NP student cannot find pediatrician to agree to have her for 6 week preceptorship

[VagabondMD]

A family friend has this problem:

The daughter, a nurse (heretofore referred to as NP2B) in her late 20's living and working in the Middle Atlantic and taking an online NP course via the State U in the Midwest where we live, would like to come back to the Midwest and complete a 6 week internship in outpatient pediatrics that is required by her program. NP2B's mother (our friend) is not a physician but lives in a neighborhood with lots of physicians (we live in same neighborhood) and is friends with lots of physicians, including a few of pediatricians. She has asked (by her report) 20 docs if they could take NP2B on as her preceptor or if they knew anyone who could and after a month or so of searching, they have come up with nothing. When the mother texted me earlier this week, she had already asked the first three names that I could think of and was denied by all three.

So I ask, why is this happening? Why can't this well-connected young woman get into a pediatrician's office for a six week preceptorship? (I have a handful of potential theories and explanations, but I will respond later.)

We had a chance meeting at a farmer's market this morning, and I asked how it was going on this issue. (Bad idea.) She was clearly exasperated and the friend that she was with, a retired nurse married to a successful academic physician, thought is was shameful that pediatricians would not welcome NP2B with open arms. I suggested that she/they offer to pay for the experience, and I threw out $2500 (WAG) for six weeks. She said that she would gladly pay to have NP2B progress forward and would try this approach.

Any other suggestions?

 

[CordMcNally]

My first thought when reading this (although it'll come across poorly): good.

[Kamban]

If it is shadowing alone then $3500 should be sufficient. But if more active teaching is required then the amount might not be worth it.

I am curious to hear the side of your 3 pediatrician friends who rejected her. Maybe an online course did not impress them.

[jacoavlu]

NP2B should be asking for herself. Not mom.

[StateOfMyHead]

Unfortunately NP2Bs are a dime a dozen and the time investment it can take to bring them up to speed is considerable. Since she is young and obviously doesn't have any professional contacts established who are willing to provide training it is also likely she has minimal if any RN experience. The years of RN experience were originally the cornerstone supporting the brief NP educational tract and has been bastardized as the universities strive to drive up revenue. Most even previously reputable brick and mortar universities are encouraging undergraduates to stay enrolled through their doctorate without taking any time to work as a RN thereby reducing the chance they won't return with the aforementioned tuition money. I know this sounds harsh but it is something she should have arranged in advance or considered in her university selection as there are schools who provide preceptor experiences.

[DCdoc]

I’m sure she’s a very nice person, but pediatrics has the lowest salary of any physician field and is constantly being encroached upon by NPs who feel they can do an equally good job without medical school or residency. I’m not qualified to judge whether or not this is accurate (NPs are online degrees???), but it does not surprise me no pediatrician is jumping to train someone who could replace them. I don’t have the article on-hand but a few months ago I read how a national company bought out a pediatrician group and fired the majority of them, replacing the with NPs.

[Dusn]

I'll just state the obvious issue here:   most doctors don't think an online course and 6 weeks of shadowing is adequate to practice medicine.

[VagabondMD]

Here are the reasons that I tried to explain to our friend:

1. The private practice pediatrician offices are probably inundated with these requests and probably have a stated policy against having these externs. I know that I would if I were in their shoes.

2. The pediatricians probably view these PNPs as a threat are not looking to make it easier for them to threaten their livelihood.

3. The pediatricians are busy and do not have time (or interest) in teaching while the work. I know at the office where my kids go, they are hustling non-stop.

4. Yes, NP2B is young, has worked in a children's hospital and in very narrow roles (NICU and infusion) where she would have no interaction with a primary care pediatrician - no network.

5. Yes, NP2B should be making the calls herself. In fairness to her, I believe that Mom got involved when she had already struck out on her own.

6. Perhaps by now, many pediatricians have had externs and found it to be a negative experience for themselves, the office or their patients.

Some updates, I have done some research online, and this is a pervasive problem. Most are blaming the NP schools for not providing the clinical rotations that are required to graduate (but are still collecting the tuition). Some even argue that it would be unconscionable for MD, DO, or PA programs to not have appropriate clinical training built into the curriculum, but I have recently learned of some for-profit DO programs that operate similarly.

Mom told me that NP2B is not permitted to pay a doctor for the experience.

There is at least one service where you can pay to be matched to a clinical preceptorship (https://www.nursepractitionerclinicalrotations.com/pricing/), and the price is $12.50/hour, which amounts to $3000 for my friend's daughter. I imagine that this training is top notch, too.

[Peds]

Why should these pediatricians be shamed exactly?

[CM]

Vagabond MD wrote:

3. The pediatricians are busy and do not have time (or interest) in teaching while the work. I know at the office where my kids go, they are hustling non-stop.

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Exactly. I'm sprinting to keep up all day. I don't know if you could pay me enough to take on the extra responsibility of training someone. Where would I find the time and energy? I might consider it for $300,000, but definitely not for $3,000. (I'm not a pediatrician, but I think this applies to any busy clinician.)

Vagabond MD wrote:

Most are blaming the NP schools for not providing the clinical rotations that are required to graduate (but are still collecting the tuition). Some even argue that it would be unconscionable for MD, DO, or PA programs to not have appropriate clinical training built into the curriculum, but I have recently learned of some for-profit DO programs that operate similarly.

Click to expand...

I'm inclined to agree that this is unconscionable. This strikes me as a scam.

[VagabondMD]

Peds wrote:

Why should these pediatricians be shamed exactly?

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Something about not helping young people in the health professions get proper training or get a leg up. Remember, this perspective comes from a retired nurse.

[EM-CCM MD]

I think this says a lot about NP training and the perception of NP training. They are making so manny NPs, the schools literally don’t even try to place them in clinicals...

[CordMcNally]

Vagabond MD wrote:

Something about not helping young people in the health professions get proper training or get a leg up. Remember, this perspective comes from a retired nurse.

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I would ask the retired nurse if she thought an online degree and non-standardized "preceptorships" are the ingredients for proper training in her opinion.

[Lordosis]

If the nurse practitioner schools do not set up their rotations what education are they actually providing? I have heard of a few DO schools and Caribbean schools that have similar issues. I don't believe it should fall to the Private Practice doctors to pick up the slack for free. It is quite costly to have a student in the office for weeks at a time.
I feel that teaching is part of our obligation and I work with a medical school to have a rural rotation 5 months out of the year. half a time is spent doing other things but I still am the students home base and provide intermittent precepting. But for the eight weeks that they are with me directly I definitely feel my time being pressured and crunched and it is hard to accomplish as much work as I normally would. which usually ends up requiring me to work more over lunch and staying later than I'd like to. Not to mention having less time to hang out on the WCI forum :-P I don't receive any compensation for this however I feel that I imposed on physicians in my past and I like to pay it back.

[SerrateAndDominate]

I’m hoping my medical school paid some money to the family doc I shadowed.

Obviously a bad situation for this kid, but she should have checked into that before taking the online/easier route. Her school is failing her.

And if letting students shadow is about paying it forward, why can’t the students shadow established NPs?