Nurse practitioner training has changed

[Anonymous]

Anonymous wrote:I am amazed by the number of psychiatric NPs with degrees from for profit online schools. These are people prescribing controlled substances / schedule 2 drugs!

probably explains the big uptick in “adult adhd” …

[Anonymous]

Anonymous wrote: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.

Oh please with the conspiracy theories 🙄

[Anonymous]

Anonymous wrote:

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??

Residency is not the same as med school. They are saying by year 4 of a four year program, they have 6000 hours. The first two years are mostly class and the second two years are a mix of seminars and clinical rotations however they are not doing 6000 hours during those two years of rotations.

Family medicine is not a 3-7 year residency.

[Anonymous]

Anonymous wrote:

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.

So glad your child is recovering. I literally just had a conversation with a friend who is an MD about this yesterday, and an NP failing to fully investigate the cause of anemia was the exact concerning example she gave from her practice.

[Anonymous]

NP have no place prescribing medicine they should only be used to manage nurses

[Anonymous]

Anonymous wrote:

Anonymous wrote:Why would somebody choose a low paying profession like nursing?
You will always be a low income earner and it will take years to pay back your student loans. Unless you have family money and get a free ride from your parents, that is the worst choice

There are other options

I actually made a mid life career change to be an RN. I used to work in marketing. Zero regrets. I now work in a sort of niche RN position and earn nearly as much as my husband who works in a senior mid tier marketing position.

There is such an ongoing desperate nursing shortage that you can find hospitals that will pay most of your tuition in exchange for a work commitment. I had 65 percent of my tuition covered in exchange for a 3 year work commitment at a local city hospital.

There are young nurses who make bank nowadays through agency and travel work stints...

There are a lot of options once you get an RN degree, especially if you are young and willing to go the agency/travel route.

Unfortunately, this still means we are bleeding med surge RNs. There are older RNs who did med surge for their careers, but as they retire, the retention issue will get horribly worse.

A good friend of mine did this too and is happy with her choice in terms of stability and income. But, she didn’t last more than 3-4 years doing bedside/med-surge. She burned out due to the hours and staffing, and also got retailated against when she raised concerns about staffing ratios. Now she’s doing a very mellow home visit nursing job while she figures out her next step.

[Anonymous]

Anonymous wrote:Also, I think this is a result of so much private equity controlling healthcare. They are squeezing every bit of profit out of healthcare practice, and what incentive do finance bros have to ensure people don't die due to poor healthcare training? A settlement of 75K is absolutely nothing to them, and that's for a wrongful death(!!).

I think we need government legislation on this. I really don't understand how it's okay for an entity solely interested in profits to control healthcare decisions. They should not be able to buy medical practices, even if one morally corrupt doctor rubber stamps their decisions.

This 100%

Nobody should be profiting or earning dividends from healthcare.

[Anonymous]

https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.13246

https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00014

A list of studies... https://www.nice.healthcare/the-nicessities/nurse-practitioners-physician-assistants-safety

Most studies to date show better health outcomes / better health management for NP seen patients in primary care vs MD.

[Anonymous]

Anonymous wrote:https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.13246

https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00014

A list of studies... https://www.nice.healthcare/the-nicessities/nurse-practitioners-physician-assistants-safety

Most studies to date show better health outcomes / better health management for NP seen patients in primary care vs MD.

This is important info, but two issues here:

1) The individual articles you posted are from 2019 and 2020, and the proliferation of essentially untrained NPs is more recent.

2) The NPs that people are worried about the most are ones practicing in specialties and not primary care.


I am fine with an NP, even in a specialty, but the training needs to be waaaaay better than it is.

[Anonymous]

Anonymous wrote:NP have no place prescribing medicine they should only be used to manage nurses

I think that if NPs couldn't prescribe meds, it would just be extremely difficult for patients to get the meds they need. It is SO hard to see a doctor. It would be ideal if there were just more doctors, but I think you will see way better results from NP care if they just had more stringent requirements for their education and experience. It looks like the quality of their education is all over the map.

I've also noticed that it's difficult to suss out where they got their education. They don't have all their creds posted like MDs do.

[Anonymous]

Anonymous wrote:Also, I think this is a result of so much private equity controlling healthcare. They are squeezing every bit of profit out of healthcare practice, and what incentive do finance bros have to ensure people don't die due to poor healthcare training? A settlement of 75K is absolutely nothing to them, and that's for a wrongful death(!!).

I think we need government legislation on this. I really don't understand how it's okay for an entity solely interested in profits to control healthcare decisions. They should not be able to buy medical practices, even if one morally corrupt doctor rubber stamps their decisions.

This ^^.

[Anonymous]

Anonymous wrote:My training was explicit that you had to see tens of thousands of normal to recognize abnormal reliably. Rashes don't often look textbook, and there is so much variation in presentation of the same diagnosis.

Without that large clinical database in your own mind, you can't reliably tell when to worry. Anemia that is not microcytic and hypochromic, or that doesn't respond as expected to treatment (as per PP)? Dig further. On the other hand, you don't order labs or antifungal treatment for pityriasis rosea when you can recognize it, even on the many varieties of skin type.

NPs can be fantastic. Old school NPs with many bedside years under the belt, or NPs who are well-trained in a narrow scope with good oversight (e.g., L&D) are more likely to be fantastic than others.

And you still need to see tens of thousands of normal before you can reliably pick out abnormal.

This is so important. You are going to have trouble hearing a murmur if you haven't heard a lot of hearts without one. Even something simple like distinguishing wheezing from rhonchi requires experience. I had a NP at a Minute Clinic listen to my lungs and tell me I had pneumonia and she gave me antibiotics. That seemed serious so I got in with my pcp the next day who sighed and said "You don't have pneumonia -- so those antibiotics aren't going to do anything and they shouldn't have been prescribed." The NP thought she heard rhonchi and panicked.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My training was explicit that you had to see tens of thousands of normal to recognize abnormal reliably. Rashes don't often look textbook, and there is so much variation in presentation of the same diagnosis.

Without that large clinical database in your own mind, you can't reliably tell when to worry. Anemia that is not microcytic and hypochromic, or that doesn't respond as expected to treatment (as per PP)? Dig further. On the other hand, you don't order labs or antifungal treatment for pityriasis rosea when you can recognize it, even on the many varieties of skin type.

NPs can be fantastic. Old school NPs with many bedside years under the belt, or NPs who are well-trained in a narrow scope with good oversight (e.g., L&D) are more likely to be fantastic than others.

And you still need to see tens of thousands of normal before you can reliably pick out abnormal.

This is so important. You are going to have trouble hearing a murmur if you haven't heard a lot of hearts without one. Even something simple like distinguishing wheezing from rhonchi requires experience. I had a NP at a Minute Clinic listen to my lungs and tell me I had pneumonia and she gave me antibiotics. That seemed serious so I got in with my pcp the next day who sighed and said "You don't have pneumonia -- so those antibiotics aren't going to do anything and they shouldn't have been prescribed." The NP thought she heard rhonchi and panicked.

Medicine isn’t as simple as normal vs abnormal. Good practioners have to have an advanced understanding of pathology, pathophysiology, and pharmacology. This cannot be done in a 2 yr PA crash course. NPs are slightly better because they get some of this in nursing school, then again in NP school, but still no where near as in depth and complete as the education a MD receives in 4 yrs medical school, plus residency, plus fellowship. Their depth of knowledge is not even comparable and goes way way beyond normal vs abnormal. They are dealing with people with complex issues involving multiple organ systems, on multiple meds, and each situation is slightly unique and individual. There needs to be critical thinking happening and that cannot happen if you don’t have the solid foundation of knowledge

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My training was explicit that you had to see tens of thousands of normal to recognize abnormal reliably. Rashes don't often look textbook, and there is so much variation in presentation of the same diagnosis.

Without that large clinical database in your own mind, you can't reliably tell when to worry. Anemia that is not microcytic and hypochromic, or that doesn't respond as expected to treatment (as per PP)? Dig further. On the other hand, you don't order labs or antifungal treatment for pityriasis rosea when you can recognize it, even on the many varieties of skin type.

NPs can be fantastic. Old school NPs with many bedside years under the belt, or NPs who are well-trained in a narrow scope with good oversight (e.g., L&D) are more likely to be fantastic than others.

And you still need to see tens of thousands of normal before you can reliably pick out abnormal.

This is so important. You are going to have trouble hearing a murmur if you haven't heard a lot of hearts without one. Even something simple like distinguishing wheezing from rhonchi requires experience. I had a NP at a Minute Clinic listen to my lungs and tell me I had pneumonia and she gave me antibiotics. That seemed serious so I got in with my pcp the next day who sighed and said "You don't have pneumonia -- so those antibiotics aren't going to do anything and they shouldn't have been prescribed." The NP thought she heard rhonchi and panicked.

Medicine isn’t as simple as normal vs abnormal. Good practioners have to have an advanced understanding of pathology, pathophysiology, and pharmacology. This cannot be done in a 2 yr PA crash course. NPs are slightly better because they get some of this in nursing school, then again in NP school, but still no where near as in depth and complete as the education a MD receives in 4 yrs medical school, plus residency, plus fellowship. Their depth of knowledge is not even comparable and goes way way beyond normal vs abnormal. They are dealing with people with complex issues involving multiple organ systems, on multiple meds, and each situation is slightly unique and individual. There needs to be critical thinking happening and that cannot happen if you don’t have the solid foundation of knowledge

Yes, I know that. I teach med students physical diagnosis.

[Anonymous]

I really don’t understand physicians assistants and nurse practitioners. Why do they keep coming up with terms? I think most patients don’t know what they mean. Patients know what an RN is and a doctor.

My parent is an OB and midwives have a similar issue. Most patients don’t know what the education of a midwife is an assume it’s more like a doula.