Wed, 07/28/2010 - 9:04pm - Posted by: observer123

Fourth year medical students have better training (more basic science training and thousands more clinical hours of training) than NPs/DNPs do. Would you let 4th year medical students practice independently without having to go through a rigorous 3-year-minimum residency? If you support the NP/DNP movement, by using that same logic, you have to support letting 4th year medical students practice independently. I guarantee that primary care fields will become popular when 4th year med students can save on a year's worth of tuition and don't have to go through a ******ish residency!

So, let's hear some support for independent practice rights for 4th year medical students!!

Wed, 07/28/2010 - 9:01pm - Posted by: observer123

Here's a sample curriculum from a BSN-DNP program (at Duke): http://nursing.duke.edu/wysiwyg/down...t_MAT_Plan.pdf

You need 73 credits to go from a college degree to a doctorate. That turns out to be less than 3 years.

Now, let's look at the fluff courses that aren't really clinically useful: Research Methods (3 credits), Health Services Program Planning and Outcomes Analysis (3 credits), Applied Statistics (2 credits), Research Utilization in Advanced Nursing Practice (3 credits), Data Driven Health Care Improvement (4 credits), Evidence Based Practice and Applied Statistics I & II (7 credits, since you told me medicine is not evidence based), Effective Leadership (2 credits), Transforming the Nation's Health (3 credits), DNP Capstone (6 credits), Health Systems Transformation (3 credits), Financial Management & Budget Planning (3 credits).

Here are the clinically useful courses: Population-Based Approach to Healthcare (3 credits), Clinical Pharmacology and Interventions for Advanced Practice Nursing (3 credits), Managing Common Acute and Chronic Health Problems I (3 credits), Selected Topics in Advanced Pathophysiology (3 credits), Diagnostic Reasoning & Physical Assessment in Advanced Nursing Practice (4 credits), Common Acute and Chronic Health Problems II (3 credits), Sexual and Reproductive Health (2 credits), Nurse Practitioner Residency: Adult Primary Care (3 credits), Electives (12 credits).

So, out of the 73 credits needed to go from BSN to DNP, 37 credits are not clinically useful. In addition, the number of required clinical hours is 612 hours (unless I miscounted something)!! Wow! And the NP program is designed the same way, with a bunch of fluff courses (11 credits out of 43 required are fluff) and requires 612 hours as well: http://nursing.duke.edu/wysiwyg/down...rriculum_2.pdf

Here are the curricula to several other programs:

* University of Arizona: http://www.nursing.arizona.edu/OSA/P...ndout_2008.pdf 31/74 credits are fluff. * Loyola's MSN to DNP: http://www.luc.edu/nursing/dnp/curriculum.shtml (where are the basic science classes? They're all public health classes!!) * MGH BSN to DNP: http://www.mghihp.edu/nursing/postpr...ulum.html?cw=1 (35/72 credits for Adult DNP are fluff while 46/83 credits for DNP in FM are fluff)

It's kinda scary how inadequate that training is in order to practice medicine independently. You can't really count prior nursing experience as time practicing medicine because you weren't practicing medicine during that time nor were you thinking in a medical manner (ie. the way a physician would). Nursing clinical hours might help you transition into medicine but they are NOT a replacement for medical clinical hours.

Now, just for comparison, let's look at a med school curriculum. I'll point out all the fluff courses here too. Here's an example from Baylor School of Medicine for M1/M2 (http://www.bcm.edu/osa/handbook/?PMID=5608) and for M3/M4 (http://www.bcm.edu/osa/handbook/?PMID=7463):

Fluff courses at Baylor School of Medicine during M1/M2 years ONLY: Patient, Physician, and Society-1 (4.5 credits), Patient, Physician, and Society-2 (6 credits), Bioethics (2.5 credits), Integrated Problem Solving 1 & 2 (10 credits).

Useful courses at Baylor School of Medicine during M1/M2 years ONLY: Foundations Basic to Science of Medicine: Core Concepts (14.5 credits), Cardiovascular-Renal-Resp (11.5 credits), GI-Met-Nut-Endo-Reproduction (14 credits), General Pathology & General Pharmacology (6.5 credits), Head & Neck Anatomy (4.5 credits), Immunology (5 credits), Behavioral Sciences (6.5 credits), Infectious Disease (13 credits), Nervous System (14 credits), Cardiology (4.5 credits), Respiratory (3.5 credits), Renal (4 credits), Hematology/Oncology (5 credits), Hard & Soft Tissues (3 credits), Gastroenterology (4 credits), Endocrinology (3.5 credits), GU/Gyn (3 credits), Genetics (3 credits), Age Related Topics (2.5 credits).

For only the M1/M2 years at Baylor, there's 162.5 total credits. Out of these 162.5 credits, 23 credits are fluff.

Core Clerkships during M3 (useful clinical training): Medicine (24 credits, 12 weeks), Surgery (16 credits, 8 weeks), Group A selective (8 credits, 4 weeks), Psychiatry (16 credits, 8 weeks), Neurology (8 credits, 4 weeks), Pediatrics (16 credits, 8 weeks), Ob/Gyn (16 credits, 8 weeks), Family & Community Medicine (8 credits, 4 weeks), Clinical Half-Day (includes Clincal Application of Radiology, Clinical Application of Pathology, Clinical Application of Nutrition, Clinical Evidence Based Medicine, Longitudinal Ambulatory Care Experience, and Apex -- 23 credits).

So, without even taking into consideration M4 electives and required subinternships (which are usually in Medicine and Surgery), medical students already have a far superior medical training than NPs or DNPs. Other examples of med school curricula:

* UMich M1/M2: http://www.med.umich.edu/lrc/medcurr...gram/m1m2.html * UMich M3/M4: http://www.med.umich.edu/lrc/medcurr...gram/m3m4.html * Duke: http://medschool.duke.edu/modules/so...index.php?id=2

You can get a BSN to DNP in about 3 years according to many programs I've looked at. Medicine involves 4 years of medical school and a minimum of 3 years of residency before allowing independent practice. Here's the math:

BSN to DNP: 2.5 - 3 years of training; longer if courses taken part-time; 600-1000 clinical hours! BS/BA to MD/DO: 4 years med school + 3-5 years residency: 7-11 years of training; not possible part-time; clinical hours > 17000

I also want to point out that there are really no valid studies suggesting that NP/DNP outcomes are equivalent to those of physicians. NPs/DNPs always mention that studies show that patients are more "satisfied" with the care/attention they receive from NPs/DNPs than from physicians. However, patient satisfaction =/= quality medical care. I talk to patients all the time when I'm volunteering in the ED, etc, and several have told me they feel much better after talking to someone. That does not mean I should be allowed to practice independently.

Also, 4th year medical students have FAR, FAR superior training compared to these NPs/DNPs. Would you be willing to let a 4th year medical student practice medicine independently? Think about it.

Wed, 07/28/2010 - 6:15pm - Posted by: hurdlepup

This article is wildly inaccurate!!!

As glossed over, the major difference is that a physician has been through substantial training, and is able to understand at a much more in depth level what might be taking place with your body if you are not feeling well.

A nurse practitioner is less qualified, but is ok to see as long as there is a supervising physician available to consult. Even then, you are trading in years of training for someone far less qualified when you visit a nurse practitioner.

BEWARE! There IS a difference! Examine the wide variability in nurse practitioner training to see how little experience is possible to still be licensed, as compared to a physician. REFUSE to see an independently practicing NP, who does not have a physician on site!!!