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Well said..

 

NPs are all trained by subspecialties, just like MDs...

 

NPs can only be specialists in a certain field (their NP master's degree, is in a specific field), and with more education and experience, they can definately become qualified enough to be able to make diagnoses just as well as an MD.

 

They cant do surgery, or some MD subspecialties (yet), such as being cardiologists, but can work in a CTU and make appropriated diagnoses.

 

Right now, CRNA's (in the US) are as far as being almost working on their own as anesthetists.

 

And also, do keep in mind that at least Nurses are quite qualified, i probably think you didnt hear whats happening with Dentists....hygienists want to open up their own dental cleaning places and pretty much take over the Dentist's jobs entirely (most of the dental income comes from cleanings).

 

MD's will still be required, nevertheless you have job security...but you gotta keep in mind that in the future their plans are probably having super-qualified nurses and 1 Head MD that oversees it all.

 

-Stef

 

I can see it going this route as well - a gaggle of NPs supervised by one doctor. The argument for/against NPs, however, is not that simple.

 

If NP training is sufficient to handle FP-style stuff, then they represent a cheaper alternative to the FP. Thus, there will be less demand for FPs.

 

According to Ian, whose word I take very seriously, NPs and PAs do not have the medical experience or academic framework to seriously consider differential diagnoses. While they may be sufficient for the common ills, it seems that they are not as effective as MDs in picking out the more insidious disorders. Thus, this places the patient who presents in a strange way at risk. If this view is taken, then NPs and PAs will not replace FPs in any way in Canada.

 

However, money always seems to trump quality; if it did not, then current FPs would be paid more money and respect.

 

In any case, I would advise students to avoid FP in the near future, due to the nature of the NP and PA. Demand for the FP may very well go down.

 

Additionally, I do not feel that a nurse's education is sufficient for medical practice and responsibility.Remember, nursing training, regardless of length, does not prepare one for medical practice. That's what medical training is for.A nurses role as a health care worker should be made clear, as should a doctor's role. The "interdisciplinary" buzzword has appeared, in my opinion, to bring upon a "too many cooks" scenario in medical care, with roles not being clearly defined.

 

Instead of filling doctor gaps with nurses, more medical school spots and residency positions should be opened. Specialties like derm, path, ortho, and radiology are expecting a HUGE shortage in the very near future; its not just family medicine that will be experiencing a crisis.

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NP's make around 80,000$+

 

 

Ok, first of all, I dont think you have the right to bash Nurse Practioners.

 

Here's the education they receive:

 

1) Bachelor of Nursing - 4Years (WAY more related to Health Care than any other Bachelor program... no offense)...

 

2) Min 2+ Years [that's like saying a 3/4GPA gets you in McMaster Med (Minimum I've seen is 5 years+ of experience) in a special field in order to be considered for a Nurse Practioner program.

 

3) 2 Years of Nurse Practioner Program.

 

So far, minimum 10 Years of training.... now doctors route:

 

1) Bachelor of ____ - 4Years(most times Science, and almost no hands-on skills whatsover towards dealing with patients)

 

2) Med School 4 Years

 

3) Family Res - 2 Years

 

Meaning minimum 10 years... to be a family doctor.

 

With all of the experience Nurse Practioners have, they should be allowed to practice as a GP; and moreover, this initiative's already in play with DrNP programs in the states. (in Canada, it'll come in a few years)...

 

Nurse's just dont have that "Doctor" prestige, but it doesnt make them inferior; (with DrNP, it's no longer Nurse practioner, but "Dr.").

 

Yeah, I admit some nurses are just stupid, but I also gotta admit there's some pretty stupid doctors out there as well...

 

-Stef

 

 

I'll agree that NP have the same lenght in training that FP do, but lenght of training doesn't mean squat.

I strongly disagree with the bold statement above.

 

Training may be the same lenght but is not equivalent.

4 years of nursing is in no way equivalent to 4 years of medicine, because it is a different field (read different, not inferior). I checked the goals and the required classes for a BSc in nursing at my school, not at all the same.

 

A FP has 6 years of medical training

 

A NP has 4 years of nursing training (even more if you consider working years)

and then 2 of medical training (didn't check what's taught in NP programs though, I'll assume its medical). All that "experience" is not equivalent to medical training.

It comes down to 6 years vs 2 years...

 

Consider a psychologist. He can have more than 10 years of training (4 undergrad, 2 MSc 2-3 PhD, 1-2 post-doc), but there is no way he can do the work of a GP.

And by the same logic, an FP could practice as an NP, don't think so...

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i think its also hard to compare 2 similar and yet 2 different professions at the same time....

 

its tough to say that nurses dont have "medical training" and its easy enough to say doctors dont have "nursing training"....but that does not make either one less capable of caring for a patient...each has its own role in the health care field and one can't work without the other. (delicate balance)

 

I think the idea is mostly to take down people from the list of 1000s of people without family doctors; and not that nurses should be "equal" to doctors or to "take over" their jobs..

 

it's true, i couldnt agree with you more, they DO need to open up more spots in med schools...the wierd thing is that there's not enough of an increase to keep up with the demand, and yet med school entrance standards are always increasing.

 

also, each NP is specialized, they cant go from one field to another, much like MDs; theres just too much pressure on the system, and one way or another, it has to balance, and my assumption is that the cheapest alternative is to make a lot of NPs primary care, and put MDs in specialities. It costs a lot more to educate an MD than an NP at the moment....and also their salaries after a lot different too.

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A FP has 6 years of medical training

 

A NP has 4 years of nursing training (even more if you consider working years)

and then 2 of medical training (didn't check what's taught in NP programs though, I'll assume its medical). All that "experience" is not equivalent to medical training.

It comes down to 6 years vs 2 years...

 

This isn't quite fair, or accurate for that matter. If you know about NP programs, they don't exist to provide "2 years of medical training" but to provide advanced nursing training. The programs aren't like a simplified condensed version of med school, they're geared to train advanced practice nurses. Still a nursing focus, not a medical focus although it might seem that the students are doing more "medical stuff." The NPs I know still realize that they are nurses and are proud to be nurses! I know it's easy to feel that your turf is being trodden on, but . . . why does everyone think NPs are going for some kind of world take over??

 

While I'm here I'll mention another something nurses and doctors need to do: learn about each other- the nature of other's training, strengths, weaknesses, and really seek to understand the other profession's role instead of retaining old assumptions and stereotypes!

 

 

According to Ian, whose word I take very seriously, NPs and PAs do not have the medical experience or academic framework to seriously consider differential diagnoses. While they may be sufficient for the common ills, it seems that they are not as effective as MDs in picking out the more insidious disorders. Thus, this places the patient who presents in a strange way at risk. If this view is taken, then NPs and PAs will not replace FPs in any way in Canada.

 

A nurses role as a health care worker should be made clear, as should a doctor's role. The "interdisciplinary" buzzword has appeared, in my opinion, to bring upon a "too many cooks" scenario in medical care, with roles not being clearly defined.

 

Instead of filling doctor gaps with nurses, more medical school spots and residency positions should be opened.

 

Please don't freak people out by accusing NPs of being unsafe!!!!!!! and putting patients at risk:eek: . . . they are regulated professionals as well. I daresay that the NP practicing within his/her scope of practice is as safe as any health professional (lol how safe would that be haha). Also, the NP role is designed to operate in tandem with an MD. The prudent nurse would be running things past the doctor and others in the health care team.

 

As for having a clearly defined role . . .NPs weren't just waiting in the shadows for the go-ahead to confuse the masses- they have a very clearly defined role under the RHPA and the Nursing Act. Hark you premeds, and read this. . . understand your colleagues.

 

I agree that more med school spots should be opened up to fill the doctor shortage. I have heard it said- by an MD- (ie/ don't burn me on saying this) that medicine's lack of foresight and organization in terms of medical school/residency spots in Canada meant that nursing had to step in and help out by creating NPs, other mid-levels to ease the doctor shortage until medicine could pull up its socks and get its act together.

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Gee I sure hope that's not sarcasm? . . . cos I would find that sort of offensive.

 

I'm a nursing student. I do realize that NP does NOT equal family doctor. I realize that 10 years of nursing education does not produce the same product as 10 years of medical education.

But I agree with some of what stef has said, eg. you don't have the right to bash NPs- as a doc, they are health care professionals in their own right and part of your team. They certainly are not inferior, in theory, but unfortunately in practice people place value on money, power and the perceived prestige, and docs 'win' in people's eyes in that regard.

 

 

How was my question in any way bashing or offensive? Get real!

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If your original comment was sarcasm, then I did find it offensive. If it was a literal question, then sorry for the misinterpretation!

 

By the way, the "you" and "your" (like when I said 'you don't have the right to bash NPs) wasn't in reference to you, just to people in general.

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I'm sure the NP's out there will kill me for this but - intelligence is a quantifiable concept. Some people really are more intelligent than others and better able to understand the complex interactions that manifest as a patient's complaint, come up with a diagnosis and co-ordinate long term management. Medical schools try to select those people because they make better doctors. Like it or not marks and MCAT scores are correlated with intelligence. NP may eventually be allowed to do the majority of FP work but they won't be able to do it as well.

 

FP's are the most important part of the health care system. Good FP's save taxpayer's thousands of dollars each day by using their extremely broad knowledge base and clinical skill to evaluate each patient and decide which tests are important to order and why, which are unnecessary, which patients really need referral to specialists, and which common presentations are likely to be zebras. FPs are gate keepers and replacing FPs with NPs will probably end up costing taxpayers more due to extra tests and less than optimally managed patients. A very important part of FP is recognizing your limitations and referring appropriately. It seems NP's don't want to recognize their limitations.

 

Of course this is all speculation and the real evidence should come from RCTs of NP managed and FP managed patient health outcomes and care expenditures. I wonder if there are any out there?

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i think its also hard to compare 2 similar and yet 2 different professions at the same time....

 

I have advocated for NPs so far on here, but this comment needs to be taken to task. It is VERY easy to compare the two, because NPs by definition almost, are meant to become primary care agents. They are trained to handle the types of cases that a Family physician would see on a daily basis. Although they may bring a fresh perspective to a case, they are not supposed to. It isn't supposed to be a different visit for the patient. It is possible they may be better with skills that many nurses excel with, such as empathy, but when a NP sees a patient, they are supposed to give the same "medical" care as the MD that would have seen them if they were not there.

 

Furthermore, although technically, a Bachelors in nursing is 4 years, they have condensed programs that do it in a year and a half if you have a degree already. I'd put the comparison to 1.5 vs. 3 years (medical school if you have no summers off, like Mac). Doing so eliminates some of the fluff (I know this because I was accepted to one of these programs the year I got accepted to Meds, and my best friend finished the program).

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I'm sure the NP's out there will kill me for this but - intelligence is a quantifiable concept. Some people really are more intelligent than others and better able to understand the complex interactions that manifest as a patient's complaint, come up with a diagnosis and co-ordinate long term management. Medical schools try to select those people because they make better doctors. Like it or not marks and MCAT scores are correlated with intelligence. NP may eventually be allowed to do the majority of FP work but they won't be able to do it as well.

 

Where's the evidence-based practice that you should be following!? :P [show me the evidence! haha]

 

Btw, do you really think taking an MCAT (which is almost totatally unrelated to providing health care...how's biology, physics and chemistry going to help me put a diagnosis or treat a patient better...honestly)....and that having high marks means more intelligence?? I think that's a load of you know what...just because I take easy electives and an easy program, and get a 4GPA doesnt mean I'm smart in any way shape or form.... having higher marks does not make you a better doctor or a health care provider... Of course there has to be some way of weeding out people that don't do homework....

 

let me give you a classic example: einstein...drop-out...yet genius....*dont you think he's intelligent?...most ppl dont even understand relativity....*

 

but do keep in mind, that getting into an NP program means a higher GPA than you think....probably similar to getting into an MD program....

 

 

MDs cant be replaced, but neither can NPs, they'll just be able to help out with the GP's shortage; for now....

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Basically MCAT helps predict Med school and USMLE performance as does GPA but MCAT was a better indicator. I think it is safe to say that, if other factors are the same (personality, empathy, work ethic etc.) a doctor who knows his trade better is a better at treating/managing patients

 

http://www.academicmedicine.org/pt/re/acmed/abstract.00001888-200510000-00010.htm;jsessionid=L8GSXSyJjwlcLZnZJSmpGfQSwZ6plTv01mL9ybL2fl2rJhtCLTVF!536197444!181195628!8091!-1

 

I agree that NPs play a valuable role in health care. I don't think that they can function in an FP role as well as trained FP, although would agree that there will be some overlap in performance distributions, i.e. some NP would be better FPs than some trained FPs. Imagine two bell curves with the tails ovelapping. Also I think that training woul account for more of the difference than intelligence, I was just saying intelligence is a factor. Sorry I sound like such an elitist bastard...

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Please don't freak people out by accusing NPs of being unsafe!!!!!!! and putting patients at risk:eek: . . . they are regulated professionals as well. I daresay that the NP practicing within his/her scope of practice is as safe as any health professional (lol how safe would that be haha). Also, the NP role is designed to operate in tandem with an MD. The prudent nurse would be running things past the doctor and others in the health care team.

 

 

I would say that NPs making medical decisions that affect diagnosis and treatment has the potential to be an unsafe practice, given the nature of an NPs training is not sufficient to perform medicine.

 

As Ian has stated, NPs are commonplace in the US. Since NPs are trained at a less in-depth level than MDs, they do not have the knowledge or expertise to be the leader of any individual's health care. The patient may be exposed to unnecessary tests and investigations, and the NP would be more likely to miss crucial diagnoses. It's simply a matter of depth of training.

 

NPs can play a useful role as health-care "sentries", so to speak, helping the doctors manage known conditions on known patients. However, the full medical responsibility would still fall on the decision-making power of the doctor, who would(or should) be the leader of the team.

 

However, some, like Nurse Acorn in the CBC podcast, state that an NP can do everything an FP can do. Thus, why don't NPs just act as a cheaper alternative to primary care? In my opinion, although doing "the job" of an FP(ie: checkups, meds, counselling etc) appears to be general enough for an NP to do, there is the underlying medical knowledge and expertise that is require to effectively recognize and treat or refer any condition in any patient that walks through the door. This is what NPs lack.

 

However, lots of people are without an FP(although some say the numbers are skewed because youngish individuals just use walk-in clinics) and the NPs could fill that gap. However, should Canadians settle for less?

 

I think its about high time that doctors start defending their turf.

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This is sort of tangential from the topic of NPs.

 

But I really do believe that there should be one central person coordinating the care of a pt. I think that a family doc is the best person for this. I am in my emerg rotation right now and I find it rather disheartening to see how many people don`t actually have a primary care giver to coordinate their care. Sure they go to walk-in clinics and eventually end up at emerg....but the focus of care is just not the same as when you go see your FP.

 

I think when too many professions start making independent decisions things can go wrong.

 

An example from my shift last night. A 20 y.o. presents with her 3rd pregnancy in less than 1-year. Had not had a family doc for some years until the one who performed her first therapeutic abortion accepted her as a pt. Fam doc places pt on OCP - pt has intolerable secondary effects. Stops and 2nd pregnancy. Tries another OCP and still too many side effects. Finally the doc prescribes an old OCP the pt has previously been on and tolerated well. Pt goes to the pharmacy to fill the prescription. The pharmacist suggests another brand that is cheaper but assures pt the dosage of hormones is similar and so should have no problems. Pt takes the cheaper pills and has secondary effects that she is worried about so stops taking them. Pt presents to emerg with 3rd unplanned pregnancy.

 

Now...yes this pt is not taking responsibility for birth control as she chooses not to use an alternate form of contraception when not on her OCP. And I suppose pharmacists can substitute similar drugs. And the pt could have refused the substitute, however, she is not so reliable lets say. So in this case to me it seems a 3rd unwanted pregnancy could have possibly been avoided if the original prescription had just been filled as ordered...or at least some form of communication could have occured between the pharmacist and the fam doc. Arguably, the pharmacist's decision to make this substitute impacted the outcome for this pt....yet this pharmacist won't even be aware of "the mess".

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ah, this topic is going nowhere.

 

i feel like all the MDs in here just wanna be superior to everyone...and there's nothing wrong with that; all those years of schooling make you want people to show you respect...

 

but this is more than that, people need primary care and theres just not enough MDs to provide...

 

my own opinion (although i'm not trying to be offensive in anyway): I sometimes also feel that becoming a doctor means you've got some sort of an inferiority complex....and achieving the MD pretty much fixes it; if you know what i mean..

 

...........and another thing.... nobody's perfect...including docs.

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ah, this topic is going nowhere.

 

i feel like all the MDs in here just wanna be superior to everyone...and there's nothing wrong with that; all those years of schooling make you want people to show you respect...

 

but this is more than that, people need primary care and theres just not enough MDs to provide...

 

my own opinion (although i'm not trying to be offensive in anyway): I sometimes also feel that becoming a doctor means you've got some sort of an inferiority complex....and achieving the MD pretty much fixes it; if you know what i mean..

 

...........and another thing.... nobody's perfect...including docs.

 

What you say is a desire to be superior, I read as a concern for the patient. People in medicine know how much training and uncertainty they still have when they are licensed. As I have stated earlier, Family docs welcome NPs, because it helps everyone, themselves included, but having said that, how can one not naturally be concerned when another is doing much the same work with less training/expertise. It isn't a knock on NPs, it is the reality of the situation. Most NPs I have heard of (haven't talked to enough to report first hand knowledge) are good at recognizing their limits. Unfortunately, I said most and not all, and those that don't are the ones that concern most people on here.

 

You can take offence to that, or formulate the opinion that docs are simply trying to defend their turf (and you'd be partially correct), however, I think it speaks to the reality that NPs are not meant to be a replacement of MDs and shouldn’t try to be. Their function is to augment the system, and it is an important function given the state of health care at present.

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Well said, exactly what i was looking for.

 

not to replace, but to help the system.

 

inevitably though, if they did make NPs primary care, it's a bit rather difficult to take away that power after the fact.

 

let's just hope they find a better way of dealing with the health care problem...(obviously making more MDs would help!)

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ah, this topic is going nowhere.

 

i feel like all the MDs in here just wanna be superior to everyone...and there's nothing wrong with that; all those years of schooling make you want people to show you respect...

 

 

 

I cannot speak for everyone. But personally and from the experience of my classmates and many preceptors MDs don`t want to be "superior". We have a job we take seriously and with the patient's best interest in mind.

 

Go ahead and state you think that MDs have inferiority complexes. But I haven`t seen MDs going around saying they can do a nurses job as well as a nurse, or function as a pharmacist, PT, OT or whatever. We respect the different roles that all professions bring to the team.

 

So when one profession starts arguing that it can do the same job as another profession...who is it that has the inferiority complex exactly?

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Go ahead and state you think that MDs have inferiority complexes. But I haven`t seen MDs going around saying they can do a nurses job as well as a nurse, or function as a pharmacist, PT, OT or whatever. We respect the different roles that all professions bring to the team.

 

they're saying they can do it better and therefore NPs shouldnt even be considered....

 

problem is, if there's not enough MDs out there...then who is the next person to fullfil that role? the system is being stuck with a huge gaping hole and they gotta do something about it, and simply put NPs would be the best suited to take on that role because of the demand.

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they're saying they can do it better and therefore NPs shouldnt even be considered....

 

problem is, if there's not enough MDs out there...then who is the next person to fullfil that role? the system is being stuck with a huge gaping hole and they gotta do something about it, and simply put NPs would be the best suited to take on that role because of the demand.

If you want to take the 'lesser of two evils' approach, then yes, having an NP as a community's primary care provider would be better than that community having nobody at all. But NPs are a temporary fix for a more systemic problem in our medical system, and we need to get to the root causes (e.g. more family physician recruitment, better wages, etc).

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i couldnt agree more to the fact more need to be recruited...they gotta open up more med school spots!

 

This is only one small but necessary step in putting our health-care system back on the rails.

 

We also need to open up more residency positions, and not just in family medicine - we have >100 unused FM spots after the match each year. The new residency spots should go to specialties that are going to face huge shortages soon, like derm, path, rads, ortho. Those are the 4 off the top of my head...

 

To actually get students to actually want to match into FM; that's another story. FPs either need to be paid more, or need to be given the freedom to pursue any specialty(yes, even plastics) they want after a few years in practice should they desire.

 

Overall, this takes money. Lots of money. It is our duty as health care professionals to lobby those who control the money - the government - to make these changes. If we do not put pressure on the lawmakers, then that money will go towards other things that are being lobbied for by other special-interest groups.

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I think if you take the approach that having an NP provide your healthcare is better than nothing, then you would be correct.

 

However, I strongly feel that care rendered by an MD is in general, going to be superior to that of an NP, particularly as it relates to the diagnosis and initial management of patients. Any monkey can adjust a hypertensive drug to good effect, once the initial diagnosis of essential hypertension has been made, and other more sinister causes have been excluded. However, there's a whole host of judgement calls that need to be made when a patient presents de novo, to diagnose and treat them safely.

 

Nurses, and I believe nurse practitioners as well, lack an immense amount of the basic science training and a lot of the clinical training that we physicians have endured in order to make those judgement calls, and make them safely. Many of them are entirely capable of following an algorithm or a pathway, but once the presentation doesn't entirely fit the pathway, they start to flounder.

 

Quite simply, if you believe that it takes 4 years of undergrad, 4 years of intense med school (at a time and mental expenditure WELL beyond nursing school), and at least 2 years of residency where you are working massive hours in the hospital, and being judged and corrected on a daily, or even hourly basis, in order to become a safe physician, then why on earth would you agree to see an NP who has training substantially less than that?

 

The fact that they may or may not have equivalent numbers of years of training is entirely irrelevant. Med schools are taking the absolute cream of the application pool, and beating them down with massive amounts of information (both basic sciences and clinical medicine) for their first two years of training. During Med 3 rotations, and Med 4 electives, you are often doing Q4 call, routinely working 30 hours straight every 4 days, for months on end, in order to train your abilities to recognize "sick" patients from "not-sick" patients, and how best to treat and discharge them both. Residency is even harder than med school from an hours basis, as well as the level of responsibility.

 

Nursing school, and the current NP curriculums don't even begin to touch this kind of intensity.

 

A nurse practitioner at its most fundamental level is a nurse who is now practising medicine without having gone through medical school.

 

I see their mistakes and oversights on a regular basis, which is pretty scary because they have an ever-increasing presence in the US healthcare system, which is doing its very best to save money by hiring these mid-level practitioners. When I try to explain to them what I am seeing on their patient's imaging, they often lack the basic science understanding of that disease, if they've even heard of it... If I have a disease and am presenting as a patient, there is no chance that I will settle for a nurse practitioner; I would rather wait and find a physician who I trusted.

 

I think a much better solution to the argument that NP's see patients who can't otherwise access primary care, is that we need to increase salaries in primary care, and make them more attractive to med school graduates. We also need to increase med school and residency spots to increase the overall physician supply. This will help ensure that patients see a physician, who is someone who has been trained from day one to be the most effective health care provider at obtaining the correct diagnosis, and initiating the correct treatment.

 

Ian

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Where's the evidence-based practice that you should be following!? :P [show me the evidence! haha]

 

Btw, do you really think taking an MCAT (which is almost totatally unrelated to providing health care...how's biology, physics and chemistry going to help me put a diagnosis or treat a patient better...honestly)....and that having high marks means more intelligence?? I think that's a load of you know what...just because I take easy electives and an easy program, and get a 4GPA doesnt mean I'm smart in any way shape or form.... having higher marks does not make you a better doctor or a health care provider... Of course there has to be some way of weeding out people that don't do homework....

 

I hope you're not serious. There are rather good reasons why physicians spend the first two years or so of their training absorbing vast amounts of information about anatomy, metabolism, pathology, immunology, genetics, and dozens of other topics. Subsequently, they spend 4-7 years in the grueling hours of a clerkship and residency, all so those basic sciences can be applied in practice.

 

let me give you a classic example: einstein...drop-out...yet genius....*dont you think he's intelligent?...most ppl dont even understand relativity....*

 

but do keep in mind, that getting into an NP program means a higher GPA than you think....probably similar to getting into an MD program....

 

 

MDs cant be replaced, but neither can NPs, they'll just be able to help out with the GP's shortage; for now....

 

Yet the fact remains that NPs are nurses not physicians, and they come from a profession with a distinct role. What's necessary is absolute clarity concerning who does what (and is qualified to do) on the "team". I'm not suggesting that such clarity is truly lacking at all, but the lines should not be blurred. As a simple rule of thumb, complex organizations only function well when everyone knows what they should be doing and the limits of their qualifications and roles - the hierarchy exists not to denote the "worth" of one person over another, but to reflect those roles that are concomittant with experience and training.

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  • 2 months later...
Never happen.

 

I agree they are covering care that family docs have done in the past, but that simply frees the doctor to handle more patients and more complicated cases. That is what they were created for, and they excel at it. Simply put, nurse practioners have the training to deal with sore ankles and the flu...freeing doctors to deal with cancer cases and CHF etc. Nurse practioners aren't meant to replace family doctors, they are meant to help them do their job more effectively.

 

 

hmm..somewhat paternalistic...the NP is a doctor's helper?

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hmm..somewhat paternalistic...the NP is a doctor's helper?

 

No, not helper, facilitator. It isn't paternalistic to acknowledge that NPs are meant to allow physicians to handle more complicated cases and help alleviate the shortages found in the health care system. Saying that it is paternalistic implies a judgment when there is none.

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  • 2 weeks later...
Yet the fact remains that NPs are nurses not physicians, and they come from a profession with a distinct role. W

 

I don't like resurrecting old and potentially inflammatory threads, but having just spent my first day back amid the joy and fun of the inpatient medicine wards of LHSC Vic I'm gonna chip in my two cents.

 

There is not only a role difference between nurses and physicians, there is also a cultural difference between them (and I don't just mean the number of times in a day that each profession says "have you gone for break yet?") I suspect that difference extends to NPs as well.

 

From the first day of clerkship, medical students are encouraged/intimidated/brow-beaten into developing differential diagnoses. If I had a nickel for every time a resident or attending has asked me "What else do you think could be causing this?", I wouldn't have to worry about my student loans. Even when attendings are talking to each other, a lot of their interaction involves debating the most likely diagnosis from a DDx. By the time a physician is fully licenced, even if s/he does a short family medicine residency, s/he will have had many years of training in generating differentials.

 

I don't find that nurses do that much. Actually I don't find that they do it at all, unless they discuss DDx's on those mysterious "breaks" that I keep hearing about but never seem to experience personally.

 

In my experience, nursing thought process seems be "Mr. W has symptom X therefore he must have pathology Y so I need to harass the resident to write an order for medication Z." Which is great when Mr. W actually has pathology Y, but not so great when he doesn't.

 

Even those nurses who've been around forever, have seen almost everything and appear to enjoy acting like they're physicians (especially around the poor medical students) don't seem very strong at generating differentials. That's why I think it's cultural.

 

I'm not saying that nurses are incapable of developing a differential, nor am I saying that they shouldn't advocate for their patients, just that their training and working culture appears not to foster that sort of approach. I don't know that a couple of years in an NP program can break those habits and I haven't worked with enough NPs to know if their training bridges that gap or not.

 

Thoughts?

 

pb

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