Bob26

I didn't respond for a couple weeks b/c of barely any free time due to being on my surgery rotation. I was given the afternoon off to go home and read due to a slower than usual day, so I figured I'd respond. But I've been reading some of the responses and wanted to respond to some things which are things I particularly disagree with. Oh yeah, sorry about the long posts. Once I start writing something, sometimes I can't stop myself after I get on a roll. It's been that way ever since HS english class. I definitely do go overboard sometimes. And besides, I'm always up for a nice friendly debate:D Anyways, I've decided to end my posts in this thread (even though there are a couple issues with the previous points I'd like to address). I think it's pretty clear I got the other side on this issue to get my balanced viewpoint. Good luck to everybody and thanks for putting up with my questions/blabbering. And remember, if I didn't care about what you guys thought on this issue, I wouldn't have bothered to come here and hear all sides.

Another common belief. And to tell you the truth, there is a decent amount that isn't relevant such as the example you gave (which is one of the more special examples you can use for your point). However, most of what you learn is relevant. For example, psychiatrists must know all of their physiology, because all the meds they are prescribing have physiological effects all over the body. They have to know the physiology of those organs too, not just neurophysiology. Primary care docs need to know all anatomy to correctly diagnose various problems themselves or know when the patient needs a referral to ortho, vascular, or any other specialists. Like I said, you're definitely right on a decent sized portion of the stuff learned in medical school, but not as much as you think. I also had the same viewpoint too before starting med school, but I've been converted after seeing how it's much more relevant than I thought.

6 Read this... This is a quote that I read a while ago on studentdoctor.net posted by a former nurse who is now a medical student about medical training compared to nursing. I've read other quotes from med students and docs who dropped out of NP programs to go to medical school. Please do not compare a nurse's or NP's training to an MD's. No matter how many years of nursing you have, it's no residency. And the pathophys classes do not equal medical school classes. Also in terms of the education, I'm just going to be blunt here and say that you don't know how much you don't know until you go to a higher level. A couple of nurses in my class (former ICU nurses who were sharp) said the exact same thing as the quote above. This absolutely does NOT mean that NP's don't have medical knowledge. They definitely do. Look back at the previous post of me talking about my MS in biochemistry. I consider myself to have a good biochemistry knowledge (due to my BS and MS in biochemistry), I'd vehemently disgree with any PhD who told me I "didn't know anything about biochemistry". BUT, I'll be the first one to admit that my knowledge level is nowhere near a PhD in biochemistry. I realize all this makes me sound like an arrogant X who thinks I'm the greatest thing since sliced bread and who thinks that I know everything about everything. Believe me, I'm not and I can't stand these type of people. But at some point I have to be honest and correct perceptions that are so flawed such as calling practicing as a nurse a form of "residency". Medical school and residency are things that you can't possible understand the difficulty of it and the depth and sheer quantity of knowledge you gain from it (not to mention the enormous stress of it) until you go through it. They don't call medical school trying drink from a fire hydrant for nothing. Although at least the residents have it better than previous generations with 80 hour work limit.

This is a common argument that is presented here. It's a good analogy because NP's definitely practice medicine. By definition, diagnosing and prescribing treatment for medical conditions is medicine, not nursing. Medication management (based on lab values, patient condition, etc...) is medicine, not nursing. If it was thought that NP's practice medicine, this would get them under the state medical boards, which would curb their rights. This is the real reason why it's considered "advanced nursing" when it's in reality medicine. Now, I have absolutely no problem with this whatsoever. I disagree with any docs who say that the only people who should have prescriptive ability should be docs. However, I also disagree with people not calling a spade a spade and just admitting that NP's practice medicine. 1. I agree. It's not always true in 100% of cases. But if it weren't fundamentally true, why have education and training? What value would there be? Why have MD's then if you can provide the same care as an NP/PA without the hassle of the extra education and training? 2. I didn't say better standard of care, I said the education and training MD's get gives them the capability to provide a "higher level" of care than NP's. Once again, as if I didn't say this enough times, this is a training issue, not a person to person issue. How's this for a better analogy then. Before med school I got a Master's degree in biochemistry b/c I thought I was going down the research road to a PhD instead of med school. I consider myself to have a good biochemical knowledge after getting both a BS and MS in biochemistry. I'd be very offended and would disagree with very strongly any PhD who told me I didn't have any biochemistry knowledge at all. However, I definitely do not have anywhere near the knowledge of biochemistry that PhD's in biochemistry have. If a PhD told me this, I would agree. It has nothing to do with me as a person, it's just a training issue. The training a PhD in biochemistry receives is far more in depth and quantity than an MS in biochemistry like myself.

Busy rotation, haven't been here in a while. Glad to see all the responses. Gotta tackle some issues in the next few posts. There are examples of quacks with an MD behind their name and who hurt, if not kill, people. There are also examples of quacks with an NP behind their name who also have the same negative consequences. One case I can think of one case when the NP failed to diagnose a simple case of pneumonia (I believe read an X-ray as normal that blatantly was not normal). Pt. did not receive treatement and eventually had to be hospitalized when if they had received correct treatment earlier, they wouldn't have had to be hospitalized. I heard the physician took one look at the office x-rays and couldn't believe how anybody could have missed the diagnosis. We can go back and forth on quack MD's and NP's. There are plenty of them there. The point is that there are quacks in every field. By saying this, as well as saying that "it's all about the individual", you're giving off the impression that there's no real difference in training or knowledge between NP and MD, which is definitely not true. And for the record, I completely definitely agree that nobody should automaticaly be given respect just because they have an MD in back of their name.

Haven't been on in a while. I'd just like to thank everyone for their responses. I have a few thoughts on what was said. This is who I'm trying to emulate. I never was an RN, but I did start as a nursing assistant (ie nurse's aide) before going to medical school, so hopefully that's good enough. And I've definitely emptied more than a few bedpans... The difference is not due to the peripheral physics or chemistry courses. There's a difference in the fundamental medical courses of pathology, pathophysiology, even anatomy and physiology. My sister is a nurse with a BSN. The material she learned in the above courses was definitely not comparable to mine (she'd say the same exact thing by the way). For example, her anatomy and physiology course was provides a superficial understanding of anatomy and physiology. It really doesn't go into the depth that the anatomy and physiology I had in medical school went into. Pathology and pathophysiology was even a bigger difference. (once again, she'd say the same thing) Her course materials and her understanding of the material in our discussions about medical disorders backs this up. She got good grades and finished towards the top of her class and is definitely a smart woman, but does not have the training I do or the depth of understanding of the medical knowledge as I do. Now, just for the record, the above fact has absolutely nothing to do with the individual, but only with the training that the individual gets. If I went to nursing school and my sister went to medical school, then our depth of knowledge would be reversed, simple as that. It's this difference in training that results in the difference in clinical knowledge between her and I. Again, that clinical knowledge difference would reversed had we gone to different schools. I'm sure she doesn't think of herself as having little medical knowledge. This would be correct of her because she does not have little medical knowledge. I'd disagree with any nurse who said he/she had little medical knowledge. But it's not equal to the medical knowledge of a physician (again, simply due to training differences, and not person differences). (the 2nd quote if from another thread I was reading) I have to step in here and be honest. It's quotes like these that give the physicians that I was talking about in my 1st post ammunition. Please to do not compare an NP's training as equal to an MD's training. The residency an MD goes through is definitely not equal to an NP's training. For example, they did not have to institute an 80 hour work hour restriction for NP's. I think an analogy is appropriate here. Saying an NP's training (and knowledge) is equivalent to an MD's is like saying an LPN's training and knowledge is equal to an RN's. An LPN's training and knowledge base is definitely not equal to an RN's. An RN has more years of training and learns as a deeper level and thus acquires a deeper understanding of the material as compared to an LPN. From my experience, I've never met an RN who believes that an LPN is an equal substitute and has the equal knowledge to an RN. I was told of the differences above by many RN's themselves. It demeans the training an MD gets to say it's equivalent to that of an NP just like it demeans that training an RN gets to say that it's equivalent to that of an LPN. The same is true for NP and MD as is true about an RN to LPN. The first quote talks about it being a "competence of the individual" thing. I definitely agree that a competent person is better than a incompetent person anyday. However, one has to look at averages though since there's a range in any field. The average RN will always have more knowledge and training than the average LPN and therefore is capable of delivering a higher level of care than the average LPN (again, solely due to the training and knowledge difference). Likewise, the average MD will always have more knowledge and training than the average NP and therefore is capable of delivering a higher level of care than the average NP (again, solely due to the training and knowledge difference). I don't expect any of this to change anybody's mind, especially since it's not as though I went from being an NP to an MD, which would give it a lot more weight. However, there were two people on studentdoctor.net who posted in a thread a couple years ago that they went from being NP's to MD's. Both of them said that they "did not know how much they did not know until they went to medical school". Did they mean that they didn't know anything prior to medical school? Absolutely not. Couldn't be more wrong. They said that they had medical knowledge prior to medical school, but that they didn't realize not as much how much more in terms of quantity, but the depth of knowledge and the deeper understanding of the concepts that was the surprising thing to them that led them to believe the above quote. Please do not be offended by anything I've wrote. After all, if I didn't care about what nurses and NP's felt, I wouldn't be here nor would I write a comment like "nurses are the real heroes of healthcare". However, I have to be honest not only with the heroes of healthcare belief which is undoubtably a popular belief on a nursing forum, but also with viewpoints that may be unpopular.

I want to get a balanced view on an issue I've seen many times. I'm a medical student who worked several years as a nursing assistant prior to medical school. Throughout both experiences I've heard plenty of talk from physicians about NP's, much of which is negative. This is obviously preaching to the choir here; I'm sure this is no news to you guys. I'm sure you are well aware that beliefs exist such as "NP's are practicing medicine" "NP's want to be doctors clinically, but they don't want the hours or to go through the years of training as a doctor" or "NP's are wanna-be-docs" and other sorts of stuff such as this. There's also a persistant view among MD's that NP's think they are equal substitutes clinically speaking for an MD. Along with this, there's a belief that NP's think they have equivalent medical knowledge of an MD. Again, this is not news to you I'm sure. There's no population in healthcare more so than nurses which knows that arrogance, and downright jerks often times, that are in medicine. Even though I'm a medical student, I know this very well, given my long time as a nursing assistant all throughout college and a couple years afterwards. Believe me, I know the crap you guys have to deal with since I've seen it for years (and have taken some of it myself too). The reason I'm posting here is because I'm a strong believer that whenever a viewpoint/opinion is expressed, one should strive to get the opposite viewpoint/opinion in order to have as well balanced view of the issue. It's only after doing this that one can make up his/her mind to come to a good conclusion on any issue. So with that, I'd like to get your views on everything I've outlined to get some balance to the views I've been hearing from MD's. Please feel free to comment on this issues. I want to get as much feedback as possible. It's nice to get a balanced view instead of hearing 1 side all day long. Do you (as an NP) think you are an full, equal clincal substitute for a physician (in a given area)? What I mean by specific area is as follows, do you think an Adult NP is an full, equal clinical substitute for an internal medicine doc; a Pediatric NP for a pediatrician; Psych NP for a psychiatrist; Neonatal NP for a neonatalogist, etc...? Thanks guys. I really appreciate it. Don't let docs get you down. Believe it or not, there are some of us out there who know how tough nursing is and appreciate how extraordinarily valuable nurses are. Nurses are the real heroes of healthcare!