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?
What is the difference between residency and collaborative practice with a physician? It seems to me to be very similar. Both Docs and NPs learn a LOT on the job in the first few years.
Too many people discount on the job experience. Who knows more: an NP practicing for ten years who keeps up on all the latest medical journals or a brand new, out of residency MD in the same speciality? Doesn't that NP have thousands upon thousands more hours on the job?
What is the difference between residency and collaborative practice with a physician? It seems to me to be very similar. Both Docs and NPs learn a LOT on the job in the first few years.
I wish NPs were still required to have experience before being given prescribing rights that is no longer the case and more the exception than the rule in today's climate. Residencies are a requirement to become a physician and are not paid at a physician rate. Prospective employers have the right to anticipate that a new grad provider is able to actually function in the role they are licensed to do without handholding, a parade or lengthy orientation, imo.
Yeah but some NP programs dont teach NPs how to practice correctly in the first place so that 10 years might be of god awful level of care.
There isnt much, um, uniformity in NP education. I think we all know that though
I think if you're god awful you won't last that long.
The reality for NP's though is on the job training is crucial because as you said, there isn't a lot of uniformity. I don't really fault the programs themselves since so much of NP education is dependent on the individual preceptors and not the actual school. Even within a single program one student might have the very best clinical experience, and another might not have been stuck with a preceptor that didn't teach them a thing. I went to a state school that was hybrid in person/online and shared my clinical sites with students from Duke, Georgetown, and Walden. Every student did fine, and we all got awesome clinical experiences. We all also knew some classmates in each of our respective programs that were having a rough go of it in their clinicals. Anecdotal to be sure, but it highlights how much different the clinical experiences can be across and within a variety of schools.
When you consider many states require a minimum of just 400-500 hours of school clinical to start practicing as an NP, it's no wonder why on the job training plays such a crucial role.
When you consider many states require a minimum of just 400-500 hours of school clinical to start practicing as an NP, it's no wonder why on the job training plays such a crucial role.
I don't understand why we are ok with this. Why should a licensed professional not be expected to be ready to work in their field with only a minimal facility specific orientation? Employers in my area are getting fed up with NPs and are leaning more toward PAs at two hospitals where I work and I have heard this is the case at a third. The two reasons I have been given are that new grad NPs are not ready for practice and weak NPs expect premium wages. Now I'm all for us asking for premium wages so I ignored that second comment although it would be nice if our peers knew what the heck they were doing so as to not make us look like a profession of boobs.
I don't understand why we are ok with this. Why should a licensed professional not be expected to be ready to work in their field with only a minimal facility specific orientation? Employers in my area are getting fed up with NPs and are leaning more toward PAs at two hospitals where I work and I have heard this is the case at a third. The two reasons I have been given are that new grad NPs are not ready for practice and weak NPs expect premium wages. Now I'm all for us asking for premium wages so I ignored that second comment although it would be nice if our peers knew what the heck they were doing so as to not make us look like a profession of boobs.
My area has the opposite problem where NPs outside of the surgical arena are much more sought after. Although that's anecdotal and means diddly squat.
Have you ever worked with interns or residents? It can be downright painful and they are by no means ready to hit the ground either, even with their extensive education by comparison.
The very nature of the medical field is one where on the job experience is always going to trump even the very best clinical experiences. It doesn't matter if you're an NP, an RN, a PA, or a physician.
If the market thought we were incompetent or unsafe, or our outcomes were significantly inferior, our minimum education hours would go up, our unemployment rate would go up, and our wages would go down. Despite all the doom and gloom from people here crapping on NP quality, none of those things have happened yet.
Anecdotes in an online forum where I would imagine more people are apt to complain than they are to celebrate will make anyone think the profession is crashing. I remember when I was studying for my boards this place made me think everyone was failing their exam even though I knew over 85% pass. Again, more people want to chat about negatives than positives.
Have you ever worked with interns or residents? It can be downright painful and they are by no means ready to hit the ground either, even with their extensive education by comparison. .
Of course I have but the fact is they aren't hitting the ground running, they aren't getting paid physician wages they are still in school.
I hear what you say about the doom and gloom but this trend of admitting anyone with a checkbook and a pulse is relatively new so I don't think anyone can speculate with certainty how it will play out. I only know what I see anecdotally as an inpatient attending admitting outside provider's patients who have decompensated so my perspective is somewhat skewed but when I repeatedly see the same NP names as the provider of unstable patients with questionable prescribing it is embarrassing at the very least and concerning for our future at the very worst.
Of course I have but the fact is they aren't hitting the ground running, they aren't getting paid physician wages they are still in school.
I hear what you say about the doom and gloom but this trend of admitting anyone with a checkbook and a pulse is relatively new so I don't think anyone can speculate with certainty how it will play out. I only know what I see anecdotally as an inpatient attending admitting outside provider's patients who have decompensated so my perspective is somewhat skewed but when I repeatedly see the same NP names as the provider of unstable patients with questionable prescribing it is embarrassing at the very least and concerning for our future at the very worst.
I totally get what you are saying, especially the part about admitting anyone with a pulse and a checkbook. I'm thankful that at least in my area the for profits don't seem too popular and the 2 NP programs in my area are public universities that are very selective.
What I really want to know is how many NPs are hitting the market today, and how many are coming from for profit, no campus programs. I would still wager that it's not very many compared to the total grads from more traditional schools (brick and mortar or online).
What I really want to know is how many NPs are hitting the market today, and how many are coming from for profit, no campus programs. I would still wager that it's not very many compared to the total grads from more traditional schools (brick and mortar or online).
Excellent query and I'd love to know these figures. I'd bet they are very high. In my state there are only 2 brick and mortar psych NP programs and they do not require any psych experience which, imo, is a huge concern. The students who graduate from these programs seem to either be very competent or horrible and anecdotally the ones with no psych experience are generally in the latter category.
I think much of it is about nursing refusing to self regulate and instead feeling that things like having the masses and credentials that sound like Doctor actually bring about validity. The term "a seat at the table" is one I often hear that sounds rather pathetic imo although I have to say the strategy does seem to be effective as nurses are an extremely powerful lobby.
I'm not sure what the future will bring and am thankful that I'm heading into the last decade of my career rather than the first but overall, so's as I don't sound too doom and gloom :) I have loved being a psych RN and NP. It has been a great career and experience however I'm just a little prickly when it seems the lack of psych providers justifies graduating anyone with a checkbook and a pulse in droves which absolutely will result in crappy care for this vulnerable population.
Have you ever worked with interns or residents? It can be downright painful and they are by no means ready to hit the ground either, even with their extensive education by comparison.
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If i had a dollar for every time I had to stop a resident from causing harm I would not be working full time. Especially military residents - they are so damn scary it amazes me there are not more reported deaths as they get turned loose with very minimal supervision...
I have yet to find an NP or PA hit the ground running. I have seen several who thought they could and seen the consequences of their hubris. If I had to pick I would take the timid newbie who was eager to learn over the overconfident one who never asked questions. Heck, when I started I know I asked too many questions and second guessed everything I did. I imagine there were more than a few eye rolls from the physicians I worked with. Even these days I ask or answer something and I get the look like I should know the answer already but sometimes just asking the question out loud helps you work through the problem and their answer is confirmation.
Newbies do not deserve the big payday when they have zero provider experience. Work a year and prove yourself then ask for wha you deserve.
I think jules said it in another post but yeah when im done and your rich and retired you can loan me the money to open up a practice then we can go in business together lol!
We will soon start seeing a drop off in quality care provided by NPs. I mean, already most i know do not know when to refer stuff out or even more commonly do it too soon. Order too many tests, etc. With these online programs jeez I dont even know how they learn. And so many graduates think they know it all when they get done because their instructors pump them full of NP=MD mantra.
I think jules said it in another post but yeah when im done and your rich and retired you can loan me the money to open up a practice then we can go in business together lol!
We will soon start seeing a drop off in quality care provided by NPs. I mean, already most i know do not know when to refer stuff out or even more commonly do it too soon. Order too many tests, etc. With these online programs jeez I dont even know how they learn. And so many graduates think they know it all when they get done because their instructors pump them full of NP=MD mantra.
One thing I see on this website is an outpouring of doom and gloom regarding our ever pending drop in quality because of online for profit universities, and to be honest, there really isn't a shred of evidence to back it up. To date most research comparing us head to head with physician's, particularly in primary care has us on par in terms of quality, outcomes, and in many cases, better satisfaction.
I personally dislike for-profit, online universities as a whole, (just like many of you) but we are also a scholarly discipline, and to see so many individuals here using anecdotes to justify their beliefs without a shred of research evidence is disappointing.
The quality of online education as a whole isn't really much different from a traditional educational experience, and it's why you're seeing some of the best medical schools in the country like Stanford and Johns Hopkins offer preclinical classes in their medical schools online.
I have no doubt if we start seeing the majority of NP graduates coming from for profit schools with no real clinical evaluation that quality will dip, but of the 20k NP graduates in 2014-2015, the number coming from online for profits is likely statistically small. On top of that, if graduates from these schools really are that bad, we will start seeing the market black ball them across the country, or the certifying agencies and states will stop recognizing the schools when it comes time to be boarded.
googs
48 Posts
I have some input here:
What is the difference between residency and collaborative practice with a physician? It seems to me to be very similar. Both Docs and NPs learn a LOT on the job in the first few years.
Too many people discount on the job experience. Who knows more: an NP practicing for ten years who keeps up on all the latest medical journals or a brand new, out of residency MD in the same speciality? Doesn't that NP have thousands upon thousands more hours on the job?