Hi everyone,

In my last semester (next spring)...=) I will be allowed to go to other sites aside from primary care. I have 240 hours to complete next spring, and I will have the minimum 500 hours to sit for my NP certification, hopefully this upcoming Fall of 2012.

So my question is what other clinical sites will best prepare me for what I will be exposed to in a general Internal Medicine or Primary care practice (aside from primary care & internal medicine) ? I would like to make the most of my clinical time to expose me to other areas that I might either benefit from from as a general practitioner. My main interest is Cardiology and I would like to spend at least 40 hours there. I was thinking possibly Derm and Ortho as my 2 other sites, along with my primary care site for my last semester.

Any other comments from practicing ANP/FNP or Student NP's? Any practice or specialty you would have liked to have been exposed to before graduating or that you think might have helped you in your current practice? Thanks in advance!

I did OB-GYN for a specialty site. It was actually quite useful when I worked in Primary Care, as I was very comfortable doing Paps and pelvics, and dealing with birth control, STIs, menstrual issues, and menopause. My patients were happy they didn't have to go to a GYN for the more routine issues. Of course, I didn't hesitate to refer the more complex GYN issues to GYN.

I wish I had spent some time in ortho and derm. I did see a lot of both issues in Primary Care and would have liked to be more knowledgable in that area.

thanks BCgradnurse for your suggestions

in my ANP program they incorporate that as well, so i am required to complete time in women's health this upcoming fall. and the practice i am in now, i have done several pap's, pelvic exam, rectal exams. my current preceptor is great !

Psych...

Renal - I work in nephrology and much cardiology is incorporated into what I do.

I might also suggest a nephrology clinic that deals with HTN too.

Another thought: Diabetes Clinics - we have two in our area run by NPs - both have fantastic reputations and the pts get great results.

Agree with the suggestions to do derm, ortho, and women's health. I would encourage you to choose fewer specialties and spend more time in them (more than 40 hours!) to get the most out of the experience.

Endocrine is very helpful since no matter what sort of adult population you treat, you WILL treat diabetes! They treat dyslipidemia and hypertension and other disorders such as PCOS, testosterone deficiency, pituitary tumors, adrenal gland disorders, etc., which are all important to recognize when treating patients in a primary care situation.

I did an endo rotation and I can palpate thyroid nodules like nobody's business!

ER, you will get exposure to lots of procedures and acute illnesses. All the students from my class that did ER loved it and want to work there when they grow up :)

I would choose Cards and Endocrine

I'm in a PNP program and we didn't have much choice over our site placements, but so far I've done neuro, GI, liver transplant clinic and well newborns. Neuro and GI were both very useful as in primary care you'll see lots of kids coming in with headaches and stomach aches. Liver transplant was fascinating and I learned a lot about rare conditions but probably not that relevant to primary care. Well newborn clinic was important to learn about how to do a newborn exam properly although I can't say it was my favorite. Next semester I'll be doing ER and I'm really looking forward to it.

If you plan on taking a job in primary care, I would also recommend psych. Like zenman recommended.

Reasons,

#1. Endo, cardio, renal, ob/gyn, etc.,:

Making referrals to these specialists is easy.

A solid knowledge base on all of these is essential in primary care practice. However, if you come across something that stumps you, conditions that are refractory to treatment or you just have that complicated patient with comoborbidities that will benefit from seeing a specialist (trust me, in the older population... a lot of them will) you can refer.

#2.

Making referrals to psych is difficult.

At least it is here in Texas. There are not very many psych providers and if you find any near your practice site (near pt home) they are usually not taking new patients. Psych is a huge probelm and a large number of your patients have some type of psych issue. Due to the difficulty in securing timely pysch services, you will find that in primary care YOU ARE the psych provider.

If you plan on taking a job in primary care, I would also recommend psych. Like zenman recommended.

#2.

Making referrals to psych is difficult.

At least it is here in Texas. There are not very many psych providers and if you find any near your practice site (near pt home) they are usually not taking new patients. Psych is a huge probelm and a large number of your patients have some type of psych issue. Due to the difficulty in securing timely pysch services, you will find that in primary care YOU ARE the psych provider.

I agree, especially about my home state of Texas, where I'll not practice till I get independent status like here in New Mexico. I've had NM patients move to TX only to move back here due to no psych providers in TX. And learn some psych so I don't have to treat all the patients primary providers get hooked on benzos, lol!

I agree, especially about my home state of Texas, where I'll not practice till I get independent status like here in New Mexico. I've had NM patients move to TX only to move back here due to no psych providers in TX. And learn some psych so I don't have to treat all the patients primary providers get hooked on benzos, lol!

New Mexico eh?

We'll have to chat zenman. I'm considering making a move to a different state in the next 2-3 years. Scope of practice will play a big role in decision making.

And yes, once again I agree with you, there are a great many people that are on benzos. Don't mention cutting back their dosage or they turn crazy on you! LOL