Philosophically, I believe it is up to the individual to get a good education - plenty of good schools are out there. It is then up to the free market to decide who gets hired. Personally, I felt my school did a good job (Johns Hopkins). Schools vary in quality and it is up to prospective students to research schools. Employers do have some idea of which schools are good and which are not. A new grad NP who went to a reputable school is going to find it easier to get a good job than a new grad NP who went to a crappy school.
Honestly, do the many complainers on this forum think that hiring managers of NPs, who are likely to be MDs or NPs, are completely clueless as to which schools are decent? I currently work in a Northern California rural FQHC and we precept NP and PA students from UC Davis and actively try to recruit from there because we know that is a good school.
My mentor is a brilliant MD (Georgetown Med, Mayo Clinic residency) and he told me he didn't expect me to know anything as a new grad NP and he wanted me to ask a lot of questions. He is happy with my progress as a first year direct-entry NP (with no RN experience) and so is our Medical Director.
Are we supposed to believe that employers are unable to read a resume, assess experience, and unable to conduct an interview and monitor shadowing time adequately? If employers are unable to do these things, then the fault is with their hiring process.
Actually, I do think hiring is not done very well in healthcare in general. Since my previous career was in business, I can say with certainty that the hiring process is much more rigorous in the best corporations than I have seen in healthcare. Here are some of the things that would be standard in corporate America:
- extensive interviews with both management and one's prospective peers
- one-on-one and panel interviews
- often, some sort of written exam to test basic knowledge, writing, and analytical skills
- some sort of evaluation of one's ability to do the job in the form of a case study or simulation. I was surprised that not one of my shadowing days included evaluation of my ability to take a basic H&P and do a basic PE.
Employers could easily increase the rigor of their hiring process to weed out the chaff.
Finally, I think there are some unrealistic expectations out there of a new grad NP. It is expected the first year will be a steep ramp up period. That is because NP residencies are few and far between. Smart employers know that and plan accordingly.
Here's what I would expect of a new grad NP:
- how to do a basic H&P and document appropriately on an EHR; ability to learn EHR in a reasonable period of time
- basics of a PE and what type of focused PE to do for common issues like URIs, UTIs, etc.
- fundamentals of pharmacology; most common meds for common diseases, when to give antibiotics or not
- how to research and find information when one does not know something, like using Uptodate and Epocrates, etc.
- basic labs/tests to order for common conditions
- ability to demonstrate critical thinking and reasonable knowledge to develop differential diagnoses
- ability to give a good report when asking questions or requesting consultation by a more experienced provider
All of the above could be reasonably assessed with a rigorous hiring process.
We have a serious shortage of primary care providers in many areas of the USA. This is both a supply and distribution problem. The last thing we need is to reduce the supply of PCPs.
As for increasing the length of school and mandating NP residencies, that has to be balanced against cost issues. Yes, MDs have 4 years of school and then internship and residency, but the average MD emerges with 200K to 300K of debt! Do any new or prospective NPs out there think it would be ok to increase the student debt of NPs?
Those who think PA education is superior are free to go to PA school. Those who want to be MDs can do the work and go to med school. Personally, I am satisfied with my NP education. Are there some things I wish had been covered in more detail? Absolutely. That doesn't mean the whole system sucks.