Hello, I am coming here to see if I can pick some information off of you all. I will state that I appreciate ahead of time the responses I will hopefully receive and hope to put them to good practice.
I am an ER physician in the southeast-ish area of the US, and usually do much travelling around. I work for various staffing agencies, usually just taking the most needed bids and such. I tend to work with many different nurse practitioners and physician assistants in the various locations, mostly in the bigger ERs. The smaller ones usually it is just me since the volume is low.
The reason I come here is because I am looking or some info on the education of nurse practitioners. Sine I occasionally lecture on ER topics at one of the local PA schools in front of medical students and Pas I have been able to get a thorough glimpse at the PA ED model, which really is not too much different than a condensed version of ours it seems. I did go to a med school here in the US which also has a PA program close by so I understand this aspect.
I have noticed at many of the facilities I work at, a higher than average (in comparison to PA and other docs) the nurse practitioners often (not a total majority) seem to be oblivious to many aspects of ER level care. Some are unable to understand the interpretation of a basic set of lab panels, X-rays, and some are unable to suture well, if at all. There are a few that are Excellent at what we do (the term we used because we are a team and I dislike the dichotomy many use separating physician practice from other types of providers since it just stems unneeded conflict and perpetuates social gaps).
I have not noticed such a large gap in practice from the physician assistants that I work with though. Nearly all of them are able to suture, interpret labs, splint, suture, read most X-rays (abdominal X-rays can be very difficult to read at times, often we physicians consult rads on these). (I am also referring to flat plate x rays not CT/MRI and the such when providing the term Xray).
The gap is narrowed it seems between the PA/NP when it comes to diagnosing illness in the fast track though, I do notice it seems the PA do edge out slightly on better diagnosis (but my time is limited in the fast track, I am only there when they have a question about something, if something gets miss-triaged, or if family requests to see me, etc etc.)
But the whole point of me coming here is to ask if they teach nurse practitioners during their educational adventure how to read X-ray, suture, splint, read basic lab panels, intubate, and what not. I have looked through curriculums but course names often do not tell accurate stories in any aspect of education.
I would feel rather rude asking my coworkers these questions, since they may take it as demeaning and I like to maintain great relationships with the other providers. So again, here I am looking for a bit of info on what type of education they provide nurse practitioners in school (we use mostly FNPs in er) to see what you all thought of the situation.
Hope I am not stepping on toes with this,,,, just looking to gather some information in an objective manner.
And no, I wouldn't expect them to have the same knowledge as a MD. I guess I just imagined that with the right background and enough education, an NP could be on the same playing field as a MD or DO. I guess I was wrong. But I suppose in a speciality like cancer, where the docs there have certs in oncology and hematology, that would be pretty hard to compete with.
What about PMHNP, could they ever be ever be equal to or close to equal to a psychiatrist? As far as skills/knowledge base is concerned. I suppose not. That's why I was liking the PO to DO option.
I think PsychNP who is a regular poster in this forum might be able to answer your question about PMHNP vs Psychiatrist... But based on the amount of time it takes to become a psych doc, I would think they know more than NP...
If you are on the fence about NP/PA vs MD/DO, I would suggest you take a step back and evaluate what you really want out of a career. If you don't mind being an assistant, PA/NP fit the bill... If you want to have full scope and all the perks and sometimes headaches that come with these perks, MD/DO might worth considering.
Again your looking at an MD/DO with an extended residency. Although I have met quite a few Phsycologists who think they are Psychiatrists they do have control of Therapeutic care plans
If you have the impression that physicians seem to take PA's more seriously, that's probably more anecdotal than anything. There is no reliable survey of physicians that can reliably establish this as a fact.
Based on conservation I heard among physicians, I think most take PA more seriously than NP... Maybe it's politics and/or familiarity with the PA degree since many US medical schools also have PA programs, and sometimes PA students take some classes alongside MD students.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Based on conservation I heard among physicians, I think most take PA more seriously than NP... Maybe it's politics and/or familiarity with the PA degree since many US medical schools also have PA programs, and sometimes PA students take some classes alongside MD students.
Lol... I don't think anyone or any organization would waste their time having a survey to find out if docs really have a preference for one or the other... That would seem petty!
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Lol... I don't think anyone or any organization would waste their time having a survey to find out if docs really have a preference for one or the other... That would seem petty!
Well I for one am not advocating for such a survey. I'm perfectly happy working in a US News and World Report Top 10 Medical Center that houses a US News and World Report Top 3 Medical School (Research and Primary Care) where physicians take NP's very seriously and are familiar with their training having seen NP students from the US News and Word Report Top 10 AGACNP program.
But then again US News and World Report rankings are dubious.
I am about to graduate from PA school. We had two entire semesters where we had to learn how to read and interpret X-rays, CTs, MRIs, Ultrasounds, PET scans, and combo PET/CTs. We were very thoroughly tested on these skills, with an emphasis on X-rays for diagnosing pneumonia, CHF, pneumothorax, aspirations, abdominal xrays for small and large bowel obstructions, KUBs, and musculoskeletel xrays. We were absolutely required to know how to tell the difference between a Salter-Harris Type 2 (most common) and Salter-Harris Type 5 (most devastating). To read that the NP curriculum does not include basic chest/abdominal/musculoskeletel xrays makes me extremely concerned. While there is a radiologist available to read Xrays that usually doesn't happen until the next day. If an NP had a patient with fever + cough and can't interpret an xray then the PT may be sent home without the right (or any) treatment. What's the benefit of ordering a CXR if you can't interpret it? That is medical negligence and a lawsuit waiting to happen. If you can't interpret a basic chest xray then you have no business treating any patient with any sort of cough as you can't tell the difference between pneumonia or a Kerley B line.
I am about to graduate from PA school. We had two entire semesters where we had to learn how to read and interpret X-rays, CTs, MRIs, Ultrasounds, PET scans, and combo PET/CTs. We were very thoroughly tested on these skills, with an emphasis on X-rays for diagnosing pneumonia, CHF, pneumothorax, aspirations, abdominal xrays for small and large bowel obstructions, KUBs, and musculoskeletel xrays. We were absolutely required to know how to tell the difference between a Salter-Harris Type 2 (most common) and Salter-Harris Type 5 (most devastating). To read that the NP curriculum does not include basic chest/abdominal/musculoskeletel xrays makes me extremely concerned. While there is a radiologist available to read Xrays that usually doesn't happen until the next day. If an NP had a patient with fever + cough and can't interpret an xray then the PT may be sent home without the right (or any) treatment. What's the benefit of ordering a CXR if you can't interpret it? That is medical negligence and a lawsuit waiting to happen. If you can't interpret a basic chest xray then you have no business treating any patient with any sort of cough as you can't tell the difference between pneumonia or a Kerley B line.
It does not matter; they are better equal or better than doctors i.e physicians.
I am about to graduate from PA school. We had two entire semesters where we had to learn how to read and interpret X-rays, CTs, MRIs, Ultrasounds, PET scans, and combo PET/CTs. We were very thoroughly tested on these skills, with an emphasis on X-rays for diagnosing pneumonia, CHF, pneumothorax, aspirations, abdominal xrays for small and large bowel obstructions, KUBs, and musculoskeletel xrays. We were absolutely required to know how to tell the difference between a Salter-Harris Type 2 (most common) and Salter-Harris Type 5 (most devastating). To read that the NP curriculum does not include basic chest/abdominal/musculoskeletel xrays makes me extremely concerned. While there is a radiologist available to read Xrays that usually doesn't happen until the next day. If an NP had a patient with fever + cough and can't interpret an xray then the PT may be sent home without the right (or any) treatment. What's the benefit of ordering a CXR if you can't interpret it? That is medical negligence and a lawsuit waiting to happen. If you can't interpret a basic chest xray then you have no business treating any patient with any sort of cough as you can't tell the difference between pneumonia or a Kerley B line.
Probably because a radiologist will be reading the film. Even in my ER where I spent 4 years, the ER docs didn't read the film, the rad did. This is the trends of how healthcare is going. It's not so much the process of reading films but when its not your "expertise" you can still be held liable for missing something. So how about the ER doc that misses the small pneumo? It happens, even rads miss them. The ability to read x-rays, CT, and MRI is just a very small portion of being able to provide care for someone, and honestly its best left to the Rads anyway. I'm not even a an APRN yet and I know the difference between salter harris fractures, the point is, the rad will be diagnosis this and more than likely in your position, they will be too! The big factor is how do you treat the fracture after diagnosis, again, probably getting sent to ortho. We can splint it and give the patient pain medication but ultiamately it will be up to a specialist to fix. What you bring up here are highly specialized skillsets that are often not seen or needed to properly move a patient through the care continuum from a PA/NP standpoint. I doubt you will read many x rays once you start practice (if any) pending on what you do.
Big ERs have the benefit of having in-house radiology who can do an immediate read on all xrays but clinics, urgent care centers, and small town ERs don't have that. If the primary provider cannot make heads or tails of a CXR then they are not equipped to practice medicine. I'm not suggesting every non-radiology provider be able to see a small pneumonia or a tiny lingular infiltrate but they better be able to see the obvious CHF or huge right lower lobe infiltrate starring them in the face. Being that FNP education lacks this basic skill I will always be careful to never have an FNP assess me or anyone I love and care about for anything remotely related to their lungs.
Worst yet- if an FNP doesn't know how to read a basic CXR they may not order one when it's certainly warranted. They will likely miss a huge infiltrate, send a patient home with nursing order to "rest", and the PT will expire.
Big ERs have the benefit of having in-house radiology who can do an immediate read on all xrays but clinics, urgent care centers, and small town ERs don't have that. If the primary provider cannot make heads or tails of a CXR then they are not equipped to practice medicine. I'm not suggesting every non-radiology provider be able to see a small pneumonia or a tiny lingular infiltrate but they better be able to see the obvious CHF or huge right lower lobe infiltrate starring them in the face. Being that FNP education lacks this basic skill I will always be careful to never have an FNP assess me or anyone I love and care about for anything remotely related to their lungs.
Worst yet- if an FNP doesn't know how to read a basic CXR they may not order one when it's certainly warranted. They will likely miss a huge infiltrate, send a patient home with nursing order to "rest", and the PT will expire.
Wow I'm glad you have such strong opinions about how FNP's operate! Certainly ordering a CXR is done by clinical presentation and PMH. Regarding urgent care centers and small town ER's, they still use a radiologist. There are several services, we use Nighthawk (yes I worked in a community ER!) They are available 24/7 to read films and a lot of smaller operations use them for radiographic intepretation when they do not have means to do so. I'm not discrediting the ability to read films, I'm saying the potential of doing so isnt going to present itself often. How competant at reading films do you think you would be if you maybe see a few a week? And while were on it, I wouldnt generalize the education of all FNP's to the profession. You're going to have good ones and bad ones, just like docs, and certainly like PA's. Perhaps you should remain more open minded about your opionions, you just might have to rely on one someday.
AndersRN
171 Posts
I think PsychNP who is a regular poster in this forum might be able to answer your question about PMHNP vs Psychiatrist... But based on the amount of time it takes to become a psych doc, I would think they know more than NP...
If you are on the fence about NP/PA vs MD/DO, I would suggest you take a step back and evaluate what you really want out of a career. If you don't mind being an assistant, PA/NP fit the bill... If you want to have full scope and all the perks and sometimes headaches that come with these perks, MD/DO might worth considering.