Legitimate gripe about NP training / education requirements?

[RomaniGypsy]

I was reading one of the internet forums focused on doctors and doctor training. I can hear y'all now... "good grief, THAT one again!"... but I have a question that I think is legitimate, regardless of the unsavory attitudes espoused by all too many people on that forum. I searched AllNurses for this information and the most recent thread I found that was close to relevant was from 7 1/2 years ago, so maybe it's time for an update anyway.

The biggest gripe that doctors and medical students (and the authors of some internet articles) seem to have with NPs is the difference in training and education. They'll say things like "you can get into a direct entry MSN program, some of which are mostly online, and come out with an NP license without having worked one minute as a nurse", and "to become a doctor you have to go through 17,000 hours of clinical training whereas to become an NP you only need around 700 such hours". I do see people considering NP vs. MD/DO and one of the biggest reasons why they look at NP is because the training won't gobble up the entirety of their lives for the next 8 years.

But from the perspective of the NP, I imagine there's a good bit of logic in a question like, "Why do I need to know every step and intermediate product of the Krebs cycle in order to diagnose, and order appropriate treatment for, strep throat?" I mean, I had strep a few times as a kid. The doctor swabbed my throat and wiped the swab in a petri dish. I waited 20 minutes, at the end of which time they must've been able to look at the petri dish's contents under a microscope, "yeah, that's strep", and then since the doctor knew what medicines work best against strep, he prescribed one. At no point was any of the super-advanced knowledge acquired in medical school required. You'd need to know pharmacology, which I imagine NPs learn in the course of their training. (And besides, in today's information age, if there's something you don't know, can't you just look it up? I recall my doctor always having a copy of the "Physician's Desk Reference" on his desk back in the day. I have an old copy of that myself, and it seems to be made so that you can look up something that has slipped your mind, or that you never knew, which would be relevant to a patient you're treating.)

So what do y'all say about this? Do you ever feel unprepared for practice due to the lesser training and education you get, compared to an MD/DO? Do you regularly catch attitude from doctors who look down upon you as a "lesser practitioner" because of your lesser quantity of training? I really do want to know what's up with that training and education discrepancy. Is it that medical school teaches you a lot of minutiae and esoterica that 99% of primary care practitioners will never need to know? If it really is true that after only two or three years of schooling (for MSN / NP) and no residency requirement, an NP is fully qualified to practice medicine to the extent of his/her scope, often independently, then why is it that medical school is 3-4 years with a 4-year residency requirement?

[meanmaryjean, DNP, RN]

Please stop.

[RomaniGypsy]

Please stop.

It's not a legitimate question? At the very least, I could stand to learn if medical school contains a lot of "fluff", and why. Your credentials make it seem like you're well-positioned to provide a thorough and intelligent answer to my question. I'd prefer that, to evidence that you consider my question asinine. I never waste people's time (mine and theirs) by asking asinine questions.

[traumaRUs, MSN, APRN]

Here is a multi-page thread on this topic:

https://allnurses.com/nurse-practitioners-np/standardization-of-np-1167380.html

Once you have experience as either a nurse, physician, etc., you will have more insight into this topic.

Moved to pre-nursing as you really need to start with the basics. Reading the internet is not the way to understand NP education.

[TheDudeWithTheBigDog, ADN, RN]

Long post:

I do see people considering NP vs. MD/DO and one of the biggest reasons why they look at NP is because the training won't gobble up the entirety of their lives for the next 8 years.

Ignore it. Everyone has the hardest, but most underrated in difficulty, job in the world. Egos are big in healthcare. ANYWAY:

To become an NP traditionally: you need your BSN (some schools you'll skip the actual degree, but you're going to take the classes and get the credits that would bring you to this point regardless).... 4 years.

Then your MSN program is typically 1 year.

Total: 5 years

Med school: Bachelor's of science degree. 4 years

Medical school classes: about 2 years

Total: 6 years

Direct to MSN: Bachelor's of science degree. 4 years.

MSN degree: typically a 2 year bridge program.

Total: 6 years

Residency is just working. A med school resident is a physician working under an MD.

Nurse practitioner is an autonomous nurse working under an MD.

There's a slight difference in the residency requirement: If you start with an ADN, by the time you finish with your MSN, you should have 4 years experience working as a nurse. The resident physician can't start until after their med classes, which means that after that 6 years, they have 0 clinical experience.

So med school: 6 years of school 4 years of clinical experience

Nurse Practitioner: 5 years of school, 3 years clinical experience while in school. Or if you want to mach a doctorate for a doctorate. The DNP has your 6 years in school with 4 years of clinical experience.

Total time for traditional RN-NP with DNP: 10 years combined school and clinical experience

Total time for premed to MD: 10 years combined school and clinical experience

The only difference comes in the direct to MSN programs, which totals out to 6 years of school. But with precepting in their role during that time, and very commonly AFTER graduating. Ultimately, in most cases it still comes out to 6 years of school, 4 years of clinical experience, totaling 10 years.

If you're becoming an NP because it's faster than becoming an MD, you're going to be disappointed, and if you want to be the equivalent of an MD, become an MD. There are differences in the job, even when an NP can be primary care in private practice. The choice of NP should be because of the nursing background, and as someone who's getting into nursing because of the goal of being an NP, my opinion is it should also be because you prefer being part of a team. Complete autonomy kind of defeats the purpose.

[nyc-cnm]

Where do you get your med school info?

Med school is 4 years, not 2. Traditionally the first 2 years are class based sciences and the last 2 are hospital based clerkships/clinical rotations.

There is no such thing as a "med school resident". Residents have completed medical school and are now learning a specialty. Residency is not "just working". They are required to learn specific information and techniques and are evaluated formally and informally all the way. The hours put it are way way in excess of 40 hours a week, not just a couple of shifts per week as is done in nursing school.

It is possible to practice as a physician without doing a residency, but most states require at least a one year internship before licensure.

Therefore a typical doctor would have 4 years of undergraduate school, 4 years of medical school and at the minimum a year's internship, therefore at least 9 years total, and usually more. An OB -GYN, for instance would need 12 years before independent practice.

And no, there is not a lot of fluff in med school.