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?
Just because collaboration happens doesn't mean it is needed. Just because it is how it has been done....doesn't mean it is best or right.
At the prominent university NP programs I checked, the number of clinical hours for a master's degree varied between 400's to 600. Compare that number to a physician's training. Look up how many hours a physician trained in the US spends in medical school, residency, internships, fellowships, specialty training. Do you see a difference between NP training and US physician training? What do you think that difference means?
Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
At the prominent university NP programs I checked, the number of clinical hours for a master's degree varied between 400's to 600. Compare that number to a physician's training. Look up how many hours a physician trained in the US spends in medical school, residency, internships, fellowships, specialty training. Do you see a difference between NP training and US physician training? What do you think that difference means?
A. Please show me a program with 400 clinical hours.
B. What does hat difference mean? Well part of it is that doctors waste a lot of time doing stuff that has nothing to do with their practice. So instead of wasting time learning about adults I won't be licensed to touch...I focus all my time on the pediatric population. Maybe NP programs make more sense!
C. Never claimed physicians and NPs were the same. They are different. It is shown in numerous studies hat NPs are capable....and some show improved outcomes.
NPs are in essence practicing medicine not nursing in the every day clinical setting. For medicine the absolute authority is a physician who attended MEDICAL school. If this were not the case why would we even have doctors. I love how PAs never get in a tizzy about independence/collaboration and do the same job as NPs.
If physicians wanted to practice nursing they would need to collaborate with that authority which is a RN/NP. Basic concepts people...
No, when NP see patients they are practicing nursing. There maybe overlaps, but by the simple fact that the professional is a nurse makes it a practice of nursing.
The same is for any other healthcare provider. An example would be when a podiatrist sees a patient for a foot or ankle problem it is a practice of podiatry, but when an Orthopod sees the patient for the same problem it is a practice of medicine.
This goes back to court rulings starting in the early 1900s.
NPs are in essence practicing medicine not nursing in the every day clinical setting. For medicine the absolute authority is a physician who attended MEDICAL school. If this were not the case why would we even have doctors. I love how PAs never get in a tizzy about independence/collaboration and do the same job as NPs.
If physicians wanted to practice nursing they would need to collaborate with that authority which is a RN/NP. Basic concepts people...
1. PAs cannot practice independently per their scope practice, so there is nothing to debate. You shouldn't think that means all PAs believe that they shouldn't be allowed to practice independently.
2. Mandatory collaboration has not shown to have any impact on quality of care. The only thing it does is increase physicians bottom line.
At the prominent university NP programs I checked, the number of clinical hours for a master's degree varied between 400's to 600. Compare that number to a physician's training. Look up how many hours a physician trained in the US spends in medical school, residency, internships, fellowships, specialty training. Do you see a difference between NP training and US physician training? What do you think that difference means?
Apparently, not enough if all the medical societies cannot provide one research study showing that physicians can give better care than APNs.
I think most people get this; it's just some people get butt-hurt for some reason.
I don't get it.
Any who, I WISH this could go on a billboard, and OP-Ed peice and simmer the ire of people with complex issues, but then that's another thread altogether.
Physician training in the US involves a bachelor's degree, usually, though not always, in a science, medical school, residencies, internships, fellowships, specialized training. This training can take 12 years or more. Physicians medically diagnose, prescribe, and treat patients. Physicians are permitted by law to practice medicine independently.
Nurse practitioner training requires an RN license and usually a BSN to begin training in reputable programs. Nurse practitioner training, at a master's level, generally takes three years. Nurse practitioner clinical hours, according to the reputable programs I researched, require from the mid 400's to 600 clinical hours. Nurse practitioners diagnose, prescribe, and treat patients, in accordance with state laws. In some states Nurse practitioners may legally practice independently.
The vast difference in education and training between US trained physicians and Nurse practitioners means that as a patient I may have a Board Certified Internist standing in front of me, diagnosing, prescribing and treating me, or I may have a Nurse Practitioner with maybe 600 clinical hours of training, standing in front of me, diagnosing, prescribing, and treating me.
Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
Physician training in the US involves a bachelor's degree, usually, though not always, in a science, medical school, residencies, internships, fellowships, specialized training. This training can take 12 years or more. Physicians medically diagnose, prescribe, and treat patients. Physicians are permitted by law to practice medicine independently.
Nurse practitioner training requires an RN license and usually a BSN to begin training in reputable programs. Nurse practitioner training, at a master's level, generally takes three years. Nurse practitioner clinical hours, according to the reputable programs I researched, require from the mid 400's to 600 clinical hours. Nurse practitioners diagnose, prescribe, and treat patients, in accordance with state laws. In some states Nurse practitioners may legally practice independently.
The vast difference in education and training between US trained physicians and Nurse practitioners means that as a patient I may have a Board Certified Internist standing in front of me, diagnosing, prescribing and treating me, or I may have a Nurse Practitioner with maybe 600 clinical hours of training, standing in front of me, diagnosing, prescribing, and treating me.
The similarities end very quickly.
At what point did I ask you to tell me about he education of MDs and NPs? I know the education. I asked where you saw an NP program with 400 clinical hours.
Just because doctors are over-educated for what they are doing doesn't mean everyone else has to do that. Isn't is possible that doctors have more education than needed? They aren't the "gold standard" for care so therefor their education isn't the gold standard. They do a job. NPs do a job. The job may be very similar but that doesn't mean they needed to follow the same path to get to their end result.
NPs are not MDs and nobody claims they are. MDs are also not proven to be the only ones capable of being providers. There's this crazy assumption that because they were first and spent lots of time in school...they are right. The facts don't support that assumption. Why do they learn adult medicine if they are going to be a pediatrician? Really doesn't make sense at all. I feel sorry for MDs and the wasted time and money. While education is always valuable...it doesn't mean you need to be over educated.
Just because doctors are over-educated for what they are doing doesn't mean everyone else has to do that. Isn't is possible that doctors have more education than needed? They aren't the "gold standard" for care so therefor their education isn't the gold standard. They do a job. NPs do a job. The job may be very similar but that doesn't mean they needed to follow the same path to get to their end result.
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Are you serious?? ???
MD's aren't the gold standard for care?
They are overeducated??
I'm sorry but when it comes to the human body and it's complexities there's never too much. You must've never been really really sick with a hard-to-diagnose illness and relied solely on the doctors detailed knowledge of all bodily systems and functions, the many hours he/she spent with analysis of medical issues, and time spent honing their problem solving abilities, to get some help. Sure, maybe for a diagnosis of
An ear infection or some dieting advice 8 years of training seems like a lot, but get real- that's not only what we rely on doctors for.
And please, don't feel so sorry for doctors, they sure don't need your pity. I never hear of MD's complaining (and several of my cousins and friends husbands are in med school or doctors-never a complaint there) in fact, most of them actually enjoy what they do and the learning
involved.
Maybe I'm nuts, but I actually have a tremendous amount of respect and admiration for doctors. Respect for the fact that they spend a decade learning to help those who need care, those who are in pain, and those who cannot help themselves
Certainly no pity from me.
And by the way, I respect nurses for the same reasons I respect doctors. They too, sacrifice a lot to be able to help people
Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
Are you serious?? ???
MD's aren't the gold standard for care?
They are overeducated??
I'm sorry but when it comes to the human body and it's complexities there's never too much. You must've never been really really sick with a hard-to-diagnose illness and relied solely on the doctors detailed knowledge of all bodily systems and functions, the many hours he/she spent with analysis of medical issues, and time spent honing their problem solving abilities, to get some help. Sure, maybe for a diagnosis of
An ear infection or some dieting advice 8 years of training seems like a lot, but get real- that's not only what we rely on doctors for.
And please, don't feel so sorry for doctors, they sure don't need your pity. I never hear of MD's complaining (and several of my cousins and friends husbands are in med school or doctors-never a complaint there) in fact, most of them actually enjoy what they do and the learning
involved.
Maybe I'm nuts, but I actually have a tremendous amount of respect and admiration for doctors. Respect for the fact that they spend a decade learning to help those who need care, those who are in pain, and those who cannot help themselves
Certainly no pity from me.
And by the way, I respect nurses for the same reasons I respect doctors. They too, sacrifice a lot to be able to help people
I am serious. We only see them as the "gold standard" because that's all that has existed for a long time. That doesn't mean that their level of education is what is truly needed. More education is wonderful in many situations....doesn't mean it is necessary.
And yes I have been very sick with a complicated issue....I also have children who have been very sick with complicated issues. There have been cases where doctors were wrong and the NP figured it out. In fact, with my one child we had an MD in the room and an NP. The MD insisted there was nothing wrong with the child. The NP questioned many "things" going on making it clear she didn't think the child was fine. The MD was so wrong....child had a brain based lifelong condition AND and connective tissue disorder that was unrelated to the first issue.
So MD gold standard for overall care? Only because for long time we didn't have NPs and when we did we didn't recognize their capabilities. We have no proof that MD is the gold standard. We just don't...they are just what we assume to be "the best".
If it was simply a matter of more education meant better care then MD/PhDs would be the best level of care that could be obtained. Also, if physician training provides the best care then why can't physician groups show that through research.
I love how PAs never get in a tizzy about independence/collaboration and do the same job as NPs.
1. PA's never get in a tizzy about INDEPENDENT practice because their scope of practice is entirely tied to physicians and thery are regulated entirely by the board of medicine. PAs have pushed this to practice without supervision on-site.
2. NPs should practice in collaboration. All providers should. This doesn't mean they can't practice independently from direct/indirect supervision.
Susie2310
2,121 Posts
At the prominent university NP programs I checked, the number of clinical hours for a master's degree varied between 400's to 600. Compare that number to a physician's training. Look up how many hours a physician trained in the US spends in medical school, residency, internships, fellowships, specialty training. Do you see a difference between NP training and US physician training? What do you think that difference means?