Misconceptions in NP/PA/MD education: experiential requirements, online, and for-profits

[SummitRN]

Does PA or medical education have some of the same hot-button issues we see in NP education?

There has been a great deal of teeth gnashing about NP education. The complains generally relate to a few of the following in combination:

1. Online programs

2. Part time programs

3. No experience required

4. For-profits

Usually the gaze is then cast on PA and MD education where supposedly none of these problems exist. Let's examine that idea with the caveat that I am no expert in PA/MD education, but I often see a lot of posts from folks who have discernibly less awareness.

1. Online programs

PA programs such as UND, Red Rock, Yale, Lock Haven, MCPHS and others offer programs that are either distance learning or a hybrid curriculum where some courses are online while campus visits are required similar to Vanderbilt's NP program.

2. Part Time

While I don't know of any part time allopathic/osteopathic programs (although some will allow 5 years to lighten the intensity), there are some part time PA programs such as Drexel, Rutgers, University of Detroit,

3. No Experience Required

There is much teeth gnashing about direct entry MSN programs despite evidence supporting the practitioners they educate. How about on the PA/MD/DO side?

MD/DO

To point out that MD/DO applicants need not have experience is just asinine because of residency. However it possible for MD/DOs to practice without a residence in many states. They might practice independently as a general practitioner or they not be independent, functioning more like a PA.

PA

16% of programs require 1000-2000 hours of healthcare experience (less than 1 year full time)

40% require no experience

44% of programs require somewhere between 8 and 500 hours

The experience requirements, where they exist, vary from shadowing to volunteering to paid professional experience.

4. For-Profit

There have long been plenty of for-profit medical schools outside of the US that accept applicants who couldn't get into US schools. They are US accredited, so their graduates do practice in the US. The first for-profit medical school in the US opened 10 years ago and more have followed.

I am not aware of a for-profit PA program... yet...

Summary: When I look at these for categories of concern, it turns out most of them are in PA and MD/DO education. However, they seem to less prevalent and the online learning shift is coming from the elite-end of education while in NP education, these changes started at the lowest common denominator (which, not coincidentally, are the for-profits).

[BostonFNP, APRN]

Oh great the local program that was just put on warning by the state BON for their RN program after deficiencies were found in 5/5 categories now has an online PA program.

EDIT: On further review, it appears that the online doctorate for PA is only for practicing PAs.

[shibaowner, MSN, RN, NP]

Thank you to the OP for starting this discussion. I'd like to point out that MDs do not have to work in healthcare before starting med school. I think that is the better analogy to NPs and PAs.

[SummitRN, BSN, RN]

Also, the PA programs listed as "online or hybrid" are not "online or hybrid" in the same sense as NP programs. They all require significant time spent on campus - not a couple weeks over the course of the program. Lock Haven is all on campus - they have lectures on the main campus that students on the other campus watches via live feeds. So online but not really. And Yale requires multiple site visits including the entire first semester being on site. MCPHS offers an online doctorate for practicing PAs who already hold a master's degree as a PA. UND is a little more similar to NP education, however it still requires 17 weeks on campus.

Agreed, which is why I gave a comparison to Vanderbilt.

My main complaints are a lack of a graduate gross anatomy class, no surgical training and far too few clinical hours.

These are definitely glaring deficiencies in my view, as is the "find your own preceptor" cost saving abdication by most NP programs.

[SummitRN, BSN, RN]

To me it boils down to the absence of a true accreditation agency strictly for NP education. CCNE and ACEN are simply not fulfilling the task of upholding any standards. CRNA education, with their own accrediting body for all CRNA programs, is not known for being infiltrated, if you will, by predatory for profit educational schemes, insufficient preceptor pools and inadequate clinical placements. CNM programs have their own accrediting body as well but they have allowed some degree of distance education (i.e., Frontier) but not let for profit schools open up programs.

I think this hits the nail on the head. How can NPs organize themselves to create an organization to accredit schools? Surely we have the political clout to do this as well as get state BONs to shift to that recognition?

It is an uphill fight with all the student loan money backing the for-profits...

[Dodongo, APRN, NP]

These are definitely glaring deficiencies in my view, as is the "find your own preceptor" cost saving abdication by most NP programs.

I have mixed feelings about being required to finding your own preceptors. In my own, personal, unique situation, I viewed this as a positive. My school had rules of course- must be board certified, must have at least 2 years practicing in current specialty, and they had to agree to documented hands on work and procedures. I was well connected as a working ICU nurse so it was no trouble to find physician and NP preceptors for this. Now, had I been in an FNP program, I do think it would have been a crap shoot driving around to offices handing out my resume. And I've said it before, had I not gone to an ACNP program, I would have gone to PA school.

But, for the sake of standardization (which is so severely lacking in NP education), schools should be required, for accreditation, to set-up rotations for their students.

There should be one accrediting body with clearly defined standards for programs.

[SummitRN, BSN, RN]

I have mixed feelings about being required to finding your own preceptors. In my own, personal, unique situation, I viewed this as a positive. My school had rules of course- must be board certified, must have at least 2 years practicing in current specialty, and they had to agree to documented hands on work and procedures. I was well connected as a working ICU nurse so it was no trouble to find physician and NP preceptors for this.

I totally agree. The irony is not lost that the NP education system's lax standardization may actually work out to better experiences and outcomes for those who are best prepared and best connected than were it more rigid and standardized. I am in a similar situation to you where it worked in my favor. But as you acknowledge it comes at a cost.

I find it telling that many NP students state the hardest/most stressful part of their educational endeavor was securing preceptors. There are so many things wrong with that.

[Dodongo, APRN, NP]

I totally agree. The irony is not lost that the NP education system's lax standardization may actually work out to better experiences and outcomes for those who are best prepared and best connected than were it more rigid and standardized. I am in a similar situation to you where it worked in my favor. But as you acknowledge it comes at a cost.

I find it telling that many NP students state the hardest/most stressful part of their educational endeavor was securing preceptors. There are so many things wrong with that.

Right. I think my experiences would be better than what the school could have come up with. Part of it being that I know these physicians and they were excited to have me, in particular, to come train with them. It's far more difficult with strangers in many ways I think.

I also told all my preceptors that I will be following their entire weekly schedule, because, again, NP students need WAY more hours than required in their programs. They all enthusiastically agreed.

[elkpark]

Anecdotally, I just met an FNP student last week who is starting clinical next term who said when she met with the preceptor she told him that she knows nothing. I asked her what she meant when she said nothing and she, again, said she knows nothing. She said she hasn't learned anything clinically yet. The school assumes she will learn it on her clinical rotation. The school requires 675 hours and has just 1.5 weeks on campus. Just mind boggling. I can not imagine starting rotations and not understanding how to develop a differential, what labs/exams to order, how to interpret and formulate a diagnosis. In general, all PA and MD students at least start clinical and graduate with a standard, basic knowledge base.

Why on earth would anyone agree to precept a student who freely admits she "knows nothing"??

[Dodongo, APRN, NP]

Why on earth would anyone agree to precept a student who freely admits she "knows nothing"??

He is her family medicine physician and also a family friend... so it sounds like a HUGE (maybe begrudging) favor.

[SummitRN, BSN, RN]

Quoting a very relevant post from the direct entry thread:

Tacomaboy3, I agree that the extra year should include more clinical hours along with more education that enhances your clinical skill. I know little about CRNP programs but I know my CRNA program has approx 2,600 clinical hours upon graduation. Also, for SRNAs to take boards there is a strict requirement of certain case types and certain skills that have been documented many times successfully.

I used to think all PA programs were tightly structured and regulated until 2 of my friends in a PA program recently told me they set up their own clinical sites and rotation specialties. One of their classmates wanted to live in California so she moved there and set up all her rotations there, she just flys to campus to take a test occasionally. It sounds like PA programs are structuring themeselves more like these hybrid NP programs than I realized.

[DizzyJ DHSc PA-C]

Quoting a very relevant post from the direct entry thread:

PA programs are required to set up rotations. However, if a student wants to go outside the area of the program they can seek out a preceptor, but the PA program still must vet the preceptor and have an affiliation agreement/contract in place. The program will verify the preceptor and also get feedback from the student about how well the preceptor is.

[DizzyJ DHSc PA-C]

1. Online programs

PA programs such as UND, Red Rock, Yale, Lock Haven, MCPHS and others offer programs that are either distance learning or a hybrid curriculum where some courses are online while campus visits are required similar to Vanderbilt's NP program.

UND - is a hybrid program, required 18 weeks on campus. This only applies to the didactic portion of course as all clinical rotations are in clinical setting.

Red Rock - 13 months of on-campus class/lab/small group work, followed by clinical rotations. Not sure how that equal to being online at all. There was an affiliation agreement in order to get a master's and part of those classes may have been online, but now red rock will be conferred directly by red rock starting this year.

Yale - has developed an online didactic portion with first cohort beginning Jan 2018....so they are not online right now.

Lock Haven - yes, I see they utilize "state of the art technology via highly interactice internet and instructional TV delivery"....does that compare to online NP programs? This is more that they have satellite campus locations and stream lectures and they have PA faculty at every site. So, there is a face-to-face interaction.

I'm tired.....but basically trying to make a point here that your information is not accurate. What if someone reads this and thinks oh this person must be an expert and knows what they are talking about 100%.....when you don't.

2. Part Time

While I don't know of any part time allopathic/osteopathic programs (although some will allow 5 years to lighten the intensity), there are some part time PA programs such as Drexel, Rutgers, University of Detroit,

University of Detroit - quick search they have a 5 year full time program. It is a combo bachelor/masters with 3 years doing undergrad and 2 years full time in the PA portion

Rutgers - has two routes. One being the standard masters program post bachelors and one being a combo bachelor/masters program like Detroit has. "The part-time option is offered for the first two years of a total of four years"...I can't translate as to what that really means. It states the program is predominantly full-time.

still very tired....but you get the point...you can't just give a blanket statement saying these programs are part-time when they kind of are not comparable to other part-time trained profession.