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Not just residency. Fix the cost (and capacity) of the education system as a whole, especially for mid-levels. There’s no reason this country should have such a
by jmye 1y ago
Not just residency. Fix the cost (and capacity) of the education system as a whole, especially for mid-levels. There’s no reason this country should have such a chronic NP shortage, and you don’t need MD/DOs for most of the healthcare gaps we have.
You also make rural care viable when you don’t have folks who need to pay off astronomical loans.
- kgwgk 1y ago> you don’t need MD/DOs for most of the healthcare gaps we have Or maybe you do! It’s for your own good. https://www.ama-assn.org/practice-management/scope-practice/ama-successfully-fights-scope-practice-expansions-threaten https://www.ama-assn.org/practice-management/scope-practice/...
- mindslight 1y agoHow are NPs not just the trend of enshittification? Most doctors already aren't very engaged in the tiny 15 minute slices of appointments, and now we're supposed to be happy that they'll be even less educated? The most straightforward way to address the doctor shortage is to make it so doctors are spending most of their time on healthcare, rather than appeasing "insurance" company bureaucrats with onerous paperwork.
- jmye 1y agoWhat a weird comment. What do you think you need an MD for, in your primary care visit, that an NP can’t do? What do you actually know about their education? What do you actually know about licensing? How much time, in a day, do you think doctors are spending on “insurance”, and what specific experience leads you to believe that? (Because the actual answer is “near zero for literally any provider who isn’t completely independent, and almost none of them are, anymore”.) Or was this just a way to memetically add “enshittification” to a conversation it doesn’t even slightly apply to, but you think that’s currently trendy?
- FireBeyond 1y agoYou can be an NP in as few as 4-5 years out of high school with some courses. That’s to me the definition of not knowing what you don’t know. I’m a critical care paramedic who has corrected many NPs on fairly fundamental learning. I’ve found that nurses with significant field experience do very well, but there are plenty of courses who will “zero to hero” you fresh out of high school. Meanwhile, PAs go through a program near as rigorous as medical school and have to have physician supervision while NPs are not subject to oversight.
- tptacek 1y agoDoctors begin delivering clinical care in year 3 of med school. You're doing a sleight of hand with this "out of high school" thing; doctors are also educated "out of high school", the difference between the two roles is 1-2 years before clinical practice, and NPs tend to practice supervised for longer periods of time than doctors. And, obviously, NPs cover a smaller range of conditions than doctors.
- FireBeyond 1y agoNo, I’m really not. You can do an accelerated RN program in 12 months - though 18 months is more common. Many colleges offer RN to BSN courses. Some of them can be 12 months (and some less reputable places offer nine months). Add in a one year graduate nursing degree with some electives and in some states you are now eligible to practice as an ARNP or CRNP. I’ve personally met several NPs who are 24 years old and are practicing. The issue is that at that point you are ignorant or often cocky about your knowledge. Versus premed 4 year degree, med student practice in years 2 and 3 and continued hand holding through residency…? There’s just a little difference.
- tptacek 1y agoThere's accelerated pre-med too! My point is: it's all "out of high school". High school has nothing to do with any of this, but you mean to attach that term to NPs, as if they were in home ec last week. No, that's not at all how it works.
- tptacek 1y agoNurse-Practitioners work harder to get their certification than almost anybody who comments on HN and it is not OK to talk about them this way.
- mindslight 1y agoWhat an oddly personal reaction. Did you get bored of infosec or something? Being HN, we're talking about systems and cohorts, not individuals. I've had some great individual NPs that were more actively engaged than most doctors. PAs as well. And I've had plenty of crappy MDs just phoning it in. But none of that is really relevant to the system meeting higher demand by simply lowering its standards rather than actually being reformed.
- FireBeyond 1y agoThere are NP mills that will take you from high school, put you through an accelerated RN and prereqs and basically have you as an independent provider in just a few years out of high school (well, 4-5), that’s ridiculous.
- akavi 1y agoIs there any evidence that _8_ years of post-secondary education (plus 3-7 years of residency at poverty wages) actually improves medical outcomes? 5 years could be plenty?
- tptacek 1y agoNPs are supervised, as are doctors on rotation, so it's 7 years before clinical practice for a doctor.
- FireBeyond 1y agoPAs might love to hear about that, since they’ve been lobbying about supervision. Dozens (I gave up counting) of states have absolutely no supervision for NPs: https://www.aafp.org/family-physician/practice-and-career/managing-your-practice/team-based-care/legal-requirements.html https://www.aafp.org/family-physician/practice-and-career/ma... - they have full autonomy as providers.
- tptacek 1y agoGood! More should.
- evantbyrne 1y agoFinding good (and available) primary care providers has always felt like going to the casino in my experience. Currently seeing an older NP who has been great. I could see a future with many more NPs. Obviously, if you know a guy or need a specialist, then do what makes sense.