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 Pediatrics, High-Risk L&D, Antepartum, L.
Major university does not mean anything to me... I got my BSN at a good state university and after 4 years working as a nurse, I decided to back to school so I can become a NP. I looked at a couple my state universities NP curricula I thought they must require more than that... then I called a former classmate who did her NP at one of these state schools right after getting her BSN; I asked if they require some more prereqs and I was shocked when se said no... I knew she only took high school chem, no general bio etc... and she told me these classes are not needed... I asked her if i had to take grad level A/P and she told me the AP we took in undergrad was enough... I was shocked to say the least!
I worked with a NP who became a physician (DO)... and I asked her opinion about NPs and she told me that NP can practice medicine, but she had very limited knowledge as a NP... and told me now looking back she thinks the NPs education she received was a joke (she was a NP for over 10 years, really)... It was amazing to hear that from a former NP... It was then I started doing more research and talked with physicians who have NP in their practices (they were very candid), and found out that NP was not for me... I just don't want to practice medicine, I just want to have the knowledge to practice medicine.
So what means something to you? Seriously? You believe all NP programs are lacking, a major university means nothing to you.
You are all okay with the PA thing but I suggest that the PA program offers nothing compared to the NP program at a school and...crickets.
You do get that your opinion is just that...your opinion. There is nothing to back it up. You can have stories of all these people you know who don't like NPs. I have stories of the same for PAs actually. I won't let one near me anymore after all the issues I've had with them. I also know somebody who is working on becoming a PA. He is a recent drug addict who was also arrested for domestic violence. It has been suggested by many (medical professionals included) that he has a personality disorder. He's going to be a PA. YAY! So that's a fact so therefore PAs are awful. Right? I mean if your opinion is so meaningful...mine must be as well.
It was suggested we compare PA curriculum to the NP curriculum. So I did. I actually compared the PA and NP curriculums at the school I am attending for my NP. I'm honestly not impressed by the PA one to be honest...I'm sure it is fine for a PA but I'm missing the part where it is better than the NP. When I look at the NP curriculum I am also taking into consideration the RN and the BSN curriculums I had to take to even apply to the NP program. The FT option is only 2 years. So we are taking somebody with minimum medical experience and giving them 2 years of education and setting them free? Please tell me how that is better than NP? Oh wait they had to have patient experience to even get into PA? Sure...I know a guy (I really do) who is becoming an EMT. Here's the thing...when I was working on my RN there were those who were EMTs and now working on their RN. There's a big difference between EMT and even RN....so we are going to take an EMT and give them 2 years of education and be okay with it?
I'm sorry but I can't find where the PA program is superior to the NP. I just can't.
I can also give many anecdotal evidence of PAs who screwed up care...couldn't swab for strep, couldn't figure out a UTI, thought a culture while on antibiotics was a non-issue.
Let's get one thing straight...
If the curriculum of PA school and NP school are comparable then why can NP's practice independently and PA's cannot??
I think all gluteus is saying is that many NP's aren't ready to practice medicine on their own right after their graduate programs... And the fact that they are being given the same autonomy as MD's is a bit much
I don't completely disagree with gluteus an it's NOT because I'm a disgruntled soon-to-be MD who's scared that I'll lose my patients to midlevel practitioners/thinks I'm cooler than nurses cuz I have am M and a D after my name
I know that there are studies showing that there may be no difference between getting treated by NP vs. MD, but with with the recent surge of NP's and the many many new online programs that pump out graduates with these easy-to-acquire online diplomas, (that don't even require the GRE's!!) I think were all nervous that these statistics will all change in a negative way for nurses
And when this happens, all NP's will suffer (as well as the whole nursing profession) because well be taken as a joke and lose credibility
So while i DO have a passion for nursing, I wonder if in a few years I'll even be taken seriously with my APN degree
You guys think your bogus studies along with screaming 'equal outcomes' from the roof of a tall building will make it so...You might fool some people with these nonsense, but you won't fool people who know about medicine... None of you have answered the concerns of that poster (post #487)...
The concerns that you point out are just more nonsense anecdotal reports. I diagnosed Raynaud's phenomenon over the phone by my fathers symptoms because the IM physician couldn't figure it out. I diagnosed recurrent laryngeal nerve damage when the surgeon and PA kept telling the patient his hoorificeness s/p lovecoughing and deep breathing enough( and before you make some sarcastic comment it was MDA that had done the patients surgery and misses the diagnosis too).
Despite your idiotic meandering about not believing peer reviewed scientific literature, because it doesn't agree with your view point all Evidenced based medicine is built upon this same kind of scientific research.
The simple truth is that if any study had been able to prove that APNs were not safe and effective as independent providers every medical society would have touted those studies in every state capital. Yet, there is absolute lack of any published studies by any medical society showing any research that APNs should be supervised.
There are always going to be good schools and bad schools. I know of one FP residency program that its' residents have had a hand in incorrectly diagnosing death in two patients! Both of those patients luckily survived and made a full recovery, but if I remember correctly the one woke up in the morgue!
If the curriculum of PA school and NP school are comparable then why can NP's practice independently and PA's cannot??
I think all gluteus is saying is that many NP's aren't ready to practice medicine on their own right after their graduate programs... And the fact that they are being given the same autonomy as MD's is a bit much
I don't completely disagree with gluteus an it's NOT because I'm a disgruntled soon-to-be MD who's scared that I'll lose my patients to midlevel practitioners.
I guess they don't understand.... I don't have any personal animosity against NP... And I won't mind if NP practice medicine under the supervision of a MD/DO for a few years... You have NP/PA who work for a few years in FM, then move on to work in psych, then again move on to another specialty.... Do you really think the are the best way to deliver medical care when NP schools don't prepare them for that... A physician has to be board certified in one specialty, and no malpractice insurance will cover you if you are an OBGYN and you want to do ortho... I am glad you get what I am saying. I have no problems against NP, but when your leaders do not look at the big pictures, and think about only one thing, they might do damage to your profession...
I know that there are studies showing that there may he no difference between getting treated by NP vs. MD, but with with the recent surge of NP's and the many many new online programs that pump out graduates with these easy-to-acquire online diplomas, (that don't even require the GRE's!!) I think were all nervous that the statistics will all change in a negative way for nurses
And when this happens, all NP's will suffer (as well as the whole nursing profession) because well be taken as a joke and lose credibility
So while i DO have a passion for nursing, I wonder if in a few years I'll even be taken seriously with my APN degree
FYI: the GRE has shown no correlation to how graduate nursing will do.
There is also a push to have more foreign medical school graduates practice in the US. We don't require medical students to even attend classes. There are a variety of problems with every program, and Credentialing exams and minimum criteria set up by each accrediting agency is meant to establish a minimum of competency to provide for safe practitioners. The research seems to suggest that these Credentialing requirements work the vast majority of the time.
Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
I guess they don't understand.... I don't have any personal animosity against NP... And I won't mind if NP practice medicine under the supervision of a MD/DO for a few years... You have NP/PA who work for a few years in FM, then move on to work in psych, then again move on to another specialty.... Do you really think the are the best way to deliver medical care when NP schools don't prepare them for that... A physician has to be board certified in one specialty, and no malpractice insurance will cover you if you are an OBGYN and you want to do ortho... I am glad you get what I am saying. I have no problems against NP, but when your leaders do not look at the big pictures, and think about only one thing, they might do damage to your profession...
Hold up there! NPs can't change their mind regularly and change up what they are doing. I will be allowed to treat patients who are under 21. That's it. I can't do psych...even on peds patients. PAs...oh they can move all around because they touch on a little bit of everything. The NP student picks a focus from the beginning and that is what they are board certified for. I can't go FNP and then decide I just want to do women's health and expect it all to go well. There are some OB/Gyn offices who will hire an FNP...but generally you are going to need to be a WHNP to work in that Ob/Gyn office.
NPs do specialize early on. PAs...don't. So the education of the PA, all 2 years, is all over the place. The 3 years I'm spending on my NP is gen eds and then everything else is peds specific. I'm not wasting my time learning about a 50 year old man...because I will never have him as a patient.
The concerns that you point out are just more nonsense anecdotal reports. I diagnosed Raynaud's phenomenon over the phone by my fathers symptoms because the IM physician couldn't figure it out. I diagnosed recurrent laryngeal nerve damage when the surgeon and PA kept telling the patient his hoorificeness s/p lovecoughing and deep breathing enough( and before you make some sarcastic comment it was MDA that had done the patients surgery and misses the diagnosis too).
Despite your idiotic meandering about not believing peer reviewed scientific literature, because it doesn't agree with your view point all Evidenced based medicine is built upon this same kind of scientific research.
The simple truth is that if any study had been able to prove that APNs were not safe and effective as independent providers every medical society would have touted those studies in every state capital. Yet, there is absolute lack of any published studies by any medical society showing any research that APNs should be supervised.
There are always going to be good schools and bad schools. I know of one FP residency program that its' residents have had a hand in incorrectly diagnosing death in two patients! Both of those patients luckily survived and made a full recovery, but if I remember correctly the one woke up in the morgue!
Talk about someone who is complaining about me giving anecdotes...Lol... Anyway you made my point about these FM residents--that was why they were 'residents'--not full-blown physicians.
Hold up there! NPs can't change their mind regularly and change up what they are doing. I will be allowed to treat patients who are under 21. That's it. I can't do psych...even on peds patients. PAs...oh they can move all around because they touch on a little bit of everything. The NP student picks a focus from the beginning and that is what they are board certified for. I can't go FNP and then decide I just want to do women's health and expect it all to go well. There are some OB/Gyn offices who will hire an FNP...but generally you are going to need to be a WHNP to work in that Ob/Gyn office.
NPs do specialize early on. PAs...don't. So the education of the PA, all 2 years, is all over the place. The 3 years I'm spending on my NP is gen eds and then everything else is peds specific. I'm not wasting my time learning about a 50 year old man...because I will never have him as a patient.
Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
I know multiple FNP/PA who did that...
PAs can do a lot of moving around because that whooping 2 years they spend in school is a little bit of everything.
NPs can't do a lot of moving around. There are some moves that can happen...not many.
So you know somebody. You seem to know somebody for any type of story out there. You must know a lot of people...
I just realized what the conversation reminds me of...talking to me 3 year old. The big difference...I can actually reason with my 3 year old and he walks away when he knows he's wrong.
IrishIzCPNP, MSN, RN, APRN, NP
1,344 Posts
So what means something to you? Seriously? You believe all NP programs are lacking, a major university means nothing to you.
You are all okay with the PA thing but I suggest that the PA program offers nothing compared to the NP program at a school and...crickets.
You do get that your opinion is just that...your opinion. There is nothing to back it up. You can have stories of all these people you know who don't like NPs. I have stories of the same for PAs actually. I won't let one near me anymore after all the issues I've had with them. I also know somebody who is working on becoming a PA. He is a recent drug addict who was also arrested for domestic violence. It has been suggested by many (medical professionals included) that he has a personality disorder. He's going to be a PA. YAY! So that's a fact so therefore PAs are awful. Right? I mean if your opinion is so meaningful...mine must be as well.