Just graduated 2 weeks ago with my Family NP and am prepping for my boards. After all the excitement of finishing and graduation, I'm starting to slip into a kind of depression and I'm wondering if any other new NP grads went through this?
I didn't actively seek a position pre-graduation because it was so hectic towards the end that I literally didn't have the time and energy. While a few had jobs lined up, most of my peers didn't either, and many decided to focus on boards and taking a vacation or two before looking for work. I really wanted this time off myself just to decompress. Now I wonder if that was such a good idea.
If seems like the further away from the intensity of school and clinicals and being around all the patients and clinics I get the more anxious and disconnected I'm feeling from being an NP. TBH, I'm scared of not being able to find a reasonable place to start off as a primary care provider. Will I be able to taking on the responsibility and work of starting this career? What if it is way more above my head than I thought it would be?
I just need to hear if anyone else ever went through this and how they managed it.
Specializes in Psychiatric and Mental Health NP (PMHNP).
17 hours ago, PsychMD said:
Peds, internal medicine, and family medicine are 3 year residencies after medical school. Some would also include obgyn and psychiatry (both 4 years) in this list.
I obviously don't know about everywhere and every different specialty, but at the two large academic teaching hospitals where I've been, NPs in my department had to staff 100% of their patients with their attending physician, and sometimes they would see the more difficult patients together. They had similar responsibilities as 2nd year residents.
As you said, NPs often are assigned more straight forward cases, and there's no reason well-trained NPs can't provide excellent quality care for routine things independently. But part of it is a prestige thing. Some patients have expectations when they go to a big name hospital that they will be seen by a world renowned physician. There was some talk at my last place to allow a couple of experienced NPs to manage a small inpatient caseload on their own, but it was shot down, I think mostly because it didn't look good.
As far as the cost goes, yeah, it would be cheaper if NPs all worked on their own without supervision, but not everywhere is always 100% profit driven, and NPs are still much cheaper than hiring additional physicians. A lot of doctors at academic centers are not seeing patients all day anyway. Many may only have a 50% clinical appointment. Many will have time allotted for supervising residents/NPs, teaching classes, doing research, and other admin tasks.
I was never try to disparage anyone, so sorry if it came across that way. Just was pointing out the most competent mid levels I've worked with have been in these type of environments. Being surrounded by bright minds, getting quality supervision on a daily basis, sitting in classes/journal clubs with residents, going to grand rounds, etc seems like an easier path to greatness than just doing 500 clinical hours and going at it on your own.
Thank you for participating here. However, you are generalizing your own experience when it is not generalizeable. You also do not seem familiar with NPs and their scope of practice.
1. Most people do not get their care from academic teaching hospitals and clinic systems. Most people do not have access to these. In addition, these systems vary in quality.
2. In states with full practice authority, there is no reason for an MD to see every patient together with an NP. I practice in California and am essentially independent. About once or twice a week, I ask an MD in our clinic a question. The MDs here don't "supervise" me and California is a restricted practice state. Johns Hopkins is in a full practice authority state (Maryland) and the NPs in their system practice independently. Do you feel Johns Hopkins provides substandard care?
3. Most patients currently don't care if they see an MD or an NPs. Plenty of patients, even at Hopkins, PREFER their NP. Just because someone has an MD does not make them a good provider. I've seen plenty of crappy MDs. MDs are like any other profession, some are excellent, some are terrible, and most are somewhere in between. Here's an example: I recently got a new patient who had a neurological problem, so I performed a basic neuro exam. The patient and her husband were thrilled! They had been seeing a neurologist for over a year who never performed a neuro exam. Both the patient and her husband transferred their primary care to me.
4. Many, many parts of the US have severe provider shortages. That means everything - MD, DO, NP, PA, DDS, etc. I work in such an area - a remote rural area. Our MDs are extremely busy seeing patients full-time and do not have time to double check everything the NPs do. The nearest city is an hour away and even in that city, they have a severe shortage of MDs of all types. I interviewed for a neurology job in Fresno, a city of over 1 million people, at a large academic teaching hospital. The head of the Neuro dept told me that there is such a shortage of neurologists in the Central Valley that stroke patients can wait up to a year to get a follow up appointment with a neurologist. He desperately needed an NP to handle routine matters so the MDs could focus on more complicated cases and couldn't even find an NP! So, MDs wanting to throw up more road blocks to patients getting timely care is very selfish, to be blunt.
Basically, in California, MDs seem to only want to live and work in San Francisco, Los Angeles, or San Diego. Do we hold the millions of people who live outside of those areas hostage to MDs who don't want to even live there? This makes my blood boil.
5. Full practice authority is here to stay and is only going to increase. Under full practice authority NPs can set up their own practice. There are plenty of NP-run clinics that do a great job. Even PAs are working toward independent practice.
Primary care (which is what I do) just doesn't pay enough for MDs to justify their high student debt, which is why med students are not choosing primary care. Also, I see no reason why NPs and PAs can't handle 90% of primary care. We're not talking neurosurgery here.
6. There is certainly room for improvement in NP education and training. The problem is the schools vary wildly in quality, from Johns Hopkins on one hand to for-profit schools that will accept anyone with a pulse. Most NPs also support NP residency, but the problem is securing funding and preceptors for these.
7. I stand corrected on the length of primary care residency. Thank you.
I have met more than one graduate of a psychiatric residency who had such significant personal failings, that they couldn't diagnose their way out of a brown paper bag.
Such physicians maintained the belief that everything your patient tells you is true, even in a corrections setting.
To be fair, I have worked with some good physicians, but the neurologist who never did an actual neurologic exam is not an outlier.
Thank you for participating here. However, you are generalizing your own experience when it is not generalizeable. You also do not seem familiar with NPs and their scope of practice.
1. Most people do not get their care from academic teaching hospitals and clinic systems. Most people do not have access to these. In addition, these systems vary in quality.
2. In states with full practice authority, there is no reason for an MD to see every patient together with an NP. I practice in California and am essentially independent. About once or twice a week, I ask an MD in our clinic a question. The MDs here don't "supervise" me and California is a restricted practice state. Johns Hopkins is in a full practice authority state (Maryland) and the NPs in their system practice independently. Do you feel Johns Hopkins provides substandard care?
3. Most patients currently don't care if they see an MD or an NPs. Plenty of patients, even at Hopkins, PREFER their NP. Just because someone has an MD does not make them a good provider. I've seen plenty of crappy MDs. MDs are like any other profession, some are excellent, some are terrible, and most are somewhere in between. Here's an example: I recently got a new patient who had a neurological problem, so I performed a basic neuro exam. The patient and her husband were thrilled! They had been seeing a neurologist for over a year who never performed a neuro exam. Both the patient and her husband transferred their primary care to me.
4. Many, many parts of the US have severe provider shortages. That means everything - MD, DO, NP, PA, DDS, etc. I work in such an area - a remote rural area. Our MDs are extremely busy seeing patients full-time and do not have time to double check everything the NPs do. The nearest city is an hour away and even in that city, they have a severe shortage of MDs of all types. I interviewed for a neurology job in Fresno, a city of over 1 million people, at a large academic teaching hospital. The head of the Neuro dept told me that there is such a shortage of neurologists in the Central Valley that stroke patients can wait up to a year to get a follow up appointment with a neurologist. He desperately needed an NP to handle routine matters so the MDs could focus on more complicated cases and couldn't even find an NP! So, MDs wanting to throw up more road blocks to patients getting timely care is very selfish, to be blunt.
Basically, in California, MDs seem to only want to live and work in San Francisco, Los Angeles, or San Diego. Do we hold the millions of people who live outside of those areas hostage to MDs who don't want to even live there? This makes my blood boil.
5. Full practice authority is here to stay and is only going to increase. Under full practice authority NPs can set up their own practice. There are plenty of NP-run clinics that do a great job. Even PAs are working toward independent practice.
Primary care (which is what I do) just doesn't pay enough for MDs to justify their high student debt, which is why med students are not choosing primary care. Also, I see no reason why NPs and PAs can't handle 90% of primary care. We're not talking neurosurgery here.
6. There is certainly room for improvement in NP education and training. The problem is the schools vary wildly in quality, from Johns Hopkins on one hand to for-profit schools that will accept anyone with a pulse. Most NPs also support NP residency, but the problem is securing funding and preceptors for these.
7. I stand corrected on the length of primary care residency. Thank you.
You're missing the point. I'm not saying NPs don't practice independently in some states or that it's the norm for NPs to staff all their patients. What I'm saying is 1. academic hospitals seem to inherently have a framework in place for ongoing education and training. 2. Not all teaching hospital may use a dyad model where the physician and NP see patient's individually, run the list at noon, and then the physician sees some or most of the NP's patients, but it was this way at two hospitals I worked at, so I doubt it's that atypical. 3. I think this type of setup is an excellent way for a NP to improve, especially as a new grad.
I have met more than one graduate of a psychiatric residency who had such significant personal failings, that they couldn't diagnose their way out of a brown paper bag.
Such physicians maintained the belief that everything your patient tells you is true, even in a corrections setting.
To be fair, I have worked with some good physicians, but the neurologist who never did an actual neurologic exam is not an outlier.
No doubt there are a lot of really incompetent and dangerous doctors out there. It's harder for the bad ones to sneak their way into prestigious teaching hospital gigs. Luckily, most of doctors I've worked with have been top notch, and some really great. But yeah, I've certainly seen a lot of bad doctors at smaller non-academic hospitals, private practices, jails, prisons, and community clinics. Really bad, really scary stuff. I recently took a non-academic job to make more money and be closer to family. The PA I work with, while lacking in experience and not getting good supervision, is really smart and already better than several of my MD coworkers, sadly.
Are we really sitting here trying to compare NP training to physician training? Because I don't think we want to pull at that thread. This poster is being a really good sport responding to these comments politely and couching everything in civility. NPs are fairly ignorant of what it takes to become a physician and ignorantly compare our education to theirs, not knowing the vast difference. And then they end up looking silly.
Come on guys, how did the conversation go sideways so soon? The OP just wanted some support and guidance on being a new NP. Can we all agree that we are all playing on the same team. Providers be it an MD, NP or PA are trying to deliver the best care possible to the patients? Yes, there are problems with the NP programs, yes there are good and bad providers, and no I don't think anyone is trying to compare NP education vs MD education that would be crazy. The academic hospital is a great setting for a new NP because most do have a very good orientation program and after they work in teams. But, so is anywhere that is willing to help guide and new NP whether it's a specialty practice or primary care. I work for a pretty large academic hospital and the NP's/MD's/PA's all seem to work well together, why is it on this board it appears so differently? I guess the anonymity of this place will allow ones true colors shine through.
Just me 2 cents for now I will keep my rose colored lenses on and look on the brighter side...lol
Specializes in Psychiatric and Mental Health NP (PMHNP).
13 hours ago, PsychMD said:
You're missing the point. I'm not saying NPs don't practice independently in some states or that it's the norm for NPs to staff all their patients. What I'm saying is 1. academic hospitals seem to inherently have a framework in place for ongoing education and training. 2. Not all teaching hospital may use a dyad model where the physician and NP see patient's individually, run the list at noon, and then the physician sees some or most of the NP's patients, but it was this way at two hospitals I worked at, so I doubt it's that atypical. 3. I think this type of setup is an excellent way for a NP to improve, especially as a new grad.
Thank you for clarifying. It is important to differentiate inpatient from outpatient care. Most NPs work in primary care. Academic teaching hospitals are a great training ground, but may not be the best training ground for primary care. In addition, there is a strong need for rural health care providers and again, academic teaching hospitals are likely not the best training ground for this, either.
MD residencies are funded by social security. There is currently no equivalent funding for NP residencies. That is why there are not a lot of NP residency programs. It would be great to come up with a way to rectify this.
Oldmanhubbard, I'm a newbie but am looking toward np in the future so I am trying to learn all I can. I fully admit my ignorance on this! What if the extra time was in a "shadowing" capacity, where an np student is not making decisions but is there as "fly on the wall" to observe & learn...would that have legal implications? Just wondering if there is a good way for a prospective np to gain extra experience in a safe/legal way?
I don’t think there are any legal issues regarding doing extra hours. My school encouraged it. We just couldn’t do it while school was on break because the agreements end when the semester ends. But you can do as many as you want during g your semester.
I don’t think there are any legal issues regarding doing extra hours. My school encouraged it. We just couldn’t do it while school was on break because the agreements end when the semester ends. But you can do as many as you want during g your semester.
Our school had hour limitations and minimums. No more than 40 a week. But by all appearances the op is wanting to do it outside the regular semesters which would place the legalities on the clinic.
FullGlass, BSN, MSN, NP
2 Articles; 1,950 Posts
Thank you for participating here. However, you are generalizing your own experience when it is not generalizeable. You also do not seem familiar with NPs and their scope of practice.
1. Most people do not get their care from academic teaching hospitals and clinic systems. Most people do not have access to these. In addition, these systems vary in quality.
2. In states with full practice authority, there is no reason for an MD to see every patient together with an NP. I practice in California and am essentially independent. About once or twice a week, I ask an MD in our clinic a question. The MDs here don't "supervise" me and California is a restricted practice state. Johns Hopkins is in a full practice authority state (Maryland) and the NPs in their system practice independently. Do you feel Johns Hopkins provides substandard care?
3. Most patients currently don't care if they see an MD or an NPs. Plenty of patients, even at Hopkins, PREFER their NP. Just because someone has an MD does not make them a good provider. I've seen plenty of crappy MDs. MDs are like any other profession, some are excellent, some are terrible, and most are somewhere in between. Here's an example: I recently got a new patient who had a neurological problem, so I performed a basic neuro exam. The patient and her husband were thrilled! They had been seeing a neurologist for over a year who never performed a neuro exam. Both the patient and her husband transferred their primary care to me.
4. Many, many parts of the US have severe provider shortages. That means everything - MD, DO, NP, PA, DDS, etc. I work in such an area - a remote rural area. Our MDs are extremely busy seeing patients full-time and do not have time to double check everything the NPs do. The nearest city is an hour away and even in that city, they have a severe shortage of MDs of all types. I interviewed for a neurology job in Fresno, a city of over 1 million people, at a large academic teaching hospital. The head of the Neuro dept told me that there is such a shortage of neurologists in the Central Valley that stroke patients can wait up to a year to get a follow up appointment with a neurologist. He desperately needed an NP to handle routine matters so the MDs could focus on more complicated cases and couldn't even find an NP! So, MDs wanting to throw up more road blocks to patients getting timely care is very selfish, to be blunt.
Basically, in California, MDs seem to only want to live and work in San Francisco, Los Angeles, or San Diego. Do we hold the millions of people who live outside of those areas hostage to MDs who don't want to even live there? This makes my blood boil.
5. Full practice authority is here to stay and is only going to increase. Under full practice authority NPs can set up their own practice. There are plenty of NP-run clinics that do a great job. Even PAs are working toward independent practice.
Primary care (which is what I do) just doesn't pay enough for MDs to justify their high student debt, which is why med students are not choosing primary care. Also, I see no reason why NPs and PAs can't handle 90% of primary care. We're not talking neurosurgery here.
6. There is certainly room for improvement in NP education and training. The problem is the schools vary wildly in quality, from Johns Hopkins on one hand to for-profit schools that will accept anyone with a pulse. Most NPs also support NP residency, but the problem is securing funding and preceptors for these.
7. I stand corrected on the length of primary care residency. Thank you.