NPs are killing us

[camoman1234]

22 minutes ago, CompassionateProvider said:

Thank you 

Ouch...you opened a can a worms...most people on this forum have extensive HCE. My graduate class had a average of 10 years of HCE (RN, RRT, PharmD, DC, EMT-P, AT-C, OT, PT, RD). You are mistaken the newer PA schools that allow lower end HCE, but you also need to think about your own profession that has direct entry options from ASN-DNP, BSN-DNP, etc. My wife is an FNP (just graduated in Dec. 2017) and she went to a 15 month BSN at a very prestigious University/Medical School and worked 1 year (full time) and went into her masters. Her entire class had a few years of nursing experience (<5 years). 

[PACrankset]

1 hour ago, CompassionateProvider said:

Wow. I happened upon this site because I was comparing Epocrates to UpToDate for my clinical practice. I am a NP student. I'm reading these posts and it saddens me.  We each have a place, as a professional there are good and bad in EVERY field (how many MD's have you worked with that should have been run out of the practice!!!!)

   I have to say, I'm GLAD that NP's are being chosen over PA's. Look at it this way, I've been an RN (with a Master's degree) for 30 years. ANYONE can go to PA school, as long as they have a degree in something. Does that even make sense? You have no clinical background to draw on and come out to practice just based on your study. Now, I won't be a hater like many of you above, but please. Be professional. 

You might want to do your research before you go throwing around statements like that. The average acceptance rate for PA school is between 2-3%, so NO not anyone can get into PA school. That's great that you have so much experience but as has been said there are NP programs that are direct entry now. It also warrants saying that most PA programs require at least one year of healthcare related experience, but the average accepted students typically have far more than that.

I work with some great NP's and PAs and you are right we all have our place and there is no reason to tear other professions down. Next time please don't rant about how unprofessional we all are by making unfounded comments about the PA education model because that is unprofessional.

[LT_Oneal_PAC]

1 hour ago, CompassionateProvider said:

Wow. I happened upon this site because I was comparing Epocrates to UpToDate for my clinical practice. I am a NP student. I'm reading these posts and it saddens me.  We each have a place, as a professional there are good and bad in EVERY field (how many MD's have you worked with that should have been run out of the practice!!!!)

   I have to say, I'm GLAD that NP's are being chosen over PA's. Look at it this way, I've been an RN (with a Master's degree) for 30 years. ANYONE can go to PA school, as long as they have a degree in something. Does that even make sense? You have no clinical background to draw on and come out to practice just based on your study. Now, I won't be a hater like many of you above, but please. Be professional. 

You were hating. As a PA with years experience as a ICU RN and experience as a student NP, I could crush this premise. Though I won’t because that’s being professional. Instead I will say that most PAs have healthcare experience before school, many quite substantial like myself. 

[camoman1234]

Also, anyone can apply to PA school with any degree, but you still have to have the prereqs. to apply (https://alliedhealth.llu.edu/academics/physician-assistant/admissions-physician-assistant/physician-assistant-requirements). This is the same thing as NP school, I could have a master's in English and get my prereqs and apply to NP school. 

https://alliedhealth.llu.edu/academics/physician-assistant/admissions-physician-assistant Class statistics for 2019 class: 1,025 applied and 36 were accepted, average cGPA 3.58.  

[DizzyJ]

2 hours ago, camoman1234 said:

 "I think at our current level of training we should be viewed as being able to reach independent practice in certain specialties without obtaining any additional degree." This is saying we are equal to an MD/DO. If you want independent practice then go to medical school. I disagree with NPs having independent practice even though their training is "nursing", but when you confront a NP about this then they tell you they practice medicine... We (PAs) are trained and practice medicine as MD/DOs are trained and do. So they is why I think we should have OTP, but not independence as we did NOT go to medical school. 

Err, no, that is how you are interpreting it.  That is not what I am saying or meaning.  That is what you are saying.  I’m saying that many who have been in FP/IM/Urgent Care/etc...could be competent providers to practice independently, safely, and as excellent PAs.  Not saying equally or equating them to be boarded physicians.  NPs have been doing it for years and there is no reason we can’t gain independence too without getting a doctorate degree.  

[camoman1234]

8 minutes ago, DizzyJ said:

Err, no, that is how you are interpreting it.  That is not what I am saying or meaning.  That is what you are saying.  I’m saying that many who have been in FP/IM/Urgent Care/etc...could be competent providers to practice independently, safely, and as excellent PAs.  Not saying equally or equating them to be boarded physicians.  NPs have been doing it for years and there is no reason we can’t gain independence too without getting a doctorate degree.  

Independence to me means an MD/DO, I disagree with NPs "practicing" independent as they are under the board of nursing so that makes it a little tricky. I practice solo and my CP comes every other Tuesday for 1/2 day, have I ever asked him a question, no, but I still did not go to medical school so I would agree with practicing solo, but having a CP attached to your name for back up, but that MD/DO is NOT responsible for what I do right or wrong. Just there for back up (i.e OTP) and we can still practice to our full license. Do I do the exact same thing as my CP, yes, but I still would like to have the back up just in case I need his help. I think our name should change as it is crap and does not represent what PAs actually do. Also, I think we should be able to get 100% reimbursement from insurance companies, I still don't understand this 85% thing...No other profession has this so why NPs/PAs? Our care is the same or even better than the next MD/DO. That is my 2 cents. :) 

[terrydin]

NPs have the benefit of the nursing lobby. They are going after the Family Medicine docs also. PAs need to organize and get savvy about this stuff soon

[Joelseff]

More confusing lingo that conflates a nursing board to a medical board.
"Board certified" in a specialty should be a term reserved for physicians.  I would wager LARGE amounts of money that very very few FNPs could pass the family practice boards.

Depends on specialty. HIV Medicine (AAHIVS) Board certification is the same test for MD/DO/PA/NP and same requirements. I almost took the boards a few years ago but switched to bread and butter Family med instead.

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[Joelseff]

Wow. I happened upon this site because I was comparing Epocrates to UpToDate for my clinical practice. I am a NP student. I'm reading these posts and it saddens me.  We each have a place, as a professional there are good and bad in EVERY field (how many MD's have you worked with that should have been run out of the practice!!!!)

   I have to say, I'm GLAD that NP's are being chosen over PA's. Look at it this way, I've been an RN (with a Master's degree) for 30 years. ANYONE can go to PA school, as long as they have a degree in something. Does that even make sense? You have no clinical background to draw on and come out to practice just based on your study. Now, I won't be a hater like many of you above, but please. Be professional. 

And be accepted into a program (about 4-10% acceptance rate) with prerequisites close to Pre Med degrees and almost always 3.5 and above GPA...

I think NP program acceptance rates are in the high 50-60% last I checked (how many NP applicants do you know who did not get in to school their first try?) and almost all are online with many direct entry programs washing out the Golden chalice you guys have of "having been a RN for a million years" before NP school...

Before the 2010's most PA programs were not direct entry and required Many hours as a medic, nurse, RT, FMG etc before getting into school... U can talk in generalities with regards to the current new grads but the programs also extended their curricula to include more of the hard Sciences from med school. We also still have more hours of Hands on rotations in more specialties with a structured clinical portion than most if not all NP programs. (I am a clinical preceptor for both PA school and NP school and there is definitely a difference just on a theoretical level as far as medical fund of knowledge. Sure the experienced RN in NP school will likely draw blood and start an IV than the direct entry PA student but the PA-S's depth of knowledge of pathophysiology, pharmacology, anatomy and physiology are superior in my opinion after training several PA's and NPs.

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[lemurcatta]

Quote

Wow. I happened upon this site because I was comparing Epocrates to UpToDate for my clinical practice. I am a NP student. I'm reading these posts and it saddens me.  We each have a place, as a professional there are good and bad in EVERY field (how many MD's have you worked with that should have been run out of the practice!!!!)

   I have to say, I'm GLAD that NP's are being chosen over PA's. Look at it this way, I've been an RN (with a Master's degree) for 30 years. ANYONE can go to PA school, as long as they have a degree in something. Does that even make sense? You have no clinical background to draw on and come out to practice just based on your study. Now, I won't be a hater like many of you above, but please. Be professional. 

Huh. I had 8 years as a paramedic, making independent patient care decisions, before getting into PA school. I also have an MS in biology. This was my second time applying before being accepted. I also have friends who graduated college, got accepted immediately into direct-entry MSN-NP programs with no interviews; they just filled out an online application and paid a fee, and a few months later they were in. These friends had never laid hands on a patient in their lives prior to this. You should research the PA application process... It is without a doubt a close second to medical school in terms of intensity and difficulty. 

I am rather amused how you came here and made an account, opened your first post with disappointment that we were flaming NP education, and espousing that "we each have our place," and then immediately lobbing snide, disingenuous remarks about our profession. I think you will find a general sentiment of here of deep respect for solid clinicians, NP or PA. I also think there are valid criticisms of NP education and its lack of rigor that can be made. 

 

[lkth487]

3 hours ago, Joelseff said:

Depends on specialty. HIV Medicine (AAHIVS) Board certification is the same test for MD/DO/PA/NP and same requirements. I almost took the boards a few years ago but switched to bread and butter Family med instead.

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Is that ACGME certified?  That would be interesting because usually the requirements (and I thought it was universal) that you had to fulfill a residency/fellowship that was open to physicians only.

[Marinejiujitsu]

Is it just me or does anyone else think scribe work is some of the best experience you can get including 30 yr RN experience. (And that's not hating)

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[Joelseff]

Is that ACGME certified?  That would be interesting because usually the requirements (and I thought it was universal) that you had to fulfill a residency/fellowship that was open to physicians only.

Not sure about ACGME but if you are not board certified you cannot bill as a specialist and Medicare/Medicaid and other insurance companies won't recognize you as a specialist.

HIV Medicine only has one certifying body the AAHIVM. HIV Medicine I think has the most collegial environment for practice. Physicians and APPs all collaborate together. Perhaps due to the organic nature if its inception. No one had time to measure *ahem* themselves since we were losing pts left and right until the advent of PIs and single tablet regimens.

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[lkth487]

If I had to redo pre-med, I'd work as a EMT and major in statistics in college.  

[lkth487]

2 minutes ago, Joelseff said:

Not sure about ACGME but if you are not board certified you cannot bill as a specialist and Medicare/Medicaid and other insurance companies won't recognize you as a specialist.

HIV Medicine only has one certifying body the AAHIVM. HIV Medicine I think has the most collegial environment for practice. Physicians and APPs all collaborate together. Perhaps due to the organic nature if its inception. No one had time to measure *ahem* themselves since we were losing pts left and right until the advent of PIs and single tablet regimens.

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That's cool!   One of my mentors is a huge pediatric HIV person, and sees all of the pedi HIV cases (including possible congenital transmissions).  He was telling me what it was like in the pediatric wards in South Africa when he was there - seems inconceivable to me. 

[Joelseff]

That's cool!   One of my mentors is a huge pediatric HIV person, and sees all of the pedi HIV cases (including possible congenital transmissions).  He was telling me what it was like in the pediatric wards in South Africa when he was there - seems inconceivable to me. 

It was crazy times. HIV was really IM but like IM godzilla style in the 80's and 90's (I worked in it in the 90's as a clinical coordinator and MA after I got out if the navy as a corpsman). Kinda fell into it and actually practiced HIV Medicine first 4-5 years of practice as a PA. It is a little different now since we have a better handle on managing viral load and CD4/CD8 preservation but the advanced aging due to cellular inflammation/inflammatory state just from viral presence despite undetectable serum levels kept us busy keeping the pts from dying from premature MI, CVA, DM complications etc.

 

It was great prep for "regular" IM/FP which I do now. Seems so much more easy to manage DM, HTN etc without worrying about DDI's and contributing AEs from ARV meds and HIV related disease like advanced aging etc. Not to mention the AIDS pts that are still around due to failure of ARVs from usually non compliance or simply intolerance to the meds themselves... Anyhoo... That's more than you asked! Hahaha. I recommend HIV for anyone who wants to really dig in IM/FP.

 

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[Joelseff]

Is it just me or does anyone else think scribe work is some of the best experience you can get including 30 yr RN experience. (And that's not hating)

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It's just you hahahahaha! ???[emoji16][emoji6]

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[EMEDPA]

15 minutes ago, Joelseff said:

It's just you hahahahaha! ???

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yup, scribing is mobile transcriptionist and shadowing. no touching patients. no responsibility other than typos. not a fan.

[EMEDPA]

23 minutes ago, Joelseff said:

It was crazy times. HIV was really IM but like IM godzilla style in the 80's and 90's (I worked in it in the 90's as a clinical coordinator and MA after I got out if the navy as a corpsman). Kinda fell into it and actually practiced HIV Medicine first 4-5 years of practice as a PA. It is a little different now since we have a better handle on managing viral load and CD4/CD8 preservation but the advanced aging due to cellular inflammation/inflammatory state just from viral presence despite undetectable serum levels kept us busy keeping the pts from dying from premature MI, CVA, DM complications etc.

 

It was great prep for "regular" IM/FP which I do now. Seems so much more easy to manage DM, HTN etc without worrying about DDI's and contributing AEs from ARV meds and HIV related disease like advanced aging etc. Not to mention the AIDS pts that are still around due to failure of ARVs from usually non compliance or simply intolerance to the meds themselves... Anyhoo... That's more than you asked! Hahaha. I recommend HIV for anyone who wants to really dig in IM/FP.

 

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agree about crazy times. I was an er tech in the bay area in the mid-80s when pcps would send all their HIV pts to the ER for interferon shots because no one in the community would give an HIV+ pt an IM injection. then was a medic in the early 90s. lots of difficult codes without DNRs, etc.

[EMEDPA]

45 minutes ago, lkth487 said:

Is that ACGME certified?  That would be interesting because usually the requirements (and I thought it was universal) that you had to fulfill a residency/fellowship that was open to physicians only.

I have a PA friend who did an MD h/a fellowship because there was an open slot at the academic ctr he worked at and he took the neuro h/a subspecialty exam (and passed).

[Marinejiujitsu]

yup, scribing is mobile transcriptionist and shadowing. no touching patients. no responsibility other than typos. not a fan.

I see them stronger out of school charting and formulating a good differential in ER medicine. At least a good one I would imagine. I wasn't a scribe btw. Lol.

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[EMEDPA]

1 minute ago, Marinejiujitsu said:

I see them stronger out of school charting and formulating a good differential in ER medicine. At least a good one I would imagine. I wasn't a scribe btw. Lol.

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my preference would be medic/RN/RT....

[lkth487]

20 minutes ago, EMEDPA said:

I have a PA friend who did an MD h/a fellowship because there was an open slot at the academic ctr he worked at and he took the neuro h/a subspecialty exam (and passed).

I don't doubt people's ability to pass - I just didn't know they were even eligible to sit!  I don't think headache is an ACGME specialty though - could be wrong. 

[EMEDPA]

I also heard 2nd hand of a PA who took an open slot in a PM&R residency years ago. doubt he was board eligible after completion though.

[lkth487]

Just now, EMEDPA said:

I also heard 2nd hand of a PA who took an open slot in a PM&R residency years ago. doubt he was board eligible after completion though.

That is very interesting!  Was he bound by the rules and regulations that governed residents?  He had to complete all four years including the intern medicine year?  That sounds like a long time to spend if you're not going to be BE at the end.