Actually, a lot of medical students/pre-med students as well.
I've been googling the subject DNP vs. MD and find little from nurses, but a slew of pure hatred for nurses and the DNP.
What gives? I understand the idea- the fear that the DNP will start to deprive the MD from practice, rather than work with the MD.
I found the threads interesting as at no point did any of the med students, not once, show concern that the quality of care provided might be lacking with a DNP.
The med students have this idea that from year 1 of undergrad through completion of a DNP program there are only 600-700 hours required in clinic, and that a DNP takes 2 years or less presuming one already has a BSN.
They also seem to rage in regards to nurses being able to work, and thus get paid, while attending school.
They call the DNP's "Dr. Fakey McNursey", and worse.
Where's the respect? What about the patients?
Why all the hostility? Why do MD's feel they're being pushed away? Is there a history of these new DNP's not providing quality care, or working with MD's? Is it just an ego issue? And why do so many existing NP's dislike the idea of the DNP (beyond what I've read- that additional education isn't apparently needed, some claim)?
I have no idea what percentage of advanced practice grad students may be in direct-entry programs (which is why I settled on using a bland, general term like "many" rather than any kind of hard figure), but here is a list of schools offering advanced practice specialties in direct-entry programs (i.e., for non-nurse students) -- this is from a quick Google search, so I'm sure it's not even a complete list:
UCSF, CSU-LA, Azusa Pacific U, U Conn, Yale, Georgetown, Emory, U Of Hawaii, UI Chicago, U of So. Maine, Boston College, MGH Institute of Health Professions, Marquette, Northeastern U, Regis College, Simmons College, Grand Valley State U, Columbia U, U of Rochester, East Carolina U, Case Western Reserve U, Ohio State U, U of Cincinnati, Oregon Health & Science U, Thomas Jefferson U, Vanderbilt U, UT Austin, U of Vermont, VA Commonwealth U, Seattle U, and U of Washington.
Also, I know that, while Duke does not have a formal direct-entry MSN program, it does offer an "ABSN-MSN pathway" that is basically the same thing (you go directly from the ABSN into the MSN program), and which offers a wide variety of advanced practice clinical specialty concentrations. I imagine that there are probably other schools out there that do the same thing, that wouldn't turn up on a search or listing of specifically direct-entry MSN programs.
That's a lot of schools that have been turning out advanced practice grads with no previous nursing experience for quite a few years (decades in some cases). Based on that alone, I feel comfortable saying "many" APNs entered advanced practice without any previous nursing experience. I continue to be surprised at how many nurses are (apparently) unaware of the existence of the direct-entry MSN programs -- they've been around now for, again, in some cases, decades. Look around just on this site at how many threads are started by people who are shopping for a direct-entry MSN program in order to become an APN, or asking questions about how to get into a direct-entry program.
I'm not necessarily condemning these programs, or suggesting the graduates are not competent; I'm just reminding folks, since the statement was made that "all" nursing grad students have significant nursing experience/background, that these programs are out there and turning out lots of graduates.
Since these programs and their graduates have been around for a long time without the kind of controversy that has erupted over the DNP discussion, I doubt that they play much of a role in the "hostile reactions" toward the DNP. There have been discussions here about whether or not direct-entry grads have a harder time finding employment than experienced-RN APN grads, but there has not been any open, widespread hostility that I've been aware of ...
i am a graduate of a direct entry program. i have a masters degree in counseling psychology and wanted to be able to do therapy and medication and so completed a direct entry pmhnp program. many of the students in my program were amazing. i would say half already had masters degrees in psychology or social work. some were newbies and had just graduated with a bach in another area. as far as i can tell all the people who graduated in my class (all pmhnp) are very good at what they do and have same scope of practice as a psychiatrist, are equally good at what they do as nurses who have been in the fiel "for years". if schools pick bright, interested students, the students can learn what is needed regardless of their background experience-this is true for nursing and medicine.
i think it is unrealistic to criticize providers based on how long someone has been in the field, either prior to school or after school. people who go into any medical/nursing prgrams are able to learn the material and apply it. med students usually have no previous medical experience either (regarding direct entry students with no previous nursing experince). granted medical students get a lot more education in their programs, but a lot of people are questioning whether it is necessary. lots of people like medical training and the intensity of the training, but is it necessary? for most providers and areas of practice, its not.
granted medical students get a lot more education in their programs, but a lot of people are questioning whether it is necessary. lots of people like medical training and the intensity of the training, but is it necessary? for most providers and areas of practice, its not.
I actually disagree with you there. I don't think there are "a lot of people" questioning whether the lengthy and rigorous medical training for physicians is necessary. In fact, many people who are involved in medical education (ie. program directors, attendings, etc) are thinking that even more training is needed in some specialties than is currently provided. For example, there have been recent talks of increasing the family practice residency length by an additional year (from three years to four). This would essentially increase clinical training by thousands of hours. In my experience, the only place where I really see that lesser and lesser education is considered a good thing is on these forums.
the md i was talking to was talking about the basic education-the first 2 years in meidcal school in particular, but possibly also inlcuding the last 2 yrs, not residencies or practical experiences. i think it would be beneficial to have more practical experiences as well. his point was how much about every detail of science related to the muscle or the eye does a psychiatrist need to know-basically focusing knowledge on the providers area of specialty or area of practice fairly early in a persons training (assuming they know what area they want to go into).
the md i was talking to was talking about the basic education-the first 2 years in meidcal school in particular, but possibly also inlcuding the last 2 yrs, not residencies or practical experiences. i think it would be beneficial to have more practical experiences as well. his point was how much about every detail of science related to the muscle or the eye does a psychiatrist need to know-basically focusing knowledge on the providers area of specialty or area of practice fairly early in a persons training (assuming they know what area they want to go into).
The problem with that line of thought is that it assumes students applying to medical school already have determined what specialty to go into. That's very unlikely. The majority of people who enter med school with a specialty in mind go into a completely different specialty.
In addition, it would be a very bad idea to get rid of any of the basic science courses. As far as I know, no med school in the US is considering this. Even the 3-year DO program that fast-tracks to primary care still retains both basic science years. The basic sciences lay the foundation for learning clinical medicine. Physicians are taught to thoroughly understand the mechanisms of physiology and pathophysiology. This is an essential foundation required for building clinical knowledge upon. No amount of experience can be a replacement for understanding the basic science behind medicine.
I do agree with dgenthusiast that the basic sciences are what you build on. Few working APNs or PAs say that mid-levels are equal to physicians.
You get that (at least in my 18 years of nursing experience) from students and wannabes.
However, I do feel (and again backed up by 18 years of nursing experience) that mid-levels of all kinds contribute to and are reimbursed for the care they provide. We are not a substittute for physicians, we are an adjunct to physicians.
That said, when we come to AN, we all come with our own set of experiences and values. I clearly state that I'm an APN, others are MDs or students of one type or another.
So, you look to the person's background and that is how you gauge their response.
back in the mid 1990's i was a premed student and the physician who ran the per med seminar class i took talked about the issue of how much training a person needs to be a medical provider (medical meaning: np, pa, and md). his sense was that medical schools and residency programs were over training/over educating for providing care. he talked about medical schools that were considering taking a more nursing model-eg: doing specialty training from the beginning of school and not doing as much general medical education. its funny that nursing is feeling they need to go more medical model-more general education, then moving into specialty training. he also suggested that medical schools were still using a 19th century model for education which was probably useful in the 19th century, but with highly specialized medicine and biology we now have, at some point it seems there may need to be a shift in the education of physicians-as there may be just too much knowledge to learn, and specialization- as a necessity dt the amount of information to learn- would occur earlier in training.
This is my feeling as well in re: the push for a PA-MD "bridge program". MD/DO and PA (or NP) probably need to meet somewhere in the middle in order to train PCPs who have sufficient exposure in training but are not burdening the needs of the system with some relative over-training.
I actually disagree with you there. I don't think there are "a lot of people" questioning whether the lengthy and rigorous medical training for physicians is necessary. In fact, many people who are involved in medical education (ie. program directors, attendings, etc) are thinking that even more training is needed in some specialties than is currently provided. For example, there have been recent talks of increasing the family practice residency length by an additional year (from three years to four). This would essentially increase clinical training by thousands of hours. In my experience, the only place where I really see that lesser and lesser education is considered a good thing is on these forums.
What needs to happen is that the didactic and clinical modules become fused earlier on in training; this would allow more clinical time in a shorter total time period.
What needs to happen is that the didactic and clinical modules become fused earlier on in training; this would allow more clinical time in a shorter total time period.
To be honest, I do not see the point in doing that. I'm also not entirely sure what you mean by "fusing" clinical training with didactics. It would be incredibly hard to have basic science lectures, exams, etc, like you would in the preclinical years at the same time when students are pulling 80 hour weeks in the hospital (in addition to the reading and studying done at home in order to do well on rotations).
Furthermore, practically every med school in the US starts clinical exposure during the first year. The clinical training one receives during the preclinical years is supposed to build a solid foundation in taking H&Ps, knowing what questions to ask, basic exams, etc, so that when you hit the clinical years, you don't waste time learning all this and can hit the ground running.
To be honest, I do not see the point in doing that. I'm also not entirely sure what you mean by "fusing" clinical training with didactics. It would be incredibly hard to have basic science lectures, exams, etc, like you would in the preclinical years at the same time when students are pulling 80 hour weeks in the hospital (in addition to the reading and studying done at home in order to do well on rotations).
Furthermore, practically every med school in the US starts clinical exposure during the first year. The clinical training one receives during the preclinical years is supposed to build a solid foundation in taking H&Ps, knowing what questions to ask, basic exams, etc, so that when you hit the clinical years, you don't waste time learning all this and can hit the ground running.
Most medical schools are going to a different model. They do the basic science year (or the first six months) and then intersperse clinicals with the next three years. In PBL programs the students do intermix clinical with the basic sciences. Clinical medicine is taught along with the basic sciences in the setting of clinical patient presentations. Generally the M3 year is dedicated to required rotations and the M4 year is largely electives (YMMV).
M3 is the first year dedicated solely to clinical training. But clinical exposure at most med schools these days begins within the first few weeks of starting M1. During the preclinical years, the clinical training teaches you to take proper H&Ps, conduct basic exams (ie. a comprehensive neurological exam, etc), follow patients for at least a short period of time, etc. It's important to have a solid foundation in this stuff before M3 so that you can hit the ground running instead of wasting time learning all this then.
I am definitely not trying to be argumentative or highjack this thread, but just want to respond that neither situation was the case in my graduate program (which I attended as a traditional, experienced-RN student -- but shared all my classes with direct-entry students who made up the majority of the student body) -- direct entry students came into the program with no healthcare background at all, they completed an advanced practice specialty MSN in three years, and they did not get licensed as an RN after the first year and work part-time during APN phase of the program. At my school, a well-known and well-respected program, direct-entry students were not eligible to sit the NCLEX until they completed the second year of their program, the first year of the APN phase of the program, and, even after they were licensed, none of the students I was aware of worked as RNs because the program itself was so rigorous and demanding (also because they had absolutely no interest in ever functioning as a "basic," bedside RN and considered themselves much too special and important to do anything like that, but that's another story). quote]
Elkpark - did you attend Vanderbilt? If so, you weren't the only one working through the program. I used to work 2 weekends per month just so I could get the cash for the airfare and hotel room, since I flew in from Texas to attend classes.
I understand completely what you are saying about direct entry students. I had never heard of those programs before attending NP school, so it just blew me away. I worked for years in nursing, just so I would be able to get accepted into a NP program - imagine my surprise when I found out that wasn't even necessary!
As far as NP/DNP haters - I've encountered more than my fair share of this type of negativity to last a lifetime. I opened a minor emergency/primary care clinic in a medically underserved area of my city 4 months ago. It was featured in the local newspaper before it opened and that really ruffled some feathers. I offer low cash prices for the uninsured and under-insured, plus I accept Medicare, Tricare and Medicaid. I'm trying to help people who have limited access to medical care, yet several physicians have made negative comments to me about owning a clinic - they think only physicians should be allowed to own practices. I'm originally from NM, where we've had independence from physician oversight for almost 20 years, so this just amazes me. A lot of physicians in my area seem to think that advanced practice nurses are a new phenomenon, even though we've been around for over 40 years.
What's really amazing is the fact that many physicians in my city refuse to accept Medicare, Tricare or Medicaid, much less work in a medically underserved area. It's like they don't want to take care of those patients, but they don't want anyone else doing it either! This is just insane. Seriously, this needs to be about patient care and not a turf war.
If you live in Texas, please contact your legislators and encourage them to pass HB 1107. We have a fighting chance to gain full independence in 2011.
viola900
14 Posts
i am a graduate of a direct entry program. i have a masters degree in counseling psychology and wanted to be able to do therapy and medication and so completed a direct entry pmhnp program. many of the students in my program were amazing. i would say half already had masters degrees in psychology or social work. some were newbies and had just graduated with a bach in another area. as far as i can tell all the people who graduated in my class (all pmhnp) are very good at what they do and have same scope of practice as a psychiatrist, are equally good at what they do as nurses who have been in the fiel "for years". if schools pick bright, interested students, the students can learn what is needed regardless of their background experience-this is true for nursing and medicine.
i think it is unrealistic to criticize providers based on how long someone has been in the field, either prior to school or after school. people who go into any medical/nursing prgrams are able to learn the material and apply it. med students usually have no previous medical experience either (regarding direct entry students with no previous nursing experince). granted medical students get a lot more education in their programs, but a lot of people are questioning whether it is necessary. lots of people like medical training and the intensity of the training, but is it necessary? for most providers and areas of practice, its not.