Why your local physician group is wary of hiring a new graduate nurse practitioner

[chillnurse, BSN, RN, NP]

Why your local physician group is wary of hiring a new nurse practitioner

Many physicians are wary about hiring new graduate nurse practitioners into their practice, and I believe they have every right to think this way. The standards required of becoming a nurse practitioner are significantly lower than that required of a physician. This is not to stay that having the title MD or DO behind your name automatically constitutes a person being an intellectual genius, but overall physicians are much more thoroughly educated than nurse practitioners.

Topics to be discussed here will include; entry into programs, difficulty of curricula, length of program, and type of people who go into the programs.

Entry into the program

Medical school requires a much stricter set of standards than most nurse practitioner schools. Medical school has its own standardized test (MCAT) required for entry. Nurse practitioner programs simply require the GRE in most cases. Nearly all medical schools require a competitive MCAT score for entry also, unlike many NP programs which will literally take any GRE score above what seems the 25^th percentile.

Difficulty of programs

Contrary to popular belief in the nurse community, medical school is much more difficult than nursing school. It may seem that nursing and medical students study about the same amount of time, but other variables must be considered. Medical students are often much more efficient than nursing students at retaining information. They often have more years of school under their belts, are more well versed in memorizing college material, and have better study habits. This is not always true, but I would bet a high dollar on this assumption. The same is also true of nurse practitioner programs. While some will debate this, the honest fact is that a completely online program with no set of written tests will not be as difficult as a completely brick and mortar medical program. Lack of written tests equates to lack of knowledge..... directly. Writing papers on nursing policy does not constitute difficulty and does not translate into better practice outcomes and clinical decision making.

Length of program

This cannot be debated. A minimum of 7 years of training vs 12-36 months (many of the programs being part time)? Who is going to be better trained? If you answer anything besides the MD, you are just plain wrong and need to reevaluate your math skills. The first debate somebody will throw at this argument is "I have been a top- level, elite trauma nurse for 20 years and know everything there is." Your right, you do know everything, ABOUT NURSING, NOT MEDICINE. I am not stating that all nursing experience is worthless, but 20 years of nursing does not equate to 20 years of practicing medicine or as a nurse practitioner. Being in the same environment doesn't count. That's like saying being a custodian wiping up the mess after a trauma scene is the same thing as performing a thoracotomy on an acutely unstable patient.

Different type of student

This one will be difficult to explain, since there are people from many walks of life that go into both professions. But in an overwhelming majority of cases, these facts and figures stand true. Medical students are often much more dedicated to the sciences than the average nursing student. Many nursing students are reaching for a secondary career and have a less than steady academic background than the average medical student. There are some second career physicians out there, but overall, not the same amount as in the nursing field. The trend does seem to be changing though with more young nurses entering the field at a younger age, thus making nursing their primary career at an early age. Quite frankly the single mom who has worked at the grocery store for 10 years and who decides to go back to be a nurse is often in a different situation than the 23 year old who has been taking 12 credit hours of science classes for the past 4 years of college.

Disclaimer

If the most you get out of this article is that medical students are geniuses and that nurses and nursing students are dumb, you have greatly missed the point. This being my disclaimer, not all of these figures stated above will be correct 100% of the time. Simple observation regarding the differences between nurses/nursing students and physicians/medical students should be enough to understand these differences though. Much of the blame is to be put on the accrediting agencies, who as I have stated in a previous post basically throw licenses in crackerjack boxes, to be earned without significant effort, testing, or any check regarding ability of the individual. Sadly, it is the same group of so-called elitist nurses who continually debate for unrestricted practice for all APRNs. No wonder nursing has a poor reputation in light of medicine. Until the standards are raised and equality (or at least near-equality) is promoted across all programs, the average APRN will not be equal to the average physician.

[Dranger]

Voice of reason! Hallelujah!

[carachel2]

Exactly what I've been saying for years!

[myelin]

Until nursing starts valuing NP education/strong clinical training over RN experience, this problem will never go away. I have read countless posts on this site about how you don't learn anything in school, everything comes from experience (specifically, RN experience), yada yada yada. While of course experience matters, so does schooling.

[Jane Eyre]

Hi all,

I have been following this APRN forum for about the past 6 months but this is my first post because I couldn’t stand to see this thread go unopposed. It’s wrong on so many levels. I'll just mentioned a couple biggies.

First, please stop comparing APRNs to doctors. We’re not trying to become doctors or Jr. doctors. We’re a totally different profession, right? Of course we’re different. Accountants are different from financial analysts, although they may overlap in some areas. Different professions, different training.

Second, all these problems discussed above are “input” problems. That’s the wrong focus, a red herring. You need to look at outcomes. Are NP outcomes inferior to MD outcomes. The evidence says ‘No’. Do patients who see NPs have poorer outcomes that those care for by doctors? Nope. Are there more malpractice suits in states where NPs can work independently from doctors? Nope. What the biggest difference between the two as far as outcomes? Patients tend to like their NPs better :). These are facts, not just my own personal opinion.

Lastly, although the OP(chillnurse) is an NP, Dranger is a med student (mentions in another post about taking the MCAT) and carachel2 has mentioned before about rather seeing an doctor than an NP if he/she had to see a new provider. I have been reading! So, your responses come as no big surprise but let’s try to go by what the evidence says regarding NPs vs. doctors. A primary care doctor who goes by what the research says should have no qualms about hiring a new grad NP.

Thanks!

[zmansc, ASN, RN]

Jane, your right on all those accounts. I have seen this recently where one person's anecdotal experience is then blown up as if it's evidence of a systemic issue. The fact in my town is that both experienced NPs and inexperienced NPs are very valued members of the provider community and the clinics are hiring more and more NPs both in primary care and into specialty practices. Inexperienced as in new grads, so I would say that I'm not seeing this phenomenon occur.

I think we would be much better served to discuss issues with how we can provide a unified front on improving the states that allow NPs to practice to the full extent of their education and training than to continue to degrade our profession and it's educational system.

[traumaRUs, MSN, APRN]

Agree with both Jane and zmansc - better to form a united front.

I've been an APN 8 years and have NEVER seen this attitude either and I am very active in my states APN organization and never hear of this - new grads as well as experienced APNs can and do get jobs.

I'm employed at a large (17+ MDs) specialty practice. Our practice employs PAs and APNs and our physicians are very respectful, confident and enjoy working with all of us.

[BostonFNP, APRN]

So OP, explain to us why NP outcomes are the same as MD outcomes, given the obviously superior education? Have you read the research? Or are you just writing and advice article about some personal beliefs?

Most physician groups love hiring NPs; they understand NPs generate revenue, provide quality outcomes, and have a reduced cost to the practice and the system.

The real story is why the local IPA doesn't want to allow NPs to have their own practice....

[scarykarrey]

What on earth does this actually have to do with being a nurse practitioner, besides purporting to be an "article" on why doctors think NPs are subpar providers? How is this actually even topical here?

[Gentleman_nurse, MSN]

Chill Nurse I respect you opinions but have to rebut some of your assertions

Contrary to popular belief in the nurse community, medical school is much more difficult than nursing school.

It is but it’s not because the content of medical school requires extremely high levels of intelligence. It’s because the environment is inefficient for learning in the first two years.

It may seem that nursing and medical students study about the same amount of time, but other variables must be considered. Medical students are often much more efficient than nursing students at retaining information.

I think that's an elitist assumption but I’ll let it go.

They often have more years of school under their belts, are more well versed in memorizing college material, and have better study habits.

Taking what amounts to 30-35 credits semester. You better be good at memorizing.

Iof nurse practitioner programs. While some will debate this, the honest fact is that a completely online program with no set of written tests will not be as difficult as a completely brick and mortar medical program.

This is false. The platform the instruction is delivered is irrelevant. The effectiveness of instruction is based on curriculum design & development.

Lack of written tests equates to lack of knowledge….. directly. Writing papers on nursing policy does not constitute difficulty and does not translate into better practice outcomes and clinical decision making.

Again that is false. Actually best practices in education state the opposite. Instructor centered lectures with multiple choice assessments are the least effective way to teach critical thinking. Rote information yes, but not thinking skills. Look up Bloom Taxonomy.

I hope to hear back from you Chillnurse. You seem to care deeply about the nursing profession.

[zenman]

Why your local physician group is wary of hiring a new nurse practitioner

Many physicians are wary about hiring new graduate nurse practitioners into their practice, and I believe they have every right to think this way. The standards required of becoming a nurse practitioner are significantly lower than that required of a physician. This is not to stay that having the title MD or DO behind your name automatically constitutes a person being an intellectual genius, but overall physicians are much more thoroughly educated than nurse practitioners.

Topics to be discussed here will include; entry into programs, difficulty of curricula, length of program, and type of people who go into the programs.

Who told you this? Where are your sources because every physician group I know of like NPs. You’re also talking about new grads. What about experienced grad? Physicians are supposed to be more thoroughly educated than NPs so why are you trying to make a comparison? I really don’t understand your lack of comprehension on a subject before you start posting drivel. Yes, even going through medical school doesn’t mean you have any clinical knowledge; it means you know how to memorize and take tests. I worked with one physician so bad I almost wrote her medical school to ask why they unleashed such an a person with no common sense on the public.

Entry into the program

Medical school requires a much stricter set of standards than most nurse practitioner schools. Medical school has its own standardized test (MCAT) required for entry. Nurse practitioner programs simply require the GRE in most cases. Nearly all medical schools require a competitive MCAT score for entry also, unlike many NP programs which will literally take any GRE score above what seems the 25^th percentile.

“Medical school requires a much stricter set of standards than most nurse practitioner schools. Actually it’s not “most” but “all.” Anyone knows that; why don’t you? If you know anything about education and testing you’d realize admission testing basically exists to keep a few people in jobs. Heck, they even said this recently on Fox news. So, basically your post so far is null and void. Let’s see if this trend continues.

Difficulty of programs

Contrary to popular belief in the nurse community, medical school is much more difficult than nursing school. It may seem that nursing and medical students study about the same amount of time, but other variables must be considered. Medical students are often much more efficient than nursing students at retaining information. They often have more years of school under their belts, are more well versed in memorizing college material, and have better study habits. This is not always true, but I would bet a high dollar on this assumption. The same is also true of nurse practitioner programs. While some will debate this, the honest fact is that a completely online program with no set of written tests will not be as difficult as a completely brick and mortar medical program. Lack of written tests equates to lack of knowledge….. directly. Writing papers on nursing policy does not constitute difficulty and does not translate into better practice outcomes and clinical decision making.

Oh God, why do I waste my time on this? It’s not “contrary to popular belief in the nurse community” unless you are a crack addict.

Are you even aware that there is no such thing as a “completely online program with no set of written tests.” So why do you say, “the honest fact is that a completely online program with no set of written tests will not be as difficult as a completely brick and mortar medical program?” Of course it isn’t because there is not one.

Writing scholarly papers is something physicians strive to do and is VERY beneficial for nurses to know how to do. You failed in that regards, obviously. I’d have put an “F” on this paper…and even recycled you back through a research course.

Length of program

This cannot be debated. A minimum of 7 years of training vs 12-36 months (many of the programs being part time)? Who is going to be better trained? If you answer anything besides the MD, you are just plain wrong and need to reevaluate your math skills. The first debate somebody will throw at this argument is “I have been a top- level, elite trauma nurse for 20 years and know everything there is.” Your right, you do know everything, ABOUT NURSING, NOT MEDICINE. I am not stating that all nursing experience is worthless, but 20 years of nursing does not equate to 20 years of practicing medicine or as a nurse practitioner. Being in the same environment doesn’t count. That’s like saying being a custodian wiping up the mess after a trauma scene is the same thing as performing a thoracotomy on an acutely unstable patient.

Then why are you debating the obvious? Do you want to figure out why part-time study might be better than full-time or do you want me to tell you?

Whiskey Tango Fox! “That’s like saying being a custodian wiping up the mess after a trauma scene is the same thing as performing a thoracotomy on an acutely unstable patient.” I can’t even began to comprehend what you were trying to convey here. Ever look up “analogies?”

Different type of student

This one will be difficult to explain, since there are people from many walks of life that go into both professions. But in an overwhelming majority of cases, these facts and figures stand true. Medical students are often much more dedicated to the sciences than the average nursing student. Many nursing students are reaching for a secondary career and have a less than steady academic background than the average medical student. There are some second career physicians out there, but overall, not the same amount as in the nursing field. The trend does seem to be changing though with more young nurses entering the field at a younger age, thus making nursing their primary career at an early age. Quite frankly the single mom who has worked at the grocery store for 10 years and who decides to go back to be a nurse is often in a different situation than the 23 year old who has been taking 12 credit hours of science classes for the past 4 years of college.

What fact and figures stand true? I’m just going to skip this before I have an MI. This is so off the wall I can’t even go there right now.

Disclaimer

If the most you get out of this article is that medical students are geniuses and that nurses and nursing students are dumb, you have greatly missed the point. This being my disclaimer, not all of these figures stated above will be correct 100% of the time. Simple observation regarding the differences between nurses/nursing students and physicians/medical students should be enough to understand these differences though. Much of the blame is to be put on the accrediting agencies, who as I have stated in a previous post basically throw licenses in crackerjack boxes, to be earned without significant effort, testing, or any check regarding ability of the individual. Sadly, it is the same group of so-called elitist nurses who continually debate for unrestricted practice for all APRNs. No wonder nursing has a poor reputation in light of medicine. Until the standards are raised and equality (or at least near-equality) is promoted across all programs, the average APRN will not be equal to the average physician.

Well, you have not stated any fact and figures so you’re off base 100% of the time. You don’t get it. If we as NPs had equal programs then we’d be physicians. Get it? I don’t want to be a physician. Get that?

Mods, what do I need to do to get kicked off this site for life? I can’t stand this level of drivel. This post is not even high school level. Please delete it…or me.

Here’s something for you to read: http://www.ftc.gov/system/files/documents/reports/policy-perspectives-competition-regulation-advanced-practice-nurses/140307aprnpolicypaper.pdf#page1

“NPs have been practicing independently for many years in some states, 21 in NM. so what will be exposed? "None of the hundreds of studies that have been done on the topic “showed that care was better in states with more restrictions” of nurse practitioner authority, said Catherine Dower, health policy and law director of the Center for Health Professions, University of California San Francisco, who addressed the committee.

Patient safety and quality of care have not suffered in states that loosened the restrictions.

“The evidence is so weighty that the conclusions are not very disputable at this point,” Dower said. “The evidence is pretty strong that it is not a problem.”

[traumaRUs, MSN, APRN]

@zenman - too bad I can only push the "like" button once!!!