Interesting Physician Perspective On NPs

zenman · Oct 28, 2012

I don't know if I agree that it's a real shame. How it's setup by the accrediting agency, PA programs are competency based, not degree based. Graduates of any PA program, associates or master's need to meet the same competencies, and those competencies are stringent. I think this is one of the strengths of the PA education model.
*** Yes I know and I agree with you.
With all due respect, and not intended to flame, and as discussed in other threads here, shameful might be the online NP program requiring in the ballpark of 500 clinical hours which may vary widely in quality. Theoretically, and i bet it has been done, not just in theory, one can obtain a BSN (or an accelerated BSN in 12 months if already have another bachelors), work very briefly as an RN if at all, then move on to an online NP program and practice after completion of the 500 hours of clinical hours.
*** It's actually worse than that. Several universities in the state I work in have direct entry masters programs for advanced practice. A person with a bachelors degree in another field can become and RN and then NP in 2.5 years without ever practicing as an RN. The 500 hours of clinical might have been appropiate for the very experienced RN who has worked in a variety of area of nursing and brings that expereince to the NP program but not (IMO) for a person without high level heathcare experience.
Granted, I have never met anyone or know anyone first hand who has done this.
*** Students of the program I describe above do clinicals at my hospital. I find them easy to spot. They are usually the ones who haven't figured out that the physicians also make mistakes on occasion, and the ones wanting to know why their patient was put on O2 without an order.
But it seems like the system is there to do it if one wanted to. And please understand, I point this out not to compare good vs bad, us vs them. I believe it's a fair critique of NP educational model. There are outstanding NP programs and from what I have read here, there seem to be some poor ones too. Huge variance if you will. I think PA education has a leg up in this issue. The standards for accreditation are stringent, well defined, and enforced.
*** I couldn't agree more. Based on my observation of working with both PA and direct entry students when they get their chance to respond to RRTs the PA students have it all ocer the direct entry NP students and both look pale and weak next to the NP student who spent 10 years working as trauma center ER RN before NP school.

When you hit the "quote" button, notice what's in front of, and behind the quote. Do the same for each section of a quote you want to address. Simple, and it is easier to read.

Know what I mean?

Anoetos, BSN, RN · Oct 28, 2012

You said, "jejune".

Awesome.

TraceyMarino · Oct 29, 2012

I started in respiratory therapy in 1987. I have been a drug rep, RRT, manager, RN, and now, I am graduating with my NP.

In the past 25 years, I have seen health care change dramatically. What has not changed is the constant ego battle that goes on with the duelling egos/duelling degrees. What never changes is that doctors (MD'S) will always believe they are smarter and better than everyone. I was enaged to an MD during his last year of med school, internship, and residency. I lived through the "match", the soul breaking first year internship, and what "being a doctor" did to his life. No thank you, not for me. The training of MD's brainwashes them to believe they are better than everyone--from their children's teachers, the guy who fixes their car, their spouse, nurses and midlevels. This brainwashing makes them very unique, often times warped, and very often difficult to deal with.

I think it is critical that people do what they love. I know great PA's, great NP's, great docs, and ones I would not let worm my dog. If you are good at what you do, docs will trust you and give you independence. There will always be docs who don't approve of mid-levels, and if you work for them they will make your life hell. Work with folks who respect you. I know a lot of docs who look down their noses at DO's. I have friends who are DO's and while in medical school, were treated very poorly by fellow MD students, interns, and attending MD's. Some folks are just jerks. Live with it and don't let it define you.

Guess what. Health care is changing. Studies show that NP's take as good of if not better care of patients than doctors do. The NP's I know have a very holistic view of the universe and as a group are pretty free thinking and progressive. In my extensive years of experience, NP's carry themselves with the attitude--I am a nurse. I am proud of it. I have unique skills, and I want to take great care of you". PA's seem to carry themselves as though they are apologizing for the fact they are not doctors. I have heard PA's spend 10 minutes to a patient that they could have gone to med school if they wanted, they did not flunk out of med school, and that they had as much training as physicians. They also seem to resent the control that physicians have over them, where NP's just go with it. Don't blow up at me for this opinion, it is formed after 25 years of watching docs, NP's, and PA's evolve.

As NP's and PA's continue to prove their worth and value, expect MORE backlash from doctors about mid-levels. Folks are graduating from med school unable to get a job. I am graduating with my FNP in December, and I have 5 offers-and I have not been looking.

Best wishes to everyone in all they decide to do. Just do it well, and all will be well!

kevagonia · Oct 30, 2012

most of the people I know recently who have commented that it will be required to be a DNP to practice tend to have been incdoctrinated by the Deans of their NP programs. This is a racket on the part of the schools. I am not saying it will not be true one day, but the schools are driving it.

-K

zoidberg, BSN, RN · Nov 3, 2012

I have heard PA's spend 10 minutes to a patient that they could have gone to med school if they wanted, they did not flunk out of med school, and that they had as much training as physicians. They also seem to resent the control that physicians have over them, where NP's just go with it.

I have to say this is quite a generalization. Many PA's love their physician supervisors and their positions in healthcare, and you cannot tell me you don't know SEVERAL disgruntled NP's who think they are as good at practicing medicine as most physicians.

Cauliflower · Nov 9, 2012

I agree with the folks who think NPs and PAs should unite in their efforts. There is absolutely no point in bickering about which is superior, and I found the nursing model and medical model drastically different in philosophy and training. I am an RN who also went through a very rigorous, competitive PA program and here's what it was like:

>1000 applicants for 50 spots

20-21 graduate credits/ semester year round (very tough) for an MS

classes 8a-5pm mon-friday

taking some courses with medical students and having to compete for grades with them

dissecting a cadaver down to the nerves and having to identify it all for exams

working 10-12 hrs/day, 5-6 days/ week during rotations, including overnight calls

having to present at grand rounds during every clinical rotation

I appreciate that PA receives a generalist education, including clinical rotations in internal medicine, psych, women's health, ER, dermatology, plus electives. Unlike NPs, PAs don't have to pick a specialty before starting school----they learn it all, do clinical rotations in all of the fields, and then can apply to PA jobs in psych as easily as they can in cardiology. There were a variety of undergraduate majors represented in the student mix----music, biology, pre-med, literature, etc. as long as all of the science and math pre-reqs were met, which was also a very long list.

Seen it from both sides.

BlueDevil,DNP, DNP, RN · Nov 9, 2012

This entire post bewilders me. I have met other dnp types who believe the same line of malarkey but they all work in academics as it is so entirely and utterly not true. Mds are obviously at the top of the food chain as they set they control the entire formulary (and can use it too!), who gets hired and in what number and what protocols exist for any given patient population.On top of that, I think, as a practicing rn and future graduate student, I absolutely see a huge difference and I care because I will one day be among the graduate students. Of course, I want to pick the right role for me and of course, they are all different. And another thought...absolutely everyone know exactly what the food chain looks like, right downtown who gets what computer or chair. This "team work" nonsense is not real and yes, I think we need some kind of leadership role and structure.

lol. I guess perhaps it may appear that way to you, as an outsider looking in. Rest assured, you are simply, as you say, bewildered. Once you are one of us, you'll see. Don't be discouraged, you can find parity.

FYI, there is always leadership. In our outfit he is indeed a MD. Of course, he never completed a residency (he failed to match*) or actually provided a day of patient care after 4th year. He went to law school and then business school instead, and presently his formal working title is "CEO." He made $9 million in bonuses last year, so for a so called "failure,"* I guess he is doing OK. He found his strength and played to it. We all have/do. It is why NPs are paid the same base salary in the group as our physician colleagues, commensurate with experience. You may not land in a group this successful and egalitarian in philosophy, but I do encourage you not to sell yourself short. Don't settle. It is way too early for bitterness and cynicism my friend!

Good luck in your studies, it will be worth it when you do get to be part of the "team." :)

VICEDRN, BSN, RN · Nov 10, 2012

lol. I guess perhaps it may appear that way to you, as an outsider looking in. Rest assured, you are simply, as you say, bewildered. Once you are one of us, you'll see. Don't be discouraged, you can find parity. FYI, there is always leadership. In our outfit he is indeed a MD. Of course, he never completed a residency (he failed to match*) or actually provided a day of patient care after 4th year. He went to law school and then business school instead, and presently his formal working title is "CEO." He made $9 million in bonuses last year, so for a so called "failure,"* I guess he is doing OK. He found his strength and played to it. We all have/do. It is why NPs are paid the same base salary in the group as our physician colleagues, commensurate with experience. You may not land in a group this successful and egalitarian in philosophy, but I do encourage you not to sell yourself short. Don't settle. It is way too early for bitterness and cynicism my friend! Good luck in your studies, it will be worth it when you do get to be part of the "team." :)

It's not bitterness and cynicism. Once upon a time, I let someone sell me on nursing school instead of medical school. After all, nurses are the real life savers, right? Took me about 8 weeks to see through that nonsense. The truth is, I'm an idealist usually and look at the trouble it has brought me. Med school is likely out of the question since I have borrowed for two bachelors. I see what I think is really real for a large part of the country. You may have found a little piece of shangri la but I live in the Deep South and I am skeptical that a) what you say is true (but rather is what you idealize) and b) if it is, that this sort of place is few and far between. I have never seen an np or pa make anywhere near the same pay as an md nor participate in the development of protocols. If you see me on the flip side, I am hoping it will be as a pa or md/do. I never want to hear the word nurse associated with my name again.

zenman · Nov 11, 2012

It's not bitterness and cynicism. Once upon a time, I let someone sell me on nursing school instead of medical school. After all, nurses are the real life savers, right? Took me about 8 weeks to see through that nonsense. The truth is, I'm an idealist usually and look at the trouble it has brought me. Med school is likely out of the question since I have borrowed for two bachelors. I see what I think is really real for a large part of the country. You may have found a little piece of shangri la but I live in the Deep South and I am skeptical that a) what you say is true (but rather is what you idealize) and b) if it is, that this sort of place is few and far between. I have never seen an np or pa make anywhere near the same pay as an md nor participate in the development of protocols. If you see me on the flip side, I am hoping it will be as a pa or md/do. I never want to hear the word nurse associated with my name again.

Actually nurses are the real lifesavers. I'll leave it to others to explain why. And you think being able to develop protocols is something big?

BlueDevil,DNP, DNP, RN · Nov 11, 2012

It's not bitterness and cynicism. Once upon a time, I let someone sell me on nursing school instead of medical school. After all, nurses are the real life savers, right? Took me about 8 weeks to see through that nonsense. The truth is, I'm an idealist usually and look at the trouble it has brought me. Med school is likely out of the question since I have borrowed for two bachelors. I see what I think is really real for a large part of the country. You may have found a little piece of shangri la but I live in the Deep South and I am skeptical that a) what you say is true (but rather is what you idealize) and b) if it is, that this sort of place is few and far between. I have never seen an np or pa make anywhere near the same pay as an md nor participate in the development of protocols. If you see me on the flip side, I am hoping it will be as a pa or md/do. I never want to hear the word nurse associated with my name again.

Deep south explains everything. My condolences.

AngelfireRN, MSN, RN, APRN · Nov 11, 2012

Nothing wrong with the South. I can't imagine living anywhere else.

PatMac10,RN, RN · Nov 11, 2012

It's not bitterness and cynicism. Once upon a time, I let someone sell me on nursing school instead of medical school. After all, nurses are the real life savers, right? Took me about 8 weeks to see through that nonsense. The truth is, I'm an idealist usually and look at the trouble it has brought me. Med school is likely out of the question since I have borrowed for two bachelors. I see what I think is really real for a large part of the country. You may have found a little piece of shangri la but I live in the Deep South and I am skeptical that a) what you say is true (but rather is what you idealize) and b) if it is, that this sort of place is few and far between. I have never seen an np or pa make anywhere near the same pay as an md nor participate in the development of protocols. If you see me on the flip side, I am hoping it will be as a pa or md/do. I never want to hear the word nurse associated with my name again.

Come to my school and the hospital I work at. We've had a whole 2 days lecture on nurses and their role In policy and protocol development. Because, more often than not, it will be nurses and other staff who carry out the said protocol, they are affected by protocols, so they are part of development of them.The CEO of the hospital where I'm employed is a nurse (not even an APRN) she has an MSN. She does a pretty good job. And I live in the South.