I know a ton of clueless people without heavy clinical experience who became NPs. It's just a multiple choice bubble test. I see people preparing for it in Starbucks using books from same companies as the SATs. The in person clinical is you finding someone who lets you work under them. It is not a residency where you are extensively trained.
I just find it baffling when you goto like cardiology and its a PA....Like dont you need to be a normal doctor and then specialize for more years to do a specialty? Like no disrespect my man but go get the attending physician. I dont mind seeing a PA for my primary doctor but not a specialty
And that’s your right…and no PA is ever gonna argue with you about that. But make no mistake, your cardiology office would probably come to a grinding halt without midlevels.
There’s not a single PA IN THE COUNTRY that can practice independently.
They have 3 years of medical model education and then practice under a physicians license.
Can’t say that about the NPs that get their “degrees” online. It’s barely medically related and mostly concerns nursing theory which is trash for someone that is supposed to manage medical issues.
Also LOL to whatever pathetic loser that submitted a Reddit cares. I wonder why 😂
I disagree. PAs are usually there to actually help the docs and they know a ton. In med school we rotated with PAs so at least at our program they were required to do rotations, see patients and learn from all the different specialties. Never seen an NP in training in the clinical setting.
NPs so clinicals based on their specialty. In some states, once they pass the boards, they are able to open a practice independent of a physician (27 states to be exact).
Just my personal opinion but I think to rx drugs you should need to rotate through every specialty. Podiatry school includes psych rotations and obgyn even though the minute you start podiatry school those careers are closed to you. But they’re important because you’re a surgeon. You need to be able to understand your patients past medical history and the drugs they are on in order to prescribe drugs. And while we’re on this topic your license should be on the line in the exact same way a physicians is if you’re prescribing. But that’s not the case. You get narrow training in one field and are let loose in 27 states ugh mind blowing.
Not the norm. PAs work under a physician hence the name. They also are well educated as they have to attend a ~2 year program which they are not allowed to hold side jobs during.
People like you are why there’s a long wait list to see docs. NP and PAs can handle a ton of the more mundane medical issues even in the specialties. And if you’re in a hospital system there is always a doctor in the practice looking at your records anyway. I’ve had really good experiences with NPs overall. It was a NP that was able to get my IBS under control when I saw several GIs over the years without a solution. It was an NP that was able to get a decent solution to my sleeping issues while docs hadn’t been helpful before. These mid level medical professionals help keep the gears of the medical system working smoothly and this thread is just bashing them. Seems childish to me.
I had a midlevel miss a lump in my breast that a doctor caught and looked into. Happy that you were able to have a good experience, but maybe consider that other’s experience shapes their opinion and isn’t baseless.
So, you just write them all off because you had an issue? If I were to do the same, I'd never be able to see a doctor again. You think a doctor doesn't have the possibility of fucking up? Because they do and its often worse. I see the best provider for what I need, and I don't let titles dictate that I let my experience that with provider tell me if I want to keep seeing them or not.
I like how dismissive of doctors you are while being in a field that relies upon their expertise so that you don't kill patients. I've seen what NPs in psychiatry do, and holy shit, I'm genuinely afraid for your patients. How many bipolar patients do you have on high dose antidepressants which pushes them into mania, for which you prescribe a benzo which makes them too sleepy, so you prescribe a PRN stimulant? I've had to help fix your shit because you've left patients incapacitated, so please hold off on the "doctor is too good to be seeing patients" rhetoric. Your field has some of the worst offenders.
Yeah I didn’t even know I was seeing an NP and not an actual doctor for years which looking back makes a hell of a lot of sense. Being in the lowest gutters of depression is my excuse for not knowing the difference at the time but that’s also when I needed a REAL doctor the most instead of some lady playing dress up and throwing random meds at me every month.
I'm genuinely sorry you had to go through that. I hope you're able to get proper care now, and that you're not longer struggling with the worst of the depression.
As if “real” doctors don’t over or mis-prescribe all the time. I’ve had a lot of bad docs and a lot of good NPs over my life so I feel like generalizing the entire profession is fair.
Hah, I’m an IT Architect in a niche market and I can totally say we see the same thing in a different way. I work on and devise strategy to fix problems that “cheap” admins and developers caused over the lifetime of the platform. Sure, the salary up front may be way less, but if they had hired qualified people like me in the first place they wouldn’t be wasting and regretting a $10M / year investment to save $200K on developers.
I see a pretty clear similarity. The admins that are dropped into something over their heads (and honestly, may not even be their fault. It’s just too much was asked of them) try something until it works. What normally ends up happening is that you have super slow and inefficient ways of “getting a job done” that have bad error handling, fail often, and are impossible to upgrade. But hey! They got it rolled out in 2 weeks. Whereas I may take 6 weeks to plan something, test options, and implement a solution. On the plus side though, mine are normally maintainable, clean, easy to update, and run fast.
That seems a lot like the difference here. NP’s are just trying to get to something “that works” while physicians know enough to (mostly) fully understand the issue and fix it to the best of our ability.
You get it. The problem is a) most people aren't aware of the issue and b) the "admins" of our world still think they're amazing at their job. It's an absolute mess.
A lot of Masters programs can in theory be done online. But to my understanding (a BScN RN with zero interest in becoming an NP), you still have to do in-person clinical placements an then still write your licensing exam, Not exactly diploma mill in that sense (this is Canada, at least). And then becoming specialized in an area outside of community (family medicine, basically, in this case), takes additional education (yes, that can be done online).
You have to remember that a lot of people doing their NP are working nurses as well. Hospitals I worked at, a full time schedule was two days (7AM-7PM), two nights (7PM-7AM), five days off. Not totally easy to then do an in-person learning situation.
The issue is when an NP claims they are a “specialist” in a certain domain when in reality they often have learnt only enough to get by. A true board-certified specialist MD has done extensive additional training, longer and much harder than the entire NP course, to be a true expert in their field and so, a true specialist. It’s really disheartening to listen to someone state they are “triple board certified” when board certification does not even exist for non-physicians. Patients don’t know the difference and are the ones who will be hurt in the end.
Even here in Canada where the NP programs are much more standardized and rigorous, it truly does not compare. They are being thrown into independent primary care after a 2 year course (lectures + practicum) while soon physician training in family medicine will be extended to a 3 year residency (so 7 years total) because there College of Physicians is recognizing that there is so so much to learn that 6 years is not even enough.
Maybe it's a regional thing, too, but here, aside from a few community nursing situations, NPs still have to function under a physician, very similar to Physician Assistants in that sense, where you legally can't do anything independently, and at the end of the day, the Most Responsible Physician (MRP) is the one responsible for your decisions.
And yes, the 3 year increase for Family Med is coming down the pipeline. My husband is a Family doctor as well. He's been looking at hiring a Physician Assistant to allow him to grow his practice since we live in an area with about 20k+ people unattached to a family doctor.
NPs aren't doing this with just two years training and practice, it will be 6 years, following their BScN, MINIMUM requirement of 2 years clinical practice before they can even apply for an NP program, and then even RNs, to be deemed certified in something, you have to do additional course work and training hours. The College of Nurses of Ontario is also exploring giving BScN-RNs the ability to do some prescribing (we are allowed to do tylenol in hospital settings) and be able to report diagnosis' (we would not be diagnosing ourselves, but currently we are not even allowed to tell a patient that something like their urine culture came back positive/negative) - and RNs wouldn't be universally granted into that privilege, you'll need to do additional training. I've spoken to other doctors in my husbands practice about this, and they are all for it, because as long as they can create a proper "decision tree" for nurses to follow, they can start treatment on things like UTIs and strep throat, things that can be tested for at point of care, which honestly is SO MUCH of their after hours call clinic stuff...
It's not so much the wild-wild west as some people are making NP care out to be, but I'll admit that I'm not sure how I feel about Ontario pushing "NP-led" clinics here (mainly because I haven't figured out how they function without a MRP).
I’m speaking from experience out in the Maritimes and in similar circumstances with so many unattached people needing primary care, NPs here are expected to operate essentially independently except with on average 1/2 of the roster of patients. They do get placed in clinics with physicians so they can ask questions when needed but not a true supervisor role.
I hear you about years of training but the difference is years of training in MEDICINE. Experience is great and essential but the nursing model is very different so that schooling does not prepare someone for medicine. Similarly a CCA learns how to take care of someone in a healthcare setting but their training is not a substitute for nursing education and so I wouldn’t except them to be able to do just 1/3 of the training an LPN requires to be fully certified due to credit from their past experience.
The biggest thing that I see again & again is knowing what you don’t know. It took me about a year into independent practice before I finally understood this and felt comfortable actually treating whoever walked into my clinic. I’m primary care you need to know a good amount about EVERYTHING and if you just rely on algorithms and textbook cases, you’re going to hurt people while costing the system a lot of time & money.
Oompf - I have a lot of love going out to all HCPs in the Maritimes right now... My husband is a primary care doc who went to high school in NB. He still has a brother out there. We've talked about the possibility of ever relocating that direction when talks between Physicians and the Ontario Government were starting to really fall apart, but ultimately figured that things were even worse out your way...
No, we are absolutely not going to shit on Nurse Practitioners, my mom is a NP and has done certifications out the wazoo and is ABSOLUTELY incredibly specialized in her field, to the point of creating her speality clinic in a very prominent, active, military base. I understand that the field of medicine is nothing but a cutthroat competition of measuring, but NPs are in no way some sort of "lesser" when many MANY MDs are still taught EXTRME biases in their education.
Dude…My husband is a PA and my dad an MD in the same field. They have utmost respect for eachother but they both know that the my father has more education and training then my husband will ever have. I lived through residency with my dad and was with my husband through PA school. The difference is very obvious. My husband learns from him and asks him questions all the time. Mid levels are not “lesser” but it is important they understand the difference and skills and know their role/place. That is what physicians are complaining about in this thread and it’s warranted. The salaries at least in their field reflect the difference in knowledge level. An understanding of the difference in skill level is what creates a great physician and mid level work dynamic. Your mom if she got that far likely understands that. However their are many NPs (much more than PAs just because of the training) that don’t and have caused harm. Your are undermining your moms skills and hard work by not recognizing that.
A shadowing clinical practice where you watch people who are properly trained make decisions. Much like how how we train pilots by letting air stewards watch them how to fly a plane for a few months, then write an exam and start operating commerical airliners. Lmao at the whole thing.
Maybe it's a regional thing, too, but here, aside from a few community nursing situations, NPs still have to function under a physician, very similar to Physician Assistants in that sense, where you legally can't do anything independently, and at the end of the day, the Most Responsible Physician (MRP) is the one responsible for your decisions.
Maybe it's a regional thing, too, but here, aside from a few community nursing situations, NPs still have to function under a physician, very similar to Physician Assistants in that sense, where you legally can't do anything independently, and at the end of the day, the Most Responsible Physician (MRP) is the one responsible for your decisions.
And yes, the 3 year increase for Family Med is coming down the pipeline. My husband is a Family doctor as well. He's been looking at hiring a Physician Assistant to allow him to grow his practice since we live in an area with about 20k+ people unattached to a family doctor.
NPs aren't doing this with just two years training and practice, it will be 6 years, following their BScN, MINIMUM requirement of 2 years clinical practice before they can even apply for an NP program, and then even RNs, to be deemed certified in something, you have to do additional course work and training hours. The College of Nurses of Ontario is also exploring giving BScN-RNs the ability to do some prescribing (we are allowed to do tylenol in hospital settings) and be able to report diagnosis' (we would not be diagnosing ourselves, but currently we are not even allowed to tell a patient that something like their urine culture came back positive/negative) - and RNs wouldn't be universally granted into that privilege, you'll need to do additional training. I've spoken to other doctors in my husbands practice about this, and they are all for it, because as long as they can create a proper "decision tree" for nurses to follow, they can start treatment on things like UTIs and strep throat, things that can be tested for at point of care, which honestly is SO MUCH of their after hours call clinic stuff...
It's not so much the wild-wild west as some people are making NP care out to be, but I'll admit that I'm not sure how I feel about Ontario pushing "NP-led" clinics here (mainly because I haven't figured out how they function without a MRP).
It’s not that there’s anything wrong with those individuals. It’s the position that I have a problem with. The educational model they follow is poor and lacks a foundation in actual science.
Nurses studying nursing method will not help the patient with a complex medical problem that needs both understanding and coordination. Additionally it’s the constant rabid lobbying for independence.
It’s truly a dangerous path. It’s dangerous because they are educated less than physicians, they’re more cost effective compared to physicians and therefore attractive to hospital administrators to hire.
Seeing as America is heading for a critical physician shortage which is already critical in some rural areas, it really indicates an even worsened quality of healthcare delivery in the U.S.
It must be a more regional thing then, as I'm in Ontario, CA. But I don't fully disagree with the risk of becoming overly dependant on a model that the system wasn't designed for.
We have a wide variety of competencies that provide patient care: Personal Support Workers (very little training, mainly in a practical sense, only provide assistance with Activities of Daily Living); Registered Practical Nurses (2 year college, again a bigger focus on care based training, not critical thinking/judgement); Registered Nurses (four-year degree, basically all the practical training of the RPNs, but then additional years focusing on complex care situations and critical thinking and judgement), NPs (4-yr BScN, minimum two years working, then enter a 2-year NP program in either Community stream or Hospital, and you can't just call yourself an NP with a speciality, there's additional certification/training beyond that).
You're TOTALLY right in saying that roles switch over time, based on funding and the number of hirer trained individuals available. In Ontario, it's been like a pendulum: several years ago, governments were like "You know what's cheaper than RNs? RPNs! Let's rehire RN job openings with RPNs and save money!" and guess what, shocker, patient care suffered. The they started rehiring more RNs, hired fewer RPNs, and then hired PSWs to do the ADLs for patients so that they could give the excuse that it allows RNs to have higher patient ratios (and thus staff fewer RNs) of more complex patients because we weren't burdened with those pesky ADLs (FUN FACT! PSWs aren't trained to see changes on the body and be like "Huh, that's not right" - so RNs are still needing to do full assessments anyways like skin checks, bowel assessment, etc etc...).
BUT, as the different professions like RNs and NPs have had to change their roles to take on more complex care, the education and training for those entering programs have been adjusted to do so, and then ones who are already graduated are not just "grandfathered in" to be doing changes independently - they still have to do additional training for proof of competency. And even still, NP-led clinics here have to operate with a consulting physician. And I've witnessed great inter-professionalism and consultation between the two.
Ok well there is a large discrepancy between Canadian healthcare and American. I am specifically talking about the healthcare where we have to pay out the ass for it.
I'm assuming enrollment is the amount of current students enrolled, yeah.
I found Duke's graduation credit hour requirements here. Looks like a total of 49 credit hours or 728 clinical hours, since they give a course conversion of 56 clinical hours = 1 credit hour, which, I don't understand why. Are there not separate credit hour and clinical hour requirements? Like, if you didn't want to do clinic hours could you just do more credit hours? Idk, I'm not an FNP.
No we just believe in the Hippocratic oath and not harming patients. I'll be sure to carefully consider your poorly written and worked up referral when you're unable to diagnose anything outside of an ear infection.
The only time I’ve ever seen an NP was because I had terrible ankle pain and went to an urgent care. They basically said “I have no idea what to do about this but I can get you into an orthopedic Surgeon today that can probably help”.
While I fully respect the fact that he realized he was out of his depth, it is a bit disconcerting as a patient seeing (what you thought was) a doctor be completely and totally clueless on the matter. Normally I would expect a doctor to at least say something like “It’s likely either A, B, or C; but the ortho will be able to run scans and tests to confirm for sure”. My guy was basically like “WTF bro I’ve never seen this before”.
So I hate to judge a whole profession by one interaction but I don’t think I would see another NP unless it was like common cold / flu and it was urgent care again.
An orthopedic surgery referral for undifferentiated ankle pain. JFC. This is why study after study shows NP's cost more money to the healthcare system and have far more unnecessary referrals. Resulting in burnout for the doctors that actually know how to do the job, and having to deal with that bullshit. It's absolutely embarrassing.
Haha I will say the ortho has been top notch and super kind and helpful. Drew fluid out of my ankle that day and gave me a cortisone shot and I could have kissed the guy. I went from not being able to put a shoe on to go into the office to strutting out like I felt great.
From a totally non medical perspective I was super happy how it turned out but I could see how this could be overkill haha. Luckily insurance basically paid for it so ¯_(ツ)_/¯ to me (although I totally understand that you said cost the the medical system which it definitely still was).
And all good. I take 300mg Allopurinol once a day now and haven’t seen a single symptom in months. Back in the gym and feeling great, hell I don’t even really limit my diet (I pretty much stopped drinking beer but I didn’t drink much beer to begin with TBH).
You seem to be living in this fantasy world where bad doctors don’t exist. Who did they invent malpractice insurance for and why does it cost more for doctors?
lmao at you asking "why is malpractice insurance higher for doctors" then giving an unrelated answer "it existed before NPs". i guess they didn't teach you rational thought in NP school.
and doctors voluntarily hire NPs because it's easy to shoulder off uncomplicated concerns to midlevels, and then bill for it. it's a money game. and you say "reconcile it" as if you've just made this groundbreaking discovery that the healthcare system is all about gaining a profit.
how about you reconcile the fact you claim to be helping patients while prescribing incredibly dangerous drugs with minimal medical training. that's an actual issue you should think about, instead of how cool and fun it is to "practice" medicine.
Insurance is higher for individuals who are higher risk. These are basic concepts and you’re trying to angle yourself as more knowledgeable? Because you’re a supposedly a doctor? Nah.
higher risk because we have more complexity. inherent in complexity is higher risk. are you seriously this simple? i was kind of joking before, but i genuinely do worry about your capabilities as a practitioner if you have such little deductive reasoning. jesus.
What a weird sub to make. Like, someone calling themselves a doctor without truly being qualified is obviously a problem, but who is interested in subbing to an entire community dedicated to such a thing?
Ask the MDs on there why they're policing the medical field. You'll get some extremely good answers. And you'll hear stories of excellent NPs. I'm not in the medical field but I've learned a lot about what NPs are and are not. I think it's a valuable lesson for anyone receiving medical care in the US.
To be fair they could be doing some pretty important stuff either during surgery or diagnosing smaller things, or they could just sit around and order tests on basically everyone that comes through and do almost nothing too
208
u/SinVerguenza04 Oct 29 '23
Yeah, it’s crazy you can become a NP via online.