The Decline of Physicians: Do we really need them anymore in Primary Care?

Specialties NP

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Legislature Votes to Make NP Payment Parity Law Permanent - Nurse Practitioners of Oregon

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?

Specializes in Adult Internal Medicine.
On the job training like everyhting is the most important. Lengt of education doesnt matter. Studies shown np are supeiror if not equal providers compared to md. Np education is more efficient than md education which wastes a tremendous amount of time and money.

I do appreciate your enthusiasm, but I am going to give you some unsolicited advice that you may not like: put your passion about this on hold for a few years (or dial it back a bit) focus on your preparation and then your practice and role transition. These issues are important but you have more important things right now to focus on.

Physicians have a very important role to play, but I think their services are better utilized in acute care and in specialties.

So you'll see your NP for your routine stuff, your minor illnesses and to manage the common chronic illnesses. When your NP sees something that s/he can't handle, then you'll be referred to a specialist who will be a physician, or at least work with a physician.

I think this is the best way to give everyone the best care and use resources most efficiently, my opinion is not about bashing physicians or inflating NPs.

I strongly disagree with this. Physicians have a very important role to play in primary care, not just acute care and specialties, and this will always be true. NP's and PA's simply don't have the education and training to provide the same high level of medical care that physicians are trained to provide. Now; if your point is that by using NP's primarily in primary care everyone gets some health care because it is cheaper and quicker to train a NP, and because their salaries are less than a physician's, and there are more of them to go round; then yes, I see your point, but people deserve to receive expert medical care from a medical doctor; the difference in education and training between a physician and NP/PA is vast, and a physician's medical knowledge and medical expertise is incomparably greater.

Good news - there are now more primary care physicians in training, and hopefully this trend will continue and there will be more physician "resources" available, so that more people can have primary care physicians if they so wish.

I live in a state that does not allow nurse practitioners to practice independently and that has strong physician opposition to independent NP practice, and I am glad I do so. Admittedly, I am fortunate to live in an area where physicians want to practice.

Specializes in Adult Internal Medicine.
NP's and PA's simply don't have the education and training to provide the same high level of medical care that physicians are trained to provide.

Based on what? Your professional expertise? Your preconceived belief? Your opinion? Just because?

Specializes in Medical Surgical.

I am not trying to NP bash because I eventually may become one, but my son ended up in the hospital with asthma related complications due to the recommendations of an NP. I have had great experiences with NP'sbut sometimes it is evident to me that the knowledge base is not on the same level as an MD in regards to their training in practicing medicine. I agree with the idea of the NP but I think it is too easy to become one and there needs to be stricter requirements.

To protect their profession from becoming over-saturated and easy for anyone to get into, unlike Nurse Practitioners have.

Law schools have not had the discipline that medical schools have shown. The quality of law school applicant, with the exception of top tier schools like Stanford, Duke, Harvard etc. has fallen off dramatically. The market saturation of attorneys has put off those individuals that are able to make handsome incomes in other fields (and are attractive law school candidates). They look elsewhere for lucrative careers, leaving law schools with those individuals that would have not been accepted being reluctantly admitted.

The physician quality should remain high for the foreseeable future and will be the standard against which APN's are compared. That's good and bad. It will keep the bar high for NP's but it will also mean that the glut of lower quality practitioner in advanced practice will soil the credibility of those that truly belong where they are.

Like law, all this will equalize in the end.

Well why do we even need MD's at all anymore? Why not just close down all the med schools and just have all NP's? If NP education is equivalent why do we need doctors at all??????

Exactly! I think every NP should be required to audit medical school classes. There is absolutely no way NP education is equivalent to medical school education. If that's what people think, then they are just fooling themselves. I know for my BSN I only had to learn 1/3 of the bones and muscles. Medical school you learn all of them. How can you diagnose and treat the human body and you don't fully understand A&P?

Specializes in Adult Internal Medicine.
I know for my BSN I only had to learn 1/3 of the bones and muscles.

Ask for your money back. I took a refresher A&P course before grad school at a cheap local community college and we were tested out on all of the bones and boney landmarks and every muscle and insertion and origin.

I think you're dreaming. Take a reality check and research the differences in physician education and training and NP/PA education and training. Compare four years of medical school, residency, internship, fellowships, physician clinical hours, with NP/PA education/training.

General family practice physicians will complete 4 yrs of medical school then a 2 yr residency program. They do not usually touch a patient until their 4th year of med school.

A fellowship is not necessary for the family physician as fellowships will lead to specialization. That being said, some GPs do go through fellowships. Most of the GPs I've worked with began right after residency. I am not disputing the difference between med school and NP education here, for the record. I am simply pointing out that family practice physicians may have the bare minimum in education, same as FNP, before entering the paid workforce. FNP clinical rotations focus on primary care, not every specialty like medical residency. The clinical hours vary depending on the program, but typically require 500-1000 hours (mine was 750) or minimum 12 weeks, max 25 weeks in family practice.

that is really too bad. Your BSN institution did you a disservice. When I entered into NP education my advanced A&P and physical assessment courses contained a mix of NP and med students...in other words, NP students took the same course as a med student. I also took Biochem...not on your everyday NP curriculum. The only think I did not do was gross anatomy. This was on top of what I had already accomplished in my BSN program, plus I had the advantage of having touched a patient (unlike med students). I feel I have an exceptional understanding of anatomy, physiology, physical assessment, pharm, and differential diagnosis. Add to that the 15 years of critical care in cardiology, and my 5 years as an acute care NP and I can run circles around many physicians. Please do not underestimate the education of nurses everywhere based on your personal experience. Sounds like you got a raw deal, indeed, from my perspective.

Specializes in Family Nurse Practitioner.
Add to that the 15 years of critical care in cardiology, and my 5 years as an acute care NP and I can run circles around many physicians. Please do not underestimate the education of nurses everywhere based on your personal experience. .

You are the rare "whole package" and although your formal NP education sounds thorough compared to most programs what sticks out to me the most is your extensive RN experience. Imvho that is likely what makes you stand out as a proficient clinician despite our limited clinical hours which I will continue to assert is inadequate in light of the growing trend of admitting and graduating NPs with zero nursing experience.

My A&P class had us responsible for every bone. It was a cool class we had the exam with all these bones in different stations with numbered areas and we went from station to station filling out our blank sheets. I cannot remember hardly any of them but neither can my MD colleagues and truth be known - it does not matter! We can look it up!

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