So the director of psychiatry and some senior psychiatrists at my hospital are in a funk. It appears surrounding hospitals are offering incentives (increased salary and other benefits) to attract psychiatrists to their institutions - and its working. So far, we have lost four psychiatrists in the past five months to nearby hospitals that are offering those incentives. Those facilities also hire FNPs and PMHNPs whereas my hospital doesn't. Clearly there is no way for my hospital to match the benefits of the other competitive institutions and there is a huge shortage of psychiatrists in the area. So... I suggested that we start hiring NPs.
Bad move.
I never seen so much hatred from health professionals. One of the senior psychiatrists actually shouted at me for coming up with "a stupid idea." He then proceeded to tell me how many years of schooling and training he's had out of some need to compare himself to a PMHNP. What really bothered me is that the director said, "I HATE Nurse Practitioners" as if that was a good enough reason for not hiring them in our facility. What they think is what they think; I can't change that. But would I be overstepping boundaries if I drew up a presentation at our next meeting to outline the benefits of hiring NPs? The chief director of psychiatry will be present at the next meeting and I really think its worth a mention.
That's really unfortunate. Their hospital will suffer because of that attitude. The health care landscape is changing tremendously and it's either you adapt to it or you continue resisting the changes. It's inevitable. NPs have proven themselves as a lower cost alternative in a market where there simply aren't enough providers to care for a growing population. It'll be rough at first to overcome such opinions and perceptions, but I think down the line things will work out. DOs were despised by MDs when they were first introduced into healthcare and now nobody thinks twice.
I dont really like to point out stuff like this but crazynut has the total wrong idea and i am not sure I understand his/her point of view on anything.
That's really unfortunate. Their hospital will suffer because of that attitude. The health care landscape is changing tremendously and it's either you adapt to it or you continue resisting the changes. It's inevitable. NPs have proven themselves as a lower cost alternative in a market where there simply aren't enough providers to care for a growing population. It'll be rough at first to overcome such opinions and perceptions, but I think down the line things will work out. DOs were despised by MDs when they were first introduced into healthcare and now nobody thinks twice.
Unfortunately, there is still a stigma that exists in the MD world that DO's represents the weaker group of physicians, although this is probably not true. I remember comments reflecting that attitude among my classmates when I was in medical school.
MDs often tend to define their intelligence and worth based on the extremely high admission standards to get into MD medical schools, which are the highest admission standards of any school in any profession. Because these admission standards are so high, students matriculating into MD schools are often the top students from the best universities in the country. Since they made the "cut", they believe they are the best of the best, and another body of professionals (DO/NP) who aim to do a similar job, but have lower admission standards, will be viewed as less qualified and less elite in their eyes.
It is a tough stigma to break, because so much of the ego of the US trained MD is due to not only their exhaustive length of training but knowing that they had to be brightest of the brightest to even get in. DO's have shown time and time again that they can compete successfully in the MD arena with similar outcomes. NP's are on their way to showing this with the outcome data that is out there.
I think it is somewhat heartbreaking for the MD's to realize that it doesn't take a valedictorian from an Ivy league university with perfect MCAT/SAT scores with a Rhodes scholar with 12 years of education/training to do their job after all. This degrades the illusion in their mind that being a doctor equates to having a prestige that is unobtainable for the common folk, and thus they will be resistant to all competing entities that claim to also be able to do their job (DO/NP), in order to protect that elitism.
In the end however, market forces will trump over prestige, and the need for cost effective healthcare with good outcomes will drive the evolution of primary care to the NP arena. In another 100 years or so, I suspect even the NP will be supplanted by something else than can do their job even cheaper/more effective (artificial intelligence), but that is an entirely different topic of discussion and reflects the trend of humanity overall.
Unfortunately, there is still a stigma that exists in the MD world that DO's represents the weaker group of physicians, although this is probably not true. I remember comments reflecting that attitude among my classmates when I was in medical school.
MDs often tend to define their intelligence and worth based on the extremely high admission standards to get into MD medical schools, which are the highest admission standards of any school in any profession. Because these admission standards are so high, students matriculating into MD schools are often the top students from the best universities in the country. Since they made the "cut", they believe they are the best of the best, and another body of professionals (DO/NP) who aim to do a similar job, but have lower admission standards, will be viewed as less qualified and less elite in their eyes.
It is a tough stigma to break, because so much of the ego of the US trained MD is due to not only their exhaustive length of training but knowing that they had to be brightest of the brightest to even get in. DO's have shown time and time again that they can compete successfully in the MD arena with similar outcomes. NP's are on their way to showing this with the outcome data that is out there.
I think it is somewhat heartbreaking for the MD's to realize that it doesn't take a valedictorian from an Ivy league university with perfect MCAT/SAT scores with a Rhodes scholar with 12 years of education/training to do their job after all. This degrades the illusion in their mind that being a doctor equates to having a prestige that is unobtainable for the common folk, and thus they will be resistant to all competing entities that claim to also be able to do their job (DO/NP), in order to protect that elitism.
In the end however, market forces will trump over prestige, and the need for cost effective healthcare with good outcomes will drive the evolution of primary care to the NP arena. In another 100 years or so, I suspect even the NP will be supplanted by something else than can do their job even cheaper/more effective (artificial intelligence), but that is an entirely different topic of discussion and reflects the trend of humanity overall.
Probably one of the best unbiased posts I have seen on the topic.
It some ways it highlights the problem with the trend of NP education. When I applied to NP school at an established and well respected program in the heart of a major medical area they accepted 55 of more than 1400 applicants. I graduated with a biology major in a premedical program from a top tier undergrad with a 3.7 GPA (and a MCAT score of 32) and I wasn't accepted my first application. Now I see online NP programs accepting >80% of applicants. It's a major problem. NPs have good clinical outcomes, as you mention, much like the DOs that paved the path, however, NPs are not controlling standards like DOs did. They are cashing in and this is going to create major problems (I fear).
I think that (sadly) the future of medicine/nursing in this country is headed (for better or worse) to the cheapest possible option. My office no longer has any RNs, instead we have MAs that do procedures only providers traditionally performed. Times are changing.
Medicine (for the foreseeable future) will always need physicians. I think medicine, for the foreseeable future before robots take all our jobs, will also need NPs/PAs. For that matter it needs RNs too. And MAs. And PCAs. If we all work together then in think we can provide excellent patient care.
I was just talking to a very experienced (and old) general surgeon today and he told me that he had an epiphany this past week: the future of his job is in the hands of the "kids with the dexterity derived from expert video gamers" rather than the tradition, which I forget his words but was akin to the experience of the ancestry of surgeons lying in butchers.
I was just talking to a very experienced (and old) general surgeon today and he told me that he had an epiphany this past week: the future of his job is in the hands of the "kids with the dexterity derived from expert video gamers" rather than the tradition, which I forget his words but was akin to the experience of the ancestry of surgeons lying in butchers.
I can definitely see my job (neurosurgeon) needing less and less skill in the foreseeable future with the advancement of technology. We are using stereotactic navigation that literally acts as a GPS device for the brain to take out brain tumors, robotics to put in spinal instrumentation, electrophysiologic monitors that can tell you in real time if a nerve is being touched the wrong way. When I think about how my forefathers in the profession performed surgery without these technologies, I can only imagine how much more skill, anatomical knowledge, and raw God-given talent it took to perform accurate neurosurgical procedures than required of neurosurgeons today.
As these technologies continue to evolve and become more automated and autonomous, it will come to a point where quite unskilled workers will be able to perform neurosurgery, and eventually no humans will be needed at all.
The high prestige and high priced education will really then be for the researchers and innovators, which are the driving force behind these technological advancements. The immense training that health care providers currently endure will really not be necessary to the degree that it required today.
I graduated from a top 10 MD school and trained at one of the top hospitals in the country. I believe this realization that significantly less educated/skilled people will eventually be able to do my job can possibly make me and my "elite" education feel less "elite". I believe this reflects the plight of the MDs in general, as they may feel the exclusiveness of job they perform afforded to them by their elite education no longer seems so exclusive.
I completely understand. I have two family members in the MD route (one is OB-GYN and another is Urology) so I've seen them in action. It takes a lot of determination and effort to have that title and I understand how it can be hard to see a new player in the game especially when it doesn't take as long as med school/residency/fellowship. The problem is that a lot of MDs have specialized out of primary care so that left a big gap to fill. I do agree that there are a lot of online programs that are diluting the applicant pool and boards of nursing really need to do something about that. I know it's important to increase the supply of nurse practitioners, but it can't be done by letting any institution do whatever they want (would you like to go from diploma to DNP in less than TWO YEARS?!). I'm exaggerating a bit but you know what I mean. We need to be cognizant of the quality of candidates that get churned out.
Tobra nailed it. My point was to expand your mind. Get you to think outside the box. I mean do you really think puppy mill NP schools are good for the general well being of our society??? Geeezzzz are nurses really that dense! Appearenly they are!
lol I just brought up surgeons as an example. Same could be said for any specialty as we are in a critical shortage of MD's across the board. If we keep steering students away from MD and into NP/PA the problem will only get worse. If you can't see the problem in then you must be blind!
I see the problem as healthcare and capitalism. Its all about the $$$$$ not pt care. That means all care will be delegated to the lowest rung on the pole in order to cut costs. If hospitals could allow CNA's to perform surgery I'm sure they would! Why? Because it's cheaper! Why pay a surgeon to do it when you can pay someone else to do it cheaper? You can find all the random remote obscure articles you want to prove NP's are better but I'm sorry. I'm not buying it. You get what you pay for! Cheap care is not always better care. Remember the hx of healthcare. Back in the day MD's put in IV's nurses weren't allowed to. Now in some places CNA's can be trained to place IV's. Just think about the implications. Is that really best?
Crazynut, the problem is you are speaking about NPs as a whole, not just about those specific types of schools. I'd wager to say most of us agree about those types of schools.
But how can puppy mill NP schools produce quality NP's? Sure it's individual. Some NP's that come out of the puppy mill are great. But overall??? No thanks! Midlevels are the capitalists solution to MD shortage. Like I said before. I much rather fix the real problem (MD shortage) than put a bandaid on it ( NP/PA). Several people have commented that they don't understand my point. It's pretty simple to me. Cheap labor is bad for healthcare! NP/PA are cheap labor!
SassyRN_972
51 Posts
That's really unfortunate. Their hospital will suffer because of that attitude. The health care landscape is changing tremendously and it's either you adapt to it or you continue resisting the changes. It's inevitable. NPs have proven themselves as a lower cost alternative in a market where there simply aren't enough providers to care for a growing population. It'll be rough at first to overcome such opinions and perceptions, but I think down the line things will work out. DOs were despised by MDs when they were first introduced into healthcare and now nobody thinks twice.