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?
Also, I find it tacky to post quotes from one message board to another. Whatever...they are just upset that their jobs are being challenged after all the money they spent. I wonder how they feel about the vast number of NPs who are actually training meds students.
SDN is a place for medical students and residents, mostly. These guys feel their $$$$ school debts literally as red-hot iron against their skins. They are actively afraid, because, for example, urgent care clinics (which was sort of sweet, rich, don't-worry-be-happy place for new FP and ER grads since the time's beginning) are turning toward recruiting mid-levels instead.
The thing is, very few to none of these guys seem to do the grueling job of everyday primary care. they are ******** about mid-levels, psychologists, etc. shamelessly occupying their "own" area of psych care, for example, but there is no mention in the tread (and anywhere else on SDN) of, say, possibility to organize high school support center for kids with mental health problems. Our district recently got such a place, and it helps many, many high schoolers and their parents, too... enormously so... the center was developed, organized and is currently run by two peds mental health NPs, because no local psychiatrist was agreeable to listening to tears-flowing 17-year olds 12 hours/week for 1/3 of what he would make just writing scripts fro these kids and not caring about what is really going on in their lives.
I do not think that making USMLE step 3 mandatory for NPs and PAs as it already is for MDs would be a bad idea (I passed it and so can honestly say that every person of average intellect and baseline medical knowledge can pass it being given enough time). But unless and until thinking that calling a known CHF "frequent flier" home every day and visiting him/her in that home every 72 hours just to be sure that the patient takes his pills, weights himself every morning, keeps his diet, able to get one more dose of Lasix right away if he needs it and get his questions answered lies somehow below a doctor's dignity, things will progress to the benefits of those who are willing to do the job and don't ***** about it. Because America The Plentiful just can't keep on with all these frequent fliers, as we all know too well.
The Princess Bride- I don't disagree with the basis of your post; a doctor goes to school longer and receives more clinical hours.
I don't think anyone is suggesting NPs will ever replace the need for MDs. The argument is, "are they educated and competent enough to perform certain tasks that in the past was completed by a MD"?
I understand that, but I'm arguing due to the lack of standardization and low entrance levels for NP schools, it is impossible to even say for sure whether NPs, as a whole, are competent to step in and take on duties that have historically belonged to MDs.
As for a NP only having a Bachelors Degree???? What State are you referring to? My wife, who has 28 years of clinical experience in Women's Health as a RN/ BSN, is now working on her NP. The minimum requirement at the moment is a Masters Degree. I understand that is changing to a Doctorate Degree next year. She plans to specialize in Women's Health, I think she meets the clinical experience you mentioned above?
I didn't say that at all. I think you misread my post. There are some NP programs in which one does not need a bachelor's degree to enter. I think that grad-entry schools need to be eliminated and that all people should be required BSNs and some bedside experience before they are allowed to start studying and practicing as NPs. Unfortunately, there are schools that allow people without any healthcare experience to enter these programs and then graduate and start practicing at an advanced level without any years as an RN.
Misdiagnosis can come from anyone, doc or APN. Happens every single day. All the NNP's I work with are outstanding. We rely heavily on them as the residents we work with are clueless most of the time. I feel they give a better family centered care due to their nursing background and they are much more proficient in procedures.
I plan on becoming an NNP. The vast majority of NNP schools require a minimum of one year clinical experience, some two, prior to even reaching the clinical portion of the NP school. So by the time one finishes NNP school, he or she will have a minimum of three to four years working at the bedside.
But most places from my personal experience, the NNP works very closely with the neonatalogist.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
Perhaps the question shouldn't be "over-educated" vs "under-educated" but "appropriately-educated". I found this article a few months ago Pharmacists increasingly take on clinical roles which basically addresses a legitimate question about the reality of dispensing as it is now compared to 40+ years ago. Is "more education" always better or should it evolve to meet changing times?
The reality is the growth of the role of the NP is a response to that evolution and turf-guarding just for the sake of turf-guarding is going to ultimately fail.
Perhaps the question shouldn't be "over-educated" vs "under-educated" but "appropriately-educated". I found this article a few months ago Pharmacists increasingly take on clinical roles which basically addresses a legitimate question about the reality of dispensing as it is now compared to 40+ years ago. Is "more education" always better or should it evolve to meet changing times?
The reality is the growth of the role of the NP is a response to that evolution and turf-guarding just for the sake of turf-guarding is going to ultimately fail.
What a tempest in a teapot. The level of hubris, offense, and paranoia displayed by our 'colleagues' on that other forum has got to be the funniest thing I've seen in a long while. First of all, NPs have been practicing independently for decades. This is nothing new. The fact that they are offended by NPs having autonomous practice is seriously the height of hubris. No, 22 year old M1 who has never touched a patient, the NP with decades of experience is not going to ask for your permission to do her job that the state has allowed her to do for decades. If it makes you mad that you have to go through the hell of med school and residency in order to practice, then change your life. No one put a gun to your head and forced you to go to med school and drop 300k. Seriously. You could have gone to nursing school instead. Your bad, not the NPs'.
Also, the paranoia about our programs is really amusing. "They teach them to hate MDs!" "They teach them to give their patients whatever they want!" Uhhh. No and no. At the end of the day, it seems like people who write these NP-bashing articles feel backed into a corner and are lashing out. As can be seen by the comments on the linked article, the public doesn't take it well. Let them keep publishing these articles about MD superiority, as it really doesn't appear to do them any favors other than to confirm negative stereotypes. CT is following NY's lead, woohoo! Oh, and I have met many awesome med students and doctors who I can't wait to work with once I graduate, for what it's worth. It's too bad that militant docs and med students (even some pre-meds, lolwut) give them a bad name.
I don't think it is conducive to anyone's cause, be they a physician or an advanced practice nurse, to bash either side. Every profession has the good, the bad, the ugly, and the excellent.
Hopefully, evidence-based research will prevail, and not personal commentary.
What is tacky about it? If you want to stay in a bubble with people who only share your opinions, then fine... You guys/gals want independent practice right, but it seems like you don't think about consequences that might ensue. What if physicians let you be truly independent where you have your own practice, you carry your own malpractice insurance etc... with no supervision at all--I mean truly independent. Do you think APN would fare that well? I find it disturbing that you guys don't even realize what these nursing organizations are pushing down your throat. Do you even look at some of these NP programs out there and their curricula? Most of them are BOGUS with a bunch of nursing theory classes. Do you really think these online programs should be putting NP in the market? As RN who is about to start a PA program , I find disturbing that some of these NP programs even exist... Until NP programs become standardized, most physicians wont take you seriously. When I was looking to become a NP, I looked at some the programs in my state and said to myself... these people gotta be kidding me with these curricula! And I compared them to some of the PA program and concluded it is dangerous to let NP practice independently..
Go to see your Family Practitioner these days, chances are your going to see a NP. Sure, maybe a Physician will glance over their charts every few months, but the patients care was entrusted to the NP by the overseeing Physician. If that Physician was concerned about the competency of the NP, they would be in the office looking over their shoulder every day. When my mom went to the Emergency room in January of 2013, it was a NP who initially evaluated her, ordered tests, talked to the family about the severity of her advanced cancer and her current medical condition, and had her admitted to the ICU where she passed away 3 days later. My friends wife is a NP for a local hospital. She makes rounds, is on call, and performs tasks just like a Physician. My point is there is a place for NPs and they are already performing those jobs. If a hospital trusts a NP to conduct the initial evaluation of a patient in the emergency room, then the hospital must have faith in their educational background to perform at a high level.
What is tacky about it? If you want to stay in a bubble with people who only share your opinions, then fine... You guys/gals want independent practice right, but it seems like you don't think about consequences that might ensue. What if physicians let you be truly independent where you have your own practice, you carry your own malpractice insurance etc... with no supervision at all--I mean truly independent. Do you think APN would fare that well? I find it disturbing that you guys don't even realize what these nursing organizations are pushing down your throat. Do you even look at some of these NP programs out there and their curricula? Most of them are BOGUS with a bunch of nursing theory classes. Do you really think these online programs should be putting NP in the market? As RN who is about to start a PA program , I find disturbing that some of these NP programs even exist... Until NP programs become standardized, most physicians wont take you seriously. When I was looking to become a NP, I looked at some the programs in my state and said to myself... these people gotta be kidding me with these curricula! And I compared them to some of the PA program and concluded it is dangerous to let NP practice independently..
Studies have demonstrated the "consequences" of NP practice: they are the same as, if not better than, MD/DO practice.
Most NPs practice with very little to no direct supervision; I see my collaborating MD twice a week, and we are both running with a clinic full of patients. He does not directly "supervise" me in any way. The closest he comes is he has to co-sign my ICU notes, which he hates.
It is quite obvious that you have no experience with the provider role. No provide MD/DO/APN/PA practices without any supports: consults, specialists, colleagues, nurses, PTs, pharmacists are all part of practice. I wouldn't practice if I had no support. Neither would my collaborating physician.
IrishIzCPNP, MSN, RN, APRN, NP
1,344 Posts
Also, I find it tacky to post quotes from one message board to another. Whatever...they are just upset that their jobs are being challenged after all the money they spent. I wonder how they feel about the vast number of NPs who are actually training meds students.