discussion regarding education of NP (DNP) and PA compared to MD/DO

wowza · Feb 26, 2010

I didn't read the article, I think I was listening to the NBC nightly news and they mentioned something about touch. They had images of healthcare providers (I think MDs) and a waitresses. They were quoting a recent journal article; I don't recall the journal. At the time the journal sounded like respectable journal, just can't recall the name.

If you come across it, send it my way. I'd be interested in reading it. Who knows, maybe it will teach me a thing or two.

wowza · Feb 26, 2010

The truth is that these accreditation procedures for medical schools are specifically designed to limit competition and have done so since their inception. That could be one reason that the poor physicians graduate with so much student loan debt. But you certainly guessed wrong about the accreditation process for an NP program. Maybe you should complete your research and not try to be so one sided in your argument.

Perhaps you do not know the context of the accreditation. The reason the LCME is so stringent is because in the not too distant past (turn of the 20th century), medical school education was completely unstandardized and quite variable... much like the DNP curriculum now. There were schools that were just not up to par. The flexner report came out and revolutionized how education was structured and how it would become accredited.

The strict accredidation standards are to ensure quality, not to prevent competition. You can see this by the fact that multiple new schools are opening. That is why a person who graduates from the "worst" MD school is going to be similarly trained as someone who graduates from harvard. Quality is what keeps people safe in medicine. Lowering your standards for accredidation or for rigor of education endangers people' lives.

Sure, they would agree accreditation is necessary, but not to the extent that the medical profession does it to limit competition. The AMA is the most anti-competitive group in the country. I don't know what you are talking about that my argument doesn't hold water. Plenty of people agree, including federal courts:

The argument was that the LCME is making accredidation so stringent that no one else can make new schools. You then use the example that the AMA has in the past been shown to try and stamp out competition.

This is a STRAWMAN (see below). The AMA and the group that accredits medical schools are not the same. The AMA is a lobbying organization that less than 20% of doctors belong to. The LCME is only an accrediting body.

Listen to yourself on this stuff about consumers. You are saying that most people realize that they are too stupid to choose a medical provider that is right for them? I don't think that more than 50% of the population would tell you that if you polled them.
Do you really think that every poor soul who walks the earth who isn't a physician is a complete moron? I'm guessing that would include you since you claim you are not a physician. Are you actually suggesting that educated people can't understand what primary care provider is right for them?

Almost every post you have made on this thread is based on different strawman arguments. Let me define what a strawman is for you:

Strawman fallacy- it is an argument based on misrepresentation of the opponent's position and attacking that false position to create the illusion of having refuted the real supposition. Thus you have the illusion of having refuted the position by substituting a superficially similar proposition (the straw man) and refuting it, without ever having actually refuted the original position.

For instance: DG said that people do no have the needed medical knowledge to know if they are getting the proper care. I used the example of possible MRSA cellulitis being treated with Keflex.

You used the strawman by framing his argument as, "people are too stupid to choose their medical provider." You then attacked that argument based on emotion and outrage directed at the false argument.

In fact he said nothing of the sort. He said, given X provider, the patient cannot tell if that provider is giving good care or not because he does not have the same kind of medical knowledge someone in healthcare does.

I will provide more and more examples because basically every post you have is a strawman. From now on I am going to call you out each time you do this.

bajasauce07 · Feb 26, 2010

What you all fail to acknowledge is that patients are never happy if you don't provide good care. Those two are definitely mutually exclusive. You can't do a poor job and make a patient happy.

MBREAZ, you still haven't offered a rebuttal to this post of mine, I would really like to hear your thoughts:

not true. definitely not true. I don't get how you believe that. If you are nice to a diabetic patient who has protenuria on his dipstick, and you never put him on an ACE-I or ARB. A few years later he enters into renal failure that could have been prevented. As long as you are nice to the guy he'll never know the difference and be completely satisfied with you as a provider. After all, I'm sure if this happened it wouldn't be malicious, it would simply be that the provider didn't know, he would explain to the patient that renal failure is a natural part of the life of many diabetics and both would continue on their way. Seriously, the scenarios are endless. Patients do not know about a lot of what we do. How in the world do you compare a happy patient to a healthy patient? they don't equate. Apples to tigers. It's not even in the ballpark. I've run across the same thing in practice, the PCP doesn't have the patient on x medicine that is necessary according to current guidelines and I have to start it in the hospital. The patient still loves their PCP even though the PCP missed something. The patient just didn't know!

And WOWZA, as far as this :"Lowering your standards for accredidation or for rigor of education endangers people' lives. "

Let the buyer beware right? who cares? :devil:

mbreaz1 · Feb 26, 2010

Haha, where did I cry? Where did I show displeasure at the outcome? All I said was that the conclusion you reached was wrong and that the reason the courts acted against the AMA was not because they wanted consumers to choose their providers. That was the point since you appear to have missed it.
I never said anything about people choosing what medical provider is appropriate for them. You really should read my post before hitting the reply button. I said that most people don't know if they're receiving quality medical care or not because they don't have the medical knowledge to do so. It's easy for people to choose a provider. For example, you've got cancer? Easy...go to the oncologist. Heart problem? Cardiologist. See? Pretty easy. You don't have to be educated to come to those conclusions. The problem is that when the person goes to said provider, they don't know how good the medical care (not patient satisfaction, btw) they're receiving is.
Do you finally understand what we're saying now? Or are you still going to stick with that same line of yours saying that we're crying and that we're scared of competition?
Edit: Also, everytime someone provided a study, I did counter it and broke down exactly what was wrong with the studies. Do you really not remember? I debunked a couple of studies you yourself linked. Go back and look at my previous posts if you need to refresh your memory. It's YOU who doesn't provide any evidence. Remember you're the one who said you don't need any studies to show that NPs/DNPs are better than physicians because you see it everyday? Yea, that was you. You're the one who refuses to critically analyze studies, not me. So, you're turning a bit hypocritical now, aren't you? You're losing a logical argument by failing to provide logical counterarguments and thus, you're resorting to personal attacks (ie. calling others stupid for disagreeing with you) and making up stuff (ie. that whole previous post of yours regarding what I wrote).

What you wrote is that the case had nothing to do with competition and consumer choice when in fact that is all it is about. The fact is that you don't ever really debunk anything. You simply say that it is untrue because it is contrary to your own opinion. You don't ever analyze anything. You obviously didn't analyze that case. Here is what you said: "Once again, nothing about letting consumers choose their provider. Most people would realize that "consumers" who don't know much about what they're buying (ie. medical care) would probably choose poorly." Now you are backpedaling and saying that isn't what you said. So I did READ your post and I did CRITICALLY ANALYZE it. You said that most people would tell you that they are too stupid to choose their own provider. That is what everyone who posts on here seems to contend. They think that everyone outside of the healthcare realm is too much of a fool to be able to understand the difference between a physician and a nurse practitioner and to be able to choose between the two. That is the whole premise of your argument. People do this in the use of a number of other professionals. There is no reason that it can't work in medicine. I guess the person doesn't know whether every little detail of their treatment is absolutely perfect or not, but "good care" is a subjective term by it's very nature. What that means is that what you consider to be good care, might even be different from another provider's opinion. Medicine is truly more of an art than it is a science. So why should you be able to push your values about what you think is "good care" onto another person's body. What this is all about is choice and competition, and you don't want either of them because it doesn't advance your position. DO you understand what I am saying now? Can you hear me?

You have never offerred a shred of true evidence. I am the only one who ever did that. You sit back and ask people to provide evidence so that you can discount it by simply saying that it isn't true, is poorly designed, or doesn't prove anything. What I have proven here is that the federal courts have agreed that the AMA is an anti-comptitive organization, to which I have heard absolutely no rebuttal. I stand behind the fact that there needs to be no further research to prove that NPs can and should practice independently. That is all that I said about there needing to be no research.

mbreaz1 · Feb 26, 2010

Perhaps you do not know the context of the accreditation. The reason the LCME is so stringent is because in the not too distant past (turn of the 20th century), medical school education was completely unstandardized and quite variable... much like the DNP curriculum now. There were schools that were just not up to par. The flexner report came out and revolutionized how education was structured and how it would become accredited.
I know all about the the Flexner report and it's aims. There were schools that we not up to par, but there were also profound criticisms of the process and they were made by physicians and medical educators. The Flexner report revolutionized medical education, but it also eliminated a number of quality institutions based on the fact that they were small, not the fact that they were not up to par. It had the effect of limiting competition in the medical education arena. In fact, that was a part of the aim of the inquisition. You are so critical of everyone's opinion who is not an allopath, but you then talk about how revolutionary and wonderful Flexner was, when he had absolutely no background. He was almost completely ignorant of anything in the medical arena, but you think he was qualified to determine what accreditation for a medical educational institution should be? And yet you still contend that a non-medical person is completely ignorant of what good care is? I may be too stupid to put this together because I am not an allopath, but that sounds like a major contradiction to me.
The strict accredidation standards are to ensure quality, not to prevent competition. You can see this by the fact that multiple new schools are opening. That is why a person who graduates from the "worst" MD school is going to be similarly trained as someone who graduates from harvard. Quality is what keeps people safe in medicine. Lowering your standards for accredidation or for rigor of education endangers people' lives.
It is not about lowering standards, it is about leveling the playing field to increase competition and lower costs.
The argument was that the LCME is making accredidation so stringent that no one else can make new schools. You then use the example that the AMA has in the past been shown to try and stamp out competition.
This is a STRAWMAN (see below). The AMA and the group that accredits medical schools are not the same. The AMA is a lobbying organization that less than 20% of doctors belong to. The LCME is only an accrediting body.
I never said that the AMA and accrediting bodies were one in the same, so your whole strawman tirade is just a bunch of garbage. You mentioned that you didn't think the AMA was anticompetitive, so I gave you one of the many examples of their anticompetitive behavior. If you care to offer a rebuttal to that, why don't you show me some proof that the AMA is not anticompetitive. You are confusing the arguments. I guess that allopathic education confuses the mind when it comes to critical thinking. Too much science floating around up there to allow for much actual thinking.

mbreaz1 · Feb 26, 2010

MBREAZ, you still haven't offered a rebuttal to this post of mine, I would really like to hear your thoughts:
not true. definitely not true. I don't get how you believe that. If you are nice to a diabetic patient who has protenuria on his dipstick, and you never put him on an ACE-I or ARB. A few years later he enters into renal failure that could have been prevented. As long as you are nice to the guy he'll never know the difference and be completely satisfied with you as a provider. After all, I'm sure if this happened it wouldn't be malicious, it would simply be that the provider didn't know, he would explain to the patient that renal failure is a natural part of the life of many diabetics and both would continue on their way. Seriously, the scenarios are endless. Patients do not know about a lot of what we do. How in the world do you compare a happy patient to a healthy patient? they don't equate. Apples to tigers. It's not even in the ballpark. I've run across the same thing in practice, the PCP doesn't have the patient on x medicine that is necessary according to current guidelines and I have to start it in the hospital. The patient still loves their PCP even though the PCP missed something. The patient just didn't know!
And WOWZA, as far as this :"Lowering your standards for accredidation or for rigor of education endangers people' lives. "
Let the buyer beware right? who cares?

Here is the key to your whole argument, the PCP in your scenario lied to their patient and acted unethically. Are you saying that primary care physicians routinely lie to their patients about their mistakes? If that is the case, you are correct, patients can't get a good idea of what quality of care they are getting because physicians are basically defrauding them. If the scenarios are endless, it seems to me that what you are saying is that a great deal of lying is going on out there and the only way to deminish the lying is to open the physicians up to competition so that more transparency is provided to the patient.

We are definitely not talking about "lowering" standards for accreditation. What we are talking about here is a redistribution of the power to make the judgement calls on what the standards should be and how they should be applied. When the power is in the hands of a few who deem themselves to be acting in the best interest of the public, they have the power to do things that are in their own self interest under the guise of that action. Typically, they do act in their own self interest because that is human nature. When they are allowed to do so with no oversight on that power, they can become a tyrant and completely forget about the interests of the public.

"This and no other is the root from which a tyrant springs; when he first appears he is a protector." -Plato

springing · Feb 26, 2010

Sure, they would agree accreditation is necessary, but not to the extent that the medical profession does it to limit competition. The AMA is the most anti-competitive group in the country. I don't know what you are talking about that my argument doesn't hold water. Plenty of people agree, including federal courts:
in Wilk v. American Medical Association (1990), a federal court concluded that it was anticompetitive for the AMA to pass an "accreditation rule" that forced hospitals to exclude chiropractors from access to medical facilities. The AMA claimed the exclusion was necessary because the chiropractors were not using proven methods of health care. However, the court decided that this choice should be made by consumers themselves and not through coerced exclusion of chiropractors from the market.

That does not have anything to do with whether DNP accreditation is equal to allopathic accreditation - or your claim that the LCME makes tuition burdens increase for matriculants.

Wowza's statement that the worst medical school prepares you as well or nearly as well as Harvard is true. This is why, when choosing residents for their programs, the residency directors don't really care where you went to school.

http://www3.interscience.wiley.com/journal/119827010/abstract?CRETRY=1&SRETRY=0

"Items ranking as most important (4.0-5.0) in the selection process included: EM rotation grade (mean ± SD = 4.79 ± 0.50), interview (4.62 ± 0.63), clinical grades (4.36 ± 0.70), and recommendations (4.11 ± 0.85). Moderate emphasis (3.0-4.0) was placed on: elective done at program director's institution (3.75 ± 1.25), U.S. Medical Licensing Examination (USMLE) step II (3.34 ± 0.93), interest expressed in program director's institution (3.30 ± 1.19), USMLE step I (3.28 ± 0.86), and awards/achievements (3.16 ± 0.88). Less emphasis (

http://journals.lww.com/academicmedicine/Fulltext/2009/03000/Selection_Criteria_for_Residency__Results_of_a.24.aspx

This one ranks medical school reputation as the 9th most important criterion for choosing a resident, after clinical grades, Step 1 scores (sounds like study #1, doesn't it?) and a host of other factors.

Can you really say that ALL DNP programs are quality?

mbreaz1 · Feb 26, 2010

That does not have anything to do with whether DNP accreditation is equal to allopathic accreditation - or your claim that the LCME makes tuition burdens increase for matriculants.
Wowza's statement that the worst medical school prepares you as well or nearly as well as Harvard is true. This is why, when choosing residents for their programs, the residency directors don't really care where you went to school.
http://www3.interscience.wiley.com/journal/119827010/abstract?CRETRY=1&SRETRY=0
"Items ranking as most important (4.0-5.0) in the selection process included: EM rotation grade (mean ± SD = 4.79 ± 0.50), interview (4.62 ± 0.63), clinical grades (4.36 ± 0.70), and recommendations (4.11 ± 0.85). Moderate emphasis (3.0-4.0) was placed on: elective done at program director's institution (3.75 ± 1.25), U.S. Medical Licensing Examination (USMLE) step II (3.34 ± 0.93), interest expressed in program director's institution (3.30 ± 1.19), USMLE step I (3.28 ± 0.86), and awards/achievements (3.16 ± 0.88). Less emphasis (

http://journals.lww.com/academicmedicine/Fulltext/2009/03000/Selection_Criteria_for_Residency__Results_of_a.24.aspx

This one ranks medical school reputation as the 9th most important criterion for choosing a resident, after clinical grades, Step 1 scores (sounds like study #1, doesn't it?) and a host of other factors.

Can you really say that ALL DNP programs are quality?

Let's just examine your initial argument. You said that there is an accreditation process for medical schools. I agreed but said that it is an anticompetitive process. You implied that there was no accreditation process for nurse practitioner programs, which I asked you to prove. YOU DID NOT. Then you said that the AMA was not anticompetitive, to which I offerred one of the many items of proof that they are indeed anticompetitive. You had no response to that. Now you are trying to tell me that because medical schools don't care where you went to school, and because they rank medical school reputation as the 9th most important criteria for choosing a resident that they are of higher quality than any DNP program? You also think that allowing physicians to artificially limit the number of medical schools and the entrants to the programs doesn't drive up costs? That sounds a little delusional to me. By the way, the second link is a survey. I believe that at least one of you or your PA colleagues on here has told me that surveys don't constitute scientific evidence and are completely irrelevant. So what exactly is it that you think you have proven with this post? I thought you were in favor of "evidence based posting". Isn't that what you guys call it?

Ranier · Feb 26, 2010

Osteopathic medical schools have, on average, higher tuitions than LCME schools despite being regulated by the AOA. And the AOA is certainly less anti-competitive in its accredidation policies; the number of osteopathic seats has rapidly outpaced that of allopathic school, with new schools and expansion branch campuses opening practically every year. They have even allowed the accredidation of a private for-profit school (RVU in Colorado). I would also add that most offshore/Caribbean med schools have similar tuitions despite also not being under LCME regulation.

I can't see clear evidence that the restrictive monopolistic accredidation tactics of the "AMA" are to blame for high med school tuition given that most non-LCME schools (ie, those in direct competition for students with the LCME schools) have even higher costs.

wowza · Feb 26, 2010

I never said that the AMA and accrediting bodies were one in the same, so your whole strawman tirade is just a bunch of garbage. You mentioned that you didn't think the AMA was anticompetitive, so I gave you one of the many examples of their anticompetitive behavior. If you care to offer a rebuttal to that, why don't you show me some proof that the AMA is not anticompetitive. You are confusing the arguments. I guess that allopathic education confuses the mind when it comes to critical thinking. Too much science floating around up there to allow for much actual thinking.

Actually my point that you keep creating strawman arguments is very valid. Especially since you have done it a few times since I posted my "tirade" about the inconsistencies of your arguments.

Your post above is again a strawman argument. I made no claim that the AMA was or was not against competition. What I said was this argument is not about DNPs competing against doctors because there are enough patients to go around. What it is about (as I said in the post you are referring to) is that it is about lowering standards. Stop misquoting me and please stop using Strawman arguments.

Let's just examine your initial argument. You said that there is an accreditation process for medical schools. I agreed but said that it is an anticompetitive process. You implied that there was no accreditation process for nurse practitioner programs, which I asked you to prove. YOU DID NOT. Then you said that the AMA was not anticompetitive, to which I offerred one of the many items of proof that they are indeed anticompetitive. You had no response to that. Now you are trying to tell me that because medical schools don't care where you went to school, and because they rank medical school reputation as the 9th most important criteria for choosing a resident that they are of higher quality than any DNP program?
You also think that allowing physicians to artificially limit the number of medical schools and the entrants to the programs doesn't drive up costs? That sounds a little delusional to me. By the way, the second link is a survey. I believe that at least one of you or your PA colleagues on here has told me that surveys don't constitute scientific evidence and are completely irrelevant. So what exactly is it that you think you have proven with this post? I thought you were in favor of "evidence based posting". Isn't that what you guys call it?

Yet again a strawman argument.

What he said was that, residencies do not care what medical school an applicant went to because the education is standardized at a high quality. It was in support of my claim that it doesn't really matter if you go to harvard or a "low tier" school because the education will be just as good. It was also in support of the strict LCME accredidation standards.

And for the record, the accredidation process is not anticompetitive. It will allow anyone to create a school as long as they meet the required standards of the LCME. If you want to set up a school. Great. You can. You just need to meet the appropriate standards. If you are really worried about it, you can still open up a medical school in the US that will be unaccredited.

Osteopathic medical schools have, on average, higher tuitions than LCME schools despite being regulated by the AOA. And the AOA is certainly less anti-competitive in its accredidation policies; the number of osteopathic seats has rapidly outpaced that of allopathic school, with new schools and expansion branch campuses opening practically every year. They have even allowed the accredidation of a private for-profit school (RVU in Colorado). I would also add that most offshore/Caribbean med schools have similar tuitions despite also not being under LCME regulation.
I can't see clear evidence that the restrictive monopolistic accredidation tactics of the "AMA" are to blame for high med school tuition given that most non-LCME schools (ie, those in direct competition for students with the LCME schools) have even higher costs.

Good point.

Note that osteopathic schools have been expanding rapidly. The osteopathic students take the exact same courses as MD students (but add a manipulation technique called OMM) and have the same hours in rotations.

springing · Feb 26, 2010

MEDICAL SCHOOL accreditation procedures (taken from http://www.lcme.org/newschoolprocess.htm ):

A medical school obtains "Candidate School" status when:

1. It has paid the $25,000 application fee to the LCME to begin the process of applying for preliminary accreditation; and

2. LCME and CACMS Secretariat staff have determined that the school meets the basic eligibility requirements to apply for accreditation (i.e., a current or anticipated charter in the U.S. or Canada and plans to offer the educational program in the U.S. or Canada); and

3. The school has submitted the required medical education database and planning self-study documents, which have been favorably reviewed by the LCME (and, for Canadian schools, also by the CACMS); and

4. Approval has been granted by the LCME for a site visit for preliminary accreditation.

A medical school achieves "Preliminary Accreditation" status when:

1. It submits a modified medical educational database and a self-study summary to the LCME; and

2. An LCME team completes a survey visit at the medical school and prepares a report of its findings for consideration by the LCME at its next regularly scheduled meeting; and

3. The LCME reviews the survey team's report and determines that the program leading to the M.D. degree meets the standards outlined in the LCME document, Guidelines for New and Developing Medical Schools; and

4. The LCME votes to grant preliminary accreditation to the program for an entering class in an upcoming academic year.

Once preliminary accreditation is granted, the program may begin to recruit applicants and accept applications for enrollment. If the program does not enroll a charter class within two years of its receipt of preliminary accreditation, it must reapply for preliminary accreditation as a new program and pay a reapplication fee.

A medical school achieves "Provisional Accreditation" status, after it receives preliminary accreditation and enrolls a charter class, when:

1. It submits a modified medical educational database and a self-study summary to the LCME; and

2. An LCME team completes a limited survey visit prior to the midpoint of the second year of the curriculum to review progress toward implementation of the educational program leading to the M.D. degree and the status of planning for later stages of the program, and prepares a report of its findings for consideration by the LCME at its next regularly scheduled meeting; and

3. The LCME reviews the survey team's report and determines that the program leading to the M.D. degree meets the standards outlined in the LCME document, Guidelines for New and Developing Medical Schools; and

4. The LCME votes to grant provisional accreditation to the program.

Once provisional accreditation has been granted, students enrolled in the program can continue their medical studies in the third and fourth years of medical education, and the program can continue to enroll new students.

A medical school achieves "Full Accreditation" status, after it receives provisional accreditation, when:

1. It submits a modified medical educational database and a self-study summary to the LCME; and

2. An LCME team completes a full accreditation survey visit that takes place late in the third year or early in the fourth year of the curriculum, and prepares a report of its findings for consideration by the LCME at its next regularly scheduled meeting; and

3. The LCME reviews the survey team's report and determines that the program leading to the M.D. degree fully complies with all LCME accreditation standards; and

4. The LCME votes to grant full accreditation to the program for the balance of an eight-year term that began when the program was granted preliminary accreditation status.

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MSN/DNP PROGRAM accreditation procedures (taken from http://www.aacn.nche.edu/Accreditation/pdf/Procedures.pdf ):

1. The program conducts a self-study process (self-assessment), which generates a document addressing the program’s assessment of how it meets CCNE’s accreditation standards. The self-study document that results from this assessment should identify the program's strengths and action plans for improvement.

2. An evaluation team of peers is appointed by the Commission to visit the program in order to validate the findings of the self study and to determine whether the program meets all accreditation standards and whether there are any compliance concerns with the key elements. Acting as a fact-finding body, the evaluation team prepares a report for the institution and for CCNE.

3. The program is provided with an opportunity to respond to the evaluation team report. Additional and/or updated information to support compliance and continuous quality improvement may be submitted at this time.

4. The self-study document, the evaluation team report, and the program’s response are reviewed by the ARC, which makes a recommendation regarding accreditation to the Board.

5. The CCNE Board, taking into consideration the ARC recommendation, decides whether to grant, deny, reaffirm, or withdraw accreditation of the program; or to issue a show cause directive. If accreditation is denied or withdrawn, the institution is accorded an opportunity to appeal the decision.

6. The Commission periodically reviews accredited programs between on-site evaluations in order to monitor continued compliance with CCNE standards, as well as progress in improving the quality of the educational program. This process is reinitiated every 10 years or sooner, depending on the success of the program in demonstrating continued compliance and improvements in the quality of the educational program.

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That does not in ANY WAY seem equivalent. And keep in mind there are many online NP programs where the school provides guidelines and approves your self-arranged clinicals but does not TRULY KNOW what is going on in those clinicals. That would be absolutely unheard of for a medical school, where your initial clinical rotations have to be approved before beginning and are observed during the first years they occur.

prairienp · Feb 26, 2010

medical school accreditation procedures (taken from http://www.lcme.org/newschoolprocess.htm ):
that does not in any way seem equivalent. and keep in mind there are many online np programs where the school provides guidelines and approves your self-arranged clinicals but does not truly know what is going on in those clinicals. that would be absolutely unheard of for a medical school, where your initial clinical rotations have to be approved before beginning and are observed during the first years they occur.

having been through several np accreditations in my life and never a medical school accreditation i cant say if they are or are not equal. have you been through both? i have been through regional accreditations for a university as my only comparisons. i can tell you the process between a regional and a np are about the same, except for the major difference of one being a program and the other a university. self assessment is a long process based on criteria from the accrediting body. the assessment is closely scrutinized, in my experience the nursing accreditation was more intense, probably due to the difference in material that was being covered.