Nurse practitioner training has changed

[Anonymous]

Anonymous wrote:

Anonymous wrote:I don't see anyone who is not an MD unless I already know for sure what is wrong.

"Something minor" isn't always actually minor, so that's a poor rule of thumb for this. Spotting a zebra requires having seen a zebra.

Whenever I’ve been sure I knew what was wrong…I was wrong. And I’m 0/4 on NPs getting it right. So I’ll avoid them.

Congratulations--you're a nurse practitioner!

[Anonymous]

I have a really good NP, who is quick to refer to her Doctor colleagues or refer things to specialists. She also has longer appointment slots than the doctor which I like.

[Anonymous]

Anonymous wrote:I’m not sure how to add an image here, but you can see a graphic showing the differences in training here: https://www.patientsatrisk.com/differences

I am not sure what medical programs have 6000 clinical hours by year 4. Certainly not the med school affiliated with my university.

I don't think the issue is that being an MD makes you an excellent clinical and being an NP makes you a bad one. We all know terrible primary care doctors and amazing NPs. The issue is when any discipline allows shortcuts and doesn't require sufficient training and experience to do the job well. There should be a minimum hours of clinical work requirement to gain admission to an NP program.

[Anonymous]

People, maybe instead of avoiding NPs and PAs, just avoid the ones with barely any experience. Should be easy to ask/find out.

[Anonymous]

Anonymous wrote:People, maybe instead of avoiding NPs and PAs, just avoid the ones with barely any experience. Should be easy to ask/find out.

It’s not always a choice, as in the examples above. Go to the emergency room, and you get who you get (this is also discussed in the original Bloomberg article).

[Anonymous]

Anonymous wrote:

Anonymous wrote:I work in medical education and have first hand experience with testing 1st yr med students and NP students about midway through their training on the head-to-toe physical exam.

I’ll just say that I won’t see a NP voluntarily…and leave it at that.

What have you seen with placement of medical students into clinical rotations? Is this a limiting factor in expanding medical school class size?

Need to change my answer from yesterday. We actually just had a conversation about this this morning at work. Yes, there are big challenges placing students on rotations. There are nowhere near enough spots for them in our hospital, and they are spread far and wide on their rotations.

[Anonymous]

Anonymous wrote:People, maybe instead of avoiding NPs and PAs, just avoid the ones with barely any experience. Should be easy to ask/find out.

Experience does not fix lack of training when it comes to the practice of medicine.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I work in medical education and have first hand experience with testing 1st yr med students and NP students about midway through their training on the head-to-toe physical exam.

I’ll just say that I won’t see a NP voluntarily…and leave it at that.

What have you seen with placement of medical students into clinical rotations? Is this a limiting factor in expanding medical school class size?

Need to change my answer from yesterday. We actually just had a conversation about this this morning at work. Yes, there are big challenges placing students on rotations. There are nowhere near enough spots for them in our hospital, and they are spread far and wide on their rotations.

That is what I have heard, as well.

You can't just open up more medical school seats. The clinical part of training has to be arranged and supported. Even if people want to teach in the clinical setting, we are down so much on staffing that it is already a large burden.

[Anonymous]

I am finding it hard to find a PCP who is not a NP.

My longtime PCP is retiring in September. The few MDs nearby are not accepting new patients. If I increase the distance from me to 30-40 miles, I can find one, but who wants to drive that distance each time they have a minor ailment, you know?

My doctor relative said that most are fine with having their care overseen by a NP if they are generally healthy and/or see a specialist regularly for any issues they have.

I am a T1D and see my endocrinologist every 3 months, so my relative said I will be fine having my PCP be a NP. I have my first new patient appointment in a few weeks so I'll see how it goes.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I’m not sure how to add an image here, but you can see a graphic showing the differences in training here: https://www.patientsatrisk.com/differences

I am not sure what medical programs have 6000 clinical hours by year 4. Certainly not the med school affiliated with my university.

I don't think the issue is that being an MD makes you an excellent clinical and being an NP makes you a bad one. We all know terrible primary care doctors and amazing NPs. The issue is when any discipline allows shortcuts and doesn't require sufficient training and experience to do the job well. There should be a minimum hours of clinical work requirement to gain admission to an NP program.

I feel like no one understands how rigorous medical school training is…. Between residency where you work 80 hours a week for 3-7 years of training and medical school (2 years of rotations) MDs easy have 6000 hours. Now you can say - well there are still bad MDs - okay but if they are still bad in your eyes then why would you be okay with someone who has a fraction of that training (500 hours) which isn’t even standardized??

[Anonymous]

Just want to raise my hand here as a health policy nut, and not and not a NP who sees these threads come up repeatedly…these are totally being seeded by the medical society (of Virginia?)

I have had both positive and negative interactions with NPs. More negative with ads overall, but admit that is probably due to seeking out MDs. So, it makes sense if I see predominantly MDs the opportunity for poor interactions is higher. I have also
had poor interactions with an NP. but I haven’t written them off altogether.

[Anonymous]

The horse has left the barn.

[Anonymous]

Anonymous wrote:My DS is a physician so I know how long his training was. I would never see a NP or PA unless it was something minor. Beware of front office staff offering an earlier appointment to an NP/PA. This happened to me at a new practice. I asked for Dr X, she had recently opted to go part time, so the staff member offered me another person. Why isn’t my co-pay cheaper if I am not seeing a physician?

Bolder text!

[Anonymous]

This is why I insist on doctors and not NPs

[Anonymous]

Anonymous wrote:I am finding it hard to find a PCP who is not a NP.

My longtime PCP is retiring in September. The few MDs nearby are not accepting new patients. If I increase the distance from me to 30-40 miles, I can find one, but who wants to drive that distance each time they have a minor ailment, you know?

My doctor relative said that most are fine with having their care overseen by a NP if they are generally healthy and/or see a specialist regularly for any issues they have.

I am a T1D and see my endocrinologist every 3 months, so my relative said I will be fine having my PCP be a NP. I have my first new patient appointment in a few weeks so I'll see how it goes.

But what happens when issues come up even if you are generally healthy? Our child was completely healthy for 12 years. Well visits only. We took them to their 12 year old well visit with the NP and found out they had low iron. No big deal - we put them on a iron supplement. A couple months and their iron levels weren't rising. Some intermittent nausea started. Went back to the PA this time from the ped group. Again viewed as minor issue. We went home and tried to adjust with diet. Then one night our child woke up shaking and pain on their right side. We went to the ER to check for appendicitis and found stage 4 cancer with a bone lesion. That is what the NP & PA missed for us. I have no idea if an MD would have put together the pieces earlier, but it has changed my view of what is routine. We all now see an MD PCP (an our child is in remission and healthy).

In support of NPs I had an amazing NP midwife. So experienced and knowledgeable. But I think she had a long bedside nursing background and then many years as an NP before I saw her.