Anyone heard of any NP to MD programs? - page 4

A girl I go to school with said that there is a school in Missouri that has a bridge program for NPs to become MDs. Have any of you heard of a program like this?? :confused: Thanks! Kitty... Read More

  1. by   yellow finch
    Quote from caldje
    5 causes of chest pain!?! even in general terms... not even close to only 5.

    :uhoh21: THAT is what the previous poster was talking about.
    Ok, so that was a really bad example (and totally out of my league since I work in Neuro) :imbar . My MD preceptor always brings that up when discussing specialties so I used it (maybe that's why he's a hospitalist). Point being is NPs can excel in specialized areas and don't have to drift only towards internal medicine.
  2. by   core0
    Quote from yellow finch
    sistermike... I don't understand your point. If you look at specialty areas of care it makes more sense for a NP to work there rather than in the area of internal medicine.

    snip
    I agree with you line of thought. I do think that your reasoning behind it is somewhat flawed. There is ample room for NPP's to work in specialty practice. The model is different than for primary care. First it is unlikely that cardiology will be working up a patient for chest pain. Either primary care, ER or medicine usually does the initial work up and turfs to specialists for further work up. For example ECG changes or increased Troponin would go to cardiology. A PE would be handled by medicine.

    What I would state is that there is no place for an independent NPP to do specialty care. This happens at too high a level even for an experienced NPP to do by themselves. I have been doing GI for five years and my SP's state that I work at the level of a third year fellow. I can handle most problems by myself and see any consult that comes into the clinic. The model for specialties is twofold. For specialties that do lots of procedures such as cardiology or GI the NPP sees new patients to generate more procedures. In other specialties such as endocrinology or oncology the patient sees the physician for the treatment plan which is then executed by the NPP. Other possibilities are to provide episodic care for patients with chronic conditions or provide care for certain conditions within a specialty such as a CHF clinic within cardiology. The concept here is to provide access to the clinic when the physicians are booked.

    As far as the type of NP that you are going to become, there are other threads that address this. There are advantages and disadvantages to all the NP specialties. These are more pronounced in the delivery of specialty care.

    David Carpenter, PA-C
  3. by   core0
    Quote from yellow finch
    Ok, so that was a really bad example (and totally out of my league since I work in Neuro) :imbar . My MD preceptor always brings that up when discussing specialties so I used it (maybe that's why he's a hospitalist). Point being is NPs can excel in specialized areas and don't have to drift only towards internal medicine.
    Actually it's not a bad example. I learned this as four in my ER rotations.
    Cardiac
    Pulmonary
    GI
    Musculoskeletal

    This is the order of danger to the patient and the order you should rule things out in. It all dependes on if you are a lumper or a splitter.

    The thing that this should point out is that just like your specialty physicians you need to be good in internal medicine to practice in a specialty. There are ample opportunities for disaster if you do not pick up subtle signs of other disease systems. If you have a harried primary care send someone to you with another problem then you need to know when its not in your system. This is the reason that specialty care comes out of internal medicine or pediatrics not family practice. You need a deeper appreciation of the appropriate type of medicine as well as the greater experience in inpatient medicine.

    David Carpenter, PA-C
  4. by   caldje
    Quote from core0
    Actually it's not a bad example. I learned this as four in my ER rotations.
    Cardiac
    Pulmonary
    GI
    Musculoskeletal

    This is the order of danger to the patient and the order you should rule things out in. It all dependes on if you are a lumper or a splitter.
    David Carpenter, PA-C
    David, if we go by organ system than any complaint can only involve 5-10 things. You should add neuro into this as well, and derm. I think we can all name 10-20 cardiac problems alone that cause chest pain and a similar ammount of GI issues that cause chest pain,as well as pulmonary. All in all, the differential for "cheat pain" can include well over fifty into the hundreds of conditions. I know you know that David?

    I wasnt arguing against NPPs in specialties, more so against the independent NPPs in specialties and I think FNPs may not be fully exposed to the poosibilities in each specialty. Im sure it depends on which school you go to but you will never see the full DDx of chest pain etc worked out if you've only ever been in an FP clinic as a student NP. which i think we actually agree on?
    Last edit by caldje on Feb 21, '07
  5. by   core0
    Quote from caldje
    david, if we go by organ system than any complaint can only involve 5-10 things. you should add neuro into this as well, and derm. i think we can all name 10-20 cardiac problems alone that cause chest pain and a similar ammount of gi issues that cause chest pain,as well as pulmonary. all in all, the differential for "cheat pain" can include well over fifty into the hundreds of conditions. i know you know that david?

    i'm just a simple gi pa. as far as i'm concerned the only reason that the heart exists is to pump blood to the abdominal organs. it also occasionally mimics gerd. the point that i make is that there are different reference frames for a work up. yes you could include derm and neuro but these are true zebras. you can rapidly exclude entire systems with a few tests which is why i like this reference instead of a problem based system. this is the way i was taught and the way that i teach students when i give lectures. your mileage may vary.

    i wasnt arguing against npps in specialties, more so against the independent npps in specialties and i think fnps may not be fully exposed to the poosibilities in each specialty. im sure it depends on which school you go to but you will never see the full ddx of chest pain etc worked out if you've only ever been in an fp clinic as a student np. which i think we actually agree on?
    once again your mileage may vary. it really depends on the acuity of the clinic and the patient population. i do agree that this is one of the problems with certain educational programs. it is the difference between specialty nursing models and medical models. i did one cp work up in 400 hours of fp. i did 15 in my first week of em. the other thing that you miss in working up conditions in fp is the feedback loop. usually in fp you may do an ecg and some other tests before you send them packing to the hospital. in em or inpatient medicine you can see your troponin come back, see what you ct shows etc. this is one reason that i think that any provider should be exposed to em, fp, inpatient medicine, surgery, psych, and ob. you need to be abled to recognize emergencies in those fields to be good at your job.

    struggling to actually address the title of the thread so as not to incur the rath of siri, this is the reason that you will probably never see a np to md program. honestly this is why you will probably never see a pa > md program either. the educational models are too different. the md educational model uses a diversed educational model with exposure to multiple fields of medicine in both medical school and residency. there is simply not enough exposure in the standard np program to provide the entering wedge here. similary the pa program is very focused on clinical medicine. in the case of the np, one is trained in nursing and the other is trained in medicine (regardless whether the practice is different). this is one of the current criticisms of some fp programs. by focusing the residency on outpatient medicine they are not getting sufficent exposure to acutely ill patients and lose the ability to rapidly diagnose rapidly evolving patient conditions.

    david carpenter, pa-c
  6. by   kb12345
    Hi Sistermike...
    Thank you for your words of encouragement and infact, some of what you said about why one might want to pursue an MD was on the money for me. I always wanted to be a psychiatrist but life happened, I got married, joined the militay, (who, by the way is willing to pay for medical school and pay me monthly at the same time), and I had children. I didn't want to sacrifice my time when my children were smaller for the rigors of medical school so I instead chose nursing school (as a stepping stone) to my ultimate goal. I eventually want to conduct research in psychopathy/sociopathy. I want to work in the field of forensics with the "criminally insane". I am a behaviorist at heart and want to know why people do what they do, you know, the nature v nurture issue. I have yet to find a way in as an NP but I know for sure I have a way in as an MD. As much as I and others would love to believe that MD's and NP's are "equal" we are not and in alot of forums (mostly by colleagues, sometimes by patients) we are not. That's a fact.
    Hi Yellow finch, in this forum you stated....."If you choose Family NP and sometimes Acute Care NP programs then your knowledge base is larger and the time in school is generally longer". Where is this program at because all of the individuals I went to school with all went the same length of time as me. We all started off in general course work, then specialized our last year of school and all graduated together. I was in class with soon to be psych NP's, pedi NP's, FNP's, etc and no one got anymore schooling than anyone else. I noticed a trend throughout your postings, you try very hard to make a pitch for MD's and NP's as "being the same", but we aren't on so many levels. In the end, if someone wants to pursue medical school, then why not?...

    APRN
    Last edit by kb12345 on Feb 22, '07
  7. by   kb12345
    Hi DC2RN,
    I totally hear you...but it's what I want, what IV'e always wanted for myself in the end. I also feel as i have stated before, that there are some doors closed to me in terms of my professional goals because I am only masters prepared that an MD would open.
    The assuption that I would be "giving up 8 years of my youth" is totally incorrect. I wouldn't be giving up anything, only gaining/attaining what I want. In 8 years I will still be me, it's where I want to be-that's what I want to affect. As I stated in an earlier post...I have been in the military now for over 10 years and they are certainly willing to pay for school and pay me as well, obviously not without a "price". I will owe 4 years of service, I get to choose if it will be on active duty or reserve status, amongst other things.

    APRN
  8. by   sirI
    "giving up 8 years of my youth" is totally incorrect. I wouldn't be giving up anything, only gaining/attaining what I want.
    Well said.

    We all must make the choice. It is an individual thing. All said and done I'm sure many if not the majority of most NPs at one time or another, considered med school. I know that I did.

    If this is what you desire, don't let a thing stand in your way.
  9. by   yellow finch
    kb12345 and others... Thanks for pointing my comments out. I was really tired when posting what I did and may not have described the NP process as well as I could have. My point was only that we all learn just about the same in school mainly because it's standardized. Depending on the specialty we choose to follow will determine how much we use of that education. We never lose our knowledge, but have the opportunity to consult other specialists when necessary. I've learned through clinicals that the internal medicine specialists continue to apply a spectrum of understanding and consult specialists for those areas they do not attack. The same goes for each person who comes by to see the patient. No one area is better than the other. My point was more that NPs are just as capable to specialize as they are to go into family practice or internal medicine. It's all challenging and we work so hard to do what we do. I, for one, cannot lower the importance of a graduate degree and have high respect for MDs with their education and experience. At the same time we can't forget how far we've gone to get to where we are right now.
  10. by   Caroline32669
    Oceania med is in Samoa and you do not need to take the MCAT if you have had medical experience. Ross University has a decent reputation and there are one or two other Carribbean schools that I can't remember the name of.
    The nursing program you are thinking of gives nurses a clinical degree call the Doctor of Nurse Practice (DNP). You can choose your focus whether it be acute care, family practice or education. It is NOT intended to make medical doctors out of nurse practitioners. Nursing has a completly different model. I think it is the result of billing problems. Nurse practitioners cannot bill full price because they are not doctors even when they perform the same service as a medical doctor. It is hopeful that this degree will help obtain full billing and educate nurses a bit more. At least that is what I think.
  11. by   veritas
    Quote from Caroline32669
    Oceania med is in Samoa and you do not need to take the MCAT if you have had medical experience... The nursing program you are thinking of gives nurses a clinical degree call the Doctor of Nurse Practice (DNP). You can choose your focus whether it be acute care, family practice or education. It is NOT intended to make medical doctors out of nurse practitioners. Nursing has a completly different model.
    anyone who wants to do MD should join the bottom of the pile and start new. seriously people, do you want to go to a doctor who did not pass mcat or interviews? do you want a doctor who took shortcuts to get into med school? i don't think so! the mcat and interviews and classes are there for extremely good reasons. those schools advertised as no mcat required, blarblarblar are not going to get you the residency required in any country, and no residency = no job = not md = back to wherever you came from or started from. think about it!
    Last edit by veritas on Oct 2, '07
  12. by   cgfnp
    Quote from veritas
    anyone who wants to do MD should join the bottom of the pile and start new. seriously people, do you want to go to a doctor who did not pass mcat or interviews? do you want a doctor who took shortcuts to get into med school? i don't think so! the mcat and interviews and classes are there for extremely good reasons. those schools advertised as no mcat required, blarblarblar are not going to get you the residency required in any country, and no residency = no job = not md = back to wherever you came from or started from. think about it!
    This is the school of thought of the general opposition to any change such as a bridge program for midlevels. It makes sense to me, however, in a growing shortage of fam docs... why not create a bridge program that includes all the essential sciences and cuts way down on all the non-primary care exposure? It COULD be condensed, it COULD work well and it COULD produce real, competent doctors for the primary care field. Hell, you could even require rural health practice for one of these "short-cut" doctors.

    "sure it makes sense to you because you are a np" states the med student. I personally hope to be so far away from medicine in any form by then it won't matter. I hate it.

    "but bridging is a short cut and that's not fair because that's not how I did it" states the med student. 4 yrs bach, min 1 yr experience, 2 yrs grad school, for a total of 7 yrs when you want to begin your likely 2 yr bridge program... hardly a shortcut.

    "but your 7 yrs isn't as hard as ours" Who cares?

    This attitude of my way or no way is costing this country a lot of lives. That's right, many people will die simply because a bridge program idea or other open minded ideas to increase the primary care doc work force will continue to be shot down because the opposition ultimately cares more for themselves than the patients. "but patient safety is what we're concerned with" No, you're not. If the number one killer is heard disease, and the way to prevent that is the simple task of lower lipids, blood pressure, controlling diabetes, and promoting heart healthy behaviors, that even us lowly midlevels can do with our eyes closed then it's easy to see that even a MD that was bridged would satisfy the laws to open their own clinic and receive the meager reimbursements to make a practice work. This would result in more patients seen, and therefore more risk factors treated, resulting in lower mortality and morbidity in this country.

    At least now you can admit that you'd rather more people die than be open minded to an alternative method of becoming a primary care MD.
  13. by   n_g
    Med schools are not starving for students. If the country needs more docs, the schools let in more students...and they start from the beginning. The AAMC has expanded enrollment by 20% in the last few years. The docs can giveth and taketh from ye.

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