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.
Cite your sources, let's read the outcomes research.
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It's difficult to set up a study of that sort... It's not like the same patient will be seen by NP/PA and researcher(s) will determine which one comes up with better differentials and order appropriate diagnostic tests... In order words, confounding factors make such study impossible.
I don't need a study to prove that med school is better than PA just like I don't need to prove PA school is better than NP. It's just obvious!
It's difficult to set up a study of that sort... It's not like the same patient will be seen by NP/PA and researcher(s) will determine which one comes up with better differentials and order appropriate diagnostic tests... In order words, confounding factors make such study impossible.
I do need a study to prove that med school is better than PA just like I don't one to prove PA school is better than NP. It's just obvious!
It is not difficult at all, with a large enough sample you don't need the same patient seen by each provider. These studies are done all the time. It is basic research methods.
Its not "obvious". Physicians and PA/NP providers have demonstrated comparable outcomes on a number of studies. More does not always equal better.
It is only obvious to someone who has already arrived at a conclusion without data. A pseudoscientist.
It is not difficult at all, with a large enough sample you don't need the same patient seen by each provider. These studies are done all the time. It is basic research methods.
Its not "obvious". Physicians and PA/NP providers have demonstrated comparable outcomes on a number of studies. More does not always equal better.
It is only obvious to someone who has already arrived at a conclusion without data. A pseudoscientist.
Comparable outcomes in HTN/DM etc, which can be managed using simple algorithm... I don't know about you, but I think medicine is more complicated than that.
Comparable outcomes in HTN/DM etc, which can be managed using simple algorithm... I don't about you, but I think medicine is more complicated than that.
The problem is, I don't think you do know. I am wagering from your posts you are not a provider or prescriber. What is your experience managing hypertension or diabetes or hyperlipidemia?
What at is the M&M associated with HTN, HL, T2DM? If it is simple to manage via algorithm then why have your almighty physicians not fixed the problem by now? If NPs were able to fully eliminate these three alone what would be the cost savings to our healthcare system?
The problem is, I don't think you do know. I am wagering from your posts you are not a provider or prescriber. What is your experience managing hypertension or diabetes or hyperlipidemia?
What at is the M&M associated with HTN, HL, T2DM? If it is simple to manage via algorithm then why have your almighty physicians not fixed the problem by now? If NPs were able to fully eliminate these three alone what would be the cost savings to our healthcare system?
The word 'adherence' comes to mind..
What is a provider? There are physicians (i.e doctors) and midlevels PA/NP...
What is a provider? There are physicians (i.e doctors) and midlevels...
Non-compliance is a really poor excuse. It has been consistently evaluated in the extant literature over the past 50 years around 10-15% and has not significantly changed. If we could cure 85-90% of HTN, HL, and T2DM then what would be the benefit to our system?
I know lots of doctors that are not physicians. You didn't answer the question about your experience managing chronic illness as a provider...
Non-compliance is a really poor excuse. It has been consistently evaluated in the extant literature over the past 50 years around 10-15% and has not significantly changed. If we could cure 85-90% of HTN, HL, and T2DM then what would be the benefit to our system?
I know lots of doctors that are not physicians. You didn't answer the question about your experience managing chronic illness as a provider...
I don't know what a provider is... Are you asking me if I am a physician (i.e doctor in healthcare settings) or a PA/NP?
§ 825.125 Definition of health care provider.(a) The Act defines health care provideras:
(1) A doctor of medicine or osteopathy who is authorized to practice medicine or surgery (as appropriate) by the State in which the doctor practices; or
(2) Any other person determined by the Secretary to be capable of providing health care services.
(b) Others capable of providing health care services include only:
(1) Podiatrists, dentists, clinical psychologists, optometrists, and chiropractors (limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by X-ray to exist) authorized to practice in the State and performing within the scope of their practice as defined under State law;
(2) Nurse practitioners, nurse-midwives, clinical social workers and physician assistants who are authorized to practice under State law and who are performing within the scope of their practice as defined under State law;
(3) Christian Science Practitioners listed with the First Church of Christ, Scientist in Boston, Massachusetts. Where an employee or family member is receiving treatment from a Christian Science practitioner, an employee may not object to any requirement from an employer that the employee or family member submit to examination (though not treatment) to obtain a second or third certification from a health care provider other than a Christian Science practitioner except as otherwise provided under applicable State or local law or collective bargaining agreement;
I am not a Christian Science Practitioner or Clinical Social Worker for sure... What the heck! Who came up with that definition? Is this from CMS?
Again you seem to be avoiding the question and focused on semantics. Let me be more direct then, are you lisenced and permitted to diagnose medical conditions and prescribe medications in your country or state?
BostonFNP, APRN
2 Articles; 5,584 Posts
Enlighten us, what percentage of PAs working in a speciality setting have completed a formal residency/fellowship?