I'm sure this topic has been discussed many times but I have some specific questions. I am currently an FNP student and I have a strong passion for primary care.
As I see it, this specialty is definitely challenging as you must pull your knowledge and be the front line to a patient's first sign of illness.
My question is does FNP knowledge prepare you to take on this role? I never found the nursing education to be mentally stimulating and I know medical school is quiet rigorous and teaches the thinking process that is necessary to take on this role. I'm not trying to put down our profession, I am just worried and misunderstood as to how our education allows us to practice independently in some states.
Can FNP adequately diagnose and manage succinctly without the waste of resources as well as MD can with experience? With all that can go wrong with the body and being the front line to diagnose and treat patients does our education allow us to perform without a disservice to our patients?
If you go to a good school and bust tail and finally land a good position in a learning environment you should be ok.
For family practice you don't need a lot of the stuff you learn in med school. Most stuff is pretty straightforward. Just don't miss the red flag symptoms and know when to refer stuff out.
Not true. In all of these professions there are people who are sub par, mediocre, above average, and exceptional. I don't subscribe to the us vs. them mentality because good clinical skills come with good work ethics and experience regardless on one's title. Are you an NP?
Oh wow I dunno why I never followed up on this thread.
I am finishing my NP studies now and my feelings are still the same lol.
I continue to feel that the task of family medicine is daunting and I am so not prepared with my measly 550 hours of clinical work. I definitely learned a lot but there's so much I don't know. I've been working with a doc and his thinking process is just superb. I mean you really have to know disease process, gross anatomy and just general indepth physiology along with many hours of application to really be proficient.
If not for the MD I have been following my thinking process would not have been more directed. Just the simple idea of "how do you approach a patient with "this"" has helped me understand how to go through my differentials and not just toss them all in a hat.
I feel like NPs are being taught the most basic standard of practice but if it comes down to something that uncommon or complex we just don't have the educational background to deduce answers. With experience you maybe able to do that if you've seen the situation before. But if it's something new , we just don't have the tools.
Maybe once I've been practicing for years my views will change but for now, this is it. Will reassess.
It is certainly true that NPs do not have an education with the same depth and breadth that a physician receives. That does not mean we can't be excellent providers. Right now, you are comparing apples and oranges in regard to your preceptor. He is an MD with years of experience (I'm assuming). You are a student who has not yet practiced. A good, experienced practitioner (NP/MD/PA) is light years away from a student in respect to knowledge and ability. You are not supposed to feel comfortable yet. I agree that 550 hours of clinical is not a lot. You can always do more if your preceptors are available and willing. Fortunately, mine were, so I took advantage and did as much extra clinical time as I could.
I think your views may change with practice experience. I feel very comfortable with what I do after almost 9 years as a NP. That doesn't mean I know it all by any measure, but I'm comfortable with my abilities and process, and I have colleagues and resources to tap into when I don't know something. I know where to go and what steps to take if I see something unfamiliar. I read journals and stay current with advances in my specialty. You don't have a lot of control over your education, but you do have control over what learning you continue to do after graduation.
Right now focus on getting as much as possible out of your clinical experiences. When you graduate, try and find a job where you will have a mentor and other colleagues to consult with. My first job out of school was at a very busy community health center. It was a tough patient population with complex medical issues. Many were very recent immigrants and had not had medical care in years. We saw a lot of tropical diseases that I didn't know anything about, so we learned about them on the job. Most of the providers were just out of residency or grad school, but we had some wonderful experienced MDs and NPs who mentored us and served as a great resource. I learned much more in that first job than I learned in school or clinical.
I guess I'm saying that at this point, don't waste time or energy lamenting about the perceived holes in NP education. They are there, but you can take steps on your own to fill those gaps over time. Actually getting out there and working as a NP will raise your skills, knowledge, and competence to a level that is not achieved in clinicals. Remember that no one starts out as an expert in any field.
Thanks BC. I'm lucky enough to have a residency program available to me near where I live which I am most likely going to apply to. I really love primary care. I know the work is hard but I love the interaction, the education and just being able to help anyone with anything that walks through the door. I really wanna be ahead of the curve.
550 hours is nothing. I completely agree. It's embarrassingly low. But you could/should have done more hours. No sense in complaining about it now. I'm assuming you are reading every medical text you can get your hands on in order to increase your knowledge base.
As was said an MD with years of experience is not a fair comparison. Even to a resident physician. But you need to do what you can to lessen the gap between yourself and a newly graduated MD. READ. It blows my mind the NP students who get on this forum and complain about their perceived lack of education, but have done absolutely nothing above and beyond what is asked of them in their programs. If you haven't read any of the books that medical students read or use to study for boards, then just stop. A good place to start is to read Harrisons or Cecils (and I mean read it, not skimming, not thumbing through, but reading it front to back, word for word) and the "first aid series" that medical students use to study for boards/USMLEs is great.
550 hours is nothing. I completely agree. It's embarrassingly low. But you could/should have done more hours. No sense in complaining about it now. I'm assuming you are reading every medical text you can get your hands on in order to increase your knowledge base.
As was said an MD with years of experience is not a fair comparison. Even to a resident physician. But you need to do what you can to lessen the gap between yourself and a newly graduated MD. READ. It blows my mind the NP students who get on this forum and complain about their perceived lack of education, but have done absolutely nothing above and beyond what is asked of them in their programs. If you haven't read any of the books that medical students read or use to study for boards, then just stop. A good place to start is to read Harrisons or Cecils (and I mean read it, not skimming, not thumbing through, but reading it front to back, word for word) and the "first aid series" that medical students use to study for boards/USMLEs is great.
Yea that's the thing. I think people should complain or things won't change. Its not a perceived lack of education, it's a fact that our education is inadequate. And it also takes someone who realizes this to make those changes to go above and beyond. You can read all the books and watch all the youtube videos (and I'm not saying you shouldn't) but medicine is still an apprenticeship. Nothing can compare to professionally guided learning.
I've been trying to gain the perspective from both MDs and NPs to really learn the difference in education to close that gap. We definitely have our strong suits as nurses but let's face it. A lot of medicine is practiced a certain way for a reason and no route you take will really change the wheel that much. If we don't fully understand the underlying knowledge that MDs gain from their didactic and apprenticed learning I will have no direction on how to close the educational gap.
From some MD perspectives they seem to believe that NPs can never attain a level where they can provide the same level of care as MDs can. Granted some of these are just arrogant a-holes but is there truth to it? I dunno but maybe, like i said, I'll gain more insight into this once I'm practicing.
Luckily I know a lot of specialized MDs that'll allow me to practice with them and continue to learn even after graduating and working. The hours and self learning will take a long time but in family medicine I believe it's definitely needed. The array of knowledge is so vast.
But this also brings me to another question. If NPs can practice independently are we still considered "mid-level" providers or is this term somehow made up to hold back the profession?
The problem with NP training, at least for me, is they focus way too much on things that don't matter (nursing theory, etc.) and don't have enough clinical component. Even though I went to an on-campus, traditional school, all of our clinical hours were self-scheduled with no oversight by the school. I also think that doing a thesis or project is a huge waste of time. While I know more about treating recurrent skin and soft tissue infections than perhaps even the MDs I work with, this isn't a very useful skill in primary care as skin and soft tissue infections aren't that common outside of an urgent care or ER.
While I think seasoned NPs can do a phenomenal job, I think new grads are really put in a terrible position and can mismanage even the simplest of diagnoses. One of my first real patients as an actual NP was a teenager who came in with acne so I gave some Clindamycin gel as it seemed warranted but only after the patient left did I learn that I needed to have him take benzyl peroxide, too. While acne should be an incredibly simple condition to treat, my clinical site for NP school was very medicare heavy and as such I didn't treat a lot of acne in school.
Yea, thank God I have Up to Date st my disposal. It has all the standard of care for almost anything. And even has approached to many very common symtomatology and I feel students just don't utilize it enough.
Specializes in Family Medicine, Medical Intensive Care.
Yea, thank God I have Up to Date st my disposal. It has all the standard of care for almost anything. And even has approached to many very common symtomatology and I feel students just don't utilize it enough.
Up-to-Date is a fantastic resource and one that I use daily, but it does not replace critical thinking that is based on a strong foundation in the basic biomedical and clinical sciences. I've seen a lot of folks practice "cookbook medicine" by following whatever Up-to-Date said and not knowing the why behind things.
Aromatic
352 Posts
If you go to a good school and bust tail and finally land a good position in a learning environment you should be ok.
For family practice you don't need a lot of the stuff you learn in med school. Most stuff is pretty straightforward. Just don't miss the red flag symptoms and know when to refer stuff out.