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LEARN the truth about the doctor shortage and how doctor substitutes are being used to try and fix it with “Full Practice Authority”.
LEARN the difference in education and training for members of your medical team.
LEARN what nurse practitioners and physician assistants are allowed to do in your state.
LEARN why this matters to your health.
ASK for more trained physicians and for more choices for your medical care.
ASK your representative to increase Graduate Medical Education (GME) funding and develop more residency training programs. Tell them to support the Resident Physician Shortage Reduction Acts of 2019 (S. 348) and 2017 (H.R. 2267).
ASK about the members of your medical team and ASK your representative to sponsor or support the Truth In Healthcare Marketing Act (H.R. 3928).
ASK your state representative to sponsor a bill allowing Graduate Assistant Physicians so that graduated physicians can be licensed to practice under supervision.
“As a former PA and now an emergency physician, I would say this is completely true. PA education packs a huge amount of the "need to know" practical clinical education into 2 years. Med school (and, probably more importantly, residency) prepare graduates to "think outside the box". I am still a big supporter of PAs, with some limitations. As for NP education, that's a whole other topic...“
”I did have some years of nursing behind me prior to becoming an NP, but more than that I sought knowledge and I understand my scope. I worked as a CNA, received my ADN, then my BSN then my MSN and most recently my DNP from an actual brick and mortar school. Thinking of getting my PhD in Population Health just for the experience and the knowledge. So many online schools are pumping out DNPs and those nurses are thinking that it will elevate them to be more clinically in line with a physician. The only thing that will provide physician training is medical school. My DNP prepared me to provide leadership within an organization it had little to do with clinical practice and everything to do with utilizing my nursing skills to assist members of my team. The physician should always be the leader of that team-patients deserve that. I work in HIV care as the quality director and a while back I realized that some patients were brought in to care and never had been seen by a physician. I am attempting to change our model where all patients are seen by a physician and then the NPs can carry out the plan of care that the physician dictates as appropriate. Should the patient have a status change they would again be referred to the physician for consultation. We as nurses (should be) excellent at education, supportive care, assessment and monitoring of changes to our patients and know when status changes require a level of clinical expertise that we cannot provide. For an NP to think they can manage conditions that are completely outside of their clinical scope is scary. However, in many organizations we see it far too often. How many primary care clinics are NPs seeing very sick patients: hospital discharges/new onset chronic conditions etc and the physician is seeing stable and established patients because the model is pushing physicians to double book and slot patients every 10-15 minutes. It’s not fair to the physicians or the NPs but mostly it’s not fair to the patients. Hospitals are using NPs as hospitalists in some organizations. I am sorry but if you are hospitalized you need an MD managing your care. NPs were created to perform thorough assessments and, pass the completely normal and refer the abnormal for physician review. Too many nurses are thinking they want to “diagnose” and “prescribe” but they have no idea what that looks like other than a larger paycheck. I feel honored to have been entrusted with that privilege as a nurse but in no way do I feel my diagnostic skills are equal to those of a physician (they are pretty darn good as a nurse)-and I’m pleased with that. I know there is a physician shortage and NPs and PAs May very well be the answer to that issue to a small degree but not by deploying a bunch of non physicians without physician oversight to provide primary care. Too much risk of missing things. “
“I was an RN, then FNP. NONE of my undergrad science counted for my state medical school. I spent 2 years taking undergrad sciences over, despite having a master degree....just to meet the minimum requirements to apply to MD school. Physics is not required for nursing at all, and the chemistry is a different version. I took the nursing version of chemistry, which is numbered 101 or 110, wheras the chemistry major/pre-med chemistry (the REAL chemistry) was numbered 120/121 or something along those lines. The rigor of the courses is quite different. Also for nursing just the one most introductory chemistry course was required, and for med I had to take a full year, plus biochemistry, and physicis. It is very different. Very easy for me to tell in particular, in that I did my nursing undergrad science at the same university where I eventually took those courses over, and went to medical school. It wasn't just a lack of acceptance because of transfer credits. This was in the early 2000. ”
“RN to NP to MD here. As an RN for 15 years, I knew a little about medical conditions and the nursing care required. As an NP (8 yrs), I knew a little more and was expected to in essence practice medicine, despite having a nursing education, and the responsibility put upon me far outweighed my fund of knowledge. About to be an MD next month, and as a beginning MD my knowledge, critical thinking, and clinical reasoning skills is about equal to where it should be as a beginner in the practice of medicine. Much more to learn and a ways to go for full independent practice and to have the requisite training, education, and skills which is required for such a responsibility. About the only thing from my nursing background that has helped me succeed in my medical education/training is my comfort with interacting with patients and the names of some drugs. It’s a fallacy and illusion that a nursing background of both education and experience prepares you for medical education and for the practice of medicine.”
“My NP colleagues may disagree with me but as an NP I am one of the few out there who do not advocate for independent practice. It may be that I am ER/UCC based but I depend highly on my MD/DOs for their leadership and wisdom. After 20 years as an NP and 30 years as an RN, I know what I do not know. Please do not stop precepting NPs. We need you. Be selective in who you precept. I think there is room for all of us in patient care, but yes indeed, we need to know our limitations. I learn every single freaking day from my MD/DO mentors. And, occasionally, they learn from me.“
“I was an excellent nurse. I attended to my patient's needs, advocated for them fiercely, and empowered them through education. But I could tell from examining the curricula of various NP programs that they simply didn't offer the education that I would need to transition from providing basic nursing care to the primary care that I wanted to practice. It has been a struggle to make that transition. Physicians think about patient problems differently than nurses do. The goals of care, the focus is not identical. I've had to work harder than traditional students to work within the medical framework, because it is so tempting to fall back on my nursing training. If I'd gone the NP route, I could have been in practice already for 2 years, instead of looking ahead at 3 more years of residency before I'd be able to practice as an attending. That is a terrifying thought. Even with as much experience as I had coming in, even with med school behind me, what I've learned is that I'm only just ready to really begin to practice as an entry level apprentice, under close supervision. Medical school was only just enough to prepare me to begin to study medicine. To think about trying to go into independent practice with just 500 hours of clinicals... that is like deciding to drive with a blindfold on. The only way I could do that would be if I were so arrogant and so greedy that I would have no conscience about the people I would hurt. The most generous interpretation is that it is a matter of ignorance. Not knowing what one doesn't know.”
“I am a nurse practitioner and there are many who are frustrated with the level of education we were offered and then thrown into jobs without any assistance or support. I am one of those. I wish I hadn't become a nurse practitioner. There’s a lot of NP’s that are frustrated with the level of education we got. I graduated and I work in a state that is independent. I literally had no support. Every job I had offered to me, I was on my own as a sole provider and I got $1 hour more than my RN job. I literally poured over UpToDate and called all my friends that were doctors and call specialists all the time. My NP education taught me NOTHING to help me practice. NOTHING. My knowledge was all from my RN experience in the ER. The problem with collaborative states is that the collaborating md doesn’t really collaborate or assist. They just get money for being on a piece of paper as the collaborator. I’ve been an NP for 4 years now and finally feel like I know a little bit what I’m doing but I still get frustrated and upset that my schooling was so inadequate I WANT physician support. I want that and it’s just not here. At least in this area they want us to work solo, pay us crap (I was offered 3 jobs at $35/hr with no benefits and terrible hours and then judge us for not being as good as them. At least thats how I feel.“
“I was an RN, then FNP. NONE of my undergrad science counted for my state medical school. I spent 2 years taking undergrad sciences over, despite having a master degree....just to meet the minimum requirements to apply to MD school. Physics is not required for nursing at all, and the chemistry is a different version. I took the nursing version of chemistry, which is numbered 101 or 110, wheras the chemistry major/pre-med chemistry (the REAL chemistry) was numbered 120/121 or something along those lines. The rigor of the courses is quite different. Also for nursing just the one most introductory chemistry course was required, and for med I had to take a full year, plus biochemistry, and physicis. It is very different. Very easy for me to tell in particular, in that I did my nursing undergrad science at the same university where I eventually took those courses over, and went to medical school. It wasn't just a lack of acceptance because of transfer credits. This was in the early 2000. ”
“Prior to medical school, I was a Clinical Nurse Specialist (CNS). The program I completed was at the University of Texas (1994-1998) through the nursing school. It was an alternate-entry Masters program for students with a BS in a non-nursing field. The first 2 years allowed one to complete the requirements for an RN license. The last 2 years allowed one to complete the Masters/CNS requirements to get licensed as a CNS. I chose the adult medicine track. The RN education was acceptable, and I was successful in getting my RN license at the 2-year mark. I guess this was not all that surprising, as the training was by nurses to produce more nurses. I worked for 2 years as an RN, while I completed my Master’s/CNS requirements. This portion of the program was in it’s infancy at that time (1996-1998), and I felt very much like a guinea pig those two years. The program had a lot of theoretical content, but not a lot of practical content. The pharmacology content to prepare us for prescriptive authority was quite poor. The physical exam content also was quite poor. I think both were taught by nurses, from what I recall, but it was a long time ago. When I completed the program, I worked in the outpatient setting as a CNS in Oncology for 2 years. I felt very much like an imposter those two years, and was grateful to have a good supervising physician and a very defined role in the clinic, which kept things somewhat safe. On the job training is mostly how I learned, and it could have been a recipe for disaster, if I hadn’t been smart enough to know when to ask for help and working with a very available and engaged supervising physician. At the encouragement of my supervising physician, I decided to apply for medical school after working as a CNS for two years. This was my best decision ever. The training was vastly different from the CNS program, from its academic content (and expected level of mastery) to its practical-based content (pharmacology & physical exam skills). When I started residency, I felt more ready and much less like an imposter.”
REPORT people practicing medicine without a license and people who tell you a nurse practitioner or physician assistant is a doctor.
REPORT medical mistakes and harm to you or your loved one.
REPORT nurses and nurse practitioners to your state Board of Nursing (BON)
REPORT physicians and physician assistants to your state Board of Medicine (BOM)
REPORT to your state Attorney General’s office if your BON or BOM is not helpful.
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