NPs vs. MD's.

Not a "troll" here, just have plenty of years experience as an NP, from a "real university", not some on-line thing, and have some thoughts/comments, for you to consider:

1. There is no doubt that MD students have much deeper & broader basic science training than any NP I have every known. Obviously.

2. Big question.... do you really need all that biochem, histology, anatomy to treat sinusitis or DMII? No, but you need it to understand a lot of other things, and to know how to interpret research and determine the best course for your patients when you are at the edge of evidence based practice.

3. Most NPs, after several years "on the job" training, are quite compentent to handle otitis media, HTN, and the other "common cold" problems most pt's have. The problem is that they don't know what is common and what is uncommon. 95% of those things will be the typical presentation of the typical disease, but nurses DO NOT KNOW the atypical presentations of many typical diseases, nor do they know the zebras that present as horses.

4. If there is something we can't handle, most certainly refer these patients onto the MD/DO. A lot of the time you won't know what you can't handle. How can you know you have to refer something if you have no idea what it is and mistake it for something else? There's been more than a few cases of nurses treating "minor" illnesses that turned out to be major and didn't get caught until late, that were OBVIOUS to any physician looking at them, particularly amongst the oncology patients that would get antibiotic after antibiotic only to end up with cancer.

5. I really resent NPs who get their training from on-line programs. My school required first year chemistry and real organic chemistry as prereqs. Most programs don't. This is exactly why I am against independent NP practice. There are far more bad programs than good ones. I knew a lot of NPs that became midlevels and felt like they knew basically NOTHING more than they knew when they were a nurse after completion of their programs, and described their clinical rotations as glorified shadowing.

6. There should be NO automous practice for any NP until the NP has 3 years experience, working collaboratively with an MD/DO. There should be no autonomous practice for NPs period.

7. Medicine is changing so rapidly. I see patients, do the same thing as the one MD in our office, and make 1/2 as much. Much of the move to NPs is driven by the insurance companies, and the very powerful nurses lobbies and associations. Nurses lobbies are as powerful as the NRA. The nice thing about being a physician is that if things get bad enough, there's a good chance we'll be able to simply opt out of the system and take cash for whatever the market will bear. Nurses are generally employees, and not very entrepreneurial, so they'll probably stick to the system till it burns to the ground.

8. The paperwork, especially prior authorizations, is just plain crazy. If there is a generic alternative, the insurance company will "fight you" until you feel like just saying, "I give up".... even if the newer drug is better for the patient. Pre-auth sucks, I'll agree with you there. **** insurance companies.

9. Burnout is a factor for both MD and NPs. Most I know are happy, but many are not. When you take a 1 week vacation, it takes 2 weeks to catch up when you return. There's miserable people in every field of work.

10. Pt's are more demanding now than ever. Be sure you name/phone/email is not publicly listed, although w/ EMRs, many patients can reach you through your practice portal. Obviously.

11. NPs have no interest in doing surgery (although some do basic stuff in derm clinics), and we are pretty much limited to FP, Psych, Peds, and Women's Health. And allergy, IM, hospitalist work, critical care, EM, derm, etc etc...

12. I see many CT scans and MRIs going to Australia and Israel for interpretation..... cheaper! Avoid radiology like the plague.... as this is
getting more common. Cheaper =/= better. When these patients start having errors and can't track down the radiologist to sue, they'll come after the hospital. And when the hospitals start paying up, they'll switch back to US radiologists. Final reads CANNOT be done by a radiologist that is NOT licensed in the state in which they are read- it's straight up illegal. Initial reads can be, but a US-trained radiologist must look them over and approve the read to absorb the liability.

13. Most hospitalists are foreign trained, here on work visas, and most (in my experience at least) are lacking in interpersonal skills, and most seem unhappy. We care about medical skills, not interpersonal skills. In the future, most hospitalists will be US trained anyway, as the number of US students is rapidly approaching the number of residencies. And those hospitalists are NOT foreign trained- they have a foreign medical education and US graduate medical education.

14. And yes, I was admitted to 2 public MD schools, and one public DO school. 15 years ago I couldn't prescribe an aspirin, now I can (idependently) prescribe Percocet..... Medicine is sure changing, and just like everything, these changes are "cost driven". I'm sorry you made the wrong choice. Med school isn't nearly as bad as you would imagine, and residency can actually be pretty chill if you choose wisely. As to the "cost driven" nature of things, the ship sinks from the bottom up. The first people to take pay cuts at the hospitals near me were the people in basic functions- transport, food prep, janitorial, CNAs. The next to take a hit were the people a step up- nurses, respiratory therapists, radiation techs, etc. Then the cuts would hit the PAs, NPs, physical therapists, audiologists, etc. Never saw a pay cut hit the docs. Never saw pay cuts hit management. Get as high up the chain as you can, because medicine is going to sink, and the farther down you are, the worse things'll be. I've got a buffer- I'll go in making 250k-300k, if I sink to 200k, no big. You're starting at 100k, if you sink to 60k, that'll really hurt.

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NPs vs. MD's.