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?
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I don't think the author was arguing about not wanting NP to practice as primary care provider. I think he wants them to do that under physician's supervision since NP education is somewhat subpar. One or I can argue that PA model/education is better, but they still have to practice under physician's supervision... I know people here will say NPs have previous experience as a RN, but practicing medicine is different and is on a league of its own... Also, I know people went straight to NP school with no prior nursing experience...
The only thing that REALLY matters is patient outcomes. The evidence I have seen shows that NPs are safe and effective health care providers with outcomes equal to physicians.
Talk about how many years of school one profession went to vs the other profession are not impressive to me at all.
The best field medical providers I have ever seen where the army's special forced medics (18D). I have seen these guys cure rashes in the jungle, remove an apendix in the desert, provid emergency dental care, deliver babies, and diagnose and treat diseas in cattle to boot. Many of these guys have never set foot in a college class room.
Proof is in the pudding and the pudding is patient outcomes.
I think he wants them to do that under physician's supervision since NP education is somewhat subpar.
..practicing medicine is different and is on a league of its own.
Subpar based on what?
Please cite your evidence that education is subpar, because every study I have ever read puts NP outcomes "on-par" with that of physicians.
Please cite your evidence that physician supervision improves NP practice or patient outcomes, because to my knowledge the studies conducted to demonstrate that have demonstrated no significant difference.
Please explain why "sub-par" educated NPs are on medical school faculties teaching medical students in both didactic and clinical environments.
And how long exactly have you been practicing medicine?
MDs seem to trust NPs, do they not? NPs are not only working in Family HC clinics, you can find them in hospitals making rounds, ordering tests, prescriptions, making diagnosis, and sometimes administering immediate life saving emergency care. I understand they consult with MDs, but it is normally after the treatment has been rendered. Sometimes a week or longer after the patient was treated.
Please cite your evidence that education is subpar, because every study I have ever read puts NP outcomes "on-par" with that of physicians.
Please cite your evidence that physician supervision improves NP practice or patient outcomes, because to my knowledge the studies conducted to demonstrate that have demonstrated no significant difference.
Please explain why "sub-par" educated NPs are on medical school faculties teaching medical students in both didactic and clinical environments.
And how long exactly have you been practicing medicine?
You keep bringing up NP studies and stuff... A study can sometimes mean 'just a study'. You know any studies can be manipulated and there are other factors that may affect a study... I am saying subpar because I looked at the curriculum of many schools (including top schools like Duke etc..) and I don't think they are teaching NPs to a level so they can practice medicine independently... Just compare a NP curriculum with a PA curriculum and you will see what I am saying unless you are adamant in staying in your little own bubble. I am not a physician yet, but I am a US medical student who had a BSN... I can tell you that there is no way I will let an NP touch me and my family for any 'serious' medical conditions. However, I won't have any problem with a PA taking care of my love ones. I just don't believe that people can practice medicine safely by using algorithm and many physicians agree with that statement (they just won't voice it)... That is just me...
Please cite your evidence that education is subpar, because every study I have ever read puts NP outcomes "on-par" with that of physicians.
Please cite your evidence that physician supervision improves NP practice or patient outcomes, because to my knowledge the studies conducted to demonstrate that have demonstrated no significant difference.
Please explain why "sub-par" educated NPs are on medical school faculties teaching medical students in both didactic and clinical environments.
And how long exactly have you been practicing medicine?
You keep bringing up NP studies and stuff... A study can sometimes mean 'just a study'. You know any studies can be manipulated and there are other factors that may affect a study... I am saying subpar because I looked at the curriculum of many schools (including top schools like Duke etc..) and I don't think they are teaching NPs to a level so they can practice medicine independently... Just compare a NP curriculum with a PA curriculum and you will see what I am saying unless you are adamant in staying in your little own bubble. I am not a physician yet, but I am a US medical student who had a BSN... I can tell you that there is no way I will let an NP touch me and my family for any 'serious' medical conditions. However, I won't have any problem with a PA taking care of my love ones. I just don't believe that people can practice medicine safely by using algorithm and many physicians agree with that statement (they just won't voice it)... That is just me...
Let's be clear: these outcome studies not "NP studies". They are published in major MEDICAL journals, including the JAMA.
Ah yes the "studies can be manipulated" excuse. I am sure you also believe that the powerful nursing lobby influenced the AMA to publish these "manipulated" studies and have prevented a single refuting study demonstrating these "manipulations" from publication.
Your point then is that NP education is "subpar" based on your expert opinion as a medical student? You haven't even begun your internship or residency and you have the arrogance to judge the education of others and speak to "what it takes" to practice medicine. You have never practiced medicine. Your education is far from compete. Perhaps you should focus your study on humility. Or perhaps the scientific process.
As far as not "letting" your family members be treated by an NP or a PA, their loss. I wonder what will happen when your loved one is faced with choosing between an experienced NP and an arrogant and overconfident pre-doc.
Let's be clear: these outcome studies not "NP studies". They are published in major MEDICAL journals, including the JAMA.
Ah yes the "studies can be manipulated" excuse. I am sure you also believe that the powerful nursing lobby influenced the AMA to publish these "manipulated" studies and have prevented a single refuting study demonstrating these "manipulations" from publication.
Your point then is that NP education is "subpar" based on your expert opinion as a medical student? You haven't even begun your internship or residency and you have the arrogance to judge the education of others and speak to "what it takes" to practice medicine. You have never practiced medicine. Your education is far from compete. Perhaps you should focus your study on humility. Or perhaps the scientific process.
As far as not "letting" your family members be treated by an NP or a PA, their loss. I wonder what will happen when your loved one is faced with choosing between an experienced NP and an arrogant and overconfident pre-doc.
I do not have a problem with PA as their education is very rigorous; it is just NP (CRNA) with their inferior education that I would not let treat me or family members as I did it before when my wife was having surgery... No matter what nonsense study that you keep spouting, it is not gonna make me believe that someone who got an online degree with a bunch of nursing theory classes from a diploma mill is competent to practice medicine...
Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
I do not have a problem with PA as their education is very rigorous; it is just NP (CRNA) with their inferior education that I would not let treat me or family members as I did it before when my wife was having surgery... No matter what nonsense study that you keep spouting, it is not gonna make me believe that someone who got an online degree with a bunch of nursing theory classes from a diploma mill is competent to practice medicine...
So all studies showing NPs in a positive light is nonsense? Interesting. I wouldn't see a PA...time and time again found them to be idiots. So I guess I can say I won't feel comfortable with a PA after their track record with my care...clearly their education is a joke.
PMFB-RN, RN
5,351 Posts
The only thing that REALLY matters is patient outcomes. The evidence I have seen shows that NPs are safe and effective health care providers with outcomes equal to physicians.
Talk about how many years of school one profession went to vs the other profession are not impressive to me at all.
The best field medical providers I have ever seen where the army's special forced medics (18D). I have seen these guys cure rashes in the jungle, remove an apendix in the desert, provid emergency dental care, deliver babies, and diagnose and treat diseas in cattle to boot. Many of these guys have never set foot in a college class room.
Proof is in the pudding and the pudding is patient outcomes.