I my FNP career I have worked in 4 different settings thus far and I was let loose after the first couple of weeks of shadowing the MD. I love that you are honest and honestly you didnt say anything to be I try to practice that now. By posting it in a public forum,youre clearly indicating that it is generalizable to others. *Side note: MDs may certainly find themselves cleaning up some messes caused by incompetent NPs. Additionally, many NPs couldnt afford the premiums our physician collegues are responsible because our pay is significantly less. I have worked with a plethora of doctors, and I can tell you that they are human beings like the rest of us with anxiety disorders, mood disorders, and even personality disorders. Therefore, nurses must determine whether pursuing an MD degree is worth the time, effort, and cost. An NP has independent practice in SOME states, but not others, and its not clear what will happen regarding NP practice nationally. I got allergy tests, and shots leaving me chronic sinusitis free. Will be in touch! As a nurse, I feel like my patients lives are in my hands. If you were a passenger on an airplane, would you rather have the hostess fly the plane than the pilot? When I heard that first-year medical student Mariposa Garth-Pelly was a nurse, I had to meet her. My thoughts: First, NPs do not practice medicine, we practice advanced practice nursing. Unless there is a problem with the number of doctors, somewhere like Alaska. I went to an emotionally charged meeting of docs the other day and one of them said please dont get stuck on my words and opinions because its going to prevent me from using my voice. People spend their lives amassing material goods, education, etc . Nor should you You consult with specialists. You dont have to, but I use an EMR (Kareo, $150/month) and most of my non-urgent patient communications are through that. Just contact me here with your phone number: https://www.idealmedicalcare.org/contact/. I do respect PAs much more, as while they are seeking to expand abilities to practice from specific supervision, they feel it should be team practice for necessary collaboration. NPs are held to the same standards and guidelines as MD. My recommendation to Ethan had nothing to do with an abusive med school experience. This overlaps with medicine in the same way that osteopathy overlaps with medicine. Im not attached either way. That is why we collaborate with specialists and all others involved in patients care. Its laughable to me to call the AANP a powerful lobby when I think of the AMA and their recent comments on NPs, even though it recalls to me their 170 year turf war against anyone besides MDs, DOs included. Yeah, as a med student, this whole post basically reads to me as, Fuck you future doctor, you should have gotten that online degree instead.. The 2008 crash saw the latest spike in RN training in US history. 3. How does that seem fair? Ask your collaborating physician or your peers for help. Thank you for being a beautiful soul Dr. Wible. For all the M.D.s who have stood up on this DB, jumped up and down, and pounded their collective chests about how great they are, and how NPs should not be permitted to practice independently, allow me to ask this: Where are all the family practice providers in rural, underserved areas? You may run circles around PA students as stated, but youd be clearly left in the dust with your paltry eight years of experience against my sister with 30 years of experience. Throughout my years I have been bullied an harassed by MDs on a regular basis. I can be reached at brookebdo@gmail.com. I am a psychiatric NP practicing independently. With this post you singlehandedly are promoting harm to patients and your physician colleagues. My daughter got her lpnthen rn..then rn with bachelor degree and finally three years for her np at a good college. In a nutshell, decrease risk for your patients and become a physician. They told me about their schedule while in school, which is pretty much nonstop for 2 years straight. I just have to sayI really, really admire your courage. I actually had no idea the extent of abuse physicians went through or that their profession is number 1 in suicides. The only reason hospitals and clinics are pushing NPs is be ause there is one thing That is true: it is cheaper to hire them than hire a doc. Remaining silent is never the solution. Like, oh, why not grab a seltzer water for me while youre up at the fridge? I still take insurance. I narrowed my focus to Family Practice. You realize the DNP degree is NONCLINICAL, right?? Not sure why men don't want to be nurses more often. Heart-wrenching photo of doctor crying goes viral. Surely that makes a huge difference. I love doctors. In my experience, PAs come out of their training with a healthy level of respect for their lack of knowledge. ALL health professionals are invited to our retreats. Our health finance paradigm needs to change. Im sorry. Stop with the generalizations that all NPs are inferior to MDs and make a name for yourself. For nurses that have their BSN (bachelor of science in nursing degree), you may have completed most medical school prerequisite requirements. That's not to say doctors never take a more holistic . I would be happy to talk to you more about this if you care to send an email! Seems to me the rates should not be lower. That seems to be what this author is sayingthe shortest, cheapest, least difficult route is best. Perhaps Im just lucky and my NP may also have turned out to be an amazing doctor. Anyway, I am considered a peer by my physician colleagues and they poke fun at me when I address them as Dr. xyz instead of by their first names. Providing for our patients is difficult no matter what, or how many, acronyms are behind ones name. You give MDs a good name with your compassionate example, my prayer is your impact continues to promote mental wellness for MDs and students. Patients have a right to choose their care and be compensated for deviations from standards of care. My scope of practice is limited to psychiatry. I think anyone who has been in primary care knows, most patients need more time and attention. We all come from different walks of life, weve all been blessed with different opportunities, a persons credentials do not determine their values. Furthermore, the program may require a fellowship. I dont care so much about autonomy, I care about healing, and I have a massive hunger for life science and want to know all I can in what ever path I choose. You are certainly one of the most enlightened physicians I have encountered, I would have loved to have worked for you when I first graduated. NPs work for years as RNs before and while attending their NP program. However, they do not have the training or the knowledge to replace primary care physicians as you suggest above. Ive known doctors who have practiced in ways that endanger patients as well. Someone brings out NPs order more tests vs. article showing same outcomes for MDs/NPs vs. compilation of mistakes NPs have made vs. the mistakes that MDs make. A first year resident cannot practice on a patient unsupervised and you condone a NP with an 18 month degree can? You can even leave my name if you feel inclined, although I dont think itll make me an overnight sensation.. Sure, you can try to do that as an NP, but as Pamela pointed out to you, 10% of the training is 90% less mastery. Additionally, any NP is going to be dealing with a lot of the same administrative, insurance, EMR garbage, so why not be well trained and better capable of taking care of the patients? Not everyone is mentally or spiritually ready to be the last decision maker when it comes to maintaining a life., 9. Thats not how life works! These corporate monsters are destroying us NP or doc alike. Retrospectively, I strongly believe this requires the rigorous training of a physician, especially in the field of primary care. > Its pretty clear that generally speaking NPs/PAs make about half of what MDs do while working in the same offices (which is fair because they had to go through half the amount of education). Hi Dr Pamela! Each profession allows nurses to provide high-level medical care to patients. However, the NPs who I meet are much more psychologically stable as a group and just lack the business strategy that we teach at the retreats. There is a remarkable difference between an MD/DO and NP/PA. I also hate the term mid level and provider..but I didnt know what word to use in place of provider. You can keep that responsibility too, Doc. I think I have enough years to say to you that I loved who you were from the day we talked and being brave and speaking the truth doesnt mean its easy. But what I CANT DO is after all my training to become a physician, go back in time and get those years back. I agree with your line of thinking, too. 4 Reasons Why Nurses Dont Want to be Doctors, The Aging Body Systems: Explaining Physiological Aging, Safety First: A Nurses Guide to Promoting Safety Measures Throughout the Lifespan. Working under interventional cardiologist, I often find myself cleaning up messes left by incompetent hospitalists/intensivists: NPs/PAs/MDs/DOs alike. I think we all know the training isnt even close to being comparable. The health system is now experiencing rates . But unsupervised solo NP is dangerous. Training does in fact matter. These comments make you question, what are you trying to hide? You can not compare the hours of clinical practice a new NP has with a new PA. Do I want an experienced hospitalist NP to talk to also? You totally get that message and it comes through in your posts!!!! Prove that youre worth your salt. But the research on unsupervised NPs compared to physicians is lacking. Do you have a problem with NPs? Because many of us have non-existent physician supervisors already. While its extremely important, it cannot be done without a proper foundation. I have had no problem accepting the hierarchy of medicine with MDs higher than NP/PAs although I think the comments here may have forever changed the teamwork model of patient care I have developed, as I will wonder what doctors have the more angry underlying attitudes expressed here. I greatly appreciate that you are thinking critically about your future training to best care for patients and balance your own well being as well. I dont see anything wrong with this article. To compare an NP to a doctor is laughable. Why More Men Don't Get Into The Field Of Nursing : NPR I agree that I did not have as many rotations as medical students do. After 20 years as a PA I would not suggest this career to someone vacillating between becoming a NP or PA. Not that I have any issues with the PA profession. It will always be a point of reference until I end up deciding, and Im grateful for that! That should highlight who is better trained I would hope. 4) I will say that much of what I learned that was most valuable came from a few attendings that I adored and from primarily (90%) my own MOTIVATION and relentlessly INQUISITIVE nature. I suspect many of us would consider a program that bridged us to MD/DO. But I know of none out there. I too have similar thoughts, but do not speak them it loud due to the backlash you are receiving. Im disappointed. When I started I was assured more time and work/life balance. The medical model with its concerns of diagnosis, treatment and cure, has a narrow and unsatisfactory view it takes of health care. The do have to have 500 hours of clinical training during the school time. Do I think Ethan will emerge with less mental health struggles as an NP? I think out training needs to be less one-size-fits-all and more personalized. Its infiltrated with variables that shouldnt even matter. 18 comments Best Add a Comment Wolfe244 4 mo. They are a vital part of healthcare teams. As an MD myself (but in pediatric subspecialty practice), I had a few thoughts: I call knowing that a gut instinct. Sounds like you have listened to your gut in the past and made a great education and career choice to become an RN. The system needs to be fixed. Lastly, many countries dont recognize a nurse practitioner license, and being able to work internationally using the full extent of my knowledge base was (and still is) important to me. Countless coverage in the ER/Trauma center. How is someone with more education is worse or equal to someone with significantly less and unregulated education. But, imagine having to make the medical decisions for a patient. This is exactly the problem with the current medical model. Although I can be a neurosurgeon if Ill go into residency training again. Politics latest: Chancellor to meet regulators in bid to tackle cost of That is, if one does not recognize the limitations of their knowledge in their practice, it is a disaster waiting to happen. SO!!!! 4) My wife insisted on seeing a business plan before she would support me. If you dont want an NP then tell me why. It really doesnt bother me not to be 100% autonomous. They only have to do 500 hours of clinical training. In my particular situation the difficulty in time and financial strain would aggravate my wifes condition much more than mine. Everything depends on the end goal of the person. The result is that today's nurses are nothing like their predecessors. The fact is, we choose to be a nurse, just like this young lady. The MDs are reporting NPs refer to specialist more. Also: Dont say PROVIDER. If I couldnt stand listening to people complaining and I just wanted to be able to treat and street in <10 minutes, I don't think I'd be a happy camper as an NP. Your nursing background will serve you well. It is necessary to apply to the medical program regardless of educational background. Please remember that whatever path you take, never shirk the importance of collaboration and consultation with other care providers. NPs are regulated by the Board of Nursing not the Board of Medicine and the BOM has much higher standards than BON in regards to the practice of Medicine. (Has anyone ever considered that it might actually be more feasible to save NP education by adding in the medical foundation than it is to save medical education by taking out the abuse?? Do NPs make more money than doctors, and do NPs really have full autonomy? And so glad you are happy in your practice and that you had good mentors. Medical model Vs Nursing Model. Kudos to any NP and PA becoming an MD. I recommend that plenty of others go to MD or DO programs. I work as an RN in BC, Can. For NPs to treat something that is simple, they will have to have plausibly ruled out all that is not simple, but appears simple. Next time, when you MDs and DOs are rounding your patients, take a very good look at the nurse caring for your patient because that nurse one day may be your FNP to whom you will entrust your patients with and you would be very grateful for the care she has provided to your patients and for the extra income she added to your pockets. We all need sometimes an extra pair of eyes or ears or hands to confirm our diagnoses. This may also help you with your decision. I can assure you that it will not be your last. Pamela: Can I publish this on my blog as I think lots of people would like to know the answers to these questions. 7. No, they do not learn CPR, start and IV, clean a gurney appropriately. Please dont lead my health care Pamela. It all depends on many, many factors that an often young premed must weigh for themselves without proper guidance. Unapprove | Reply | Quick Edit | Edit | History | Spam | Trash. While there are valid reasons to choose becoming NP over MD/DO, rest assured the education and preparation is NOT equivalent. Thats where I was. He scoffed at me when I said adults with heart failure, diabetes, renal failure, depression and chronic pain were a little bit different than kids with an earache (dont get me wrong, earaches suck and deserve care, but its a faulty comparison). You will always have your nursing education and experience to enhance your practice and you also will have a medical education. Dont you dare ASSUME bc Im an NP that I cant treat patients in a safe, accurate, and comprehensive manner. One significant factor to consider is where you wish to practice. Patients are not all the same (and they deserve more than 7-minute visits). How Nurses Become Doctors | Work - Chron.com Well this has changed but until we all work as a team without the bullying in health care, there will be a divide between MDs and NPs. I also disagree you can master it by being a life-long learner. This is what were working on in our little corner of Austin!! But, PAs, with rare exception, are trained in medical schools, alongside medical students with preceptors that are often the same attendings as the medical students. Every few months new policies would come down for no apparent reason which put more of a strangle-hold on providers and hamstrung their efforts to give patients care they deserved. Overall, it can take up to 10 years to become an MD. But those environments are made up of people and it is the people in them who make it toxic. For that, I am thankful. I do believe Pam is quite capable writing her own blog. I would think MDs would be secure enough in their own skin to understand this and not feel the need to degrade NPs. And ultimately if providing high quality primary care is Ethans goal, (not becoming a surgeon or specialist), a nurse practitioner can very well provide that. You ask for help too when something does not add up. I see many of our fabulous ED RNs go onto NP school. Concern grows around US health-care workforce shortage: 'We don't have After BS/BA, PAs have average 100 grad hours, sorry no history of PA, only pharm, neurology, oncology, nephrologythen 2000+ clinical hours. So you and your little eight years will never encounter a fourth of what she has accomplished in her career. Do you not think this will lead to over consulting, over referring and over utilization of tests/labs ? A brief football analogy. I work in ambulatory clinic in large hospital system. I also love many NPs Ive met. In medicine, a provider is an economic term used to lump all the revenue-generators together into one pile (often to see how much more money can be squeezed out of them). Ethan has severe anxiety. Ive been fair in my criticism to my own profession. NPs may make a similar income as physicians in certain areas such as psychiatric and primary care but not many others. A labor of love. My only other response is to please stop associating me with the word burnout which is a victim blaming and shaming term that deflects attention from the system that perpetuates human rights violations against our brothers and sisters in medicine. Thanks for writing. You are so right, education in any scope is merely what you make of it. When they say please just see one more patient a day counter with I will see one less patient per day, do with that what you will.. We have a problem with NPs practicing MEDICINE UNSUPERVISED with NURSING training. I dont think she deserves this kind of vitriol. You ate delusio al if you think that overall NPs are better than doctors. I reached out to a medical aid mission that accepts donations from hospitals. I absolutely feel that those pursuing medicine need to know all their options including naturopathic medical school. Then you have at least 6-8 or more years of school (assuming the RN has a bachelors degree and not an associate degree. If you don't have ADHD, Adderall and Ritalin won't work for you Im hurt for our physician colleagues as I feel you are equating an NP to an MD/DO. Burnout same as doctors for far less pay. The patient-provider relationship has been systematically destroyed by ballooning, unnecessary administrative costs and the direct translation of expenses and revenue into waste. I became a NP entering from a totally different profession (City Planning) at age 45, a journey that spanned from 1996-now. There is no question that medical school is completely different from advanced practice nursing education but some of the MD/DO responses foolishly underestimate NP dedication to patient safety, seemingly assuming they are the sole keepers of positive patient outcomes. That is a lot of responsibility already. If a midlevel education is sufficient for practicing medicine, then why in the world does anybody go through this process. Making more than $75,000 dollars per year wont really make you any happier. Sometimes the choice is rerouting to naturopathic school. So, I would ask that you give a more even set of advice when someone comes to you with this question re what type of provider should I be.. For those so adamant speaking against NPs and PAs, I sure hope that they do not employ NPs because that would only speak volumes to their hypocrisy. Ive written extensively on the dangers of using this term. #2 If physicians would go practice in areas that need them, like rural areas, or reservations, or other places that might not necessarily be the nicest to live, then our nations wouldnt need independently practicing NPs. NP programs are not rampant with human rights violations. Healthcare is collaborative, and the best docs Ive worked with had respect for all members of the team. Im very curious to understand if this division in training models still seems useful to practitioners (who arent just carrying a chip on their shoulder about why their training is better). I do so many things that Im not sure what to call them all. Why not make PAs a doctorate? I read some unfortunate replies to your interview. (Later attendings have written me apologizing for belittling me for what science how now proven was correct all along). If one doc is practicing assembly-line medicine is 7-minute increments and another is seeing patients q 30 minutes then obviously those with higher throughput and larger patient panels in shorter visits are higher risk. What I recommend to this nurse in his unique situation does not reflect a lack of love for my own profession. PAs are trained in the medical model, and NPs are trained in the nursing model. People do go this route. I know that going in, I will never have that medical school background and I wish that I did..and I know my limitations, believe me, not afraid to ask questions. If I made Doctor money, Id be in a better position to do that. I just wanted to share my experience and hopefully provide some perspective to what seems to be a very polarizing topic. Women have primarily been "caregivers" while men traditionally were "leaders.". I love that I have the time to connect with my patients and dig deep to find out what is really going on with them. Why so much generalizing? So, supervising is incorrect to use. I sure hope that all the complicated patients get to see the doctor..but as we all know, there is such a mind body connection in medicine and that is something a good nurse has a wealth of experience in that cant be taught in any medical program! As an NP what do you see as the difference? Traditionally, nurses are beyond criticism. Launch Your Ideal Clinic or Coaching Practice. No degree guarantees that you will practice ethical, safe, accessible medicine for your patients. It all comes down to each individuals training and experience. I wont lie to you, this is a long, exhausting, exhilarating, draining, crazy adventure. Why would she need specific Doctors to help her rewrite this passage. and 3000 clinical, thats before residency. Maybe you can lead in creating a more unified and less divisive environment for the next gen of health professionals. These mid level providers are not and never will be the equivalent of a physician when it comes to knowledge and educational background. Also love the word healer! And although NPs do have the ability to work without the doctor on site? I still think medicine is the most fulfilling career for those who want to pursue with INFORMED CONSENT of the risks.
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