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

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

  • Avatar StateOfMyHead 
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    Terrible situation with plenty of blame to go around.

    This problem seems pervasive in NP education and frankly the fact that whoever accredits NP schools hasn’t strongly addressed it does untold damage to their quest for legitimacy.

    I have been involved in many iterations of this problem. As I said at one point I offered to literally set up a site and be the site coordinator for a well-regarded NP school if they could buy some of my time from the uni. I would have done it for 4-5% of my salary. No interest whatsoever. Not only did they not have resources to help students find sites they didn’t have any funds to develop an established training site.

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    What a shame they didn’t take advantage of your offer. It is more likely they didn’t want to spend the funds as opposed to not having the resources.

    #234186 Reply
    Liked by Roentgen
    MPMD MPMD 
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    Terrible situation with plenty of blame to go around.

    This problem seems pervasive in NP education and frankly the fact that whoever accredits NP schools hasn’t strongly addressed it does untold damage to their quest for legitimacy.

    I have been involved in many iterations of this problem. As I said at one point I offered to literally set up a site and be the site coordinator for a well-regarded NP school if they could buy some of my time from the uni. I would have done it for 4-5% of my salary. No interest whatsoever. Not only did they not have resources to help students find sites they didn’t have any funds to develop an established training site.

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    What a shame they didn’t take advantage of your offer. It is more likely they didn’t want to spend the funds as opposed to not having the resources.

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    I was genuinely surprised. It was a great site with lots of acuity, really nice attendings, zero hours of resident coverage/year. The students used to rotate there with me and they got to do all kinds of stuff. I let one student going into FM intubate and put in b/l chest tubes. I mean that would have been an amazing case for a PGY3 EM resident or a mid-level surgery resident and it was going to a student. I probably had 30 students over the years get their first ED tube or line.

    NP who rotated with me that gave me the idea of trying to develop the site got to intubate, put in an IJ, do an LP, endless suturing etc. It really would have been incredible.

    Oh you won’t do this for free? No thank you not interested.

    #234189 Reply
    White.Beard.Doc White.Beard.Doc 
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    Human beings are quite resilient, and the body often heals itself from illness.

    NPs do not have the depth of knowledge or experience of physicians, at the same time some of them are quite good and some of them are quite awful.  But in the majority of straightforward cases, it frequently doesn’t make much of a difference if you are treated by an MD or an NP.  In a minority of cases, having a quality, experienced, knowledgable physician makes all the difference in the world.

    Avatar G 
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    WBD, I was going to say the same thing, and will add that we have a robust safety net for managing complications: the tertiary emergency department and its quiver of specialists.

    I find that even MD schools rely on the assumed charity of volunteer preceptors. It is ludicrous.

    NP2B should have reasonable expectation that when she pays a tuition check, her school should provide education.

    I suspect doctors will once again lose in the court of public opinion (rich, arrogant bastards who through lack of precepting are putting children at risk), but at some point, you have to lie in the bed you made: Online school to learn medicine…what could possibly go wrong?

    Avatar Dilaudidopenia 
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    Similar thing happened to me.

    I learned about hip replacements online.  Read the textbook chapter and everything.  But then no orthopedic surgeon would precept me!  What gives?!?!?!!?

    There’s this prevailing attitude that Primary Care is somehow less important, easier, of lower value, or doesn’t require expertise.  As anecdotally observed from all the nonsense “referrals” I get in the ED from midlevels in this setting (outpatient office, UC, ECF), this is certainly not the case.

    In the past 2 weeks:

    -Laceration sent from UC.  “Too complicated for us to fix.”  Was a starter lac that I would have an MS3 repair.

    -Sent to ED for INR check for resolved epistaxis

    -Sent to ED from ECF for sub-acute humerus fx in a hospice patient

    They add no value, probably increase costs with all their testing and “referrals,” and are outright dangerous.

    Lordosis Lordosis 
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    Come on now who will provide antibiotics to all those URIs?

    “Never let your sense of morals prevent you from doing what is right.”

    #234241 Reply
    Liked by MaxPower, ENT Doc
    Avatar StarTrekDoc 
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    I do think it’s the way rnp schools dont recruit protoring directly is a large reason for the lack of enthusiasm from docs. If it were a concern of competition then we wouldn’t be having med students either.

    In pvt practice it’s really hard to expect this kind to protoring that so informal. If one would even consider it, it would be directly with university over such randomness of rnp way…..unless the practice itself was.looking for APP and this a way to trial run student for future hire.

    Personally, RNP schools will need to step up on this if they see to reach their lofty goals of independent practices and formal training programs that’s not reliant on individual placements

    #234243 Reply
    Liked by Vagabond MD
    ENT Doc ENT Doc 
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    This does speak to the quality of the school. Also, the mom’s perspective is that of a mother and not a nurse. As a nurse she should know this all stinks to high heaven. As a mom she doesn’t want to see her daughter suffer. Choices have consequences.

    Avatar trebizond 
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    Agree with White Beard, many of our medical interventions and probably a good number of surgical interventions are of very marginal benefit. The mechanism makes scientific sense but because of internal compensatory mechanisms, redundancy, and potentially adverse effects, etc. the intervention or lack thereof doesn’t do as much as we think it will.

    One of my hospitalist attendings in residency related that she was shocked when she called many of her post-discharge patients and they were not taking dual antiplatelet therapy after a stent weeks before, never picked up their antibiotic for their COPD exacerbation, lasix for heart failure, etc. She estimated that a good ~25-30% of patients weren’t taking their “new” discharge meds, and most seemed to be doing pretty well.

    I’ve worked with a few great NPs and some not so good NPs. The difference was years of experience and dedication to the patient and their diseases, integrity, willingness to take the time to read the literature and learn, and fair play. I remember in residency the cardiology NPs and PAs were awful, switching up patient panels on a daily basis to give the interns disasters/discharge nightmares and themselves easy patients, refusing admissions after 1 PM (although they were technically working until 4) and dumping everything after 1 onto the intern, etc. The NPs and PAs on pulm transplant were the complete opposite, dedicated, staying after the usual work hours, actually knew lots about transplant rejection and opportunistic infection and O2 delivery, chipping in to help the resident with the admissions, knew the patients really well. A completely different culture and outcome.

    For NPs, since so much of their training is not formalized, they really do need to have a strict criteria of *years* of experience as a nurse in a particular clinical context before training as an NP to work in that context. It’s unbelievable to me that a physician would need to complete one or more additional residencies or fellowships to switch from ED to peds or GI oncology to CT surgery, yet an NP can do this with hardly any retraining at all. This newly minted RN -> NP nonsense is just that, a terribly undertrained half-clinician who will be lost and lack the crucial insight that other mid levels (and generalists) need, which is how not to pull the trigger too soon or too late on testing, escalation of the level of care, or subspecialist referral.

    Avatar redsand 
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    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. 😉

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    Another reason could be that NP schools have evaluation forms that ask the evaluator to attest to the student’s skills in terms of the NP school’s rating scale and whatever learning objectives the school has, which the preceptor may not have been provided a copy of. And I suppose in a pediatric rotation, such objectives would include knowing the difference between typical and abnormal development, knowledge of how to use screening tools (such as developmental screens and others like mood disorders screening), creating differential diagnoses (of course not specific to pediatrics), physical exam skills and abilities, some use of critical thinking, and loads of other evaluation metrics from being able to look things up to respecting families and being culturally sensitive. Which physicians in private practice may have no baseline for evaluating NPs if they haven’t done it before, haven’t received any training in how to evaluate an NP student from the student’s school…why take on the task? Physicians have attended medical school so they at least have a frame of reference (themselves and colleagues) for what a 3rd year/4th year student should know and not know, and they also have an idea of what residents in their field should be capable of doing as well as what is needed to be a successful attending in the field.

    I haven’t ever been asked to precept an NP student, but I have worked with many medical students over the years (both in residency and as an attending). Because medical students are more of a known quantity in terms of standardized curricula and you know which medical school is sending them (even if they are doing an away rotation, they had to apply to the home medical school and the rotation standards are of the home medical school), I would think it’s easier to precept a medical student with respect to knowing what the expectations are and evaluations.

    #234257 Reply
    Liked by hatton1
    Avatar Kamban 
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    Mom told me that NP2B is not permitted to pay a doctor for the experience.

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    I am not sure if this is really the case or that she does not want to spend the extra $3500 on top of the tuition fee. Well if the NP2B wants to get the diploma she has to pony up the fee or else she won’t become a NP. I don’t see how an online course from a remote college can ask the students to preceptorship on their own yet forbid them to pay for it.

    One of the nearby brick and mortar university has a NP program that has NP educators take them around in the hospital and try to educate them and give clinical experience. I think they have some sort of financial arrangement with the hospital. The physicians don’t teach them or have them shadow them as far as I know. Many NP’s end up in the field where they were RN before – Cardiology becomes cardiology NP, Oncology becomes Oncology NP and so on. They use the past experience to get them going in that field but they almost locked in, and are like fish out of water if they try some other specialty or primary care.

     

    #234260 Reply
    Liked by hatton1, ENT Doc
    Avatar jhamaican 
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    Must fight back against these NP

     

    I can tell within the first 5-10 seconds on a phone when the NP is calling a consult.

     

    The educational gap is that big.

    They often cannot answer basic questions about the patient other than stammering something about the attending told them to call.

     

    They also run around unsupervised in the hospital making twice as much as me while I still have to staff with an attending (current fellow).

     

    Most NP think they are very competent because they handle run of the mill cases easily after seeing a few hundred. But anything out of the ordinary and they flounder.

    They want the same autonomy and pay but without the responsibility if something goes wrong or a difficult case comes up.

    it is scary because most NP have no idea how much they do not know.

     

    yes I am getting bent over, but I have no choice at this point in time.

    Don’t blame the pediatricians who are unwilling to take on extra work only to train their potential (6 week online trained) replacements.

     

    Rant over.

    Vagabond MD Vagabond MD 
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    I had a chance meeting last night with an NP colleague, and I told her about this situation. She suggested a community health center, as that is where she had some of her clinical training.

    The pace is slower, and once they got her up to speed, they were allowing her to see patients with supervision, give vaccines, etc.

    #234278 Reply
    Liked by SLC OB
    Avatar Tim 
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    Saw one interesting approach on the internet (nursing related). Some potential employers will offer the preceptorship as part of a recruiting process. The interest is in recruiting that makes the training time be of value. Combine that with efforts towards underserved/rural areas and she can get the 6 weeks completed. Sometimes the desired location gives way, 6 weeks is all it takes I guess. She might need to change her target .

    #234289 Reply
    jfoxcpacfp jfoxcpacfp 
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    This thread is stunning and eye-opening. Glad I read it. In the beginning, I was rooting for the “poor student”. Soon after I got into it, I had a totally different perspective. Fascinating and sometimes scary what goes on in medicine that the non-medical public is not privy to.

    Johanna Fox Turner, CPA, CFP: I am not your financial advisor; any responses are for general purposes only
    http://www.fox-cpas.com/for-doctors-only ~ [email protected]

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