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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

  • CM CM 
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    Joined: 01/14/2017
    Also I question whether these APRNs (or MD / DO students / residents) should be doing rotations exclusively in non-academic / referral-center type places.

    Click to expand…

    They should not.

    We have some local DO students doing rotations at my rural hospital, but they are just inserted into the preceptor’s regular clinic day. The preceptor does not have time set aside for teaching and the students don’t have any real responsibilities. They are passive observers for the most part. It’s a terrible education and I’m sure that internship will come as quite a shock.

    Students ought to have direct patient care responsibilities that are well defined, and they should be taught by experienced clinicians who are well versed in the latest literature, and those clinicians should have devoted teaching time set aside as part of their regular job. In other words, they ought to have rigorous training in a university setting.

    It’s difficult enough to become expert even with rigorous training. Off-the-cuff, make-it-up-as-you-go training is nuts.

    Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried bags for Cyd Charisse (gracious). Hosted epic company parties after Friday night rehearsals.

    #234452 Reply
    CordMcNally CordMcNally 
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    You’d be hard pressed to find someone that would assume a NP would have the training that an MD does…. I don’t think anyone is arguing that they could give as comprehensive care as a physician.

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    They argue that themselves. Take a peek at this AANP position statement on quality of nurse practitioner practice: AANP

    I’ll quote some of the highlights: “they bring a unique perspective to health services in that they emphasize both care and cure”. Kind of a passive aggressive statement against physicians.

    “The body of literature supports the position that NPs provide care that is safe, effective, patient-centered, timely, efficient, equitable and evidenced based. Furthermore, NP care is comparable in quality to that of their physician colleagues. Patients under the care of NPs have higher patient satisfaction, fewer unnecessary hospital readmissions, fewer potentially preventable hospitalizations and fewer unnecessary emergency room visits than patients under the care of physicians.” So, not only are they saying they are, at worse, equal in care to their physician counterparts, they are saying they are better. The American Academy of Emergency Medicine came out with a statement saying they do not support independent practice of NPs. We need more physicians fighting back against these outlandish “opinions”. Not being a preceptor to these students (and voicing disapproval of their education system) is a great start.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    Avatar jm129 
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    Status: Physician
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    certainly CordMcNally.

    however, I will say that perhaps AANP will have better PR skills and larger influence than AAEM unfortunately.

    Their education system is highly concerning and will not advance medicine in the right direction.

     

    #234459 Reply
    Liked by RocDoc, wonka31
    SLC OB SLC OB 
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    NP care is comparable in quality to that of their physician colleagues.

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    That is ridiculous!

    I have supervised a NP since Nov 2017, when my clinic got brought on as a department of the hospital (private practice prior to that and my partners supervised her). She was so offended that the hospital “made” her send charts to me for review. “She is a NP, not a PA, and could hang her own shingle if she wanted!”

    Not quite 2 years later, she sends me a ton of charts because I review them, make recommendations, and discuss/educate her. She has been in practice longer than me but she realizes that I can still add value from the training I learned. I am thankful she changed her mind on this… as it would have been a rough time if she continued to resist.

     

    #234460 Reply
    Liked by RocDoc, Kamban, wonka31
    Avatar MrsIMDoc 
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    Status: Physician
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    Joined: 01/09/2016

    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.

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    If by community health center you mean a FQHC, those often have a HIGH FAST pace because they need to keep the volume up.  Giving vaccines?  These rotations are where they are supposed to learn independent practice. A nurse shoudl already know how to give vaccines.

    #234463 Reply
    Liked by mkintx, Lordosis
    Avatar MrsIMDoc 
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    For physicians reading this concerned with the push for unsupervised practice of medicine by poorly trained NPs, please join us here https://www.physiciansforpatientprotection.org/

    #234465 Reply
    Avatar Tim 
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    Status: Accountant
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    One “HUGE” difference that is glossed over is the value of a residency. MA’s and NP’s don’t spend years learning their craft.
    Sorry. The MCAT, Step, and National Boards have a standard book knowledge, clinic, training programs.

    6 weeks preceptorship (non standardized) doesn’t compute. It’s the first step in a long road. Residency is one small line on a chart claiming relatively equal skills.
    Trial and error is not the way to go.

    #234468 Reply
    Liked by wonka31
    Avatar jhamaican 
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    Status: Physician
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    Joined: 07/19/2019

    You’d be hard pressed to find someone that would assume a NP would have the training that an MD does…. I don’t think anyone is arguing that they could give as comprehensive care as a physician.

    Click to expand…

    They argue that themselves. Take a peek at this AANP position statement on quality of nurse practitioner practice: AANP

    I’ll quote some of the highlights: “they bring a unique perspective to health services in that they emphasize both care and cure”. Kind of a passive aggressive statement against physicians.

    “The body of literature supports the position that NPs provide care that is safe, effective, patient-centered, timely, efficient, equitable and evidenced based. Furthermore, NP care is comparable in quality to that of their physician colleagues. Patients under the care of NPs have higher patient satisfaction, fewer unnecessary hospital readmissions, fewer potentially preventable hospitalizations and fewer unnecessary emergency room visits than patients under the care of physicians.” So, not only are they saying they are, at worse, equal in care to their physician counterparts, they are saying they are better. The American Academy of Emergency Medicine came out with a statement saying they do not support independent practice of NPs. We need more physicians fighting back against these outlandish “opinions”. Not being a preceptor to these students (and voicing disapproval of their education system) is a great start.

    The official AANP position is that NP care is equivalent to if not superior to physician care?

     

    That whole paragraph is essentially a shrouded attack on physicians

     

    This is likely not true.

    And even if it is true, is only because we give the easiest bread/butter cases to the NP.

    How ridiculous.

    #234495 Reply
    Liked by snowcanyon
    ENT Doc ENT Doc 
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    Status: Physician
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    Joined: 01/14/2017

    You’d be hard pressed to find someone that would assume a NP would have the training that an MD does…. I don’t think anyone is arguing that they could give as comprehensive care as a physician.

    Click to expand…

    They argue that themselves. Take a peek at this AANP position statement on quality of nurse practitioner practice: AANP

    I’ll quote some of the highlights: “they bring a unique perspective to health services in that they emphasize both care and cure”. Kind of a passive aggressive statement against physicians.

    “The body of literature supports the position that NPs provide care that is safe, effective, patient-centered, timely, efficient, equitable and evidenced based. Furthermore, NP care is comparable in quality to that of their physician colleagues. Patients under the care of NPs have higher patient satisfaction, fewer unnecessary hospital readmissions, fewer potentially preventable hospitalizations and fewer unnecessary emergency room visits than patients under the care of physicians.” So, not only are they saying they are, at worse, equal in care to their physician counterparts, they are saying they are better. The American Academy of Emergency Medicine came out with a statement saying they do not support independent practice of NPs. We need more physicians fighting back against these outlandish “opinions”. Not being a preceptor to these students (and voicing disapproval of their education system) is a great start.

    The official AANP position is that NP care is equivalent to if not superior to physician care?

     

    That whole paragraph is essentially a shrouded attack on physicians

     

    This is likely not true.

    And even if it is true, is only because we give the easiest bread/butter cases to the NP.

    How ridiculous.

    Click to expand…

    What they do is this.  They find some algorithmic type care – something simple.  They get a few NPs to run the study and a sympathetic MD to join the study so there aren’t just a bunch of CNPs on the study.  Then they show no difference (on what is probably an underpowered study) and churn this stuff out in whatever nursing journal will accept it.  Then they amass the studies and imply care is broadly the same.  Moronic politicians who don’t know statistics and who can’t see through these parlor tricks lap it up (and their donations)… and freedom to practice independently ye shall have.

    CordMcNally CordMcNally 
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    Joined: 01/03/2017

    Unfortunately, NP groups and societies have been spouting this non-sense for years. All it takes for the lay public to believe something is for an official society to tell them something. The public isn’t going to comb through the research and see that these “studies” are garbage. I’m actually surprised any physician would help any NP student at this point. They’ve been on a full scale attack against the physician profession for years and we’ve mostly just been taking it.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    Lordosis Lordosis 
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    Status: Physician
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    Joined: 02/11/2019

    Sounds like someone should start a movement…

    It would not go over well with the general public.  Physicians are difficult to herd towards a cause. Nurses lobby way stronger. Physicians have already given up the reins to admin who mostly have nursing background.

    maybe not…

     

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

    #234519 Reply
    MPMD MPMD 
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    Status: Physician
    Posts: 2608
    Joined: 05/01/2017

    You’d be hard pressed to find someone that would assume a NP would have the training that an MD does…. I don’t think anyone is arguing that they could give as comprehensive care as a physician.

    Click to expand…

    They argue that themselves. Take a peek at this AANP position statement on quality of nurse practitioner practice: AANP

    I’ll quote some of the highlights: “they bring a unique perspective to health services in that they emphasize both care and cure”. Kind of a passive aggressive statement against physicians.

    “The body of literature supports the position that NPs provide care that is safe, effective, patient-centered, timely, efficient, equitable and evidenced based. Furthermore, NP care is comparable in quality to that of their physician colleagues. Patients under the care of NPs have higher patient satisfaction, fewer unnecessary hospital readmissions, fewer potentially preventable hospitalizations and fewer unnecessary emergency room visits than patients under the care of physicians.” So, not only are they saying they are, at worse, equal in care to their physician counterparts, they are saying they are better. The American Academy of Emergency Medicine came out with a statement saying they do not support independent practice of NPs. We need more physicians fighting back against these outlandish “opinions”. Not being a preceptor to these students (and voicing disapproval of their education system) is a great start.

    The official AANP position is that NP care is equivalent to if not superior to physician care?

     

    That whole paragraph is essentially a shrouded attack on physicians

     

    This is likely not true.

    And even if it is true, is only because we give the easiest bread/butter cases to the NP.

    How ridiculous.

    Click to expand…

    What they do is this.  They find some algorithmic type care – something simple.  They get a few NPs to run the study and a sympathetic MD to join the study so there aren’t just a bunch of CNPs on the study.  Then they show no difference (on what is probably an underpowered study) and churn this stuff out in whatever nursing journal will accept it.  Then they amass the studies and imply care is broadly the same.  Moronic politicians who don’t know statistics and who can’t see through these parlor tricks lap it up (and their donations)… and freedom to practice independently ye shall have.

    Click to expand…

    I don’t know the studies here but you’re right that it would be unbelievably difficult to actually study this. You’d need thousands and thousands of patients (power) over tons of time (good endpoints) and even then the confounders might be fatal. Something as simple as the sicker patients seeking MD care would throw a wrench into the whole thing.

    You are correct, to do this well this would be the life’s work of someone with an NIH grant not a case-control series in a nursing journal.

    #234520 Reply
    Avatar StateOfMyHead 
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    Status: Advanced Practice Provider
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    Sounds like someone should start a movement…

    It would not go over well with the general public.  Physicians are difficult to herd towards a cause. Nurses lobby way stronger. Physicians have already given up the reins to admin who mostly have nursing background.

    maybe not…

     

    Click to expand…

    You are correct and actually the lack of push back to admin, CMS etc has been and will continue to have the potential to be far more detrimental to patients and physicians than NP issues. Unfortunately the momentum for all the above has been established and to counteract it would require an organized, respectul, time consuming effort among respected physicians which is not likely to happen.

    #234543 Reply
    Liked by Lordosis
    Avatar Dilaudidopenia 
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    Status: Physician
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    Joined: 05/22/2016

    You can’t do the study because it would be unethical to randomize patients to NP (and really any midlevel, PA too) care.

    I’m telling you.  I’ll get a midlevel presentation in the ED.  They will stop presenting after the physical exam, the way an MS1 first learning how to do an H&P would:

    “OK. So what’s your differential?”

    “Maybe like a virus or pneumonia?”

    “What about x,y,z?” –> This is followed by a blank stare, as one or more of x,y, or z they haven’t even heard of.

    “Ok so what do you want to do?”

    “I dunno. Labs I guess.”

    “…..ok, I’ll go see the patient.”

    ENT Doc ENT Doc 
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    You can’t do the study because it would be unethical to randomize patients to NP (and really any midlevel, PA too) care.

    Click to expand…

    According to their national body it would be 100% ethical since, at worst, they provide equivalent care AND have better patient satisfaction.

    #234592 Reply
    Liked by Vagabond MD

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

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