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

Bob26 · Dec 14, 2006

Busy rotation, haven't been here in a while. Glad to see all the responses.

Gotta tackle some issues in the next few posts.

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.

There are examples of quacks with an MD behind their name and who hurt, if not kill, people.

There are also examples of quacks with an NP behind their name who also have the same negative consequences.

One case I can think of one case when the NP failed to diagnose a simple case of pneumonia (I believe read an X-ray as normal that blatantly was not normal). Pt. did not receive treatement and eventually had to be hospitalized when if they had received correct treatment earlier, they wouldn't have had to be hospitalized. I heard the physician took one look at the office x-rays and couldn't believe how anybody could have missed the diagnosis.

We can go back and forth on quack MD's and NP's. There are plenty of them there.

The point is that there are quacks in every field. By saying this, as well as saying that "it's all about the individual", you're giving off the impression that there's no real difference in training or knowledge between NP and MD, which is definitely not true.

And for the record, I completely definitely agree that nobody should automaticaly be given respect just because they have an MD in back of their name.

Bob26 · Dec 14, 2006

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.

This is a common argument that is presented here. It's a good analogy because NP's definitely practice medicine. By definition, diagnosing and prescribing treatment for medical conditions is medicine, not nursing. Medication management (based on lab values, patient condition, etc...) is medicine, not nursing.

If it was thought that NP's practice medicine, this would get them under the state medical boards, which would curb their rights. This is the real reason why it's considered "advanced nursing" when it's in reality medicine.

Now, I have absolutely no problem with this whatsoever. I disagree with any docs who say that the only people who should have prescriptive ability should be docs.

However, I also disagree with people not calling a spade a spade and just admitting that NP's practice medicine.

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.

1. I agree. It's not always true in 100% of cases. But if it weren't fundamentally true, why have education and training? What value would there be? Why have MD's then if you can provide the same care as an NP/PA without the hassle of the extra education and training?

2. I didn't say better standard of care, I said the education and training MD's get gives them the capability to provide a "higher level" of care than NP's.

Once again, as if I didn't say this enough times, this is a training issue, not a person to person issue.

How's this for a better analogy then. Before med school I got a Master's degree in biochemistry b/c I thought I was going down the research road to a PhD instead of med school.

I consider myself to have a good biochemical knowledge after getting both a BS and MS in biochemistry.

I'd be very offended and would disagree with very strongly any PhD who told me I didn't have any biochemistry knowledge at all.

However, I definitely do not have anywhere near the knowledge of biochemistry that PhD's in biochemistry have. If a PhD told me this, I would agree.

It has nothing to do with me as a person, it's just a training issue. The training a PhD in biochemistry receives is far more in depth and quantity than an MS in biochemistry like myself.

Bob26 · Dec 14, 2006

6

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!

Read this...

I was a nurse for 8 years before going to medical school - and I didn't know ANYTHING compared to what I know now -
I second all the others and I would consider myself as coming from the trenches - but until you are HERE you are still over -----------> there
and have no idea, none.

This is a quote that I read a while ago on studentdoctor.net posted by a former nurse who is now a medical student about medical training compared to nursing.

I've read other quotes from med students and docs who dropped out of NP programs to go to medical school.

Please do not compare a nurse's or NP's training to an MD's. No matter how many years of nursing you have, it's no residency. And the pathophys classes do not equal medical school classes.

Also in terms of the education, I'm just going to be blunt here and say that you don't know how much you don't know until you go to a higher level.

A couple of nurses in my class (former ICU nurses who were sharp) said the exact same thing as the quote above.

This absolutely does NOT mean that NP's don't have medical knowledge. They definitely do.

Look back at the previous post of me talking about my MS in biochemistry. I consider myself to have a good biochemistry knowledge (due to my BS and MS in biochemistry), I'd vehemently disgree with any PhD who told me I "didn't know anything about biochemistry".

BUT, I'll be the first one to admit that my knowledge level is nowhere near a PhD in biochemistry.

I realize all this makes me sound like an arrogant X who thinks I'm the greatest thing since sliced bread and who thinks that I know everything about everything. Believe me, I'm not and I can't stand these type of people.

But at some point I have to be honest and correct perceptions that are so flawed such as calling practicing as a nurse a form of "residency".

Medical school and residency are things that you can't possible understand the difficulty of it and the depth and sheer quantity of knowledge you gain from it (not to mention the enormous stress of it) until you go through it.

They don't call medical school trying drink from a fire hydrant for nothing.

Although at least the residents have it better than previous generations with 80 hour work limit.

Bob26 · Dec 14, 2006

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.

Another common belief. And to tell you the truth, there is a decent amount that isn't relevant such as the example you gave (which is one of the more special examples you can use for your point).

However, most of what you learn is relevant. For example, psychiatrists must know all of their physiology, because all the meds they are prescribing have physiological effects all over the body. They have to know the physiology of those organs too, not just neurophysiology.

Primary care docs need to know all anatomy to correctly diagnose various problems themselves or know when the patient needs a referral to ortho, vascular, or any other specialists.

Like I said, you're definitely right on a decent sized portion of the stuff learned in medical school, but not as much as you think.

I also had the same viewpoint too before starting med school, but I've been converted after seeing how it's much more relevant than I thought.

mvanz9999, RN · Dec 14, 2006

Another common belief. And to tell you the truth, there is a decent amount that isn't relevant such as the example you gave (which is one of the more special examples you can use for your point).
However, most of what you learn is relevant. For example, psychiatrists must know all of their physiology, because all the meds they are prescribing have physiological effects all over the body. They have to know the physiology of those organs too, not just neurophysiology.
Primary care docs need to know all anatomy to correctly diagnose various problems themselves or know when the patient needs a referral to ortho, vascular, or any other specialists.
Like I said, you're definitely right on a decent sized portion of the stuff learned in medical school, but not as much as you think.
I also had the same viewpoint too before starting med school, but I've been converted after seeing how it's much more relevant than I thought.

I agree. Could you maybe some up all your points above? I don't quite see where you are going with all this.

tnd511 · Dec 14, 2006

XX

If you carefully read what I wrote, you will see that I said that these years will contribute to my further education and in "a way they have been a portion of my residency". I in NO way said that my 13 years of nursing made me equal to a Dr., did I???? I am pretty on top of my knowledge base and will freely admit that I don't know everything, nor will I ever know everything, no matter the number of years I am in school. You would be well served to adopt the same attitude! and your patients will appreciate a Dr. who knows when to say I don't know, but I will find out!

Further more I added, and I quote from my initial post.......

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!!!

So Bob, good luck in school and PLEASE remember that you are always going to be learning....the day you stop learning, please STOP practicing medicine!!

BTW, why again did you feel the need to come and post on this board when (they) have a board of thier own? You were never going to get the answer you seek. But then again I get the feeling that you weren't really seeking any answers, rather furthering the already great divide, JMO.

mvanz9999, RN · Dec 14, 2006

I don't think I'll ever understand that divide. We're all on the same team, no?

MS, APRN, BC, FNP · Dec 14, 2006

Medical school and residency are things that you can't possible understand the difficulty of it and the depth and sheer quantity of knowledge you gain from it (not to mention the enormous stress of it) until you go through it.
.

As a NP I really do wish I could look at the MD credential and trust in that when I consult but it's not possible with some. My patients and I have been burned more than once by making that assumption. I made the mistake of passing the buck to an MD when they would have been better off had I completely handled their care instead. We have one MD here that is brilliant and is the go to guy for other MDs when they are over their heads. He'll be the first to denegrate their medical education. The fact is there are few that are as dedicated to the profession of medicine as he is. You are only in med school. You are not practicing in the real world. Let me know when you are because being a primary care provider is something you can't possibly understand the difficulty of it and the sheer quantity of knowledge you gain from it (not to mention the enormous stress of it) until you go through it. When you have as much experience as I have as a primary care provider which will be in about 10 years if you graduate today give me a call.

Studies have proven that patients are just as well served with NPs as they are MDs, and that is the bottom line, but thanks for your input. Your point is MDs have more training. No one is disputing that. Do you think we're idiots. My point is you can't trust the individual that has this training, because somewhere along the way someone dropped the ball when they let him graduate. So it comes down to knowing the competance of the individual before seeking care. There are gaps in everybodies education. I've had to inform a doc about the latest standard of care about certain conditions that he wasn't aware of. It's all about continuing education. I hope you continue with yours when you graduate from med school.

Uberman5000 · Dec 15, 2006

You won't get a balanced view, even from CNN, except for your last statement.

LOL - CNN is balanced? I guess if you are a socialist lol -- Anyway, I dont feel that NP's are equivalent to MD's as far as legitimate power is concerned, M.D's just get paranoid when they see their patients going to different providers, they dont want to lose power..its only natural to criticise and demonize in some instances.....

Bob26 · Dec 15, 2006

I didn't respond for a couple weeks b/c of barely any free time due to being on my surgery rotation. I was given the afternoon off to go home and read due to a slower than usual day, so I figured I'd respond.

But I've been reading some of the responses and wanted to respond to some things which are things I particularly disagree with.

Oh yeah, sorry about the long posts. Once I start writing something, sometimes I can't stop myself after I get on a roll. It's been that way ever since HS english class. I definitely do go overboard sometimes.

And besides, I'm always up for a nice friendly debate:D

Anyways, I've decided to end my posts in this thread (even though there are a couple issues with the previous points I'd like to address).

I think it's pretty clear I got the other side on this issue to get my balanced viewpoint.

Good luck to everybody and thanks for putting up with my questions/blabbering.

And remember, if I didn't care about what you guys thought on this issue, I wouldn't have bothered to come here and hear all sides.

CrazyPremed, MSN, RN, NP · Dec 22, 2006

Thanks for you input, Bob.

You have given great insight to those of us on the fence between APRN or medical school. Many of us believe and agree with everything that you have said.

Good luck in your studies.

CrazyPremed

Dixiecup · Dec 29, 2006

Oh Bob,
What a can of worms. I think the question you are asking is if I think my practice is equivalent to that of the mighty physician. I would have to say no. I also don't think that necessarily has to be a bad thing.
Let me help you achieve some balance. I have often heard medicine referred to as a science, while the idea that nursing could be a science is often not taken as seriously. However, consider that many physicists, chemists, and the like would consider the idea of medicine as a science equally laughable.
One thing that nursing and medicine have in common is that neither is a basic science, but both are applied sciences. We apply the concepts developed by chemists, physicists, biologists, ect. to the human condition, whether it be well, ill, or injured. Medicine and nursing both do research to determine how new science can help, alter, or be a detriment to the human body.
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.
I realize there is some feeling of threat and fear from many physicians that NPs will take over the world or something equally inane. The fact is there is plenty of work to go around. Even with the addition of NPs to the care mix there are many people going without needed healthcare provider attention.
Perhaps it could start with you. Don't sweat the small stuff, and a lot of it is small stuff. Don't let the point get lost in the semantics. Don't be dragged into a one sided turf war that has no exit strategy.
Everyone who needs to be comfortable with my abilities is comfortable with my abilities. Sometimes I put in the femoral line and the ER doc does the intubation..... sometimes the ER doc puts in the femoral line and I do the intubation. In the end what matters is someone put in the femoral line and someone did the intubation. As long as we are both capable of getting the job done, what difference does it make who actually did the job??

I'm impressed and terrified at the same time. I actually don't think I could ever do either one!!! :eek: