Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I appreciate the use of nurse practitioners and physician assistants. However, I'd also call for reduction in price for services to reflect this cheaper option; indeed, nurse practitioners and physician assistants are not paid as much as MDs, something that should be reflected in pricing for services.
My wife is a CRNP with 37 years combined experience as an RN and CRNP. My son is an MD in his fellowship. She calls my son to ask for advice about patients and issues that she is not familiar with. She knows she will never have the in-depth knowledge and understanding that he gained from a pre-med undergrad degree, four years of medical school, residency, and fellowship.
Like I said I did not expect full credit for time served with OJT. But your wife has accumulated a lot of knowledge in her 37 years in the field. She did not learn everything because she still needs a doctor's guidance. I just don't understand why our educational establishment cannot giver her some credit for her extensive OJT.
I would also assume that many times she calls your son simply out of protocol and not because she really needs his advice. If something went wrong and she did not have his blessing; then it would be her job. I am just guessing that it is a necessary formality. Out of curiosity ask her what percentage of times she talks to the doctor when she already knows what he will tell her?
95% of the time any issue you have can be addressed by a NP or shey have sense enough to refer you to a specialist. My wife and I, between us have only seen our doctor one time is the last three years in spite of going every six months for blood work. The time I had to see him was to remove a wart that our NP was not allowed to do. He also has to sign our prescriptions.
Both my wife and I are perfectly happy seeing our NP who we have been using now for over 10 years. I'm sure the overall cost of the doctors practice using 2 NP's are factored in. To think the doctor is far more knowledgable that our NP is ridiculous. We bred Labradors for 25 years for the show ring, many aspects we knew more than our vets especially in genetics and reproduction and sometimes our vets would call us for our thoughts.
Like I said I did not expect full credit for time served with OJT. But your wife has accumulated a lot of knowledge in her 37 years in the field. She did not learn everything because she still needs a doctor's guidance. I just don't understand why our educational establishment cannot giver her some credit for her extensive OJT.
I would also assume that many times she calls your son simply out of protocol and not because she really needs his advice. If something went wrong and she did not have his blessing; then it would be her job. I am just guessing that it is a necessary formality. Out of curiosity ask her what percentage of times she talks to the doctor when she already knows what he will tell her?
I don't understand what kind of credit you think a NP or PA should receive. First of all, few NPs or PAs are planning or hoping to go to medical school. They wouldn't have gone the NP or PA route if they were interested in med school, so it is a non-issue. Second, and I think I tried to explain this before, med school is not undergrad where you have X number of credits to take. Most of it is on the job training supervised by some who is ahead of you in the program, who is also supervised by someone higher in the program.
My son and wife don't work together. She would probably like to call him daily to pick his brain, but she doesn't want to intrude on his life. She works with physicians who have ultimate responsibility for their patients. I doubt she ever asks them questions that she already knows the answer to. More often, she is running a plan of care by the MD to confirm it is what the MD wants to do. Each MD works differently. They have different protocols of care and prescribe different medications.
While my wife has been an RN and then an CRNP for a total of 37 years, medical care has changed a great deal over that time. My son has an in-depth understanding of medications at the cellular level that my wife will never have. The is no way that a BSN and CRNP and compare with the education that a physician receives, especially at top programs. He has nine years of training with medical school, residency, and fellowship. Her NP program (at the same University) can't compare with that level of training.
I don't understand what kind of credit you think a NP or PA should receive. First of all, few NPs or PAs are planning or hoping to go to medical school. They wouldn't have gone the NP or PA route if they were interested in med school, so it is a non-issue. Second, and I think I tried to explain this before, med school is not undergrad where you have X number of credits to take. Most of it is on the job training supervised by some who is ahead of you in the program, who is also supervised by someone higher in the program.
My son and wife don't work together. She would probably like to call him daily to pick his brain, but she doesn't want to intrude on his life. She works with physicians who have ultimate responsibility for their patients. I doubt she ever asks them questions that she already knows the answer to. More often, she is running a plan of care by the MD to confirm it is what the MD wants to do. Each MD works differently. They have different protocols of care and prescribe different medications.
While my wife has been an RN and then an CRNP for a total of 37 years, medical care has changed a great deal over that time. My son has an in-depth understanding of medications at the cellular level that my wife will never have. The is no way that a BSN and CRNP and compare with the education that a physician receives, especially at top programs. He has nine years of training with medical school, residency, and fellowship. Her NP program (at the same University) can't compare with that level of training.
I got confused when you said that your wife asked for your son's opinion. I thought they worked in the same medical practice. I would still be interested in the answer to my question about how many times your wife talks to her doctor for 'advice' but already knows the answer. I am not saying that she knows everything; what I did say is that much of this dialog has to be formality. She has to ask many of the questions simply because she does not have the authority.
As far as medicine changing all the time: Yes. But how many times are patients pointing out those changes to their doctors? Our doctors do not always keep up with the changes. Just with medications our pharmaceutical industry would never have a commercial on TV if our doctors knew the best medications. Our doctors are learning of these new medications from their patients; which is not the way the system was designed. In theory our doctors know what is the best medication for each patient - but that is not what is happening in practice.
As far as what kind of credit I am asking for: You point out that your son has nine years of medical school, residency, and fellowship. Doing the jobs that NP's and PA's do; isn't that similar to an internship or residency without the authority? You state that many of these NP's and PA's were never planning on becoming doctors; but many had problems that would not allow them to continue down that path. Some had young families, some had trouble with financing, and some had other problems that would not allow them to continue. I have never said I want a rubber stamp and a magic wand to grant these specialist the white jacket without any effort. But I do think that we should acknowledge some of the effort and dedication by very skilled medical practitioners. If it is not credit for OJT; then it should be a special financial aid package to allow those that do want to further their education and their standing in the medical community.
I got confused when you said that your wife asked for your son's opinion. I thought they worked in the same medical practice. I would still be interested in the answer to my question about how many times your wife talks to her doctor for 'advice' but already knows the answer. I am not saying that she knows everything; what I did say is that much of this dialog has to be formality. She has to ask many of the questions simply because she does not have the authority.
As far as medicine changing all the time: Yes. But how many times are patients pointing out those changes to their doctors? Our doctors do not always keep up with the changes. Just with medications our pharmaceutical industry would never have a commercial on TV if our doctors knew the best medications. Our doctors are learning of these new medications from their patients; which is not the way the system was designed. In theory our doctors know what is the best medication for each patient - but that is not what is happening in practice.
As far as what kind of credit I am asking for: You point out that your son has nine years of medical school, residency, and fellowship. Doing the jobs that NP's and PA's do; isn't that similar to an internship or residency without the authority? You state that many of these NP's and PA's were never planning on becoming doctors; but many had problems that would not allow them to continue down that path. Some had young families, some had trouble with financing, and some had other problems that would not allow them to continue. I have never said I want a rubber stamp and a magic wand to grant these specialist the white jacket without any effort. But I do think that we should acknowledge some of the effort and dedication by very skilled medical practitioners. If it is not credit for OJT; then it should be a special financial aid package to allow those that do want to further their education and their standing in the medical community.
In regard to your question about how many times my wife talks to her doctor for 'advice' but already knows the answer, she says rarely. She doesn't want to be bothering the doctors with unnecessary questions. This is why she will sometimes call my son, plus she finds he does a better job of explaining concepts or giving reasons for his answers.
Regarding medicine changing all the time and how many times patients pointing out changes to their doctors, I never mentioned questions from patients. Her patients are elderly and have many chronic conditions. Some primary care practitioners may be learning about prescriptions drugs from their patients but it doesn't apply in either my son or wife's situations. My wife's patients sometimes bring their medications in a shopping bag because they can't remember all the drugs they are on. My son is in the ICU. He reads extensively and teaches residents and med students.
Regarding your last paragraph, the answer to all of your questions is no. I'm not a medial professional so I can't give you many specifics. You might compare it to an electrician who wants to become an electrical engineer. Should he be able to waive some of the classes for electrical engineering because of the on the job training as an electrician?
I doubt there are many med school students who had problems that would not allow them to continue down that path and instead became a NP or PA. I would say that would be highly unusual. Almost all of my sons med school class finished med school. There were 2-3 who did not match. I think one had come to the conclusion that he did not want to be a doctor. Sometimes people don't match because of the specialty. Residents and fellows are paid, so financing is not an issue. They can often moonlight in the ER and other places to earn extra money.
I think you are trying to solve a problem that doesn't exist. I think we could increase the number of doctors in this country by opening up more medical school and residency slots, not by waiving requirements.
I think you are trying to solve a problem that doesn't exist. I think we could increase the number of doctors in this country by opening up more medical school and residency slots, not by waiving requirements.
Maybe the problem does not exist? I would like to hear from some of the PA's and NP's if they would turn their nose up on special financial aid or possible credits towards getting their PHD's. I do not believe in something for nothing. But when you devote years of your life to medicine, like your wife, it is nice to think that somebody appreciates your work (especially if you do a great job). Actually your wife is probably thinking of retiring in just a few years so she might not be a good example?
America is facing a shortage of doctors: https://news.aamc.org/press-releases...tage_04112018/. More PA's and NP's will help. However, with an incentive, some might go on to get their sheepskins? If the current system is not providing the professionals our Country needs; should we not also look at possible alternatives besides importing more foreign doctors - that still have to pass our medical requirements?
Maybe the problem does not exist? I would like to hear from some of the PA's and NP's if they would turn their nose up on special financial aid or possible credits towards getting their PHD's. I do not believe in something for nothing. But when you devote years of your life to medicine, like your wife, it is nice to think that somebody appreciates your work (especially if you do a great job). Actually your wife is probably thinking of retiring in just a few years so she might not be a good example?
America is facing a shortage of doctors: https://news.aamc.org/press-releases...tage_04112018/. More PA's and NP's will help. However, with an incentive, some might go on to get their sheepskins? If the current system is not providing the professionals our Country needs; should we not also look at possible alternatives besides importing more foreign doctors - that still have to pass our medical requirements?
There are two district PhD programs for nurses (terminal degree), one called DNP (Doctor Nursing Practice) and the other a Doctor of Philosophy in Nursing. The PhD track is more research based than clinical experience of the DNP.
I work with several DNPs, we address them rightfully as "Doctor". In speaking with them none aspire to become an MD. Their passion lies in the field of nursing, and in patient care.
The shortfall of physicians is a two-fold issue. There is a problem due to the shortage of residency program slots, especially in competitive fields. Few students want to go into General Practice, Family Medicine, etc. Secondly, the NRMP has not added additional slots to residency programs despite more new medical schools opening and existing medical schools increasing their incoming class size. In 2017 there were 42,000 students for 32,000 residency slots. Of those 42,000 about 6,000 were foreign graduates. They will not make up for the increasing gap of providers.
There are two district PhD programs for nurses (terminal degree), one called DNP (Doctor Nursing Practice) and the other a Doctor of Philosophy in Nursing. The PhD track is more research based than clinical experience of the DNP.
I work with several DNPs, we address them rightfully as "Doctor". In speaking with them none aspire to become an MD. Their passion lies in the field of nursing, and in patient care.
The shortfall of physicians is a two-fold issue. There is a problem due to the shortage of residency program slots, especially in competitive fields. Few students want to go into General Practice, Family Medicine, etc. Secondly, the NRMP has not added additional slots to residency programs despite more new medical schools opening and existing medical schools increasing their incoming class size. In 2017 there were 42,000 students for 32,000 residency slots. Of those 42,000 about 6,000 were foreign graduates. They will not make up for the increasing gap of providers.
I am really out of my league and I know that. I am simply asking the questions because I do not know the answers. I am just asking if it would be possible to do anything and I am learning that many might not want the help to become a doctor. There is one thing I do know and that is to never say never; I am sure that some would appreciate any help they could get.
The shortfall of physicians is a two-fold issue. There is a problem due to the shortage of residency program slots, especially in competitive fields. Few students want to go into General Practice, Family Medicine, etc. Secondly, the NRMP has not added additional slots to residency programs despite more new medical schools opening and existing medical schools increasing their incoming class size. In 2017 there were 42,000 students for 32,000 residency slots. Of those 42,000 about 6,000 were foreign graduates. They will not make up for the increasing gap of providers.
Good points above. I would add that two additional important considerations for adding residency spots are funding and quality of training considerations. The funding, of course, has to come from the federal government. The training quality aspect in some ways is even harder because it has more moving parts. Adding residency spots to a program requires approval from the specialty specific Residency Review Committee, which must ensure adequate faculty to offer didactics, significant enough patient volume, facilities and other resources to appropriately train. If those factors aren't present, you end up with trainees that can't practice independently, may fail their boards, and that can ultimately lead to less qualified practitioners.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
