems. It's very safe because it's safe in general. The drugs are well studied and there are many monitoring devices that make it easier to detect problems. You could probably sit an icu nurse in there with no problems

It's like flying a plane. The most important parts are take off and landing. In between, there is a lot of cruise control. You don't need to sit there with two hands constantly having a death grip on the yoke. But crashing is a one in a million event. Outcomes wouldn't change if you had a stewardess sitting in the cockpit for most of the flight but that doesn't make them a pilot.

Nurses are also the least qualified people to be talking about studies. I've seen what goes into a bsn. There's a lot of grou projects about pointless crap and paper writing about topics no one cares about. But at least they learn how to write footnotes in the proper apa style which no one uses.

They get almost no training in how to read and evaluate scientific studies which is very apparent when you see them babbling about "oh there are no studies for this" or when they talk about the equivalence studies as if a paper in a nursing journal, funded by nursing groups about watching a few nurse practitioners fiddle with diabetes meds for 6 months is an accurate way to evaluate their skills against physicians. By the way, there are no studies that prove that parachutes improve outcomes for people that jump out of planes. I guess that means a backpack is equivalent to a parachute

 

[studenthealth12]

There is a study that shows they order almost 30% more test than physicians...

just so you are aware, what you just explained was that there was a study highlighting that there is a difference in cost, not quality. I am not disagreeing with you that nurse practitioners may order more tests or maybe more cautious when they are treating patients, however I have not read one study stating that their quality of care is leading two patients having adverse effects. If that were the case, nurse practitioners wouldn't be allowed to work in any hospital in the country.

 

[studenthealth12]

I don't think anyone here is denying that this is reality - but just because it happens doesn't mean it's a great idea.

that is a good point. I would agree with you that in some settings it is not a great idea. In some settings, physicians who work with nurse practitioners should ensure that they are actually supervising them. However, in other settings such as primary care, this really does not make any sense. If my nurse practitioner is working with an orthopedic physician, you can guarantee that she is being supervised. On some level. In primary care though, I really do not see the need simply because the reality of what is happening has not shown us any statistics that this is a bad thing.

 

[Psai]

Statistics don't tell you the whole story. It depends on who is obtaining the numbers, their intention, their methods, etc. A lot of ebm is crap and there are many disagreements in the literature about everything but ask a nurse about a study that agrees with their viewpoint and you'd think that these studies were handed down by God on Mount Sinai

 

[studenthealth12]

I'm guessing that your years in the hospital were as an anesthesiologist since you seem so qualified to be judging their work. Supervision doesn't mean sitting in the room 24/7 micromanaging every single thing the nurse does. It means coming up with a plan for the anesthetics, what drugs in what amounts and being there for induction, extubation. Also being available if there are problems. It's very safe because it's safe in general. The drugs are well studied and there are many monitoring devices that make it easier to detect problems. You could probably sit an icu nurse in there with no problems

It's like flying a plane. The most important parts are take off and landing. In between, there is a lot of cruise control. You don't need to sit there with two hands constantly having a death grip on the yoke. But crashing is a one in a million event. Outcomes wouldn't change if you had a stewardess sitting in the cockpit for most of the flight but that doesn't make them a pilot.

Nurses are also the least qualified people to be talking about studies. I've seen what goes into a bsn. There's a lot of grou projects about pointless crap and paper writing about topics no one cares about. But at least they learn how to write footnotes in the proper apa style which no one uses.

They get almost no training in how to read and evaluate scientific studies which is very apparent when you see them babbling about "oh there are no studies for this" or when they talk about the equivalence studies as if a paper in a nursing journal, funded by nursing groups about watching a few nurse practitioners fiddle with diabetes meds for 6 months is an accurate way to evaluate their skills against physicians. By the way, there are no studies that prove that parachutes improve outcomes for people that jump out of planes. I guess that means a backpack is equivalent to a parachute

I see your point about the supervision. From my experience, which is working with anesthesiology groups and other physician groups to develop policies regarding supervision, it has been explained to me that supervision isn't the word that we should be using anyway, as you stated most of it is on cruise control and nobody needs to be in the room. So although I agree with you on some level, I do believe that we need to stop using the word supervision.

also, nurse practitioners, nurse anesthetist, should not be referred to as nurses. That is part of the problem, all physicians refer to nurses as if they are all the same.the funny thing is that you state that they are not qualified to talk about studies. 2 of our nurse practitioners went to Yale undergrad and Duke for their Doctorate degree and you don't believe they are qualified. Oh yes, I believe that they double majored in biology and nursing. Once again, I am NOT stating the nurse practitioners and nurse anesthetists are more highly educated than physicians. But by stating that they are not qualified to talk about studies, is a very ignorant comment.

with respect to the studies, the American Medical Association did a study 15 years ago which found that the quality of care and the outcomes were equivalent between nurse practitioners and physicians. I agree with you that we should always be looking at studies to see who is funding them and how they were analyzed, however many of these studies have been done across the board with both nurses and physicians working hand-in-hand to analyze the issue. You might want to read the Institute of Medicine's report on it which was co-authored by a physician.once again, although I agree with you on some level, your conclusion that oldies studies are fun did eminem related to buy your sis is large sweet basil us.once again. although I agree with you on some level that we should be skeptical of any type of study, your conclusion that nurses have funded and manipulated these studies is largely baseless. Feel free to post an analysis that 40 years of research has been manipulated by the nursing establishment. I believe it would be an interesting read.

 

[studenthealth12]

Statistics don't tell you the whole story. It depends on who is obtaining the numbers, their intention, their methods, etc. A lot of ebm is crap and there are many disagreements in the literature about everything but ask a nurse about a study that agrees with their viewpoint and you'd think that these studies were handed down by God on Mount Sinai

I agree with you that we should be looking at all studies with an eye towards understanding what is the motivation. However, with studies regarding nurse practitioners and nurse anesthetist, these studies have been performed by both nursing and medical professionals. For example, 15 years ago the American Medical Association published a study done by physician that stated the quality of care and outcomes were equivalent between physicians and nurse practitioners. In addition, the Institute of Medicine, which is run by physicians, published a report four years ago including the same, and report was co-authored by a physician. There is 30 or 40 years of research on the topic. I find it hard to believe that every study, including the ones I just named, have been manipulated by the nursing establishment.

 

[SouthernSurgeon]

Took longer than I expected for the all-nurses crowd to show up

 

[Psai]

What studies? Post them. I trust cochrane, uspstf, nejm but I do not trust the ama or the institute of medicine. Nurses are nurses. Nurses are not doctors. You can say what you want about doctorates but everyone and their grandmothers has a doctorate these days without much to show for it. I've seen np students and they have been very unimpressive. A lecture one gave to the nursing students at my school had info that was plagerized right off of Wikipedia. I have not done an np program but a quick overview of their courses show very few classes about things actually related to medicine. They are probably good if you want to learn bullcrap about leadership or jean watson's theory about human caring but not if you want to actually take care of patients.

Any undergraduate bio degree is not impressive either. They are a dime a dozen and the easiest out of the hard sciences. Don't make me laugh about nursing majors. I already talked about the bsn but I've taken nursing classes in undergrad and they were vastly inferior to the equivalent introductory bio classes that I also took. In fact, my nursing microbio professor asked me why I was taking her class instead of the one for bio majors because that one is much more rigorous

 

[studenthealth12]

What studies? Post them. I trust cochrane, uspstf, nejm but I do not trust the ama or the institute of medicine. Nurses are nurses. Nurses are not doctors. You can say what you want about doctorates but everyone and their grandmothers has a doctorate these days without much to show for it. I've seen np students and they have been very unimpressive. A lecture one gave to the nursing students at my school had info that was plagerized right off of Wikipedia. I have not done an np program but a quick overview of their courses show very few classes about things actually related to medicine. They are probably good if you want to learn bullcrap about leadership or jean watson's theory about human caring but not if you want to actually take care of patients.

Any undergraduate bio degree is not impressive either. They are a dime a dozen and the easiest out of the hard sciences. Don't make me laugh about nursing majors. I already talked about the bsn but I've taken nursing classes in undergrad and they were vastly inferior to the equivalent introductory bio classes that I also took. In fact, my nursing microbio professor asked me why I was taking her class instead of the one for bio majors because that one is much more rigorous

Here is your Cochrane study: http://dhhs.ne.gov/publichealth/licensure/documents/SubOfDrsByNursesInPrimaryCare.pdf

"The findings suggest that appropriately trained nurse can produce as high quality care as primary care doctors and achieve as good health outcomes for patients."

 

[W19]

@studenthealth12 Are you a nurse?

 

[studenthealth12]

What studies? Post them. I trust cochrane, uspstf, nejm but I do not trust the ama or the institute of medicine. Nurses are nurses. Nurses are not doctors. You can say what you want about doctorates but everyone and their grandmothers has a doctorate these days without much to show for it. I've seen np students and they have been very unimpressive. A lecture one gave to the nursing students at my school had info that was plagerized right off of Wikipedia. I have not done an np program but a quick overview of their courses show very few classes about things actually related to medicine. They are probably good if you want to learn bullcrap about leadership or jean watson's theory about human caring but not if you want to actually take care of patients.

Any undergraduate bio degree is not impressive either. They are a dime a dozen and the easiest out of the hard sciences. Don't make me laugh about nursing majors. I already talked about the bsn but I've taken nursing classes in undergrad and they were vastly inferior to the equivalent introductory bio classes that I also took. In fact, my nursing microbio professor asked me why I was taking her class instead of the one for bio majors because that one is much more rigorous

also, I have stated nothing concluding that nurse practitioner education and physician education or equivalent. Nobody is arguing that they are equivalent. The problem that I have is that the outcomes are the same. According to the studies from 30 to 40 years of research, the outcomes are the same. So although you are correct that the education is different, somehow nurse practitioners with their limited education are able to produce results that are just as good as physicians who have more training. Obviously, we need to place value on education. However, we cannot ignore the reality of what professionals are producing in the real world. For example, some attorneys have done 3 years of law school, and masters degree in a specialized area of the law, & a judicial clerkship. However, nobody in the legal world argues that that individual is the only one who can produce high-quality results in an area of law just because they received more than just a three years of education to become an attorney. Here is an example that is closer to home. In many countries, the medical education is drastically different than in the United States. For example, in the Philippines you could have an undergraduate degree and a medical degree in five to six years. This is the same as underst practitioners schooling in length. Yet because this individual passes a test, we allow them to be equivalent to the physician trained at Harvard or Michigan.

 

[studenthealth12]

@studenthealth12 Are you a nurse?

Nope.

 

[SouthernSurgeon]

Here is your Cochrane study: http://dhhs.ne.gov/publichealth/licensure/documents/SubOfDrsByNursesInPrimaryCare.pdf

"The findings suggest that appropriately trained nurse can produce as high quality care as primary care doctors and achieve as good health outcomes for patients."

You skipped an important sentence: "however the research available is quite limited"

The longest study they included was 18 months; all the rest were a year or less with many being short (days to weeks) observational studies

 

[BestDoctorEver]

As someone with a BSN degree, I guarantee you that I will not let any NP treat me for anything other than routine stuff...

 

[studenthealth12]

You skipped an important sentence: "however the research available is quite limited"

The longest study they included was 18 months; all the rest were a year or less with many being short (days to weeks) observational studies

agreed. The research is limited. However, if you want a more long-term analysis look to the reality of how nurse practitioners have been utilized over the past 20 years operating in clinic by themselves, providing care independently in 20 different states, and none of those states have gone back and changed this. Also many hospitals and medical staffs have a greed to staff nurse practitioners at clinics by themselves without any physician supervision. think, for a second, we need to recognize the reality that there are not enough physicians to provide care to all of the patients out there. Nurse practitioners have done a great job helping with this shortage issue and in many parts of the country are the sole provider in various communities and are providing excellent care.

 

[Psai]

What outcomes and results are you talking about? The statements you are parroting from your teachers sound pretty but are of little substance. Did you even read the report or did you Google and post the first thing you found? Out of the 25 studies that they looked at, only one had sufficient power to even assess what you're talking about and followup was less than a year. It's even underlined for you, not sure how you missed it. Generally in outpatient settings you don't have people dying on you left and right. You'll see rare things like mucinous adenocarcinoma or pheochromocytoma once in a year. If you miss that, it won't reach statistical significance in a study but it makes all the difference for the patient.

You're obviously a dullard but I'm posting this so that other people can see it and recognize how shoddy those tired talking points are. And for all the assertions of equivalence made by nursing groups, I have yet to see a single nurse choose a nurse over a doctor for their care or for their families

 

[Ost3oclast]

Nope.

Are you a doctor nurse?

 

[Pacna]

Not sure what you're talking about their buddy...then again, I have no experience with the mob. Just CT surgeons.

That's no problem! I'll break down the analogy for you. In both situations, the person who is being treated poorly is in no position to argue with their abuser. In fact, arguing will likely only make their situation worse. Also, in both situations the abuser is in a position of power (the Mob would be physical power, while the CT surgeon would have power to hurt the person's career and suffer no consequences), and they are choosing to treat people who can't defend themselves poorly.

Thus, the moral responsibility falls on the abuser in both situations. Just treat people (especially those under you) well! That's all I'm saying!

 

[Sirach38]

That's no problem! I'll break down the analogy for you. In both situations, the person who is being treated poorly is in no position to argue with their abuser. In fact, arguing will likely only make their situation worse. Also, in both situations the abuser is in a position of power (the Mob would be physical power, while the CT surgeon would have power to hurt the person's career and suffer no consequences), and they are choosing to treat people who can't defend themselves poorly.

Thus, the moral responsibility falls on the abuser in both situations. Just treat people (especially those under you) well! That's all I'm saying!

Thanks for the explanation. Unfortunately, the culture of medicine is what it is for now. Maybe it will change in the future

 

[Psai]

That's no problem! I'll break down the analogy for you. In both situations, the person who is being treated poorly is in no position to argue with their abuser. In fact, arguing will likely only make their situation worse. Also, in both situations thoe abuser is in a position of power (the Mob would be physical power, while the CT surgeon would have power to hurt the person's career and suffer no consequences), and they are choosing to treat people who can't defend themselves poorly.

Thus, the moral responsibility falls on the abuser in both situations. Just treat people (especially those under you) well! That's all I'm saying!

Ah yes I treated him poorly and abused him by pointing out that he is an (accepted) medical student

 

[fancymylotus]

As someone with a BSN degree, I guarantee you that I will not let any NP treat me for anything other than routine stuff...

I like you

 

[KnuxNole]

The two, while different, are not inseparable.

There will be so many times when someone will be a dick and the best thing you can do is shut your trap and take it. The earlier you learn this, the better off you'll be.

Yeah, and then you passively aggresively screw them, and mess them up

 

[KnuxNole]

And yes, nurse practioners are NURSES who practice with supervision(unless they are pathetic), they sure as hell aren't doctors, haha.

 

[SouthernSurgeon]

also, nurse practitioners, nurse anesthetist, should not be referred to as nurses. That is part of the problem, all physicians refer to nurses as if they are all the same

That isn't remotely true. No one calls a nurse practitioner "nurse". They call them NP. And they call nurse anesthetists CRNA.

And just in case they forget you can be dang sure that NP's badge is going to say John Smith, BSN, ACNP, MPH, MHA, BNPCFDA.

In many countries, the medical education is drastically different than in the United States. For example, in the Philippines you could have an undergraduate degree and a medical degree in five to six years. This is the same as underst practitioners schooling in length. Yet because this individual passes a test, we allow them to be equivalent to the physician trained at Harvard or Michigan.

Again not true at all. They only get called "equivalent" to the US MD if they go through residency and obtain a medical license, not if they "just pass a test". Residency being the key formative experience in training.

 

[Doctor Bob]

And just in case they forget you can be dang sure that NP's badge is going to say John Smith, BSN, ACNP, MPH, MHA, BNPCFDA.

What is up with that phenomenon? Some badges have so many "degree" letters that I can't figure out the person's name.

Dr. Bob, DO, MPH, BLS, BS, ACLS, ATLS, EMT-CT, PALS, MAJ USAF

 

[SouthernSurgeon]

What is up with that phenomenon? Some badges have so many "degree" letters that I can't figure out the person's name.

Dr. Bob, DO, MPH, BLS, BS, ACLS, ATLS, EMT-CT, PALS, MAJ USAF

It's very rarely doctors that do this.

I don't really understand it either. I like staring at the badges and trying to decipher what they all stand for.

 

[Doctor Bob]

I don't really understand it either. I like staring at the badges and trying to decipher what they all stand for.

I saw a badge one time that had 5 degrees, two of which were repeats. MSN, BSN, MSN, CCRN, BSN
I had to do a double take.

 

[acceptmeplease]

Nursing culture started sucking the life out of me the first day of nursing school. It's just a bunch of hens pecking at everyone else. "CRNAs and NPs are great because Florence Nightingale..."

The clinics mentioned above that are only staffed by NPs usually have these little red signs by the receptionist that tell patients with real medical conditions to go an emergency department.

 

[Joebird22]

On a side note wouldn't our time be better spent going after pseudo science like naturopaths, chiros, acupuncturists, etc. Than these NP/MD/PA debates lol.

 

[SouthernSurgeon]

On a side note wouldn't our time be better spent going after pseudo science like naturopaths, chiros, acupuncturists, etc. Than these NP/MD/PA debates lol.

 

[Wordead]

On a side note wouldn't our time be better spent going after pseudo science like naturopaths, chiros, acupuncturists, etc. Than these NP/MD/PA debates lol.

The midlevel creep has more serious implications for patient health down the road, unlike the homeopaths which are still confined to people with more money than brain cells.

 

[studenthealth12]

That isn't remotely true. No one calls a nurse practitioner "nurse". They call them NP. And they call nurse anesthetists CRNA.

And just in case they forget you can be dang sure that NP's badge is going to say John Smith, BSN, ACNP, MPH, MHA, BNPCFDA.





Again not true at all. They only get called "equivalent" to the US MD if they go through residency and obtain a medical license, not if they "just pass a test". Residency being the key formative experience in training.

first of all, in some places physicians do call nurse practitioners nurses. For you to say that it is not even remotely true is ignoring the fact that you likely have only practiced at a handful of facilities in your career. Have you practiced in all 5000 hospitals in the United States? If that is the case then I will agree that you have the knowledge to know that nobody uses those terms. I am Telling You from my experiences, this does happen.

second, yes international medical graduates have to pass a test and do a residency. your statement so ignores the fact that their education is inferior to some medical graduates in the United States. This is the exact same argument that you are making against nurse practitioners. For example, would you be comfortable with a nurse practitioner after they have completed a residency? Because that is what you are saying about international medical graduates. You are stating that their education does not matter because they have passed a test and finished a residency. I am just trying to figure out why it is okay for them but not okay for others.

 

[studenthealth12]

Nursing culture started sucking the life out of me the first day of nursing school. It's just a bunch of hens pecking at everyone else. "CRNAs and NPs are great because Florence Nightingale..."

The clinics mentioned above that are only staffed by NPs usually have these little red signs by the receptionist that tell patients with real medical conditions to go an emergency department.

with respect to the emergency department, I agree with you. I also see those signs in every family physicians office I have ever been in. I guess it is not very different for either of them.

 

[Baller MD]

first of all, in some places physicians do call nurse practitioners nurses. For you to say that it is not even remotely true is ignoring the fact that you likely have only practiced at a handful of facilities in your career. Have you practiced in all 5000 hospitals in the United States? If that is the case then I will agree that you have the knowledge to know that nobody uses those terms. I am Telling You from my experiences, this does happen.

second, yes international medical graduates have to pass a test and do a residency. your statement so ignores the fact that their education is inferior to some medical graduates in the United States. This is the exact same argument that you are making against nurse practitioners. For example, would you be comfortable with a nurse practitioner after they have completed a residency? Because that is what you are saying about international medical graduates. You are stating that their education does not matter because they have passed a test and finished a residency. I am just trying to figure out why it is okay for them but not okay for others.

Yes. I would be comfortable if they completed residency AND all the requirements to get there ie medical school, step 1-3, etc.

 

[Psai]

first of all, in some places physicians do call nurse practitioners nurses. For you to say that it is not even remotely true is ignoring the fact that you likely have only practiced at a handful of facilities in your career. Have you practiced in all 5000 hospitals in the United States? If that is the case then I will agree that you have the knowledge to know that nobody uses those terms. I am Telling You from my experiences, this does happen.

second, yes international medical graduates have to pass a test and do a residency. your statement so ignores the fact that their education is inferior to some medical graduates in the United States. This is the exact same argument that you are making against nurse practitioners. For example, would you be comfortable with a nurse practitioner after they have completed a residency? Because that is what you are saying about international medical graduates. You are stating that their education does not matter because they have passed a test and finished a residency. I am just trying to figure out why it is okay for them but not okay for others.

Many columbia np students couldn't even pass a watered down step 3 which is a test that doctors pass easily without even studying. You say pass a test as if it were easy. Step ain't the nclex

 

[acceptmeplease]

first of all, in some places physicians do call nurse practitioners nurses. For you to say that it is not even remotely true is ignoring the fact that you likely have only practiced at a handful of facilities in your career. Have you practiced in all 5000 hospitals in the United States? If that is the case then I will agree that you have the knowledge to know that nobody uses those terms. I am Telling You from my experiences, this does happen.

second, yes international medical graduates have to pass a test and do a residency. your statement so ignores the fact that their education is inferior to some medical graduates in the United States. This is the exact same argument that you are making against nurse practitioners. For example, would you be comfortable with a nurse practitioner after they have completed a residency? Because that is what you are saying about international medical graduates. You are stating that their education does not matter because they have passed a test and finished a residency. I am just trying to figure out why it is okay for them but not okay for others.

It's highly unlikely that, even if eligible, an NP could pass the step exams.

Even if "inferior", the international medical graduates are still exposed to the material on which the USMLE exams test.

 

[Ost3oclast]

first of all, in some places physicians do call nurse practitioners nurses. For you to say that it is not even remotely true is ignoring the fact that you likely have only practiced at a handful of facilities in your career. Have you practiced in all 5000 hospitals in the United States? If that is the case then I will agree that you have the knowledge to know that nobody uses those terms. I am Telling You from my experiences, this does happen.

second, yes international medical graduates have to pass a test and do a residency. your statement so ignores the fact that their education is inferior to some medical graduates in the United States. This is the exact same argument that you are making against nurse practitioners. For example, would you be comfortable with a nurse practitioner after they have completed a residency? Because that is what you are saying about international medical graduates. You are stating that their education does not matter because they have passed a test and finished a residency. I am just trying to figure out why it is okay for them but not okay for others.

Lol if NP's could pass steps I-III and do residency I would be totally down to see one....but seeing as a fair percentage can't even pass step 3.....I'll pass

 

[Pacna]

Ah yes I treated him poorly and abused him by pointing out that he is an (accepted) medical student

Strawman down! Call 911!

That analogy was to illustrate the principle of how using a position of power to treat someone else poorly is wrong.

What I said about your comment was that it is a good example of the attitude that permeates medical education which is at the core of the needless emotional gauntlet in clerkships/residencies. That attitude being that solely because person x is farther along in their education than person y, person x is more deserving of respect. Certainly person x is more likely to have better knowledge, but that doesn't have anything to do with respect.

You pointed that out to ad hominem/shame him into silence, much like you used a strawman fallacy against me for the same desired effect. You wouldn't have said "ok mr 'attending physician'" if his same comment had been made by a doc.

Sorry for my derailing and ranting. It upsets me to see this sort of thing, especially in my peers who I admire.

 

[Psai]

.

 

[studenthealth12]

Yes. I would be comfortable if they completed residency AND all the requirements to get there ie medical school, step 1-3, etc.

its sad that we cannot have an intelligent conversation about what is best for the patient and the future of our healthcare system. It is obvious to me that many people on this forum are more concerned with their power and prestige then what is actually best for the millions of patients that do not have access to good care.I support nurse practitioners, and believe they provide excellent care for many patients throughout the United States. There are plenty of studies that support my belief but even more importantly, there are millions of patients who benefit from their services every day.

 

[Psai]

Nurse practitioners go to the same places that doctors do, the desirable urban areas. And they are increasingly going into specialty care as can be seen by all the cards nps, gi nps, etc. And patients get worse care for it. My preceptor sent a patient for a cards referral for their chronic chest pain and the np sent them back with a ridiculous diagnosis of dehydration. Got a bunch of these stories. Ain't no one going into primary care in underserved areas serving millions lol

Your one study that you posted didn't support your belief either

 

[WhippleWhileWeWork]

Lol if NP's could pass steps I-III and do residency I would be totally down to see one....but seeing as a fair percentage can't even pass step 3.....I'll pass

It was a watered down abbreviated test based off of step 3, not even a legit step 3.

I thought the point of boards/licensing exams was to make sure there was an objective barrier to entry for practicing medicine on humans. NPs are practicing medicine, no matter what semantic game they want to play.

 

[SouthernSurgeon]

its sad that we cannot have an intelligent conversation about what is best for the patient and the future of our healthcare system. It is obvious to me that many people on this forum are more concerned with their power and prestige then what is actually best for the millions of patients that do not have access to good care.I support nurse practitioners, and believe they provide excellent care for many patients throughout the United States. There are plenty of studies that support my belief but even more importantly, there are millions of patients who benefit from their services every day.

Ah the ultimate troll maneuver of trying to say that we don't care about what's best for patients.

To be very clear - I care very much about what is best for patients. Nurse practitioners acting as primary care providers without supervision is NOT what's best for patients. I firmly believe that they provide inferior care.

The existing research is inadequate at best to draw any conclusions about the quality of care they provide, and disingenuous at worst.

 

[GUH]

I thought a good way to make the designations clearer was to refer to MD/DO as physician. That is, until I saw an NP refer to herself as a "nurse physician." There's no winning for losing.

Use the term "Medical Doctor" or "the practice of medicine". Nurses do not practice medicine, and if they tried to use that term then they would be subject to oversight by state medical boards.

 

[thepoopologist]

I don't believe a good NP is equal to a good physician, as a good physician is well read, has seen thousands of cases, and has the ability to really think outside, inside and around the box, and at the same time is decisive. If I'm in the hospital, this is the provider I want taking care of me. I don't think results in themselves are very telling of how effective someone is. In the primary care setting especially, providers can get by on pure dumb luck and the body's homeostatic mechanisms. The rationale behind someone getting better can be along the lines of, "I don't know, here's a Z-pak," to "Based on the interval history, physical exam findings, and the medical history, it's probably [A or B or C or D but most likely A because of X] and requires [Y] treatment." Now if it's nothing serious, no big deal, the patient recovers and that's what matters. If it's something more serious, then I want the latter provider. Now, the question is whether it's always the physician who thinks more often like the latter. Who knows, really, because I can't discount the fact that I've bumped into as many horrible docs and I have good ones.