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'm only in my senior year toward my BSN, but there are potentially some pathologies that can be picked up on better by physicians other than nurse practitioners. I could be wrong. Perhaps a PCP as the head of a clinic who is easily reached for consultation? But I do foresee FNPs being the new norm for primary care.
How is this a real thread? It's absolute lunacy to think that a NP or PA is equivalent to an MD. I am an ACNP student and have a previous bachelor's degree in a hard science prior to my BSN in which I took undergraduate anatomy and physiology. I know that NP education pales in comparison to medical school, so I opted to take the gross anatomy and physiology courses offered through the medical school. It was incredibly difficult and covered EVERYTHING. NPs, in general, don't even know how to speak the language of medicine and physicians recognize this right away. My ability to converse with physicians and PAs has completely changed after taking these courses. How one thinks they can practice medicine without knowing this information is beyond me. I don't think RNs and NPs understand just how much information they are never exposed to in school. My program has 7 clinical semesters and I plan on working every shift my preceptor does during that time frame. The 800 clinical hour requirement is appalling. I think there are some great NPs out there and some awful MDs. Absolutely. But to try and say that the average NP is better equipped than the average physician to practice medicine is insane. Go to NP school and be happy with the role you play after graduation. But recognize that on the whole NP education is lacking some crucial elements and, if so inclined, try and supplement your education to make yourself a better provider.
My program has 7 clinical semesters and I plan on working every shift my preceptor does during that time frame. The 800 clinical hour requirement is appalling.
How many hours have you done so far?
But to try and say that the average NP is better equipped than the average physician to practice medicine is insane.
I don't think anyone (perhaps save for the trollish folks) are trying to argue that NPs are "better equipped to practice medicine". There is a substantial amount of data on physician vs NP outcomes on a myraid of core measures that demonstrates comparable outcomes for both groups. Are there parts of medicine that aren't covered by those types of studies, absolutely, and these data can not be extrapolated to all of medicine, however, it certainly suggests that NPs are competent in their roles as providers.
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 am not sure how this is a good thing. One of the biggest "pro's" by many NP's was being a "cost effective option" to physicians to combat the rising costs of health care. If an NP gets paid the same as a physician, why bother hiring an NP?
I am not sure how this is a good thing. One of the biggest "pro's" by many NP's was being a "cost effective option" to physicians to combat the rising costs of health care. If an NP gets paid the same as a physician, why bother hiring an NP?
That means NPs are reimbursed from insurance at the same rate for doing the same job which I support and which in theory should increase our value and compensation however no worries because I'm sure the number of co-dependent NPs with zero business savvy will continue to accept horrible paying jobs. All while feeling self righteous because if they didn't personally do the prior authorizations, answer the phones or scrub the office floor it wouldn't get done and all their beloved patients would surely perish. Written only partially tongue in cheek.
At this point I have my first rotation arranged. It's surgery and the understanding the surgeon I'm with has is I will be in the OR with him whenever he's in the OR for the duration of the quarter (~10 weeks). And I agree with your statement. Generally, after a few years in practice, even students from subpar programs are quite capable and practice at an appropriate level. I just wish I didn't have to go out of my way as a student to take classes through a separate educational program to learn the practice of medicine. And I attend one of the more rigorous schools out there. I simply feel that there is not a single NP program out there that adequately prepares students with their minimum requirements. It is incumbent upon each student to seek out opportunities to raise the level of their education.
I simply feel that there is not a single NP program out there that adequately prepares students with their minimum requirements.
Prepared for what, entry to practice as a novice provider?
What is your statement based on? Published data? Professional experience as a provider? Professional experience as an educator? Opinions are fine but statements like this hurt the profession. Once you have finished your program and have been in practice, if you still feel this way, great, but until then you have to think about if you have the experience/expertise to be making this kind of statement.
That means NPs are reimbursed from insurance at the same rate for doing the same job which I support and which in theory should increase our value and compensation however no worries because I'm sure the number of co-dependent NPs with zero business savvy will continue to accept horrible paying jobs. All while feeling self righteous because if they didn't personally do the prior authorizations, answer the phones or scrub the office floor it wouldn't get done and all their beloved patients would surely perish. Written only partially tongue in cheek.
I am really on the fence about the "equal pay" issue, I can see a valid argument on both sides.
Prepared for what, entry to practice as a novice provider?
What is your statement based on? Published data? Professional experience as a provider? Professional experience as an educator? Opinions are fine but statements like this hurt the profession. Once you have finished your program and have been in practice, if you still feel this way, great, but until then you have to think about if you have the experience/expertise to be making this kind of statement.
NP educational programs hurt the profession. There's a reason so many people, working NPs included, feel this way. And, as a student experiencing the educational process for NPs at this very moment, I think I am more than qualified to comment on it. As I stated above, I felt strongly enough about it that I sought out additional educational opportunities. You are free to use biased, systematic reviews performed almost exclusively by nurses to prove your points, but any one who is experienced in evaluating research knows these studies are low quality. We all know that until a head to head, randomized controlled trial is performed, there's really no way to know if NPs provide EQUAL care to that of physicians. This study, of course, will never be performed as it is impossible in health care and probably unethical. I certainly feel that NPs should be proud of themselves. But the educational process is hurting the profession as a whole. Imagine. If we were to include graduate level anatomy, physiology and increase our clinical hours (something that many NPs and NP students are opining for) what would PAs and MDs have to say against us? Nothing. Rather than justifying our minimal educational requirements with fluffed up "research" we should increase our requirements and raise the quality of the profession. But, I'll check back here in 2 years when I'm done with my program and let you know if I regret taking these medical classes and putting in extra hours as they were just unnecessary in my practice.
NP educational programs hurt the profession. There's a reason so many people, working NPs included, feel this way. And, as a student experiencing the educational process for NPs at this very moment, I think I am more than qualified to comment on it.
What exactly about your experience, haven't not yet even begun clinical training yet alone had any actual clinical practice experience, makes you "more than qualified" to determine competent clinical practice?
One thing you need to keep in mind as your do your training is that the most dangerous providers are the ones that practice beyond their experience, knowledge, and training.
As I stated above, I felt strongly enough about it that I sought out additional educational opportunities.
Congratulations, graduate school (in every discipline) is about the self-directed work that you do.
You are free to use biased, systematic reviews performed almost exclusively by nurses to prove your points, but any one who is experienced in evaluating research knows these studies are low quality. We all know that until a head to head, randomized controlled trial is performed, there's really no way to know if NPs provide EQUAL care to that of physicians. This study, of course, will never be performed as it is impossible in health care and probably unethical.
What studies are you talking about? Please, cite them here. Now that you mention that they "will never be performed", example of landmark RCTs published in major peer-reviewed medical journals:
Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W. Y., Cleary, P. D., ... & Shelanski, M. L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. Jama, 283(1), 59-68.
Lenz, E. R., Mundinger, M. O. N., Kane, R. L., Hopkins, S. C., & Lin, S. X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up. Medical Care Research and Review, 61(3), 332-351.
the educational process is hurting the profession as a whole. Imagine. If we were to include graduate level anatomy, physiology and increase our clinical hours (something that many NPs and NP students are opining for) what would PAs and MDs have to say against us? Nothing.
Why not make NP school longer than medical school with a 15 year residency program at the end? You wouldn't mind spending another few hundred thousand and working for basically free for 15 years would you? Especially when there is no evidence that outcomes would be any better. What would you use as your rationale to justify that additional cost and time?
NP education has it problems and we (practicing NPs and educators) need to tackle them, in my opinion, but there truly isn't any evidence right now to support it.
I wouldnt mind leaving the primary care to nurse practitioners. at least the HTN, basic thyroid issues, diabetes, sinus congestion, bronchitis and all the commonalities really dont take much thought to manage in MOST cases. Please, have at it. The complex stuff can be referred out to specialists. As long as people know the red flags to watch out for then yeah 11 years of post secondary education is overkill for lots of stuff. But NP school is/was too easy and still needs to be a little bit harder, esp if people are opting for independant practice.
I do not see a shortage coming in primary care patients so yeah why not let NPs be the first line of defense.
But in regards to education quality in and of it self med school is much better than NP school and attracts a different crowd.
Khaan
58 Posts
I'm only in my senior year toward my BSN, but there are potentially some pathologies that can be picked up on better by physicians other than nurse practitioners. I could be wrong. Perhaps a PCP as the head of a clinic who is easily reached for consultation? But I do foresee FNPs being the new norm for primary care.