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The real reason Duke keeps shutting down the Family Medicine Residency is that even the medical students still interested in Family Medicine don't choose the Duke program. The program has trouble filling its slots in the match. The reason for that is that Family Medicine Residents at Duke are last in line for opportunities to learn. On every rotation they have to take a back seat to the residents pursuing that field. They aren't likely to have opportunities to learn procedures or assist in surgeries and faculty in the various departments, most of whom don't even consider Family Medicine a legitimate area of practice, certainly aren't going to waste any time on them when they have real residents to teach.
There are other Family Medicine programs which offer a real training experience (including several in North Carolina). Students who have looked into what's available will preferentially choose those programs. Students who do not match with their program of choice (not the best and brightest) have to take what ever slots are available and end up at programs like the one at Duke.
While it's true that fewer medical students choose a primary care residency, that's because they have found out that you can't make a living in primary care anymore. When primary care physicians are eventually replaced by PAs and FNPs, patients will be getting the care that they and the healthcare insurance companies are willing to pay for.
The real reason Duke keeps shutting down the Family Medicine Residency is that even the medical students still interested in Family Medicine don't choose the Duke program. The program has trouble filling its slots in the match. The reason for that is that Family Medicine Residents at Duke are last in line for opportunities to learn. On every rotation they have to take a back seat to the residents pursuing that field. They aren't likely to have opportunities to learn procedures or assist in surgeries and faculty in the various departments, most of whom don't even consider Family Medicine a legitimate area of practice, certainly aren't going to waste any time on them when they have real residents to teach.
There are other Family Medicine programs which offer a real training experience (including several in North Carolina). Students who have looked into what's available will preferentially choose those programs. Students who do not match with their program of choice (not the best and brightest) have to take what ever slots are available and end up at programs like the one at Duke.
While it's true that fewer medical students choose a primary care residency, that's because they have found out that you can't make a living in primary care anymore. When primary care physicians are eventually replaced by PAs and FNPs, patients will be getting the care that they and the healthcare insurance companies are willing to pay for.
Interesting perspective! you said "keeps shutting down the FM program". How many times have they shut it down?
As far as the education of a PA - it is a Master's Degree level of education. The programs are usually 2 years, the first being didactic and the second is comprised of clinical experiences in a wide variety of medical settings. They have to pass a national board certification.
In this area of the country, the term "mid-level provider" or "physician extender" is used to refer to PAs and NPs. A nurse practitioner also has a Master's Degree and is board certified in their specialty, most often by the AANC. The majority of NPs have several years of nursing experience prior to becoming an NP (I had over 20). One difference in preparation is that NP programs can be specialized: Adult Primary Care, Pediatrics, Family Practice, Neonatal, Women's Health, Oncology etc. etc.
There are good and bad PAs/NPs just as there are good/bad MDs. A good NP/PA can certainly handle most every day medical problems and injuries. We can examine, diagnose, prescribe, but in the state of NC, it is required we have a supervising physican available should the need arise.
So, one year of classes and one year of clinical for PA. For RNs, 4 years of classes/clincal, and NPs on top of their work experience 2+ years clinical/classes, and MDs, 2 years classes, 2 years clinical, then residency of whatever years, plus maybe a fellowship.
Do you want to see the guy who has 2 years of experience or the NP with 6+ years or the MD with 10+ years experience (if they aren't a resident). I know which one I would pick. I'm pretty sure I can do everything a PA can. Lets have perspective, if you have a condition that requires a perscription drug, why would you go to the guy (PA) who can't even perscribe?
This is the one time I know of and it explains why they did it, which aligns with what Dr. Sandy Williams told a group of us in 2006.
Stop info Duke University Closes Family Medicine Residency -- AAFP News Now -- American Academy of Family Physicians (http://www.aafp.org/online/en/home/publications/news/news-now/resident-student-focus/20060614duke.html - broken link)
Start info Rejuvenated Duke Family Medicine Residency Blossoms -- AAFP News Now -- American Academy of Family Physicians (http://www.aafp.org/online/en/home/publications/news/news-now/resident-student-focus/20090513duke-renewed.html - broken link)
When was the other? Were you a resident there or a Duke staffer?
So, one year of classes and one year of clinical for PA. For RNs, 4 years of classes/clincal, and NPs on top of their work experience 2+ years clinical/classes, and MDs, 2 years classes, 2 years clinical, then residency of whatever years, plus maybe a fellowship.
Do you want to see the guy who has 2 years of experience or the NP with 6+ years or the MD with 10+ years experience (if they aren't a resident). I know which one I would pick. I'm pretty sure I can do everything a PA can. Lets have perspective, if you have a condition that requires a perscription drug, why would you go to the guy (PA) who can't even perscribe?
As a PA I can absolutely guarantee you can't do everything I can....make that "anything" I can....
Also, an RN isn't getting 4 years of strictly "nursing" training in a BSN program.
A PA has to meet the same undergrad prereqs as a med student. PA programs are also more rigorous than NP programs.
By the way, PA's CAN prescribe.. Or should I say "perscribe"
So, one year of classes and one year of clinical for PA. For RNs, 4 years of classes/clincal, and NPs on top of their work experience 2+ years clinical/classes, and MDs, 2 years classes, 2 years clinical, then residency of whatever years, plus maybe a fellowship.
Do you want to see the guy who has 2 years of experience or the NP with 6+ years or the MD with 10+ years experience (if they aren't a resident). I know which one I would pick. I'm pretty sure I can do everything a PA can. Lets have perspective, if you have a condition that requires a perscription drug, why would you go to the guy (PA) who can't even perscribe?
Both PAs and NPs have prescriptive privileges - for all classes of drugs and schedule II-V narcotics. As an NP who had over 20 yrs experience as an RN in ER, critical care (ICU/CCU) and 12 yrs experience as an NP, I feel I am pretty much capable of handling most problems that present in an urgent care.
So, one year of classes and one year of clinical for PA. For RNs, 4 years of classes/clincal, and NPs on top of their work experience 2+ years clinical/classes, and MDs, 2 years classes, 2 years clinical, then residency of whatever years, plus maybe a fellowship.
Do you want to see the guy who has 2 years of experience or the NP with 6+ years or the MD with 10+ years experience (if they aren't a resident). I know which one I would pick. I'm pretty sure I can do everything a PA can. Lets have perspective, if you have a condition that requires a perscription drug, why would you go to the guy (PA) who can't even perscribe?
I think you all have some facts mixed up. I am not defending any health care provider over another as I've seen nurses who were better than docs, new docs better than experienced one, PA's better and worse, etc... it's dependent on the individual, the quality of their training, etc.
However, your summary doesn't really share the true picture.
PA's - as ljd said, 4 yr degree + 2yr PA training = 6 yrs. But the 4yr must be relevant to the med field and the person must have experience in the med field such as bio research, chemist, teacher in the sciences. It is very difficult to get into Duke's program. Admissions And, they can write prescriptions and can specialize, just as nurses can.
An RN as commonly know, can be someone degreed as Associate in Nursing or BSN, or even a diploma. With a Bachelors degree they can earn a Master's degree with concentration in NP = 6yrs. They can undergo further specialist training and education such as a doctorate, and can write prescriptions.
Doc training is as you said, 4 yr BS, 4 yr med school, then specialty training via numerous residencies from 1yr to yrs. What is unique about training at Duke is that a med student is trained also as a scientist. Their 3rd year is devoted to an elective research experience or independent study of the basic sciences.
The Clinical training program was cancelled for the first time in 1985. Other department chairs (PDC) felt faculty were spending too much time on that foolish enterprise.
In answer to your question I have never been affiliated with the Duke Family Medicine Residency Program in any way.
For what it's worth, the research year for Duke medical students which makes them "scientists" is not unique to Duke. The Vanderbilt medical school has had a similar program for over 30 years.
I suspect there may be some differences in the 2 academic year and 2 clinical year experiences for nursing students and medical students.
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Or should I say "perscribe"
Duke Family Medicine Residency History
