Help-Real quick question: I want to get a balanced view from all sides on this issue.

MS, APRN, BC, FNP · Nov 25, 2006

I think if you ask any MD if NPs are a suitable replacement for an MD in a rural underserved area or a poor urban area. They would say a NP is a suitable replacement for an MD. If you ask them the same question in a high paid metro area, the answer would be of course not. NPs aren't as qualified. Funny how that works out. We're good enough to be PCPs for the poor, but not the rich.

.....and that's what it all boils down to kids, money.

I'd like to add that I have the utmost respect for some MD specialists that I've worked with and thank god for them, but I've also known some real MD jokers in general practice that weren't fit to polish the stethoscopes of some of the NPs I've known. As I've said before it comes down to the competence of the individual.

Bob26 · Nov 30, 2006

Haven't been on in a while. I'd just like to thank everyone for their responses.

I have a few thoughts on what was said.

But, this doc's focus is different than most other docs', anyway. After all, he started as a nurse's aide, became an RN and is now an MD. He actully helps a pt to the bathroom and empties a bedpan every once in awhile. Nurses AND pts love him.

This is who I'm trying to emulate. I never was an RN, but I did start as a nursing assistant (ie nurse's aide) before going to medical school, so hopefully that's good enough.

And I've definitely emptied more than a few bedpans... :madface:

Although the physicians I work with have taken a few more science courses that I have taken, I can't recall the occasion when some obscure factoid from physics class has come up in practice. I can only assume this is because it is the application of such facts that make up the practice of medicince rather than reciting off flash cards the actual facts themselves.

The difference is not due to the peripheral physics or chemistry courses. There's a difference in the fundamental medical courses of pathology, pathophysiology, even anatomy and physiology.

My sister is a nurse with a BSN. The material she learned in the above courses was definitely not comparable to mine (she'd say the same exact thing by the way).

For example, her anatomy and physiology course was provides a superficial understanding of anatomy and physiology. It really doesn't go into the depth that the anatomy and physiology I had in medical school went into.

Pathology and pathophysiology was even a bigger difference. (once again, she'd say the same thing)

Her course materials and her understanding of the material in our discussions about medical disorders backs this up. She got good grades and finished towards the top of her class and is definitely a smart woman, but does not have the training I do or the depth of understanding of the medical knowledge as I do.

Now, just for the record, the above fact has absolutely nothing to do with the individual, but only with the training that the individual gets. If I went to nursing school and my sister went to medical school, then our depth of knowledge would be reversed, simple as that.

It's this difference in training that results in the difference in clinical knowledge between her and I. Again, that clinical knowledge difference would reversed had we gone to different schools.

I'm sure she doesn't think of herself as having little medical knowledge. This would be correct of her because she does not have little medical knowledge. I'd disagree with any nurse who said he/she had little medical knowledge. But it's not equal to the medical knowledge of a physician (again, simply due to training differences, and not person differences).

As I've said before it comes down to the competence of the individual.

When a NP graduates from school, he/she should not be practicing independently. When a doc graduates from their pre med program, they of course should not be practicing independently. Both providers go through a kind of residency where they see patients until they're competent enough to be independent. For a NP that is more vague, but they do an equivalent residency. The NP gets their residency through their work experience.

(the 2nd quote if from another thread I was reading)

I have to step in here and be honest. It's quotes like these that give the physicians that I was talking about in my 1st post ammunition.

Please to do not compare an NP's training as equal to an MD's training. The residency an MD goes through is definitely not equal to an NP's training. For example, they did not have to institute an 80 hour work hour restriction for NP's.

I think an analogy is appropriate here. Saying an NP's training (and knowledge) is equivalent to an MD's is like saying an LPN's training and knowledge is equal to an RN's.

An LPN's training and knowledge base is definitely not equal to an RN's. An RN has more years of training and learns as a deeper level and thus acquires a deeper understanding of the material as compared to an LPN.

From my experience, I've never met an RN who believes that an LPN is an equal substitute and has the equal knowledge to an RN. I was told of the differences above by many RN's themselves.

It demeans the training an MD gets to say it's equivalent to that of an NP just like it demeans that training an RN gets to say that it's equivalent to that of an LPN.

The same is true for NP and MD as is true about an RN to LPN. The first quote talks about it being a "competence of the individual" thing. I definitely agree that a competent person is better than a incompetent person anyday.

However, one has to look at averages though since there's a range in any field. The average RN will always have more knowledge and training than the average LPN and therefore is capable of delivering a higher level of care than the average LPN (again, solely due to the training and knowledge difference).

Likewise, the average MD will always have more knowledge and training than the average NP and therefore is capable of delivering a higher level of care than the average NP (again, solely due to the training and knowledge difference).

I don't expect any of this to change anybody's mind, especially since it's not as though I went from being an NP to an MD, which would give it a lot more weight.

However, there were two people on studentdoctor.net who posted in a thread a couple years ago that they went from being NP's to MD's.

Both of them said that they "did not know how much they did not know until they went to medical school".

Did they mean that they didn't know anything prior to medical school? Absolutely not. Couldn't be more wrong.

They said that they had medical knowledge prior to medical school, but that they didn't realize not as much how much more in terms of quantity, but the depth of knowledge and the deeper understanding of the concepts that was the surprising thing to them that led them to believe the above quote.

Please do not be offended by anything I've wrote. After all, if I didn't care about what nurses and NP's felt, I wouldn't be here nor would I write a comment like "nurses are the real heroes of healthcare".

However, I have to be honest not only with the heroes of healthcare belief which is undoubtably a popular belief on a nursing forum, but also with viewpoints that may be unpopular.

MS, APRN, BC, FNP · Nov 30, 2006

Please do not be offended by anything I've wrote. After all, if I didn't care about what nurses and NP's felt, I wouldn't be here nor would I write a comment like "nurses are the real heroes of healthcare".
However, I have to be honest not only with the heroes of healthcare belief which is undoubtably a popular belief on a nursing forum, but also with viewpoints that may be unpopular.

I'm not offended at all. What I don't understand is how some of the MDs I've seen have even graduated at all because the depth and breadth of understanding you speak of certainly hasn't manifested itself in their standard of practice. I can think of one MD that has lost his hospital priviledges and now operates in a very small town, another that lost his medical license altogether. He was a complete quack. He hurt many people. Another that is in the process of losing his license, and yet another that still has his license, but anybody in the know stays away from him. That's just what I can think of off hand. Excuse me if I don't share your enthusiasm about their superiorority. As I've said there are some MD specialists that I know that are simply great. They are what a MD should be. I consult with them and respect them very much. I don't care what credentials a person has, they will have to earn my respect just as I have earned my reputation among patients and the local medical community. I don't give anybody a free pass just because they have a MD after their name.

zenman · Nov 30, 2006

The difference is not due to the peripheral physics or chemistry courses. There's a difference in the fundamental medical courses of pathology, pathophysiology, even anatomy and physiology.

You mean it gets worse than Guyton's???

This summer I'm in a shaman's class and I team up with this physician who also had a Ph.D. in cellular biology. I ask him why he's here and he says he, and many of his peers, are just sick and tired of not being able to help patients get better. So...do they need more A & P or should we be focusing on something else...like shaking that rattle?

CrazyPremed, MSN, RN, NP · Nov 30, 2006

Haven't been on in a while. I'd just like to thank everyone for their responses.
I have a few thoughts on what was said.
This is who I'm trying to emulate. I never was an RN, but I did start as a nursing assistant (ie nurse's aide) before going to medical school, so hopefully that's good enough.
And I've definitely emptied more than a few bedpans...
The difference is not due to the peripheral physics or chemistry courses. There's a difference in the fundamental medical courses of pathology, pathophysiology, even anatomy and physiology.
My sister is a nurse with a BSN. The material she learned in the above courses was definitely not comparable to mine (she'd say the same exact thing by the way).
For example, her anatomy and physiology course was provides a superficial understanding of anatomy and physiology. It really doesn't go into the depth that the anatomy and physiology I had in medical school went into.
Pathology and pathophysiology was even a bigger difference. (once again, she'd say the same thing)
Her course materials and her understanding of the material in our discussions about medical disorders backs this up. She got good grades and finished towards the top of her class and is definitely a smart woman, but does not have the training I do or the depth of understanding of the medical knowledge as I do.
Now, just for the record, the above fact has absolutely nothing to do with the individual, but only with the training that the individual gets. If I went to nursing school and my sister went to medical school, then our depth of knowledge would be reversed, simple as that.
It's this difference in training that results in the difference in clinical knowledge between her and I. Again, that clinical knowledge difference would reversed had we gone to different schools.
I'm sure she doesn't think of herself as having little medical knowledge. This would be correct of her because she does not have little medical knowledge. I'd disagree with any nurse who said he/she had little medical knowledge. But it's not equal to the medical knowledge of a physician (again, simply due to training differences, and not person differences).
(the 2nd quote if from another thread I was reading)
I have to step in here and be honest. It's quotes like these that give the physicians that I was talking about in my 1st post ammunition.
Please to do not compare an NP's training as equal to an MD's training. The residency an MD goes through is definitely not equal to an NP's training. For example, they did not have to institute an 80 hour work hour restriction for NP's.
I think an analogy is appropriate here. Saying an NP's training (and knowledge) is equivalent to an MD's is like saying an LPN's training and knowledge is equal to an RN's.
An LPN's training and knowledge base is definitely not equal to an RN's. An RN has more years of training and learns as a deeper level and thus acquires a deeper understanding of the material as compared to an LPN.
From my experience, I've never met an RN who believes that an LPN is an equal substitute and has the equal knowledge to an RN. I was told of the differences above by many RN's themselves.
It demeans the training an MD gets to say it's equivalent to that of an NP just like it demeans that training an RN gets to say that it's equivalent to that of an LPN.
The same is true for NP and MD as is true about an RN to LPN. The first quote talks about it being a "competence of the individual" thing. I definitely agree that a competent person is better than a incompetent person anyday.
However, one has to look at averages though since there's a range in any field. The average RN will always have more knowledge and training than the average LPN and therefore is capable of delivering a higher level of care than the average LPN (again, solely due to the training and knowledge difference).
Likewise, the average MD will always have more knowledge and training than the average NP and therefore is capable of delivering a higher level of care than the average NP (again, solely due to the training and knowledge difference).
I don't expect any of this to change anybody's mind, especially since it's not as though I went from being an NP to an MD, which would give it a lot more weight.
However, there were two people on studentdoctor.net who posted in a thread a couple years ago that they went from being NP's to MD's.
Both of them said that they "did not know how much they did not know until they went to medical school".
Did they mean that they didn't know anything prior to medical school? Absolutely not. Couldn't be more wrong.
They said that they had medical knowledge prior to medical school, but that they didn't realize not as much how much more in terms of quantity, but the depth of knowledge and the deeper understanding of the concepts that was the surprising thing to them that led them to believe the above quote.
Please do not be offended by anything I've wrote. After all, if I didn't care about what nurses and NP's felt, I wouldn't be here nor would I write a comment like "nurses are the real heroes of healthcare".
However, I have to be honest not only with the heroes of healthcare belief which is undoubtably a popular belief on a nursing forum, but also with viewpoints that may be unpopular.

Great reply.

CrazyPremed

augigi, CNS · Nov 30, 2006

I think an analogy is appropriate here. Saying an NP's training (and knowledge) is equivalent to an MD's is like saying an LPN's training and knowledge is equal to an RN's.
It demeans the training an MD gets to say it's equivalent to that of an NP just like it demeans that training an RN gets to say that it's equivalent to that of an LPN. The same is true for NP and MD as is true about an RN to LPN.

Actually, that's the proverbial apples and oranges. RNs and LPNs are both studying nursing, but to different depths and breadths. However NPs and MDs are NOT studying the same thing. One is NOT superior to the other, as doctors are studying medicine while NPs are studying nursing. Different ballgame. Noone thinks NPs are mini doctors. However they do reasonably think that they can easily provide safe care independently when MD intervention is not required.

By your own analogy, MDs should be pleased to leave certain "lower level" tasks to the inferiorly trained NP. I just don't even get what the argument is, apart from MDs losing out on billing.

In addition, I'd have to disagree with a blanket assumption that more indepth A&P or pathology leads to a better standard of care. In theory it should, but it's not guaranteed.

Overall, you sound like a great person to have on the healthcare team and made your points eloquently. I'm not an MD or an NP, so this is only my personal opinion.

tnd511 · Dec 1, 2006

As a nurse for nearly 13 years, I have worked in many areas of nursing and I feel that my experiences have made me pretty well-rounded. I am starting a CC, ER, Trauma NP/CNS program in Jan. I do feel that my almost 13 years of nursing experience will contribute to my education and in a way these years have been a portion of my "residency". I have worked CC for years and learned from the attendings as well as the residents. This learning has definitely augmented my initial training and will contribute to future education.

When most people start med school how many years of medical experience do they have???? I would dare say no where near 13, but I could be wrong.

Once in my program I will take more classes in Physiology and Patho., multiple classes in assessment, pharmacology, and so on. So while I am sure that your education far out weighs that of your sister's BSN, so will my NP education out weigh that of my BSN.

The main difference that I can see between the 2 programs is that when you go to med school you take alot of very broad classes and after many years of generalized practice you then can decide on a specialty. When you become an NP you are specialized from the beginning, therefore eliminating alot of general classes that aren't needed for the practice that one has chosen.

So while I don't equate NP's and MD's, I do feel that when I am finished with school that I will be ready to provide SAFE and adequate care that will only get better with years of practice.....just like all graduates from med school.....if I didn't believe that, I wouldn't even go to NP school!!! And BTW, I have no desire to become a Dr. I am very happy and proud of being a nurse.

If you ask me that one big difference between the MD and the NP is RESPECT:nono: , which is very sad!

CrazyPremed, MSN, RN, NP · Dec 6, 2006

When most people start med school how many years of medical experience do they have???? I would dare say no where near 13, but I could be wrong.

No, but the 4 years of intense medical training combined with the 3-5 years of extremely intense residency (plus fellowship if one chooses), will more than make up for that.

Honestly, I think that the medical training is what causes the 'great divide' between NP's and MD's. If NP programs added more classes and a one-year residency, I could see the profession finally getting the pay and respect it deserves. Does anyone think this will happen?

CrazyPremed

gauge14iv, MSN, APRN, NP · Dec 7, 2006

Honestly, I think that the medical training is what causes the 'great divide' between NP's and MD's. If NP programs added more classes and a one-year residency, I could see the profession finally getting the pay and respect it deserves. Does anyone think this will happen?
CrazyPremed

That is SUPPOSED to be the intent of the new DNP programs - however, there are DNP programs out there that are more education, leadership or management focused rather than clinical. Columbia's program is supposed to be highly focused on clinical and includes a residency - I hope that other programs will follow suit!

Josh L.Ac. · Dec 7, 2006

Okay, so do NPs and DNPs really do "nursing" or is that just semantics to allow them to practice under the BON? From the NPs I've talked to, they basically practice "holistic medicine" but call it nursing. No nursing diagnosis, very little bed-side nursing, more medical diagnosis and treatment.

mvanz9999, RN · Dec 7, 2006

So while I don't equate NP's and MD's, I do feel that when I am finished with school that I will be ready to provide SAFE and adequate care that will only get better with years of practice.....just like all graduates from med school.....if I didn't believe that, I wouldn't even go to NP school!!! And BTW, I have no desire to become a Dr. I am very happy and proud of being a nurse.
If you ask me that one big difference between the MD and the NP is RESPECT:nono: , which is very sad!

If I can add to this, I am neither an MD nor a nurse, but I think it comes down to the first part above. NPs can provide adequate and safe care. The route one takes to be able to do that has little bearing on ability. Doctor's may take more in-depth courses, but how does that really affect the care given? How much of all those in-depth science courses are used by any doctor in the course of day-to-day patient care? A psychiatrist isn't going to use a great deal of gross anatomy, nor does he/she need to be able to deliver a baby to provide excellent care for the patient. So is the fact that MDs have far more book knowledge always applicable? I think not.

jer_sd · Dec 7, 2006

Okay, so do NPs and DNPs really do "nursing" or is that just semantics to allow them to practice under the BON? From the NPs I've talked to, they basically practice "holistic medicine" but call it nursing. No nursing diagnosis, very little bed-side nursing, more medical diagnosis and treatment.

well since the act of diagnosing and treating disease is done by nurses (nps) with education in nursing it is the practice of nursing. just as an eye exam is the practice of optometry or osteopathy or medicine. Or diagnosing and treating glossitis in a cancer patient can be a dental, medical, or nursing act. if a nurse diagnosis and treats a uti it is nursing (yes not taught in basic rn programs but we have that advanced practice thing going on). at least that is my opinion on the proffesion. but I don't put nursing diagnosis on my charts either....Jeremy