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 DHSc, PA-C.
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.

Much much different view point. I have by far seen PAs as an excellent working relationship with RNs and have seen few NPs as having an superiority complex towards RNs. In general though most PA/NP I have encountered treat RNs with respect.

What outrageous behaviors? You make it sound like you see PAs killing patients left and right. Education is different. Some providers are taught to be complex thinkers required to evaluate and respond to a situation and others are taught more of an algorithmic approach in which they are less likely to stray from a straight path.

I can learn something new form most members of the healthcare team. No matter if they are MA, RN, PA, NP, MD....for you to say out of 200 people you learned from 3 of them paints the picture of, again I say, of someone who feels superior to most.

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Specializes in ICU + Infection Prevention.
If you want to take biochem and genetics, pharmacology etc. then probably should have gone to medical school.

What NP school did you go to that didn't have pharmacology and genetics (although it might not be a discrete class)?

Biochem is not a med school class. It is a prereq.

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What NP school did you go to that didn't have pharmacology and genetics (although it might not be a discrete class)?

Biochem is not a med school class. It is a prereq.

Biochem is actually a class given in medical school, and not required by any school as a pre-req (at least not any school I'm aware of and I looked at A LOT when I was researching in undergrad). It's hammered pretty hard for medical students.

But pharm and genetics (at least at a cursory level) are definitely taught in RN and NP programs. Now again, it's not to the level of medical school, obviously, but the important aspects are covered. My entire first bachelor's degree was essentially genetics and while it has its utility, it's not going to make or break 99% of what most providers see in any given day.. And by the time I graduate I'll have had 2 full years of pure pharmacology. Plus 8 years of practice working with a wide range of medications. And while I don't support practicing as an RN as replacement for formal education, it can't be denied that an astute RN who goes out of their way to learn alongside the intensivists or specialists they work with will have a pretty firm foundation in medicine by the time they graduate.

I just wish this was the model across the board.

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Specializes in ICU, LTACH, Internal Medicine.
If you want to take biochem and genetics, pharmacology etc. then probably should have gone to medical school.

Well, they actually study it all. Volume and depth is less, so many NPs just read med school textbooks.

That's not a sacred knowledge or rocket science.

P.S. biochem and organics are standard prereqs for CRNA schools. For the rest, they might be required or used as "science GPA boosters".

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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 don't know where you did your MSN, but every reputable program requires NPs to be able to understand and articulate this.

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I don't know where you did your MSN, but every reputable program requires NPs to be able to understand and articulate this.

No, NP programs are not teaching the process by which glucocorticoids induce down regulation of epithelial cell adhesion molecule, CD62L and other selectins on the surface of lymphocytes and endothelial cells.

Yes, every NP program, every RN program for that matter teaches that steroids increase the WBC count. But he said the why behind it. And you're not fooling anyone here saying that NP programs teach the biochemical reactions accounting for it.

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Specializes in Adult Internal Medicine.
No, NP programs are not teaching the process by which glucocorticoids induce down regulation of epithelial cell adhesion molecule, CD62L and other selectins on the surface of lymphocytes and endothelial cells.

To be really honest, this is clinically (nearly) useless information. It is academically interesting but outside of one small possible implication I can't think of a single clinical reason this is important, especially as this is only one of several contributors to steroid leukocytosis. Perhaps in a sub-sub-specialty this might be important, but for most clinicians this is just extraneous information that will long be forgotten in clinical practice.

If you disagree, take a poll of 20 local physicians and see how many cite CD62L as the cause of steroid leukocytosis or even the marginal compartment or PMN in general.

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Specializes in CVICU, MICU, Burn ICU.
To be really honest, this is clinically (nearly) useless information. It is academically interesting but outside of one small possible implication I can't think of a single clinical reason this is important, especially as this is only one of several contributors to steroid leukocytosis. Perhaps in a sub-sub-specialty this might be important, but for most clinicians this is just extraneous information that will long be forgotten in clinical practice.

If you disagree, take a poll of 20 local physicians and see how many cite CD62L as the cause of steroid leukocytosis or even the marginal compartment or PMN in general.

Thanks Boston. Well said. In fact poll the docs and see how much of ANY specific biochem they remember that does not directly pertain to their specialty. Some stuff will stick, but let's just face it, "use it or lose it" applies to most humans, including those of higher intelligence who are able to earn a medical degree. How do I know this? Cause I know docs. and we talk and play memory games like this sometimes. An MD doesn't make one a walking encyclopedia.

And anyway, is anyone really arguing that MDs DON'T get more schooling than NP's? I haven't seen that argument here. But I would agree that someone who wants the at-the-cellular-level biochem answer to all clinical presentations should go to med school. They won't get all those answers there, but they'll get more than in any nursing school. I think that is one reason they get paid 2 to 4 times more than NPs;)

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

Then explain it O wise one

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What NP school did you go to that didn't have pharmacology and genetics (although it might not be a discrete class)?

Biochem is not a med school class. It is a prereq.

HAHAHA wrong again.

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Specializes in ICU, LTACH, Internal Medicine.
To be really honest, this is clinically (nearly) useless information. It is academically interesting but outside of one small possible implication I can't think of a single clinical reason this is important, especially as this is only one of several contributors to steroid leukocytosis. Perhaps in a sub-sub-specialty this might be important, but for most clinicians this is just extraneous information that will long be forgotten in clinical practice.

If you disagree, take a poll of 20 local physicians and see how many cite CD62L as the cause of steroid leukocytosis or even the marginal compartment or PMN in general.

For that matter, I saw an MD/PhD and the chairman of Psych department of a large academical center pushing his teenage son for uro eval under general anesthesia because the boy started to have early morning erections, which his dad thought to be sure symptom of some sort of cancer.

As one of the uro surgeons said after he privately spoke with that doctor, let's thank the Lord that the family had no daughters. And you are telling about some CD62L receptor here :)

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Specializes in ICU, LTACH, Internal Medicine.

Am I alone here thinking that Mr. Wrong is a low-quality troll which deserves no food?

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