I have been following your discussions here on the recent media coverage of the primary gap, and NPs place in it. I posted this on another forum that I moderate, and felt it was only fair to give you all a chance to chime in. I hope it doesn't come across as an attack, but rather a clinician of a different stripe with some real questions about how we market ourselves. The text below is addressed to PAs, so read in that context:
I have been reading the coverage of the recent articles from CNN and Time that we discuss here, in particular the responses on allnurses.
Of course I have to provide my PA disclaimer.....I work with NPs.....about a dozen of them at my institution. I have never had a negative experience with any of them, and have no need to write a "hit piece". We confer, they give medical feedback, I give surgical, etc....collegial and pleasant.
That being said, I have read over and over again about the presumed advantage NPs provide over docs (this is in their words) becuase they offer a "nursing perspective", "treat the patient, not the disease", "look at the patient as a whole", "offer prevention as well as treatment", etc.....
I really don't see this as NP bashing, but I see these comments as somewhat elitist....or at least "leading the argument". The NPs I work with practice the same medicine (!) as the rest of us, PAs, MDs, etc. Their preop cardiac workups look just like any other. And they're good. A clinic NP treating OM...are they really offering that much of an edge over a non-NP due to their nursing background? What does the nursing backgroud teach about listening, empathy, and thinking about interdependent body systems that our medical model education does not?
This all seems like a phoney selling point that is SO subjective that there is no way to argue it, putting NPs in a position which is easy to defend and impossible to refute.
Thoughts?
Do you feel like you treat your patients any less holistically b/c you were trained in the medical model?
Let's go ahead and quantify what you mean by making a living. If they really love it so much, why wouldn't they be willing to do the job for 100,000 a year as opposed to the 160,000 they are currently making. You say the reimbursements are too low to maintain cost, and that is a lie. There are no physicians going out of business because they can't maintain costs. They do however refuse to cut costs to run their practice in a manner where they spend the time they should with patients. Reimbursement cuts are coming. Best figure out how to cut those costs or the NPs will take over the field.
There are MANY physicians going out of business or enter group practice because they can't maintain costs. Many are doing the job for much less than the average salary of around $170,000 (hence the average) and then factor in the average $150,000 debt that they carry after medical school.
We never were talking about mirroring the scope of practice. We are simply talking about independent practice. The educational/training/testing model does not have to be the same in order for that to happen. I'm not sure what fantasy land you are living in, but that simply isn't true. Part of the reason that people prefer NPs is because they do have different training.
If a healthcare practitioner is in independent practice then their scope of practice should mirror that of a physician. If you are offering the same services as that of a physician then why should the scope of practice differ ? Yes, NPs have different training and is not a clinical doctorate or masters but a doctorate in nursing practice with greatly decreased clinical time.
The thing that worries me is (from American College of Nurse Practitioners:
Education and certification requirements vary.
Forty-two states require national certification as part of NP licensure.
Just over half of the states require NPs to be prepared with a master's degree, while
some states only require completion of a few months of post-RN education.
You obviously don't understand how a free market economy works. When you offer your services to the market, you get paid the same as the guy down the street who is offerring the same service. Unless you offer more value. That is the whole point, physicians do not offer good value in primary care. They offer terrible value. And no, you don't need studies that prove NPs are better. All you need to do is ask their patients if they would like to see them in independent practice. Your problem is that you think medicine is all science is all there is to healing people. That is far from the truth.
Wow...now I finally understand why NP curricula have so many statistics courses. It seems you still don't understand how studies work.
You absolutely need studies in order to support your theory that NPs provide equivalent care as physicians. Your word is worth next to nothing without evidence.
You do realize that the average patient has absolutely no idea what good medical care is right? Patient satisfaction surveys are a horrible way to assess medical competency of a provider. I satisfy a lot of people; does that mean I'm a spectacular health care provider? With your logic, it appears I am. I don't think only science can heal people. But at least I don't completely disregard science like you seem to. The gist of your argument so far has been:
More education is not beneficial
You don't need basic science courses
You don't need enough clinical training
Learning on the job is more than enough
Physicians are greedy
NPs/DNPs are the same as physicians and should be reimbursed as such
Because patients are more satisfied with NPs, it means that NPs provide superior care compared to physicians
Medicine doesn't really use much science
Did I get that right so far? My problem isn't that I think science is the only thing that matters in medicine. You're putting words in my mouth again just like you did in the other thread. However, you seem to make the non-science part of medicine much more important than the science part. Without the science part, there can't be medicine. No matter how compassionate or nice you are, Uncle Bill's glioma isn't going to magically disappear because he felt satisfied with you.
How would NPs/DNPs be offering more value than PCPs? You're saying they should be reimbursed equally. So what you're saying is that even though NPs/DNPs have lesser training, they offer more value than physicians who have gone through a rigorous medical training? Something in your logic doesn't make sense. You're arguing for equal pay and then are saying that the lesser trained one provides more value for society. Huh?
You also conveniently keep avoiding answering my question about letting M4s practice. I have provided evidence (multiple links to NP/DNP program curricula and MD curricula) and have shown that an M4 has much superior training than NPs/DNPs have. Why not let them practice independently? I have offered this solution to the PCP shortage that wouldn't have to depend on lesser trained individuals practicing independently. This is good news for the patients because they get better trained health-care providers. Will you just tell me to "quit cryin" like you did in the other thread when I posted nothing but absolute facts whereas you didn't?
You haven't provided a single shred of evidence as to why NPs/DNPs should practice independently nor have you provided any evidence as to why NP training is adequate enough to practice without physician oversight. You keep saying that education is not beneficial and that what you learn on the job is good enough. That makes no sense. Physicians go through med school and residency before they're allowed to practice independently; why should you, with significantly inferior training, be allowed to practice independently?
You keep saying you care about patients only. However, if you truly cared for your patients, you wouldn't be saying that NPs/DNPs have equivalent training as physicians nor would you be saying that a better trained healthcare provider is not necessarily a good thing. It sounds to me like you just want to be a doctor without actually putting in the effort to become one. Unfortunately, no matter what the nursing organization says, the path to becoming a physician is NOT by becoming a nurse; there are no shortcuts in medicine.
Why would you demand to teach quantum mechanics when you only have the knowledge base to understand high school algebra? You may understand some basic/common sense thing, but beyond that, you just don't have the knowledge base. Similarly, just because you take one pathophys course (!!!) doesn't mean you can provide equivalent care as a physician who spends all of M2 studying path and spends the rest of his/her training (many years) practicing and understanding pathology/pathophys before becoming comfortable enough to practice independently.
There are MANY physicians going out of business or enter group practice because they can't maintain costs. Many are doing the job for much less than the average salary of around $170,000 (hence the average) and then factor in the average $150,000 debt that they carry after medical school.
And yet I still find myself having a hard time shedding the first tear for them, along with most of the rest of America. I wonder why? Could it be that is because they make more than three times the US median household income? And again, it has nothing to do with maintaining costs, they just don't understand how to cut costs.
Wow...now I finally understand why NP curricula have so many statistics courses. It seems you still don't understand how studies work.
You absolutely need studies in order to support your theory that NPs provide equivalent care as physicians. Your word is worth next to nothing without evidence.
You do realize that the average patient has absolutely no idea what good medical care is right? Patient satisfaction surveys are a horrible way to assess medical competency of a provider. I satisfy a lot of people; does that mean I'm a spectacular health care provider? With your logic, it appears I am. I don't think only science can heal people. But at least I don't completely disregard science like you seem to. The gist of your argument so far has been:
More education is not beneficial
You don't need basic science courses
You don't need enough clinical training
Learning on the job is more than enough
Physicians are greedy
NPs/DNPs are the same as physicians and should be reimbursed as such
Because patients are more satisfied with NPs, it means that NPs provide superior care compared to physicians
Medicine doesn't really use much science
Did I get that right so far? My problem isn't that I think science is the only thing that matters in medicine. You're putting words in my mouth again just like you did in the other thread. However, you seem to make the non-science part of medicine much more important than the science part. Without the science part, there can't be medicine. No matter how compassionate or nice you are, Uncle Bill's glioma isn't going to magically disappear because he felt satisfied with you.
How would NPs/DNPs be offering more value than PCPs? You're saying they should be reimbursed equally. So what you're saying is that even though NPs/DNPs have lesser training, they offer more value than physicians who have gone through a rigorous medical training? Something in your logic doesn't make sense. You're arguing for equal pay and then are saying that the lesser trained one provides more value for society. Huh?
You also conveniently keep avoiding answering my question about letting M4s practice. I have provided evidence (multiple links to NP/DNP program curricula and MD curricula) and have shown that an M4 has much superior training than NPs/DNPs have. Why not let them practice independently? I have offered this solution to the PCP shortage that wouldn't have to depend on lesser trained individuals practicing independently. This is good news for the patients because they get better trained health-care providers. Will you just tell me to "quit cryin" like you did in the other thread when I posted nothing but absolute facts whereas you didn't?
You haven't provided a single shred of evidence as to why NPs/DNPs should practice independently nor have you provided any evidence as to why NP training is adequate enough to practice without physician oversight. You keep saying that education is not beneficial and that what you learn on the job is good enough. That makes no sense. Physicians go through med school and residency before they're allowed to practice independently; why should you, with significantly inferior training, be allowed to practice independently?
You keep saying you care about patients only. However, if you truly cared for your patients, you wouldn't be saying that NPs/DNPs have equivalent training as physicians nor would you be saying that a better trained healthcare provider is not necessarily a good thing. It sounds to me like you just want to be a doctor without actually putting in the effort to become one. Unfortunately, no matter what the nursing organization says, the path to becoming a physician is NOT by becoming a nurse; there are no shortcuts in medicine.
Why would you demand to teach quantum mechanics when you only have the knowledge base to understand high school algebra? You may understand some basic/common sense thing, but beyond that, you just don't have the knowledge base. Similarly, just because you take one pathophys course (!!!) doesn't mean you can provide equivalent care as a physician who spends all of M2 studying path and spends the rest of his/her training (many years) practicing and understanding pathology/pathophys before becoming comfortable enough to practice independently.
I absolutely understand how studies work. I just don't agree that your need to see evidence that NPs provide equivalent care to physicians should have to be satisfied in order to change the law. You have been shown numerous studies that provide this evidence, however you discount them as being skewed or come back with some ludicrous argument about how the NPs in the study were supervised, so it doesn't prove the point. Then you claim to provide facts to support your opinions but the only study you came up with comparing NPs to physicians is something that has to do with specialty practice. We aren't talking about specialty practice here, we are discussing primary care. So that study however inaccurate it may be isn't relevant anyway. The point I keep making about studies is, that you don't need them to change the law, all you need is public opinion and the stroke of a pen.
I don't disregard the science, but I don't think it is more than half of the equation. I also don't think that every patient that walks in the door is a moron and can't decide whether or not the service was good. Alot of patients are smarter than you think, and physicians aren't the only people in the world who know something. The gist of your argument so far has been:
Physicians are the smartest people in the world
Physician training is superior to that of all professsions
Nobody on earth can have even a minute understanding of medicine if they aren't a physician because they just simply aren't smart enough
It is impossible to learn how to do what a physician does unless you walk through the doors of a medical school for a few years
Physicians deserve to get paid more than everyone else for doing the same job
Patients are just plain stupid if they like a provider who spends more time with them and provide better outcomes because they could have a physician with an extra year of training who only has 5 minutes to spend with them because they have to make $150,000 per year
Instead of using a qualified workforce of NPs who are ready and willing to provide services at a lesser reimbursement rate than current physician reimbursements, we should forgive student loans for physicians, increase their reimbursement rates, and give them immunity from being punished in the courts even if they are careless and negligent and make mistakes because they want to run 50 patients through their office a day.
Did I get that right so far? My problem isn't that I think science is not a part of medicine. You're putting words in my mouth again just like you did in the other thread and you are doing in this one. Medicine existed long before science did. How can you argue that without science there can be no medicine? People have diseases and are healed numerous times when medicine can't explain it, so don't go saying that science is 99% of medicine. Furthermore, studies can be skewed. Even if the data are empirical, results are open to interpretation, so let's not try to say that studies provide facts. They do provide evidence, but the evidence is subjective.
The reason NPs offer more value is that they spend more time listening, diagnosing, treating, and preventing that physicians do. That is the NP model. Many patients do see more value in that than they do in the extra year of MD training. Furthermore, they do the same job, which deserves the same reimbursement. Value is quantity divided by price. If you do more for less money, you provider better value.
Who cares about M4s? You keep bringing them up, but that isn't relevant to the discussion.
Again, the difference is only one year of education. I don't see why you think this is such a huge difference. The only evidence you have provided is a few course listings from some sample programs. You haven't attended the courses, you don't know what they teach, and you haven't even shown us a syllabus to prove what the course is all about.
NP training isn't a shortcut, just a different route. The training is different. Some people may prefer a physician, and some may prefer an NP. All I am saying is that people deserve the right to choose the provider they want. They don't deserve to have a physician dictate that because they were trained according to a certain model.
If a healthcare practitioner is in independent practice then their scope of practice should mirror that of a physician. If you are offering the same services as that of a physician then why should the scope of practice differ ? Yes, NPs have different training and is not a clinical doctorate or masters but a doctorate in nursing practice with greatly decreased clinical time.
The thing that worries me is (from American College of Nurse Practitioners:
Education and certification requirements vary.
Forty-two states require national certification as part of NP licensure.
Just over half of the states require NPs to be prepared with a master's degree, while
some states only require completion of a few months of post-RN education.
I absolutely understand how studies work. I just don't agree that your need to see evidence that NPs provide equivalent care to physicians should have to be satisfied in order to change the law. You have been shown numerous studies that provide this evidence, however you discount them as being skewed or come back with some ludicrous argument about how the NPs in the study were supervised, so it doesn't prove the point. Then you claim to provide facts to support your opinions but the only study you came up with comparing NPs to physicians is something that has to do with specialty practice. We aren't talking about specialty practice here, we are discussing primary care. So that study however inaccurate it may be isn't relevant anyway. The point I keep making about studies is, that you don't need them to change the law, all you need is public opinion and the stroke of a pen.
I don't disregard the science, but I don't think it is more than half of the equation. I also don't think that every patient that walks in the door is a moron and can't decide whether or not the service was good. Alot of patients are smarter than you think, and physicians aren't the only people in the world who know something. The gist of your argument so far has been:
Physicians are the smartest people in the world
Physician training is superior to that of all professsions
Nobody on earth can have even a minute understanding of medicine if they aren't a physician because they just simply aren't smart enough
It is impossible to learn how to do what a physician does unless you walk through the doors of a medical school for a few years
Physicians deserve to get paid more than everyone else for doing the same job
Patients are just plain stupid if they like a provider who spends more time with them and provide better outcomes because they could have a physician with an extra year of training who only has 5 minutes to spend with them because they have to make $150,000 per year
Instead of using a qualified workforce of NPs who are ready and willing to provide services at a lesser reimbursement rate than current physician reimbursements, we should forgive student loans for physicians, increase their reimbursement rates, and give them immunity from being punished in the courts even if they are careless and negligent and make mistakes because they want to run 50 patients through their office a day.
Did I get that right so far? My problem isn't that I think science is not a part of medicine. You're putting words in my mouth again just like you did in the other thread and you are doing in this one. Medicine existed long before science did. How can you argue that without science there can be no medicine? People have diseases and are healed numerous times when medicine can't explain it, so don't go saying that science is 99% of medicine. Furthermore, studies can be skewed. Even if the data are empirical, results are open to interpretation, so let's not try to say that studies provide facts. They do provide evidence, but the evidence is subjective.
The reason NPs offer more value is that they spend more time listening, diagnosing, treating, and preventing that physicians do. That is the NP model. Many patients do see more value in that than they do in the extra year of MD training. Furthermore, they do the same job, which deserves the same reimbursement. Value is quantity divided by price. If you do more for less money, you provider better value.
Who cares about M4s? You keep bringing them up, but that isn't relevant to the discussion.
Again, the difference is only one year of education. I don't see why you think this is such a huge difference. The only evidence you have provided is a few course listings from some sample programs. You haven't attended the courses, you don't know what they teach, and you haven't even shown us a syllabus to prove what the course is all about.
NP training isn't a shortcut, just a different route. The training is different. Some people may prefer a physician, and some may prefer an NP. All I am saying is that people deserve the right to choose the provider they want. They don't deserve to have a physician dictate that because they were trained according to a certain model.
Please stop putting words in my mouth. It discredits your argument when you make things up and attribute it to me. Please point out where I have said that physicians are the smartest, have the best training out of any profession, that no one else is smart enough to understand medicine, etc. Really, point it out where I've said that. You're refusing to face the facts and are resorting to making up things. You on the other hand, HAVE insisted that NP training is good enough to make them equivalent to physicians, you HAVE said that physicians are greedy, you HAVE said that NPs are superior healthcare providers because of the results of patient satisfaction surveys, etc.
And I really don't think you have any idea what the value or purpose of studies are. You have to show evidence that NP outcomes are similar to that of attending physicians (you know, those who have completed their training).The burden of proof is on YOU to design valid studies; it's NOT on your opponents. As both myself and many others have pointed, there has not been a single valid study without significant flaws or bias. Come on! You have to take like 5-6 statistics courses during NP/DNP training (I don't know why...) and you guys still can't come up with good studies? Not only that, you can't interpret studies for flaws? You seem to take any study that puts the nursing profession in a good light and pretend that it's completely accurate without even looking for problems.
Who cares about M4s? We should be "fair," as you said, to patients. Let them have access to better trained individuals. Patients are pretty stupid when it comes to medical knowledge. Key point in case you don't understand or feel like twisting my words: I have NOT said people are stupid at everything; I have stated that most people have no basic medical knowledge and thus, are VERY POOR judges of the medical care they receive. You can keep pretending that because of patient satisfaction surveys, you provide superior care; but everyone knows that patient satisfaction surveys are pretty damn useless. If you truly understand the reason for performing studies, as you say you do, you'd realize that anecdotal evidence is useless.
NPs do not offer more value. They have offer more time with the patient, but that's it. If you had similar training as physicians AND you offered more time, then you might be offering more value. Otherwise, nope. That's like saying since I sit around and talk with patients, with nothing more than a biology degree, and I spend more time with patients than either NPs or physicians, I'm healing people. Using your logic, I'm an amazing healthcare provider! Could I have independent practice rights please? I promise I'll charge less than NPs do, so I'll save the system even more money! That makes a lot of sense right?
You DO NOT do more for less money. You do a LOT less for a little less money. So, it's actually you that's offering very little value in comparison to PCPs.
It's admirable that you're defending your profession, but you're adamantly refusing to face the fact that NP/DNP training is severely inadequate and it's borderline dangerous to let NPs/DNPs practice independently. My example with M4s shows that. You don't want patients to be independently treated by M4s, but you want independent rights yourself? That makes no sense. I have pointed out repeatedly that an M4 has superior basic science AND clinical training, so why be scared to let the public be treated by M4s? The only reason I can think of is that you're worried that you will make less money. It all comes down to NP/DNP greed; skipping medical school and pretending to be a doctor with inadequate training does not actually make you equivalent to a medical doctor.
Do you want to point out the inadequacies of even more NP/DNP curricula than I already have? You just keep pushing away the fact that no NP/DNP curricula offers a half-decent training. You keep saying that it's okay to have inferior training and I don't understand why. Are you worried you can't handle the science heavy classes? Because I have no idea how nursing theory is going to help in the practice of medicine.
If I can go right from a 2 year RN program (associates) or even 4 year RN program (BSN) for a few months of post-grad training and be an independent practitioner that does not make one iota of sense. Period. Regardless of what opinions anyone has on the differences between a DNP program and MD/DO school.
Please stop putting words in my mouth. It discredits your argument when you make things up and attribute it to me. Please point out where I have said that physicians are the smartest, have the best training out of any profession, that no one else is smart enough to understand medicine, etc. Really, point it out where I've said that. You're refusing to face the facts and are resorting to making up things. You on the other hand, HAVE insisted that NP training is good enough to make them equivalent to physicians, you HAVE said that physicians are greedy, you HAVE said that NPs are superior healthcare providers because of the results of patient satisfaction surveys, etc.
And I really don't think you have any idea what the value or purpose of studies are. You have to show evidence that NP outcomes are similar to that of attending physicians (you know, those who have completed their training).The burden of proof is on YOU to design valid studies; it's NOT on your opponents. As both myself and many others have pointed, there has not been a single valid study without significant flaws or bias. Come on! You have to take like 5-6 statistics courses during NP/DNP training (I don't know why...) and you guys still can't come up with good studies? Not only that, you can't interpret studies for flaws? You seem to take any study that puts the nursing profession in a good light and pretend that it's completely accurate without even looking for problems.
Who cares about M4s? We should be "fair," as you said, to patients. Let them have access to better trained individuals. Patients are pretty stupid when it comes to medical knowledge. Key point in case you don't understand or feel like twisting my words: I have NOT said people are stupid at everything; I have stated that most people have no basic medical knowledge and thus, are VERY POOR judges of the medical care they receive. You can keep pretending that because of patient satisfaction surveys, you provide superior care; but everyone knows that patient satisfaction surveys are pretty damn useless. If you truly understand the reason for performing studies, as you say you do, you'd realize that anecdotal evidence is useless.
NPs do not offer more value. They have offer more time with the patient, but that's it. If you had similar training as physicians AND you offered more time, then you might be offering more value. Otherwise, nope. That's like saying since I sit around and talk with patients, with nothing more than a biology degree, and I spend more time with patients than either NPs or physicians, I'm healing people. Using your logic, I'm an amazing healthcare provider! Could I have independent practice rights please? I promise I'll charge less than NPs do, so I'll save the system even more money! That makes a lot of sense right?
You DO NOT do more for less money. You do a LOT less for a little less money. So, it's actually you that's offering very little value in comparison to PCPs.
It's admirable that you're defending your profession, but you're adamantly refusing to face the fact that NP/DNP training is severely inadequate and it's borderline dangerous to let NPs/DNPs practice independently. My example with M4s shows that. You don't want patients to be independently treated by M4s, but you want independent rights yourself? That makes no sense. I have pointed out repeatedly that an M4 has superior basic science AND clinical training, so why be scared to let the public be treated by M4s? The only reason I can think of is that you're worried that you will make less money. It all comes down to NP/DNP greed; skipping medical school and pretending to be a doctor with inadequate training does not actually make you equivalent to a medical doctor.
Do you want to point out the inadequacies of even more NP/DNP curricula than I already have? You just keep pushing away the fact that no NP/DNP curricula offers a half-decent training. You keep saying that it's okay to have inferior training and I don't understand why. Are you worried you can't handle the science heavy classes? Because I have no idea how nursing theory is going to help in the practice of medicine.
DG, you like to dish it out, but you can't take it. You enjoy putting words in my mouth, but when I make inferences from your comments, you go nuts. NP training is obviously good enouth to put a product out there that is perfectly capable of providing equivalent care. I don't need a study to show me that. All I need to do is look out there at the 150,000 NPs that are doing it everyday. That is pretty simple to see even if you are a blind man. You are the one who thinks that studies are the only way to gather evidence. Most of the rest of the population can take the overwhelming evidence already provided along with their personal experience and make a decision. You are the one who thinks there must be a study to prove it to me. Kinda like needed a study to prove to you that the wind blows. If NPs didn't offer better value, patients would not be satisfied with them. If your extra year of education offerred better value and your premises were correct, NPs would never help anyone get better and nobody would like them. Patient satisfaction is a very key indicator into the quality that you provide as a clinician. Why would anyone be satisfied if NPs botched the job everday because of their "lesser" education?? This is all already proven. Studies won't make it any more or less true.
If I can go right from a 2 year RN program (associates) or even 4 year RN program (BSN) for a few months of post-grad training and be an independent practitioner that does not make one iota of sense. Period. Regardless of what opinions anyone has on the differences between a DNP program and MD/DO school.
And yet I still find myself having a hard time shedding the first tear for them, along with most of the rest of America. I wonder why? Could it be that is because they make more than three times the US median household income? And again, it has nothing to do with maintaining costs, they just don't understand how to cut costs.
1) Because it would not make sense to pay someone a greater salary because they spend 10-15 years (on average) of college, professional, and post graduate training to do a profession that is among the most challenging, has one of the highest rates of liability (i.e. medical malpractice), and still one of the most respected professions ? In addition, physicians have the highest consumer confidence ratings among professions.
And again (again), it has everything to do with maintaining costs. Most of the problem is administrative costs to deal with insurance companies, A recent survey (5/09) found that physicians spend an average of around $70,000 just on costs directly related to dealing with insurance companies (which is a large proportion of income).
L. P. Casalino, S. Nicholson, D. N. Gans et al., "What Does It Cost Physician Practices to Interact with Health Insurance Plans?" Health Affairs Web Exclusive, May 14, 2009, w533-w543.
In addition, the average student debt of the graduating medical student is $155,000 which equates to a $1,700 monthly payment. Assuming monthly payback that's approximately $60,000 in interest (which generally increases since the salary of residents prohibits most from beginning the payback until after residency which adds the compounded interest).
DG, you like to dish it out, but you can't take it. You enjoy putting words in my mouth, but when I make inferences from your comments, you go nuts. NP training is obviously good enouth to put a product out there that is perfectly capable of providing equivalent care. I don't need a study to show me that. All I need to do is look out there at the 150,000 NPs that are doing it everyday. That is pretty simple to see even if you are a blind man. You are the one who thinks that studies are the only way to gather evidence. Most of the rest of the population can take the overwhelming evidence already provided along with their personal experience and make a decision. You are the one who thinks there must be a study to prove it to me. Kinda like needed a study to prove to you that the wind blows. If NPs didn't offer better value, patients would not be satisfied with them. If your extra year of education offerred better value and your premises were correct, NPs would never help anyone get better and nobody would like them. Patient satisfaction is a very key indicator into the quality that you provide as a clinician. Why would anyone be satisfied if NPs botched the job everday because of their "lesser" education?? This is all already proven. Studies won't make it any more or less true.
Patients are more satisfied because of what NPs currently can provide (i.e. more time, patient education), but that will change with independent practice - between administrative costs, time spent with health insurance (see above), and pressure to increase number of patient visits. Also, frequently satisfaction may not correlate with outcomes - just because I like you as a provider may not mean my HTN or DM is under control.
Also, please do not minimize what one year of education provides. It has already been emphasized about the lack of clinical coursework involved in NP educational programs and that one year of medical school or rotations involves more coursework or clinical hours in one week than any graduate program (most systems courses range from 10-15 credits - and there are 4-5 systems per semester !). That adds a lot in terms of education and while it may not be immediately quantifiable (since yes the average patient does not have a rare disorder or disease), it is still very important.
There are not fires every day in the average suburb, yet firefighters train regularly to fight them (and train for different types of fires). If I only trained to fight house fires, and one day a year there was a fatal car fire, then overall you would say that I did a good job because I trained for what was more common. Unfortunately, if that's my car I would probably feel otherwise.
pianoman511
35 Posts
There are MANY physicians going out of business or enter group practice because they can't maintain costs. Many are doing the job for much less than the average salary of around $170,000 (hence the average) and then factor in the average $150,000 debt that they carry after medical school.