Which makes more money physician assistant or nurse practitioner
So said my newest patient after her previous primary care provider, a nurse practitioner retired. Sandeep Jauhar, author of Doctored: The Disillusionment of an American Physicianresonated with me. The fact that 17 states have legislated nurse practitioners the right to practice primary care medicine without physician oversight is very worrisome. There is a primary care crisis. We do need more primary care providers. Though nurse practitioners can fulfill some of the demand they cannot do so without doctor oversight.
Though on paper it seems like what primary care doctors do is easy, in fact when digging a little deeper, one finds out these two specialties are not the same though some states view them as such. It boils down to training. Primary care is a cognitively challenging specialty. The amount of training doctors receive is far greater than that of nurse practitioners. As Malcolm Gladwell, best-selling author of Outliers: The issue is also making the right judgement calls.
Primary care is where most patients present for the first time to the health care system. With their constellation of symptoms, it is the listening, examining, and diagnostic skills of the primary care provider that makes the difference between ordering the right tests, the right treatments, and if needed, the right referrals or ordering too many unnecessary tests, prescribing inappropriate treatments, or generating extra referrals.
If primary care was so simple and easy, perhaps these concerns of inadequate training would be overblown. Either doctors or nurse practitioners can play the role well. What differentiates doctors from nurse practitioners is our training, clinical experience, disciplined thought process, and a framework to problem solve provide a depth of understanding that simply is lacking in nurse practitioner training.
Outbreaks of once eradicated childhood illnesses spread by international travel to our shores. Patients are living longer with chronic illnesses and on multiple medication regimens. Can nurse practitioners make the correct judgement calls on increasingly complex patients in primary care?
When she has symptoms, she is trying to find a solution to allow her to feel better or to remove any worry or anxiety generated by the new symptom. This is when she seeks care with a primary care provider. Sometimes understanding the cause of these symptoms is clear. Other times, the diagnosis may not be clear. The work-up requiring more thought.
Both the patient and the provider cannot know prior to the encounter whether the resulting diagnosis, work-up, and treatment is simple or complex. When a patient has a new problem, the job she is trying to solve is for someone to help her. Yet, policy makers believe that nurse practitioners are as capable as primary care doctors in discerning these clinical differences.
Policy makers believe nurse practitioners can practice independently from doctors and be free of oversight in the cognitively demanding specialties of internal medicine and family medicine. The observation of deliberate practice of 10, hours and the reality that primary care sees both simple and complex problems in an unpredictable manner coupled with the double standard of different training and different certification training suggests that nurse practitioners are not ideally suited to be front-line providers free of physician oversight.
Should nurse practitioners want this independence, they should be held to the same certification standards as doctors. Nevertheless, if policy makers feel primary care is a job that nurse practitioners free of physician oversight can solve for patients seeking initial care, then they might wish to allow nurse practitioners to expand into another specialty:. I have encountered a nurse practitioner working with my surgeon.
This should not have to happen. I did not know if she was supposed to make the decision or not. Personally I did not want to work with her. She was overly emphatic, which made me suspicious of her motives. Get them out of my way.
Kidney stones range in size, and perhaps the patient did have very small kidney stones. Your opinion piece does not offer enough information to make an educated, unbiased decision regarding the quality of care provided to the patient you are discussing.
Additionally, there is a call for nurse practitioners to achieve their DNP prior to practicing independently. No, nurse practitioners are not doctors, they are advanced practice clinicians whose experience and treatment is different from that of physicians, but no less safe. Numerous studies have revealed that nurse practitioners provide care that is equal in quality to that of physicians, and that patients often report that NPs have better bedside manners and do a better job educating their patients how to take care of themselves.
Your opinion here is clearly biased, and offers no research-based information to support your claims that nurse practitioners provide inferior care. NPs are just as invested in protecting their licenses as medical doctors are, and are equally capable of providing quality care to their clients. You are correct, it is possible that this nurse practitioner was using layman terms. Agree that the training of nurse practitioners is indeed different from that of physicians, but saying it is no less safe is an assumption.
As the NYT piece illustrated the amount of training hours differs. A comparable analogy would be airline pilots. Today many are trained in flight school. Years ago many were trained in the military. Are they about the same?
In basic routine situations, yes. But in more complex and difficult situations — no. Nurse practitioners do have a role in primary care. They should not do so, however, independently and without physician oversight. Med school is a fraternity. Jane Fitch, president of the American Society of Anesthesiologists, began as a nurse anesthetist but later earned a medical degree. Do your homework before you make statements regarding care being suboptimal from NPs.
On the contrary, research has shown that care is equal or better when it is provided by an NP. Journal for Nurse Practitioners. I also do not hesitate to consult with my MD colleagues, if needed. I can also say that most of my patients prefer the NP as we spend more time talking with the patient and not at them, understanding them as a whole person and not just a diagnosis or condition.
They prefer the wholistic approach, vs the diagnose and treat approach. One is not better than the other, just different. Would you mind telling me when you wrote this article? I am doing a paper for school and this article was perfect for my research. What are you smoking. Np are great you can never have too much education but they are not doctors.
Just a way that hospital systems can make more money for less. And if they mis a diagnosis oh well. We are fucked political correctness is destroying us.
My NP order almost every test medicare allowed then Dump3d me. Thats right had her office call to say Why are you coming? She had set up the appointmentshe said to go over all the tests. Had 5he nerve to tell me well you got your physical for the year. Didnt bother to ask if i still had my problemwhich i still do.
When i asked if she conferred with an M D her office said she didnt have to. If N P dont need q md degree then why do Doctors. She ended asking when did i want to make a well visit6 months or a year. I wanted to tell her When Hell Freezes Over! Clearly, to make such an ignorant statement, you are either 1 just ignorant, or 2 could not get into medical school.
Perhaps many Advanced Practice Registered Nurses APRNs would have gone to medical school, if they so desired. Being a nurse is what most APRNs love about their role and is the defining element. What most do not understand, is that there is a stark difference in a disease focused medical and a holistic nursing approach. Nurses appreciate caring for the entire patient, not just a disease and often learn more about preventative care than most physicians do.
It has also been demonstrated APRNs spend more time talking with and educating patients than physician colleagues. APRNs do not want to replace physicians. They want to care for patients using evidence based knowledge yet utilizing a nursing approach to their fullest abilities. For those who still believe a medical doctor is at the top of the hierarchy, as we head toward the future of healthcare, these are the people who will be very disillusioned.
Many are able to recognize physician resistance to this change for what it is. Physicians will always have an important role, particularly in specialty medicine. However, their role is redefining itself and will inevitably change with modern times, which will benefit not only the medical community but the public as well.
Per the American Association of Nurse PractitionersNPs are quickly becoming the health partner of choice for millions of Americans. As clinicians that blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management, NPs bring a comprehensive perspective to health care.
Read on and learn why Americans make over million visits to NPs every year. In short, a nurse practitioner applicant is a registered nurse with a BSN undergraduate degree that has successfully passed a state licensing exam with at least two years experience who has made the decision to return back to school.
By the time I complete my education as a Family Nurse Practitioner, I will have over twenty two years of health care experience. As a critical care nurse with over twenty two years of experience caring for patients, I have witnessed many health care providers who lack the judgement and knowledge to accurately diagnose and treat patients. Nurse practitioners do not have a monopoly on poor patient outcomes. Physicians are granted a margin of error in which they are allotted a certain number of poor patient outcomes that can lead to injury or death and in many cases are allowed to continue to practice.
Nurses do not have the luxury of margin of errors extended to other members of the medical profession. When a nurse makes an error that leads to the harm of a patient they are barred from working until they undergo extensive training and show proof of academic and moral rehabilitation.
The future of healthcare is changing the delivery of care and who that care will be provided by. I am a NP and have had the honor of working with excellent doctors that have collaborated with me through the years, we have gained each others respect, it is a relationship.
Sad we have no control over our practice or our patients. Office visits are 15 min. Trust me I can see that doctors have no control over their position in all this. This is just you speculating. Did you have access to the work up done by APRN? Some of the things I have seen doctors do are far worse than anything you mention. This one example does not prove anything at all regarding nurse practitioners.
I think they must have given you classes in how to be arrogant as well. I earned my BSN RN from approximately hours of lecture and clinicals.
I think worked for five years full-time in medical-surgical, oncology, and home health nursing for approximately an additional 7, hours of direct patietn care. In graduate school I will receive another hours of direct patient care, not counting the coursework. The primary difference is in my holistic model versus a medical model.
As a patient I have to agree with Susan. In my personal experience I have had negative experiences with MDs and POSITIVE experiences with NPs. I choose to see a NP for my PCP and I can tell you why. When I was 13 years old I had severe back pain and at the time was quite literally crooked. He then proceeded to give me all the vicodin in the world. After 3 months of excruciating pain my parents decided to take me to see a different DOCTOR…. Because of HER my NP I am doing much better, I am no longer in the shape of a S because she actually helped me instead of shoving pain pills in my face.
I still see her, I love her and I have NEVER had bad care. When I am sick I get seen in a matter of a week. I also see a NP for my vagina. So I, along with most of North America, disagree with you. My kind regards to your Doctor EGO.
I do not and never will feel that any one who is a nurse practitioner is as qualified to make a medical decision as an MD. I am not denying the education it took them to get to that point, obviously a lot of hard work.
That said it is just not the same and never will be. If you go to a group of Doctors, without requesting anyone specific, you get an nurse practitioner or if you are lucky a PA. Where are all the doctors and is it just a matter of who is cheaper to keep on the payroll? NOTHING REPLACES MEDICAL SCHOOL. I was web-surfing for message board material on the topic of public perception of nurse practitioners when I ran across your blog.
We will also agree that anecdote has limited value. These anecdotes are illustrations of individual frailty and failure. I think humility is an essential requirement for a scientific mind. For intelligent folks, simply studying physiology or anything medically relevant, come to think of it should provide an ample dose of humility.
The amount of information is unwieldy, and despite the quantity of information, humanity is not living in an age of enlightenment. I often hear persons of average education express distaste for the arrogance of physicians. The NP reactions are here are knee-jerks, driven by ego. Jane Fitch was apparently in possession of oversized ego prior to medical school. Personally, I do not require the gauntlet of medical school to know where I stand intellectually.
I am not an egomaniac. I am good at using references. I see some connections, I miss others. Why might NPs have egos out of proportion to their abilities? If you want them, just email me. Personally, I like the collaborative practice model. Attempting to practice independently as a new NP graduate sounds utterly ludicrous.
The ego battles help no one. I found that my medical expertise were more suited to a tertiary center where people with advanced medical or severe illnesses generally came after a referral from their primary physician. I see the future of Physicians in primary care will change towards most working in major centers with no real need to work in outpatient clinics.
There may not even be a need for family physicians and most will probably become internists or branch out to other specialties. In a qualitative based society a physicians MD qualification will always be considered higher than an NP or PA. In the hierarchy of the medical field a Physician is at the top. The scope of practice for a nurse practitioner in the United States is defined by regulatory boards of nursing, as opposed to boards of medicine that regulate medical doctors.
If an NP wants to get the same pay-scale, same respect as a physician then there are no shortcuts but to get an MD degree. What is factual; however, is that many doctorally prepared nurse practitioners are proving their egalitarianism by passing the same final USMLE step in the board exam. So yes, please call me your primary care provider; call me your primary care doctor; call me Jack; I am all of these. If this is something you aspire for, then medical school is the only track to take.
I liken this to any kid can learn to ride a bike in a day; this for the most part is primary care. Furthermore, I would not expect a new family medicine doctor to have the wherewithal to do much more than your average nurse practitioner fresh into practice.
Furthermore, family medicine docs and internists need to set their egos aside and stop falsifying the aptitude of other interdisciplinary providers. Advanced practice nurses have a hard road ahead; primarily because of the precedence set for our profession at inception. It blows my mind that Nightingales fundamental theoretical constructs are still being glorified within nursing institutions, as the discipline has undeniably grown markedly away from its premise.
Moreover, as a nurse working in the 21st century, I remind myself that what makes my discipline unique is not theory alone, but caring for my patients through a multi-disciplinary approach meanwhile paying careful attention to evidenced based medicine in my practice. This is what sets us apart from physicians. Lastly, my name is Kathryn and not Jack. NPs, but every account, are FRAUDS.
If you want to treat patients and prescribe medications, do the work and go to medical school. I for one, will not allow an NP to TOUCH me. They are taking advantage of a healthcare system that wants the McDonalds approach: I will fight until the day I day against this ridiculous and fraudulent practice.
As for you NPs who are offended by this, I only recognize credible sources. I refuse to seek medical care from a person who has to look at pictures of what I may or may not have on a computer screen, and then have to look up the medication to prescribe, because the picture resembles what I might have. I should add, I think nurses in a hospital setting are wonderful. I was hospitalized with a serious injury a few years ago, and I could never thank them enough for their compassion.
An NP who specializes in neurology? Wanna fly with me? This does not make them frauds. It also does not mean that physicians are perfect and do not make mistakes, because I can tell you they do; and more often than you may think. I cannot tell you how many times I have had to beg a physician to order more tests on a patient because they were actively having a hemorrhagic stroke, MI, going septic, etcinstead of transferring them to another unit or discharging them home. I agree with Dr.
I started my career as a Navy Corpsman medic in the military, serving 4 tours in Iraq and 2 tours in Afghanistan. Not only was I responsible for keeping my Marines alive, I was also responsible for providing care to entire civilian populations because their doctors fled the country as soon as the war broke out.
I provided various levels of care to men, women, and children who were caught in the crossfire of war.
As an RN, I worked in the intensive care unit of a Level 1 trauma hospital, where I continued to learn from physicians and nurse practitioners who are some of the best in the business. Now, as an NP, I work in a busy primary care office where I see up to 30 patients a day. I also know my limitations and I know when to make the appropriate referrals to the specialists. These specialists are ALWAYS physicians. Inthere were aroundnurse practitioners in the United States.
Now there are overThis is a biased opinion. One NP cannot represent the entire NP population. I have a Microbiology Degree and another degree in Nursing.
I had a Medical Technologist license ASCPRN, PCCN, BLS and ACLS and all my experience counts as clinical experience. When I used to work in the lab where MDs call me to ask me the most stupid questions.
I assume they are new to the profession. Do they represent the entire MD population? Your article is unfair. Do you really think nurses can do their job without knowledge of pathophysiology and symptom recognition?
Most docs miss those and nurses with good symptom recognition is the first one to alert the doctors. The success of hospitalists are mostly due to nurses. Especially if they have received mentoring and on-the-job training. Becoming an NP requires NO clinical experience between the two degrees. Someone could complete their BSN, immediately enroll in an MSN program, then, DAY ONE after after graduation, be considered to be fit for practicing independently.
Are you kidding me??? Even then, I had 2 more years of residency and had to pass my FP boards before I was fully ready to be out on my own. On top of that, I have to pass the same FP boards every 10 years and keep up with a huge amount of CME.
In fact, during my residency, I have seen many experienced PAs and NPs who do quite good work and, they taught me a lot. But they had years of on the job training. But not all NPs have this opportunity. I thought they wanted to be completely independent.
NPs are not being trained adequately across the board. To me, that signals a flaw in the program design. There is NO substitute for hands on experience and hands on, collaborative clinical problem solving.
ANYONE who wants to have independent, non-supervised practice privileges must complete a residency. One that guarantees minimum competencies of all graduates upon completion of the residency. Sure, let NPs have the independent practice privilege and PAs for that matter but make them do a residency first. Derm biopsy; Fluorescein stain eye exam; Sutures; Joint injections; Navigating a patient through a Hospice experience; Signing the death certificate; Doing a day newborn exam; Knowing pediatric developmental milestones; Guiding parents though bed wetting, feeding and behavioral challenges; Knowing peds derm; Knowing how to deal with in office emergencies etc, etc, etc.
We learn a lot in med school but residency is where the real, day to day learning takes place. Primary care can fool you. Easy stuff is easy. Straightforward stuff is straightforward.
But not every patient has the classical or typical presentation of diseases. Thinking that we can take the shortcut by not requiring adequate training for NPs might look like a quick and cheaper solution to the primary care shortage. Mid-Level providers basically function at the level of a 4th year medical student with half the intelligence.
Sorry truth is truth. The tests came back and confirmed that it was lyme and she was started on treatment right away. As a nurse practitioner for over 17 years, I liked to add to the discussion that anything outside the scope of practitioner is ALWAYS referred to a specialist. We, as nurse practitioners, are not in the practice to just shrug patient issues off.
This is where most doctors get this wrong. We want our patients to be well.
PA's make more $$ than NP's?! | allnurses
If we are unsure of a diagnosis, we will reach out and refer. I am truly insulted that doctors believe that we minimize and are undereducated regarding patient care. I truly care about my patients and will do whatever it takes to make my patient well and get an accurate diagnosis. I know my resources and use them if need be. Why would you want NPs independently staffing ERs? I also recently found hepatitis missed by MD. I am not smarter or wiser and thankfully the MD I work with does not feel I am incompetent as with two eyes, we seem to help each other.
Instead of patients being the focus of our efforts through collaboration, there is this animosity between medical doctors and the mid-levels that is getting in the way. If you trained as an NP then that is what you are and do not compare yourself to a physician. This is where I am finding a whole lot of hypocracy in our healthcare system. Mid-level providers now have the opportunity to practice independently — it scares me and frustrates me to no end because of what I had to go through to become an MD.
Doctor is a privileged title and I cringe every time I hear an NP or PA call themselves a doctor — most of it has to do with wanting to be perceived as more than they are to their patients. Many will deny this happens but I see it everyday where I work. This is so incredibly wrong and this is where we are headed as long as mid-levels continue to try to elevate themselves to the MD status without the credentials to back it up.
I have seen it over and over. Do you call that a success story? The same goes for antibiotic use — when I review charts I am baffled at how many times they are prescribed without a legitimate reason — at least there was nothing charted that would justify their use.
Again not an isolated event — I have seen it hundreds of times. The basics of primary care! Even after six months of working in a clinic making k they have a hard time making decisions without significant clinical support. Turns out the patient had a broken arm.
I understand not all NPs are trained the same but so far I have not seen anything that indicates sufficient competence for independent practice. Many of my doctor colleagues have expressed the same sentiment. Important to note — all of our NPs have been trained at different schools. Yes, I am bitter about what is happening in our healthcare system. There needs to be a better definition of roles to improve collaboration of care.
Those of you that do this will lose the respect of those that can become your mentor and advocate. Learn your place and stick to it. Not only is it misleading and false advertising, it violates the fundamental trust patients have in all of us who care for them. I am a PA with 16 years experience. How to make money from taking surveys currently work in Cardiology.
Will I sometimes catch things that my MD might miss or overlook? Will I occasionally make mistakes? While I occasionally save the day? However, I AM NOT A DOCTOR. I DID NOT GO TO MEDICAL SCHOOL; I SHOULD NOT be allowed to practice medicine completely independently.
They did not go to medical school. They SHOULD NOT be allowed to practice medicine without a collaborative agreement with a physician. I might have a somewhat controversial opinion on the matter, as I teach nursing. I do feel that physician extenders are important, but I believe in 95 best binary option demo collaborative model as it relates to nurse practitioners, and not the independent model.
I also believe part of the problem lies in the wide disparity in education and the format of delivery in many graduate schools as it relates to the quality and intensity of the theory and clinical piece.
If graduate schools of nursing would make the admissions requirements tougher and the required clinical hour piece longer, the quality practitioner might be better. Which tests, if any, were needed that the NP did not order in her work up? If I had a nickel for every upset family member that called because their mom or dad mistakenly told online trading course with academy of financial trading education they had an some awful, serious condition when in fact it was a UTI or the likes.
A missed symptom or misdiagnosed symptom can send me into a whirlwind of symptoms that were silent days before. I think there should be a limit on the number of NPs in the chinese stock market crash chart. Hard to regulate and insulting to enforce?
Your friend will not have a problem finding a job in internal medicine. If anything that is a specialty that needs more doctors. Here is a place that is actively hiring… http: We are well educated and perfectly suited to the job. Physicians make mistakes too. Sounds like you are feeling threatened. This article is nothing short of hate speech, and you are not exactly a credit to your profession.
I went to medical school because I wanted to be sure I had a solid understanding of basic science followed by a solid understanding of pathophysiology. I willingly sacrificed years of my life because I realized that the privilege of buy forex using credit card a medical doctor also came with it the responsibility of lives.
If I was going to take on that forex trader pro uk, then I wanted to be CERTAIN I did everything in my power to have the proper fund of knowledge.
My year-old mom LOVED her NP ……. A first-year medical student should be able to tell you that. My mom is making money playing online poker elementary school teacher with no medical background. She said she loved that her NP was thorough. I informed my mom that the correct term is called wasteful, and now she sees a medical doctor who DID make sure she had her yearly mammogram which was missed the past two years despite a family history of breast cancer.
To someone with no medical knowledge, that may seem unpersonable and not thorough but far from it. First, do no harm. When my mom learned she no longer had to have a transvaginal US every six months which also means she no longer has to pay the copayment for the procedure her loyalty quickly changed from the NP to the MD.
And this is just one example…. I have so many more including my own personal experience. Maybe appalled or dismayed more appropriately describes federal funding for nonprofit organizations in canada feelings? They are all important.
Important for our patients and that is what should matter. At least to me that is what is important……I naively thought everyone felt the same way. To me this makes sense because student loans are killing new MDs, and they can make a lot more in a specialty. This is what the medical community need to figure out and change. The 21 states that have passed a form of independent practice for NPs is because of the primary care shortage, not so they can do hip replacements.
I am a nurse practitioner and worked as an RN for a decade in level one trauma centers. I do not doubt that most doctors understand pathophysiology and diseases more than most nurse practitioners. The school I attended also had a large medical school, and many of our classes were combined with medical students. Devoluciones finanzas forex of this was to get us to understand the others profession.
Great for NP students, but it was pointed out in some lectures they wanted to break doctors tunnel vision. For decades medical students were trained to look for and treating the disease, but they failed to see and treat the whole patient. Nurses are trained at seeing and treating the whole person, which is probably one reason that for 40 years nurses have ranked first in honesty and ethics except for after when it was firefighters.
The MD I work with and myself consult often to specialists and people we know. They are also open-minded to what is broker option binaire wikipedia best for the patient. I have worked as an instructor at the University of Michigan School of Nursing and the University of Michigan Medical Medical Center. I have seen mistakes made by both NPs and MDs.
I think it is import for large metropolitan Drs ti understand Davis that more rural areas in midwestern states have a real shortage of all physicians right now. This is not anecdotal; there are literal thousands of studies you can find on line. Within two years, I became so frustrated I started sending my patients down to UMMC for care. Then my health started to decline and I could not find a Dr or a NP who would listen empathetically or just order some the french triangular trade system other basic labs.
There are no neurologists here. After 2 yrs and a formal complaint against a NP in a local hospital, my own diagnosis was finally taken seriously: I cotatii valutare forex the idea of primary care was changed away to its true definition.
Upon looking it up, primary care is health care at a basic with an initial approach from a doctor or nurse for treatment so it means the one who should be giving consultations are the ones who has a wide range of knowledge on such field. It is safe and assuring to say, I think it is better to have the care from nurses with physician oversight to fully cover what is to be taken care and the right treatment to be applied. Person responsible for make money online with sharecash will be the one with the license of your ailment.
I can see the frustration on both sides: In these areas patients are traveling 2 hours for medical treatment. Nursing school, NP school, and experience versus medical schoolresidency cannot be compared. A medical doctor is a medical doctor and I respect their dedication.
A nurse practitioner is an intelligent nurse with an advanced degree and experience, which is to be respected as well. Both professions bring different experiences, but possess the compassion and commitment to safely treat patients.
Doctors consult nurses on the hospital units daily and nurses consult doctors routinely. We work as a team. As a new FNP, I can safely exam, prescribe, and treat less complicated primary care patients.
I do not wish to replace a doctor in complicated, tertiary cases. I refer patients routinely to their PCP or a specialist if it is out of my scope of practice. I understand my limits. I pursued my MSN-FNP to help bridge the gap in healthcare, not to compete with another well respected discipline.
No amount of education or experience can guarantee perfection in healthcare. As a nurse and as an FNP, I have noted many errors on physical exams, diagnosing, treatments, documentation made by both stock market jindal steel. We are not perfect, that is why healthcare has always been a team. There is plenty of work! The first was when I stupidly allowed on to do a uteran biopsy on me. That resulted in excess bleeding, pain and even after the suggested rest period I collapsed in my garage due to what felt like a knife in my lower abdomen.
PHYSICIAN ASSISTANT vs. NURSE PRACTITIONER (2017)The second mistake was allowing a NP with only hours manage my psychiatric medicines. My gut told me no, but I took a leap of faith and I should have known better. She was rude, acted like a know-it-all and dangerously dropped mgs on a controlled substance I am taking.
As I said, NEVER again…I am going back to my primary MD who I should have never left. Only hours of experience past the 4 years of RN? It take floor hours to get a state beauty technician license. Sometimes no one corrected the patients and that was very strange to me.
Patients see anybody wearing a lab coat as doctors. We as clinicians should enlighten them about the different types of providers in healthcare and definitely correct them. I completely agree with everyone whatever that even meansbut I can see both sides of the argument.
MDs, PAs, and NPs are all primary care providers. Who would I trust the most with the amount of knowledge to treat me? As a doctor from a different discipline, my classmates and professors often had this discussion. You are a primary care provider, but not a physician so introduce yourself as such. Healthcare is complicated and to your average person, white coats are doctors no matter how long or short the coat is and everyone else which makes more money physician assistant or nurse practitioner scrubs are seasonality of the stock market crash 1929 newspaper article not CNAs, MAs, RTs, etc.
This particular situation reminds me of the hierarchy within mental health providers: Before seeing a mental health provider, the consent form and terms of agreement involves the education and background of the provider, what they are trained to do, and their approach to treatment.
If it matches with the individual being served, then great. Medical care needs to be clear cut! Or be able to practice independently? What if the RNs that went to get their ASN 2-year degree thought getting their BSN additional 2 years was adequate enough to do what NPs do should that ever change? Liu I am currently a Family NP student right now. I have a big respect for the primary care specialty and I understand how difficult it is to become an expert in this setting.
That 1929 stock market crashes said I also understand the knowledge that MDs have and the rigorous education that you guys obtain. So I agree that oversight is definitely needed. I am saying this from my own perspective and no experience in the field. There can be a million things that a primary care provider must be able to discern for the patient and without the proper education it is an extremely daunting task.
My question is even with MD oversight, after many years of experience do you think an NP will be able to practice independently eventually? Did you sit in class and correct your history professor when they referred to themselves as Dr.
Do you tell your dentist not to call themselves Doctor. Doctor reflects a degree obtained not a profession. You are a physician or medical doctor. If you have your doctorate and refer to yourself as such, that is not misleading. Somewhere along the line physicians hijacked the term and think it belongs to them.
They view a prestige with the term and think they are the only profession worthy of using the title. Healthcare has to be evidence based, and there is no evidence that suggests 10, scottrade exercise option fee hours is necessary to provide competent primary care.
As a matter of fact evidence suggests the contrary. Many, many, many, evidenced best investment options kerala, peer-reviewed, systematic reviewed studies have shown NPs provide as good or better care in the primary setting when compared to MDs.
This is not due to lower wages either. This accounts for costs associated with unnecessary testing, over medication, preventable hospital admissions, etc. Compliance is greater as well.
Most likely a result of an education with a larger focus on patient education and interview techniques which assess and focus on psychosocial influence of disease and wellness.
All of which are extremely appropriate for primary care. Essential I would say. All of this anecdotal evidence is the lowest form of evidence and is useless in a scientific discussion.
Any provider who makes judgements based on such is irresponsible and unsafely over-confident in their own, biased reasoning. Evidence based is evidence based. It often yields counter-intuitive, unexpected results. We designed the process that way on purpose. If it did not then there would be rn consultant jobs from home use for it, and as it stands, it is the cornerstone of good medicine.
Three…what is really going on is that there are a bunch of people, who are butt hurt at the fact that someone can do the same job without having had to go through the same process or spend as much money. I am only talking primary care here. They have the audacity the suggest that they can do the same job as me!
I did four years of medical school, four years of residency with 10, hours of clinical! How is it possible to say you are as qualified or close to equal?! That argument meaning of auction in stock market logical.
If you chose primary care then thank you. In emergency, inpatient or specialized medicine NPs are not as qualified. No question and supervision is needed. Another likely realistic aspect contributing to the attack on the profession has to do with your ego getting hurt. Many MDs perceive that an NP even suggesting they can effectively perform as well in primary care is insulting to their profession.
MDs are restricted with resouces and liability in primary care and cannot practice within their full scope in that setting regardless. Forex upper bound lower bound all refer out for that anyway!
They are going to order their own tests and do thier own work up from scratch. Even when someone has abnormal labs they are told to go the the ED for a workup. It should be a place for health promotion, disease prevention and management of chronic illness and minor acute illness.
All of which are well within the scope of NP practice. There is a continued trend of less MDs becoming PCPs, but you also will fight to the bone that no one else dare step up to the plate.
The Pre-Physician Assistant Major: Choose Wisely - Inside PA Training
Think of the patients! Yes articles have said NPs provide similar care at lower costs. However, those are for easily measured areas of preventive care and predictable algorithmic care such has chronic conditions like diabetes, high cholesterol, etc. When it comes to diagnostics, i. My experience that NPs do not do as well in these areas of clinical ambiguity.
The 10, hours was referring to getting better at diagnostics which is a cognitive skill. When getting to a diagnosis, I always wonder afterwards, was there a better and faster way to get to the right diagnosis if I had asked this question, ordered this test, done this exam? Was it possible I ordered too many tests and where they needed?
As part of their training, family physicians focus on the whole patient including psychosocial influence and motivational interviewing. Again, that is the purpose of evidence based to minimalize human error and bias. My point with the 10, hours is that more is not always better and an experienced NP will naturally accrue the same experience, so 10, means no difference over time.
Why not 12, why not 9, 15 or 20? How was 10, determined? If more is always better why not more? All practitioners will get better over time hopefully but when do we say its safe to do it alone? At least I hope not. In 10 years you should question yourself, in 15, 25 and so on.
Its your job to. The point is, when does the benefit out way the risk? When are you safe enough to help more than not? Furthermore, across the board is several other studies, states that have less regulation and allow NPs to practice without restriction have better health outcomes and overall health.
Admittedly all of the research makes it difficult to attribute a causal effect, however, its an interested and consistent trend. Something that does have a direct correlation is that states with greater restriction have less NPs in primary care and more employed in hospitals. This is attributed to the difficulty of obtaining written collaborative agreements, contracts determined by physicians that favor physician interests.
Laws in all states do not even require a physician to be present at an office for diagnoses or treatment of patients. Therefore, restricting NPs transcription jobs from home canada restricting primary care, arguably the highest needs field in healthcare.
Patrick ewing quote we make a lot of money whole thing is a joke with conflicts of interest driven by free automated forex robots and ego.
We could even use the arbitrarily selected 10, hours of practice before being independent which evidence of over 40 years has shown to not be additionally beneficial. NPs have a unique body of knowledge and need to be regarded as such and any nurse practitioner who does not believe that is only hurting the profession. The biggest argument, as you mentioned, is NP training hours are less than one of three years in medical school residency. In FNP school we have to demonstrate role preparedness and a differential framework of thought to rule in and rule out.
I will be graduating next week and realize my training has equipped me to be a safe entry level nurse practitioner. Thanks for your thoughts. I had a sudden, severe sore throat, and went to urgent care where I was seen by an NP. When my instant strep test came back negative, she proceeded to GOOGLE my symptoms to no availperformed the lab strep test, and sent me home.
When my conditioned worsened, I returned and saw a different NP two days later. So, I went 5 days without treatment for shingles because 2 NPs were ryder stock options googling my symptoms and unable to locate test results to confirm their diagnosis.
Shingles is no picnic; try getting them in your mucous membranes. I got so sick I lost 20 lbs in 3 weeks and will likely have nerve pain for months longer than I would have had I been diagnosed and treated in a timely manner. NPs are NOT doctors. As I began reading this article I noticed you start with an anecdote of a NP failure. Further into the article I was surprised to see one of my favorite authors mentioned, Malcolm Gladwell, as he will usually embellish facts with his great storytelling.
I was even forex sb surprised that you would use the 10, hour rule as this is a much debated topic and one I would recommend you read about before using again. I also noticed that NPs prior experience was not noted. The AANP states that the average age of an NP is 48 and has been in practice for The traditional BSN student graduates at age 22, do the math.
NPs, just like MDs, practice within a certain area of medicine for which they have education and training. Knowing your limits is key and it comes can you really make money with doba to clinical judgement and decision making. Have you never asked a colleague for input?
This article is nothing more than a bias opinion to protect your occupation. I believe MDs have more in depth knowledge than NPs in many areas, but I also believe that NPs have enough education and training to provide care equal to that of their MD counterparts in the specialty for which they have education and training.
I was a CNA for 4 years, LPN for 6, RN FOR 10, bsn for 3, msn for 10…had certifications in ICU, med-surg, ER, rehab etc. Here currency in toronto trading jobs the bitter truth.
I attended a rigorous program at Khi forex rates. Would you let a medical doctor than studied medicine online and found his own preceptor in a local clinic treat you. NP programs should be limited to universities with teaching hospitals only.
That should be the future. The statement you made about NPs having or less total hours of practice is not accurate. I am currently in NP school and have came cara deposit di instaforex dengan kartu kredit through the ranks, beginning delta hedging nifty options an LPN, then RN Associate Degree, then BSN, and now NP.
This has been over the course of many years and now my 4th nursing program. Although I do agree that there are certain things only physicians must do. Nurses are trained to treat patient holistically.
We look at EVERY thing about the patient, including their families. I believe NPs have their own place in health care and have the education and training to make assessments and perform skills. Our whole nursing career is based on learning to assess. You must look at the individual provider, as there are some MDs who are reckless and practice dangerously, just as there are some nurses. Also, downgrading the medical approach in comparison to the holistic approach sounds good until you actually understand medicine, and then you will realize it makes zero sense.
Instead, those hours are spent in information packed course work and in cramming for the USMLE- ultimately vying for a coveted spot in a sought after residency.
It is, obviously, the goal that a resident will gain extra insight in a 3 year apprentice program — guided by a gifted chief resident. As a 30 year veteran BSN, who was accepted and attended 1. By virtue of anatomy lab, bio chem, histology, and neurology- our education paths are divergent.
I am fortunate to have been accepted in an FNP program which is carefully designed to heighten the level of expertise obtained in the profession of nursing and create a qualified APRN candidate- capable of treating patients in a family practice setting. When I conclude my FNP curriculum, I will have at least FNP clinical hours. Combined with many years in the clinical setting as a professional nurse.
Success rate of forex trading does, however, require a full collaboration between the all powerful AMA and the good stewards of APRN and PA curriculums.
Instead, we should initiate a come-to-the-table approach and follow the lead of amazing faculty like Dr. Catherine Lucey at UCSF school of medicine. Teaching the concept of illness scripts to anyone who will listen. As an RN, soon to be FNP and a former medical student — I do not believe adding more letters to my name is the best or only answer for bridging the gap between MD and APRN.
One language- one practice — multiple practitioners. The Accountable Care Organization ACO business model has identified the financial opportunity in streamlining healthcare to a diagram where the PCP is the center of the patient universe. Therefore, I challenge Dr. Liu and others to consider the benefit of a team approach and leave the patriarchal model of medicine behind. In the meantime, I will pray for a kind and gentle physician overseer in the state of Georgia where I will soon be deemed qualified to practice as an FNP presently NOT one of the 22 states with full prescribing authority or even one of the states with reduced prescribing authority.
This information was obtained from AANP. I received terrible care for over six years from two separate nurse practitioners. I was taken back by how little they knew of how to make rides cost money on roller coaster tycoon 2 basic physiology, anatomy, and disease pathology. They categorically do not have enough education and training, and it is obvious that there intelligence simply is not on par with an MD.
Enough PC nonsense, this should be obvious.
Nurse Practitioner vs Physician Assistant
If you want to be a physician, and you are not intelligent or capable enough to get day trading how many monitors medical school, please stay out of medicine.
All we are getting is binary option trading with paypal qualified health care providers.
The fact that NP are independently acting in the role of primary care physicians is fastest way to make money on animal crossing wild world symptom of a broken health care system. I am an adult nurse practitioner who went through a prestigious direct-entry nurse practitioner program.
For those unfamiliar with such programs, students without a nursing background spend years obtaining an RN, then years earning a MSN and being eligible to sit for a nurse practitioner certification exam. Yes, you read correctly years!!! There are very few residency programs and they are not required to practice. And then we are off to practice! We are not trained to handle medically complex patients and definitely not in the absence of a collaborating physician! Most do this not because they are greedy, but because the cost of medical training which, unlike NP school, requires many years leaves them with six-figure debts.
We need to find a way to make primary care a financially feasible specialty for medical students so that primary care can be administered in a way that works for patients and providers alike!
I have been a practicing FNP for 2 years now. In my state, NPs do have independent practice, but only after a 2 year supervisory period during which a majority of charts have to be reviewed by an MD or a nurse practitioner with at least 10 years of experience.
Yes, in medical school you get a residency, in which the oversight and mentorship is likely superior to what I received in my first 2 years of practice. I will admit that upon entering practice I felt woefully unprepared to have the health of patients in my hands remember I was in a supervisory period where all charts were reviewed. What has the MD who just finished a residency seen, that a nurse practitioner who has been practicing independently for 10 years has not?
I had a supervising NP with 10 years of experience and a supervising MD with 35 years of experience. They were both excellent providers, and his ability to provide good medical care to his patients was NOT superior to hers, in any way. I also speak as a nurse practitioner who took over the patient panel of a DO, and have seen some of the ridiculous choices, overprescribing, and unnecessary referrals to specialists that this particular physician made.
For example, she performed extensive testing arsenic testing, referrals to GI, the list goes on on an 84 year old woman with renal failure, based on a total bilirubin level of 1. Of course, I would never judge her entire profession based on this judgement…. I understand the concern that many physicians express here, but making generalized statements about the capability of a doctor, based on their degree, versus that of an experience nurse practitioner is shortsighted.
We need to protest NP diagnosing, and prescribing medicine. Just thinking about a NP diagnosing me, without sufficient training, or medical school, just makes my blood boil. My question is, why is there a shortage of Doctors, and how can we resolve this issue without degenerating the entire health system?
Perhaps if med school was more affordable, that would help some. Even efficient computers should helpby getting more done in less time. Who cares about the middle class and poor shit?
They are sending a message that their health is not as important as those who can afford a qualified doctor. We have to stop this from happening. Demand to be treated by a doctor.
You are not even an American! Foreign people come over here to make money and then have the nerve to criticize out health care. I am a PhD chemist. I saw a NP by accident and after that, decided I would only see NP from now on. All have been highly trained, skilled and have longevity of practice. You are arrogant and wrong!
I have been a NP for 12 years in primary care. I am in a state which allows independent practice. I ran a satellite office for four years by myself. I had a pediatrician who would come in for newborn checks two afternoons per week only and we alternated well checks until the child was two years of age at my insistence. Your discussion fails to address that most NPs are accustomed to working in a team as RNs prior to becoming NPs.
This is an advantage. I know when to ask for oversight. In my previous practice, we hired H-1 physicians as we were listed as a non-profit. Many unfortunately could barely even speak English and had difficulty obtaining an accurate history, so your article is crap. You should be ashamed of yourself.
We are intensely focused on make care super convenient, quick and easy, and inexpensive by providing care via app or website. We currently provide treatment for simple uncomplicated primary care issues like acne, bladder infection, birth control medicine, heartburn, hair loss, and sinusitis among others.
We look forward to making more services available as we expand to more states. Sorry if this upsets anyone, but I am very scared having these people unattended. I have no medical degree, yet I have been much more knowledgeable then any nurse or PA I have ever encountered.
Well, I guess it would be if I wanted tendinitis or other antibiotics have previously failed. Now for a sinus infection the MINIMUM time on Cefdinir would be days NOT 7 days.
Needless to say, I finally made it back to my doctor in the same practice and he was shocked that she would only prescribe for an issue like that for 7 days and of course wrote me a second prescription for the rest of them which I had to pay for twice.
He then said he would speak to her and explain to her how to prescribe antibiotics for a sinus infection. If you have no clue how they even work and what the severe side effects could be then you have no business writing prescriptions. At this rate, anyone could just go off the street and become a midlevel provider.
What was even more appalling was during the same visit, a lady was sitting there doing nursing duties checking bp and blood sugar ect who turned out to be an X-ray tech! I was horrified when I figured it out and there was no doctor present at all at the clinic. It was shocking and completely out of control. As a patient, I have lost complete respect for nurses over the years.
They want to play doctor yet every single one I have ever seen has given me false information or have not had the first clue on what they were talking about. Then I magically see a doctor and he understands exactly what I am talking about and the issue so I can get the correct treatment.
And the way I see it as a health care customer, aka patient, is that NP or PA visits should only be half the price because you are only receiving half the care. I hate to sound rude or disrespectful in any way.
I know they try, but after repeatedly being misdiagnosed and mislead by non-doctors, causing a delay of real care, it has really shown me that are not qualified to play doctor.
The way I look at it, if you do the schooling and receive your doctorate in any form of education, you are entitled to be called a doctor, period!
After reading over all of the comments I felt compelled to comment myself as this single post has generated a two year debate. The ongoing struggles between mid level providers and physicians grows stronger as payer systems shrink and the cost of education rises.
At its core, the art of medicine is now an evidenced based conglomerate which has been marginalized by a database that can be accessed by anyone including physicians, midlevel providers, and even the layman. I feel like it has convoluted and blurred the lines to a point where a new struggle has emerged trying to figure out who runs the show, who should be paid the most, and who should call the shots.
I, like many here have seen both sides of the spectrum in regards to quality of care which is affected by many aspects including demands of institutions, apathy towards ones profession, and lack of knowledge. One thing that has stuck with me over the years is something a seasoned colleague once told me and is echoed by the NYT article: We can all benefit from that fact.
My training was at a university level and mutual respect was common practice but there is always an unspoken undertone that I think you can feel. We all want to be the best and while doing work that oftentimes requires a level of confidence, I believe it is unavoidable not to have confrontation of ego and an ability to believe that your plan is the only plan. Nonetheless I routinely perform many of the skills that have been outlined above not limited to emergent resuscitation, intubation, etc.
I do agree that a strong base in physiology and more importantly pathophysiology and an avoidance on the reliance of diagnostic tests does allow us all in the profession of providing quality of care clears way for the construct of medical care. I do believe too however that experience and exposure to multiple versions of the same thing and atypical presentations are very valuable in being a well rounded provider.
I am hesitant to say which side of our debate that I am part of so I want to leave that part anonymous. I will say that at the end of the day, no matter what profession you have decided to undertake physician vs nurse practitioner vs physician assistantmake sure that you understand that your limits are defined by your understanding of basic knowledge of biological science coupled with the experience you have gained based on the environmental diversity that atmosphere can provide.
I hope this conversation will continue with a less callous approach on both sides of the spectrum. As a nurse practitioner I agree that doctors are the people with a medical degree and that their training leaves them better prepared Of course training and preparation costs and is becoming increasingly expensive.
I would argue that training needs to change to address the accessibility of appropriately trained competent individuals who can treat patients be these doctors, nurses etc At present the elitism in access to medical school has excluded many able intelligent people from reaching their potential and we have a shortage of both nurses and doctors. You neglect to account for the clinical hours as a registered nurse. I have 10 years as an ICU nurse before I applied to my primary care program.
And please remember in EVERY field there is a spectrum of excellence. I have met far more idiotic MDs who entered the profession solely for the prestige and could care less about the patient. There are exceptional practitioners and lackluster ones in ever field. Not to mention NPs must be rectified far more frequent than MDs, and for some specialties recertification is only recommended not mandatory.
The decision to become an NP is not one entered into lightly and we ate fully aware of the differences. Hence we study day and night, join associations, subscribe to every EBR journal, and do everything to be as informed as possible.
Not to mention consult with physicians. If only they spent that time working with patients instead of pushing the propaganda and making these huge claims that doctors only care about the disease and not the patient. Every medical school teaches about treating the patient as a person. Their entire motto is treating the patient holistically. The kids from my college and high school who went onto become nurses and nurse practitioners were C students and many of them were dumb as a rock.
But now they flaunt their DNP degrees they got from Online Nurse Practitioner school where you can make up your own clinical hours and have them signed off. Yeah good work controlling glucose and blood pressure. Oh great nice to meet you Dr. Gold, Is there anything I can get you? Who the hell is my real doctor!!! I love the nurses coming on here and bashing physicians. Why not be truthful as to how one obtains a doctorate in nursing. Several advertise little to no time on campus. Tests are honor systems.
No classes really on medicine. Most classes on administration and other. Or when a simple diagnosis is missed because of the lack of training. It is the patients responsibility to do their homework on who is treating them. ANYONE who makes wide over reaching claims that encompasses entire groups of people is probably unaware of how the system actually works, or works in the field and is insecure about their own quality of practice.
A Full time Nurse will work 1, hours a year in medicine and most reputable schools require 2 years of nursing experience prior to applying to the program in addition to the clinical rotation hours mentioned above. I would rather see an NP who has practiced for 10 years than an MD or DO right our of residency. Good Vanity Fair article piece regarding the Air France crash and the differences in quality of experience between the two pilots. The crew arrived in Rio three days before the accident and stayed at the Sofitel hotel on Copacabana Beach.
At Air France, the layover there was considered to be especially desirable. Dubois had come up the hard way, flying many kinds of airplanes before hiring on with Air Inter, a domestic airline subsequently absorbed by Air France; he was a veteran pilot, with nearly 11, flight hours, more than half of them as captain.
But, it became known, he had gotten only one hour of sleep the previous night. Rather than resting, he had spent the day touring Rio with his companion. Flight took off on schedule at 7: The Airbus A is a docile twinjet airplane with an automated cockpit and a computer-based fly-by-wire control system that serves up an extraordinarily stable ride and, at the extremes, will intervene to keep pilots from exceeding aerodynamic and structural limits.
Though he was the Pilot in Command, and ultimately responsible for the flight, he was serving on this run as the Pilot Not Flying, handling communications, checklists, and backup duties. Occupying the right seat was the junior co-pilot, Bonin, whose turn it was to be the Pilot Flying—making the takeoff and landing, and managing the automation in cruising flight.
Bonin was a type known as a Company Baby: By now he had accumulated 2, hours, but they were of low quality, and his experience was minimal, because almost all of his flight time was in fly-by-wire Airbuses running on autopilot. Your article is simply regarded as personal opinion without such. As for my opinion about you, again just as validated as your assumptions, you see patients over an app.
Wow, this seems very safe alot safer than an NP seeing a patient in person. No wonder you are blogging. I guess you have to make your money somewhere. I would like to make an observation in regards to the assertion and argument of interchangeability. NPs can and do provide many of the primary care and acute care services that Physicians do in the same setting. Just as a PCP may provide much of the same care to patients with heart diseaseyet it does not make them a cardiologist.
The question arises, does that mean they are inferior in managing hypertension? I would never equate the care I provide to my patients as being the same as a Physician, nor would I want it to be. I relish my training in relationship based care and focus on evidence based practice.
But I will assert the quality of care provided within my scope has been proven repeatedly. Personally I find the ongoing attempts to compare and place NPs and MDs in some hierarchal war tiresome.
I would encourage those who dismiss the role NPs play in the growing healthcare environment take a moment to examine the numerous RCTs on outcomes, and patient satisfaction. This entire discussion has further secured my decision to go into speciality care. My team members and colleagues have embraced my position and approach.
Just as I consult and refer to them for a positive stress test or for worsening valvular disease they in return consult and refer to me for the ongoing management needs of their chronic cardiac disease patients. Team based disease management and care is the future of healthcare and those who refuse to be a team player will find it difficult.
No longer do the initials behind ones name mean they are at the helm. And one last observation, NPs are not Physicians but they most certainly can be Doctors, as are most professors in Academia, as are some Pharmacists, as are Attorneys. Many of my fellow NPs have their DNP and some of us have a DNP and PhD, yet each time we enter an exam room we proudly introduce ourselves as a Nurse Practitioner.
Precisely why this article is titled Why Nurse Practitioners Should Not Do Primary Care Without Physician Oversight. Good luck and thanks for your insights. I function as in independent provider in a hospital clinic. I also interpret those results and treat accordingly. This being said, I have numerous cardiologists available by phone if I have a question I consult with them. The same as any provider would; the same as you do I am sure for tricky dermatology issues, renal failure or cardiac sarcoidosis.
On numerous occasions our Cardiologists have said something to the following. Our NPs know what they are doing and they do it well. Otherwise we just get in the way. Ultimately it is about trust… I certainly hope one day you will have the opportunity to work with more NPs and you will be open to giving them an honest assessment based not on assumptions but on their outcomes, knowledge and abilities. As a MD, details matter! I agree that Nurse Practitioners need more clinical hours. I feel like the first year of FNP school was still talking about stupid nursing theory.
I would rather start into shadowing and clinical experience for an entire extra year. I think the schools are doing Nurse Practitioners no favors. I have had many physicians miss a diagnosis I have caught. I knew the answer from being a RN and not from school.
Also, I have had many physicians diagnose me incorrectly and not listen to me. Let the statistics and patients tell you the truth. It seems sad to me that physicians often feel threatened by NPs. We work as a team and not 1 person MD, DO, NP, or PA knows everything. I should clarify what physicians missed.
They were wrong and in very serious cases with potentially scary outcomes. So while I respect the thought that you are concerned for the patients, I am hoping that is the essence of the article, I would heartily disagree with your assessment of ALL independent NPs.
This is an interesting thread, and I see some very passionate responses. I think there is a traditional patriarchal understanding of what a nurse does and how much they know.
Education in nursing is always evolving as is medical science. I have been a nurse for a long time, and also have seen awful conduct by physicians; however, that being said, I do think that they are essential to a multidisciplinary team.
All our specialties are made to provide the best care in a team approach. One of the issues is that nurses are allowed to enter practice at various levels of education. This may be the crux of the problem that physicians have with us practicing primary care. As much as all of us would like all nurses to have a doctorate degree, its just not likely to happen while there is such a severe shortage of healthcare providers. That being said, a doctoral prepared nurse has had years of experience, and has likely had more time with patients than a physician coming off of residency.
Do new physicians need oversight if they were to open their own practices? We should embrace each others capabilities, and not say that one is better at providing care than the other, because its not the truth. The Institute of Medicine and the Robert Wood Johnson Foundation advocate for nurse practitioners, and its too bad that there are some standing in the way in improving access and health outcomes by impeding NP progress.
That is a protected title for them!!! Doctor is not,many other professions have doctorate degrees,which entitles them to be called DR. This can include nurse practitioners. Physicians have more training and they are a precious commodity,however nurse practitioners are severely needed in medicine also and can handle the challenge. Physicians will always be needed ,especially in specialties,so I do not understand what they fear. First, I note the wide variation in egocentricity among the NPs commenting.
This appears in two areas in the comments: If that is true, then why not allow RNs or CNAs to practice independently? Big egos are dangerous. The second area I note relates to claims of equivalency in training. Yes, I know that a lot of NPs are plenty smart, but getting into a nursing program is not even close in competitiveness, and much of the coursework is far less rigorous compare typical requirements for organic chem and biochem, for example.
They are absolutely necessary, and in very small communities independent practice may be the only option to provide any health care at all. Also, I note that after the first confusion and presentation of evidence, she admitted her error and apologized—a big ego sort might well have argued right to the wall, and that is not acceptable.
Would be interesting to compare this statement with the ED. I have always suspected the ED to be the front line introduction. My observation has been most new patient referrals to primary care come at discharge from a hospital say. In the last 16 months as a patient I have had 3 horror stories with NP and PA I am so angry with them.
The first of the 3 screw ups was the only one to properly identify themselves as not a doctor. There seems to be an overwhelming problem of FAKE DOCTORs in my area, which led me to read this article today. I tried to book an appointment with my primary care today and I was asked if I would see another doctor in the practice. After getting off the phone I decide to look up this other doctor only to find they are a Nurse Practitioner, NOT a Doctor!
I was lied to! It is absolutely an ethical issue! Not only is this person not gone through same training as a doctor but they are going to charge me as if they were a doctor! If you want to be a doctor MD or DO go to school, that is all it takes.
Save the time and go to school. I cancelled the appointment today right after I found out I was lied to. Now I read all that was stated prior and now knowing I can report the NP, PA that screwed up I am going to do that. So thank you for educating me on that.
Maybe that will help with improving quality healthcare future patient gets. Your email address will not be published. You may use these HTML tags and attributes: Get important exclusive advice and tips on how to save money while staying healthy. Learn how to make intelligent choices in America's Healthcare System. I'm Chief Clinical Officer of the start-up Lemonaid Health. I'm also spent 15 years as a practicing board-certified family physician with Kaiser Permanente as well as held various senior leadership roles.
I'm the author of two books, the latest book The Thrifty Patient - Vital Insider Tips for Saving Money and Staying Healthy. I'm passionate about making health care better for patients by providing easy to read and actionable information and also by developing physician leaders who can lead change to make care more personal, convenient, and worry free.
Follow me davisliumd on twitter. Read My Full Bio. Website powered by RedstoneX SEO CMS. Home Leadership Resources Dr. Family physician, author, blogger, speaker, physician leader. Marjorie Burnette on February 4, at 3: Davis on February 4, at 7: Jay on September 26, at 4: Doctor is a title, not a profession. Nothing you posted demonstrates any lack of insight or acumen on the part of the NP. Davis on October 3, at 6: Laura on December 4, at 9: Becky King on March 10, at 1: Davis on March 10, at 6: John on April 14, at 2: Mahan on July 15, at 1: Jennifer on August 3, at 4: Nurses will never replace doctors, nor should they.
Ken Isaacs on December 7, at What is a nurse Practitioner? How to become a NP In short, a nurse practitioner applicant is a registered nurse with a BSN undergraduate degree that has successfully passed a state licensing exam with at least two years experience who has made the decision to return back to school.
Steve Russ on March 17, at 1: Carolyn on June 12, at 9: NormanNP on May 18, at 4: Susan Ercia on August 2, at 3: Debi Haney on August 7, at 7: Erin on September 26, at 1: DNP in training on October 11, at 4: Arjun on October 23, at 7: Kathryn on November 1, at Joe on November 4, at 4: Mike on November 25, at 4: Joe, Calm down buddy. Myla on December 23, at 2: Concerned on December 23, at 4: Require NPs to get the ALL training they need BEFORE they graduate.
Alanna on February 12, at 4: Eileen Rothrock on February 13, at 2: Please, use common sense. Patricia Hall on February 25, at 9: Frustrated on March 7, at 8: