Misconceptions in NP/PA/MD education: experiential requirements, online, and for-profits

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Does PA or medical education have some of the same hot-button issues we see in NP education?

There has been a great deal of teeth gnashing about NP education. The complains generally relate to a few of the following in combination:

1. Online programs

2. Part time programs

3. No experience required

4. For-profits

Usually the gaze is then cast on PA and MD education where supposedly none of these problems exist. Let's examine that idea with the caveat that I am no expert in PA/MD education, but I often see a lot of posts from folks who have discernibly less awareness.

1. Online programs

PA programs such as UND, Red Rock, Yale, Lock Haven, MCPHS and others offer programs that are either distance learning or a hybrid curriculum where some courses are online while campus visits are required similar to Vanderbilt's NP program.

2. Part Time

While I don't know of any part time allopathic/osteopathic programs (although some will allow 5 years to lighten the intensity), there are some part time PA programs such as , Rutgers, University of Detroit,

3. No Experience Required

There is much teeth gnashing about direct entry MSN programs despite evidence supporting the practitioners they educate. How about on the PA/MD/DO side?

MD/DO

To point out that MD/DO applicants need not have experience is just asinine because of residency. However it possible for MD/DOs to practice without a residence in many states. They might practice independently as a general practitioner or they not be independent, functioning more like a PA.

PA

16% of programs require 1000-2000 hours of healthcare experience (less than 1 year full time)

40% require no experience

44% of programs require somewhere between 8 and 500 hours

The experience requirements, where they exist, vary from shadowing to volunteering to paid professional experience.

4. For-Profit

There have long been plenty of for-profit medical schools outside of the US that accept applicants who couldn't get into US schools. They are US accredited, so their graduates do practice in the US. The first for-profit medical school in the US opened 10 years ago and more have followed.

I am not aware of a for-profit PA program... yet...

Summary: When I look at these for categories of concern, it turns out most of them are in PA and MD/DO education. However, they seem to less prevalent and the online learning shift is coming from the elite-end of education while in NP education, these changes started at the lowest common denominator (which, not coincidentally, are the for-profits).

Specializes in ICU, LTACH, Internal Medicine.
Out of curiosity, does your program know about this? This has been a big issue in the past with students because of the manner in which the school's malpractice insurance covers students.

My school provided for students, but it only covered allocated clinical hours. So, I bought my own.

All my preceptors knew about this practice, no one of them winced :)

Specializes in ICU, LTACH, Internal Medicine.

Dear Globoid,

there is a thing in this country which has an overflowing abundance of medical data of all sorts and big money to deal with it. It is also not depending on, or financed by, any MD or Nursing organization. It is named "medical insurance". These guys, especially private ones, employ the best of the best statistitians in the world and have very vested interests in determining healthcare trends, so that they could avoid paying one$ more than they have to.

Their research is not published but they can be found nevertheless if one has access to the industry. And, so far, these guys found no difference in clinical outcomes among patients with common chronic disorders (HTN, DM II, obesity, smoking, COPD - these I know for sure) when managed by NPs, MD/DOs, PAs or "care teams". That's why they still pay for that care, doesn't matter who provides it.

I should not even explain to you, probably, that it will be that mundane, uncomplicated, everyday care that determines if you and me would receive any sponsored medical care at all in 25 years or if healthcare system of the US would collapse under avalance of chronic critically sick patients before that. I also shouldn't remind you that it was MD/DOs' party who, after being wined and dined by Big Pharma, concluded that opioid analgetics are "safe and effective" for chronic non-cancerous pain and thus subjected American population to opioid abuse epidemic which already killed more than did any war in American history, as an only one among many of this party's pitfalls.

If you would like to muse about those stupid nurses who know not what they don't know, you are very welcome to join the party on StudentDoctor. Otherwise, come where I am and try to fix just something in a place where half of the adults are addicted, where kids faint in school because there's no food in home and where average income is below powerty line. Work with these people. Look into their eyes. See them speaking quietly about one or another their friend, neighbor or relative dropping dead almost every month. Then we will sit and chat about those who "know nothing".

Specializes in Adult Internal Medicine.

In regard to NP getting full authority it is not a concern though, most will continue to work for docs anyway. its not going to hit our paychecks. Most hospitals will not give APRN full individual patient care rights no matter what the states say, so big deal, give it to them.

It should be a concern if you actually believe your initial position that the secret studies show that NPs increase the cost of care and don't provide quality care. Again, you seem to only be concerned about your paycheck not the patients, that's not a great starting position for entering practice.

If there ever is a flood of NPs providing patient care without oversight to any great extent the lawyers will clean up that mess with a large influx of lawsuits anyway.

There probably will be a exponential increases in malpractice suits against NPs. I am not sure how this factors into your argument: 37% of physicians are named in malpractice cases of professional negligence while only 1.7% of NPs are, and that's with 220,000 NPs practicing.

In retrospect, I have met some great MLPs who know their limits, consult as needed, and are great with the patients (we all have limits), but to compare their knowledge base and ability to perform complex diagnostic methods to the same level of a well trained physician (especially an american trained physician) is absurd.

I have met some great physicians than know their limits, consult as needed, and are great with patients. All providers need to know their limits because overconfidence kills patients, I would have though in your 2 years of residency you would have at least a healthy respect for that. Humility goes a long way.

I do apologize for stepping on toes, but please use common sense. Physicians are the basis of medicine, nurses are the basis of patient care and communication between physician and patient/nursing, both are equally important, but please do not blur the lines between them.

If you think you can be the base of medicine without being the base of patient care then you have a lot to learn about the quality practice of medicine outside the "knowledge base" and "complex diagnostic methods" you are so proud of.

Specializes in CVICU, MICU, Burn ICU.
Dear Globoid,

there is a thing in this country which has an overflowing abundance of medical data of all sorts and big money to deal with it. It is also not depending on, or financed by, any MD or Nursing organization. It is named "medical insurance". These guys, especially private ones, employ the best of the best statistitians in the world and have very vested interests in determining healthcare trends, so that they could avoid paying one$ more than they have to.

Their research is not published but they can be found nevertheless if one has access to the industry. And, so far, these guys found no difference in clinical outcomes among patients with common chronic disorders (HTN, DM II, obesity, smoking, COPD - these I know for sure) when managed by NPs, MD/DOs, PAs or "care teams". That's why they still pay for that care, doesn't matter who provides it.

I should not even explain to you, probably, that it will be that mundane, uncomplicated, everyday care that determines if you and me would receive any sponsored medical care at all in 25 years or if healthcare system of the US would collapse under avalance of chronic critically sick patients before that. I also shouldn't remind you that it was MD/DOs' party who, after being wined and dined by Big Pharma, concluded that opioid analgetics are "safe and effective" for chronic non-cancerous pain and thus subjected American population to opioid abuse epidemic which already killed more than did any war in American history, as an only one among many of this party's pitfalls.

If you would like to muse about those stupid nurses who know not what they don't know, you are very welcome to join the party on StudentDoctor. Otherwise, come where I am and try to fix just something in a place where half of the adults are addicted, where kids faint in school because there's no food in home and where average income is below powerty line. Work with these people. Look into their eyes. See them speaking quietly about one or another their friend, neighbor or relative dropping dead almost every month. Then we will sit and chat about those who "know nothing".

Disclaimer: I haven't read through all the comments in this thread. To Globoid -- I agree you have made some SDN-esque comments. I think and hope that a bit more real-world experience will bring more balance to your view. I think you do know about collaboration in health-care (you must if you are in residency now) -- and over the coming years it will become even more crystal clear how very dependent you are on a team. And the same is true for everyone else on that team. It's cliche, but as Boston said, we all need each other. So silly that we must be reminded (and I am speaking to medical AND nursing egos when I say this).

To KatieMI -- I really loved your comment here, because I think your perspective so beautifully illustrates the holistic NP mindset, as well as the very crucial contribution NP's have to make to American healthcare.

In a perfect world, not "blurring the lines" between nursing and medicine would NOT be the greatest priority. In a perfect world none of us would be focused on such role-play or finger pointing because we would be too busy working together to address the health of the populations we serve. The truth is, as individuals, we won't be very effective in our work without that mindset.

And let me just say --- I am so thankful for physicians -- especially the great many who 'get it'. I think this thread was comparing educational paths? Of course, it doesn't make sense for NP education to echo MD education -- but APN education would surely benefit from the consistently higher standards for admission and practice we see in medical education.

My biggest gripes were:

1. Lack of structure

2. Lack of finding preceptors (my school provided however)

3. Lack of gross anatomy. Patho is just not enough. Initially reading radiology reports had my head spinning, nurses just don't learn the body's anatomy well enough.

4. Lack of clinical hours, sure you can do more but the mandated amount is far too low.

5. Biggest part: NP school seems too keen on memorization. We all know the BUN is elevated in dehydration, buy why is it elevated in GI bleeds. The "why" is often lost. Why is there a high white count with steroids? etc etc.

Biggest part: NP school seems too keen on memorization. We all know the BUN is elevated in dehydration, buy why is it elevated in GI bleeds. The "why" is often lost. Why is there a high white count with steroids? etc etc.

I listened to Dr. Goljan's lectures over the past couple months and he addresses both of these! Things that med students taking step 1 are expected to know...

I cannot for the life of me figure out how all militant nursing rhetoric says "we are a team... we are interdependent" And then right after claim equivalency and push for independent practice rights.

If you want to take biochem and genetics, pharmacology etc. then probably should have gone to medical school.

Specializes in DHSc, PA-C.

PAs, sorry but I do not have much of a good record among that group. I have worked along or with 100-200 and can honestly 3 have impressed me. the rest range from functional, modestly competent to what the heck are you doing. Granted that was just my experience in 10 different states, but I am sure there are some great ones out there or at least I hope there are.

Oh wow. Only 1.5-3% of PAs have "impressed" you? What the heck are your standards? I'm sensing some narcissistic personality disorder. What do you think about the population in general? How many patients have "impressed" you? How many doctors?

Oh wow. Only 1.5-3% of PAs have "impressed" you? What the heck are your standards? I'm sensing some narcissistic personality disorder. What do you think about the population in general? How many patients have "impressed" you? How many doctors?

3 were excellent and I learned from each of them. Like I said the rest ranged from competent to way less. What stood out to me most from the group is their arrogance especially when you interact with them as an RN where NPs didn't own that behavior (for the most part). I have seen some pretty outrageous behavior from PAs...where NPs seems to ask before going rogue. Like I said this has been my exposure to the group and it has colored my opinion, but I am always hoping to encounter those who are exceptional.

Specializes in Adult Internal Medicine.
I cannot for the life of me figure out how all militant nursing rhetoric says "we are a team... we are interdependent" And then right after claim equivalency and push for independent practice rights.

Because you clearly don't understand the independent practice issue.

Specializes in Family Nurse Practitioner.
If you want to take biochem and genetics, pharmacology etc. then probably should have gone to medical school.

Unfortunately you are probably correct but how sad and what a waste of nursing students' potential.

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