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?
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..
All anecdotal, I agree 100%, but things are drastically changed from the studies you reference and I do not believe, again anecdotal, that NP outcomes or employer satisfaction will fare as well over the next decade. To be perfectly honest I have more concerns about the current policy at schools, like Hopkins, who are encouraging undergraduates to get their APRN with zero requirement for RN experience, as I am about the online schools. Again no data to back up my concerns or assertions I'm simply adding them for discussion based on what I'm personally seeing in my area working at several hospitals.
Do we really want things to decompensate to the extreme that patients have suffered so greatly the certifying agencies will really give a hoot and do something to ameliorate future malpractice?
Do we really want things to decompensate to the extreme that patients have suffered so greatly the certifying agencies will really give a hoot and do something to ameliorate future malpractice?
Of course not, but then again, we also have no proof that things are actually deteriorating that much in the first place. Especially when the logic most seem to be using is that an online education is significantly inferior to a brick and mortar education, when the reality is that there isn't proof of a significant difference after nearly 20 years of online education. If such were the case, all disciplines, not just nursing, would be pulling the plug on online degrees.
The larger concern for me is when these schools offer no supervision to what their students are doing in their clinicals, offer no real way to verify student clinical hours, and offer no formal skills training. That's scarier to me than the delivery method of a pathophysiology course.
internet or distance education itself is fine, but many of these schools dont have proctored tests. some do via testing centers or webcam monitoring but many do not. How can you evaluate somebody if they are not tested on it? Writing papers? Not really, you can simply paraphrase everything you read on the internets.
I mean the only time i show up in lecture hall is on test days so thats distance learning for med school right?
Not to mention 800 clinical hours. I mean does anybody really see everything they need to see and know exactly what to refer out when they graduate? No, they dont. NPs need residencies so they gain more credibility, thus higher salary, and employers dont have to worry about training them. People shouldnt have to learn basic stuff on the job, like, you know, on real patients. Thats supposed to be what schooling is for. Where are the studies comparing new NP vs new physician at?
Here are one of the studies that points the deficiencies at many current NP institutions
Of course with time and self study this gap can be closed but in many times it is not. These nursing people who do these studies know to pick the best of the best when comparing to physicians. On average, Toe to toe in a diagnosis royal, i think anybody with common sense knows the physician will come out on top.
Does anybody really think they are ready to practice after 500-1000 clinical hours and a basic level patho course along with a basic pharm and a few adult/child diagnosis classes????? Plus if you want to advocate for independence you have to be back it up with proper education (which some schools provide much better than others)
Half the states in our country already offer independent practice to NPs. If our care was so inferior, this would not be the case. The medical lobby has far more resources and money to try and prevent NPs from practicing independently than the nursing lobby has, and each year more and more states authorize independent practice because the data supports it.
Your article is just comparing raw numbers of total education without any insight into clinical competence or outcomes. It also fails to mention how most (not all) NPs have extensive clinical experience (thousands of hours) before they go back and get their masters. You also offer no proof that these research articles are being biased in their selection.
Im also not really sure the examination methods of a program really mean that much long term. I'd rather attend a school based on their clinical requirements, on campus requirements, and their board success rate versus whether students are required to test in front of a webcam. Especially when more and more data coming out on rigorous testing in general isn't that favorable.
It also fails to mention how most (not all) NPs have extensive clinical experience (thousands of hours) before they go back and get their masters.
I would like to see some actual documentation that "most" new graduate NPs have "extensive clinical experience," now that the direct-entry programs for non-nurses are so prevalent and so many people are going on to grad school as new (or relatively new) grads. I'm not saying I'm sure it's not true; just that I have no confidence that it still is true.
I would like to see some actual documentation that "most" new graduate NPs have "extensive clinical experience," now that the direct-entry programs for non-nurses are so prevalent and so many people are going on to grad school as new (or relatively new) grads. I'm not saying I'm sure it's not true; just that I have no confidence that it still is true.
Are direct entry programs in the majority or even all that common? I honestly don't know of any in my region or state (Texas). All the programs in my area specify at least a year of experience before applying and they recommend 2 years.
I spent an hour probing for these studies, they are all out dated. Which they were probably not wrong back in the day before standards dive bombed.
But it takes an inherent belief that nurses are intellectually superior to physicians and that their training is better to believe they are able to do the exact same thing in 1/8th the time.
The fact that nursing is much less rigorous, less lengthy, admissions standards are not even close to that to medical school and residency, their clinical experiences in many cases is not nearly as guided, shows it is nearly impossible to have the same quality at or near graduation as an FM physician.
Rigorous testing is not perfect, but much better than online discussion posts and paper writing.
Nursing exp is useful but a residency should be required.
What would you say if i said med school graduates should be able to do family medicine without residency? Many of them have spent more hours in clinicals than probably many new NPs have their entire lives (6k hours), since many NPS rush straight through to their NP
Are direct entry programs in the majority or even all that common? I honestly don't know of any in my region or state (Texas). All the programs in my area specify at least a year of experience before applying and they recommend 2 years.
I'm in between 2 large metropolitan areas with a bazillion universities and although this won't satisfy anyone's need for hard data anecdotally the RNs I know at the 4 hospitals where I have privileges now are 87% in online schools with zero requirements for RN or specialty experience. In fact 2 are going to a school where the 3.0 gpa will be waived with a letter of explanation and there are no actual admission dates so new admits can start taking classes whenever the next semester starts. N=15 so not a huge number compared to the total who I'm sure are pursuing their NP in this area but enough to alarm me. Our wages are already tanking and in psych we have wiggle room but what about the short sighted FNPs already working for $50 an hour?
Solid anatomy class, physiology class, basic cell bio/genetics, pathology class, then system based review.
physical exam class and a standalone pharm class with pharm integrated into the above
1500 clinical hours
1 year fam medicine residency paid at 45k/year with fam med residents.
2 years in the class with last year also in clinicals
then off to residency
Proctored exams, in house physical exam tests.
In 3 years you would have a great primary care provider with the above curricula. Takes out some of the wasted effort in med school and beefs up the standards of NP programs
Honestly that would be optimal for primary care. One year experience as a nurse prior to entering.
Solid anatomy class, physiology class, basic cell bio/genetics, pathology class, then system based review.
physical exam class and a standalone pharm class with pharm integrated into the above
1500 clinical hours
1 year fam medicine residency paid at 45k/year with fam med residents.
2 years in the class with last year also in clinicals
then off to residency
Proctored exams, in house physical exam tests.
In 3 years you would have a great primary care provider with the above curricula. Takes out some of the wasted effort in med school and beefs up the standards of NP programs
Honestly that would be optimal for primary care. One year experience as a nurse prior to entering.
Where is your proof that all of that is actually necessary? If anything, NP's are proof in primary care that significantly longer time spent in school doesn't necessarily equate to better patient outcomes or care. You yourself just posted in another thread blasting the worth of a degree and touting how people without degrees can be just as successful. Not really sure what you want...more school or less. Seems to depend on the thread.
An article published this week discusses how states with free practice authority have more NP's working in rural and underserved areas, decreased hospitalizations, and better overall health outcomes.
I'm not saying NP education is perfect, and we all know the variety and quality of education shifts from school to school, but what we do know is that in terms of primary care, NP's are doing a solid job with as you pointed out, less education.
Never said less education is better, just that people without degrees can be ultra successful, even though most that do not have them are not. You are correct in saying that you can learn everything you need for primary care via an NP education at its current tone, and extra reading. But many people wont do that extra reading. The near guarantee via the physician route is they will not let people through an american medical school and residency without the set of knowledge to manage a PCP practice without help. Whether or not people choose to do what is best for the patient is up to them, but in there minds, somewhere in the past, they were taught what they need to know, even the worst in the class that barely scrape by with 70s.
NP education does not give that guarantee, it doesnt stop people from excelling on their own time, and some schools might give that guarantee, but not all do. Some programs graduate downright dangerous graduates that cant even do physical exams and dont even know which medicines are part of which CYP450 enzyme class.
To think that the current standardized NP curriculum is adequate is complete ignorance. Of course patients in BFE are going to have better outcomes, its either see any NP or not care at all, so basically anything would improve outcomes.
You may be one of those NP who went above and beyond to learn what needed to be learned, if so then your an awesome person for looking out for patients, but there are those who are not, and I have worked with them, its embarrassing. Even the good schools have lowered their admissions standards at many places recently, taking pretty much everybody that applies, while lowering clinical rotation control, thus making those 700 hours worth even less. Unless all NPs can handle everything, on their own, day one, as a family med trained physician should be able to, then it is not universally adequate.
Can all NPs day one out of school -
read EKGs well enough to determine all the variable heart blocks, and abnormal findings of genetic disorders (the rest should be basic)
suture everything that has not gone through muscle/tendon/ligaments
drain all types of superficial abscesses
manage HTN from stage 1 all the way to complex multimedicine combinations without their patient passing out over 5 minutes
read all plain film X rays without need of radiology
complex rheumatic workups
correctly diagnose headaches without throwing a ct at everybody
manage children with various genetic disorders, what they are at risk for, etc
apply splints to and know the time frame for referral for all types of tendon lacerations and fractures and which ones need ER care
know each bug that causes diarrhea and the exact workup for each with proper time frames
understand the results that radiologists provide for all sorts of ct/mri/NM/US, and know when to refer to a surgeon
manage all sorts of skin issues without making the patient wait months for a derm appointment.
Pretty much all FM residencies at this time have those as requires before you can graduate, in order to cut back on referrals, some docs probably jump the gun, but they know what they should do.
I doubt that many NP day one can do all that, especially nowadays. Maybe back 10 years ago when standards were in place, but these online places sure aint gonna set you up in a clinical site that throws all that experience at you in 800 or so hours.
Its really scary people think they know it all day one after NP school. Goodness its like the laborers who make fun of engineers, mostly because they are jealous they make more money...
I am not even anti-NP, yet I can at least see reason.
Need more parameters than just BP and HLD to determine quality of care. At least recent studies. They will never be able to perform a study that is purely NP vs MD with no allowed consultations though since that would be dangerous to the patient in some aspects. I have seen a few that say "little consultation between NP and MD in these patients occurred." How much proof/help is that statement lol!
Its gonna be a sad day for patients when walden and kaplan grads work in solo rural health centers and these poor patients trust them with their lives.
Just to add some icing, by your logic, if I dropped out of school now and went back to work as an NP, my ability to provide patient care would be better than if I decided to do family medicine. I mean dang I better just quit studying and attending class/clinicals, my ability to perform is just going to go down hill in medical school :):):):)
Jules A, MSN
8,864 Posts
All anecdotal, I agree 100%, but things are drastically changed from the studies you reference and I do not believe, again anecdotal, that NP outcomes or employer satisfaction will fare as well over the next decade. To be perfectly honest I have more concerns about the current policy at schools, like Hopkins, who are encouraging undergraduates to get their APRN with zero requirement for RN experience, as I am about the online schools. Again no data to back up my concerns or assertions I'm simply adding them for discussion based on what I'm personally seeing in my area working at several hospitals.
Do we really want things to decompensate to the extreme that patients have suffered so greatly the certifying agencies will really give a hoot and do something to ameliorate future malpractice?