Residencies: doctors have it figured out - page 5

by Amistad

8,598 Unique Views | 77 Comments

After chatting with a fourth year med student today at clinical, it occurred to me how vastly different the physician career-path is from our own. Fourth year medical students are undergoing the process of being matched to a... Read More


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    Quote from KatieMI
    That's all correct - except that the physicians' shortage is located into primary care domain, and that structure of the US medical care is unique. Nowhere in the developed world a doctor may be economically forced to choose specialty because necessity to pay back educational loans or inability to pay insane malpractice insurance rates. Nowhere in the developed world nurses and mid-level providers do so much of medical care. Drawing blood for routine labs, taking ECGs, teaching, complicated dressing changes, line and ostomy care, drugs titration were all parts of doctors' job just some 30 years ago and still are in many countries, not even speaking about "routine" prescribing, monitoring, labs control, etc., done more and more by mid-levels, just like feeding, ambulating and toileting were all parts of nursing care same 30 years ago. Now my classmates balk on taking vital signs and feeding because it is "CNA's job".
    I agree and if the system continues along the path it is presently on (and I see not reason why it will not), CNAs, MAs and other unlicensed assisting personnel will essentially replace the RN and LPN. "Nurses" in the near future, to the extent they exist at all, will be required to have DNPs and will essentially be paraphysicians.

    The question really is, what are doctors are going to do after that happens? It is true that much now in the RN scope of practice was formerly in that of the MD - and still is in many countries. It is also true that much in the present scope of RN practice is now being done by unlicensed assistive personnel. The UAP scope of practice is growing and in my view, this has occurred with at least passive assistance from the ANA, though for reasons that I do not understand. The result is not unexpected: A cheapening of the "ordinary" RN and the rise of the APRN.

    Again in my opinion, the vast majority of what is now in the purview of the RN, will in the not-too-distant future, be done by UAP's. The RN is destined to follow the route of the LPN. Nursing in the future will be done by APRN's and NP's who will supplant the role now performed by the GP or other primary care physician.

    Just my opinion but I have a crisp new Franklin I'd be willing to wager . . .
    Last edit by chuckster on Mar 14, '13
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    Well, docs have nobody to blame but themselves. Their support of abusive and ancient system of training, their laziness, conservatism and proverbial greed led to that, and it's not going to be better for them any time soon. We'll have to wait and see for the results with Obamacare coming upon us, but in any case APNs are here to stay, whether AMA wants it or not.
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    Correct me if I'm wrong, but the pathway to medical education seems to be more typical then the pathway to nursing education. Basic nursing education is very diverse as opposed to basic medical education. There are nearly 3.5 million licensed nurses in the U.S and there are a diversity of schools with nursing programs. There are nearly 800,000 physicians in the U.S. Available medical schools are more standard. As was pointed out earlier, the large influx of nurses with diverse basic education may be contributory to the low interest in nurse residency programs by the powers that be. However, at the graduate level, the hours required to complete an advanced practice nurse program seems pretty consistent across the board. With undergraduate nursing, in particular, being in disarray, I can't help but wonder as some of you may be wondering whether that means that graduate level nursing will finally be established as entry level. I wonder this in light of the establishment of CNL (clinical nurse leader) programs.
  4. 0
    Quote from KatieMI
    Well, docs have nobody to blame but themselves. Their support of abusive and ancient system of training, their laziness, conservatism and proverbial greed led to that, and it's not going to be better for them any time soon. We'll have to wait and see for the results with Obamacare coming upon us, but in any case APNs are here to stay, whether AMA wants it or not.
    Katie, I agree with much of what you write but the nurses are in the hole not only because of external forces such as the AMA but because we refuse to get our act together. I know of several people who switched professions because nursing felt like a disenfranchised profession to them.
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    I would never want to be a doctor a nurse "resident" spending 80hrs at least a week for $40-50k a year! Never! many hospitals disregard resident work hours , and taking call all night after surgery all day them in am , is that pt safe? or 6-6pm sun to fri then 6pm to 6am night float from sun to friday, is that pt safe ? most nurses whine and cry if they work more than 4 twelves i a row. there isnt much complaining from residents about hrs to non fellow residents because there are repricussions for it. the attitude is you knew it going in , so suck it up. i dont believe the current system is a that pt or resident safe either.
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    [QUOTE=Mijourney;7225485, I can't help but wonder as some of you may be wondering whether that means that graduate level nursing will finally be established as entry level. I wonder this in light of the establishment of CNL (clinical nurse leader) programs.[/QUOTE]

    *** You might get a few people to invest in graduate education to make the kind of money nurses make, and do the hard physical labor nurses do in an economic depression like we are in. However eventualy when the economy straitens out who is going to be willing to do that when there will be other better paying, less physicaly demanding jobs one can become qualified for through graduate education? Most people will be unwilling to invest the time, effort and money for a graduate education to become qualifed for a job that involves punching a time clock, making a lower middle class wage, dealing up close and personal with body fluids, and flat out hard work. I know I wouldn't.
  7. 1
    Quote from PMFB-RN
    *** You might get a few people to invest in graduate education to make the kind of money nurses make, and do the hard physical labor nurses do in an economic depression like we are in. However eventualy when the economy straitens out who is going to be willing to do that when there will be other better paying, less physicaly demanding jobs one can become qualified for through graduate education? Most people will be unwilling to invest the time, effort and money for a graduate education to become qualifed for a job that involves punching a time clock, making a lower middle class wage, dealing up close and personal with body fluids, and flat out hard work. I know I wouldn't.
    PMFB-RN, your points are well taken. I think a growing number of nurses are opting for graduate education, especially nurse practitioner, because these nurses have more autonomy and potential for better pay. Someone correct me if I'm wrong but I believe NP services are billed like a physician's whereas we garden variety nurses are part of room and board. If the scope of their practice changes to allow them to admit patients and write certifications for areas like home health, then NPs impact revenue, although we regular nurses impact revenue with the care we provide. You're right, though, that the economy has a great effect on people coming into and/or staying in the profession. I'm not certain that will end once the economy has improved because nurses, particularly RNs, make pretty decent wages although that is debatable in many circles. In addition, if we do see nursing residency become more wide spread, it may increase retention in the profession. On the basis of that, the question for me is what is the turnover rate of advanced practice nurses meaning how many of them give up their board certifications?
    SummitRN likes this.
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    We have a nurse residency at the hospital. It's a year long program.
    PMFB-RN likes this.
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    Quote from Mijourney
    PMFB-RN, your points are well taken. I think a growing number of nurses are opting for graduate education, especially nurse practitioner, because these nurses have more autonomy and potential for better pay. Someone correct me if I'm wrong but I believe NP services are billed like a physician's whereas we garden variety nurses are part of room and board. If the scope of their practice changes to allow them to admit patients and write certifications for areas like home health, then NPs impact revenue, although we regular nurses impact revenue with the care we provide. You're right, though, that the economy has a great effect on people coming into and/or staying in the profession. I'm not certain that will end once the economy has improved because nurses, particularly RNs, make pretty decent wages although that is debatable in many circles. In addition, if we do see nursing residency become more wide spread, it may increase retention in the profession. On the basis of that, the question for me is what is the turnover rate of advanced practice nurses meaning how many of them give up their board certifications?

    *** Oh graduate education makes great sence for advanced practice nurses and seems to be a good investment. But advanced practice nurses don't usually work in the same conditions as staff RNs. They have more oppertunity to not work nights, not have to do heavy manual labor and avoid the associated injuries, don't usually punch time clocks, and have far more independence and automomy. I question if they make more money, in particular NP since all those I know took a pay cut to do it, but they didn't have to work nights, weekend and holidays to make like the staff RN does.
    I was questioning if many people would be willing to invest in graduate education to become basic RNs. Sure a few will, more in the current crappy ecomomy, but I think when the economy improves few will do so.
    SummitRN likes this.
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    Yes, PMFB-RN, you are correct on certain levels. But, more and more jobs are being automated and outsourced as we write and those jobs will never come back. Currently, we are faced with the health and medical industry being the predominant industry in terms of jobs. I'm not sure that will change anytime soon in light of the fact the boomer population has not reached its peak. I also believe that as long as we have two year nursing programs that we will always have people who will be looking for the fastest way to decent wages.


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