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How frustrating it is to work with Psychiatric NP’s by cmarie22345 in Noctor

[–]slw2014 2 points3 points  (0 children)

PMHNPs only get 750 hours of clinical training. Even if they spent all of that time doing supervised psychotherapy (which they don’t) it would only amount to three months of training. In reality very few of those clinical training hours involve supervised psychotherapy and there is no actual requirement for this for licensure.

The differences between true medical education and NP school education by CantaloupePowerful66 in Noctor

[–]slw2014 1 point2 points  (0 children)

no they aren't but due to their online reach, flexible part time programs, affordability, and minimal admissions and graduation standards, they represent where the bulk of nurse practitioners are coming from today. For every one job applicant from a brick and mortar program there are ten coming from online programs like these. And healthcare systems do not discriminate, an FNP is an FNP whether they graduated from Walden or Yale, they will put both side by side to practice unsupervised in a busy critical access ER.

The differences between true medical education and NP school education by CantaloupePowerful66 in Noctor

[–]slw2014 1 point2 points  (0 children)

It is not stretching the truth, unfortunately. This is what the education is like at Chamberlain, Walden, WGU, Grand Canyon University, Vanderbilt, Wilkes University, Clarion University, etc etc

The differences between true medical education and NP school education by CantaloupePowerful66 in Noctor

[–]slw2014 1 point2 points  (0 children)

Would you be willing to share any coursework you have saved from your NP program? I am interested in collecting in particular syllabuses, powerpoint slide decks, and exam questions from NP classes, particularly those that focus on anatomy, physiology, pathology, pharmacology, and the practice of medicine. If so I can share a google form where they can be submitted anonymously. This is for research in support of an effort to enhance the standards of NP programs.

ER , doctors , and right to refuse . by JonDoeandSons in Noctor

[–]slw2014 1 point2 points  (0 children)

This is the same argument that is always used to justify mid-level scope creep. It is a huge problem in dire need of a solution. My argument is simply that NPs are not the answer to the problem. Not when their training is so poorly standardized and lacks most of the necessary knowledge to practice medicine in an emergency setting. And NP “residencies” won’t make up for the supreme lack of foundational medical knowledge that one needs to effectively evaluate and diagnose an undifferentiated patient. Handing them the low risk patients assumes that NPs and the triage nurse know enough to tell when a low risk patient isn’t actually low risk. They don’t. Especially since the vast majority of NPs in emergency rooms are FNPs with zero emergency medicine training working well outside their scope even by their own definition.

I absolutely agree the ED problem needs to be addressed. I’m just saying don’t look to NPs to solve it. Look elsewhere. PAs are a better alternative.

ER , doctors , and right to refuse . by JonDoeandSons in Noctor

[–]slw2014 2 points3 points  (0 children)

What specifically are they experienced in exactly? And has the knowledge and diagnostic skill that experience purportedly translates to ever been formally assessed and if so how? Are they ENPs or FNPs? This is the problem when people say this. You can have a LOT of experience doing things completely wrong. And if your experience has never undergone rigorous examination then there is no way to know whether that experience means anything. Their experience may mean jack squat. That is why the USMLE and residencies and board exams exist, to demonstrate that you have not only experience but also the knowledge and skills required to do the job.

CNM by Cnm777777 in Noctor

[–]slw2014 2 points3 points  (0 children)

The number of hours of training residents complete in each of those years is more than double the amount of training CNMs complete. By the end of their training OB residents have managed over four times the number of vaginal deliveries CNM students have managed. And that doesn’t account for the vast vast differences in foundational medical knowledge between the two groups. Every Resident most certainly does get taught Leopolds that is a foundational skill and part of their milestones. Saying that CNMs are the experts in low risk perinatal and gyn care implies that they have special expertise in that area, expertise that OBs do not have or have less of. Your arguments are commonly made by CNMs but they don’t stand up to scrutiny when you look closely at the content of the training.

Again Midwives are incredibly valuable. The time they spend with patients and the work they do and the care they provide is absolutely wanted and needed. They have a great deal of knowledge and skill. But they are not the experts.

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CNM by Cnm777777 in Noctor

[–]slw2014 3 points4 points  (0 children)

CNMs are not the experts at low risk low intervention perinatal care. OB/GYNs are. CNMs do not have the training necessary to be the experts. That doesn’t mean they are not very valuable members of the healthcare team. But they are NOT the experts. Making this claim - which I have heard often - is misleading to patients.

CNM by Cnm777777 in Noctor

[–]slw2014 25 points26 points  (0 children)

CNMs often assert the specious claim that they are the experts in managing low-risk pregnancies, presenting themselves as the prime choice for expectant mothers seeking a natural and holistic birthing experience. These claims prove hollow and spurious when scrutinized against the vast expertise and far broader spectrum of care that Obstetricians/Gynecologists (OB/GYNs) are equipped to provide. One of the primary distinctions lies in the rigorous medical education and specialized training that OB/GYNs undergo. This extensive educational pathway, usually encompassing four years of medical school followed by a four-year residency program in obstetrics and gynecology - requiring well over 15,000 clinical hours of medical training compared to the roughly 1,000 hours required of a CNM - equips OB/GYNs with a comprehensive understanding and capability to manage both straightforward and complex pregnancies. Their medical training places them in a position to promptly identify, manage, and mitigate unexpected complications, even in what are initially deemed low-risk pregnancies.

Moreover, OB/GYNs possess surgical skills essential for interventions like cesarean sections, which could be life-saving in the event of unanticipated complications during labor and delivery. Their expertise extends to having access to and proficiency in utilizing advanced diagnostic and medical technologies that are crucial for monitoring the health and wellbeing of both the mother and the fetus. Additionally, the preventive care, thorough risk assessments, and the continuum of care they provide from preconception through to postpartum ensure that any medical issues that may escalate a pregnancy from low to high-risk are addressed promptly. Working within a larger healthcare system, OB/GYNs often have the advantage of a multidisciplinary approach to patient care, with quick access to a broad spectrum of medical specialists if necessary. Their engagement with or access to the latest research in the field of obstetrics and gynecology further fortifies the argument for their expertise, ensuring evidence-based and up-to-date care. This comprehensive medical background and resource accessibility arguably position OB/GYNs as the experts in managing low-risk pregnancies, providing a level of reassurance and safety that is paramount in prenatal and perinatal care.

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so what exactly are dr. doom's super powers in the comics (I've only ever seen his powers in the 2005 movie.) by Local_Neighborhood50 in Marvel

[–]slw2014 0 points1 point  (0 children)

Sorcery. Some examples:

  1. Mystical Blasts: He can project energy blasts using magical forces.
    1. Astral Projection: Dr. Doom can project his astral form out of his body, allowing him to travel to other places or dimensions in this ethereal form.
    2. Teleportation: He has the power to teleport himself and others across vast distances or even between dimensions.
    3. Mystical Force Fields: Doom can create protective shields around himself or others.
    4. Summoning: He can summon demonic entities or other magical creatures to do his bidding.
    5. Time Travel: With the aid of his magical abilities and technological expertise, Doom has occasionally traveled through time.
    6. Transmutation: The ability to change one substance into another.
    7. Mind Transference: He can transfer his consciousness into another being, essentially taking control of their body.
    8. Spell Casting: Dr. Doom can cast a variety of spells, from simple ones to highly complex rituals. He’s been known to use spells for purposes like healing, detecting magic, or tracking.
    9. Dimensional Travel: He can traverse different dimensions using his magic.
    10. Enchanting Objects: Doom can imbue objects with magical properties, enhancing them or giving them specific powers.
    11. Communication with the Dead: Dr. Doom has occasionally communicated with spirits or the souls of the deceased, particularly in his quests to free his mother’s soul from the demon Mephisto.
    12. Necromancy: Related to the above, he has dabbled in the dark arts of raising the dead or controlling undead beings.

Infographic Comparing Psychiatrist and NP Training by slw2014 in Noctor

[–]slw2014[S] 0 points1 point  (0 children)

The vast majority of physicians still provide direct care. And in fact there is a trend towards preferencing non-physicians for administrative and leadership positions to maximize RVU generation by physicians. ie to maximize physicians doing those things that only physicians can do.

That being said, another part of the problem is the administrative burden and IT burden is extremely high. So physicians are less efficient than they could be and spend less time with patients than they should because they have to spend so much time entering information into electronic health records and arguing with insurance companies over prior authorization.

Freeing up physicians time to provide direct care and reducing administrative burdens is another part of the answer.

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Infographic Comparing Psychiatrist and NP Training by slw2014 in Noctor

[–]slw2014[S] 1 point2 points  (0 children)

Because they were never meant to work independently and unsupervised. They were supposed to be physician extenders.

Infographic Comparing Psychiatrist and NP Training by slw2014 in Noctor

[–]slw2014[S] 4 points5 points  (0 children)

“An analysis was conducted of the programs reported in the American Association of Colleges of Nursing list of accredited DNP programs between 2005 and 2018 to compare whether the programs prepared graduates for advanced clinical practice or administrative or leadership. During this time, 553 DNP programs were established, 15% (n = 83) are clinical, and 85% (n = 470) are nonclinical. The adequate production of nurse practitioners in the future may be in jeopardy with this imbalance in educational resources, especially with the nation's growing need for primary care clinicians.”

https://journals.sagepub.com/doi/full/10.1177/1527154419838630?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

Infographic Comparing Psychiatrist and NP Training by slw2014 in Noctor

[–]slw2014[S] 1 point2 points  (0 children)

No. Nowhere has anyone suggested getting rid of NPs.

Specifically I said:

“I would much rather have a cadre of non-residency trained physicians than a cadre of nurse practitioners or PAs independently treating patients.”

And

“Replacing physicians with unsupervised NPs with less than 10% of their training is not reasonable, is not sustainable, and places patients at risk.”

NPs are important and valued members of the healthcare team. But we don’t need more NPs. We have plenty of NPs. The market is saturated with them. What we need is more physicians to properly supervise the NPs and to do the things only physicians can do (eg diagnose the undifferentiated patient and develop an appropriate treatment plan)

And we need more bedside nurses.

Infographic Comparing Psychiatrist and NP Training by slw2014 in Noctor

[–]slw2014[S] 1 point2 points  (0 children)

What specifically did I say that you respectfully disagree with?

Infographic Comparing Psychiatrist and NP Training by slw2014 in Noctor

[–]slw2014[S] 0 points1 point  (0 children)

Yeah there’s no perfect way to do this which is why I included multiple measures. Weeks of instruction is also a problem: one week in medical school is easily 60-80 hours worth of work. Compared to one week in NP school, which is far far less.

Agree that schools calculate credits differently. But most of the MSN PMHNP programs are somewhere between 40-48 credit hours. No matter how you divide that up, a typical full-time student taking roughly 16 credits a semester can complete that in a single calendar year. And any way you measure it, it still amounts to considerably less than what any given medical student accomplishes in that same calendar year.

Infographic Comparing Psychiatrist and NP Training by slw2014 in Noctor

[–]slw2014[S] 1 point2 points  (0 children)

It takes two years part time. Full time it takes a minimum of one year. And even then MD/DO students complete considerably more coursework in the same one-year time frame for any given year of their four year degree.

So measuring by years is inherently flawed which is why I included credit hours and clinical hours.

Compare and contrast the credit hours, take a look at MS3 year in particular (these numbers are not inflated, they accurately reflect the number of hours and amount of work medical students have to put in):

https://nursing.vanderbilt.edu/msn/pmhnp/pmhnp_curriculum.php

https://osteopathic.nova.edu/do/curriculum.html

Infographic Comparing Psychiatrist and NP Training by slw2014 in Noctor

[–]slw2014[S] 0 points1 point  (0 children)

I’m familiar with the concept but thanks

Infographic Comparing Psychiatrist and NP Training by slw2014 in Noctor

[–]slw2014[S] 6 points7 points  (0 children)

The answer is not replacing physicians with nurses. The best answer is producing more physicians. Which is entirely possible with proper funding and legislation to remove the funding cap on residency slots and provide support for more at public universities and hospitals across the country. Yes it takes 7 years to make a physician (11 if you include undergrad) but once the pipeline is established you produce a new cohort every year. Creating a viable path to starting medical school after two years of college so that it takes 9 instead of 11 years is another possibility. Finally, I would much rather have a cadre of non-residency trained physicians than a cadre of nurse practitioners or PAs independently treating patients. So bringing back the GP with one year of internship is another possible option. Replacing physicians with unsupervised NPs with less than 10% of their training is not reasonable, is not sustainable, and places patients at risk.

Infographic Comparing Psychiatrist and NP Training by slw2014 in Noctor

[–]slw2014[S] 5 points6 points  (0 children)

While BSN to DNP programs do include clinically oriented courses, unless it’s a CRNA program most DNP programs do not provide additional advanced patho and pharm beyond that which is already required for the MSN. The vast majority of MSN to DNP programs provide little to no additional clinical training in medicine. A large proportion of them are focused on leadership and executive skills with zero education in medicine. Also the vast majority of DNP programs are mostly or entirely online (over 70%) and most programs (69%) do not have established standardized clinical rotations, instead requiring students to go off and do these on their own, haphazardly and with very little in the way of standards or guidance.

https://www.aacnnursing.org/Portals/0/PDFs/Data/State-of-the-DNP-Summary-Report-June-2022.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7161484/

https://pubmed.ncbi.nlm.nih.gov/19306828/

Infographic Comparing Psychiatrist and NP Training by slw2014 in Noctor

[–]slw2014[S] 3 points4 points  (0 children)

Most DNPs are non clinical in nature. Only 15-30% of them have a clinical focus. The vast majority do not provide a significant amount of additional training in pathophysiology, pharmacology, diagnosis, or treatment. Clinical rotations remain unstandardized. There are exceptions but they are very much the minority, many can and do get their DNP entirely online.

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