I have recently been presented with a series of events that got me thinking about an evolutionary educational process that I believe will help this country tremendously.
I have emailed the Dean of the University of Kansas School of Medicine; a place where I believe will be a perfect launch pad for such a program.
I am a practicing NP in rural Kansas, where I do clinic, hospitalist function, ED, long term care, and just about anything that comes through the door. The hospital I work at is very rural, and the two docs are nearing the end of their career. Needless to say, there aren't a lot of physicians beating down the door, which threatens the very existence of the whole institution. We all are aware of the ever-worsening shortage of primary care docs, especially since many of us PA/NPs are filling that role. In comes my idea...
We all have been reading about and some of us participating in doctorate programs, which I believe is an effort, at least in part, to become completely autonomous providers. However, I don't think we'll ever be on a level playing field with physicians, whether we think we should or not (I personally don't think our education is anywhere near where it needs to be if we were to even consider competing with allopathic or osteopathic physicians).
So, instead of fighting all the time, I propose a solution: a new educational pathway for NPs and PAs can become physicians using the most advanced telecommunications and internet technology available so we can continue to provide care but we can earn a MD or DO. Now I've heard the cynics who will say "no shortcuts to medicine, blah blah blah" but I urge you to find anyone that has been through the minimal 6-7 years of education, and then the probable 3-4 years of additional training it would take to complete a new program such as this, to consider this a "shortcut".
At this point in time, there is only one program I am aware of that one can do something like this. It is in American Samoa, and although I'm certain there are students and graduates doing just fine, I know several states will not license graduates of this program. The only other way to earn a MD or DO is to start as if you are a 22 year old college graduate - something that is just not practicle or feasible in the vast majority of our situations.
When I enrolled in a DNP program at Saint Louis University, I was encouraged to finally hear about these new "clinical-based doctorate programs" for nurse practitioners. However, after sitting through the first two days on the campus and hearing what it was really all about (really no different than a PhD in my opinion), I was very disappointed but not terribly surprised and dropped out immediately.
I did hear a common statement from many NPs in the program - the hunger for more education and the desire to earn a MD/DO. Several of us spoke about the reason why none of us are able to do it (families, income, etc etc).
So, the people and their desire is there (probably on a much larger scale than I can imagine). The need for primary care doctors is there. Now we need to find some open-minded schools to create a program to make it happen.
The program would have to allow for a great deal of self study. It would have to have practicing physicians who could mentor NP/PA students in the program, which wouldn't be a stretch in many cases as many of us are already working side-by-side. It should fill the gaps in our education which needs to be determined by a team of both NP/PAs and MD/DOs. It should not include rotations in specialty fields; only primary care. And, we should only be able to practice primary care medicine so graduates don't go into specialties thus defeating the purpose of the program. It should have an abbreviated residency training program since many of us have already been practicing every day for many years (ie every 3 years of practice equals 1 year of residency, etc). If graduates do poorly on the USMLE and board certification exams, it will be clear where the weaknesses are and adjustments could be made accordingly.
The institution providing such a program could charge just about anything they wanted, as there are many programs that will pay back student loans for practicing in rural areas. It would also command attention from federal funding, especially in light of all the Obamacare changes.
I believe there would be literally thousands of us jumping all over a program such as this. I certainly would be first in line....
I told my friend last year that these programs would be sprouting up in no time. Its the only natural progression that can come from NP's and esp since nurses make the best doctors. It sounds like you want to be involved in the dirty work of getting it started, I myself want to finish NP work there and when I look up again these programs will be everywhere and I will take advantage. Good luck and Godspeed as Im sure others are working diligently at this.
These programs will NOT "sprout" up in no time, it's doubtful they ever will. The State Medical Boards will set their offices on fire before this happens.
Google the PA/DO bridge - the PA's have depths more basic science background than NPs yet it took years to iron out a program that really only saves the PA's one year of training - they still attend the first two years of med school (full time, mind you, part-time nor remote/online medical study does not exist) and have slighty shorter clinical years. The result is ~3 years of school (vs. 4) + the full, ACGME-accredited residency. I believe even then they're restricted to a family practice residency (3 years). PA's are required to have years of experience before they take this program, and entrance is ultra-competitive... and still requires the MCAT.
And this is for a DO. Do the math, and this is NOT a shortcut at all for PA's, it actually takes them significantly longer than students who go straight out of undergraduate. There will similarly be no shortcut for nurses wanting to make the transition. If you want to be an MD, you have to play the game and go to medical school like everyone else.
Please... oh please, explain how nurses make 'better' doctors for us? Is it because you 'care' more? Because nurses 'look at the whole patient'?
I'm sure it was 'doubtful' that nurses would ever have prescriptive authority but they now do. Chaos and conflict brings about change. Primary doctors are running low and the number of insured will greatly increase with the passage of the healthcare bill. This is why part of that bill was to greatly increase the number of primary practitioners available to the public, per the government. This will indeed anger many doctors who feel they had to 'work harder' but from that anger will come those doctors who want to be known as initiators and innovators and find a way to create that program to shut those whining doctors up. They will say 'if you want them to be doctors, then lets make a program'. DUUUUH. Only logical thinking such as the original poster would lead one to see that the closer nurses are to MD's that bridge programs would pop up, just like bridges from Bachelors to BSN or LPN to MSN!
And in previous years that quote was just a cute saying, but with the flood of NP in the market I can say personally that nurses do indeed make better doctors. Nurses take on a wholistic approach and treat their patients more humbly rather than getting their MD credentials and being pompous throwing info at patients and walking out leaving the Nurses and Patients to decipher what he said. Personally I have seen two adult NPs that were top notch and made me feel totally comfortable as a patient and very recently my preemie son was at Peds NP who did a complete body asessment on him and found a deformity on his spine... a gluteal crease or something... that even his neonatologist didnt find in 8 weeks in the NICU. Specialty doctors can be very knowledgeable and the bridge will be basic at first, no doubt, like Family Practice, but not far from happening.
You sound a bit sarcastic and cynical and I do not know your credentials but if you want to turn your nose up at the possibilities that lie ahead I feel sorry for you. Healthcare is dynamic and will NEVER stay the same. You can either get with it or be without it. This board is for nurses interested in empowering one another and I am totally tickled that you woke up on the wrong side of the bed! Hope you have a better day :)
I'm sure it was 'doubtful' that nurses would ever have prescriptive authority but they now do. Chaos and conflict brings about change. Primary doctors are running low and the number of insured will greatly increase with the passage of the healthcare bill. This is why part of that bill was to greatly increase the number of primary practitioners available to the public, per the government. This will indeed anger many doctors who feel they had to 'work harder' but from that anger will come those doctors who want to be known as initiators and innovators and find a way to create that program to shut those whining doctors up. They will say 'if you want them to be doctors, then lets make a program'. DUUUUH. Only logical thinking such as the original poster would lead one to see that the closer nurses are to MD's that bridge programs would pop up, just like bridges from Bachelors to BSN or LPN to MSN!
And in previous years that quote was just a cute saying, but with the flood of NP in the market I can say personally that nurses do indeed make better doctors. Nurses take on a wholistic approach and treat their patients more humbly rather than getting their MD credentials and being pompous throwing info at patients and walking out leaving the Nurses and Patients to decipher what he said. Personally I have seen two adult NPs that were top notch and made me feel totally comfortable as a patient and very recently my preemie son was at Peds NP who did a complete body asessment on him and found a deformity on his spine... a gluteal crease or something... that even his neonatologist didnt find in 8 weeks in the NICU. Specialty doctors can be very knowledgeable and the bridge will be basic at first, no doubt, like Family Practice, but not far from happening.
You sound a bit sarcastic and cynical and I do not know your credentials but if you want to turn your nose up at the possibilities that lie ahead I feel sorry for you. Healthcare is dynamic and will NEVER stay the same. You can either get with it or be without it. This board is for nurses interested in empowering one another and I am totally tickled that you woke up on the wrong side of the bed! Hope you have a better day :)
That is referred to as an anecdote and has no bearing on anything. Let me drop another example for you: "I know, personally, that I can fly. I've seen myself do it." Does this mean I can fly? Does it mean anything at all? No. The fact that you personally think nurses are better providers means nothing and proves nothing.
And please... my credentials? Credentials don't validate or invalidate any argument; its the argument's substance that matters. Would you believe the world is flat if a Ph.D told you it was? Was there something wrong with what I said?
You brought up my favorite argument! Medical doctors are taught repeatedly how to view the patient holistically (note how I spell that) and how to integrate psychosocial findings into patient history. The fact that you haven't seen a medical doctor do this is surprising. Further, I don't understand when/how/why the nursing field decided that they are the only profession that "cares" about their patients and view their care as holistic. Please, explain this.
Let me give you the facts one more time.
Fact: There is a strictly prescribed set of standards set forth by the National Board of Medical Examiners that defines exactly what a physician (MD/DO) must know. These are tested repeatedly with the USMLE Step 1, Step 2 CK/CS, and Step 3. They're often re-tested by state medical boards over certain intervals.
Fact: Nurses, even DNP's, are not required to know a majority of these standards by graduation, especially the science-oriented and molecular disciplines. A career filled with years of experience won't compensate for the lack of fundamental understanding, either. For instance, the first time the Columbia DNP class was offered a simplified, lower minimum passing score-version of the USMLE Step 3, 50% of them failed the test. MD pass rate is ~99% for first-time test takers. Google this, it's common knowledge. It might help to explain that the first DNP class through Columbia were not the direct-admission DNP students we see so commonly today; these were seasoned Master's-prepared nurse practitioners. How can I be more clear?
Without going to medical school like every other physician, please tell me exactly how you think nurses plan to "bridge" (we all know the elephant in the room is "shortcut") their way into a medical doctorate. If you want to put in the time, the dedication, and the effort to obtain an MD degree, please... be my guest. There are a number of nurses who have done this. They changed professions and entered medical school like every other physician.
Look, we all understand primary care is stretched thin... but why is a shortcut the solution? Why lower the bar?
I do not have the time nor the energy to argue the 'what if' all day. We stated our positions, moving on. I did not read past your first line when I saw the thesis you had written. Point is when the program comes along I will take it. Then you can protest at Washington if you want to. Good Luck to you!
I do not have the time nor the energy to argue the 'what if' all day. We stated our positions, moving on. I did not read past your first line when I saw the thesis you had written. Point is when the program comes along I will take it. Then you can protest at Washington if you want to. Good Luck to you!
There will be a NP to MD bridge when there is a PA to NP bridge. PAs already have the knowledge above an RN, so why not have them take some nursing theory courses and hand them an NP degree. Then, in those states that allow it, they can practice independently.
Not gonna happen for the same reasons an NP to MD won't happen.
coco3299
81 Posts
I told my friend last year that these programs would be sprouting up in no time. Its the only natural progression that can come from NP's and esp since nurses make the best doctors. It sounds like you want to be involved in the dirty work of getting it started, I myself want to finish NP work there and when I look up again these programs will be everywhere and I will take advantage. Good luck and Godspeed as Im sure others are working diligently at this.