American Academy of Family Physicians thoughts on NPs

[SkiBumNP]

So this was posted on another message board. I want to get your thoughts on this

Read thru

Family Physician and Nurse Practitioner Training published by AAFP, 2008....look at what they list as the educational training for NPs and other comments. I'm insulted. Someone needs to have a chat with the folks at the American Academy of Family Physicians.....

It went on to say this:

High-quality care is the goal for family physicians and nurse practitioners.

TRUE

Family physicians complete training for complex, differential diagnoses and medical treatments.

TRUE

Nurse practitioners complete training for common diagnoses and treatments

TRUE, this goes on to say allot of BS

You know what you're getting with a physician.

TRUE, though there are many bad doctors, at least the education is standardized. WAY more than we can say for NP programs

Nurse practitioner certification can mean various levels of training.

See previous section

Clinical care is only one-third of nurse practitioner training.

It is embarrassing how little clinic training we have as NPs.

Why spend our energy on whining about what other are saying (when much is true anyway). Why don't we spend our energy making our profession better.

We need standardization in our education ... we need Recertification board exams ... we need more clinical training ... we need residencies for every NP.

We need to STOP saying "was an RN for blah blah years" - it's not the same.

[Annaiya, NP]

My personal opinion is that, regardless of what healthcare profession you go into, a significant portion of how much you learn and how large your knowledge base is is dependent on you. You don't have to only learn what a professor teaches you. It's easy to go beyond and get a more in-depth understanding of something. You just have to be willing to put in the effort to achieve that.

I think this statement really is the key. It is amazing to me how lazy some of the NP students and NPs are. I have been outright embarrassed for my chosen profession by some of my NP preceptors, by their obvious lack of knowledge in front of the MDs that they work with. The excuse they give me for not knowing something they should in their specialty? "School didn't teach us that." Never mind the fact that there are CEs offered and books out there that could teach them it, but they don't care to spend the time.

Then there are the NPs that still wear nursing scrubs, because they are cheap and comfortable. Instead of wearing professional dress, like their physician counter-parts. How you look makes a huge difference in how people treat you, and how you are viewed by your patients.

There is so much discussion about the lack of rigorous NP training on these forums, but very little discussion about other important factors that hurt our image a lot more. My experience is most physicians know very little about the details of our education, but rather form their opinions about nurses and NPs based on their experience working with them. When the NPs they work with put in no personal effort to learn their area of specialty, they will never be respected. Regardless of how much discussion there is here about the abilities of NPs vs. MDs, the fact remains that MDs spent years studying all day probably pretty much every day. And then they generally work long hours after they are done with school, never mind residency. So we will not earn their respect if we are unwilling to work as hard as they do.

[Corey Narry, MSN, RN, NP]

I think this statement really is the key. It is amazing to me how lazy some of the NP students and NPs are. I have been outright embarrassed for my chosen profession by some of my NP preceptors, by their obvious lack of knowledge in front of the MDs that they work with. The excuse they give me for not knowing something they should in their specialty? "School didn't teach us that." Never mind the fact that there are CEs offered and books out there that could teach them it, but they don't care to spend the time.

Then there are the NPs that still wear nursing scrubs, because they are cheap and comfortable. Instead of wearing professional dress, like their physician counter-parts. How you look makes a huge difference in how people treat you, and how you are viewed by your patients.

There is so much discussion about the lack of rigorous NP training on these forums, but very little discussion about other important factors that hurt our image a lot more. My experience is most physicians know very little about the details of our education, but rather form their opinions about nurses and NPs based on their experience working with them. When the NPs they work with put in no personal effort to learn their area of specialty, they will never be respected. Regardless of how much discussion there is here about the abilities of NPs vs. MDs, the fact remains that MDs spent years studying all day probably pretty much every day. And then they generally work long hours after they are done with school, never mind residency. So we will not earn their respect if we are unwilling to work as hard as they do.

I agree with what you said there but would just like to add that this observation is not limited to NP's alone. I have all due respect to the PA profession, but this lackadaisical attitude could be seen on some PA's as well.

[NPinWCH]

I want to clarify some of my statements. The PAs I know want independent practice. They don't want to be called Assistants anymore, they want independence, freedom and the ability to practice like NPs. PAs haven't been able to get their independence because they are associated with the AMA. When the only power you have comes from physicians it's hard to break away. How can you stay licensed if your authority comes from the AMA and you want independence? The AMA isn't going to give that control up, they don't like NPs on their turf, which is why they created PAs in the first place. So, while the nursing board lobbied for NPs, the AMA isn't going to lobby for PAs and neither are physicians. Why would you? You don't want more competition...

Second, I never said I was equal to an MD/DO, or had equal training to an MD/DO. I said in my family practice setting I do the same job as the MDs I work with. We all see the same patients, we all treat the same patients, refer and consult the same things. I by no means know everything and am the first to acknowledge my limitations. I run things by my colleagues if I have a question and never hesitate to do a quick consult in the hall. The docs do actually ask me or the other NP for advice at times. Sometimes, we NPs have the answer...after all we are the ones in the office the docs refer to the get their difficult patients BPs and Hgba1cs under control with diet, exercise and gasp, yes even medication adjustments.

I know my limitations, if I am not sure of something I question, refer or consult. I know that MD/DO have more training, spend more time learning, med school, internship, residency...I get it and I respect you all for it.

I am an FNP and I feel that the training I received prepared me well to care for the patient population I see. Could it be that an MD/DO is over-trained for primary care? Possibly. Could it be that the future of primary care may better be served by FNP/PA, with MD/DO as specialists? Could be. There is a VERY, VERY large shortage of MD/DO in primary care as it is...maybe this turf war is a moot point to begin with????

[AbeFrohman, BSN, RN]

I want to clarify some of my statements. The PAs I know want independent practice. They don't want to be called Assistants anymore, they want independence, freedom and the ability to practice like NPs. PAs haven't been able to get their independence because they are associated with the AMA. When the only power you have comes from physicians it's hard to break away. How can you stay licensed if your authority comes from the AMA and you want independence? The AMA isn't going to give that control up, they don't like NPs on their turf, which is why they created PAs in the first place. So, while the nursing board lobbied for NPs, the AMA isn't going to lobby for PAs and neither are physicians. Why would you? You don't want more competition...

True with the exception of why they created PAs. PAs actually existed before NPs, albeit only by a year or so. Now AAs, they were created in opposition of CRNAs. That may be where you getting confused.

Also, most do not want "independent" practice (though they do want a better MD/DO bridge than is currently available at LECOM), but I would say that most want to go to "sponsored" or "collaborative" practice that most NPs have.

[whatdoIdonow?]

I'm liking the turn in this thread to some very interesting information about both the NP and PA fields.

[myelin]

I know PAs who wish they'd become NPs, because of supervision/ind. practice issues (and the name as well, it's just god awful to be called an assistant when you're that highly skilled).

[FNPdude74]

When I call for a sick appointment with my doctor, and the receptionist tells me the only appointment available is with the NP, I feel like I am being take advantage of. The education of the NP is nowhere near that of the MD. And, the price of the appointment isn't being reduced related to the decreased amount of education of the NP. I wait to see the doctor on the off chance my condition will require that added expertise of an MD education. Sure, there are bad doctors, but the facts are the NP doesn't have the same credentials. Additionally, doesn't the NP have to operate under the license of an MD inorder to be able to write Rx's and can only write certain types of Rx's?I guess that means there are checks and balances on the NP, but that's only because of their reduced education. And why pay for the middle man when I can get the main man for the same price? I bring all this up because I'm an RN looking into my next step in education- MSN to teach, NP to go into clinical practice. When I looked into the curriculum of the PA's, it was much more science based than either. I am more comfortable seeing a PA than an NP for my medical concerns because of this education gap. So, I see the point of the article in question.

You are seriously misinformed. I'm a FNP in active duty military air force. I am allowed to prescribe it all, but choose not to prescribe certain things due to need of a specialist consult. Even as a FP doc you wouldn't give T3 for hypothyroidism because you need frequent monitoring and adjusting initially. You'd first consult with the endocrinologist and as a FP provider, you'll be managing it. I did work up a person for pheochromo and MS. You are never by yourself even as a physician. Always consult otherwise risk a lawsuit on why you didn't consult. For example, courts will ask (if you're in FP), "but you're not a neurologist and you tried to manage this person you're self? But still, you're not board certified as a neurologist." NPs in most states don't have to be under MD licenses to prescribe. WE ARE NOT UNDER THEIR LICENSE. Why do you think we take board exams to get certified and get licenses as NPs? Please get your facts straight before you post stuff like this. My physicians sometimes also consult with NPs. For example, a FP doc consulted with a derm NP in a large hospital in the military. Why? Because the NP is specialized in derm and the FP doc see many other things rather than derm issues all day. However, I do agree that we need a formal post education training. That way, we can try to cover many topics during training and be more familiar with them while practicing such as knowing which labs to order, how to interpret them, and the next plan of care.