An article appeared today in the New York Times as a followup to a bill passed in New York granting nurse practitioners the right to provide primary care without the oversight of a physician. The authors of the bill state "mandatory collaboration with a physician no longer serves a clinical purpose and reduces much-needed access to primary care". The need for more primary care providers is due to the shortage of primary-care physicians, the aging boomer population, and the Affordable Care Act.
Although the president of the American Association of Nurse Practitioners feels that the current "hierarchical, physician-centric structure" is not necessary, many physicians disagree citing that the clinical importance of the physician's expertise is being underestimated and that the cost-effectiveness of nurse practitioners is being over-estimated.
Many physicians also feel that "nurse practitioners are worthy professionals and are absolutely essential to patient care. But they are not doctors."
What are your thoughts on this? Where do nurse practitioners fit into the healthcare hierarchy?
Wow!.. They are physicians in training. It is impossible to get a job with a year internship even you can be a fully licensed physician in some states. These residents are just physicians by name. Do you really believe a nurse that graduated with a BSN and go straight to University of Phoenix to get a NP degree will function on the same level as a physician who graduates from the worst med school in the country and did a 3-year residency in FM? If you believe that, there is no need for me to argue with you...
Considering I have seen one of the worst or easiest FP residencies to get into (depending on your point of view) and worked/taught some of those residents I wouldn't use that as an apt comparison.
NPs and physicians both provide quality care.
APNs just want to provide care at the level that is proven that they can without the mandatory interference from excessive laws or unneeded physician oversight.
The point was made that one can be a physician after three years. You commented that the three year residency must have been forgotten. It seemed to me that you are saying one can not be a physican without a three year residency. Not adding up for me.
First off, that wasn't me.
Second, that's two different arguments.
1. A physician after 3 years of medical education (b/c some medical schools have 3 year curriculums)
2. A resident leaving before finishing his residency and practicing medicine a fully licensed Physician.
So, you are saying that your training taught you to quote Wikipedia as solid scientific evidence source. I think I would ask for refund on your research courses.
So, you are saying that your training taught you to quote Wikipedia as solid scientific evidence source. I think I would ask for refund on your research courses.
I can now see that you have no real education, no ability to grasp any thought that did not originate in your own head, no familiarity with a classical education in philosophy, logic, or deductive reasoning. No ability to understand where and when to apply different evidences for different arguments. No ability to differentiate subtle but substantial differences in the meaning of words. No ability to reflect on your own arguments and demand the same burden of evidence for them as you do for others.
In short, you're saying everything while saying nothing.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Wow!.. They are physicians in training. It is impossible to get a job with a year internship even you can be a fully licensed physician in some states. These residents are just physicians by name.
OK, so residents are not physicians. Thank you clearing that up for me.
Do you really believe a nurse that graduated with a BSN and go straight to University of Phoenix to get a NP degree will function on the same level as a physician who graduates from the worst med school in the country and did a 3-year residency in FM? If you believe that, there is no need for me to argue with you.
That is a rather curious thing to ask. I don't know of ANYONE who thinks NP = physician. I certainly know better. I don't know anyone who thinks the training recieved in an NP program is comparable to a residency trained physician.
I have read most of this discussion and haven't seen anyone state that NP training is the same as medical training.
I guess I have no idea why you would ask this question. Especialy why you would ask me.
I didn't know U of P even had an NP program.
In nursing we have two levels of nurses, RNs and LPNs. I am an RN but I realize that one doesn't have to have full RN training to preform many nursing tasks.
Considering I have seen one of the worst or easiest FP residencies to get into (depending on your point of view) and worked/taught some of those residents I wouldn't use that as an apt comparison.
NPs and physicians both provide quality care.
APNs just want to provide care at the level that is proven that they can without the mandatory interference from excessive laws or unneeded physician oversight.
Since you said you (have) taught some med students in probably one of the worst US residency programs, do you really believe a nurse from Keiser University and went straight to University of Phoenix for a NP degree would function on the same level with the worst resident in this program after completing his/her 3-year residency?
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
First off, that wasn't me.
Oh sorry. You all look the same to me.
1. A physician after 3 years of medical education (b/c some medical schools have 3 year curriculums)
Yes we are well aware that some medical schools have three year curriculms. I appreciate the education I have recieved in this discussion. Before today I did not realize that residents are not physicians.
2. A resident leaving before finishing his residency and practicing medicine a fully licensed Physician.
Nobody is asking about or discussing that. Try to keep it strait.
It's as if you don't realize that a Ph.D and an MD/DO are completely different degrees. Do you know the difference? I'm going to assume you'll do some quick wikipedia reading and sort this out. After you do that, you'll realize that a Ph.D in say...biochemistry, has very little in common with a doctorate in Medicine. One would not, nor should not, expect that a PH.D would make their clinical medicine knowledge or skill stronger. There are no "clinical medicine" classes required for a Ph.D. One has nothing to do with the other.
So no.
You're lucky I've discounted it, did you even read that article? Only 50% of NPs passed a weak, abbreviated, watered down *read EASIER* version of Step 3. You sure you really want to build your castle on that foundation??
If someone says they can paint the Mona Lisa but struggles to paint a straight line, I don't usually need scientific evidence to make a conclusion. Nor do most people, you might want to rethink that strategy.
I'm getting it from the same place you're getting "it's about money and egos" in fact, I took that phrase without justification straight off of your previous post. Man, so much for your all "scientific evidence" approach, amIright?!
"to the fullest of their training". I like an Orwellian phrase as much as the next person, but that's some pretty empty rhetoric. I can train a high school drop out to design internal combustion engines...should he be allow to do it? Think harder.
Yes, physicians who passed Step 1 (the hardest), Step 2 (medium soft hard), Step 3 (time for viagra?), would be crushed by an abbreviated easier version of Step 3. Is there a sarcasm emoticon that I can use here? Honestly, does this make sense to you?
You want to practice medicine? Go to medical school. If you can get in.
I fully understand the difference between a clinical doctorate and research doctorate. Since I have one and will be starting the other in the Fall semester.
The point about MD/PhDs is as valid as trying to say that medical education alone makes a physician superior to NPs.
A sample of NPs were given a test that they had never seen or studied for the first time and the pass rate was 50%, and your point is what that physicians don't study for any of the USMLE exams and just happen to have high pass rates?.
I said the NP certification exam which are not based on USMLEs.
I practice nursing, specifically advanced practice nursing as a CRNA. I do not need to go to medical school to do that. I already practice at the same level as anesthesiologists and provide the exact same care completely independent.
Physicians do not have a monopoly on education or patient care like many would like to think they do.
Believe it or not many APNs did not choose to go to medical school. It wasn't because we applied to medical school and couldn't get in.
I like school (obviously with all my education no joke intended), but there is absolutely no benefit for me to go to medical school and then turn around and do the exact same job I do now. Now an MD/PhD if I could keep my same salary might interest me...Do you know someone who is going to pay me 130-150K/yr+ plus full benefits to goto school for that?..lol
Yes we are well aware that some medical schools have three year curriculms. I appreciate the education I have recieved in this discussion. Before today I did not realize that residents are not physicians.
Strange, because here you claimed to know the opposite. "If my residents are not physicans, despite holding a license to practice medicine (usually as PGY 2) what are they?"
I'm assuming the question was rhetorical, if it wasn't....well it was so why even bother.
Nobody is asking about or discussing that. Try to keep it strait.
Oh really, nobody?
"It seems like you are saying that without a three year residency a person can not be a physican. I know that the residents I work with consider themselves to be phsyicans, yet they have not completed all three (or more) years of residency.?"
If your residents leave their residency early, they can't not be physicians. What about this is hard for you to connect to what you said? I was actually trying to make your argument concise and coherent for you.
Since you said you (have) taught some med students in probably one of the worst US residency programs, do you really believe a nurse from Keiser University and went straight to University of Phoenix for a NP degree would function on the same level with the worst resident in this program after completing his/her 3-year residency?
I think they both could provide equal care in the FP setting. What is important for any type of healthcare provider to know is when to consult.
I have seen both physicians and nurses make mistakes, and most often physicians make mistakes because they think they know too much and are egotistical in thinking they are right. Nurses IMHO seem to make mistakes mostly because they are too dogmatic in their approaches.
HotHamWater
36 Posts
Oh dear, this is getting embarrassing. Here,
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