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Amistad Amistad (New Member) New Member

Residencies: doctors have it figured out

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You are reading page 4 of Residencies: doctors have it figured out. If you want to start from the beginning Go to First Page.

In the US, there is (and has been for some time) a shortage of physicians. While in the past, there may have been some localized shortages of nurses, in most parts of the US, there is now a significant oversupply. Virtually every medical school graduate passing the USMLE finds a position as a doctor in short order and it is extremely rare for a licensed new graduate physician to not find a job in practice. In contrast, growing numbers of nursing school graduates passing the NCLEX struggle to find work of any sort and it would not be surprising to find that large numbers new grad RN's never work in health care.

The US presently ranks 53rd globally in the number of physicians per capita, with fewer doctors relative to population than nearly all industrialized countries and even some third world countries (Physicians (Per 10,000 Population) - GlobalHealthFacts.org). The situation is quite different for nurses with the US is in the top tier - 15th on a per capita basis (Nurses and Midwives (Per 10,000 Population) - GlobalHealthFacts.org).

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In the US, there is (and has been for some time) a shortage of physicians. While in the past, there may have been some localized shortages of nurses, in most parts of the US, there is now a significant oversupply. Virtually every medical school graduate passing the USMLE finds a position as a doctor in short order and it is extremely rare for a licensed new graduate physician to not find a job in practice. In contrast, growing numbers of nursing school graduates passing the NCLEX struggle to find work of any sort and it would not be surprising to find that large numbers new grad RN's never work in health care.

The US presently ranks 53rd globally in the number of physicians per capita, with fewer doctors relative to population than nearly all industrialized countries and even some third world countries (Physicians (Per 10,000 Population) - GlobalHealthFacts.org). The situation is quite different for nurses with the US is in the top tier - 15th on a per capita basis (Nurses and Midwives (Per 10,000 Population) - GlobalHealthFacts.org).

That's all correct - except that the physicians' shortage is located into primary care domain, and that structure of the US medical care is unique. Nowhere in the developed world a doctor may be economically forced to choose specialty because necessity to pay back educational loans or inability to pay insane malpractice insurance rates. Nowhere in the developed world nurses and mid-level providers do so much of medical care. Drawing blood for routine labs, taking ECGs, teaching, complicated dressing changes, line and ostomy care, drugs titration were all parts of doctors' job just some 30 years ago and still are in many countries, not even speaking about "routine" prescribing, monitoring, labs control, etc., done more and more by mid-levels, just like feeding, ambulating and toileting were all parts of nursing care same 30 years ago. Now my classmates balk on taking vital signs and feeding because it is "CNA's job".

If the system continues to grow the way it goes now, CNAs, MAs and other assisting personnel will be the most numerous healthcare "providers" while nurses doing meds, assessments and all other "medical" and educational care and mid-levels picking up 85% of the rest "routine" doctors' work. The question is what doctors are going to do after that happens. But that's their fault, not nurses'.

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***

*** Yes well said and 100% correct. However it is my observation that new grads are graduating from nursing school helpless at the bedside and not having learned simple and basic nursing tasks and skills. Rather than the well trained new nurse concentrating on learning time managment, advanced skills and critical thinking when she is first hired, she must be trained in fundamental nurse tasks and skills by her employer. This dramaticaly increases the cost of training new grads.

*** .

Double the number of clinical hours required. Make it mandatory for the program to keep accreditation to give students hospital-based clinical hours. Make externship/internship mandatory. Limit paper writing to 1/course for BSN programs and 2/semester for ADN and LPN. Make online courses available for core, leadership and such. Course papers shouldn't account for more than 20% of total score of every course. Every course must have clinical component (and if they cannot put anything clinical in "core curriculum", they probably can discard the whole thing as unnecessary). Make programs unable to offer optional courses like "death and dying" or "family nursing" without half time spent in clinical site.

And, for God's sake, stop using labs! Students have their own bodies to practice on, and nobody will die because of couple of pokes. We do it anyway whether professors allow it or not.

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I think part of the problem is that medical schools limit the numbers and nursing schools are constantly trying to flood the market with as many nurses as they can.

Are new nurses willing to work for dirt cheap wages and be on call for lengthy periods of time and submit to the hierarchical nature of medical residencies? It doesn't seem so.

This is so true with regard to flooding the market. The BON's need to start capping the numbers including local and international nurses. You've got too many schools, too many eligible candidates for licensure and the result is a disaster.

At least until there truly is a shortage years down the road, it would be wise to halt things, and most of those schools that have been cropping up in recent years should probably close anyway. Many of the newer programs are inadequate.

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That's all correct - except that the physicians' shortage is located into primary care domain, and that structure of the US medical care is unique. Nowhere in the developed world a doctor may be economically forced to choose specialty because necessity to pay back educational loans or inability to pay insane malpractice insurance rates. Nowhere in the developed world nurses and mid-level providers do so much of medical care. Drawing blood for routine labs, taking ECGs, teaching, complicated dressing changes, line and ostomy care, drugs titration were all parts of doctors' job just some 30 years ago and still are in many countries, not even speaking about "routine" prescribing, monitoring, labs control, etc., done more and more by mid-levels, just like feeding, ambulating and toileting were all parts of nursing care same 30 years ago. Now my classmates balk on taking vital signs and feeding because it is "CNA's job".

I agree and if the system continues along the path it is presently on (and I see not reason why it will not), CNAs, MAs and other unlicensed assisting personnel will essentially replace the RN and LPN. "Nurses" in the near future, to the extent they exist at all, will be required to have DNPs and will essentially be paraphysicians.

The question really is, what are doctors are going to do after that happens? It is true that much now in the RN scope of practice was formerly in that of the MD - and still is in many countries. It is also true that much in the present scope of RN practice is now being done by unlicensed assistive personnel. The UAP scope of practice is growing and in my view, this has occurred with at least passive assistance from the ANA, though for reasons that I do not understand. The result is not unexpected: A cheapening of the "ordinary" RN and the rise of the APRN.

Again in my opinion, the vast majority of what is now in the purview of the RN, will in the not-too-distant future, be done by UAP's. The RN is destined to follow the route of the LPN. Nursing in the future will be done by APRN's and NP's who will supplant the role now performed by the GP or other primary care physician.

Just my opinion but I have a crisp new Franklin I'd be willing to wager . . .

Edited by chuckster

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Well, docs have nobody to blame but themselves. Their support of abusive and ancient system of training, their laziness, conservatism and proverbial greed led to that, and it's not going to be better for them any time soon. We'll have to wait and see for the results with Obamacare coming upon us, but in any case APNs are here to stay, whether AMA wants it or not.

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Correct me if I'm wrong, but the pathway to medical education seems to be more typical then the pathway to nursing education. Basic nursing education is very diverse as opposed to basic medical education. There are nearly 3.5 million licensed nurses in the U.S and there are a diversity of schools with nursing programs. There are nearly 800,000 physicians in the U.S. Available medical schools are more standard. As was pointed out earlier, the large influx of nurses with diverse basic education may be contributory to the low interest in nurse residency programs by the powers that be. However, at the graduate level, the hours required to complete an advanced practice nurse program seems pretty consistent across the board. With undergraduate nursing, in particular, being in disarray, I can't help but wonder as some of you may be wondering whether that means that graduate level nursing will finally be established as entry level. I wonder this in light of the establishment of CNL (clinical nurse leader) programs.

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Well, docs have nobody to blame but themselves. Their support of abusive and ancient system of training, their laziness, conservatism and proverbial greed led to that, and it's not going to be better for them any time soon. We'll have to wait and see for the results with Obamacare coming upon us, but in any case APNs are here to stay, whether AMA wants it or not.

Katie, I agree with much of what you write but the nurses are in the hole not only because of external forces such as the AMA but because we refuse to get our act together. I know of several people who switched professions because nursing felt like a disenfranchised profession to them.

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I would never want to be a doctor a nurse "resident" spending 80hrs at least a week for $40-50k a year! Never! many hospitals disregard resident work hours , and taking call all night after surgery all day them in am , is that pt safe? or 6-6pm sun to fri then 6pm to 6am night float from sun to friday, is that pt safe ? most nurses whine and cry if they work more than 4 twelves i a row. there isnt much complaining from residents about hrs to non fellow residents because there are repricussions for it. the attitude is you knew it going in , so suck it up. i dont believe the current system is a that pt or resident safe either.

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*** You might get a few people to invest in graduate education to make the kind of money nurses make, and do the hard physical labor nurses do in an economic depression like we are in. However eventualy when the economy straitens out who is going to be willing to do that when there will be other better paying, less physicaly demanding jobs one can become qualified for through graduate education? Most people will be unwilling to invest the time, effort and money for a graduate education to become qualifed for a job that involves punching a time clock, making a lower middle class wage, dealing up close and personal with body fluids, and flat out hard work. I know I wouldn't.

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*** You might get a few people to invest in graduate education to make the kind of money nurses make, and do the hard physical labor nurses do in an economic depression like we are in. However eventualy when the economy straitens out who is going to be willing to do that when there will be other better paying, less physicaly demanding jobs one can become qualified for through graduate education? Most people will be unwilling to invest the time, effort and money for a graduate education to become qualifed for a job that involves punching a time clock, making a lower middle class wage, dealing up close and personal with body fluids, and flat out hard work. I know I wouldn't.

PMFB-RN, your points are well taken. I think a growing number of nurses are opting for graduate education, especially nurse practitioner, because these nurses have more autonomy and potential for better pay. Someone correct me if I'm wrong but I believe NP services are billed like a physician's whereas we garden variety nurses are part of room and board. If the scope of their practice changes to allow them to admit patients and write certifications for areas like home health, then NPs impact revenue, although we regular nurses impact revenue with the care we provide. You're right, though, that the economy has a great effect on people coming into and/or staying in the profession. I'm not certain that will end once the economy has improved because nurses, particularly RNs, make pretty decent wages although that is debatable in many circles. In addition, if we do see nursing residency become more wide spread, it may increase retention in the profession. On the basis of that, the question for me is what is the turnover rate of advanced practice nurses meaning how many of them give up their board certifications?

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