A lot of you have been asking for a video talking about the issue of unmatched residents. I actually discussed this topic in depth in my Surprising Facts About the 2022 Match over on the Kevin Jubbal, M.D. channel: ua-cam.com/video/hpFZHeX1vOk/v-deo.html
The lack of adequate residencies to accommodate all medical school graduates is a travesty! Currently there are 154 M.D. schools and 38 D.O. schools and the number in my state are projected to increase by 2 more in the coming years. If government funding is not available currently to accommodate all graduates what will happen in the future? In my opinion all graduates should be able to do an internship and this could be accomplished by slashing the first year salary, making funds available to pay all graduates as interns because it is in all respects a training year. It has not been that many years since med school graduates would sometimes do an internship and then hang out their shingle or work with an established practice, often in an underserved area, rural in most cases. Presently government funding is used to train PA's and APRN's to bridge the gap where there are not enough MD's to serve an area. If an M.D. completed an internship and then worked as a licensed physician he or she would be a more qualified asset than the NP's and PA's. To not utilize the medical school graduate who does not match and is unable to complete an internship is a lost asset and a waste of money for the taxpayer who paid taxes to support the local state medical school. The military uses medical school graduates as independent practitioners after an internship. They can then apply for residency programs or complete their service obligation as a general medical officer. To do otherwise is an injustice to the medical school graduates who do not match and the communities that are medically underserved.
I made the decision to pursue PA because I do not want a doctor’s scope of practice. If someone is going to PA or NP school hoping to do a doctor’s job, they are just trying to avoid medical school and the other extra responsibilities (I.e. legal) that doctors hold and those are NOT the people I want treating patients independently.
Agreed. I want to pursue NP school to continue to be part of the team, that's what the nursing role has always been. I respect the MD/DO role, and like knowing that if something is over my head, I can ask for help and have a resource to learn from as I practice. That being said, NP schools are too loose in my opinion. It's just too weird that it's each individual students job to locate their preceptor. I don't see how that benefits the student or the evetual patient.
@Jeff Lorry I only studied a lot when i went for the first time last year but the second time was so easy, all thanks to my aunt who introduced me to Miss Catherina Alison am really grateful
I'm not here to convince for her but to share my testimony for what I confirmed, she’s Trust worthy and best option ever seen, thanks Miss Catherina Alison, God bless you, I've never seen or heard any of her clients has complain of failed. I think she's just too lucrative and perfect for this job
It’s ridiculous to me that some pre-nursing students will talk to me about how they want to do nursing and do a short course to become an NP because then they’ll be able to do what “doctors do, without having to waste so much time.” It scares me that some people who think the extra practice and guidance a physician get, in order to treat a living human, is a WASTE of time, just because they want to brag about practicing independently. As a newly matriculated med student, I was very fortunate to meet some wonderful PAs/NPs in my premed years that were so smart, but has never had to outwardly brag. They had the trust of their team, and knew exactly where their limits were and strived to learn from it. I only met one NP who was as described above, and although she was the most outspoken, she was the least trusted, even by her fellow NPs.
I mean there’s currently an issue right now with new grad nurses wanting to take up travel contracts because for some reason they think nursing school and actual nursing practice are the same when they aren’t. So in that sense they’re also wanting to shoot the sh!t in that aspect as well! There needs to be a lot of understanding that needs to happen unfortunately
A large part of medical training is a waste of time. An ophthalmologist for example will not need 90% of what they learned in medical school. Same thing for orthopedic surgeons and other specialties. They actually learn to become doctors in residency. . . . not medical school. Also . . what's up with tuition these days?!? OUTRAGEOUS COST with some students coming out $400,000-$500,000 in DEBT. . .
Yes, what they said to you is ridiculous, but you’re talking to pre-nursing students, AKA, people who know nothing about nursing. Pre-nursing students might have big ideas about what they want to accomplish but when they get into nursing school, they’ll find out they really didn’t know anything at all. I’ve seen some people like that in my day, and they didn’t even make it through their BSN program, let alone a masters + post-masters NP program or a DNP program. I used to want to be a doctor when I was a kid, but I got married young and raised children instead. My my 30s, it no longer seemed like a practical goal. I can still help people as an NP, and I want to work in mental health (an area with a major need for providers and not enough providers to help everyone in need). To become a PMHNP, I will have a total of 9 years of college education. It’s not exactly the super quick and easy pathway that people make it out to be.
@@restalot1 In theory you’re right, but life is not so straightforward. I also think med school is the time for you to find your specialty as well. Most students don’t come into med school (or at least me and my classmates) having a DEFINITE choice. Maybe a preference, but we are still open to options. So how would we know in our first and second year what we would need to know? Then comes third and fourth year when we are able to take what we learned, actually apply it, and find what we truly are good at and/or like. We’re taking care of people’s lives here, and people aren’t going to be a standard that you just need to learn a few controls of and it’ll be fine. I wrote this comment 2 months ago and I have felt very tired since then and sometimes think “when would I ever even apply this detail?” But at the end of the day, I feel very privileged to be in my position, so the 0.001% chance it might show up one day when I’m practicing, even if it’s not part of my specialty, is fine by me.
@@NovaBrite618 true! Again, I don’t have anything against PA/NP in general (I know many very great ones, some I personally even think could have gone farther than some docs if they had chosen to) I’m mainly just directing it to those my age who think it’s crazy for me to go to med school when they’ll be an np in 1/4 the time and think we’ll end up having essentially “the same job”😅
A Med School Insiders video that explains what happens when a student doesn't match into a residency spot would go a long way in understanding the problem at hand, and what to possibly expect in the future. Thank you!
as a new NP grad, if i wanted the scope of a physician, i would’ve gone to med school. i feel like my school kept pushing “full practice authority!” and i was the only one questioning it. i do not have enough schooling to do the things a physician does!
YES!!! I'm deciding between NP/PA or MD, but i literally dont want to practice independently lmao. so while im willing to do the schooling, going MD makes no sense for me. If you want independent practice, dont go to NP or PA school, why is that so hard for people...ugh
If you think that you need oversight when caring for a population that seeks your care for mostly HEENT and GI issues in primary care, then you should have pursued another career. An RN already recognizes many if not most of these diagnoses without the advanced training. A major part of the medical model is to know when to consult-- hence a primary care sending a patient to cardiology for a new murmur or arrythmia. Sounds like you're trolling.
@@Meneedsabreak a person without the expertise wanting oversight for their job that doesn’t help them develop that expertise is completely a reasonable thing to want.
@@Nanajsiuz your comment is reasonable when you state it in this general context, but I contend that the "oversight" described is more of managing than collaborating. Most NPs do not have their own practice, and fellowships are few. However, most have tons of bedside experience in progressive/intermediate/critical care and are well versed in the standards of practice by the time they complete the MSN program with subsequent certification. Collaboration and growth are the key words, not oversight from an overseer-- whom by the way is not an experienced NP but a physician who just looks down at nursing science melded with the medical diagnostic model. Believe me, nurses respect physicians and their advanced specialized knowledge; yet many physicians are taught that nurses are stupid and are insultive as newbies in their first job. We are supposed to be a team but this commenter absolutely can not speak for me nor my APRN colleagues with the minimization of her educational experience.
One of the major takeaways from this research is how far behind NP education and clinical practice is when compared to PA's. Yet, they are granted much more autonomy due to their more immersive internal advocacy.
NP programs are kinda BS (specifically the online programs that are popping up faster than Starbucks), but nurses in and of themselves deserve a shit ton of respect because they rule the hospital. PAs should probably have the upper hand because they are trained on the medical model and the lack of training that many NPs have... but there are some damn good NPs out there, I can almost guarantee you that they didn't do an online NP program though. If you do an online program, you need to be required to do residency or some shit.
@@grant4360 only some nurses deserve respect. The NICU/PICU ones actively seek worse care for their patients. Also most floor nurses barely know anything about nursing. There is a reason ICU nurses have to come to codes🤣
Good video. I agree with the end assessment. PA for 19 years. I don't like being viewed as a cheap doctor replacement by politicians, and healthcare administrators. I have less training, but I also have a significantly lower paycheck. It is really frustrating when some expect the same volume, and acuity load from PAs and NPs when we are less educated, and PAID LESS. I have worked with a broad spectrum of physicians from the ones who hate us, and treat us like scribes or med students to the ones that supposedly love us, and would be perfectly happy to sit back and let us do all their work for them. I value my physician colleagues both for their skill, and their leadership, and I never wanted to replace them.
You speak of something that is so commonly devastating for new graduates trying to get a job. On many threads where information is shared, quite a few new NP/PA describe their orientation as basically a week and then expected to see the same volume of patients. Is there really a fear of NP/PA physician replacement or just another way to penny pinch by undermining their value?
@@Meneedsabreak BOTH. There was an article in doximity recently that expressed the fear that #1 patients will have worse outcomes (which they have about as much evidence for as ivermectin curing covid), and #2 about how hospital administrators and business types see us as a cheap replacement (even as a travel PA I make less than travel RNs, and even some senior permanent staff RNs on my current ER assignment in California). When you're paying an ER doc $280/hour, and you need a second provider, it only makes sense to hire a PA for $70/hour. In many cases the PA will be expected to carry a similar workload (maybe not initially, but you're made to feel like a loser if you let the doc take all the high acuity cases, even though they will rarely see any of the lower acuity stuff unless they are cherry picking to get their numbers up for bonuses). Some physicians are great, and really appreciate what we do. Some abuse the hell out of us. And yes, some do fear that the secret cabal is trying to replace them with a cheap alternative.
@@robertfox4524 right now, lots of NPs are working as travel RNs because the full time NP positions are so low-balled that it is insane. My program was pretty great because the faculty moved mountains to make sure our MSN degrees remain valuable and respected. However, it is sad when I hear RN colleagues articulate how worthless it is to gain advanced education because they can make more money $$ than NPs while avoiding scorn. NPs and PAs bring valuable knowledge and can do so much to support the entire team --- physicians are people too and can't be everywhere. I really wish the negative hype could be diminished by sensible discernment.
@@Meneedsabreakyep that was me. First job in family medicine. 2 days of shadowing a NP and then 14 patients of my own. That of course increased to 22 patients. And the APPs were the ones that were on call when it was our on call week, not the physicians. And the physicians were seeing the same amount of patients and same complexity as well (I wish I had gotten the easier patients 😂). And paid a lot less.
It's always frustrating when a FPA advocate mentions those comparative studies but neglects to understand that they are not comparing truly independent practicing midlevels with physicians. These are arguments the AANP and AANA continue to have in bad faith.
On the other hand, we don't have very many studies that look at the effectiveness of independent practice because there is not very much of it. It might be the best evidence that they have to work with and their should be studys proposed that allow a simulated independent practice in order to properly evaluate the ability of NPs and PAs
Im a PA working in trauma surgery at a level 1 trauma center, and 1/2 of my job is acting as the safety net under the new PGY-1s who rotate through our service every month. I teach them how to admit, discharge!, consult, remove a chest tube, what nurses can do vs what providers need to do, etc. All the little things that can between the cracks- updating a patient’s problem list so we’re billing appropriately, turning off unnecessary IV fluids, labs, and imaging (some patients have had a “stable CXR” for >10 days). And as they advance through residency, they teach me A LOT too. The other 1/2 of my job is running the geriatric trauma service, and those are my patients but I can always (and often do) call the rounding attending that day whenever I have questions on a patient’s care. I love my job because to me I really feel like I am optimizing physician-led care while also getting to provide care of my own when it is needed, which is what APPs are here for!
I love how you emphasized that we shouldn’t think about it in terms of us vs them We all want what is best for our patients and the heath of our country
It's not a surprise to find out that a patient receiving treatment from someone with a third of the training would cost patients more money in the aggregate. It's so tempting to just look at any given interaction and its cost, "MD cost $100, APP cost $65. Aha! See!?" In the world, however, it's more complicated, you can pay $100 one time, or $65 three times (you may even eventually pay that $100 anyway) for the same outcome. And that cold math doesn't consider the indirect costs to the patient such as time off work going to more appointments, time spent living with uncertainty when there's no diagnosis, the frustration with thinking your APP solved your issue only for it to resurge, etc.
Hope this gives light to everyone fighting against power when our own common goal is equitable and affordable care for our patients. It's important to back-up arguments with research in all sectors. Thanks Dr. Jubbal! RN here pursuing MD/DO soon.
Really frustrating trying to make an appt and asking for a doctor but being told NPs are basically the same thing just book with the NP provider instead
I agree. My medically complex son has been seeing a specialty MD for the last 6 years only to be told that from here on out, he will be seeing the PA. It’s been our experience that NP/PAs don’t have the experience to work with medically complex and come up with treatment plans that aren’t as comprehensive or contraindicated given his numerous medical conditions.
Would love to see a video on MD/MBA programs! With your background this would be especially interesting. There are so many problems in medicine that some business acumen could help navigate, but it's hard to know if these programs are worth it because few people have shared about them. Thanks!!
amazing video!!!! when discussing cost, you mentioned it's definitely cheaper for the hospitals to employ mid-levels. however, these mid-levels often make it more expensive for the patient (or government if they are on Medicare) for those reasons you stated. so basically the hospitals are saving money while the patients spend more money...ahhhh the world we live in :(
There aren't a lot of physicians out there who say, "Damn! I don't know what this is or what to do about it. Let me consult the PA/NP." That's just not happening. Not because physicians hate APPs or anything like that. It's just that APPs are not likely to have the answers for the kinds of things that will vex a physician. NOTE: that is not to say that an APP _cannot_ have the answer. Considering the time crunch healthcare workers are under, it is not worth hounding an APP for a consult. This alone ought to be enough to help draw some conclusions about where the guidelines should begin and end.
APP consults happen all the time … ED doc consults cards APP on a weird EKG … ED doc consults Ortho APP surgery is urgent or routine… Surgeon consults intensivist group APP to see about to see if they are ok with surgery now or if more ICU Resus is needed to survive surgery … it’s a world of grey and not enough physicians to go around thus the invention of APPs
@@HeyItsLonewolf exactly. Everyone is pissed when you consult a doctor and get the np. Your like fuck I might as well go evaluate them for this specialty myself
this is honestly why I want to be a PA. I want to practice medicine and provide care to my community, but I'm not comfortable with the level of responsibility that comes with MD or DO. I'm more than happy to have someone I can ask questions especially in more complex or zebra cases.
@@LOLWAAHH - Generally, a certain set of symptoms will equal common conditions, like how a horse is commonly thought of as the hoofbeat animal. "When you hear hoofbeats, don't think zebras, think horses". However, when a client has symptoms that are NOT so common, clinicians still frequently try to shove those clients into the common horses model instead of looking for an uncommon, more exotic condition - the zebra model. ---------------- For example, over the years, my primary treated me for many illnesses like 60 bronchitis episodes (true!), 4 pneumonias, 1 mono, 1 RSV, 1 rheumatic fever, 1 HPV mediated cancer, etc - looking at each thing as a separate horse. After I had viral meningitis twice in one year and he finally found out that I have near absent IGM, B cells, etc, I was I referred to an immunologist. All those separate diseases / horses were actually just symptoms of one very big zebra - an immune deficiency. I now get IGG infusions Q 4 weeks with great effect. My primary was so embarrassed that he never recognized a pattern, that he stopped looking me in the eye when I saw him, but would just mumble at me while facing his computer screen. ------------------- So, the moral of the story is that sometimes when you hear hoofbeats, they aren't horses at all, but ARE zebras and you have to have the training, knowledge, experience, and innate cognitive ability to recognize it.
There needs to be more investment in the amount of residency slots across the board, as well as greater incentives for primary care paths. I would even say that there should be more efforts to supporting expansion of medical school if the applicant load continues to increase like this. I don't think growing these endeavors will be easy but it needs to be acknowledged and supported by anyone able to help!
That’s wat i was thinking because although I have no issue going through medical school it’s scary to waste all that time and not match for residency. I don’t necessarily want to be a NP but it seems a more sensible route
@@RichObiQuan Because of the knowledge and the experience level that MDs/ODs have compared to nurse practitioner. Don’t count the nursing experience as a real one! Some nurses just do tasks without trying to understand what is going on!
Depends on if you're practicing at the bottom or top of your license. The NPs who lack diagnostic skill or experience always compensate by ordering more tests. You see this same behaviour in Physicians who practice at the bottom of their license and residents in training. The difference is residents gain more experience and medical education and become more precise. That infrequently happens for mid levels unless they work alongside good doctors in a solid institution. Healthcare providers are like bodyguards. You get what you pay for. Experience cannot be taught.
Online diploma mill DNP programs require as little at 500 hours of "clinical experience" this can be online or shadowing, many of these schools do NOT require any previous nursing experience. Blows my mind that these people are allowed to practice independently
This is reassuring. I really want to go into FM but other students keep telling me that I'll just be doing what NPs and PAs can do. It's nice to see the data to back up otherwise.
If ONLY PAs and NPs start handling primary care then usa will be in flames and ER would be even more overworked than it is now cause NP and PAs would miss things physicians have been taught to catch
I've worked under NPs and PAs before but the reality is that they simply follow whatever formula their attending physician follows. They don't really understand the how or why as much as we do and as a result are much less flexible on making comprehensive treatment plans. Even their knowledge is a fraction of that of am attending physician. I've had patients ask what a malignancy is, but the provider was unable to answer.
@@maximumovermuslim6337 lmao what ? I'm an undergrad and know what that is. Idk if it's fair to compare a clearly ignorant app with a regular attending
Thank you so much for explaining the difference between these medical careers as I am a non-traditional pre med that wants to become a doctor. I’m still in my twenties but was feeling like it’s too late. I want to be a physician! I want to practice independently and now I understand the reason for the rigor of education.
It would definitely be interesting to see the true data about the physician shortage because even though some don't match, there are also those in transitional years but medical schools count them as matching even though they don't have a guaranteed specialty, and residency slots still go unfilled post soap which blows my mind.
In a TY myself, it’s crazy how many qualified applicants there are and don’t actually end up matching. It’s definitely the way of the game but it also sucks for the applicant and the benefit to the respective specialty profession they could have made.
@@redd1417 I think there was a crazy statistic last yr that 80% of the nrmp students didn't match and had to go through soap and the soap is what brought the match rate into the 90s but it's crazy that for that graduating class you had a one in five chance of not matching the first time around. It's frankly terrifying.
@@kaitlynkilpatrick36 I'm sure that number applies to certain applicants, which can vary from specialty to MD/non-MD status. The match rate for a number of specialties has definitely gone down over the years which goes to show how little programs are doing to increase their spots to match the growth of medical schools.
My PCP is an NP and she’s awesome, but these concerns are very valid. It’s terrifying, the thought that even if I get into med school, I might not get into residency. It motivates me even more to learn as much as I can now.
not to mention DNPs who can go by "dr" and more states beginning to legally allow it. nurses have a strong lobby for independence and are vying for more pay along with being called a doctor
if a person earned a doctoral degree...they have earned the right to the title..other professions such as psychologist use the title with no problem..introducing self as dr so and so and then stating that they are a nurse practitioner should be ok
Doctor I think Is absolutely fine if the NP is working in independent practice. People need to realize doctors can be anyone with a doctorate degree but a physician is only for those who went to medical school
Of course it’s legally allowed. MDs do not own the title of Dr. Anyone with that level of terminal degree has earned the title, for example; professors, pharmacists, etc. It’s our responsibility to educate the public and be transparent about our degrees and titles.
@@bdawn3519 i meant going by doctor in a clinical setting. it's misleading to patients and it's illegal in some states. in az and de, an np has to clarify that they are a nurse if they use the title doctor in a clinical setting. in seven other states it's illegal to use the title doctor all together. earning the title through an accelerated two year online program with a few clinical hours and then having to refer out all your patients to real doctors with real training isn't really earning anything. by the way, i'd also argue that kevin jabbal isn't a doctor, either. he was never board certified or an attending.
I don’t understand why NP/PA get offended by the term “mid-level.” I am an EMT-Basic, and provide Basic Life Support. I don’t see “Basic” as an insult. It’s just a descriptor of my training in the overall medical hierarchy, like “mid-level.”
Speaking as a PA, most PAs do not. I don't care what you call me. I'm a PA and I treat patients as part of a team with a physician. I'm happy doing so.
PAs don't mind. But most who feel threatened use it as a derogatory term. What amazes me is that you have some Drs who have no business being doctors and vice versa. Point is, to be a competent clinician, you have to have experience and training which is the status quo for bein a physician. But the same doesn't hold true for others who acquire similar training over the years. I mean there is only so many ways to diagnose and treat a particular disease process. But the default argument is always cognitive intuition and reason which if you let then tell it, seems to be only reserved for those selected fews who obtained a 4 year medical degree and attended residency training.
@@js2156 admittedly, the only PAs/NPs I’ve ever met who actually take issue with it are online. I work in a community hospital ER that employs mid-levels for managing lower acuity patients, and they are fantastic. Absolutely essential to keeping the ER from getting backed up. They have a great collaboration with our docs and are respected by everyone. How it should be
They get mad at my institution. Also, I just heard an NP the other day refer to herself as the attending and she got corrected by the patient. Too much hubris
Great video. Everyone in the hospital has a vital role based on knowledge, skill, and training and it's important to stick to those roles. Would love a video addressing the physician shortage!
ICU PA here. I love working alongside attending physicians and residents as part of the comprehensive team. I enjoy having oversight and the ability to ask questions when I am unsure how to manage certain diagnoses/issues. I have also seen the reverse of this be of value when residents are able to ask PAs with many years of experience questions they may have pertaining patient care. In the inpatient setting I believe this team approach ensures patients are provided the highest quality care possible.
Would very much enjoy a video of the issues you raised regarding matching and lack of places for training medical students at graduation. This is a problem that I had no idea existed.
Also mentioned above, but it's also crazy that these unmatched doctors can't even attempt to practice as a mid-level under a physician, because we they are unlicensed they cannot even be in P.A. or N.P. spots
I feel like a fresh attending will not be as effective as a NP who has been practicing for 20 years. Also a 20 year FM attending will perform better than a fresh attending. The point I think is that not every patient needs the best possible care--the number of House tier doctors are very small. So the question should be "what is an appropriate level of care, and who is capable of providing that". Research clearly points to NPs and PAs being capable of delivering high-quality primary care on their own. This decision should ultimately be up to the patient to choose which provider they want. Nobody is forcing anyone to have a NP/PA. The patient chooses to go to the appointment. In rural areas they may not have many choices, but it's still a choice. And if a provider is not giving excellent care, they are removed.
There is a physician shortage but mainly because a lot of medical students don’t want to match into a primary care specialty, and the shortage is mainly in rural and remote areas that are places where a lot of ppl just don’t want to live
I mean, technically there is a shortage across all specialties. I think part of the problem is marketing of primary care and making other specialties out to be exclusive.
@@redd1417 NPs made it harder to practice in rural areas. In order to accept medicare in a rural clinic you need an NP on staff. Unfortunately not many NPs go rural. Research shows mid levels go to big cities just like physicians.
The US should start using the Australian BMP model to increase rural/remote physician numbers. Basically the government offers you a heavily subsidised position (sometimes 100%) in medical school, in exchange you owe a term of service in rural and remote practice. Though in Australia we have mandatory 3 years post-graduate period where you serve in the hospital rotating through various specialties BEFORE you apply to accredited training programs, so basically all doctors here have a minimum 3 years of acting as defacto primary care physicians (though under supervision obviously).
The other problem, in addition to residency issues, is the issue of cost of medical school vs PA/NP programs. I’m a Bachelor Degreed Flight Paramedic, B. S. In Emergency Medical Care Paramedic Sciences, that was a pre-med/PA degree. However, after 13 years of practicing as a prehospital provider, I’m looking to expand either into a PA role or MD, but having 2 kids, a wife, and house payment, I can’t in good conscience put our family into the debt of a 2nd house, just to attend school, not even considering the loss of what might as well be 7 years of income between how little residents get pay and getting paid nothing to attend medical school. If we want more physicians we have to make medical school accessible, and the post medical training programs have to take all the medical students that graduate, otherwise good, even great, candidates go to PA/NP school or into business, law, etc. Personally I’ve been waiting/hoping for the NAEMSE’s 2010 position paper on EMS education to get picked up more mainstream, particularly by PA programs who seem uniquely suited to create this prehospital practitioner level in combination with PA training to provide a more independent practice PA, but alas, I’m starting to think it won’t happen in my life time.
I am just curious how many ppl in AMA/congress that are pushing for the mid-level provider independent practice has (and prefer to see) NP/PA as their PCP over MDs. This would be really interesting research studies to conduct and find out.
I've always enjoyed working with NPs as a patient as opposed to physicians. Their approach seems more natural generally. I really think this is due to how they're billed though. NPs generally can spend more time with patients. As far as whether NPs should practice independently, I agree this video makes a good case as to why they shouldn't. As a side note, I was referred to a "specialist" I thought was a physician and referred to him as doctor. He was an NP, not even a D-NP and didn't correct me. That miffed me a bit.
Ask any psychiatrist about new patients presenting to their clinic who were being managed by an NP. It’s horrific. I’ve reported multiple NPs to their state licensing board for gross mismanagement of medications and unnecessary use of medical procedures like brain imaging. Their diagnostic skills are awful. If a patient has irritability they get a diagnosis of bipolar disorder despite meeting no further mania criteria. It’s gross mismanagement of patient care. I recently had a new patient who didn’t meet criteria for major depressive disorder and was started on paxil… Arguably the worst SSRI for depression in a young patient based on its side effect profile. A competent fourth-year medical student could do a better job on a psych eval of many of these patients than an independent NP. They should never be practicing independently, at least in my field of mental health.
Young lady p'd/w episode of psychosis, driving halfway across the US. Turned out she was recently rx'd 60mg-40mg Vyvanse qd (max is 70 qd, and her ADHD was not nearly bad enough to warrent max therapeutic dose.) Guess who her 'psychiatrist' was? This NP at a pill mill in a FPA state who wasnt even reacheable for contact during routine business hours. No place for NPs in Psychiatry IMHO, and this is coming from a med student, not even in residency
@@ceintureblanche7742 should specify what type of NP…. FNP vs PMHNP have different training and scopes. Seems odd to me you guys lump all NPs together.
My mom is a CNM/NP, and based on what I hear about her coworkers I agree they should not be independently practicing. Especially in labor and delivery it’s common for CNMs to not understand (or ignore) provider/patient boundaries especially in birth centers. Because of not having boundaries they put their patients at risk thinking that they can save the patient when they don’t have the training. My mom worked as an RN for 20 years so she understands the boundaries, but the ones who went straight through from RN to NP seem to lack those boundaries.
LOL have you ever looked at the infant and maternal mortality data if the United States? The United States is the leading killer of infants and mothers of any industrialized nation. Honey, this is exactly what happens when doctors interfere with the natural cycle of life because they want to avoid litigation. It’s not about CNM vs MD, it’s about preventing negative outcomes (birth injury, misdiagnosis, brain damage) so that physicians and hospitals don’t get sued. Unfortunately, in a court of law, a doctor has to show the took all correct measures to PREVENT an infant or mother’s death to avoid negligant practice lawsuits.
As a future Nurse Practitioner, I look forward to working alongside a physician and becoming an important part of the healthcare system in order to achieve positive patient outcomes.
Unmatch MDs and DOs should jump into mid-level rolls immediately and indefinitely until they match, whether they are AMGs or IMGs, their training out the gate is far superior to any PA or Nurse imo.
You should really stratify out PAs and NPs instead of lumping them together as APPs/Mid-Levels. Our training as PAs is *exponentially* better than an NP's. Most don't even know how to do something as basic as suturing when coming out of school. Our training is nowhere near that of a residency-trained physician, though.
You sound pretty sure of your opinion that you outrank nurse practitioners. I had 20 years of actual BSN RN patient care under my belt prior to my family nurse practitioner program. My supervising physician sometimes calls me for advice.
@@dawnbarchett8026 Yeah, I find myself doubting that a physician would ask an FNP for medical advice. Sorry, the discrepancy in training is just too large. Also, yes, the standard opinion of physicians in my experience has been that PAs are vastly better trained than the majority new grad NPs. I guess having admission standards really does make a world of difference.
@@dawnbarchett8026 PAs are better educated than most NPs. That is a straight up fact! Their schooling is rigorous, and organized. The graduates they produce don't have such a wide variance in competency. Also, they actually learn medicine, not nursing.
@@dawnbarchett8026 I think JS meant that his training in medicine is exponentially better due to the fact that his training is in medicine and not nursing. Many PA students go to MD/DO medical colleges with PA programs and take many of the same medical classes (at the same class with medical students). Most PAs actually don't want to get full independence though they do have closer training to real doctors when compared to NPs. To most, it seems that NPs have an inferiority complex. Heck, I did medical school clinicals at hospitals with PA students on the medical team as well, but the difference in medical knowledge was apparent during rounds. Can't say the same about NPs since they don't really train with Doctors or PAs, mostly shadow for their clinicals. B
I know that PA school is different from Np school but I’m sure a newly grad NP with more than 10 years experience in ICU can handle cases in the ICU compare to a PA that does not have background in the ICU.
@@bonzahrn5148 you are certainly right about that! The system is broken and a lot of people are falling through the cracks. That issue is much bigger than practitioners
@@bonzahrn5148 he mentions the root of the issue in the video as I’m sure you heard. The issue is the bottleneck in the supply of new doctors… the remedy is not granting physician privileges to mid-levels who lack the qualifications.
You do know the word “doctor” is not exclusive to physicians? A person who is able to finish a doctorate degree can call themselves doctors. Physicians finished their “doctor” in medicine. Pharmacists are doctors as well. Even physical therapists can get their doctorate and call themselves doctor.
Improving access to high tier care is HUGE and the whole grasping onto scopes is really really really hurting the growing population of humans, especially in remote areas. However, I think anyone whos taking any university science course can agree. When it comes to research and formulating unproven treatment plans you really want someone well versed in science and cellular function. Which usually comes from the scientific approach that is gained otw to medical school. I actually wonder what the thought process is on Paramedics, they work independently on critical calls ALL THE TIME. Where there is No supervision and you really have to self study beyond what they teach you to be effective. Now for the acceptance rate arguement, thats usually reflective of how many facilities are available to train them. So for instance, as a Canadian I can skip the rigor of getting into a Canadian medical school and go to the UK which has hundreds of years into building university infrastructure to teach medical students. So the UK has more slots available and pumps out more Docs. Personally, I think every career choice should simply have a recognizable pathway towards entering medical school, that has nothing to do with your undergrad - How long have you been practicing, what are the results of your patients, and can you pass the med school entrance exam? It should be, oh your a PA/ NP well now if you want into medical school you have to to this and this and this, regardless of your experience because we said so, I dont think that really considers the reality that these people will be highly successful in medical school and thus increase the health care provided to the overall society. The problem to me is, the difficulty of recieving medical school training. Haha buddy says exactly that in the end nice.
*copy* (Thanks Doc), A Med School Insiders video that explains what happens when a student doesn't match into a residency spot would go a long way in understanding the problem at hand, and what to possibly expect in the future. Thank you!
Video about bottleneck for MD/DO training, including the different match rates between US MD vs US DO vs American IMG vs Foreign IMG would be awesome! Especially regarding how it's ultimately connected to Medicare funding
The limited number of residency spots is scary for many pre-meds out there. There are already so many obstacles not being able to get into residency for a certain specialty is not cool. If there is anything that pre-meds can do to help I am sure we would be down to help.
I’d love to see a video on the physician shortage and what can be done about it. As an Army Veteran who’d love to attend Medical School, a ~6.5% acceptance rate isn’t exactly appealing and then the residency issues on top of that have pushed me to consider other careers.
@@future3325, you might be right but overall, the acceptance rate is still low in this country. Then people wonder why there’s a doctor shortage. Not saying quality needs watered down but something has to change.
@@CornFed_3 there isn’t a physician shortage just a distribution problem… last thing you want is a bunch of doctors who can’t find a job. It’s competive for a reason
@@SK-mr6ov, you’re partially right. There is a shortage in a sense but also a distribution problem because of residency program issues. Another issue is where people seem to flock to. The glamour of city life and high salaries draws more than lower cost of living areas with not as high of salary.
@@future3325 I haven’t found any concrete evidence backing this statement. I am also a military vet who is looking to get into medical school! Would you be able to cite the source for me please?
I'm in nursing and I can tell you the faculty pushed this agenda non stop. most of my classmates see through the BS but it seems to be the PhD types in the nursing field who push it so hard. they are obsessed with putting Dr in front of their name however they can
Let’s be real y’all we all know that insurance companies will not ensure NP and cRNA‘s independent process Unless they could pay leagues more than a physician. This is strictly a way to get hospitals to hire a cheaper labor to replace physicians
The best midlevels I’ve worked with have been those that went to an in-person program and those that chose specialties that matched their previous clinical background. Online trained NPs have an enormous learning curve and should NOT be independently practicing.
for the final study, dd they ensure they were comaparing similar patients? I'm wondering about the social and economic determinants of health and if that was assessed.
I'm not going to lie. Seeing that acceptance rate is rather disheartening. I'm a practicing speech therapist, and I'm studying for the MCAT. I do NOT have the same undergraduate training as, I imagine, most other applicants. I do have more than 6000 hours of clinical experience, but I doubt that'd be good enough to place me significantly above than higher scoring applicants. I would definitely like to hear thoughts on how the med school/residency acceptance rate could be addressed. Thanks for the great video!
It’s a little misleading. It means that each school accepts on average 6.5% of applicants, NOT that only 6.5% of applicants matriculate into medical school. It’s not unusual to apply to 20 schools. If you have a 6.5% chance at each one, your overall chance is much higher. Even if you are an average applicant, your in-state medical schools and DO programs are a reasonable fallback as they will often accept roughly half of in-state applicants.
@@qprtx oh! Okay yeah I definitely misunderstood what that statistic was trying to say. That makes much more sense. Also.... 20 med school applications?! 😮. My letter writers are going to be pissed lmao. Thank you very much for this response.
@@seanknapp4458 Don't worry, it's a single application (AMCAS most likely) sent to 20 separate schools. Some states, like Texas, have a separate application (TMDSAS), but the same concept applies. 1 application sent to multiple schools. Your letter writers should rest assured! Lol
@@seanknapp4458 Arthur is right. The letter writers only need to submit one letter generally. Those get sent with the standard application to as many schools as you would like with (unfortunately) a fee attached to each submission. You will have to bear the burden of secondary applications though, which are unique question sets, mini essays, and supplemental information for most of the schools you apply to. Even after jumping through that hoop, most won’t give you an interview, but you only need one to accept you! And you’ll find that your real world experience makes you more mature and capable of taking on the stressors of medical training than many students in your class who came straight from undergrad. I applied to 21 schools in 2013 and was only offered a single interview, but that was enough. Good luck! It’s a thrilling, stressful, but wonderful journey.
This is ridiculous, and I'm shocked AMA is allowing and promoting this! NPs will NEVER be MDs, and vice versa. They are two different types of work. It's crazy harmful not only for MDs, but first and foremost for patients. Absolutely baffled this is happening.
Full practice authority doesn't mean they can just open a pediatric clinic or primary care facility. There are a lot of hoops you need to jump through, and all of which requires ABIM board certified physician. Of those NPs who do decide to become independent, most of them operate legal medspas and drip bars. None of which are covered by insurance it's still medicine though because it's a free market and the buyer can dictate what FDA approved medical services they want.
As a PA, I’m not a fan of being lumped in with NPs especially with education, clinical hours, studies, etc. I know we do similar things in a day but to me I don’t understand why NPs have independent practice and we cannot (although I’ll say I do not want independent practice, and I did not become a PA because I wanted to be a doctor). I love working together as a team. Honestly a big reason PAs are pushing for something called optimal team practice is because the NPs do have independent practice in some states and the issue is, they are getting more jobs because they don’t need to be linked to a physician. Do I think that’s right? No. As far as PA school, our didactic years are usually 15 months and we barely have any breaks (1-2 weeks in between semesters and no summer breaks). We must have healthcare experience because we are hitting the ground running. One of my semesters was 32 credit hours in a semester. After PA school we have done more credit hours in our masters program than most doctorate programs have. We have at least 1 year full time clinical experience. And what you mentioned about clinicals with NPs, that’s another difference with PAs. According to our national standards, our programs are mandated to have clinical sites for us. We do not find our own. Depending on the school it’s usually 4-6 weeks a rotation and these include core mandatory rotations (including general surgery which NPs do not do) and 1-2 electives usually. We also cannot work in most programs and those who do may be doing a shift or two in a month compared to where it seems NP schools, a lot of nurses work (even full time) while in school. Another difference is online programs. As you mentioned there are a lot of online programs for NP. There are a couple hybrid PA programs (although most of us PAs are pushing against those and do not think they should be a thing). In those they must go into school a certain amount of times in didactic but the lectures are online mostly (most PA programs you must be present at every single lecture, this is even different from what I have heard with med school). During clinical year of course it’s all in person. There was another thing you said about the differences and I’ll post it if I think about it. Oh.. acceptance rate. Yes. It seems like it’s easy to get into NP school why it’s increasingly difficult to get into PA programs. It took me 5 years with a 3.6 GPA, and 10k direct patient care hours to be accepted. One program I was accepted to, had a 1% acceptance rate. On average I think PA programs have a 2-10% acceptance rate and I may have heard that overall like how many people apply to any PA school and how many get in, is about 30% (most students apply to multiple programs). And the majority of pre PAs do not get into PA school their first year. I started in primary care I was expecting them to do some training before I was seeing patients. Well.. they had me shadow a NP for 2 days and the next day I started seeing 14 patients on my own. By the end they were wanting us seeing 22 patients a day. I left after 22 months. I moved states and I’m looking for a job that has good training models. I don’t want to cause harm to anyone of course. I want to help these patients the best I can. I’m also looking for a more collaborative job than in family medicine. Oh and from what I have seen these days more and more nurses are getting their BSN and then going straight into DNP without any nursing clinical experience. And then they want to be called doctor. I don’t think if you’re not a physician, you should not be called doctor in clinical practice as it’s confusing. Same goes for doctorates for PAs but I haven’t really heard of those PAs calling themselves doctor other than in the educational (not clinical) setting which is one of the reasons they got their doctorate in the first place (for education). Two more I thought of. You had mentioned studied show we prescribe more abx and order more tests then physicians. Inthink that’s possibly true for older PAs but in my program (graduated in 2020) they were very adamant about not prescribing abx when not needed because of abx resistance and also not ordering a bunch of labs and imaging that aren’t needed. So I think us need PAs will change that.
Nursing programs are pretty competitive these days. Chemistry, Biology 1+2, micro, A&P 1+2, pre calculus Algebra, and other exams to get in with a large swath of people applying. At least this was my school experience. The online schools should not be a thing tho. A brick & mortar school with a solid program makes for good APP’s. Our program requires at least 2 years of RN experience within your specialty and a 3.4 entry GPA. Also, the person matters. I’d love to do PA school for some of their rotations and love the sciences, but I’d waste nearly 3 years waiting to get in, and countless amounts of money, so I’m likely to do NP.
Np, PA cannot be equal to an MD. Increase the residency spot, There are many Us citizens IMG passed USMLE but not getting residency and even cant work as PAs or NP. so they are working at Walmart LOL
The AANP is trying to make all Nurse Practitioner programs doctoral level (Doctor of Nursing Practice) by 2025, meaning that the masters programs are going quickly and being replaced by doctoral programs.
Very detailed video that sticks to the data. Love it! I would enjoy a video describing the residency cap-I made a short video about the 1997 Balanced Budget Act that was largely responsible for the bottleneck problem and would like another perspective.
RN here and future critical care NP. i very much look forward to working along side a physician and do not wish for independent practice. find it ridiculous
Yep, it's unfortunate but I think going forward the only way for medical students to protect the future of their career is to become surgeons as NP and PA's will never take that from them. Obviously this is a problem though because only like 30% of medical students end up in surgical specialties right now, it's fucked up that the other 70% is getting hung out to dry by state legislatures
I agree! An MD is much better educated. I was forced to see an APN who was not supervised by an MD. I was sent for 3 unnecessary expensive tests. It delayed the diagnosis, put my health at risk, and put my body thru more stress and radiation in a short period of time than the best practice standards recommended. The APN I had seen never truly understood the results of my tests and did not know what the steps to take next. As a patient I needed to know my Physician knew what to do to take care of my situation. I am changing to an MD as soon as possible.
In the flip side, I had a neurologist ask me (a bedside nurse) if TPA was appropriate. I’ve had dr’s order inappropriate contrast and be corrected by a radiologist. I could go on, but please don’t say using your resources appropriately is doing nothing. It’s exactly what was being advocated for in this video. Not practicing solo, consulting with those who know more. Etc.
@@bonzahrn5148 Do you think the neurologist was asking out of true ignorance or asking to see if you knew? Because ALL neurologists working in a hospital know indications for tpa.. Also, Doctors can order incorrect things occasionally it's only problem if the mistakes are consistent.
@@Benboy887 Yep this sounds like a bullshit story. I'd bet even neurology residents one month into residency know when to use tpa. Hell, most medical students know considering it is tested on their boards
@@xxDPKINGxx Are you even in the health field? How much experience do you have working in a tertiary hospital? Do you know what the MDT is? It`s significance? Do you truly believe doctors work solo and call all the shots ? Do doctors spend 12hours with their patients? Do they monitor how their patients respond to their treatment? Again, are you in the health field?
I 100% agree with your verdict that APPs should not be independently practicing. As an ER scribe and freshly-matriculated nursing student who has very possible future plans of becoming an APRN in the distant years, I've seen the kind of complex cases that even some of the APPs I've worked with have even felt stumped on themselves, and the doctor on site was happy to help and they've been equally grateful for the help and have had subsequent good patient outcomes. This is a beautiful system that I honestly feel doesn't need any fixing whatsoever. I definitely can see the provider shortage at hand, but I too just simply want to see more residency spots open, so that the same system can continue but at greater outreach. Plus, if I become an APRN, I wouldn't want to go in it entirely alone. Something like that is my one of my worst nightmares. I love directly working with doctors and receiving the great teaching and lessons I've learned just in my time as a scribe, and I trust their judgment and experience completely and wholly. If I become an NP or CRNA, I would want nothing more than that same collaborating relationship to continue on. When I have a doctor directly above me and nearby for consult as needed, it makes me feel as happy and secure as it gets.
The nurses who I see advocating for increased scope of practice are always the very young and over-confident types. The types who made it through nursing school by the skin of their teeth and now feel limitless. The best, most-experienced nurses know that are some things in healthcare that doctors are more well-suited for and vice-versa for nurses.
I cannot say anything about a Physician Assistance but after going to a urology department in a hospital in Akron Ohio. I can tell you I was so disappointed in the ability and knowledge of the Nurse Practitioner, I now wear a medical ID bracelet that states “I refuse all treatment from any Nurse Practitioner.” Nothing was explained and I was not told of all the equipment needed and how to use it. This caused two trips to the emergency department to take care of problems. These problems could have been handled at home had proper information and equipment been explained.
As a senior nursing student who has been accepted into NP school, I honestly find that most of the "scope creep" controversy is coming from corporations and the educational system or the national associations for PAs and NPs. In my experience with family who are MD, PA, and NP, I find that they tend to like collaboration. MD/DO can focus on more intense patients while PA/NP can lean on the physician when they're out of their depth. However, a lot of hospitals likely are pushing for independent practice because then they won't have to pay physician salary. Furthermore, the educational system also promotes independent practice without giving new grad NP/PA the tools or training to do well leading to liabilities and malpractice. I could have pursued MD/DO, but I believe that God led me to nursing to help the field of nursing especially since midlevels aren't going anywhere anytime soon. Maybe that will be through pushing for additional training or residency programs for NPs, but I'm hopeful that my career can lead to something. Anyways, for all of the MD/DO, thank you for what you do and the same goes to NP/PA. For the physicians, I would like to be supervised immediately upon graduation, how would I go about doing that? I'm also going to apply for a residency program, but there is only one in my area that accepts four applicants a year. I'm going for FNP by the way. Anyways, just some food for thought to reduce the animosity between midlevels and physicians. Thank you. God bless you! I'll be praying for you!
Just work with each other! It's a teamwork, not a competition. Every profession has a role. I don't know the statistics, but there are always people from every profession, including physicians, who makes mistakes. For example, physicians also misdiagnose and/or give wrong dosages, so that's when the pharmacists come in and correct them. Not every person is expected to know/do everything and hence different professions were made. The job is to work together and always prioritize the patient's health and safety.
I hear this "work together" stuff all the time and I do agree with this. Working together becomes a little harder when unqualified people are constantly trying to take shortcuts to your position without putting in the work. A big problem is that some professions are beginning to forget their role.
Problem is people don't want to work together and that includes NPs and PAs look at the push for independence and for physicians look at those who don't want to collaborate
@@geraltoftrivia2757 You don`t sound like someone in the field. I don`t get how someone would try to take your position when they are studying something completely different.
I’m a nurse and debating between going the NP vs MD route. I’ve worked with some amazing NPs but I’m leaning towards MD as my end goal is autonomy. I don’t see the purpose of going the NP/PA route if I know my end goal is to be completely independent. Each path has its own value, it’s a waste of time and money choosing one and trying to turn it into the other without gaining that additional education and clinical experience. I’ve also seen people go from nursing school straight into an NP program, which absolutely makes no sense to me. Imo one of the strengths of being an NP is gaining that clinical experience BEFORE you begin training as a provider. Nursing is such a unique niche, wish the focus was on enhancing that skill set more than turning it into something else.
I’m currently a nursing student and having a hard time deciding what to do. I cannot afford med school, and frankly see more appeal to working as an NP. I don’t want a doctor’s scope of practice, I don’t want to be in surgery, and don’t feel comfortable with the responsibility of making the decision on someone’s care. I would much rather go to a consuting physician if I’m unsure than be the physician that “has” to know everything. Especially for the specialty I want to go into I see a lot more appeal to being an NP vs physician. However I also don’t want to be distrusted/disrespected by patients or other healthcare professionals because of being an NP. Like, I fully understand that as an NP I’ll be less educated on complexities or rarities or details and would GLADLY speak to a physician when it gets into that. I just don’t want people to look down on me or lump me in with scope creeps. I don’t know. I anyone has avoid, please lol
Question for you, how would a paramedic mid-level provider fit in this scaffold of the medical system? They do have significantly less medical training in the broad range of general medicine, but they do operate independently from their outfit which is the biggest detractor from PA and NP folks according to you. I would imagine that if you were to become a mid-level provider it would come with a lot more schooling so that might hammer out the differences in knowledge. Like it or not, the scope of practice for a paramedic can go very nearly to the furthest reaches of what an ER doctor can do. I know of paramedics who have cardiac arrest c-sections in their scope of practice. With that in mind, would there be a place for "field practice" providers who can do most of the same things that a PA is allowed to do in their private practice but geared specifically for medical Care to austere environments. Some examples could be oil rigs, wildland fire camps, civil unrest/war zones, definitive care in the prehospital setting.
I don’t know if NP is Worth spending all my life time for because i have tried youtube l associates and some others and still failed 4 attempt. I feel so frustrated don't know what to do anymore don’t even have time for my own kids any more 💔💔💔😔😔.
Frustration is a very positive sign. It means that the solution to your problem is within range, but what you're currently doing isn't working, and you need to change your approach in order to achieve your goal.
I’ll keep on studying till i pass no matter how many times i fail, I’ll advise you don’t give up because we all have come a long way so keep try till you get there one day or better still go get help from Mrs Cynthia
A lot of you have been asking for a video talking about the issue of unmatched residents. I actually discussed this topic in depth in my Surprising Facts About the 2022 Match over on the Kevin Jubbal, M.D. channel: ua-cam.com/video/hpFZHeX1vOk/v-deo.html
The lack of adequate residencies to accommodate all medical school graduates is a travesty! Currently there are 154 M.D. schools and 38 D.O. schools and the number in my state are projected to increase by 2 more in the coming years. If government funding is not available currently to accommodate all graduates what will happen in the future? In my opinion all graduates should be able to do an internship and this could be accomplished by slashing the first year salary, making funds available to pay all graduates as interns because it is in all respects a training year. It has not been that many years since med school graduates would sometimes do an internship and then hang out their shingle or work with an established practice, often in an underserved area, rural in most cases.
Presently government funding is used to train PA's and APRN's to bridge the gap where there are not enough MD's to serve an area. If an M.D. completed an internship and then worked as a licensed physician he or she would be a more qualified asset than the NP's and PA's. To not utilize the medical school graduate who does not match and is unable to complete an internship is a lost asset and a waste of money for the taxpayer who paid taxes to support the local state medical school. The military uses medical school graduates as independent practitioners after an internship. They can then apply for residency programs or complete their service obligation as a general medical officer.
To do otherwise is an injustice to the medical school graduates who do not match and the communities that are medically underserved.
@@georgewashington687 cant agree more.
I made the decision to pursue PA because I do not want a doctor’s scope of practice. If someone is going to PA or NP school hoping to do a doctor’s job, they are just trying to avoid medical school and the other extra responsibilities (I.e. legal) that doctors hold and those are NOT the people I want treating patients independently.
Agreed. I want to pursue NP school to continue to be part of the team, that's what the nursing role has always been. I respect the MD/DO role, and like knowing that if something is over my head, I can ask for help and have a resource to learn from as I practice. That being said, NP schools are too loose in my opinion. It's just too weird that it's each individual students job to locate their preceptor. I don't see how that benefits the student or the evetual patient.
@@HelixChaga I failed 3 times, i lost money to reviews that never helped but the major thing is that I've not lost hope
@Jeff Lorry I only studied a lot when i went for the first time last year but the second time was so easy, all thanks to my aunt who introduced me to Miss Catherina Alison am really grateful
I'm not here to convince for her but to share my testimony for what I confirmed, she’s Trust worthy and best option ever seen, thanks Miss Catherina Alison, God bless you, I've never seen or heard any of her clients has complain of failed. I think she's just too lucrative and perfect for this job
@@gabrielocasio8415 I saw someone say she's not legit. i couldn't stop laughing, really people say a lot of shit these day's
It’s ridiculous to me that some pre-nursing students will talk to me about how they want to do nursing and do a short course to become an NP because then they’ll be able to do what “doctors do, without having to waste so much time.” It scares me that some people who think the extra practice and guidance a physician get, in order to treat a living human, is a WASTE of time, just because they want to brag about practicing independently. As a newly matriculated med student, I was very fortunate to meet some wonderful PAs/NPs in my premed years that were so smart, but has never had to outwardly brag. They had the trust of their team, and knew exactly where their limits were and strived to learn from it. I only met one NP who was as described above, and although she was the most outspoken, she was the least trusted, even by her fellow NPs.
I mean there’s currently an issue right now with new grad nurses wanting to take up travel contracts because for some reason they think nursing school and actual nursing practice are the same when they aren’t. So in that sense they’re also wanting to shoot the sh!t in that aspect as well! There needs to be a lot of understanding that needs to happen unfortunately
A large part of medical training is a waste of time. An ophthalmologist for example will not need 90% of what they learned in medical school. Same thing for orthopedic surgeons and other specialties. They actually learn to become doctors in residency. . . . not medical school. Also . . what's up with tuition these days?!? OUTRAGEOUS COST with some students coming out $400,000-$500,000 in DEBT. . .
Yes, what they said to you is ridiculous, but you’re talking to pre-nursing students, AKA, people who know nothing about nursing. Pre-nursing students might have big ideas about what they want to accomplish but when they get into nursing school, they’ll find out they really didn’t know anything at all. I’ve seen some people like that in my day, and they didn’t even make it through their BSN program, let alone a masters + post-masters NP program or a DNP program. I used to want to be a doctor when I was a kid, but I got married young and raised children instead. My my 30s, it no longer seemed like a practical goal. I can still help people as an NP, and I want to work in mental health (an area with a major need for providers and not enough providers to help everyone in need). To become a PMHNP, I will have a total of 9 years of college education. It’s not exactly the super quick and easy pathway that people make it out to be.
@@restalot1 In theory you’re right, but life is not so straightforward. I also think med school is the time for you to find your specialty as well. Most students don’t come into med school (or at least me and my classmates) having a DEFINITE choice. Maybe a preference, but we are still open to options. So how would we know in our first and second year what we would need to know? Then comes third and fourth year when we are able to take what we learned, actually apply it, and find what we truly are good at and/or like. We’re taking care of people’s lives here, and people aren’t going to be a standard that you just need to learn a few controls of and it’ll be fine. I wrote this comment 2 months ago and I have felt very tired since then and sometimes think “when would I ever even apply this detail?” But at the end of the day, I feel very privileged to be in my position, so the 0.001% chance it might show up one day when I’m practicing, even if it’s not part of my specialty, is fine by me.
@@NovaBrite618 true! Again, I don’t have anything against PA/NP in general (I know many very great ones, some I personally even think could have gone farther than some docs if they had chosen to) I’m mainly just directing it to those my age who think it’s crazy for me to go to med school when they’ll be an np in 1/4 the time and think we’ll end up having essentially “the same job”😅
A Med School Insiders video that explains what happens when a student doesn't match into a residency spot would go a long way in understanding the problem at hand, and what to possibly expect in the future. Thank you!
There are many videos out there.. just search in UA-cam
as a new NP grad, if i wanted the scope of a physician, i would’ve gone to med school. i feel like my school kept pushing “full practice authority!” and i was the only one questioning it. i do not have enough schooling to do the things a physician does!
YES!!! I'm deciding between NP/PA or MD, but i literally dont want to practice independently lmao. so while im willing to do the schooling, going MD makes no sense for me. If you want independent practice, dont go to NP or PA school, why is that so hard for people...ugh
If you think that you need oversight when caring for a population that seeks your care for mostly HEENT and GI issues in primary care, then you should have pursued another career. An RN already recognizes many if not most of these diagnoses without the advanced training. A major part of the medical model is to know when to consult-- hence a primary care sending a patient to cardiology for a new murmur or arrythmia. Sounds like you're trolling.
@@Meneedsabreak a person without the expertise wanting oversight for their job that doesn’t help them develop that expertise is completely a reasonable thing to want.
@@Nanajsiuz your comment is reasonable when you state it in this general context, but I contend that the "oversight" described is more of managing than collaborating. Most NPs do not have their own practice, and fellowships are few. However, most have tons of bedside experience in progressive/intermediate/critical care and are well versed in the standards of practice by the time they complete the MSN program with subsequent certification. Collaboration and growth are the key words, not oversight from an overseer-- whom by the way is not an experienced NP but a physician who just looks down at nursing science melded with the medical diagnostic model. Believe me, nurses respect physicians and their advanced specialized knowledge; yet many physicians are taught that nurses are stupid and are insultive as newbies in their first job. We are supposed to be a team but this commenter absolutely can not speak for me nor my APRN colleagues with the minimization of her educational experience.
@@Meneedsabreak - I so wish that the "thumbs down" scores could be visible to you.
One of the major takeaways from this research is how far behind NP education and clinical practice is when compared to PA's. Yet, they are granted much more autonomy due to their more immersive internal advocacy.
Yes, nurses are always considered the special child everyone caters to.
NPs often get hired over PAs by default because of the FTP and sometimes even get offered a higher salary than PAs. It’s absurd.
NP programs are kinda BS (specifically the online programs that are popping up faster than Starbucks), but nurses in and of themselves deserve a shit ton of respect because they rule the hospital. PAs should probably have the upper hand because they are trained on the medical model and the lack of training that many NPs have... but there are some damn good NPs out there, I can almost guarantee you that they didn't do an online NP program though. If you do an online program, you need to be required to do residency or some shit.
Right as always, Cannon xD
@@grant4360 only some nurses deserve respect. The NICU/PICU ones actively seek worse care for their patients. Also most floor nurses barely know anything about nursing. There is a reason ICU nurses have to come to codes🤣
Good video. I agree with the end assessment. PA for 19 years. I don't like being viewed as a cheap doctor replacement by politicians, and healthcare administrators. I have less training, but I also have a significantly lower paycheck. It is really frustrating when some expect the same volume, and acuity load from PAs and NPs when we are less educated, and PAID LESS. I have worked with a broad spectrum of physicians from the ones who hate us, and treat us like scribes or med students to the ones that supposedly love us, and would be perfectly happy to sit back and let us do all their work for them. I value my physician colleagues both for their skill, and their leadership, and I never wanted to replace them.
You speak of something that is so commonly devastating for new graduates trying to get a job. On many threads where information is shared, quite a few new NP/PA describe their orientation as basically a week and then expected to see the same volume of patients. Is there really a fear of NP/PA physician replacement or just another way to penny pinch by undermining their value?
@@Meneedsabreak BOTH. There was an article in doximity recently that expressed the fear that #1 patients will have worse outcomes (which they have about as much evidence for as ivermectin curing covid), and #2 about how hospital administrators and business types see us as a cheap replacement (even as a travel PA I make less than travel RNs, and even some senior permanent staff RNs on my current ER assignment in California).
When you're paying an ER doc $280/hour, and you need a second provider, it only makes sense to hire a PA for $70/hour. In many cases the PA will be expected to carry a similar workload (maybe not initially, but you're made to feel like a loser if you let the doc take all the high acuity cases, even though they will rarely see any of the lower acuity stuff unless they are cherry picking to get their numbers up for bonuses). Some physicians are great, and really appreciate what we do. Some abuse the hell out of us. And yes, some do fear that the secret cabal is trying to replace them with a cheap alternative.
@@robertfox4524 right now, lots of NPs are working as travel RNs because the full time NP positions are so low-balled that it is insane. My program was pretty great because the faculty moved mountains to make sure our MSN degrees remain valuable and respected. However, it is sad when I hear RN colleagues articulate how worthless it is to gain advanced education because they can make more money $$ than NPs while avoiding scorn. NPs and PAs bring valuable knowledge and can do so much to support the entire team --- physicians are people too and can't be everywhere. I really wish the negative hype could be diminished by sensible discernment.
@@Meneedsabreakyep that was me. First job in family medicine. 2 days of shadowing a NP and then 14 patients of my own. That of course increased to 22 patients. And the APPs were the ones that were on call when it was our on call week, not the physicians. And the physicians were seeing the same amount of patients and same complexity as well (I wish I had gotten the easier patients 😂). And paid a lot less.
Thank you, Dr. Jubbal. I wish the AMA advocated for physicians and physician training as strongly as you do.
Search for AMA Scope of Practice :)
But why don’t you? This is your fight.
It's always frustrating when a FPA advocate mentions those comparative studies but neglects to understand that they are not comparing truly independent practicing midlevels with physicians. These are arguments the AANP and AANA continue to have in bad faith.
👏👏👏👏... 💯💯💯% facts. But this is how the narrative has to be spun in order for it to turn out a certain way..
On the other hand, we don't have very many studies that look at the effectiveness of independent practice because there is not very much of it. It might be the best evidence that they have to work with and their should be studys proposed that allow a simulated independent practice in order to properly evaluate the ability of NPs and PAs
Im a PA working in trauma surgery at a level 1 trauma center, and 1/2 of my job is acting as the safety net under the new PGY-1s who rotate through our service every month. I teach them how to admit, discharge!, consult, remove a chest tube, what nurses can do vs what providers need to do, etc. All the little things that can between the cracks- updating a patient’s problem list so we’re billing appropriately, turning off unnecessary IV fluids, labs, and imaging (some patients have had a “stable CXR” for >10 days). And as they advance through residency, they teach me A LOT too. The other 1/2 of my job is running the geriatric trauma service, and those are my patients but I can always (and often do) call the rounding attending that day whenever I have questions on a patient’s care. I love my job because to me I really feel like I am optimizing physician-led care while also getting to provide care of my own when it is needed, which is what APPs are here for!
I love how you emphasized that we shouldn’t think about it in terms of us vs them
We all want what is best for our patients and the heath of our country
It's not a surprise to find out that a patient receiving treatment from someone with a third of the training would cost patients more money in the aggregate. It's so tempting to just look at any given interaction and its cost, "MD cost $100, APP cost $65. Aha! See!?" In the world, however, it's more complicated, you can pay $100 one time, or $65 three times (you may even eventually pay that $100 anyway) for the same outcome. And that cold math doesn't consider the indirect costs to the patient such as time off work going to more appointments, time spent living with uncertainty when there's no diagnosis, the frustration with thinking your APP solved your issue only for it to resurge, etc.
Hope this gives light to everyone fighting against power when our own common goal is equitable and affordable care for our patients. It's important to back-up arguments with research in all sectors. Thanks Dr. Jubbal! RN here pursuing MD/DO soon.
Really frustrating trying to make an appt and asking for a doctor but being told NPs are basically the same thing just book with the NP provider instead
I agree. My medically complex son has been seeing a specialty MD for the last 6 years only to be told that from here on out, he will be seeing the PA. It’s been our experience that NP/PAs don’t have the experience to work with medically complex and come up with treatment plans that aren’t as comprehensive or contraindicated given his numerous medical conditions.
Y'all my med school just assigned this video as a part of one of our classes. I'm dead haha. Great stuff @medschoolinsiders.
W Med school
@MedClaire - Good news.
Which school do you go to?
Would love to see a video on MD/MBA programs! With your background this would be especially interesting. There are so many problems in medicine that some business acumen could help navigate, but it's hard to know if these programs are worth it because few people have shared about them. Thanks!!
amazing video!!!!
when discussing cost, you mentioned it's definitely cheaper for the hospitals to employ mid-levels. however, these mid-levels often make it more expensive for the patient (or government if they are on Medicare) for those reasons you stated. so basically the hospitals are saving money while the patients spend more money...ahhhh the world we live in :(
There aren't a lot of physicians out there who say, "Damn! I don't know what this is or what to do about it. Let me consult the PA/NP." That's just not happening. Not because physicians hate APPs or anything like that. It's just that APPs are not likely to have the answers for the kinds of things that will vex a physician. NOTE: that is not to say that an APP _cannot_ have the answer. Considering the time crunch healthcare workers are under, it is not worth hounding an APP for a consult. This alone ought to be enough to help draw some conclusions about where the guidelines should begin and end.
I saw it happen the other night
APP consults happen all the time … ED doc consults cards APP on a weird EKG … ED doc consults Ortho APP surgery is urgent or routine… Surgeon consults intensivist group APP to see about to see if they are ok with surgery now or if more ICU Resus is needed to survive surgery … it’s a world of grey and not enough physicians to go around thus the invention of APPs
@@Matt-bg6kf They consult the service, they don't know who is on the other end.
@@HeyItsLonewolf exactly. Everyone is pissed when you consult a doctor and get the np. Your like fuck I might as well go evaluate them for this specialty myself
@@sara215 lol a nurse accepting consult ahahahahahah thats some fucked up USA bullshit i would go crazy in that shitty system.
Thanks for putting this out there, we need to raise awareness so patients understand who they are actually being treated by.
It's only so many ways to diagnose the same thing..
@@NN-ko8fu yup great observation
this is honestly why I want to be a PA. I want to practice medicine and provide care to my community, but I'm not comfortable with the level of responsibility that comes with MD or DO. I'm more than happy to have someone I can ask questions especially in more complex or zebra cases.
i completely agree!!
What’s a zebra case?
@@LOLWAAHH - Generally, a certain set of symptoms will equal common conditions, like how a horse is commonly thought of as the hoofbeat animal. "When you hear hoofbeats, don't think zebras, think horses". However, when a client has symptoms that are NOT so common, clinicians still frequently try to shove those clients into the common horses model instead of looking for an uncommon, more exotic condition - the zebra model.
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For example, over the years, my primary treated me for many illnesses like 60 bronchitis episodes (true!), 4 pneumonias, 1 mono, 1 RSV, 1 rheumatic fever, 1 HPV mediated cancer, etc - looking at each thing as a separate horse. After I had viral meningitis twice in one year and he finally found out that I have near absent IGM, B cells, etc, I was I referred to an immunologist. All those separate diseases / horses were actually just symptoms of one very big zebra - an immune deficiency. I now get IGG infusions Q 4 weeks with great effect. My primary was so embarrassed that he never recognized a pattern, that he stopped looking me in the eye when I saw him, but would just mumble at me while facing his computer screen.
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So, the moral of the story is that sometimes when you hear hoofbeats, they aren't horses at all, but ARE zebras and you have to have the training, knowledge, experience, and innate cognitive ability to recognize it.
@@LOLWAAHHrare conditions
This was the BEST presentation on this topic I have ever seen! Thanks, Dr.Jubbal! 🙂👋🏽👨🏽⚕️ - PA since 2000
There needs to be more investment in the amount of residency slots across the board, as well as greater incentives for primary care paths. I would even say that there should be more efforts to supporting expansion of medical school if the applicant load continues to increase like this. I don't think growing these endeavors will be easy but it needs to be acknowledged and supported by anyone able to help!
100%
That’s wat i was thinking because although I have no issue going through medical school it’s scary to waste all that time and not match for residency. I don’t necessarily want to be a NP but it seems a more sensible route
I’m a nurse who is preparing to become a NP, and I’m against independent practice and supporting the idea if working under a physician’s supervision
Why?
Be prepared for the propaganda onslaught you'll receive.
@@RichObiQuan Because of the knowledge and the experience level that MDs/ODs have compared to nurse practitioner. Don’t count the nursing experience as a real one! Some nurses just do tasks without trying to understand what is going on!
@@sezeef interesting
@@sezeef Its DO, an OD is an optometrist
Depends on if you're practicing at the bottom or top of your license. The NPs who lack diagnostic skill or experience always compensate by ordering more tests. You see this same behaviour in Physicians who practice at the bottom of their license and residents in training. The difference is residents gain more experience and medical education and become more precise. That infrequently happens for mid levels unless they work alongside good doctors in a solid institution. Healthcare providers are like bodyguards. You get what you pay for. Experience cannot be taught.
Online diploma mill DNP programs require as little at 500 hours of "clinical experience" this can be online or shadowing, many of these schools do NOT require any previous nursing experience. Blows my mind that these people are allowed to practice independently
What schools are doing this?
@@Duar1503 As I read this from Africa, I wonder why your government allows such mediocrity.
Not true
This is reassuring. I really want to go into FM but other students keep telling me that I'll just be doing what NPs and PAs can do. It's nice to see the data to back up otherwise.
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If ONLY PAs and NPs start handling primary care then usa will be in flames and ER would be even more overworked than it is now cause NP and PAs would miss things physicians have been taught to catch
Exactly! I’m tired of everyone making it seem like primary care is easy. Being a good PCP is not easy… like at all.
I've worked under NPs and PAs before but the reality is that they simply follow whatever formula their attending physician follows. They don't really understand the how or why as much as we do and as a result are much less flexible on making comprehensive treatment plans. Even their knowledge is a fraction of that of am attending physician. I've had patients ask what a malignancy is, but the provider was unable to answer.
@@maximumovermuslim6337 lmao what ?
I'm an undergrad and know what that is.
Idk if it's fair to compare a clearly ignorant app with a regular attending
I love how detailed this is. So helpful! 🙏🏽
Valuable part of the team, they are great to work with, help alleviate the burden. I love working alongside with them.
Thank you so much for explaining the difference between these medical careers as I am a non-traditional pre med that wants to become a doctor. I’m still in my twenties but was feeling like it’s too late. I want to be a physician! I want to practice independently and now I understand the reason for the rigor of education.
It would definitely be interesting to see the true data about the physician shortage because even though some don't match, there are also those in transitional years but medical schools count them as matching even though they don't have a guaranteed specialty, and residency slots still go unfilled post soap which blows my mind.
In a TY myself, it’s crazy how many qualified applicants there are and don’t actually end up matching. It’s definitely the way of the game but it also sucks for the applicant and the benefit to the respective specialty profession they could have made.
@@redd1417 I think there was a crazy statistic last yr that 80% of the nrmp students didn't match and had to go through soap and the soap is what brought the match rate into the 90s but it's crazy that for that graduating class you had a one in five chance of not matching the first time around. It's frankly terrifying.
@@kaitlynkilpatrick36 I'm sure that number applies to certain applicants, which can vary from specialty to MD/non-MD status. The match rate for a number of specialties has definitely gone down over the years which goes to show how little programs are doing to increase their spots to match the growth of medical schools.
I love that you have read all the statistics so we don't. Thank you.
My PCP is an NP and she’s awesome, but these concerns are very valid. It’s terrifying, the thought that even if I get into med school, I might not get into residency. It motivates me even more to learn as much as I can now.
not to mention DNPs who can go by "dr" and more states beginning to legally allow it. nurses have a strong lobby for independence and are vying for more pay along with being called a doctor
if a person earned a doctoral degree...they have earned the right to the title..other professions such as psychologist use the title with no problem..introducing self as dr so and so and then stating that they are a nurse practitioner should be ok
@@ticktock1861 i personally think only MD should use the title dr. as the joke goes, all others are doctors until an emergency.
Doctor I think
Is absolutely fine if the NP is working in independent practice. People need to realize doctors can be anyone with a doctorate degree but a physician is only for those who went to medical school
Of course it’s legally allowed. MDs do not own the title of Dr. Anyone with that level of terminal degree has earned the title, for example; professors, pharmacists, etc. It’s our responsibility to educate the public and be transparent about our degrees and titles.
@@bdawn3519 i meant going by doctor in a clinical setting. it's misleading to patients and it's illegal in some states. in az and de, an np has to clarify that they are a nurse if they use the title doctor in a clinical setting. in seven other states it's illegal to use the title doctor all together. earning the title through an accelerated two year online program with a few clinical hours and then having to refer out all your patients to real doctors with real training isn't really earning anything. by the way, i'd also argue that kevin jabbal isn't a doctor, either. he was never board certified or an attending.
Imagine completing med school and not being able to become a doctor because you never match 😭 would be horrible
This is scary 😟
I don’t understand why NP/PA get offended by the term “mid-level.” I am an EMT-Basic, and provide Basic Life Support. I don’t see “Basic” as an insult. It’s just a descriptor of my training in the overall medical hierarchy, like “mid-level.”
Speaking as a PA, most PAs do not. I don't care what you call me. I'm a PA and I treat patients as part of a team with a physician. I'm happy doing so.
PA here. also agree with the above statement.
PAs don't mind. But most who feel threatened use it as a derogatory term. What amazes me is that you have some Drs who have no business being doctors and vice versa. Point is, to be a competent clinician, you have to have experience and training which is the status quo for bein a physician. But the same doesn't hold true for others who acquire similar training over the years. I mean there is only so many ways to diagnose and treat a particular disease process. But the default argument is always cognitive intuition and reason which if you let then tell it, seems to be only reserved for those selected fews who obtained a 4 year medical degree and attended residency training.
@@js2156 admittedly, the only PAs/NPs I’ve ever met who actually take issue with it are online. I work in a community hospital ER that employs mid-levels for managing lower acuity patients, and they are fantastic. Absolutely essential to keeping the ER from getting backed up. They have a great collaboration with our docs and are respected by everyone. How it should be
They get mad at my institution. Also, I just heard an NP the other day refer to herself as the attending and she got corrected by the patient. Too much hubris
Great video. Everyone in the hospital has a vital role based on knowledge, skill, and training and it's important to stick to those roles. Would love a video addressing the physician shortage!
Yes! Medicine is definitely a team sport!
This is awesome, also shows the symbiotic relationship between the NP/PA and doctor.
ICU PA here. I love working alongside attending physicians and residents as part of the comprehensive team. I enjoy having oversight and the ability to ask questions when I am unsure how to manage certain diagnoses/issues. I have also seen the reverse of this be of value when residents are able to ask PAs with many years of experience questions they may have pertaining patient care. In the inpatient setting I believe this team approach ensures patients are provided the highest quality care possible.
Would very much enjoy a video of the issues you raised regarding matching and lack of places for training medical students at graduation. This is a problem that I had no idea existed.
Also mentioned above, but it's also crazy that these unmatched doctors can't even attempt to practice as a mid-level under a physician, because we they are unlicensed they cannot even be in P.A. or N.P. spots
I feel like a fresh attending will not be as effective as a NP who has been practicing for 20 years. Also a 20 year FM attending will perform better than a fresh attending. The point I think is that not every patient needs the best possible care--the number of House tier doctors are very small. So the question should be "what is an appropriate level of care, and who is capable of providing that". Research clearly points to NPs and PAs being capable of delivering high-quality primary care on their own.
This decision should ultimately be up to the patient to choose which provider they want. Nobody is forcing anyone to have a NP/PA. The patient chooses to go to the appointment. In rural areas they may not have many choices, but it's still a choice. And if a provider is not giving excellent care, they are removed.
There is a physician shortage but mainly because a lot of medical students don’t want to match into a primary care specialty, and the shortage is mainly in rural and remote areas that are places where a lot of ppl just don’t want to live
I mean, technically there is a shortage across all specialties. I think part of the problem is marketing of primary care and making other specialties out to be exclusive.
@@redd1417 NPs made it harder to practice in rural areas. In order to accept medicare in a rural clinic you need an NP on staff. Unfortunately not many NPs go rural. Research shows mid levels go to big cities just like physicians.
The US should start using the Australian BMP model to increase rural/remote physician numbers. Basically the government offers you a heavily subsidised position (sometimes 100%) in medical school, in exchange you owe a term of service in rural and remote practice. Though in Australia we have mandatory 3 years post-graduate period where you serve in the hospital rotating through various specialties BEFORE you apply to accredited training programs, so basically all doctors here have a minimum 3 years of acting as defacto primary care physicians (though under supervision obviously).
The other problem, in addition to residency issues, is the issue of cost of medical school vs PA/NP programs. I’m a Bachelor Degreed Flight Paramedic, B. S. In Emergency Medical Care Paramedic Sciences, that was a pre-med/PA degree.
However, after 13 years of practicing as a prehospital provider, I’m looking to expand either into a PA role or MD, but having 2 kids, a wife, and house payment, I can’t in good conscience put our family into the debt of a 2nd house, just to attend school, not even considering the loss of what might as well be 7 years of income between how little residents get pay and getting paid nothing to attend medical school. If we want more physicians we have to make medical school accessible, and the post medical training programs have to take all the medical students that graduate, otherwise good, even great, candidates go to PA/NP school or into business, law, etc.
Personally I’ve been waiting/hoping for the NAEMSE’s 2010 position paper on EMS education to get picked up more mainstream, particularly by PA programs who seem uniquely suited to create this prehospital practitioner level in combination with PA training to provide a more independent practice PA, but alas, I’m starting to think it won’t happen in my life time.
I am just curious how many ppl in AMA/congress that are pushing for the mid-level provider independent practice has (and prefer to see) NP/PA as their PCP over MDs. This would be really interesting research studies to conduct and find out.
I've always enjoyed working with NPs as a patient as opposed to physicians. Their approach seems more natural generally. I really think this is due to how they're billed though. NPs generally can spend more time with patients. As far as whether NPs should practice independently, I agree this video makes a good case as to why they shouldn't. As a side note, I was referred to a "specialist" I thought was a physician and referred to him as doctor. He was an NP, not even a D-NP and didn't correct me. That miffed me a bit.
@@jeffandrew5698 cool anecdote, but research shows they're more expensive and provide poorer outcome. did you even bother watching this video?
An absolute BANGER of a video. Thank you for such a detailed video
Great video. Very informative. Thank you for using actual data to back up the facts instead of the echo chambers we all live in.
Ask any psychiatrist about new patients presenting to their clinic who were being managed by an NP. It’s horrific. I’ve reported multiple NPs to their state licensing board for gross mismanagement of medications and unnecessary use of medical procedures like brain imaging. Their diagnostic skills are awful. If a patient has irritability they get a diagnosis of bipolar disorder despite meeting no further mania criteria. It’s gross mismanagement of patient care. I recently had a new patient who didn’t meet criteria for major depressive disorder and was started on paxil… Arguably the worst SSRI for depression in a young patient based on its side effect profile. A competent fourth-year medical student could do a better job on a psych eval of many of these patients than an independent NP. They should never be practicing independently, at least in my field of mental health.
agreed!
Absolutely agree, especially when one considers the impact some of these psychiatric diagnoses can have on the Pt.s future career prospects.
Young lady p'd/w episode of psychosis, driving halfway across the US. Turned out she was recently rx'd 60mg-40mg Vyvanse qd (max is 70 qd, and her ADHD was not nearly bad enough to warrent max therapeutic dose.) Guess who her 'psychiatrist' was? This NP at a pill mill in a FPA state who wasnt even reacheable for contact during routine business hours. No place for NPs in Psychiatry IMHO, and this is coming from a med student, not even in residency
@@ceintureblanche7742 should specify what type of NP…. FNP vs PMHNP have different training and scopes. Seems odd to me you guys lump all NPs together.
@@Lola-385 Doesn't matter, should not be practicing in Psychiatry either way
My mom is a CNM/NP, and based on what I hear about her coworkers I agree they should not be independently practicing. Especially in labor and delivery it’s common for CNMs to not understand (or ignore) provider/patient boundaries especially in birth centers. Because of not having boundaries they put their patients at risk thinking that they can save the patient when they don’t have the training. My mom worked as an RN for 20 years so she understands the boundaries, but the ones who went straight through from RN to NP seem to lack those boundaries.
LOL have you ever looked at the infant and maternal mortality data if the United States? The United States is the leading killer of infants and mothers of any industrialized nation. Honey, this is exactly what happens when doctors interfere with the natural cycle of life because they want to avoid litigation. It’s not about CNM vs MD, it’s about preventing negative outcomes (birth injury, misdiagnosis, brain damage) so that physicians and hospitals don’t get sued. Unfortunately, in a court of law, a doctor has to show the took all correct measures to PREVENT an infant or mother’s death to avoid negligant practice lawsuits.
Thanks for your work spreading awareness about this situation!
Definitely need a video on how to overcome the shortage of physicians.
As a future Nurse Practitioner, I look forward to working alongside a physician and becoming an important part of the healthcare system in order to achieve positive patient outcomes.
Been waiting YEARS for this episode
Unmatch MDs and DOs should jump into mid-level rolls immediately and indefinitely until they match, whether they are AMGs or IMGs, their training out the gate is far superior to any PA or Nurse imo.
You should really stratify out PAs and NPs instead of lumping them together as APPs/Mid-Levels. Our training as PAs is *exponentially* better than an NP's. Most don't even know how to do something as basic as suturing when coming out of school. Our training is nowhere near that of a residency-trained physician, though.
You sound pretty sure of your opinion that you outrank nurse practitioners. I had 20 years of actual BSN RN patient care under my belt prior to my family nurse practitioner program. My supervising physician sometimes calls me for advice.
@@dawnbarchett8026 Yeah, I find myself doubting that a physician would ask an FNP for medical advice. Sorry, the discrepancy in training is just too large.
Also, yes, the standard opinion of physicians in my experience has been that PAs are vastly better trained than the majority new grad NPs. I guess having admission standards really does make a world of difference.
@@dawnbarchett8026 PAs are better educated than most NPs. That is a straight up fact! Their schooling is rigorous, and organized. The graduates they produce don't have such a wide variance in competency. Also, they actually learn medicine, not nursing.
@@dawnbarchett8026 I think JS meant that his training in medicine is exponentially better due to the fact that his training is in medicine and not nursing. Many PA students go to MD/DO medical colleges with PA programs and take many of the same medical classes (at the same class with medical students). Most PAs actually don't want to get full independence though they do have closer training to real doctors when compared to NPs. To most, it seems that NPs have an inferiority complex. Heck, I did medical school clinicals at hospitals with PA students on the medical team as well, but the difference in medical knowledge was apparent during rounds. Can't say the same about NPs since they don't really train with Doctors or PAs, mostly shadow for their clinicals. B
I know that PA school is different from Np school but I’m sure a newly grad NP with more than 10 years experience in ICU can handle cases in the ICU compare to a PA that does not have background in the ICU.
Excellent. Hope you do continue this line of research/presentation. Very valuable stuff. Thank you.
If you want to be a doctor, you have to go to medical school. There's no way around that 🤷🏾♀️
But if we want to provide healthcare to our country, something’s gotta give
@@bonzahrn5148 you are certainly right about that! The system is broken and a lot of people are falling through the cracks. That issue is much bigger than practitioners
@@bonzahrn5148 he mentions the root of the issue in the video as I’m sure you heard. The issue is the bottleneck in the supply of new doctors… the remedy is not granting physician privileges to mid-levels who lack the qualifications.
You do know the word “doctor” is not exclusive to physicians? A person who is able to finish a doctorate degree can call themselves doctors. Physicians finished their “doctor” in medicine. Pharmacists are doctors as well. Even physical therapists can get their doctorate and call themselves doctor.
@@Mike-te9si that is false equivalence as we are clearly talking about medical doctors here.
Improving access to high tier care is HUGE and the whole grasping onto scopes is really really really hurting the growing population of humans, especially in remote areas. However, I think anyone whos taking any university science course can agree. When it comes to research and formulating unproven treatment plans you really want someone well versed in science and cellular function. Which usually comes from the scientific approach that is gained otw to medical school. I actually wonder what the thought process is on Paramedics, they work independently on critical calls ALL THE TIME. Where there is No supervision and you really have to self study beyond what they teach you to be effective. Now for the acceptance rate arguement, thats usually reflective of how many facilities are available to train them. So for instance, as a Canadian I can skip the rigor of getting into a Canadian medical school and go to the UK which has hundreds of years into building university infrastructure to teach medical students. So the UK has more slots available and pumps out more Docs. Personally, I think every career choice should simply have a recognizable pathway towards entering medical school, that has nothing to do with your undergrad - How long have you been practicing, what are the results of your patients, and can you pass the med school entrance exam? It should be, oh your a PA/ NP well now if you want into medical school you have to to this and this and this, regardless of your experience because we said so, I dont think that really considers the reality that these people will be highly successful in medical school and thus increase the health care provided to the overall society. The problem to me is, the difficulty of recieving medical school training. Haha buddy says exactly that in the end nice.
*copy* (Thanks Doc), A Med School Insiders video that explains what happens when a student doesn't match into a residency spot would go a long way in understanding the problem at hand, and what to possibly expect in the future. Thank you!
Would love to see a quick video covering the same topic for anesthesiologists and APPs in the field
Video about bottleneck for MD/DO training, including the different match rates between US MD vs US DO vs American IMG vs Foreign IMG would be awesome! Especially regarding how it's ultimately connected to Medicare funding
nice summary of this issue, would love to see a video going into the physician shortage/limited residency spots
The limited number of residency spots is scary for many pre-meds out there. There are already so many obstacles not being able to get into residency for a certain specialty is not cool. If there is anything that pre-meds can do to help I am sure we would be down to help.
I’d love to see a video on the physician shortage and what can be done about it. As an Army Veteran who’d love to attend Medical School, a ~6.5% acceptance rate isn’t exactly appealing and then the residency issues on top of that have pushed me to consider other careers.
If its any consolation, veterans usually have a significantly higher acceptance rate
@@future3325, you might be right but overall, the acceptance rate is still low in this country. Then people wonder why there’s a doctor shortage. Not saying quality needs watered down but something has to change.
@@CornFed_3 there isn’t a physician shortage just a distribution problem… last thing you want is a bunch of doctors who can’t find a job. It’s competive for a reason
@@SK-mr6ov, you’re partially right. There is a shortage in a sense but also a distribution problem because of residency program issues. Another issue is where people seem to flock to. The glamour of city life and high salaries draws more than lower cost of living areas with not as high of salary.
@@future3325 I haven’t found any concrete evidence backing this statement. I am also a military vet who is looking to get into medical school! Would you be able to cite the source for me please?
What a great video, im glad you made a video on this!
As a future PA I cant appreciate this video enough. It is a problem and its nice that you distinguished this creep isnt from every mid level.
I'm in nursing and I can tell you the faculty pushed this agenda non stop. most of my classmates see through the BS but it seems to be the PhD types in the nursing field who push it so hard. they are obsessed with putting Dr in front of their name however they can
Let’s be real y’all we all know that insurance companies will not ensure NP and cRNA‘s independent process Unless they could pay leagues more than a physician. This is strictly a way to get hospitals to hire a cheaper labor to replace physicians
Would love to see a video describing what you mentioned near the end of the video…Physician shortage, the Match, Medicare funding for residencies etc…
A physician shortage video would be excellent
The best midlevels I’ve worked with have been those that went to an in-person program and those that chose specialties that matched their previous clinical background. Online trained NPs have an enormous learning curve and should NOT be independently practicing.
Definitely a brick and mortar supporter! 😊
for the final study, dd they ensure they were comaparing similar patients? I'm wondering about the social and economic determinants of health and if that was assessed.
I'm not going to lie. Seeing that acceptance rate is rather disheartening. I'm a practicing speech therapist, and I'm studying for the MCAT. I do NOT have the same undergraduate training as, I imagine, most other applicants. I do have more than 6000 hours of clinical experience, but I doubt that'd be good enough to place me significantly above than higher scoring applicants. I would definitely like to hear thoughts on how the med school/residency acceptance rate could be addressed. Thanks for the great video!
It’s a little misleading. It means that each school accepts on average 6.5% of applicants, NOT that only 6.5% of applicants matriculate into medical school. It’s not unusual to apply to 20 schools. If you have a 6.5% chance at each one, your overall chance is much higher. Even if you are an average applicant, your in-state medical schools and DO programs are a reasonable fallback as they will often accept roughly half of in-state applicants.
@@qprtx oh! Okay yeah I definitely misunderstood what that statistic was trying to say. That makes much more sense.
Also.... 20 med school applications?! 😮. My letter writers are going to be pissed lmao. Thank you very much for this response.
@@seanknapp4458 Don't worry, it's a single application (AMCAS most likely) sent to 20 separate schools. Some states, like Texas, have a separate application (TMDSAS), but the same concept applies. 1 application sent to multiple schools. Your letter writers should rest assured! Lol
@@arthurhusein4661 okay that's good to hear lol thank you!
@@seanknapp4458 Arthur is right. The letter writers only need to submit one letter generally. Those get sent with the standard application to as many schools as you would like with (unfortunately) a fee attached to each submission. You will have to bear the burden of secondary applications though, which are unique question sets, mini essays, and supplemental information for most of the schools you apply to. Even after jumping through that hoop, most won’t give you an interview, but you only need one to accept you! And you’ll find that your real world experience makes you more mature and capable of taking on the stressors of medical training than many students in your class who came straight from undergrad. I applied to 21 schools in 2013 and was only offered a single interview, but that was enough. Good luck! It’s a thrilling, stressful, but wonderful journey.
This is ridiculous, and I'm shocked AMA is allowing and promoting this! NPs will NEVER be MDs, and vice versa. They are two different types of work. It's crazy harmful not only for MDs, but first and foremost for patients. Absolutely baffled this is happening.
Nobody is saying they are MD’s and this is more of the nursing boards and not medical
Full practice authority doesn't mean they can just open a pediatric clinic or primary care facility.
There are a lot of hoops you need to jump through, and all of which requires ABIM board certified physician.
Of those NPs who do decide to become independent, most of them operate legal medspas and drip bars. None of which are covered by insurance it's still medicine though because it's a free market and the buyer can dictate what FDA approved medical services they want.
I can’t wait to see the details of the Physician shortage video in the future!
Thank you, I’ve been waiting for this video.
Absolutely fire and informative video, thanks for all you do!
Nice video! As a future medical oncologist, I’d love to see a detailed video on that. Are we getting that anytime soon?
A video about the causes and effects of the physician shortage would be awesome!!
As a PA, I’m not a fan of being lumped in with NPs especially with education, clinical hours, studies, etc. I know we do similar things in a day but to me I don’t understand why NPs have independent practice and we cannot (although I’ll say I do not want independent practice, and I did not become a PA because I wanted to be a doctor). I love working together as a team. Honestly a big reason PAs are pushing for something called optimal team practice is because the NPs do have independent practice in some states and the issue is, they are getting more jobs because they don’t need to be linked to a physician. Do I think that’s right? No. As far as PA school, our didactic years are usually 15 months and we barely have any breaks (1-2 weeks in between semesters and no summer breaks). We must have healthcare experience because we are hitting the ground running. One of my semesters was 32 credit hours in a semester. After PA school we have done more credit hours in our masters program than most doctorate programs have. We have at least 1 year full time clinical experience. And what you mentioned about clinicals with NPs, that’s another difference with PAs. According to our national standards, our programs are mandated to have clinical sites for us. We do not find our own. Depending on the school it’s usually 4-6 weeks a rotation and these include core mandatory rotations (including general surgery which NPs do not do) and 1-2 electives usually. We also cannot work in most programs and those who do may be doing a shift or two in a month compared to where it seems NP schools, a lot of nurses work (even full time) while in school. Another difference is online programs. As you mentioned there are a lot of online programs for NP. There are a couple hybrid PA programs (although most of us PAs are pushing against those and do not think they should be a thing). In those they must go into school a certain amount of times in didactic but the lectures are online mostly (most PA programs you must be present at every single lecture, this is even different from what I have heard with med school). During clinical year of course it’s all in person. There was another thing you said about the differences and I’ll post it if I think about it. Oh.. acceptance rate. Yes. It seems like it’s easy to get into NP school why it’s increasingly difficult to get into PA programs. It took me 5 years with a 3.6 GPA, and 10k direct patient care hours to be accepted. One program I was accepted to, had a 1% acceptance rate. On average I think PA programs have a 2-10% acceptance rate and I may have heard that overall like how many people apply to any PA school and how many get in, is about 30% (most students apply to multiple programs). And the majority of pre PAs do not get into PA school their first year.
I started in primary care I was expecting them to do some training before I was seeing patients. Well.. they had me shadow a NP for 2 days and the next day I started seeing 14 patients on my own. By the end they were wanting us seeing 22 patients a day. I left after 22 months. I moved states and I’m looking for a job that has good training models. I don’t want to cause harm to anyone of course. I want to help these patients the best I can. I’m also looking for a more collaborative job than in family medicine.
Oh and from what I have seen these days more and more nurses are getting their BSN and then going straight into DNP without any nursing clinical experience. And then they want to be called doctor. I don’t think if you’re not a physician, you should not be called doctor in clinical practice as it’s confusing. Same goes for doctorates for PAs but I haven’t really heard of those PAs calling themselves doctor other than in the educational (not clinical) setting which is one of the reasons they got their doctorate in the first place (for education).
Two more I thought of. You had mentioned studied show we prescribe more abx and order more tests then physicians. Inthink that’s possibly true for older PAs but in my program (graduated in 2020) they were very adamant about not prescribing abx when not needed because of abx resistance and also not ordering a bunch of labs and imaging that aren’t needed. So I think us need PAs will change that.
Nursing programs are pretty competitive these days. Chemistry, Biology 1+2, micro, A&P 1+2, pre calculus Algebra, and other exams to get in with a large swath of people applying. At least this was my school experience. The online schools should not be a thing tho. A brick & mortar school with a solid program makes for good APP’s. Our program requires at least 2 years of RN experience within your specialty and a 3.4 entry GPA. Also, the person matters. I’d love to do PA school for some of their rotations and love the sciences, but I’d waste nearly 3 years waiting to get in, and countless amounts of money, so I’m likely to do NP.
Np, PA cannot be equal to an MD. Increase the residency spot, There are many Us citizens IMG passed USMLE but not getting residency and even cant work as PAs or NP. so they are working at Walmart LOL
NP is a masters, plus training, plus Clinicals, plus state exam. Not bachelors…
The AANP is trying to make all Nurse Practitioner programs doctoral level (Doctor of Nursing Practice) by 2025, meaning that the masters programs are going quickly and being replaced by doctoral programs.
you are confused
Very detailed video that sticks to the data. Love it!
I would enjoy a video describing the residency cap-I made a short video about the 1997 Balanced Budget Act that was largely responsible for the bottleneck problem and would like another perspective.
I would really like a video on physician shortage.
And how horribly it’s handled across specialties…
@@redd1417 I would really like that too
RN here and future critical care NP. i very much look forward to working along side a physician and do not wish for independent practice. find it ridiculous
That is why i like surgical branches because many think medicinal branches are talking, precribing, and ordering...
Yep, it's unfortunate but I think going forward the only way for medical students to protect the future of their career is to become surgeons as NP and PA's will never take that from them. Obviously this is a problem though because only like 30% of medical students end up in surgical specialties right now, it's fucked up that the other 70% is getting hung out to dry by state legislatures
I agree! An MD is much better educated. I was forced to see an APN who was not supervised by an MD. I was sent for 3 unnecessary expensive tests. It delayed the diagnosis, put my health at risk, and put my body thru more stress and radiation in a short period of time than the best practice standards recommended.
The APN I had seen never truly understood the results of my tests and did not know what the steps to take next. As a patient I needed to know my Physician knew what to do to take care of my situation. I am changing to an MD as soon as possible.
There is a np in my hospital that consults the pharmacist to replete magnesium. She is really getting paid 150k for doing nothing.
In the flip side, I had a neurologist ask me (a bedside nurse) if TPA was appropriate. I’ve had dr’s order inappropriate contrast and be corrected by a radiologist. I could go on, but please don’t say using your resources appropriately is doing nothing. It’s exactly what was being advocated for in this video. Not practicing solo, consulting with those who know more. Etc.
@@bonzahrn5148 Do you think the neurologist was asking out of true ignorance or asking to see if you knew? Because ALL neurologists working in a hospital know indications for tpa.. Also, Doctors can order incorrect things occasionally it's only problem if the mistakes are consistent.
@@Benboy887 Yep this sounds like a bullshit story. I'd bet even neurology residents one month into residency know when to use tpa. Hell, most medical students know considering it is tested on their boards
@@Benboy887 You missed the point, do some internal work, you sound like someone who desperately wants to feel special.
@@xxDPKINGxx Are you even in the health field? How much experience do you have working in a tertiary hospital? Do you know what the MDT is? It`s significance? Do you truly believe doctors work solo and call all the shots ? Do doctors spend 12hours with their patients? Do they monitor how their patients respond to their treatment? Again, are you in the health field?
Yes please! I’d love a video discussing the issue of medical school graduates getting into residency programs.
I 100% agree with your verdict that APPs should not be independently practicing. As an ER scribe and freshly-matriculated nursing student who has very possible future plans of becoming an APRN in the distant years, I've seen the kind of complex cases that even some of the APPs I've worked with have even felt stumped on themselves, and the doctor on site was happy to help and they've been equally grateful for the help and have had subsequent good patient outcomes. This is a beautiful system that I honestly feel doesn't need any fixing whatsoever. I definitely can see the provider shortage at hand, but I too just simply want to see more residency spots open, so that the same system can continue but at greater outreach.
Plus, if I become an APRN, I wouldn't want to go in it entirely alone. Something like that is my one of my worst nightmares. I love directly working with doctors and receiving the great teaching and lessons I've learned just in my time as a scribe, and I trust their judgment and experience completely and wholly. If I become an NP or CRNA, I would want nothing more than that same collaborating relationship to continue on. When I have a doctor directly above me and nearby for consult as needed, it makes me feel as happy and secure as it gets.
The nurses who I see advocating for increased scope of practice are always the very young and over-confident types. The types who made it through nursing school by the skin of their teeth and now feel limitless. The best, most-experienced nurses know that are some things in healthcare that doctors are more well-suited for and vice-versa for nurses.
Incredible. Thanks for the video!
I am a healthcare provider applying to medical school. please make a video on the limitations on residency spots. You rock
I cannot say anything about a Physician Assistance but after going to a urology department in a hospital in Akron Ohio. I can tell you I was so disappointed in the ability and knowledge of the Nurse Practitioner, I now wear a medical ID bracelet that states “I refuse all treatment from any Nurse Practitioner.”
Nothing was explained and I was not told of all the equipment needed and how to use it. This caused two trips to the emergency department to take care of problems. These problems could have been handled at home had proper information and equipment been explained.
Same! But it was a Doctor! I refuse to be seen by one EVER again. Their lack of knowledge is dangerous!!!
Medical liability and accountability is all that matters.
Aren't cadavers an integral part of medical training? Do mid-levels get to train on cadavers?
The only thing I’m hearing here is MD school needs to be better to their students and NP&PA schools need more structure
As a senior nursing student who has been accepted into NP school, I honestly find that most of the "scope creep" controversy is coming from corporations and the educational system or the national associations for PAs and NPs. In my experience with family who are MD, PA, and NP, I find that they tend to like collaboration. MD/DO can focus on more intense patients while PA/NP can lean on the physician when they're out of their depth. However, a lot of hospitals likely are pushing for independent practice because then they won't have to pay physician salary. Furthermore, the educational system also promotes independent practice without giving new grad NP/PA the tools or training to do well leading to liabilities and malpractice.
I could have pursued MD/DO, but I believe that God led me to nursing to help the field of nursing especially since midlevels aren't going anywhere anytime soon. Maybe that will be through pushing for additional training or residency programs for NPs, but I'm hopeful that my career can lead to something.
Anyways, for all of the MD/DO, thank you for what you do and the same goes to NP/PA. For the physicians, I would like to be supervised immediately upon graduation, how would I go about doing that? I'm also going to apply for a residency program, but there is only one in my area that accepts four applicants a year. I'm going for FNP by the way.
Anyways, just some food for thought to reduce the animosity between midlevels and physicians. Thank you. God bless you! I'll be praying for you!
Just work with each other! It's a teamwork, not a competition. Every profession has a role. I don't know the statistics, but there are always people from every profession, including physicians, who makes mistakes. For example, physicians also misdiagnose and/or give wrong dosages, so that's when the pharmacists come in and correct them. Not every person is expected to know/do everything and hence different professions were made. The job is to work together and always prioritize the patient's health and safety.
I hear this "work together" stuff all the time and I do agree with this. Working together becomes a little harder when unqualified people are constantly trying to take shortcuts to your position without putting in the work. A big problem is that some professions are beginning to forget their role.
Mistakes are more likely to occur with less experience, such as midlevels.
Problem is people don't want to work together and that includes NPs and PAs look at the push for independence and for physicians look at those who don't want to collaborate
Patient centered care, always.
@@geraltoftrivia2757 You don`t sound like someone in the field. I don`t get how someone would try to take your position when they are studying something completely different.
I’m a nurse and debating between going the NP vs MD route. I’ve worked with some amazing NPs but I’m leaning towards MD as my end goal is autonomy. I don’t see the purpose of going the NP/PA route if I know my end goal is to be completely independent.
Each path has its own value, it’s a waste of time and money choosing one and trying to turn it into the other without gaining that additional education and clinical experience.
I’ve also seen people go from nursing school straight into an NP program, which absolutely makes no sense to me. Imo one of the strengths of being an NP is gaining that clinical experience BEFORE you begin training as a provider. Nursing is such a unique niche, wish the focus was on enhancing that skill set more than turning it into something else.
I’m currently a nursing student and having a hard time deciding what to do. I cannot afford med school, and frankly see more appeal to working as an NP. I don’t want a doctor’s scope of practice, I don’t want to be in surgery, and don’t feel comfortable with the responsibility of making the decision on someone’s care. I would much rather go to a consuting physician if I’m unsure than be the physician that “has” to know everything. Especially for the specialty I want to go into I see a lot more appeal to being an NP vs physician. However I also don’t want to be distrusted/disrespected by patients or other healthcare professionals because of being an NP. Like, I fully understand that as an NP I’ll be less educated on complexities or rarities or details and would GLADLY speak to a physician when it gets into that. I just don’t want people to look down on me or lump me in with scope creeps. I don’t know. I anyone has avoid, please lol
Question for you, how would a paramedic mid-level provider fit in this scaffold of the medical system?
They do have significantly less medical training in the broad range of general medicine, but they do operate independently from their outfit which is the biggest detractor from PA and NP folks according to you. I would imagine that if you were to become a mid-level provider it would come with a lot more schooling so that might hammer out the differences in knowledge. Like it or not, the scope of practice for a paramedic can go very nearly to the furthest reaches of what an ER doctor can do. I know of paramedics who have cardiac arrest c-sections in their scope of practice. With that in mind, would there be a place for "field practice" providers who can do most of the same things that a PA is allowed to do in their private practice but geared specifically for medical Care to austere environments. Some examples could be oil rigs, wildland fire camps, civil unrest/war zones, definitive care in the prehospital setting.
I don’t know if NP is Worth spending all my life time for because i have tried youtube l associates and some others and still failed 4 attempt. I feel so frustrated don't know what to do anymore don’t even have time for my own kids any more 💔💔💔😔😔.
The NP test is very difficult and frustrating to pass, I can't believe i failed after studying with so many materials😞
Frustration is a very positive sign. It means that the solution to your problem is within range, but what you're currently doing isn't working, and you need to change your approach in order to achieve your goal.
Sometimes it doesn't matter how hard you study you also need to pray to God for success
Please does anyone know who this Mrs Cynthia is? I really need to speak with her I'm frustrated 🥺
I’ll keep on studying till i pass no matter how many times i fail, I’ll advise you don’t give up because we all have come a long way so keep try till you get there one day or better still go get help from Mrs Cynthia