The title says it all. Have you faced hates or disrespect from physicians (either attending or training) just because you are a NP? Because I did. Online.
As a RN and a NP student, I have seen many great attending physicians who work collaboratively and respectively with NPs. That rosy perception completely changed once I joined Reddit medical communities. There are massive posts showing hates against NP. The two main areas of criticism come down to: 1. Taking NP's malpractice cases or individual's anecdotal examples to basically question competency of all NPs in the states (although I am curious as to malpractice cases in comparison with MDs), 2. misunderstand and derogate the implication DNP (though it's an academic degree, not a clinical degree as MD, the physicians and trainee there seem to take it as NPs just trying to put a doctor title and lobbying to obtain an independent practice despite NP's allegedly inadequate competency.
I am not here to say NPs are equally trained as MDs because they are certainly not. Also, I also feel NP education has definitely rooms for improvement (another area of discussion).
Also, I acknowledge these people don't represent the majority medical societies so should take these views with a grain of salt. Nonetheless, I am unsure what to make out of the hates from these physicians (primarily in training) who will be our future coworkers other than trying to continuously learn and improve my competency and hopefully avoiding these toxic people in my future career if I have a choice.
I would appreciate any insightful advice from current NPs in the field. Thank you!
There are advantages to being an NP over a PA such as full IP in many states. Also realize that if you go back to school to become a DNP realize that beyond the Masters level almost none of the content is clinical. At the end of the day I could care less what anyone thinks of me besides my clients. It is not uncommon for me to go six months without speaking to another human save for a client on tele video, my SO, my 19 year old son and people at the insurance companies where I call to get prior auth’s.
Also, I would submit that if you are going back to school and wish to continue clinical practice that a PhD might be a superior option since at least you could conduct a longer, dedicated thesis towards more relevant clinical practice questions. For example you might consider something like:
a. The use of AI/expert systems in identifying the most appropriate antibiotics in bacterial pneumonia in various regions around the United States a case controlled cohort study and analysis. Or.....
b. How genetic testing and markers may play a role in choosing the most appropriate antibiotics in bacterial pneumonia.
Thesis questions such as these would at least impact directly upon the work that you do and perhaps contribute something to furthering patient care and outcomes while also building upon your previous education.
They care that I know inside and out what I am doing. Clinical knowledge, communication, and patient outcomes assign us each our "label."
Quite an interesting post here. You point out that the priority is patient care and outcomes. Despite the training disparities - which don't matter that much because there are data to support each option. I have met and personally been steered down the incorrect path by MDs, both on the job as an RN and in personal health matters. Many referrals to the outpatient practice I am at the hand of an MD that "gave up" on the patient.
But, the NP to PA thing is quite silly to be honest. Also, if you already have an MSN, the DNP would be easier. But none of my cohort was able to work full time and do both the capstone and pt care hours and the hours required in year 3.
Honestly, if I didn't work in a hospital, if I didn't learn about med school myself, or met and talk to PAs, I wouldn't really know what they do either. I have met BSNs that don't know what a DNP is... The critical things are continued development post graduation and org leadership that support the profession and standardize school rigor and curriculum.
Quite possible the stupidest thing I’ve ever read.
If you have already completed the MSN, the extra work for the DNP is not harder than doing the BSN to DNP, which was one of the points that person made in the post.
If you have already completed the MSN, the extra work for the DNP is not harder than doing the BSN to DNP, which was one of the points that person made in the post.
I probably should have been more clear in my statement.
Reference was to the thought that someone would put all that work to become a nurse practitioner only to go to PA school because of peace of mind over “role confusion”. Who the hell has that kind of money and time to burn to acquire a more subjugated role. LOL it’s a fairly absurd concept.
I probably should have been more clear in my statement.
Reference was to the thought that someone would put all that work to become a nurse practitioner only to go to PA school because of peace of mind over “role confusion”. Who the hell has that kind of money and time to burn to acquire a more subjugated role. LOL it’s a fairly absurd concept.
The only scenario where it might make sense is in some areas (think East Coast Boston/New York) where PA's are relatively more sought after in acute care settings relative perhaps to acute care NP's. Maybe, if someone wanted to stay in such a job market and stay in acute care this might make sense. If the only goal is increasing knowledge I would propose that the 1000's of hours required to go back for your DNP would be better spent reading Harrison's Guide to Internal Medicine cover to cover several times (which I did even before nursing school) along with resources such as Lecturio.com and https://boardsbeyond.com/homepage . These three resources alone (granted they would take an equal amount of time, but you could at least keep your job) covered in depth would likely expand your clinical knowledge beyond what going for a DNP would yield.
Specializes in Former NP now Internal medicine PGY-3.
No real need for hate unless there are NPs coming out and saying they are equal to doctors, even then we just shake our head and move on. Nps are an important role in healthcare but I am not worried about them replacing physicians. Most NPs know their limitations as everyone in healthcare should, a few don't, unfortunately... but its not NP specific
Specializes in Psychiatric and Mental Health NP (PMHNP).
Who cares what anonymous people say on social media? You don't even know if those people are really doctors.
MDs have more education and training than NPs. However, does that make them far superior providers? Evidently not, based on the evidence. Granted, NPs are not going to be neurosurgeons, but for basic care, NPs do a fine job. It's the old 80/20 rule, people. Honestly, I think RNs could do a significant portion of primary care, like treating the common cold, draining abscesses, sports and employment physicals, etc. It's just that in healthcare, unlike a lot of other professions, there is such incredible insecurity and jealousy over education and "turf."
Now that I have a few years of NP experience, preceded by 20 years of business executive experience, I'm going to make some anecdotal observations:
1. Most MDs are weird. They are not people I would want to socialize with. Most RNs and NPs are "normal" and fun to hang out with. I think this is because MDs are generally super nerds, and had to study so hard for so long, that they didn't develop great social skills. I'm a nerd, too (HS valedictorian, Captain of the Debate Team, Yale undergrad initially, blah, blah). Out of my Yale friends, I never kept in touch with the pre-meds, but pretty much every other major, I remained friends with. And for patients, that does make a difference. Over and over again, my patients tell me, "You really listen to me and make me feel like you care."
2. MDs vary widely in quality from outstanding to crap. It's a bell curve, like any other profession.
3. MDs have no clue about NP education. They do not understand that NPs must specialize on entering school. Most of them think 18 months to 2 years of NP schools is some kind of med school "lite" that covers everything med school does, very lightly.
4. Nursing is holistic. That is often dismissed, but I am now appreciating the difference. I have switched from primary care to mental health. I have patients that are switching from MDs to me. Why? Because I actually care about them as humans, and ask about their families, jobs, etc. I don't view them as nothing more than chemical factories that consume pills. I give them practical advice and guidance beyond just what medication to take. I also help them with things like GoodRx, etc. I understand that things like their home environment, lack of a car, etc., impacts their ability to care for themselves.
5. Unfortunately, at least in the US, MDs are taught to be arrogant a**holes who think they know everything about everything and don't want to admit when they don't know something. That can cause real harm to patients. Once, while in primary care, I was filling in for a doctor on vacation. One of their patients had been seeing the MD for almost a year about an issue, which clearly the MD did not know how to treat. I didn't either, and said so, then sent the patient to a specialist. I saw that patient again and he was extremely grateful, saying the specialist knew immediately what was wrong and provided the correct treatment! This type of thing has happened to me multiple times.
6. Many patients complain that the MD just types on their computer and never even looks at them! At least I look at my patients!
Medicine is not "magic" and most of it is not rocket science. In addition, good patient care is not purely mechanistic and requires a good provider-patient relationship, something many MDs fail to understand. I think most MDs are very insecure people with poor social skills and over-inflated egos and a huge sense of entitlement.
Honestly, in what other field would someone make 2x as much for doing the exact same thing? If patients had to actually pay cash based on hourly rates, which normally are based on compensation, who would pay 2 or 3x as much for the exact same thing? If I could buy a Starbucks coffee for $2.50 at store A or $5 at store B, where do you think I would go? I think this is fueling all this MD hate of NPs and independent practice. They are angry and resentful that people with less education and training are doing the same thing, and equally as well. Since many MDs' entire personal identity is based on their perceived superiority over the rest of us mere mortals, it is easy to see why they get angry.
Specializes in Former NP now Internal medicine PGY-3.
23 hours ago, FullGlass said:
Who cares what anonymous people say on social media? You don't even know if those people are really doctors.
MDs have more education and training than NPs. However, does that make them far superior providers? Evidently not, based on the evidence. Granted, NPs are not going to be neurosurgeons, but for basic care, NPs do a fine job. It's the old 80/20 rule, people. Honestly, I think RNs could do a significant portion of primary care, like treating the common cold, draining abscesses, sports and employment physicals, etc. It's just that in healthcare, unlike a lot of other professions, there is such incredible insecurity and jealousy over education and "turf."
Now that I have a few years of NP experience, preceded by 20 years of business executive experience, I'm going to make some anecdotal observations:
1. Most MDs are weird. They are not people I would want to socialize with. Most RNs and NPs are "normal" and fun to hang out with. I think this is because MDs are generally super nerds, and had to study so hard for so long, that they didn't develop great social skills. I'm a nerd, too (HS valedictorian, Captain of the Debate Team, Yale undergrad initially, blah, blah). Out of my Yale friends, I never kept in touch with the pre-meds, but pretty much every other major, I remained friends with. And for patients, that does make a difference. Over and over again, my patients tell me, "You really listen to me and make me feel like you care."
2. MDs vary widely in quality from outstanding to crap. It's a bell curve, like any other profession.
3. MDs have no clue about NP education. They do not understand that NPs must specialize on entering school. Most of them think 18 months to 2 years of NP schools is some kind of med school "lite" that covers everything med school does, very lightly.
4. Nursing is holistic. That is often dismissed, but I am now appreciating the difference. I have switched from primary care to mental health. I have patients that are switching from MDs to me. Why? Because I actually care about them as humans, and ask about their families, jobs, etc. I don't view them as nothing more than chemical factories that consume pills. I give them practical advice and guidance beyond just what medication to take. I also help them with things like GoodRx, etc. I understand that things like their home environment, lack of a car, etc., impacts their ability to care for themselves.
5. Unfortunately, at least in the US, MDs are taught to be arrogant a**holes who think they know everything about everything and don't want to admit when they don't know something. That can cause real harm to patients. Once, while in primary care, I was filling in for a doctor on vacation. One of their patients had been seeing the MD for almost a year about an issue, which clearly the MD did not know how to treat. I didn't either, and said so, then sent the patient to a specialist. I saw that patient again and he was extremely grateful, saying the specialist knew immediately what was wrong and provided the correct treatment! This type of thing has happened to me multiple times.
6. Many patients complain that the MD just types on their computer and never even looks at them! At least I look at my patients!
Medicine is not "magic" and most of it is not rocket science. In addition, good patient care is not purely mechanistic and requires a good provider-patient relationship, something many MDs fail to understand. I think most MDs are very insecure people with poor social skills and over-inflated egos and a huge sense of entitlement.
Honestly, in what other field would someone make 2x as much for doing the exact same thing? If patients had to actually pay cash based on hourly rates, which normally are based on compensation, who would pay 2 or 3x as much for the exact same thing? If I could buy a Starbucks coffee for $2.50 at store A or $5 at store B, where do you think I would go? I think this is fueling all this MD hate of NPs and independent practice. They are angry and resentful that people with less education and training are doing the same thing, and equally as well. Since many MDs' entire personal identity is based on their perceived superiority over the rest of us mere mortals, it is easy to see why they get angry.
Glad to get that off my chest!
The younger generation of docs seem to be more normal to me. And yes most fam med docs aren’t that great most people who go into fam med were at the bottom of everyone’s med school class. We had a few strong people go into it but not so much. Sounds like the docs you worked with are meh or you have a chip on your shoulder.
also not worried about independent practice since it doesn’t rly change anything. Plus primary care doctor salaries keep going up vs the specialties. Which is good we need more good candidates to go into family medicine
The younger generation of docs seem to be more normal to me. And yes most fam med docs aren’t that great most people who go into fam med were at the bottom of everyone’s med school class. We had a few strong people go into it but not so much. Sounds like the docs you worked with are meh or you have a chip on your shoulder.
also not worried about independent practice since it doesn’t rly change anything. Plus primary care doctor salaries keep going up vs the specialties. Which is good we need more good candidates to go into family medicine
But that is the level that nurse practitioners generally are up against. The majority of nurse practitioners work in some form of primary or urgent care. Surgeons and specialists(docs at the top of their level) aren’t worried about NP autonomy. They know what they bring to the table. The only people who are seriously concerned are residents dismayed at the expense of their school and their mediocre resident pay compared with NPs their forced to report to who have in their view substandard education(literally statements I’ve seen on Reddit residency pages). Many of whom really have no interest in primary care short of a fall back.
Doctors who work in fields where NPs have made greater headway generally are more accepting of the trend. Partly because they see opportunities to save money while expanding their practice and because they recognize those newer md’s don’t give a damn about family medicine or primary care.
I am curious where you are seeing salaries increasing though in this field, because I don’t see it. Reimbursement is dropping all the time. Just looking at my own clinic system (four clinics) I often feel mid levels are floating those salaries. We have 6 total docs (two own the practice who don’t see full loads and often come and go as they please) and everyone’s schedule is equally slotted. 15 min office visits and 30 min physicals. None will see anyone outside those confines. And when they do their revenue reports, it’s clear their expenses are never met compared to lower paid staff who often exceed these measures. These docs are getting paid at least twice the salary. But given MD reimbursement, the difference should only be 15% more. These docs aren’t seeing more patients and they’re billing for the same complexity as everyone else.
There is no reason that NP's cannot form together to create LLC's and open their own "primary" care clinics and instantly increase their pay by at least 50% while at the same time increasing their autonomy. Even in states that require MD supervision (most of these do not cap how many NP's can be overseen by a single MD) it is easy enough to find an MD to provider "supervision" for around a 10% fee. The umbrella company I work under is owned by Licensed Mental Health Counselor's and employs about 50 Psych NP's and maybe 250 therapists. The NP's all earn well over 200K (as do most of the therapists) and the owners are netting millions each month on their 30% (cut) and their $600 admin fee. It's a reasonable system for everyone involved.
myoglobin, ASN, BSN, MSN
1,453 Posts
Also, I would submit that if you are going back to school and wish to continue clinical practice that a PhD might be a superior option since at least you could conduct a longer, dedicated thesis towards more relevant clinical practice questions. For example you might consider something like:
a. The use of AI/expert systems in identifying the most appropriate antibiotics in bacterial pneumonia in various regions around the United States a case controlled cohort study and analysis. Or.....
b. How genetic testing and markers may play a role in choosing the most appropriate antibiotics in bacterial pneumonia.
Thesis questions such as these would at least impact directly upon the work that you do and perhaps contribute something to furthering patient care and outcomes while also building upon your previous education.