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?
Look, don't lie to support your opinions. We all know that physicians on average don't get 17,000 clinical hours before practicing independently. Let's try for maybe half that or less. And yet again, there you go with the idea that you have to be smarter to go to medical school than anyone on the planet, and if you didn't go, you aren't as smart as the people who did. That is ludicrous.
The cost of practicing isn't all overhead. Some of it is what you pay yourself. Furthermore, alot of overhead is optional. It depends on what building you want to locate your practice in, how much space you want, how many people you hire, what sort of system you use, and how efficiently you run your business. Most doctors are not good at this, and when they find themselves not making the salary that they want to make, they either try to see more patients or sell their practice to a hospital and guarantee themselves a salary whether the practice makes money or not. If you set the practice up to run efficiently and on a low budget and stick to it, you can lower overhead. It is really very simple math. An NP can run a very low overhead practice and doesn't need to pay themselves as much as the physician thinks they have to. Fewer patients, lower reimbursement and the NP can make the same or more than they make by working for the physician and letting the physician get paid a surcharge on their work.
By the way, I have seen zero links to any evidence in any of your posts.
Please don't tell me I'm lying. It's simple math like pianoman showed:
average work hours/week: 80 hours (though we all know that not all programs follow this rule)
average weeks/year worked: 49
average hours worked/year: (80)(49) = 3920
So far, it's pretty much the same as pianoman presented. Then, you take into account that the shortest residency is 3 years long. So, (3920)(3) = 11760 hours. In addition to this, you need to add in the M3/M4 clinical hours; M3 and M4s are subject to the same work hour rules as residents are. So, add in another (3920)(2) = 7840 hours. If you add up M3 + M4 + residency hours, you get 19600 hours.
That's a LOT of clinical training before independent practice. Now, a BSN to DNP program requires between 600-1000 clinical hours. It's scary how inadequate that is! You can't say residency doesn't matter because then, your clinical hours don't count either. Residency is supervised clinical training, not an on-the-job training where you practice on real people with no physician oversight.
And I HAVE provided many links supporting what I have said. If you would look back a couple of pages in this thread, I provided a VERY detailed analysis of several NP/DNP curricula and compared it to MD/DO curricula. I also provided that same evidence in a previous thread where you also responded to me. I have also provided in that previous thread, several examples of studies and I told you exactly where the big flaws in each study was. You have chosen to ignore it then just as you have been choosing to ignore it now.
I realize that you don't like statistics and that you don't trust statistics (as you yourself said in a previous thread), but unfortunately, there's a lot of science and stats involved in medicine. Satisfaction does not cure people; it's wrong to suggest that science is a useless facet of medicine. You're putting way too much emphasis on patient satisfaction. Do you care more if your patient is satisfied or if he/she is treated appropriately? I haven't found any studies stating that there's a direct correlation between patient satisfaction and outcomes. If you have such a study, please link it.
Don't say that you don't need evidence to prove anything. You absolutely need evidence. Otherwise, like I said previously, your word alone is worth next to nothing. So is mine. That's why I provide links and evidence rather than just spout off opinion.
If you can't find the links that I've posted that I've directed you two a few paragraphs ago, I will repost them again. If you want me to analyze every single NP/DNP curricula and compare it MD/DO curricula (even though I've pointed it out for several schools already), you'll have to wait till next weekend for that.
My only point to you is that many other people make sacrifices that are just as big for their professions, that isn't limited to physicians.
You are right, there is no linking to any proof and it is my opinion that physicians are poor financial managers. If anyone can run a practice with lower overhead then why will the costs still be there for everyone. You are contradicting yourself. What I really can't explain is, why don't physicians try to lower their overhead. I know for a fact that most of them won't try to, but I don't understand why.
Sure, every other profession requires some sacrifices as well but how many other professions require nearly a decade of post-college training, hundreds of thousands of dollars worth of debt, high amount of work hours per week, etc?
Definitely not the NP/DNP route! Heck, you can go from a BSN to DNP online and part-time while only needing to step foot on a campus for 1 week per semester. Surely you're not saying that is equivalent to the sacrifices medical training requires? You can't get a medical degree online nor can you train part-time.
You're right, there are other professions that require lots of sacrifices but not many of them require the amount that medicine requires; pursuing an NP/DNP degree certainly doesn't come even close to the same level of intensity. While I have no studies to back up my statement that NP/DNP training doesn't require as much sacrifice as MD/DO training, it seems like common sense when you look at the possibilty of training part-time, online, requiring a significantly fewer number of years of training, requiring far less intensive courses, requiring far less clinical training, etc.
Please don't tell me I'm lying. It's simple math like pianoman showed:
average work hours/week: 80 hours (though we all know that not all programs follow this rule)
average weeks/year worked: 49
average hours worked/year: (80)(49) = 3920
So far, it's pretty much the same as pianoman presented. Then, you take into account that the shortest residency is 3 years long. So, (3920)(3) = 11760 hours. In addition to this, you need to add in the M3/M4 clinical hours; M3 and M4s are subject to the same work hour rules as residents are. So, add in another (3920)(2) = 7840 hours. If you add up M3 + M4 + residency hours, you get 19600 hours.
That's a LOT of clinical training before independent practice. Now, a BSN to DNP program requires between 600-1000 clinical hours. It's scary how inadequate that is! You can't say residency doesn't matter because then, your clinical hours don't count either. Residency is supervised clinical training, not an on-the-job training where you practice on real people with no physician oversight.
And I HAVE provided many links supporting what I have said. If you would look back a couple of pages in this thread, I provided a VERY detailed analysis of several NP/DNP curricula and compared it to MD/DO curricula. I also provided that same evidence in a previous thread where you also responded to me. I have also provided in that previous thread, several examples of studies and I told you exactly where the big flaws in each study was. You have chosen to ignore it then just as you have been choosing to ignore it now.
I realize that you don't like statistics and that you don't trust statistics (as you yourself said in a previous thread), but unfortunately, there's a lot of science and stats involved in medicine. Satisfaction does not cure people; it's wrong to suggest that science is a useless facet of medicine. You're putting way too much emphasis on patient satisfaction. Do you care more if your patient is satisfied or if he/she is treated appropriately? I haven't found any studies stating that there's a direct correlation between patient satisfaction and outcomes. If you have such a study, please link it.
Don't say that you don't need evidence to prove anything. You absolutely need evidence. Otherwise, like I said previously, your word alone is worth next to nothing. So is mine. That's why I provide links and evidence rather than just spout off opinion.
If you can't find the links that I've posted that I've directed you two a few paragraphs ago, I will repost them again. If you want me to analyze every single NP/DNP curricula and compare it MD/DO curricula (even though I've pointed it out for several schools already), you'll have to wait till next weekend for that.
So your overinflated figure of 80 hours a week doesn't even give you 17,000 on average. I rest my case on that one. You are wrong and you lied. You provided no real evidence in any of those links. Like I said before, just some course listings that don't prove anything. Furthermore I could care less what your analysis of NP program curricula is. You aren't qualified to evaluate it. And I'm sorry, but nobody has to prove anything to you in a study regarding independent NP practice, you are not the decision maker. The public and legislators are the decision makers.
You have obviously never heard of the art of medicine, and you will be very unsuccessful in your career if you don't discover it and learn to practice it.
Sure, every other profession requires some sacrifices as well but how many other professions require nearly a decade of post-college training, hundreds of thousands of dollars worth of debt, high amount of work hours per week, etc?
Definitely not the NP/DNP route! Heck, you can go from a BSN to DNP online and part-time while only needing to step foot on a campus for 1 week per semester. Surely you're not saying that is equivalent to the sacrifices medical training requires? You can't get a medical degree online nor can you train part-time.
You're right, there are other professions that require lots of sacrifices but not many of them require the amount that medicine requires; pursuing an NP/DNP degree certainly doesn't come even close to the same level of intensity. While I have no studies to back up my statement that NP/DNP training doesn't require as much sacrifice as MD/DO training, it seems like common sense when you look at the possibilty of training part-time, online, requiring a significantly fewer number of years of training, requiring far less intensive courses, requiring far less clinical training, etc.
Look, I thought you were speechless. Why don't you can the BS about how much more dedication it takes to be a doctor than with any other profession. There are millions of people who work just as many hours and train just as hard to do what they want to do who never make anywhere close to as much money as a doctor will in their first year of practice. Contrary to your heavily biased opinion. many people other than doctors work tons of overtime. It is a required part of their job. It is hard, but they do it to try to make it in their chosen profession. And they do it all without crying that someone should pay them more for it. Many NPs work very hard to learn their profession too. So do lawyers, accountants, and even salespeople. Don't act like you are the only one who studies hard, works long hours, requires dedication, and puts in many years to reach their goal. That simply isn't true. Don't even try to compare it
So your overinflated figure of 80 hours a week doesn't even give you 17,000 on average. I rest my case on that one. You are wrong and you lied. You provided no real evidence in any of those links. Like I said before, just some course listings that don't prove anything. Furthermore I could care less what your analysis of NP program curricula is. You aren't qualified to evaluate it. And I'm sorry, but nobody has to prove anything to you in a study regarding independent NP practice, you are not the decision maker. The public and legislators are the decision makers.
You have obviously never heard of the art of medicine, and you will be very unsuccessful in your career if you don't discover it and learn to practice it.
Actually, if you read what I posted and what pianoman posted, it's very likely that my 17000 hours quote is on the lower side. Did you miss all the math that I showed? I said physicians get more than 17000 hours in clincal training and I calculated 19600. 19600 > 17000. Where have I lied? And 80 hours/week is NOT an inflated number. You do realize that a lot of programs fudge the numbers so that residents can work more than 80 hours right? So, the actual amount of clincal training that residents get may be more than what I've stated. So, it's in fact you who's wrong not me. Why do I feel like I'm arguing with a child who stubbornly refuses to believe that the tooth fairy isn't real?
Why am I unqualified to comment on NP courses but you are okay with qualifying medical courses? You keep saying that NP/DNP training is the same as physician training but how do YOU know that since you've likely never taken a medical school course? So, if I'm wrong with my analysis, you've been wrong this entire time you've been saying NP = MD. Your posts contradict themselves.
Also, since anecdotal stories are the only true kind of evidence on these forums, the several NP-turned-MDs I've talked to have said how medical education has opened their eyes to how little they learned in NP school and that it's scary to think people feel that NP training is adequate to practice independently. Another NP-turned-MD on a different forum mentioned how in NP schools, you are trained to hate physicians and that the majority of what you learn involves nurse activism, etc. (just as I pointed in my curricula analysis) and not much clinical science at all compared to medical school; scary stuff huh? Since you're a fan of anecdotal evidence, you've got to believe that!
You DO need to provide evidence; not just to me but to the public as well. You can't just tell the public nor the legislators to just trust your word; you have to provide solid evidence as to whether or not your outcomes are similar to those of physicians. I've been corresponding with several congressmen and talking to some people in various local newspapers near where I live regarding this issue of NP/DNP training. I'm glad to say that the congressmen I've talked have responded positively to my analysis. I'm hoping a few local newspapers will let me submit some of my comparisons and publish them so that the public can be aware of the significant differences between medical training and NP/DNP training. You're right that it is the public and the legislators who will have to make the ultimate decision. I can only hope that the truth about NP/DNP training reaches the public and legislators before it's too late.
Sure, every other profession requires some sacrifices as well but how many other professions require nearly a decade of post-college training, hundreds of thousands of dollars worth of debt, high amount of work hours per week, etc?
Definitely not the NP/DNP route! Heck, you can go from a BSN to DNP online and part-time while only needing to step foot on a campus for 1 week per semester. Surely you're not saying that is equivalent to the sacrifices medical training requires? You can't get a medical degree online nor can you train part-time.
You're right, there are other professions that require lots of sacrifices but not many of them require the amount that medicine requires; pursuing an NP/DNP degree certainly doesn't come even close to the same level of intensity. While I have no studies to back up my statement that NP/DNP training doesn't require as much sacrifice as MD/DO training, it seems like common sense when you look at the possibilty of training part-time, online, requiring a significantly fewer number of years of training, requiring far less intensive courses, requiring far less clinical training, etc.
You are a little bit too wrapped up in the significance of your training to ever become a good practitioner. The truth is, it is what you make it. Your sacrifice may be greater than one NPs, but far less than that of another. The argument you are making is a silly one. But your comments here prove that you think that because you are in medical school, you are superior to anyone else on the face of the earth, otherwise you wouldn't be arguing superiority with me. There are many other professionals who sacrifice more than physicians do to reach their goals. It is silly for you to say otherwise. The reality is that physicians OVERtrain for primary care. Your problem is you can't admit that because you have too much invested in your physician education.
Look, I thought you were speechless. Why don't you can the BS about how much more dedication it takes to be a doctor than with any other profession. There are millions of people who work just as many hours and train just as hard to do what they want to do who never make anywhere close to as much money as a doctor will in their first year of practice. Contrary to your heavily biased opinion. many people other than doctors work tons of overtime. It is a required part of their job. It is hard, but they do it to try to make it in their chosen profession. And they do it all without crying that someone should pay them more for it. Many NPs work very hard to learn their profession too. So do lawyers, accountants, and even salespeople. Don't act like you are the only one who studies hard, works long hours, requires dedication, and puts in many years to reach their goal. That simply isn't true. Don't even try to compare it
I never said that no one else works as hard as doctors. All I've said was that there aren't many professions that require the same length and intensity of training as physicians do. That is a true statement. I'm not questioning anyone's intelligence nor am I personally insulting them. I'm just stating something that is widely known.
I went on to show that while you can get an NP/DNP online and part-time, you can't do that with an MD/DO. If you're getting a degree online and part-time, surely it means that you have other things going on in your life rather than just training. So clearly, you're not devoting all your efforts to the training; you're doing other things in your life for a greater chunk of the day. You can't say the same with medical training, where you have nearly a decade of nonstop training (not available online or part-time). During this time, your focus is on medical education only. Yes, time-management will allow you to enjoy life but NP/DNP training does not take up as significant of a portion of time as MD/DO training does. Taking courses online and part-time doesn't come to the same level of intensity as the medical training. Surely you can't deny that.
I'm sure you're going to tell me I'm a jerk and that I think everyone else in the world sucks and only physicians rock and that no one in the world works as hard as physicians do because physicians are gods. Go for it. Even though I've repeatedly mentioned that I'm not questioning anyone's intelligence, please go ahead and assume as if I am and attack me without evidence. I'm looking forward to reading your post.
Actually, if you read what I posted and what pianoman posted, it's very likely that my 17000 hours quote is on the lower side. Did you miss all the math that I showed? I said physicians get more than 17000 hours in clincal training and I calculated 19600. 19600 > 17000. Where have I lied? And 80 hours/week is NOT an inflated number. You do realize that a lot of programs fudge the numbers so that residents can work more than 80 hours right? So, the actual amount of clincal training that residents get may be more than what I've stated. So, it's in fact you who's wrong not me. Why do I feel like I'm arguing with a child who stubbornly refuses to believe that the tooth fairy isn't real?
Why am I unqualified to comment on NP courses but you are okay with qualifying medical courses? You keep saying that NP/DNP training is the same as physician training but how do YOU know that since you've likely never taken a medical school course? So, if I'm wrong with my analysis, you've been wrong this entire time you've been saying NP = MD. Your posts contradict themselves.
Also, since anecdotal stories are the only true kind of evidence on these forums, the several NP-turned-MDs I've talked to have said how medical education has opened their eyes to how little they learned in NP school and that it's scary to think people feel that NP training is adequate to practice independently. Another NP-turned-MD on a different forum mentioned how in NP schools, you are trained to hate physicians and that the majority of what you learn involves nurse activism, etc. (just as I pointed in my curricula analysis) and not much clinical science at all compared to medical school; scary stuff huh? Since you're a fan of anecdotal evidence, you've got to believe that!
You DO need to provide evidence; not just to me but to the public as well. You can't just tell the public nor the legislators to just trust your word; you have to provide solid evidence as to whether or not your outcomes are similar to those of physicians. I've been corresponding with several congressmen and talking to some people in various local newspapers near where I live regarding this issue of NP/DNP training. I'm glad to say that the congressmen I've talked have responded positively to my analysis. I'm hoping a few local newspapers will let me submit some of my comparisons and publish them so that the public can be aware of the significant differences between medical training and NP/DNP training. You're right that it is the public and the legislators who will have to make the ultimate decision. I can only hope that the truth about NP/DNP training reaches the public and legislators before it's too late.
I don't need to provide you with evidence, and I have already talked with a great number of legislators and Congressmen who are on board with independent practice for NPs. There are bills being introduced into legislatures all over the country to begin the process. The majority of the public already favors it. They favor it because they already know the truth. They are paying too much for the services they receive and they want it stopped. They want reform and they want it now. This is also a big part of the federal reform that is on the table. I am afraid you are a little too late to be writing and contacting legislators, but have fun wasting your time.
I never said that no one else works as hard as doctors. All I've said was that there aren't many professions that require the same length and intensity of training as physicians do. That is a true statement. I'm not questioning anyone's intelligence nor am I personally insulting them. I'm just stating something that is widely known.
I went on to show that while you can get an NP/DNP online and part-time, you can't do that with an MD/DO. If you're getting a degree online and part-time, surely it means that you have other things going on in your life rather than just training. So clearly, you're not devoting all your efforts to the training; you're doing other things in your life for a greater chunk of the day. You can't say the same with medical training, where you have nearly a decade of nonstop training (not available online or part-time). During this time, your focus is on medical education only. Yes, time-management will allow you to enjoy life but NP/DNP training does not take up as significant of a portion of time as MD/DO training does. Taking courses online and part-time doesn't come to the same level of intensity as the medical training. Surely you can't deny that.
I'm sure you're going to tell me I'm a jerk and that I think everyone else in the world sucks and only physicians rock and that no one in the world works as hard as physicians do because physicians are gods. Go for it. Even though I've repeatedly mentioned that I'm not questioning anyone's intelligence, please go ahead and assume as if I am and attack me without evidence. I'm looking forward to reading your post.
I don't understand why you have to run down everyone else to build yourself up. Most other professions aren't so afraid of competition as you bunch of physicians are. I guess it is because you have been without competition for so long that you are afraid to compete. Most other professionals would say bring on the competition, because they have confidence in themselves that they can beat the competition. Physicians are terribly insecure about having to compete with NPs. That is evidence by how they go on the attack when independent practice is mentioned. Dentists do the same thing when independent practice is mentioned for dental hygeinists, even when all they are doing is cleaning underpriveledged children's teeth. The same reaction came from an Illinois physician group when a retail clinic wanted to advertise their prices. WHY? Physicians are deathly afraid of competition! That is the only reason. Explain to me why there is so much fear over the competition. But if there is no fear, there is no reason to fight so hard, is there?
I don't doubt that with your education and experience you are able to handle a complex patient. My question to you would be whether or not it helps you to have physician oversight or the option to consult them with a difficult patient ? Also, do you anticipate that anything will change with the way you practice now if NPs were given independent practice rights ?
I work in a group practice by choice and by law (since I guess I could have moved). Depending which practice I am at: I don't only just talk with my doctors, I pick up the phone and talk with the specialist. We practice family medicine we take care of who we can and refer the rest (but we don't give up their care)... They refer, I refer. I ask them questions, they ask me questions. When I am out they follow my patients, when they are out I follow their patients. There are certain types of patients/procedures I like, they have certain types of patients/procedure they like: we work together... We tell our patients up front their care can/may be delivered by anyone of us at any time.
My question/concern is not that an experienced, competant provider is caring for complex patients, but that with independent practice rights, a new grad with very limited experience who doesn't have the experience and physician oversight is expected to manage the same type of patients. (I know some DNP programs have residencies, but they are not the same in terms of clinical hours and intensity of training as an MD/DO program)
Not so scientific approach but I spoke with several NPs, PAs, and MDs at several of the practices I am affiliated/have been affiliated with... I even let them read the thread.
The doctors who work in group practices do so because:
- They share office expenses
- They share Malpractice fees
- The ability for internal consultation
- Better ability to have time off without affecting the patients and the bottom line.
Two practice have a satellite office:
- PA and NP staff the office
- Charts reviewed by an MD one day a week.
- One practice uses computer charting one does not (guess which doctor is more happy)...
Several practices are not private but have CEOs/boards etc...
- Responsibility to the patients only with no direct connection to worries of running the office
- The MDs told me there was no pressure of being the boss
- The NPs told me there was no pressure by the doctors to see larger and larger numbers of patients..
Only one practice where the doctor worked alone:
- Has a set number of patients and is not adding.
- Most of his practice was his fathers practice.
One practice up north (hospital owned):
- PA runs the office
- NP is part time
- MD comes in once a week to sign charts.
- Anything above the norm is referred to the hospital.
One hospitalist:
- Medical school was a breeze due to the fact that the pre-med program was so intense.
- Office medicine is for wussies...
One specialty practice (Three MDs, Three PAs and three NPs.)
- They practice in their specialty and consult out the rest
- PAs help in surgery and rounds.
- NPs help in office and rounds.
- The aim is that while in the hospital any patient with a problem has minimal wait time for a provider from their practice.
So what does all this have to do with ...but that with independent practice rights, a new grad with very limited experience who doesn't have the experience and physician oversight...They all agreed (except the surgeons) that the first two years of practice were horrific.... No one too turn to with problems.
12 for 12 doctors told me (paraphrase) In todays world if you want to die early from stress go the route of primary care medicine alone.
I work in a group practice by choice and by law (since I guess I could have moved). Depending which practice I am at: I don't only just talk with my doctors, I pick up the phone and talk with the specialist. We practice family medicine we take care of who we can and refer the rest (but we don't give up their care)... They refer, I refer. I ask them questions, they ask me questions. When I am out they follow my patients, when they are out I follow their patients. There are certain types of patients/procedures I like, they have certain types of patients/procedure they like: we work together... We tell our patients up front their care can/may be delivered by anyone of us at any time.
Not so scientific approach but I spoke with several NPs, PAs, and MDs at several of the practices I am affiliated/have been affiliated with... I even let them read the thread.
The doctors who work in group practices do so because:
- They share office expenses
- They share Malpractice fees
- The ability for internal consultation
- Better ability to have time off without affecting the patients and the bottom line.
Two practice have a satellite office:
- PA and NP staff the office
- Charts reviewed by an MD one day a week.
- One practice uses computer charting one does not (guess which doctor is more happy)...
Several practices are not private but have CEOs/boards etc...
- Responsibility to the patients only with no direct connection to worries of running the office
- The MDs told me there was no pressure of being the boss
- The NPs told me there was no pressure by the doctors to see larger and larger numbers of patients..
Only one practice where the doctor worked alone:
- Has a set number of patients and is not adding.
- Most of his practice was his fathers practice.
One practice up north (hospital owned):
- PA runs the office
- NP is part time
- MD comes in once a week to sign charts.
- Anything above the norm is referred to the hospital.
One hospitalist:
- Medical school was a breeze due to the fact that the pre-med program was so intense.
- Office medicine is for wussies...
One specialty practice (Three MDs, Three PAs and three NPs.)
- They practice in their specialty and consult out the rest
- PAs help in surgery and rounds.
- NPs help in office and rounds.
- The aim is that while in the hospital any patient with a problem has minimal wait time for a provider from their practice.
So what does all this have to do with ...but that with independent practice rights, a new grad with very limited experience who doesn't have the experience and physician oversight...They all agreed (except the surgeons) that the first two years of practice were horrific.... No one too turn to with problems.
12 for 12 doctors told me (paraphrase) In todays world if you want to die early from stress go the route of primary care medicine alone.
I fully understand and agree with your post, with the exception that independent practice for NPs doesn't necessarily mean solo practice. It could mean group NP practice, just without physician supervision.
dgenthusiast
237 Posts
Please don't tell me I'm lying. It's simple math like pianoman showed:
average work hours/week: 80 hours (though we all know that not all programs follow this rule)
average weeks/year worked: 49
average hours worked/year: (80)(49) = 3920
So far, it's pretty much the same as pianoman presented. Then, you take into account that the shortest residency is 3 years long. So, (3920)(3) = 11760 hours. In addition to this, you need to add in the M3/M4 clinical hours; M3 and M4s are subject to the same work hour rules as residents are. So, add in another (3920)(2) = 7840 hours. If you add up M3 + M4 + residency hours, you get 19600 hours.
That's a LOT of clinical training before independent practice. Now, a BSN to DNP program requires between 600-1000 clinical hours. It's scary how inadequate that is! You can't say residency doesn't matter because then, your clinical hours don't count either. Residency is supervised clinical training, not an on-the-job training where you practice on real people with no physician oversight.
And I HAVE provided many links supporting what I have said. If you would look back a couple of pages in this thread, I provided a VERY detailed analysis of several NP/DNP curricula and compared it to MD/DO curricula. I also provided that same evidence in a previous thread where you also responded to me. I have also provided in that previous thread, several examples of studies and I told you exactly where the big flaws in each study was. You have chosen to ignore it then just as you have been choosing to ignore it now.
I realize that you don't like statistics and that you don't trust statistics (as you yourself said in a previous thread), but unfortunately, there's a lot of science and stats involved in medicine. Satisfaction does not cure people; it's wrong to suggest that science is a useless facet of medicine. You're putting way too much emphasis on patient satisfaction. Do you care more if your patient is satisfied or if he/she is treated appropriately? I haven't found any studies stating that there's a direct correlation between patient satisfaction and outcomes. If you have such a study, please link it.
Don't say that you don't need evidence to prove anything. You absolutely need evidence. Otherwise, like I said previously, your word alone is worth next to nothing. So is mine. That's why I provide links and evidence rather than just spout off opinion.
If you can't find the links that I've posted that I've directed you two a few paragraphs ago, I will repost them again. If you want me to analyze every single NP/DNP curricula and compare it MD/DO curricula (even though I've pointed it out for several schools already), you'll have to wait till next weekend for that.