Oregon equal pay for equal work law has been signed into law in an independent practice state with NP's and PA's getting paid FULL amount from private insurance. This means that a new grad NP's will be paid the same amount as an attending family physician and psychiatrist and also have the same rights and scope of practice as a family physician and psychiatrist.
With the tremendous push for equal pay and for autonomy for PA and NP, is there any reason for medical students to want to go into primary care anymore? I guess my question is, it seems so bizarre that someone would put themselves through hell when they could become a competent provider through the NP route or PA route.
So do you think with these new laws, PA's and NP's will ultimately lead primary care? will these laws drive away medical students from primary care? Is it financially reasonable for a medical student to become a family physician in an equal pay state?
As an sNP, I'm incredibly thrilled and happy at how much progress our profession has made. However, I also understand how some medical students hoping to go into family medicine can feel cheated and grumpy about it. What are ya'll thoughts?
I don't want to speak for FNP, but from my point of view, I will talk about my experience in both academia and in practice. There are a number of people on Allnurses in general who use their own lived experience and use that to make broad general statements about nursing practice or education, and instead of coming up with pro-active solutions, they just complain. Many of us who have pursued any education beyond a BSN are happy that we did and understand the value of our education. When someone says "I simply feel that there is not a single NP program out there that adequately prepares students with their minimum requirements" I have to question their perspective. Has this person really looked into and knows the outcomes of every NP program? I don't even know that information and I teach graduate students.
I won't disagree with you, but I do want to point out that not everyone is in a place to make a proactive (or at this point reactive) change. I'm a student, so, at the moment, I'm focused on learning as much as I can - above and beyond what's required. And broad generalizations are pretty standard in all facets of life. I haven't tried every steak from every restaurant in the country. However, I can say confidently that I like steak, in general. Have I attended every NP school? Or PA or MD school? No. None of us have. But we all know about them and, in general, can formulate opinions of them.
And I must say that when I was applying to schools, I researched multiple, multiple schools - poured over curriculums, admission requirements, clinical hours, etc. Being who I am I made excel spreadsheets compiling all this information. And this was for NP, PA and medical programs. I have what I consider, a good sample size of schools to make a few generalizations.
I enjoy coming on this forum, as I am encouraged by NPs and NP students calling for the elevation of our profession through the raising of minimum requirements. There are 3 possible paths to essentially similar jobs - NP, PA and MD. We have the lowest requirements of these graduate programs. Poorly designed studies showing equivalence aside, why should we not want our providers to be the best? As msn10 alluded to, education has inherent value. Two or three more classes won't add much cost to a program, but the impact it will have on the profession and its place in the healthcare system would be profound.
There are a number of people on Allnurses in general who use their own lived experience and use that to make broad general statements about nursing practice or education, and instead of coming up with pro-active solutions, they just complain. .
In all fairness how do you know those of us disillusioned with nursing practice or education are only complaining here and not also doing things in real life to foster proactive alternatives?
I enjoy coming on this forum, as I am encouraged by NPs and NP students calling for the elevation of our profession through the raising of minimum requirements. There are 3 possible paths to essentially similar jobs - NP, PA and MD.
I was just having a discussion today about the NP curriculum. This thread had me interested in asking. The NP's that I work and teach with said they would favor another pharm, but more of a pharm class that had to do specifically with interactions with other drugs and an element of genomics which will become very big very fast as we have already witnessed point of care decision making, EHR's and genomics explode in the last 3-5 years with programs like SMART.
What I don't want to get away from completely is the nursing model. Partnering with physician groups and pharmacists is great, but remember, they see it from a very medical point of view. Them "overseeing us" would be a nightmare. What did come up in our discussion today (and remember these are college professors who still work as NP's because we have to and want to) is the fact that when we have a PA vs NP shadow us in the clinic or watch us at the bedside, the focus is different. Very often you will see the nurse understand the nuances with patients - patient is saying one thing, but there is an underlying issue that is a bigger problem. PA's don't seem to have the same 6th sense with regards to holistic perspective, and that is okay, they are trained differently.
With regards to Jules and Dodongo, it sounds as if you may like the medical model better and that's okay. Dodongo you still have time to switch to a PA if you want to. I think all 3 programs PA/NP/MD need to reevaluate every year and make changes to their programs. There are some pretty crappy programs in all three fields. Remember, there are many physicians who go to medical in other countries.
Some of those programs scare me to death.
I am fine with the amount of schooling I have because my ICU and cardiac experience in nursing was very intense and I worked at a Level I center which is obviously a teaching facility and the staff MD's and RN's did a great job "training" us as well. I don't know that another pharm would have helped. But when you get out of school, just like after your BSN, you continue to find learning opportunities in your area.
In all fairness how do you know those of us disillusioned with nursing practice or education are only complaining here and not also doing things in real life to foster proactive alternatives?
Because my work and research in conflict management tells me otherwise. Are there people that do both? Sure. However, many people who do not like to speak up at work do so on these threads. If students get together and really start to demand a "better product" people in licensing boards do listen. I have witnessed it first hand. I COMPLETELY changed a class I had, and by extension, we absolutely transformed our undergraduate program to include one more nursing course and take out an elective to give students another clinical and then added 2 more electives for nurses that they were asking for and put new threads throughout the entire curriculum, added more experiential learning, provided a week-long boot camp for NCLEX (not including all the other preps we have for it) and have brought in some unbelievable new professors.
I know I am in a bit of a Utopia, we have 125+ nursing students per grade and we get approx. 2000 applicants per year. I know things can change, but when people only complain on forums, it doesn't' help. I just wonder how many students go to AANP conferences or write letters to them (as a collective group which carries more weight) to demand higher standards? They do listen, but they have to hear from the right people.
lol we all know its just a money bang. schools and BON get rich and people get to wear their white coats proudly. Everybody wins except the students at the tail end of the NP gold rush, currently working NPs, and the patients.
NP schools are a lot more than you are giving them credit for. There are variances in school quality, but your sweeping statements are factless. I have seen a lot more physicians in favor of NP's than the opposite and if NP's were killing people at alarming rates, we would hear about it. It makes me nervous when I read posts from medical students who have such disrespect for a discipline they will have to work so closely with. If you like medicine better, great, go like medicine, but many physicians also really like working with NP's and value their input and expertise.
Preceptor training. We have looked at preceptor training as there is ample evidence from other disciplines that outcome quality is dependent on the effectiveness of the preceptor in their role; sadly many preceptors have never done any formal (or informal) training.
Bedside nurses have gone through quite a bit of training in many places as preceptors. My job before this one was creating preceptor workshops and nurse residency courses and I trained nurses all over the country. It was fantastic. There will be a NP preceptor course created probably in the next year as grant funding is coming through. The CCNE has accredited many BSN programs, I think the NP one will follow the same teaching methods which is all based on adult learning principles. You are right, however, having a trained preceptor makes a big difference.
I just wonder how many students go to AANP conferences or write letters to them (as a collective group which carries more weight) to demand higher standards? They do listen, but they have to hear from the right people.
I agree that students are the key to education changes because they are the consumer. Rest assured my big mouth doesn't just lend itself only to online forums. :) I am very active in local happenings, professional organizations and although I am highly particular I precept 1-2 students a year. I believe if I'm going to complain I also need to put my money where my mouth is and do something. Although I know I'm more productive in real life I also believe the things I write here cause people to think regardless of if they agree or disagree and I also learn about different perspectives from other posters.
many physicians also really like working with NP's and value their input and expertise.
Overall this has been my experience also. I have been fortunate to have been welcomed into the fold by an overwhelming majority of the physicians I have worked with over the years.
There are decent programs. mostly im talking about the schools where most of the learning is through writing papers and discussion posts with no proctored tests or well managed clinical hours.
Back when I went to NP school I went to a decent program, not great, but at least we had tons of tests and only had to write one paper the entire time. No discussion posts or any of that non-sense. These programs still exist but the unfortunate thing is that lazy students are the ones that go thru the discussion board curriculum and still come out with the ability to prescribe. Its those schools that shouldnt be allowed to stay open bc I am pretty sure there isnt a PA or physician training program that doesnt require people to be able to at least pass real exams prior to taking the board exam. Thats where the problem lies, not necessarily in every school. Even if somebody has a ton of nursing experience they still need to actually take graduate level exams that arent open book.
That and the nursing texts are awful. The pathophys books written by APRNs, I have yet to come across one that is well written and easy to understand. The USMLE prep books I have now are much better written and let people take in more information in less time. If anybody has an interest in physiology they should read costanzo's full text TBH, not a combined phys/path book
For the love of Pete can we lay off the self-inflated NP BS and doc bashing?
Sorry, my Grammarly didn't recognize Pete? Who is he? I've been saying it for years.......NPs will soon phase out doctors in certain areas of health care.....If you want to bash someone, please direct that verbiage toward Obama and his genius plan..........ObamaCare's bottom-up ideology is what is driving doctors out of certain areas of health care. Fortunately for NPs we are the bottom-up..........
i actually do agree with MRL that obamas bottom up everything is not the way to keep healthcare going.... much less anything else. I do not know of many fiscally liberal countries that have been a success. Primary care physician salaries are still rising nicely, partially due to the increase in managerial aspects of NP/PAs and such.
Oregon equal pay for equal work law has been signed into law in an independent practice state with NP's and PA's getting paid FULL amount from private insurance. This means that a new grad NP's will be paid the same amount as an attending family physician and psychiatrist and also have the same rights and scope of practice as a family physician and psychiatrist.
I don't want to assume, but are OR NPs given full practice independence/autonomy--i.e., can Rx sched II-V without physician oversight, practice without a collaborative or supervisory agreement, therefore able to open their own private practice and practice independently?
I suspect the AMA will do everything in its power to ensure NPs do not become credentialed providers within many PPO/HMO plans. So that's great, you get to make as much as an MD; good luck finding an insurance plan other than Medicare/Caid to credential you. Maybe I'll be pleasantly surprised.
Dodongo, APRN, NP
793 Posts
I won't disagree with you, but I do want to point out that not everyone is in a place to make a proactive (or at this point reactive) change. I'm a student, so, at the moment, I'm focused on learning as much as I can - above and beyond what's required. And broad generalizations are pretty standard in all facets of life. I haven't tried every steak from every restaurant in the country. However, I can say confidently that I like steak, in general. Have I attended every NP school? Or PA or MD school? No. None of us have. But we all know about them and, in general, can formulate opinions of them.
And I must say that when I was applying to schools, I researched multiple, multiple schools - poured over curriculums, admission requirements, clinical hours, etc. Being who I am I made excel spreadsheets compiling all this information. And this was for NP, PA and medical programs. I have what I consider, a good sample size of schools to make a few generalizations.
I enjoy coming on this forum, as I am encouraged by NPs and NP students calling for the elevation of our profession through the raising of minimum requirements. There are 3 possible paths to essentially similar jobs - NP, PA and MD. We have the lowest requirements of these graduate programs. Poorly designed studies showing equivalence aside, why should we not want our providers to be the best? As msn10 alluded to, education has inherent value. Two or three more classes won't add much cost to a program, but the impact it will have on the profession and its place in the healthcare system would be profound.