I’m an FNP and proud of what I’ve accomplished. However, the more I learned the more I realized how much I don’t know. The type of schooling, education and hours put in just do not come close to matching what a physician has gone through. I think with years of experience an NP or PA can narrow the gap, but I feel should still not be completely autonomous
Scope of practice is so vital. It’s a HUGE ETHICAL problem if people start doing things they were not trained to do. NP’s are AWESOME! So are PA. But they are not the same as a physician. There is no comparison, they are different and serve a different function towards a UNIFIED healthcare team. I do not think being physician lead is most important, but the problem comes when someone has a clinical presentation of something or another and the less trained NP is not able to recognize it. Everyone makes mistakes, but I would prefer my life in the hands of the person best qualified to make that decision. In short this is really complicated and the reality is money is king so money will win in the end. Regardless of patient outcomes.
Non-expert here with a probably-legitimate concern: Be careful about this “team” approach. Big teams, big facilities, centralized networks, and big administrative overhead, by common sense, must be expensive. If you’re too inclusive and welcoming, then your patients will get fleeced.
what boggles my mind is why is there a Physician shortage? why medical schools keep rejecting excellent applicants left and right? Applicants with great scores, extracurriculars and personal statements get rejected and yet schools refuse to provide feedback, these applicants are left in limbo and choosing other career paths.
THIS. The whole scope creep debate is really a way to deflect from the older gen MDs restricting residency slots to keep their salaries high and screw the next generation. But some of the people who bash PAs and NPs don’t realize that they are also suffering due to the physician shortage and all of this is literally a direct result of the government/boomer doctors 🤷🏾♀️
The medical profession brought this on themselves. You can harp on and on about how important physicians are, but at the end of the day you need to actually *have* physicians to have physician-led care.
There are 2 bottle-necks: number of residency spots and residency CHOICE. The problem of physician shortage also has another dimension: no one wants to go into the specialties we need most. Primary care chief among them. The burnout rate in primary care is insane and they have to spend more time (outside work mind-you) doing documentation than any other specialty. The burden placed on them far outweighs their drop in salary.
What midlevels seldom understand is that we physicians do NOT have a problem with them in the healthcare setting; we have a problem when they start assuming our roles WITHOUT the requisite level of education. I would never allow myself or my family members to undergo anesthesia by a CRNA. Ever. That's not to say that CRNAs don't have their specific role in the healthcare sphere.
First off, there’s no data suggesting that the excessive training that American doctors have leads to better patient outcomes. The US (and Canada) have the longest track to becoming a physician of any country. Most countries allow doctors to graduate with 33% less training and yet foreign doctors who migrate to the US have similar patient outcomes as their American counterparts. So if anything, there’s more proof that doctors in the US are OVER prepared. Now this isn’t to say that NPs and PAs training is perfect. In fact, most would agree that they need more clinical hours and residency programs are rapidly popping up in numerous states. That being said, the data is quite clear that patient outcomes under mid levels is just a good as a physician. Lastly, that’s the beauty of choice, you can choose whom you’re comfortable with taking care of you. If you don’t want a CRNA anesthetizing you for surgery, then ask for an anesthesiologist.
@@cbl6520 in the UK after 5/6 years of medical school you must complete 9/10 years to become a senior Physician or Surgeon. So way longer overall than USA. Usually training is longer due to multiple obstacles like not enough training places or time out for additional degrees.
@@gingerbg7602 First off, there’s no premed in the UK, you go straight into medical school, so shave 4 years off the journey. Undergrad medical studies (medical school) is 4 years, followed by 2 years of foundation training, and 3 years of GP training, so becoming a GP takes 9-11 years, as opposed to 11-13 years in the US. Specialist training is an additional 3-7 years depending on specialty. Even though specialist training is similar in length, the total time to become a doctor is still 33% shorter than in the US. All of this is taken directly from the British Medical Association’s website.
@@cbl6520 yeah here in Italy, we do 6 years of med school. 360 credits. Clinical rotations start from 2nd year all the way up to 6th. Residency is the same length. I dont know what boondock countries youre talking about. Please show me facts and data. Where did you get the 33%?
And yet we have CRNAs put people to sleep by the thousands in our ambulatory center, and guess how many issues there have been? Give me a break. Do I want a CRNA doing cardiac anesthesia, probably not. But they put our gallbladders to sleep and I haven't seen a single issue in the 7 years I've been in the OR.
That’s very pointless and an archaic way of thinking, in muse of “patient safety” . Why should the government pay more money for that, when you can hand select specialized mid level contractors to take strain off of the system. You also underestimate what a small increase in residency positions will do to clinical in hospital MD jobs. They will get very saturated . It’s not like the government is building hospitals left and right
@@jays5926 so your solution to physician shortages is to not to train more physicians? You reasoning behind this is because the field will be more saturated? So you will push for more midlevels instead of physicians to fix the physician shortage? This is the most retarded logic ever
@@D2524-v8r we all know there is no true physician shortage . There is a shortage of physicians at the level of primary care . That’s a major difference and it’s an inherent flaw in the structure of how we train and employ MDs
@@jays5926 Okay why cut out the ductors anyways. Just make it mandatory by lottery and then have midlevels assist. Replacing the physicians entirely because there's a shortage of primary care doctors doesn't sound good
Practicing PA have education level of a 3rd year medical student, NPs have even less knowledge base than PAs. So yes not only they do put people at risk but also skyrocket cost of healthcare by mismanaging resources. answer to doctors shortages is not more midlevels but for increase residency training slots for physicians.
These comments are in and of itself quite divisive and incorrect towards PA's and NP's. Please explain to me and everyone else how a two year PA program is less education then an NP; an NP first went through 3 years of nursing school, then an additional 2-3 years of NP school. Most NP schools also require at least a year of experience prior to attending NP school. Last I checked, that equals 5-6 years of medical education and training for an NP.
@@divemaster162 So lets break it down by the numbers. graduating Medical school I had ~ 176 credits of graduate education with 3500-4000 hours of clinical exposure. PA school is ~120-130 credits with ~ 2000h clinical hours, NP school is ~48 credits with just 500-600 clinical hours. So if you read my comment carefully I stated that PAs actually have MORE not less training snd education than an NP. On top of that PA education is far more rigorous than NP school. and PAs follow Medical model simillar to those in medical school. I used to teach in a nursing program prior. From what i can tell your their level of sciences is that of a bachelors degree. On top of that PA school is standardized across the country while NP school is not. Nursing experience is no where near that of what you need as a clinician. My med school class had 2 prior nurses so although they did have some knowledge of basic protocols such as how to administers certain meds , it was no where near enough to know how to manage Pts, come up with differentials, assessment, plans ect. Also nursing "experience" varies broadly from OP to IP and you cant compare those. remember that Doctors , based on specialty do additional 3-11 years of post graduate training in residency which can account to 12-20k additional hours of managing complex patients. If you or you loved ones are sick who would you rather oversee your care? NP, PA, or MD/DO??
@@mh2blade First off, I wasn't comparing MD/DO to PA and NP. I was referring to your comment that PA's have more training and education than an NP. I have been heavily involved in education and training for RN's, PA's, and NP's. Nursing school is on average 120+ credit hours. NP school can range anywhere from additional 40+ to 70+ credit hours, depending on the specialty route one is taking. PA school is often the beginning of formal medical education and they need the clinical time to gain the experience. NP school requires at a minimum of one year of experience (which is 2080 hours) prior to attending the NP school. MOST NP's have far more years of experience than that before going to NP school. By the time NP students start, they have a LOT more clinical time and experience, and therefore require less clinical time during school than student PA's. Making the statement that "Nursing experience is no where near that of what you need as a clinician" is extremely ignorant and demonstrates a very poor understanding, as well as, appreciation of the field of nursing. These type of comments need to stop! I have seen plenty of Doc's get their butts saved by nurses. Nursing experience varies widely on the specialty area they go into after they graduate (an office nurse will have a very different clinical experience than an ICU nurse). I have worked with many NP's and PA's and find both to be very strong assets to the communities in which they serve. There is NO evidence to support that one is better than the other (only unfounded biases). You ask who I would rather take care of my loved one, a PA/NP vs MD/DO. That really depends on the issue(s) at hand. If my loved one is in the ICU, on multiple gtts and vented, I will take an ICU NP/PA over a family practice doc any day of the week! I am going to have a more informative conversation about surgery with a surgical NP/PA than an ED doc. There are so many different areas of practice PA's and NP's work in. To say that one is inferior or superior to another is completely ignorant and false. I find the level of competency is more related to the individual than the profession as a whole......this is true with PA's, NP's, MD's, DO's. Each has strong and weak providers.
@@divemaster162 he was right though. No amount of nursing training (even experience unless you got like 30 years on you) will stand up to the amount of knowledge exposure to all types of anatomy, physiology, pathophysiology, pharmacology, diagnostics and differential diagnostics, and other training medical students have to do in their 1-2nd years. As per the “nurses save docs all the time” I assume it’s because they take CARE of the patient…or isn’t it called…nursing them? So because they did what they were trained to do, which is keep that patient alive, they are now clinicians and can now diagnose and treat patients who have complex conditions like pheochromocytoma or glioblastoma? You are implying this even if you mean it. This goes for most health professionals. NP’s, Medics, RN’s. Pharmacists have an argument for pharmacology and PA bc same model of teaching (equivalent to 2-3 years of MD/DO). But even then that’s a stretch because now they’re having to relearn these things and must be able to take more training and such than they’re used to. You can maybe make an argument for other allied health professionals and or “mid levels” with high experience, but their experience doesn’t mean they’re better. It just means they’ve been doing THEIR job longer. Should NP/PA’s be independent? No. Should they be able to open their own clinics however, and practice under expanded protocols UNDER a physician with regular consulting, testing, extreme CE standards, and if they have experience? Why not. We already place these standard on medics. If I’m not mistaken medics require more CE than ADN nurses but that might be a misunderstanding. But that’s not independence, that’s autonomy. Who is stupid enough to argue semantics? Unfortunately a lot of people here. Stay safe. Much love!
I agree, as someone who is spending more than 4 years to be trained as a medical professional its hard to see people who have only spent half the time training getting just as much autonomy in patient care concerning. Not because they aren't qualified to do so but because they simply have not had the education or training required to adequately treat patients in that capacity. I do believe that they are an important part of the medical team but cannot be the sole providers for patients.
here to comment what i usually do on videos about this debate: the nurse practitioner role was invented for seasoned nurses to bridge the knowledge between themselves and physicians. NPs are dangerous when they enter their programs shortly after or even from their BSN programs. where i live (central canada) you need AT LEAST two (and the more the better) years of practice in a specialty like ICU, ER, or OR. in addition, where i live, PAs function as ‘senior residents.’ we certainly have our struggles when it comes to our healthcare system but the midlevel debate is something i think we handle pretty well.
It's a compensation problem. Midlevels want more autonomy so they can bill directly. Physicians have played a role in exacerbating this problem by happily employing 10 midlevels with limited supervision, only signing off on the minimum number of charts and profiting off it while working 1-2 days a week. Don't get me wrong they have every right to do this, but what do you expect when you have a midlevel with 10-20 years experience who can generate as much if not more revenue than some physicians but only get compensated for a fraction of that?
MD incompetence is a major driver of these changes. Just think of who is responsible for the opioid crisis , benzo crisis, antibody resistance. there NEEDS to be mid levels . For example , pharmacist intervention for the topics I just described .
@@jays5926 the antibiotic resistance comes from ppl eating animals that are fed antibiotics lmfao why you think they tell you to eat chicken soup when u get a cold
you're pointing to midlevels with 10-20 years of experience when you're forgetting that new grad midlevels know absolutely nothing and has no right to be autonomously providing patient care. you're comparing apples to oranges
So just want to ask a question.. what would be the difference from say a PA working in primary care for 10 to 15yrs vs a new minted Physician just graduating from residency?? Who leads the team then.. this is where it gets tricky because the narrative is training and education and hours logged before being able independently practice. So which one would be ideal. 5 to 10yrs in practice in that specialty or 3yrs of residency. And I'm only using PCP as an example because other specialties will vary significantly..
it can potentially be similar, but for the PA it heavily depends on the individual and the intensity and how complex the cases he sees during his 10-15 years of practice are. some diseases that are mentioned in textbooks but rarely pop up in real life will have been taught to the physician in the classroom but the same can't be said about PA. (because even if real life clinical hours are comparable, the formal education is still longer in the case of a physician. and even if the clinical hours are comparable in length, the responsibilities expected of them during that time are vastly different for both roles) so, if the PA is a rockstar and continues to self study in his own time and master the pathophys of all the diseases he comes across, he can be just as competent as a physician, but most wouldn't do so.
I am sooo confused on this and would love advice! In my state NPs can run private practices, in addition, they run all the urgent care/walk in clinics. My local school graduates 60 NPs/ year. No mcat or gre required, just an overall GPA of 3.0! Plus, get this, I share an office with 5 NPs, so to keep this anonymous, 1 told me she got all her board exam answers from the internet!!!!! So the whole idea of increasing NP admissions was to get them to the rural areas, not happening here! Our two largest cities in this state have populations of 120,000 and 80,000 there are a few 25,000 and the rest are
Oh and btw since my local school now made it a DNP program, they are all going by “doctor” in their advertising and what they have their patients call them!
I do not think NPs and PAs are trying to replace MDs/DOs but are just trying to work to highest degree of their license while providing high quality care. It is ugly and I think there is a lot of misconceptions and misinformation out there.
@@giorgio2506 I mean expand some allied professional scope is a good idea tho. Just add better training. Example allow Medics more scope to start blood products for MTP or other vasoactive agents that they can’t or typically can’t use. Maybe allow EMT’s to interpret EKG, teaching interpretations to them? Not nursing or NP/PA or MD/DO but I mean they got specialty training in EM. Why not give them more so they can help/do more? Trade off could be requiring more training for paramedics, maybe an associates in order to formalize training as credits and can help if they choose to go bachelors later on in life.
@@giorgio2506they already do though, in most hospitals. This is how I know you are clueless about the education and competitiveness of med school. No doc I ever met worries about these issues only online foreign docs seem to have an issue with mid-levels 5000 miles away from them.
The AMA also historically opposed women being able to become physicians and the recognition of DOs as physicians. Milton Freeman argued their function has been to increase medical fees and physician wages. "Stop scope creep" is not about what is best for the patient, but what is best for the physician.
How about you talk to some physicians and try to hear their side of the story, instead of listening to long dead economists like Milton Friedman. If scope creep isn't stopped, then more patients will be seen by medical professionals that have had less training. I have no problem with midlevels, but they are a part of a healthcare team that must be respected and carried out in order to be effective, and not have stupid and juvenile arguments. Giving midlevels independent practice would undermine physician positions and the patients would be seen by other medical professionals with significantly less training. NPs are notorious for this and their AANP keeps actively lobbying for independent practice rights and claims sexism despite there being more female medical students than male students now, you can search it up yourself. PAs on the other hand are a lot more qualified than an NP and make an excellent edition to the healthcare team, it is more difficult to get into PA school than NP school and they need to complete up to 4 times the amount of clinical hours (About 2,000) to that of an NP. Even though the requirements to become a PA are a lot more rigorous, it still would be less than that of an attending physician who will usually have about 10,0000 hours of clinical experience. PAs can help to extend the reach of medical care when supervised by a physician, but should not be replacing doctors. That is both bad for patients and bad for doctors, not just bad for doctors.
Yeah. When can't argue with substance lets bring up long dead history. Who didn't oppose women being at anything years ago. They didn't have freaking voting rights let alone working
@@pnp072000 @Kranky. K! I'd encourage you to look at actual research that has been done comparing patient outcomes of the physician vs. PAs/NPs as provider as part of forming your opinion. Examples: "A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians' Patterns of Practice and Quality of Care in Health Centers" (2017) looked at 23,000+ visits over 5 years and concluded: "On 7 of the 9 outcomes studied, no statistically significant differences were detected in NP or PA care compared with PCMD care. On the remaining outcomes, visits to NPs were more likely to receive recommended smoking cessation counseling and more health education/counseling services than visits to PCMDs (P≤0.05). Visits to PAs also received more health education/counseling services than visits to PCMDs (P≤0.01; design-based model only)." "Current Evidence and Controversies: Advanced Practice Providers in Healthcare" (2019): "...a retrospective study of 30 million patient visits to community health centers found that APPs cared for similar patient populations as physicians and achieved equivalent or better results on quality metrics (eg, smoking cessation, depression treatment, statin therapy) and utilization (eg, physical exams, education/counseling, imaging, medication use, return visits, referrals)." Is this a comprehensive review of literature? No. Should I even be engaging in this discussion? Probably not. But if anyone is going to base their stance on this issue on the idea that care outcomes by mid-level providers are inferior and dangerous, I strongly encourage you to take a little time and look at the literature and actual data first.
@@BlueAndGoldLanguage wow you can’t even find any study that was not funded by midlevel interest groups. No IRB board would approve any study like this, it puts patient safety at risk. Again you prove out point demonstrating that midlevels do not even have the scientific literacy expected in a college freshman. Also for future reference cite from higher quality peer review journals. I’m shocked some would actually try to back unsubstantiated claims from journals that are basically pay to publish (1.3 impact factor for ajmc for example). When I was back in college PI would not even let undergrads publish in journals like that.
I'm sorry, but I, nor any PA or CRNA I work with as a General Surgery PA have EVER talked about replacing surgeons or anesthesiologists. Can we do more, safely, under the supervision and collaboration of an MD? You bet. I absolutely advocate to expand our scope into arenas that satisfy the above. (For example, we do much of the clinical proctology work, freeing up the surgeons to see more-and more complicated consults. We expanded our scope, but did is safely, in collaboration, and initially under the supervision and training of an MD) Do we want to expand our scope beyond this? To BECOME the surgeon or anesthesiologists, no. Straight up, no. And all this rhetoric from the talking heads at the AMA and PPP is super counterproductive, disingenuous, abrasive, and fosters an environment of me versus you tribalism. This isn't helpful in 2021, with the way medicine is practiced-and will CONTINUE to be practiced into the future. We're not going back to the 20th century when the MD was king much to the chagrin of many MDs I'm sure. PAs, CRNA, NPs have been around for quite some time now. Where's the data that the rise of modern multi-professional medicine has causatively, and significantly harmed patient care? And concerning the gap in education: Medical education is great, medical education is awesome, and some docs probably use all of their didactical training on the daily. But, how many are willing to stand up and honestly say how much biochemistry and pathophysiology from medical school you're using on a DAILY basis in your practice? We were attached to our medical school, and went to the same lectures as our med student colleagues (assuming the med students actually showed up. How many MDs want to stand up and report how many lectures they actually went to in person?) . We did the same cadaver dissections as our medical student colleagues (1 PA student to 3 Med students). Sure you use bits and pieces, and maybe more if you're a real go getter, but honestly a considerable amount of what you learn in didactic is out the door. How much did you really learn in all your clinicals? Or when you took a few months off in year 4? I would contend that the majority you learn, certainly on a mostly forgotten didactic foundation, is in your residencies and fellowships. So, a PA student, with a similar-albiet less rigorous forgettable didactic after 4-6 years on the job working hand in hand with attendings are going to know quite a bit. The same level as an MD? No. Enough to safely manage a significant amount of low to moderately complex clinical scenarios? Yes. Sorry, but yes.
Hey, I’m on the MD side of this issue. Wanted to say that I really respect the perspective I give here. Perhaps it’s easier for us in surgery, because we physically work together more closely than our medical counterparts. It seems less adversarial. I also think that the whole issue of “independent practice” isn’t the same for us, because like you said surgical PAs do not secretly wish they were the surgeon
Uh with the same logic as yours, can we have LPNs take RNs jobs? I mean your RN education is pretty much the same as those of LPNs. Probably less of a gap than RNs and MDs
@@giorgio2506 You’re statement does not apply to what this person is saying about the position/role of the PA. Also, your position on LPNs and RNs is also not factual nor is it relevant. LPNs that desire to become RNs have to return back to school and engage in additional clinical experiences. Some LPNs have no desire to become RNs and that’s totally cool. Healthcare is a collaborative process in which all roles are unique and valuable. “Stop the Scope” is divisive and is not adding value to the current state of our healthcare infrastructure in the United States.
I am a PA and all I know is most of my urological patients are fed up with their primary care provider. For all the years of training primary care/ Family Medicine MDs have the worst bedside manner and can not properly manage their time which leads to long wait times or feeling rushed when you are in their presence. Instead of focusing on PA and NPs they should properly train FMP doctors to have patience and better beside manner.
I’m not. Will NEVER allow to be seen by some PA ever again. You are nowhere as knowledgeable as a medical doctor. But for some reason, people in your profession like to upcharge patients and bill them at doctor’s level for urgent care quality work. Only in 🇺🇸🤡
Part of the problem is Americans contempt for higher education and therefore seeing the lack of formal training PAs and NPs get as a “good thing” I see so many posts by PAs and NPs complaining that medical school is too long and they want to make money NOW. There’s a reason why physicians are responsible for so much education.
![NP & PA vs MD & DO | The Scope Creep Controversy [Research Explained]](http://i.ytimg.com/vi/Ow5N9jXJ-_A/mqdefault.jpg)
![NP & PA vs MD & DO | The Scope Creep Controversy [Research Explained]](/img/tr.png)
I’m an FNP and proud of what I’ve accomplished. However, the more I learned the more I realized how much I don’t know. The type of schooling, education and hours put in just do not come close to matching what a physician has gone through. I think with years of experience an NP or PA can narrow the gap, but I feel should still not be completely autonomous
Scope of practice is so vital. It’s a HUGE ETHICAL problem if people start doing things they were not trained to do. NP’s are AWESOME! So are PA. But they are not the same as a physician. There is no comparison, they are different and serve a different function towards a UNIFIED healthcare team. I do not think being physician lead is most important, but the problem comes when someone has a clinical presentation of something or another and the less trained NP is not able to recognize it. Everyone makes mistakes, but I would prefer my life in the hands of the person best qualified to make that decision. In short this is really complicated and the reality is money is king so money will win in the end. Regardless of patient outcomes.
Non-expert here with a probably-legitimate concern: Be careful about this “team” approach. Big teams, big facilities, centralized networks, and big administrative overhead, by common sense, must be expensive. If you’re too inclusive and welcoming, then your patients will get fleeced.
Right..... Who paid you to say this?
what boggles my mind is why is there a Physician shortage? why medical schools keep rejecting excellent applicants left and right? Applicants with great scores, extracurriculars and personal statements get rejected and yet schools refuse to provide feedback, these applicants are left in limbo and choosing other career paths.
THIS. The whole scope creep debate is really a way to deflect from the older gen MDs restricting residency slots to keep their salaries high and screw the next generation. But some of the people who bash PAs and NPs don’t realize that they are also suffering due to the physician shortage and all of this is literally a direct result of the government/boomer doctors 🤷🏾♀️
The medical profession brought this on themselves. You can harp on and on about how important physicians are, but at the end of the day you need to actually *have* physicians to have physician-led care.
There are 2 bottle-necks: number of residency spots and residency CHOICE. The problem of physician shortage also has another dimension: no one wants to go into the specialties we need most. Primary care chief among them. The burnout rate in primary care is insane and they have to spend more time (outside work mind-you) doing documentation than any other specialty. The burden placed on them far outweighs their drop in salary.
The AMA is a rackett.
What midlevels seldom understand is that we physicians do NOT have a problem with them in the healthcare setting; we have a problem when they start assuming our roles WITHOUT the requisite level of education. I would never allow myself or my family members to undergo anesthesia by a CRNA. Ever. That's not to say that CRNAs don't have their specific role in the healthcare sphere.
First off, there’s no data suggesting that the excessive training that American doctors have leads to better patient outcomes. The US (and Canada) have the longest track to becoming a physician of any country. Most countries allow doctors to graduate with 33% less training and yet foreign doctors who migrate to the US have similar patient outcomes as their American counterparts. So if anything, there’s more proof that doctors in the US are OVER prepared.
Now this isn’t to say that NPs and PAs training is perfect. In fact, most would agree that they need more clinical hours and residency programs are rapidly popping up in numerous states. That being said, the data is quite clear that patient outcomes under mid levels is just a good as a physician.
Lastly, that’s the beauty of choice, you can choose whom you’re comfortable with taking care of you. If you don’t want a CRNA anesthetizing you for surgery, then ask for an anesthesiologist.
@@cbl6520 in the UK after 5/6 years of medical school you must complete 9/10 years to become a senior Physician or Surgeon. So way longer overall than USA. Usually training is longer due to multiple obstacles like not enough training places or time out for additional degrees.
@@gingerbg7602
First off, there’s no premed in the UK, you go straight into medical school, so shave 4 years off the journey. Undergrad medical studies (medical school) is 4 years, followed by 2 years of foundation training, and 3 years of GP training, so becoming a GP takes 9-11 years, as opposed to 11-13 years in the US. Specialist training is an additional 3-7 years depending on specialty. Even though specialist training is similar in length, the total time to become a doctor is still 33% shorter than in the US.
All of this is taken directly from the British Medical Association’s website.
@@cbl6520 yeah here in Italy, we do 6 years of med school. 360 credits. Clinical rotations start from 2nd year all the way up to 6th. Residency is the same length. I dont know what boondock countries youre talking about. Please show me facts and data. Where did you get the 33%?
And yet we have CRNAs put people to sleep by the thousands in our ambulatory center, and guess how many issues there have been?
Give me a break.
Do I want a CRNA doing cardiac anesthesia, probably not. But they put our gallbladders to sleep and I haven't seen a single issue in the 7 years I've been in the OR.
Same issue with CRNAs
Yes please increase the number of medical residencies! Great video! Some estimate 5,000 to 10,000 M.D.s who can't get into residencies.
That’s very pointless and an archaic way of thinking, in muse of “patient safety” . Why should the government pay more money for that, when you can hand select specialized mid level contractors to take strain off of the system.
You also underestimate what a small increase in residency positions will do to clinical in hospital MD jobs. They will get very saturated . It’s not like the government is building hospitals left and right
This is merely a matter of legislation and that’s it
@@jays5926 so your solution to physician shortages is to not to train more physicians? You reasoning behind this is because the field will be more saturated? So you will push for more midlevels instead of physicians to fix the physician shortage? This is the most retarded logic ever
@@D2524-v8r we all know there is no true physician shortage . There is a shortage of physicians at the level of primary care . That’s a major difference and it’s an inherent flaw in the structure of how we train and employ MDs
@@jays5926 Okay why cut out the ductors anyways. Just make it mandatory by lottery and then have midlevels assist. Replacing the physicians entirely because there's a shortage of primary care doctors doesn't sound good
Practicing PA have education level of a 3rd year medical student, NPs have even less knowledge base than PAs. So yes not only they do put people at risk but also skyrocket cost of healthcare by mismanaging resources. answer to doctors shortages is not more midlevels but for increase residency training slots for physicians.
These comments are in and of itself quite divisive and incorrect towards PA's and NP's. Please explain to me and everyone else how a two year PA program is less education then an NP; an NP first went through 3 years of nursing school, then an additional 2-3 years of NP school. Most NP schools also require at least a year of experience prior to attending NP school. Last I checked, that equals 5-6 years of medical education and training for an NP.
@@divemaster162 So lets break it down by the numbers. graduating Medical school I had ~ 176 credits of graduate education with 3500-4000 hours of clinical exposure. PA school is ~120-130 credits with ~ 2000h clinical hours, NP school is ~48 credits with just 500-600 clinical hours. So if you read my comment carefully I stated that PAs actually have MORE not less training snd education than an NP. On top of that PA education is far more rigorous than NP school. and PAs follow Medical model simillar to those in medical school. I used to teach in a nursing program prior. From what i can tell your their level of sciences is that of a bachelors degree. On top of that PA school is standardized across the country while NP school is not. Nursing experience is no where near that of what you need as a clinician. My med school class had 2 prior nurses so although they did have some knowledge of basic protocols such as how to administers certain meds , it was no where near enough to know how to manage Pts, come up with differentials, assessment, plans ect. Also nursing "experience" varies broadly from OP to IP and you cant compare those. remember that Doctors , based on specialty do additional 3-11 years of post graduate training in residency which can account to 12-20k additional hours of managing complex patients. If you or you loved ones are sick who would you rather oversee your care? NP, PA, or MD/DO??
@@mh2blade First off, I wasn't comparing MD/DO to PA and NP. I was referring to your comment that PA's have more training and education than an NP. I have been heavily involved in education and training for RN's, PA's, and NP's. Nursing school is on average 120+ credit hours. NP school can range anywhere from additional 40+ to 70+ credit hours, depending on the specialty route one is taking. PA school is often the beginning of formal medical education and they need the clinical time to gain the experience. NP school requires at a minimum of one year of experience (which is 2080 hours) prior to attending the NP school. MOST NP's have far more years of experience than that before going to NP school. By the time NP students start, they have a LOT more clinical time and experience, and therefore require less clinical time during school than student PA's. Making the statement that "Nursing experience is no where near that of what you need as a clinician" is extremely ignorant and demonstrates a very poor understanding, as well as, appreciation of the field of nursing. These type of comments need to stop! I have seen plenty of Doc's get their butts saved by nurses. Nursing experience varies widely on the specialty area they go into after they graduate (an office nurse will have a very different clinical experience than an ICU nurse). I have worked with many NP's and PA's and find both to be very strong assets to the communities in which they serve. There is NO evidence to support that one is better than the other (only unfounded biases). You ask who I would rather take care of my loved one, a PA/NP vs MD/DO. That really depends on the issue(s) at hand. If my loved one is in the ICU, on multiple gtts and vented, I will take an ICU NP/PA over a family practice doc any day of the week! I am going to have a more informative conversation about surgery with a surgical NP/PA than an ED doc. There are so many different areas of practice PA's and NP's work in. To say that one is inferior or superior to another is completely ignorant and false. I find the level of competency is more related to the individual than the profession as a whole......this is true with PA's, NP's, MD's, DO's. Each has strong and weak providers.
@@divemaster162 he was right though. No amount of nursing training (even experience unless you got like 30 years on you) will stand up to the amount of knowledge exposure to all types of anatomy, physiology, pathophysiology, pharmacology, diagnostics and differential diagnostics, and other training medical students have to do in their 1-2nd years. As per the “nurses save docs all the time” I assume it’s because they take CARE of the patient…or isn’t it called…nursing them? So because they did what they were trained to do, which is keep that patient alive, they are now clinicians and can now diagnose and treat patients who have complex conditions like pheochromocytoma or glioblastoma? You are implying this even if you mean it. This goes for most health professionals. NP’s, Medics, RN’s. Pharmacists have an argument for pharmacology and PA bc same model of teaching (equivalent to 2-3 years of MD/DO). But even then that’s a stretch because now they’re having to relearn these things and must be able to take more training and such than they’re used to. You can maybe make an argument for other allied health professionals and or “mid levels” with high experience, but their experience doesn’t mean they’re better. It just means they’ve been doing THEIR job longer. Should NP/PA’s be independent? No. Should they be able to open their own clinics however, and practice under expanded protocols UNDER a physician with regular consulting, testing, extreme CE standards, and if they have experience? Why not. We already place these standard on medics. If I’m not mistaken medics require more CE than ADN nurses but that might be a misunderstanding. But that’s not independence, that’s autonomy. Who is stupid enough to argue semantics? Unfortunately a lot of people here. Stay safe. Much love!
I agree, as someone who is spending more than 4 years to be trained as a medical professional its hard to see people who have only spent half the time training getting just as much autonomy in patient care concerning. Not because they aren't qualified to do so but because they simply have not had the education or training required to adequately treat patients in that capacity. I do believe that they are an important part of the medical team but cannot be the sole providers for patients.
here to comment what i usually do on videos about this debate: the nurse practitioner role was invented for seasoned nurses to bridge the knowledge between themselves and physicians. NPs are dangerous when they enter their programs shortly after or even from their BSN programs. where i live (central canada) you need AT LEAST two (and the more the better) years of practice in a specialty like ICU, ER, or OR. in addition, where i live, PAs function as ‘senior residents.’ we certainly have our struggles when it comes to our healthcare system but the midlevel debate is something i think we handle pretty well.
It's a compensation problem. Midlevels want more autonomy so they can bill directly. Physicians have played a role in exacerbating this problem by happily employing 10 midlevels with limited supervision, only signing off on the minimum number of charts and profiting off it while working 1-2 days a week. Don't get me wrong they have every right to do this, but what do you expect when you have a midlevel with 10-20 years experience who can generate as much if not more revenue than some physicians but only get compensated for a fraction of that?
Bingo
This is why I laugh when I hear MDs crying for the sake of patient safety
MD incompetence is a major driver of these changes. Just think of who is responsible for the opioid crisis , benzo crisis, antibody resistance. there NEEDS to be mid levels . For example , pharmacist intervention for the topics I just described .
@@jays5926 the antibiotic resistance comes from ppl eating animals that are fed antibiotics lmfao why you think they tell you to eat chicken soup when u get a cold
@@jays5926 ahh yes more midlevels managing psych meds?!?! you mean like giving bupropion to bipolar pts?
you're pointing to midlevels with 10-20 years of experience when you're forgetting that new grad midlevels know absolutely nothing and has no right to be autonomously providing patient care. you're comparing apples to oranges
Patients deserve physicians
So just want to ask a question.. what would be the difference from say a PA working in primary care for 10 to 15yrs vs a new minted Physician just graduating from residency?? Who leads the team then.. this is where it gets tricky because the narrative is training and education and hours logged before being able independently practice. So which one would be ideal. 5 to 10yrs in practice in that specialty or 3yrs of residency. And I'm only using PCP as an example because other specialties will vary significantly..
it can potentially be similar, but for the PA it heavily depends on the individual and the intensity and how complex the cases he sees during his 10-15 years of practice are. some diseases that are mentioned in textbooks but rarely pop up in real life will have been taught to the physician in the classroom but the same can't be said about PA. (because even if real life clinical hours are comparable, the formal education is still longer in the case of a physician. and even if the clinical hours are comparable in length, the responsibilities expected of them during that time are vastly different for both roles)
so, if the PA is a rockstar and continues to self study in his own time and master the pathophys of all the diseases he comes across, he can be just as competent as a physician, but most wouldn't do so.
I am sooo confused on this and would love advice! In my state NPs can run private practices, in addition, they run all the urgent care/walk in clinics. My local school graduates 60 NPs/ year. No mcat or gre required, just an overall GPA of 3.0! Plus, get this, I share an office with 5 NPs, so to keep this anonymous, 1 told me she got all her board exam answers from the internet!!!!! So the whole idea of increasing NP admissions was to get them to the rural areas, not happening here! Our two largest cities in this state have populations of 120,000 and 80,000 there are a few 25,000 and the rest are
Oh and btw since my local school now made it a DNP program, they are all going by “doctor” in their advertising and what they have their patients call them!
Yikes
It's time to abolish self-regulation of medical licensure. The AMA is a little more than a racket that keeps the gravy train flowing for doctors.
Lmao np don't gave a standard of requirements .they not subject to malpractice.
I do not think NPs and PAs are trying to replace MDs/DOs but are just trying to work to highest degree of their license while providing high quality care. It is ugly and I think there is a lot of misconceptions and misinformation out there.
Lets have LPNs have the same scope of practice as RNs then!
@@giorgio2506 I mean expand some allied professional scope is a good idea tho. Just add better training. Example allow Medics more scope to start blood products for MTP or other vasoactive agents that they can’t or typically can’t use. Maybe allow EMT’s to interpret EKG, teaching interpretations to them? Not nursing or NP/PA or MD/DO but I mean they got specialty training in EM. Why not give them more so they can help/do more? Trade off could be requiring more training for paramedics, maybe an associates in order to formalize training as credits and can help if they choose to go bachelors later on in life.
Then tell the AANP to stop lobbying congress for independent practice rights
@@giorgio2506they already do though, in most hospitals.
This is how I know you are clueless about the education and competitiveness of med school. No doc I ever met worries about these issues only online foreign docs seem to have an issue with mid-levels 5000 miles away from them.
The AMA also historically opposed women being able to become physicians and the recognition of DOs as physicians. Milton Freeman argued their function has been to increase medical fees and physician wages. "Stop scope creep" is not about what is best for the patient, but what is best for the physician.
How about you talk to some physicians and try to hear their side of the story, instead of listening to long dead economists like Milton Friedman. If scope creep isn't stopped, then more patients will be seen by medical professionals that have had less training. I have no problem with midlevels, but they are a part of a healthcare team that must be respected and carried out in order to be effective, and not have stupid and juvenile arguments. Giving midlevels independent practice would undermine physician positions and the patients would be seen by other medical professionals with significantly less training. NPs are notorious for this and their AANP keeps actively lobbying for independent practice rights and claims sexism despite there being more female medical students than male students now, you can search it up yourself. PAs on the other hand are a lot more qualified than an NP and make an excellent edition to the healthcare team, it is more difficult to get into PA school than NP school and they need to complete up to 4 times the amount of clinical hours (About 2,000) to that of an NP. Even though the requirements to become a PA are a lot more rigorous, it still would be less than that of an attending physician who will usually have about 10,0000 hours of clinical experience. PAs can help to extend the reach of medical care when supervised by a physician, but should not be replacing doctors. That is both bad for patients and bad for doctors, not just bad for doctors.
Yeah. When can't argue with substance lets bring up long dead history. Who didn't oppose women being at anything years ago. They didn't have freaking voting rights let alone working
@@pnp072000 @Kranky. K! I'd encourage you to look at actual research that has been done comparing patient outcomes of the physician vs. PAs/NPs as provider as part of forming your opinion.
Examples:
"A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians' Patterns of Practice and Quality of Care in Health Centers" (2017) looked at 23,000+ visits over 5 years and concluded: "On 7 of the 9 outcomes studied, no statistically significant differences were detected in NP or PA care compared with PCMD care. On the remaining outcomes, visits to NPs were more likely to receive recommended smoking cessation counseling and more health education/counseling services than visits to PCMDs (P≤0.05). Visits to PAs also received more health education/counseling services than visits to PCMDs (P≤0.01; design-based model only)."
"Current Evidence and Controversies: Advanced Practice Providers in Healthcare" (2019): "...a retrospective study of 30 million patient visits to community health centers found that APPs cared for similar patient populations as physicians and achieved equivalent or better results on quality metrics (eg, smoking cessation, depression treatment, statin therapy) and utilization (eg, physical exams, education/counseling, imaging, medication use, return visits, referrals)."
Is this a comprehensive review of literature? No. Should I even be engaging in this discussion? Probably not. But if anyone is going to base their stance on this issue on the idea that care outcomes by mid-level providers are inferior and dangerous, I strongly encourage you to take a little time and look at the literature and actual data first.
@@BlueAndGoldLanguage wow you can’t even find any study that was not funded by midlevel interest groups. No IRB board would approve any study like this, it puts patient safety at risk. Again you prove out point demonstrating that midlevels do not even have the scientific literacy expected in a college freshman.
Also for future reference cite from higher quality peer review journals. I’m shocked some would actually try to back unsubstantiated claims from journals that are basically pay to publish (1.3 impact factor for ajmc for example). When I was back in college PI would not even let undergrads publish in journals like that.
@@BlueAndGoldLanguage These are pretty bad studies if you look beyond the abstract and conclusion lol
I'm sorry, but I, nor any PA or CRNA I work with as a General Surgery PA have EVER talked about replacing surgeons or anesthesiologists. Can we do more, safely, under the supervision and collaboration of an MD? You bet. I absolutely advocate to expand our scope into arenas that satisfy the above. (For example, we do much of the clinical proctology work, freeing up the surgeons to see more-and more complicated consults. We expanded our scope, but did is safely, in collaboration, and initially under the supervision and training of an MD) Do we want to expand our scope beyond this? To BECOME the surgeon or anesthesiologists, no. Straight up, no. And all this rhetoric from the talking heads at the AMA and PPP is super counterproductive, disingenuous, abrasive, and fosters an environment of me versus you tribalism.
This isn't helpful in 2021, with the way medicine is practiced-and will CONTINUE to be practiced into the future. We're not going back to the 20th century when the MD was king much to the chagrin of many MDs I'm sure.
PAs, CRNA, NPs have been around for quite some time now. Where's the data that the rise of modern multi-professional medicine has causatively, and significantly harmed patient care?
And concerning the gap in education: Medical education is great, medical education is awesome, and some docs probably use all of their didactical training on the daily. But, how many are willing to stand up and honestly say how much biochemistry and pathophysiology from medical school you're using on a DAILY basis in your practice? We were attached to our medical school, and went to the same lectures as our med student colleagues (assuming the med students actually showed up. How many MDs want to stand up and report how many lectures they actually went to in person?) . We did the same cadaver dissections as our medical student colleagues (1 PA student to 3 Med students). Sure you use bits and pieces, and maybe more if you're a real go getter, but honestly a considerable amount of what you learn in didactic is out the door. How much did you really learn in all your clinicals? Or when you took a few months off in year 4? I would contend that the majority you learn, certainly on a mostly forgotten didactic foundation, is in your residencies and fellowships. So, a PA student, with a similar-albiet less rigorous forgettable didactic after 4-6 years on the job working hand in hand with attendings are going to know quite a bit. The same level as an MD? No. Enough to safely manage a significant amount of low to moderately complex clinical scenarios? Yes. Sorry, but yes.
Hey, I’m on the MD side of this issue. Wanted to say that I really respect the perspective I give here. Perhaps it’s easier for us in surgery, because we physically work together more closely than our medical counterparts. It seems less adversarial. I also think that the whole issue of “independent practice” isn’t the same for us, because like you said surgical PAs do not secretly wish they were the surgeon
Uh with the same logic as yours, can we have LPNs take RNs jobs? I mean your RN education is pretty much the same as those of LPNs. Probably less of a gap than RNs and MDs
@@giorgio2506 You’re statement does not apply to what this person is saying about the position/role of the PA. Also, your position on LPNs and RNs is also not factual nor is it relevant. LPNs that desire to become RNs have to return back to school and engage in additional clinical experiences. Some LPNs have no desire to become RNs and that’s totally cool. Healthcare is a collaborative process in which all roles are unique and valuable. “Stop the Scope” is divisive and is not adding value to the current state of our healthcare infrastructure in the United States.
@@angiecam91 Yeah... I am gonna go ahead and guess that you are a nurse who wants to enter through the back door and creep up the ladder.
@@giorgio2506 you’re a joke.
I am a PA and all I know is most of my urological patients are fed up with their primary care provider. For all the years of training primary care/ Family Medicine MDs have the worst bedside manner and can not properly manage their time which leads to long wait times or feeling rushed when you are in their presence. Instead of focusing on PA and NPs they should properly train FMP doctors to have patience and better beside manner.
I’m not. Will NEVER allow to be seen by some PA ever again. You are nowhere as knowledgeable as a medical doctor. But for some reason, people in your profession like to upcharge patients and bill them at doctor’s level for urgent care quality work. Only in 🇺🇸🤡
Part of the problem is Americans contempt for higher education and therefore seeing the lack of formal training PAs and NPs get as a “good thing” I see so many posts by PAs and NPs complaining that medical school is too long and they want to make money NOW. There’s a reason why physicians are responsible for so much education.
Naw, it's just a healthy contempt for the AMA.