4 ms·

I for one am glad we don't just let foreign doctors transfer their credentials - the education and standards are not always the same, and not really sure I want

by ejb999 3y ago

I for one am glad we don't just let foreign doctors transfer their credentials - the education and standards are not always the same, and not really sure I want to go see a doctor that moved here after taking a accelerated/minimal set of courses at whatever country happens to have the easiest/cheapest graduation requirements. Certainly there are some countries that probably have similar course of study and requirements as the USA, but I think you would need to approve transfer's very carefully after serious review of the sending countries education and training requirements. NP vs MD education is not even close to being similar - that is why their is no easy path from one to the other - a typical NP will graduate having done ~600 to 700 hours of patient care hours. A typical MD will have had 12,000 to 16,000 hours of patient care experience before they start practicing - there are plenty of things were seeing an NP is more than enough - but you can't just give a few months of extra training to bump an NP to an MD - their education and knowledge is not even close to comparable. There is a place for both in our health care system - but they are not the same job.

ilc 3y ago
Personally, I'll take the 60 year old NP over the 30 year old doctor 95%+ of the time. The NP has seen more and been around the block. The doctor still is a baby in medicine.
- FireBeyond 3y ago
  The problem is the Zero-to-NP programs that have an "Accelerated RN" component. One (not all) aspects of the NP program was similar to your comment, building off career and professional experience, and using that as one basis for knowledge. These programs are not even giving you the RN -student- nursing experience (let alone post graduation), they're skipping that entirely. Looking online: "Become an NP in 20 months". "NP in 27 months". From HIGH SCHOOL. In EMS, there is a push to make paramedicine at least an associates, if not a bachelors degree (there are programs with all three, certificate, associate, bachelors). Paramedics are the advanced version of when you call 911. The invasive side (versus EMT which is - largely - non-invasive). Cardiac arrest and dysrhythmia management (ECG interpretation, manual defib and pacing, approximately a dozen cardiac drugs), airway management and intubation (including sedatives, paralytics and analgesia), childbirth, trauma, burns. In my area we can give approximately 60 different meds IM, IV, IN, IO from fairly benign to quite acute (adenosine, atropine, etomidate, rocuronium, etc.) The push for this is for at least two years of school, if not four. But yet you have schools pumping out NPs in as little as a year and eight months? With zero field supervision (for better or worse, and with varying degrees of intensity, PAs ostensibly operate under physician supervision/direction). This is going to cause a huge problem, I expect. Not the concept as a whole, but our YOLO attitude to these things, and schools seeing dollar signs.
  - ilc 3y ago
    You will get no disagreement here. I specifically pointed at older NPs for a reason. Heck even old RNs will know what they are doing. For us programmers it is a bit like why you don't let the new kid push straight to prod. But an older engineer may have a key to do it. ;) There is some wisdom that comes with the grey hair.
- devilbunny 3y ago
  Do what you like, it's your life, but as a physician I've been stunned on occasion by some of the misunderstandings of very experienced nurses. They don't have a medical education. They have a nursing education. They are different things. A good doctor relies on experienced nurses for what they are good at - which is recognizing someone who's in trouble, because they have spent a lot more hours at the bedside than we have and have superb spidey senses. If a nurse asks me to look at a patient, I will. If it's an experienced nurse, I'll come running.
  - ilc 3y ago
    A good doctor. That is a huge proviso alas. I wish it wasn't.
    - devilbunny 3y ago
      "Good" from our perspective is not always the same as "good" from a patient perspective. Some of the best doctors I know have the bedside manner of a chunk of midsummer roadkill. And some of the worst could charm anyone.
      - IG_Semmelweiss 3y ago
        and nurses could tell you exactly who's who. The best friend to have is an OR nurse. She knows which doctor is on cocaine, who cannot stop shaking when handling the scalpel, who cannot bother with a prep checklist before a surgery. If you are doing surgery for a loved one, consult an OR nurse. They will tell you what's up. Best of all, nurses all talk to each other, so chances are someone in their group will know that Dr. Charming over at hospital X is nicknamed The Undertaker by in-the-know staff...
        devilbunny 3y ago
        Definitely true.
      - ilc 3y ago
        I've seen that and honestly, as long as they do the job well, I let it ride. I've also seen doctors where their social skills honestly impaired them from getting through to people and thus getting the needed outcomes. Also... Your "roadkill" doc may do well with me. Smooth talkers always seem to come up short for me.
IG_Semmelweiss 3y ago
I don't disagree, but its a good thing that we can buy Ferraris and Kias and let everyone decide what's best for them. I think foreign doctors could fill a niche there too. I don't know why we have people going bankrupt due to medical bills when we have foreign doctors that could drive prices down significantly so that the poorest or underinsured could benefit.

by ejb999 3y ago

ilc 3y ago

Personally, I'll take the 60 year old NP over the 30 year old doctor 95%+ of the time. The NP has seen more and been around the block. The doctor still is a baby in medicine.

FireBeyond 3y ago
The problem is the Zero-to-NP programs that have an "Accelerated RN" component. One (not all) aspects of the NP program was similar to your comment, building off career and professional experience, and using that as one basis for knowledge. These programs are not even giving you the RN -student- nursing experience (let alone post graduation), they're skipping that entirely. Looking online: "Become an NP in 20 months". "NP in 27 months". From HIGH SCHOOL. In EMS, there is a push to make paramedicine at least an associates, if not a bachelors degree (there are programs with all three, certificate, associate, bachelors). Paramedics are the advanced version of when you call 911. The invasive side (versus EMT which is - largely - non-invasive). Cardiac arrest and dysrhythmia management (ECG interpretation, manual defib and pacing, approximately a dozen cardiac drugs), airway management and intubation (including sedatives, paralytics and analgesia), childbirth, trauma, burns. In my area we can give approximately 60 different meds IM, IV, IN, IO from fairly benign to quite acute (adenosine, atropine, etomidate, rocuronium, etc.) The push for this is for at least two years of school, if not four. But yet you have schools pumping out NPs in as little as a year and eight months? With zero field supervision (for better or worse, and with varying degrees of intensity, PAs ostensibly operate under physician supervision/direction). This is going to cause a huge problem, I expect. Not the concept as a whole, but our YOLO attitude to these things, and schools seeing dollar signs.
- ilc 3y ago
  You will get no disagreement here. I specifically pointed at older NPs for a reason. Heck even old RNs will know what they are doing. For us programmers it is a bit like why you don't let the new kid push straight to prod. But an older engineer may have a key to do it. ;) There is some wisdom that comes with the grey hair.
devilbunny 3y ago
Do what you like, it's your life, but as a physician I've been stunned on occasion by some of the misunderstandings of very experienced nurses. They don't have a medical education. They have a nursing education. They are different things. A good doctor relies on experienced nurses for what they are good at - which is recognizing someone who's in trouble, because they have spent a lot more hours at the bedside than we have and have superb spidey senses. If a nurse asks me to look at a patient, I will. If it's an experienced nurse, I'll come running.
- ilc 3y ago
  A good doctor. That is a huge proviso alas. I wish it wasn't.
  - devilbunny 3y ago
    "Good" from our perspective is not always the same as "good" from a patient perspective. Some of the best doctors I know have the bedside manner of a chunk of midsummer roadkill. And some of the worst could charm anyone.
    - IG_Semmelweiss 3y ago
      and nurses could tell you exactly who's who. The best friend to have is an OR nurse. She knows which doctor is on cocaine, who cannot stop shaking when handling the scalpel, who cannot bother with a prep checklist before a surgery. If you are doing surgery for a loved one, consult an OR nurse. They will tell you what's up. Best of all, nurses all talk to each other, so chances are someone in their group will know that Dr. Charming over at hospital X is nicknamed The Undertaker by in-the-know staff...
      - devilbunny 3y ago
        Definitely true.
    - ilc 3y ago
      I've seen that and honestly, as long as they do the job well, I let it ride. I've also seen doctors where their social skills honestly impaired them from getting through to people and thus getting the needed outcomes. Also... Your "roadkill" doc may do well with me. Smooth talkers always seem to come up short for me.

IG_Semmelweiss 3y ago

I don't disagree, but its a good thing that we can buy Ferraris and Kias and let everyone decide what's best for them. I think foreign doctors could fill a niche there too. I don't know why we have people going bankrupt due to medical bills when we have foreign doctors that could drive prices down significantly so that the poorest or underinsured could benefit.