springing

MEDICAL SCHOOL accreditation procedures (taken from http://www.lcme.org/newschoolprocess.htm ): A medical school obtains "Candidate School" status when: 1. It has paid the $25,000 application fee to the LCME to begin the process of applying for preliminary accreditation; and 2. LCME and CACMS Secretariat staff have determined that the school meets the basic eligibility requirements to apply for accreditation (i.e., a current or anticipated charter in the U.S. or Canada and plans to offer the educational program in the U.S. or Canada); and 3. The school has submitted the required medical education database and planning self-study documents, which have been favorably reviewed by the LCME (and, for Canadian schools, also by the CACMS); and 4. Approval has been granted by the LCME for a site visit for preliminary accreditation. A medical school achieves "Preliminary Accreditation" status when: 1. It submits a modified medical educational database and a self-study summary to the LCME; and 2. An LCME team completes a survey visit at the medical school and prepares a report of its findings for consideration by the LCME at its next regularly scheduled meeting; and 3. The LCME reviews the survey team's report and determines that the program leading to the M.D. degree meets the standards outlined in the LCME document, Guidelines for New and Developing Medical Schools; and 4. The LCME votes to grant preliminary accreditation to the program for an entering class in an upcoming academic year. Once preliminary accreditation is granted, the program may begin to recruit applicants and accept applications for enrollment. If the program does not enroll a charter class within two years of its receipt of preliminary accreditation, it must reapply for preliminary accreditation as a new program and pay a reapplication fee. A medical school achieves "Provisional Accreditation" status, after it receives preliminary accreditation and enrolls a charter class, when: 1. It submits a modified medical educational database and a self-study summary to the LCME; and 2. An LCME team completes a limited survey visit prior to the midpoint of the second year of the curriculum to review progress toward implementation of the educational program leading to the M.D. degree and the status of planning for later stages of the program, and prepares a report of its findings for consideration by the LCME at its next regularly scheduled meeting; and 3. The LCME reviews the survey team's report and determines that the program leading to the M.D. degree meets the standards outlined in the LCME document, Guidelines for New and Developing Medical Schools; and 4. The LCME votes to grant provisional accreditation to the program. Once provisional accreditation has been granted, students enrolled in the program can continue their medical studies in the third and fourth years of medical education, and the program can continue to enroll new students. A medical school achieves "Full Accreditation" status, after it receives provisional accreditation, when: 1. It submits a modified medical educational database and a self-study summary to the LCME; and 2. An LCME team completes a full accreditation survey visit that takes place late in the third year or early in the fourth year of the curriculum, and prepares a report of its findings for consideration by the LCME at its next regularly scheduled meeting; and 3. The LCME reviews the survey team's report and determines that the program leading to the M.D. degree fully complies with all LCME accreditation standards; and 4. The LCME votes to grant full accreditation to the program for the balance of an eight-year term that began when the program was granted preliminary accreditation status. ---- MSN/DNP PROGRAM accreditation procedures (taken from http://www.aacn.nche.edu/Accreditation/pdf/Procedures.pdf ): 1. The program conducts a self-study process (self-assessment), which generates a document addressing the program’s assessment of how it meets CCNE’s accreditation standards. The self-study document that results from this assessment should identify the program's strengths and action plans for improvement. 2. An evaluation team of peers is appointed by the Commission to visit the program in order to validate the findings of the self study and to determine whether the program meets all accreditation standards and whether there are any compliance concerns with the key elements. Acting as a fact-finding body, the evaluation team prepares a report for the institution and for CCNE. 3. The program is provided with an opportunity to respond to the evaluation team report. Additional and/or updated information to support compliance and continuous quality improvement may be submitted at this time. 4. The self-study document, the evaluation team report, and the program’s response are reviewed by the ARC, which makes a recommendation regarding accreditation to the Board. 5. The CCNE Board, taking into consideration the ARC recommendation, decides whether to grant, deny, reaffirm, or withdraw accreditation of the program; or to issue a show cause directive. If accreditation is denied or withdrawn, the institution is accorded an opportunity to appeal the decision. 6. The Commission periodically reviews accredited programs between on-site evaluations in order to monitor continued compliance with CCNE standards, as well as progress in improving the quality of the educational program. This process is reinitiated every 10 years or sooner, depending on the success of the program in demonstrating continued compliance and improvements in the quality of the educational program. --- That does not in ANY WAY seem equivalent. And keep in mind there are many online NP programs where the school provides guidelines and approves your self-arranged clinicals but does not TRULY KNOW what is going on in those clinicals. That would be absolutely unheard of for a medical school, where your initial clinical rotations have to be approved before beginning and are observed during the first years they occur.

That does not have anything to do with whether DNP accreditation is equal to allopathic accreditation - or your claim that the LCME makes tuition burdens increase for matriculants. Wowza's statement that the worst medical school prepares you as well or nearly as well as Harvard is true. This is why, when choosing residents for their programs, the residency directors don't really care where you went to school. http://www3.interscience.wiley.com/journal/119827010/abstract?CRETRY=1&SRETRY=0 "Items ranking as most important (4.0-5.0) in the selection process included: EM rotation grade (mean ± SD = 4.79 ± 0.50), interview (4.62 ± 0.63), clinical grades (4.36 ± 0.70), and recommendations (4.11 ± 0.85). Moderate emphasis (3.0-4.0) was placed on: elective done at program director's institution (3.75 ± 1.25), U.S. Medical Licensing Examination (USMLE) step II (3.34 ± 0.93), interest expressed in program director's institution (3.30 ± 1.19), USMLE step I (3.28 ± 0.86), and awards/achievements (3.16 ± 0.88). Less emphasis ( http://journals.lww.com/academicmedicine/Fulltext/2009/03000/Selection_Criteria_for_Residency__Results_of_a.24.aspx This one ranks medical school reputation as the 9th most important criterion for choosing a resident, after clinical grades, Step 1 scores (sounds like study #1, doesn't it?) and a host of other factors. Can you really say that ALL DNP programs are quality?

6 new medical schools have opened in the past few years and tuition has gone up. 11 more allopathic medical schools are set to open in the next 4 years. I would bet every single penny in my savings account that they won't stay the increase of tuition rates a whit. Your argument that the accrediting process is there to hinder new medical schools (not to actually make sure they PRODUCE WORTHY DOCTORS) and that raises tuition carries no water. I've heard the "AMA keeps the supply artificially low" argument before, but never using accreditation procedures as proof. I'm pretty sure most PATIENTS would agree that the procedures are necessary.

How does having fewer medical schools contribute to more debt?

the dnp is there to inflate the ego and the bank accounts of mundinger (i'm aware she's resigned) and a select few other school administrators...the extra year+ of schooling doesn't actually add anything to your clinical knowledge base, but it works for what it was intended to do...pad the pockets of university staff and exploit nurses who are weary of the disregard and disrespect so often slung their way and want to be able to tell people they have a doctoral degree, even if it only took them 3 years to obtain it.but that still doesn't change the fact that the two years of the old np curriculum - 1 and a half if you delete the classes that provide no clinical knowledge - pale in comparison to what other healthcare providers are receiving. and i don't understand and have never received any good explanation for why this isn't seen as a problem. you receive a fraction of the clinical hours of the pa, and thus you are unable to move specialties, but it takes you the same amount of time to receive your degree because you fill the space with classes that won't help you diagnosis or treat. a pa, in theory, can work in an emergency department, an infusion center, a dermatologist's office, planned parenthood, a community health clinic. they can do that because they received that training. an np has a narrower scope of practice. how is that advantageous? what is alarming to me is the lack of concern this inspires in future and current nps. what on earth is wrong with more clinical hours? you have countless posts on this forum asking for information on how to become an np the fastest. which route is best? which route will get me there quicker? i have not seen one post yet that asks which program is best. which program will teach me the most. i went through 15 pages of posts here. i didn't see one. there are over 100 accredited np programs in the country, none of which are held to a standardized format, and few people are concerned about which are the best. that is a problem. you get a lot of "which specialty will open up the most jobs?" not a lot of "will i be prepared for all those different jobs?" i did a search and did find one person asking about nurse practitioner fellowships. let's compare. here's what you have to do to start a new medical school in this country. http://www.lcme.org/procedur.htm http://www.lcme.org/standard.htm http://www.lcme.org/newschoolprocess.htm what do you have to do to start an np program? get mundinger to show up and cut the ribbon, i guess.

As much as I was enjoying this debate, I am for sure done with it because it's SO one-sided in terms of fact and logic...and you know whose side I'm on. But I want to weigh in on this. I'm not a PA, but I do know that PAs ARE mostly independent of MDs. In most states PAs can open up their own primary care clinics and operate without an MD on board. "MD supervision" equates to meeting with an MD once every few months. On another forum there's a PA who posts regularly who runs an entire emergency department by himself at night while the MD sleeps at home.I also don't believe that PA training is inferior. That's laughable because PAs can switch specialties and NPs can't. Why can PAs switch? Because their training prepares them for every field of medicine as a midlevel. NP training prepares them for one thing, and if they want to switch, they have to complete a whole new year of education, which will contain the clinical hours the PA already had in their original two/three years of education. What I don't understand is why the NPs WANT it like this. I just don't get it. I know a lot of people don't actually support the DNP and resent a whole year of management and fluff (padding a nursing dean's pockets!) but the core MSN curriculum is so fluffy too, and it does hold NPs back because if they want to switch they have to go back to school again (and pad a nursing dean's pockets...) why continually insist your education is superior when it holds you back from being as mobile as the PA?

Physician training is excessive? Go through the curriculum of medical school and a typical family medicine residency and tell me what you'd remove.

The problem with this is that no matter how great the customer service is, it doesn't repair your rusty clockwork. My feelings go like this: A family medicine physician is preferable to a family nurse practitioner. A family nurse practitioner is preferable to having NO primary care provider. I think most people can or SHOULD agree to that. I go a bit further and think it's a waste of a physician to have him/her doing scutwork someone else could be doing. I do think (and numbers bear me out on this) that there is a shortage of PCPs, and thus going to a physician for a well-child exam is not always the best use of that physician's skills. There's a reason many doctors in the real world love and get along with PAs and NPs...they relieve some of the work and some of the stress. And what that implies by default is that physicians have a superior knowledge base - 2 years plus RN experience is good, but it's not comparable to 7 years. That knowledge base is more important than whether or not the PCP holds your hand and makes you feel all warm-fuzzy inside. I'd rather a patient go to a PCP who recognizes the signs of testicular torsion than a PCP who's nice and chummy and can't see that the pt is about to lose a ball. We don't need to bring physician mistakes or NP mistakes into the mix. Exceptions DO NOT prove the rule. Of course doctors make mistakes, but you can't in one post claim that malpractice isn't that big of a deal and then in another post start bringing up physician errors. You can't have it both ways.

If you can find one place where I actually said any of that, I'll be happy to concede the point. Except, I never did. You are blinded by ideology and bringing the tone of the thread WAY down.

Everything you post is a rant...it's a little alarming. None of it is based in logic, it's a continual, froth-mouthed screed against physicians. You are so blinded by ideology and hatred of doctors you don't even realize that Medicare cuts and malpractice insurance/suits affect NPs as well. As more and more NPs become independent of doctors, all those problems that affect medical professionals are going to affect nursing professionals as well.

And that's a wrap. Your whole argument is based on emotion, not logic. I have no idea what made you hate doctors so much, but I hope it doesn't cause you to avoid a good psychiatrist for the subject. Physicians are pretty integral to the health system and one would assume you'll have to deal with them on a customer basis eventually.Your pathos adds absolutely nothing to this discussion. It doesn't matter whether you think it's irrelevant; people do care, so your statement is automatically wrong. Student loan debt is a crisis in this country. It has risen over 3 times as fast as inflation. It doesn't matter whether you think a kid is selfish for not wanting to accumulate 300,000 in student loans before interest; that's a choice many people think twice about, and if it endangers the supply of physicians, it needs to be looked at. *sigh*One would think you would have looked this up before coming to a forum thread like this. http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/advocacy-policy/medical-student-debt.shtml Again, your arguments have no basis in medical economics whatsoever. This isn't going to increase competition, at least not for primary care. It's going to decrease the amount of practicing primary care physicians, not INCREASE. Where's the competitor? The supply will continue to DWINDLE. I think it's yet another symptom of the rampant anti-intellectualism in this day and age. Doctors receive a minimum of 11 years of education after high school. They are some of the most educated individuals in the country AND they are in a position where they tell a person what they should and should not be doing with their lives. That makes a lot of people angry and resentful.

6.8%, same as all federal loans. You call yourself a "numbers guy" and have no idea what the interest on Stafford loans are? Which is still better than a physician making 100k with 180k loans. You're not correct. Pediatric specialties are for the most part VERY low as is general pediatrics.http://www.jobs-salary.com/pediatric-endocrinologist-job-salaries.htm Of course there are nurses who graduate with 50k debt. There are also physicians who graduate with 300k debt. But the AVERAGE debt for physicians is 150,000 in grad school alone - that doesn't include undergrad. If you can find me anything that says average nurse debt is 50,000, that would be great. Until then YOU are making up numbers and trying to make the EXCEPTION prove the RULE. I'm not in medical school. I'm just not a moron. Name some. With proof. Facts, statistics, SOMETHING. Indulge yourself in evidence-based posting. By the way, a nurse working 80 hours a week for a mere $25 an hour would be making $96,000 a year. By the way, 20% cuts in medicare are coming, so physician salaries will only continue to lower. If half your patients are on medicare, that's a 10% salary cut for you. Would you still work at your hospital if they called you into your office and told you they were slicing your salary by 10%?

Are you kidding me? That's an absolute joke.You tell me what other field has average indebtedness of 150,000 just in grad debt, not counting undergrad, and has to work for 40k for the next 4-7 years while interest accumulates on that debt. You don't imagine that interest magically goes away during residency, do you? Then again, maybe you do. Say you have a burning desire to be a pediatric endocrinologist and help all those new juvenile diabetes cases. You graduate medical school with 150,000 in debt. You do a pediatric residency (3 years) and a pediatric endocrinology fellowship (3 years.) By the time you're making over 55k a year salary, your student loan debt has become 190k. You will make about 100k as a pediatric endocrinologist. Even if you were a regular old pediatrician, you wouldn't be making much more than 100k. After state and federal taxes, you will be making 75k a year, or 6250 a month. In order to pay off those loans in 10 years to avoid accumulating more interest, you'll be paying 2800 a month in student loans. Your take-home pay will be 3450 a month, AKA lower than many nurses' take-home pay. Get it now? Or do I have to draw up more examples? Demeaning the amount of time physicians train makes you look silly. No one seriously thinks that med students don't work DAMN hard to enter the profession (do you work 80 hours a week for 40,000 a year?), and no one with any sense believes that 150,000 in graduate loans is something to dismiss out of hand.

Nurse practitioners are advanced practice NURSES, not mini-doctors. To say that NURSES shouldn't require NURSING experience is strange. What physicians assistants receive is immaterial. They are physician assistants, not advanced practice nurses. Bedside experience is always a plus, always. It teaches you how to manage your time, how to manage a wide and sometimes overwhelming slate of patients, how to manage paperwork, how to recognize emergencies, signs and symptoms. Registered nursing develops your instincts. Nurse practitioner programs hone those instincts into usable skills. If you want to be a doctor, go to med school. If you want to be a physician assistant, go to a PA program. If you want to be an advanced practice nurse...practice nursing.

To the OP: Since you speak French, try Switzerland. Better working environment than France or Belgium. No idea what licensing requirements they have. To the derailers: If you're willing to travel anywhere to get that nursing job, why aren't you considering the military?

I just had this debate with a bunch of people in a philosophy forum! My take: whether healthcare is a right or a privilege is COMPLETELY meaningless. Really. Healthcare is essential for society to function properly. If you want to live in a civilized, productive society, you MUST provide healthcare. Complaining that it isn't a "right" misses the point that sometimes life isn't fair; you might not like the fact that it is necessary, but it is. So is some form of government; so are prisons (which your tax dollars ALSO go to support. Maybe we should just be executing felons, it would save money!); so is public education. Substitute healthcare for education. Can you imagine ever having a debate about whether or not we should be providing free education to children? Can you imagine people complaining that their taxes shouldn't go to provide public education for someone else's children (and, sadly, this does happen)? There are many families who could never afford to send their children to school if school cost money, or even if there was no bus service. They would also benefit from putting their kids to work instead of sending them to school. Maybe we should be pushing for that, eh? Without taxes going to support social services, or some way of providing and delivering social services to those who could not afford them otherwise, you don't have a country. You have Somalia. The fact that an organization that usually provides free care to impoverished, underdeveloped nations recently set up a free clinic in Tennessee should be considered a national shame. The strange thing about all this is that between providing healthcare and enshrining free speech, healthcare is far more important when it comes to extending your lifespan. Yet one is considered a right and one is not.

One thing you gotta remember is that a lot of nursing students are non-traditional. They come back to school from other professions and/or have families already. Oftentimes they have to work on the side to help support said families. If you're a single person in college for the first time, you probably won't find nursing school as challenging.

Err, your English skills seem excellent to me! I would never have any idea that you weren't a native English speaker if you hadn't said so. In fact, without being rude to my fellow allnurses members...you communicate much better than a lot of native speakers on these forums. Sometimes I am completely surprised that such-and-such person actually graduated from college... If you worry about your accent, I recommend picking up a Pimsleur course. You'll be mimicking different phrases and sentences and if you really work at it, you can completely eliminate any accent. On the other hand, some people love an exotic voice :)

MDs are justified in their worries that NPs are going to overtake certain MD careers. Of course, they blame the NPs, not the MDs. It's not the fault of any nurse practitioner that so few graduate MDs choose family practice or pediatrics residencies. If MDs choose not to do general primary care, they can't complain that NPs are entering primary care in these numbers. Last time I checked the number of vacancies for family practice physicians grows every single year. You choose an FP residency and you have pretty much a GUARANTEED job, plus loan repayment, at an ever-widening array of locations. But MDs aren't choosing FP and they aren't choosing pediatrics - they are putting their need for money over these fields and then complaining that NPs are seizing the opportunity to provide care to populations that would otherwise be going without. Any MD who complains about NPs and isn't in primary care only has themselves to blame; it's like people who complain about the president but don't vote. Now, I don't believe that NPs should go around calling themselves "doctor" any more than physical therapists or physician's assistants should be calling themselves doctor. And I don't believe that NPs and MDs should have the same scope of practice or same model of care. But there is a DESPERATE need in this country for nurse practitioners, and as long as this need exists, it should be filled. I feel that the debate over this has COMPLETELY lost sight of who exactly we're supposed to be serving here. Doctors and nurses are both employed by the same people - the patients. Doctors and nurses both SERVE the same people - the patients. Pushing health care providors out of the field is scorched earth; it's a pyrrhic victory; it's nonsense.

I realize that this is a bit of thread necromancy, but I would just like to note that if you're going to count residency as part of a physician's clinical training hours, you should count years as an RN as training hours for NPs. In Canada, you cannot become an NP without two years working as an RN. So figure 37.5 hours a week, 4 weeks a month, 11 months out of the year, times two: 3300 hours. Say you're doing ASU's BSN-DNP, that's 1000 clinical hours training to be an NP. This is not counting the hours you spend in clinicals in your ASN or BSN program. I also want to note that unlike MDs, almost all of which learn things they will never, ever use in their training (i.e. opthamology, dermatology, etc), NP training is specialized for exactly what they want to do. Of course, this makes it difficult for NPs to catch those "zebras" that come out of nowhere and they were never trained to watch for, but that is why NPs work under the supervision of a doctor...most of the time. I am fully opposed to ANY person becoming an NP without at least 2 years of work as an RN, and I am also opposed to any NP opening their own clinic without at least 5-10 years of experience working supervised with MDs. This brave new world of NP autonomy is going to crash quickly if inexperienced NPs start making colossal mistakes and get hit with malpractice lawsuits. If NPs grab too much, too fast, too soon, they will end up with less than what they started with.

Advanced nursing degrees and careers are only just starting to take off around the world and are mainly found in anglophone countries. The only career we recognize as advanced in the US that is common in Italy is the midwife, but they are not considered advanced there and make the same as nurses - 1200 or so Euros a month before unsocial hours, overtime, bonuses, etc. The regular profession of nursing is not as advanced in Italy as it is in the United States, either. Throughout much of southern Europe, nurses are more like what we would call CNAs here. They are not well paid. You have to go to Ireland, the UK (still not as well paid as the US), Denmark, Norway and Sweden to find decent nurse salaries. As a side note...if you are descended from an italian person and meet certain requirements (has to be through the male line before 1948, and your ancestors must not have become naturalized American citizens. Having been born in the US to an italian immigrant is fine as long as the immigrant did not become a citizen before the birth) you are eligible for italian citizenship whether you speak the language or not.

I think if you plan on staying within the U.S. CNM is the most PRACTICAL route. However, it's worth it to note than in many other countries, DEM is the norm, not the outlier. In Australia, for instance, where midwives attend the vast majority of births, getting your bachelor's degree in midwifery as opposed to nursing is considered the best route to take because you spend more years learning the trade. You can also obtain a midwifery certificate after one year of post-BSN study, but getting the bachelor's in midwifery is preferred. In New Zealand, midwives must obtain midwifery degrees. In Britain, only nurses who specialized in adult health care can take a post-bachelor's course to become a midwife. Any other nurse specialization is required to take the whole three-year midwifery degree. in Canada, there are a bunch of four-year midwifery bachelor's programs. It seems like just like the metric system and the side of the road we drive on, America is determined to be contrary to the rest of the world :) However, with the exception of Canada (where salaries are about as high as the U.S.), midwife salaries are on par with other nurses with bachelor's degrees.

I'm in MI, so I'm used to snow, and the only way I could bear living in Marquette would be if it were only the LPN program, LOL. It snows from October to May!

1) I wanted to be a nurse at a young age, because I idolize my grandmother and she was a nurse for decades. My mother always discouraged me. She said I would spend my life cleaning bedpans and vomit and would end up bitter and miserable, in those exact words. I gave up the idea for a long time, until my sister was hospitalized last July (and is still in the hospital) and I was able to see what nurses actually do. There is no other job that gives you as much direct patient contact as a nurse. It's incomprehensible to me how little time doctors actually have to be with their patients. I want to be in the trenches. 2) I'm undecided between two very different fields. My dream is to be an NP or a CNM. As I'm still a pre-nursing student, obviously that's a long way off and nothing is set in stone. I think either way, if I end up an RN or an APRN, I'll be happy in either of these two fields...psych or L&D. On one hand, my life has been touched by addiction in a profound way, and I would love to work with recovering addicts or teenagers with mental health issues. On the other hand, I am very passionate about women's health and can't imagine how gratifying it would be to bring new life into the world. I grew up on a farm and birth was a regular occurence. I witnessed calves being born before I ever got my first sex ed class. Birth is a miracle.

What on earth does that have to do with the original post?