Doctor Shortage-Who Should Fill the Gap?

Where are you getting info that getting an NP/DNP takes only one year less that becoming an attending? You can get a DNP in 2-3 years while physicians have to have a minimum of 7 years of training (did you forget that residency is postgraduate medical training?). So, it's not a difference of one year. It's a difference of several years.

The biggest difference is that physicians in training get around 17000 clinical hours while NPs/DNPs get around 1000!! NPs/DNPs are severely lacking in that on-the-job training that both you and I have been emphasizing. How can you say 1000 = 17000? That just doesn't make sense!

NP/DNP training is NOT EQUIVALENT to physician training. Please stop suggesting that. I have given several examples that show that both the basic science training AND clinical training is completely different/lacking in the NP/DNP curriculum compared to physicians. Do you want me to provide more examples? Anyone saying that NP/DNP training is equivalent to physician training is either ignorant or is blatantly lying. Which one are you?

Instead of responding to what I post with heavy bias towards nursing (I can understand since it is a nursing forum), please take a look at the examples I provided and realize that the training of nursing midlevels is nowhere near the level of that of physicians. Come on, you don't even need four statistics courses to realize that!

There is absolutely a difference between NP/DNP training and physician training. Physician training is FAR SUPERIOR! They get a significantly greater basic science education and they get a significantly greater clinical training experience. So please stop perpetuating the lie that NPs/DNPs are trained equivalently. It's a slap in the face of the medical profession. I mean why should anyone go to medical school if you're suggesting an easier path is equivalent to medical training? Med students are idiots for taking the longer route, with more debt, etc. when they could have just become a doctor by becoming a DNP. To me, this is what it seems you're suggesting since you keep repeating that their training is the same as physicians. Do you seriously believe this?

And you keep failing to answer my question regarding M4s. Please answer it. I pointed out, with several examples, that M4s are better trained BOTH clincally and in the basic sciences than NPs/DNPs are. Should M4s be allowed to practice independently? If you say no, how can you advocate for someone with less training than M4s to practice independently?

Please answer my question instead of avoiding it again and again. It's getting frustrating repeating it over and over and it just seems to get conveniently ignored. Thanks and looking forward to your response; hopefully you won't put words in my mouth again or make points unrelated to what we're discussing.

The problem is that NP/DNP training is so different between different schools. There's absolutely no standardized curriculum and the amount of required clinical hours is embarrassing/scary. How can you honestly say that most of the people graduating from these programs have the same level of competency as physicians?

You seem to have missed my post where I provided examples and compared NP/DNP training to physician training. I also showed that NP/DNP training is woefully inadequate to be practicing independently without physician oversight. Please go back and read it. You do seem pretty biased towards NPs.

And what do you think the physicians are doing when you're "educating" the patient? Are they sitting in the lounge playing video games or are they with another patient/working on paperwork? It's always easy to blame others without thinking.

And are you seriously suggesting that physicians prefer amputating to educating someone on managing their diabetes? Are you Obama in disguise? This sounds oddly similar to his very stupid tonsillectomy comment. I'll assume you're not Obama. You have to realize that every surgery has risk. Why would physicians be willing to take this risk (and have the possibility of getting sued if something went wrong) when medicine can manage these things with much less liability? Please think before you make comments like this. It really sounds just like the comment Obama made.

So, I've provided examples that show NPs/DNPs are not adequately trained and are NOT equivalent to physicians. I have also provided examples that show that a 4th year medical student has more basic science AND clinical training than NPs/DNPs do. No one else has answered my question regarding allowing M4s to practice independently. And no one else has provided any evidence suggesting that NP/DNP training is the same as that of physicians (as some people have been suggesting).

The way to become a doctor is NOT by becoming a nurse. If you want to be a doctor in a clinical setting, please go through medical school. Otherwise you do not have the same training nor the qualifications to be a doctor and work independently. To suggest otherwise shows that you're either ignorant or explicitly lying. Hopefully, you're the former.

There may need to be some standardized curriculum across NP or DNP programs, but like I have said before, it is irresponsible to say that you have to be a physician to provide primary care services. When you compare the curriculum, you have no basis to say what is adequate or what is not. You haven't taken the courses, you are simply providing commentary based on the course names. How do you know what is or isn't taught in the class. You have absolutely no idea. What you are touting as evidence is simply your own uninformed interpretation of what a course name means to you. That is not evidence my friend.

You also suggest that NPs have to have the same level of education to provide primary care services. This is basically where we disagree. The point is that the same level or better services can be provided with less training. People don't need the expensive firepower of the allopathic or osteopathic education to be treated for a sore throat. A more basic NP education works just fine for that as well as a host of other ailments.

Regardless of what Mr. Obama's proposals to solve our healthcare crisis are, he is right on point with his tonsilectomy comment. He has the physicians pegged with that hypothetical example. Physicians would prefer to order tests when they could rely on much less expensive means like listening to the patient and diagnosing based on symptoms. They prefer to do something that takes less time and makes them more money. They have ownership in the testing equipment which translates to a huge conflict of interest. They participate in studies where they have direct conflicts of interest and think that by disclosing their affiliation, that they are absolving themselves of that direct conflict. It simply doesn't work that way. Physicians have huge conflicts that need to be removed by increased regulation of their profession. Your problem is that you are blinded by the financial incentives and you have been brainwashed by the medical establishment into thinking that it is okay to rob the American public and justify it by saying that you work towards a noble cause of saving lives, and the only reason that you have to do it is because trial lawyers plan to put you out of business. That is malarkey. Physicians know that they are lining their pockets and driving healthcare costs to the point of breaking our economy when they do it, and there is no justification for it. It is robbery and fraud.

Do you honestly think that the majority of physicians are only in it for the money? Please provide evidence for this other than anecdotes. My understanding is that there are many easier ways to make money rather than spending your 20s studying.

Do you understand what defensive medicine is? The society in America today absolutely sucks! They have no sense of personal responsibility and are always looking to blame someone else; we are a very litigious society. What's cheaper, ordering a test that costs several hundred dollars and can potentially save you hundreds of thousands to millions, or not order a test and risk losing hundreds of thousands to millions of dollars in the following malpractice suit? Maybe if Americans stopped blaming anyone except themselves for their problems, there would be less ordering of unnecessary tests. This is a cultural problem; not one that exists only in healthcare.

Also, what do you say about the NPs/DNPs that are actively pushing for equal reimbursement rates as physicians? That's not going to save health care any money at all now is it? So what's the point of having NPs/DNPs if you can have someone with better training do the same job for the same reimbursement? This push for equivalency seems a lot greedier than what you have suggesting about physicians.

You're saying that NPs/DNPs get their clinical training as they're practicing? Why not eliminate residency then? The medical graduates can get their training while practicing as well. Saves them the hell of residency and allows them to start repaying loans quicker. If, as you say, it's working for NPs/DNPs, it sure as heck will work for MDs/DOs. So if you don't consider residency, then NP/DNP training is only one year less than physician training. You're saying that you feel NPs/DNPs should spend several years after graduating practicing under a physician and that this would residency-like. However, just because you feel that this should happen doesn't mean it's happening in the real world.

Regarding Obama's comment about the tonsillectomy, he's absolutely wrong with that comment. Here's a response of the AAO-HNS to Obama's tonsillectomy comment: http://www.businesswire.com/portal/s...09&newsLang=en Also, if you do a literature search, you'll see that the incidence of tonsillectomies has actually been decreasing for the last 10 years or so. Doctors are waiting longer and longer before resorting to tonsillectomies. So, no, Obama was absolutely wrong in his comment.

Also, up till now you were saying that NP/DNP education is equivalent to MD/DO. Now you're saying that "a more basic NP education works just fine?" Why'd you change your stance on the levels of training? You're right that a significant portion of medicine is algorithmic. You can be a high school graduate and follow cookbook medicine for a good chunk of what comes into the doctor's office; you don't even need to waste time getting an NP/DNP for that stuff. However, the problem lies in the fact that not everything that comes in is simple; if you're lacking in training, how will you know to recognize a benign appearing symptom that is actually much more serious? How will you know what red flags to look for when your training is not the same as a physician's? Sure, you'll learn after you encounter something like that after the first time but at what cost? Harming the patient? Or worse?

You keep saying that there are several ways to get from point A to point B. That might be true in other fields, but it's not necessarily so in medicine. MDs/DOs have already set the standard high, that's the point B you want to reach. However, NP/DNP training does not adequately train you to reach point B. How am I qualified to know what the fluff courses are? It doesn't take a genius to realize that you don't need 4-5 statistics courses to understand how to read studies. Why is there such a research focus in a clinical degree? The curricula waste many credits on research topics that are better suited for a PhD. Also, what the heck is something like "DNP Capstone?" Does that really help you in clinical practice? What about "Effective Leadership?" I don't see any such useless courses in medical training; you'd think there'd be more of those if they were so relevant to the practice of medicine.

And please, stop resorting to calling me names/calling me arrogant, etc. just because I disagree with your view. My concerns are valid and they have been raised by many others including those in the nursing field itself. I also know several NPs who pursued an MD and they can attest that there is a huge difference in training and that compared to and MD education, NP/DNP education does feel very inadequate. I know anecdotes aren't worth much but I guess it seems to be the cool thing to do these days.