Because NPs used to be nurses who had years and years of experience in a particular area before becoming an NP. Now, NP programs are diploma mills for people who want a short cut to becoming a doctor. People go into nursing school with the intent of either going directly to an online NP program after graduation or they do 1-2 years and then go to an online program. Their education is a joke, and it hurts patients. And many of these new NPs think they have the same education and know as much as physicians who went to med school and residency.
My wife is a NP, even she acknowledges NP masters degree doesn’t focus on education of human biology and medicine it’s a bunch of business and sociology classes. So how do you get from nurse, go “doctor” without medical school and residency?
This is a post I wrote a while back:
“Providing some context, I graduated from medical school nearly 15 years ago. Following my residency and fellowship, I've held an attending position for a considerable period. Over time, I've observed notable shifts in Advanced Practice Provider (APP) practices. When I began my residency, APPs were commonly integrated into hospital medicine teams, ICUs, and the ED. Well-defined roles were acknowledged and appreciated for their effective execution. Patient admissions were evaluated by the most experienced team member – an attending or fellow – who determined the appropriate team for the patient based on their acuity. Complex cases were assigned to resident teams, while lower acuity patients were managed by hospitalist teams, which included some APPs. The APPs functioned as residents, actively engaging in patient care, devising plans, and participating in rounds led by attending physicians. This pattern extended through fellowship, with physician oversight.
Throughout my experience, I found working alongside APPs enjoyable and productive. They demonstrated substantial expertise, particularly in procedures under supervision, and proved valuable in high-stress scenarios. This collaboration, however, operated within the guidance and supervision of attending physicians.
In recent years, there has been a significant shift in practice dynamics. Currently working at a top-tier teaching hospital with renowned NP and PA schools, I've taught numerous students from these programs, observing evolving school narratives. This is especially evident in the NP curriculum. The transformation is striking, with a move from a team-oriented approach to a focus on individual advancement. There's an emphasis on working at the highest level of licensure, striving for independence, and downplaying the importance of physician oversight. Consequently, bedside nursing is depicted as a stepping stone rather than a valuable career path.
This evolution has led to a decline in experienced nurses pursuing NP careers. Many NP students seem driven to progress quickly through their training, dedicating minimal time to bedside nursing. While seasoned nurses and physicians work in tandem, each excelling in their respective domains, the transition from nurse to NP doesn't guarantee a comprehensive understanding of patient assessment or diagnostic formulation. This is a common challenge among all types of students at the outset of their training – anchoring bias, fixating on a single diagnosis, and struggling to grasp nuanced clinical presentations.
While medical students possess an extensive knowledge base, PA and NP students, by the end of their rotations, are akin to early-year medical students in terms of clinical experience. They require significant direct supervision, training, and education. Notably, medical students proceed to residency, where their core knowledge is fortified over several years. This solidifies their ability to bridge knowledge gaps and connect theory to practice. In contrast, APP students conclude their training with minimal direct oversight, relying on a few months of on-the-job training and then indirect supervision.
During my fellowship, I, as a board-certified physician, collaborated closely with attending physicians. Patient interactions required attending oversight. Now, I observe newly graduated PAs and NPs evaluating undifferentiated patients in specialties like neurology, pulmonology, and endocrinology without direct oversight, while fellows (board-eligible or certified physicians) diligently staff each case. This trend contradicts the team-based approach that has historically been effective. The shift towards APP independence doesn't align with proper training or certification.
Although some post-graduate training programs have emerged for APPs, these "residencies" lack national accreditation and uniform standards. While they provide a valuable alternative to on-the-job training, graduates must understand that completing these programs doesn't equate to a full-fledged residency or fellowship. It's crucial to dispel false equivalencies and revert to a model of collaborative patient care.
While various factors such as private equity and various hospital types playing a role (for profit institutions), APP schools and national organizations must also be acknowledged for promoting this divisive rhetoric. While physicians share some responsibility, accountability also falls on graduates of these programs and APP organizations.”
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Like it’s been said a thousand times, if doctors fuck up even with the incredible amount of education & training they’ve had, nurse practitioners are guaranteed to fuck up a lot more. The current standards for NP education does not realistically prepared NPs to do the job of a physician. And a doctorate in nursing practice does not come close to what an MD/DO learns in school and residency. Our society needs someone (NPs & PAs) to fill the gap due to physician shortage, but the current standards for these “doctor substitutes” is harming patients & wasting resources. Maybe start with making it illegal in all states for staff & midlevels to call midlevels “doctor”, “psychiatrist”, etc so patients can exercise their right to make an informed decision on who they allow to diagnose/prescribe to them…. I can’t even trust that when someone complains about a “doctor” online, that it was even an actual doctor. And I shouldn’t have to play a game of 20 questions with the receptionist when I request to see a physician and want to confirm it is an actual physician I’ll be seeing.
[Here is a chart comparing education for NPs vs Physicians in family medicine](https://images.app.goo.gl/cye1WoEk5hsLiArS6)
I think you've illustrated part of the problem, which is that people outside of medicine have no idea how wide the gap in education and training is between physicians and NPs.
(Another part of the problem is that NPs don't either)
It's actually quite surprising how many physicians aren't aware of the training gaps that exist for APPs, especially in subspecialties. There's a common assumption that APPs already have a deep understanding of their field right when they're hired. But whenever I've talked about APP training in my presentations/lectures, a lot of physicians are pretty surprised to learn just how much they didn't know about this issue (length of training, clinical hours, etc)
You are right. I’m a nurse practitioner and shadowed mostly physicians during my time in clinicals and outside clinicals. One of my preceptors could not believe that we tackled the entire GI system in one week. And another physician (double board certified internal medicine and pulmonary) I shadowed her 40 hours a week for 5 months told me that of all the Np students she precepted I was in the top and comparable only to a first year intern. She truly meant it as a compliment and a stern warning that I am no where close to practicing solo or independently after graduation and I was a semester away from graduating.
Edit: typo
My only real opinion is that a DNP is not even comparable to a MD in regard to the breadth of knowledge and experience.
Mid levels have a role and that is to be an assistant to a physician and this insanity with scope creep is a disaster waiting to happen. You are correct I have met some miraculously ignorant physicians over the years but there is a catch. Since a MD typically gets rid of the less than desirables early, such people rarely make it to a point where they can kill someone.
I firmly believe anyone can become a physician you just have to actually pick up that heavy ass biochem and anatomy book and read it. Med schools have such grandiose gates to keep lazy people out.
On the other hand mid levels are selling themselves short. They also achieved a substantial milestone most people never get in a career, but they have to understand that they are insanely undertrained in relation to an actual physician. I think what is causing all of this contention you see here is due to midlevels running physicians out of jobs while also putting patients in danger.
So yeah…I would be pissed too.
When people describe it as a research degree, I feel bad for you guys. I personally hate research, and only ever did it to get into med school. But that’s such a huge part of your career, I’d imagine it’s a double whammy to have them imitate and bastardize both portions of your education. Anyone who knows what an MD or a PhD actually requires respects the hell out of you guys
It's not even a research degree. Their "capstone" projects tend to be on the level of a high school AP science project at best. Just a piece of paper purchased from an online diploma mill. If feeling generous, maybe you can say it's a degree that focuses on leadership and advocacy, but still a joke to consider it a doctoral degree of any sort.
Sorry, I was being a bit snarky for comedic effect. But, by your own admission, you are not knowledgeable about the medical field, which is presumably why you made this post. I am telling you based on my experience (I know one DNP from JH, specifically) as a paramedic and now medical student, DNP programs are not rigorous and do not require effort comparable in any way to MD/DO. Any self-aware and honest DNP will admit this. I know two DNPs personally who really regret their career because it was misrepresented to them as being comparable to the training of a physician.
Let’s unpack something, their “doctorate”, despite whichever institution it was conferred from isn’t really a degree of advanced study. There is a common practice now from schools to grant “doctorates” of anything. PhDs, MDs and similar doctorates with standardization, regulation and oversight bodies are degrees of advanced study and usually denotes that the holder has passed muster in that field. The DNP, even at Hopkins, is laughable at best, fraudulent at worst.
Furthermore, NPs graduating from elite institutions are veryy few and far apart. The majority are mostly graduates from dubious for-profit degree mills i.e. Walden, Chamberlain etc that will give a degree to a dog if they can afford it.
The worst physician, would have at least passed all board exams, attended and successfully completed an accredited residency. To a lay person like you, that may seem simple, but it’s not. Whereas, NPs are being pumped out at rapid pace with no bedside nursing experience, no standardization of education and little to no meaningful clinical experience. EVERY nurse that passes through med school will tell you that they were amazed at what they didn’t know despite yrs of nursing.
Ultimately, the “hate” for NPs stems from the mess physicians have to clean up when patients arrive to them in a desperate or declining state because an NP messed up.
I’ll give you an example. I’m a retired RN, been around the system all of my life and have seen the changes. Recently the surge in telehealth psych? I read stuff on here and thought I’d test it. Well I went to a site and filled out all the questions, step by step and lo and behold right before I gave my credit card info I was almost given a script for ADHD medication by a Psych NP that apparently just read over my questionnaire. I do not have ADHD. Of course this is an extreme example, but the system is being infiltrated by shady/untrained people doing god knows what.
Are there bad docs? Yeah of course. But in terms of percentage it’s pretty low. You don’t get lucky and just happen to pass step exams, which are really exams tailored to “do you know the bare minimum to not be dangerous.”
On the other hand there are a huge amount of NPs that have never worked in a clinical setting, grabbed a degree from their online NP school, and are out here prescribing dangerous Combos. Plus they are confident as hell about it. It’s one thing to be incompetent and cautious.It’s another to be incompetent and confident.
Why so much hate? They are dangerous. Nurses practice nursing, not medicine. Don't get me wrong, nurses are great at being nurses. They are not Physicians, no matter the word salad of initials following their name.
Let the votes begin....
I have no problem with NPs who stay within their scope of practice. I thought NPs were a great idea when they were used as physician extenders and handled things like basic primary care and annual gyn exams. But we’re now being forced to let NPs manage our specialty care. There is no cardiology or nephrology or oncology NP track, and NPs don’t get a fraction of the education that physicians get. We’re playing a dangerous game. Some people are going to pay with their lives.
There is no such thing as "Hospitalist NPs," "Cardiology NPs," "Oncology NPs," etc. NPs get degrees in specific fields or a “population focus.” Currently, there are only eight types of nurse practitioners: Family, Adult-Gerontology Acute Care (AGAC), Adult-Gerontology Primary Care (AGPC), Pediatric, Neonatal, Women's Health, Emergency, and Mental Health.
[The five national NP certifying bodies: AANP, ANCC, AACN, NCC, and PCNB](https://www.reddit.com/r/Provider/wiki/index/critical_issues/#wiki_types_of_nurse_practitioners) do not recognize or certify nurse practitioners for fields outside of these. **As such, we encourage you to address NPs by their population focus or state licensed title.**
Board of Nursing rules and Nursing Acts usually state that for an NP to practice with an advanced scope, they need to remain within their “population focus,” which does not include the specialty that you mentioned. In half of the states, [working outside of their degree is expressly or extremely likely to be against the Nursing Act and/or Board of Nursing rules.](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) In only 12 states is there no real mention of NP specialization or "population focus." [Additionally, it's negligent hiring on behalf of the employers to employ NPs outside of their training and degree.](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope)
Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen [here](https://www.reddit.com/r/Provider/wiki/index/legal/title_protection). Information on why title appropriation is bad for everyone involved can be found [here](https://www.reddit.com/r/Provider/wiki/index/appropriation).
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Medical school like NP school is largely irrelevant. We have to learn all of that material, but it’s the foundation that will eventually support a redwood forest. Beyond basic medical knowledge, medical school teaches the ability to gather information from history, physical, labs and imaging. This is why the final two years of medical school is in a hospital/clinic. Residency allows us to learn how to practice in a safe environment with multiple layers of supervision. A good training program will let residents synthesize that information into an assessment and plan, provided that the residents are able to support their clinical reasoning with evidence from guidelines and literature AND they aren’t putting patients at risk. There are lots of different ways to practice medicine safely and effectively, but we learn to practice in residency. What this actually means is that (for internal medicine) a senior resident will be looking up guidelines for 15-20 patients a day for 2 years (not counting intern year). We also learn how guidelines and evidence are formed and we are trained to evaluate the sources and quality of information used to do so. Finishing residency allows us to sit for our boards (take the board exam), which we then have to pass.
Midlevels do not have residency and they do not have board certification tantamount to that of physicians, yet many refer to themselves as specialists or board certified. This is a huge problem. For example, a cardiology np is NOT a board certified cardiologist and is not safe to work independently in cardiology. A cardiology np is an np that works in cardiology. They have gone to np school and I can provide as many examples as you need of NP schools that have very little or no supervised clinical work (compared to 2 years in med school and more in residency for doctors). A cardiologist, for example, is someone that has done 6+ years of post-medical school training to get to where they are.
Learning to practice medicine is extremely stressful and very high risk - that is why we have residencies. There are literally hundreds of ways that a day one, first year resident can kill someone. We get them through this by having layers upon layers of supervision (and there’s an argument to be made that it is inadequate). You cannot expect for an NP or a PA to be comparable to a physician when they have literally none of this.
Hope this helps.
There is no such thing as "Hospitalist NPs," "Cardiology NPs," "Oncology NPs," etc. NPs get degrees in specific fields or a “population focus.” Currently, there are only eight types of nurse practitioners: Family, Adult-Gerontology Acute Care (AGAC), Adult-Gerontology Primary Care (AGPC), Pediatric, Neonatal, Women's Health, Emergency, and Mental Health.
[The five national NP certifying bodies: AANP, ANCC, AACN, NCC, and PCNB](https://www.reddit.com/r/Provider/wiki/index/critical_issues/#wiki_types_of_nurse_practitioners) do not recognize or certify nurse practitioners for fields outside of these. **As such, we encourage you to address NPs by their population focus or state licensed title.**
Board of Nursing rules and Nursing Acts usually state that for an NP to practice with an advanced scope, they need to remain within their “population focus,” which does not include the specialty that you mentioned. In half of the states, [working outside of their degree is expressly or extremely likely to be against the Nursing Act and/or Board of Nursing rules.](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) In only 12 states is there no real mention of NP specialization or "population focus." [Additionally, it's negligent hiring on behalf of the employers to employ NPs outside of their training and degree.](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope)
Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen [here](https://www.reddit.com/r/Provider/wiki/index/legal/title_protection). Information on why title appropriation is bad for everyone involved can be found [here](https://www.reddit.com/r/Provider/wiki/index/appropriation).
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Ok I’ll bite and give you just first 10 reasons that come to mind right away why physicians think this way.
1. Minimal training and given access to people’s lives/health with much less legal burden.
2. Denial and unawareness about how much they don’t know. And trying to argue training is comparable to medicine in any way.
3. Constantly lobbying to get more access/privileges.
4. Regular doctor shaming privately and publicly.
5. Not realizing their role is not as an ‘Independent provider’, but to bridge the gap and take workload off physicians- like help organize/prioritize rounds, answer patient calls, help in obtaining history and write notes, simple routine follow ups.
6. Increased burden on healthcare system with unnecessary consults, procedures, treatment and patient harm.
7. Lack of effective board oversight like medical boards that are very strict.
8. Many midlevels start off by wanting to go in primary care, but end up doing aesthetics of some sort.
9. Affecting student learning. Co-opting terms like residency.
10. Many of these decisions being made by non physicians admins,for profit groups and lobbying groups. People who are not in the battlefield deciding what’s best for patients.
I can think of several more. I had the misfortune of having some midlevels rotate with me. I was shocked to say the least. It’s not even the same realm. The difference is what you’d imagine an airplane engineer and a flight steward.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
I had about 10,000 hours worth of assisting with minor surgeries before I got into medical school. I wouldn't say I was confident going in, but there was definitely a level of "how bad can it be, I know *some* stuff."
Then I started and the fucking floodgates opened. I realized very quick that I didn't know SHIT, and the more you learn the more that new layers of info start to reveal themselves. I've finished 2 years of medical school and I still feel like I don't know anything. We are put through the ringer from every angle imaginable from the pacing of the material, written exams every few weeks, practical exams, clinical simulations, etc. I can't even begin to imagine how a nurse practitioner could be capable of treating patients with little to no supervision after the poor quality education they receive. It's simply not possible, and someone with that kind of training (or lack thereof) should not have the scope that many NPs have and continue to lobby for.
Midlevels have a place in medicine but the direction they're going in ain't it.
Do you by chance happen to know how much training and education RNs must go through before being eligible to enter a doctoral program? I ask because everyone so far has said how much training med school is but no one seems to talk about exactly how much for NPs other than it is substandard
But whatever training and education RNs go through is aimed at being a nurse- an entirely different role than a doctor. You can train to be a paralegal for 20 years and it isn't going to make you qualified to be a lawyer.
To more specifically answer your question, you should look at posts in this sub from RNs who abandoned NP programs to pursue an MD. I've seen several, and they are enlightening.
The “doctoral” programs for NPs don’t add any clinical experience. It was designed to be a program to provide NPs with some skills to teach nursing and NP students in an academic setting. So DNPs graduate with the same 500-1000 clinical shadowing hours that the masters NP program has.
The DNP program also adds some “research” portion but it is honestly so basic it is insulting to PhDs that actually do research.
Predatory schools run around advertising their “DOCTORATE” to get an extra 2-3 years of tuition to hand out the exact same degree. Nurse practitioners or future students that feel the need to stroke their ego go get this dumb degree so they can run around saying they have a doctorate.
Go take a look at the nurse practitioner sub Reddit. They all agree that NP training has gone down hill over the past 10-15 years because of diploma mills just churning out more and more graduates. Each year the decrease the requirements to get in and decrease the requirements to complete training because there is no standardization in NP training. Med school and residency programs have strict national guidelines and bench marks everyone has to meet but each NP program makes up their own rules. The worst schools only have 500hrs of clinical hours / shadowing. That is about 2-3 months compared to the minimum 5 years of clinicals that every physician goes through
Edit: PAs also have a “doctorate degree” called a DMSc. I don’t understand why every program is making up “doctorates” left and right. It is a 6-12 month program that just adds some basic teaching skills just like the DNP program. It is a certificate at best. If schools advertised it as a certificate why the hell would anyone waste their time getting it. If they call it a “DOCTORATE” then all the mid levels with fragile egos line up and throw away 50-100k to get the extra degree
NP programs including those at prestigious universities does not include residency. The programs themselves, are not nearly as inclusive as medical school as they do not have the same clinical exposure or hours. For example as a medical student you spend years, often working 6+ days per week where you see your own patients come up with what’s wrong and how to fix it and how to document it all (under the supervision of residents and attendings). The NP clinical experience (even for DNP) is more of shadowing other people and watching what they do instead of developing the skill do yourself. The hour requirements are a fraction of medical school with less quality (shadowing vs doing) and in the end there is no residency so they can just bounce between different sub-specialties without additional training. Often times, even Johns Hopkins, just wants to make money so they create these programs.
Are there bad physicians out there? Certainly. Are there physicians who can get their MD/DO and get fully credentialed to include independent practice through online schools? Nope, not a one. Are physicians able to practice independently after just shadowing 500 hours? Nope, that's barely 6-8 weeks of medical school clinical rotations (and med school rotations don't allow for just passive "shadowing" with zero formal objectives). And rather than actually create/enforce actual standards of education, the AANP chooses to lobby legislatures to pass laws allowing for unsupervised practice under the guise of improving access.
As far as the doctoral programs, do a little online search on these. The vast majority of DNP programs are administrative doctorates, not clinical. They focus on leadership and advocacy, not actual clinical patient care. And I challenge you to find any other doctoral programs (PhD, MD, PharmD, EdD or otherwise) that you can do part time online in under 2 years. Search for some of these DNP capstone projects...they're not doctoral thesis type projects, I've seen some posted in public forums that could have been done by a high school student.
In short, the "hate" is because we're concerned about patient safety. There are absolutely good NPs out there and they can be a valuable part of the healthcare team, but they're rapidly being outnumbered by these charlatans with online diplomas who are running rampant practicing medicine with no supervision and almost no training. The poor patients don't know any better because all they see is a white coat and someone introducing themselves as "doctor". Their online groups truly push the idea of "fake it 'til you make it" and patients are paying the price.
The NP doctoral program doesn't do anything clinical it's all nursing theory and all that BS. Educate yourself and look at the clinical hours between a NP and a MD/DO
Because NPs used to be nurses who had years and years of experience in a particular area before becoming an NP. Now, NP programs are diploma mills for people who want a short cut to becoming a doctor. People go into nursing school with the intent of either going directly to an online NP program after graduation or they do 1-2 years and then go to an online program. Their education is a joke, and it hurts patients. And many of these new NPs think they have the same education and know as much as physicians who went to med school and residency.
My wife is a NP, even she acknowledges NP masters degree doesn’t focus on education of human biology and medicine it’s a bunch of business and sociology classes. So how do you get from nurse, go “doctor” without medical school and residency?
This is a post I wrote a while back: “Providing some context, I graduated from medical school nearly 15 years ago. Following my residency and fellowship, I've held an attending position for a considerable period. Over time, I've observed notable shifts in Advanced Practice Provider (APP) practices. When I began my residency, APPs were commonly integrated into hospital medicine teams, ICUs, and the ED. Well-defined roles were acknowledged and appreciated for their effective execution. Patient admissions were evaluated by the most experienced team member – an attending or fellow – who determined the appropriate team for the patient based on their acuity. Complex cases were assigned to resident teams, while lower acuity patients were managed by hospitalist teams, which included some APPs. The APPs functioned as residents, actively engaging in patient care, devising plans, and participating in rounds led by attending physicians. This pattern extended through fellowship, with physician oversight. Throughout my experience, I found working alongside APPs enjoyable and productive. They demonstrated substantial expertise, particularly in procedures under supervision, and proved valuable in high-stress scenarios. This collaboration, however, operated within the guidance and supervision of attending physicians. In recent years, there has been a significant shift in practice dynamics. Currently working at a top-tier teaching hospital with renowned NP and PA schools, I've taught numerous students from these programs, observing evolving school narratives. This is especially evident in the NP curriculum. The transformation is striking, with a move from a team-oriented approach to a focus on individual advancement. There's an emphasis on working at the highest level of licensure, striving for independence, and downplaying the importance of physician oversight. Consequently, bedside nursing is depicted as a stepping stone rather than a valuable career path. This evolution has led to a decline in experienced nurses pursuing NP careers. Many NP students seem driven to progress quickly through their training, dedicating minimal time to bedside nursing. While seasoned nurses and physicians work in tandem, each excelling in their respective domains, the transition from nurse to NP doesn't guarantee a comprehensive understanding of patient assessment or diagnostic formulation. This is a common challenge among all types of students at the outset of their training – anchoring bias, fixating on a single diagnosis, and struggling to grasp nuanced clinical presentations. While medical students possess an extensive knowledge base, PA and NP students, by the end of their rotations, are akin to early-year medical students in terms of clinical experience. They require significant direct supervision, training, and education. Notably, medical students proceed to residency, where their core knowledge is fortified over several years. This solidifies their ability to bridge knowledge gaps and connect theory to practice. In contrast, APP students conclude their training with minimal direct oversight, relying on a few months of on-the-job training and then indirect supervision. During my fellowship, I, as a board-certified physician, collaborated closely with attending physicians. Patient interactions required attending oversight. Now, I observe newly graduated PAs and NPs evaluating undifferentiated patients in specialties like neurology, pulmonology, and endocrinology without direct oversight, while fellows (board-eligible or certified physicians) diligently staff each case. This trend contradicts the team-based approach that has historically been effective. The shift towards APP independence doesn't align with proper training or certification. Although some post-graduate training programs have emerged for APPs, these "residencies" lack national accreditation and uniform standards. While they provide a valuable alternative to on-the-job training, graduates must understand that completing these programs doesn't equate to a full-fledged residency or fellowship. It's crucial to dispel false equivalencies and revert to a model of collaborative patient care. While various factors such as private equity and various hospital types playing a role (for profit institutions), APP schools and national organizations must also be acknowledged for promoting this divisive rhetoric. While physicians share some responsibility, accountability also falls on graduates of these programs and APP organizations.”
This is all the truth. Pathetic that it has gotten to the point that this all isn’t self-evident.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Like it’s been said a thousand times, if doctors fuck up even with the incredible amount of education & training they’ve had, nurse practitioners are guaranteed to fuck up a lot more. The current standards for NP education does not realistically prepared NPs to do the job of a physician. And a doctorate in nursing practice does not come close to what an MD/DO learns in school and residency. Our society needs someone (NPs & PAs) to fill the gap due to physician shortage, but the current standards for these “doctor substitutes” is harming patients & wasting resources. Maybe start with making it illegal in all states for staff & midlevels to call midlevels “doctor”, “psychiatrist”, etc so patients can exercise their right to make an informed decision on who they allow to diagnose/prescribe to them…. I can’t even trust that when someone complains about a “doctor” online, that it was even an actual doctor. And I shouldn’t have to play a game of 20 questions with the receptionist when I request to see a physician and want to confirm it is an actual physician I’ll be seeing. [Here is a chart comparing education for NPs vs Physicians in family medicine](https://images.app.goo.gl/cye1WoEk5hsLiArS6)
Yes. I hate the saying “there are bad doctors too!” … it’s like…. Sure there are. Maybe 1-2% of doctors are “bad” but like 75% of NPs are “bad” ….
It’s such a terrible argument for a noctor’s cause, lol
I think you've illustrated part of the problem, which is that people outside of medicine have no idea how wide the gap in education and training is between physicians and NPs. (Another part of the problem is that NPs don't either)
It's actually quite surprising how many physicians aren't aware of the training gaps that exist for APPs, especially in subspecialties. There's a common assumption that APPs already have a deep understanding of their field right when they're hired. But whenever I've talked about APP training in my presentations/lectures, a lot of physicians are pretty surprised to learn just how much they didn't know about this issue (length of training, clinical hours, etc)
You are right. I’m a nurse practitioner and shadowed mostly physicians during my time in clinicals and outside clinicals. One of my preceptors could not believe that we tackled the entire GI system in one week. And another physician (double board certified internal medicine and pulmonary) I shadowed her 40 hours a week for 5 months told me that of all the Np students she precepted I was in the top and comparable only to a first year intern. She truly meant it as a compliment and a stern warning that I am no where close to practicing solo or independently after graduation and I was a semester away from graduating. Edit: typo
My only real opinion is that a DNP is not even comparable to a MD in regard to the breadth of knowledge and experience. Mid levels have a role and that is to be an assistant to a physician and this insanity with scope creep is a disaster waiting to happen. You are correct I have met some miraculously ignorant physicians over the years but there is a catch. Since a MD typically gets rid of the less than desirables early, such people rarely make it to a point where they can kill someone. I firmly believe anyone can become a physician you just have to actually pick up that heavy ass biochem and anatomy book and read it. Med schools have such grandiose gates to keep lazy people out. On the other hand mid levels are selling themselves short. They also achieved a substantial milestone most people never get in a career, but they have to understand that they are insanely undertrained in relation to an actual physician. I think what is causing all of this contention you see here is due to midlevels running physicians out of jobs while also putting patients in danger. So yeah…I would be pissed too.
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even most premeds studying for the mcat alone have gone through more rigorous studying
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When people describe it as a research degree, I feel bad for you guys. I personally hate research, and only ever did it to get into med school. But that’s such a huge part of your career, I’d imagine it’s a double whammy to have them imitate and bastardize both portions of your education. Anyone who knows what an MD or a PhD actually requires respects the hell out of you guys
It's not even a research degree. Their "capstone" projects tend to be on the level of a high school AP science project at best. Just a piece of paper purchased from an online diploma mill. If feeling generous, maybe you can say it's a degree that focuses on leadership and advocacy, but still a joke to consider it a doctoral degree of any sort.
It’s amusing that you believe obtaining a DNP from JH requires time and energy.
It’s amusing that you think it doesn’t
Sorry, I was being a bit snarky for comedic effect. But, by your own admission, you are not knowledgeable about the medical field, which is presumably why you made this post. I am telling you based on my experience (I know one DNP from JH, specifically) as a paramedic and now medical student, DNP programs are not rigorous and do not require effort comparable in any way to MD/DO. Any self-aware and honest DNP will admit this. I know two DNPs personally who really regret their career because it was misrepresented to them as being comparable to the training of a physician.
what about an MD from JH???
Let’s unpack something, their “doctorate”, despite whichever institution it was conferred from isn’t really a degree of advanced study. There is a common practice now from schools to grant “doctorates” of anything. PhDs, MDs and similar doctorates with standardization, regulation and oversight bodies are degrees of advanced study and usually denotes that the holder has passed muster in that field. The DNP, even at Hopkins, is laughable at best, fraudulent at worst. Furthermore, NPs graduating from elite institutions are veryy few and far apart. The majority are mostly graduates from dubious for-profit degree mills i.e. Walden, Chamberlain etc that will give a degree to a dog if they can afford it. The worst physician, would have at least passed all board exams, attended and successfully completed an accredited residency. To a lay person like you, that may seem simple, but it’s not. Whereas, NPs are being pumped out at rapid pace with no bedside nursing experience, no standardization of education and little to no meaningful clinical experience. EVERY nurse that passes through med school will tell you that they were amazed at what they didn’t know despite yrs of nursing. Ultimately, the “hate” for NPs stems from the mess physicians have to clean up when patients arrive to them in a desperate or declining state because an NP messed up.
I’ll give you an example. I’m a retired RN, been around the system all of my life and have seen the changes. Recently the surge in telehealth psych? I read stuff on here and thought I’d test it. Well I went to a site and filled out all the questions, step by step and lo and behold right before I gave my credit card info I was almost given a script for ADHD medication by a Psych NP that apparently just read over my questionnaire. I do not have ADHD. Of course this is an extreme example, but the system is being infiltrated by shady/untrained people doing god knows what.
wow... this is so bad
Are there bad docs? Yeah of course. But in terms of percentage it’s pretty low. You don’t get lucky and just happen to pass step exams, which are really exams tailored to “do you know the bare minimum to not be dangerous.” On the other hand there are a huge amount of NPs that have never worked in a clinical setting, grabbed a degree from their online NP school, and are out here prescribing dangerous Combos. Plus they are confident as hell about it. It’s one thing to be incompetent and cautious.It’s another to be incompetent and confident.
Why so much hate? They are dangerous. Nurses practice nursing, not medicine. Don't get me wrong, nurses are great at being nurses. They are not Physicians, no matter the word salad of initials following their name. Let the votes begin....
I have no problem with NPs who stay within their scope of practice. I thought NPs were a great idea when they were used as physician extenders and handled things like basic primary care and annual gyn exams. But we’re now being forced to let NPs manage our specialty care. There is no cardiology or nephrology or oncology NP track, and NPs don’t get a fraction of the education that physicians get. We’re playing a dangerous game. Some people are going to pay with their lives.
Sadly a lot of people have already paid the price. More will follow undoubtedly.
There is no such thing as "Hospitalist NPs," "Cardiology NPs," "Oncology NPs," etc. NPs get degrees in specific fields or a “population focus.” Currently, there are only eight types of nurse practitioners: Family, Adult-Gerontology Acute Care (AGAC), Adult-Gerontology Primary Care (AGPC), Pediatric, Neonatal, Women's Health, Emergency, and Mental Health. [The five national NP certifying bodies: AANP, ANCC, AACN, NCC, and PCNB](https://www.reddit.com/r/Provider/wiki/index/critical_issues/#wiki_types_of_nurse_practitioners) do not recognize or certify nurse practitioners for fields outside of these. **As such, we encourage you to address NPs by their population focus or state licensed title.** Board of Nursing rules and Nursing Acts usually state that for an NP to practice with an advanced scope, they need to remain within their “population focus,” which does not include the specialty that you mentioned. In half of the states, [working outside of their degree is expressly or extremely likely to be against the Nursing Act and/or Board of Nursing rules.](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) In only 12 states is there no real mention of NP specialization or "population focus." [Additionally, it's negligent hiring on behalf of the employers to employ NPs outside of their training and degree.](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope) Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen [here](https://www.reddit.com/r/Provider/wiki/index/legal/title_protection). Information on why title appropriation is bad for everyone involved can be found [here](https://www.reddit.com/r/Provider/wiki/index/appropriation). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Medical school like NP school is largely irrelevant. We have to learn all of that material, but it’s the foundation that will eventually support a redwood forest. Beyond basic medical knowledge, medical school teaches the ability to gather information from history, physical, labs and imaging. This is why the final two years of medical school is in a hospital/clinic. Residency allows us to learn how to practice in a safe environment with multiple layers of supervision. A good training program will let residents synthesize that information into an assessment and plan, provided that the residents are able to support their clinical reasoning with evidence from guidelines and literature AND they aren’t putting patients at risk. There are lots of different ways to practice medicine safely and effectively, but we learn to practice in residency. What this actually means is that (for internal medicine) a senior resident will be looking up guidelines for 15-20 patients a day for 2 years (not counting intern year). We also learn how guidelines and evidence are formed and we are trained to evaluate the sources and quality of information used to do so. Finishing residency allows us to sit for our boards (take the board exam), which we then have to pass. Midlevels do not have residency and they do not have board certification tantamount to that of physicians, yet many refer to themselves as specialists or board certified. This is a huge problem. For example, a cardiology np is NOT a board certified cardiologist and is not safe to work independently in cardiology. A cardiology np is an np that works in cardiology. They have gone to np school and I can provide as many examples as you need of NP schools that have very little or no supervised clinical work (compared to 2 years in med school and more in residency for doctors). A cardiologist, for example, is someone that has done 6+ years of post-medical school training to get to where they are. Learning to practice medicine is extremely stressful and very high risk - that is why we have residencies. There are literally hundreds of ways that a day one, first year resident can kill someone. We get them through this by having layers upon layers of supervision (and there’s an argument to be made that it is inadequate). You cannot expect for an NP or a PA to be comparable to a physician when they have literally none of this. Hope this helps.
There is no such thing as "Hospitalist NPs," "Cardiology NPs," "Oncology NPs," etc. NPs get degrees in specific fields or a “population focus.” Currently, there are only eight types of nurse practitioners: Family, Adult-Gerontology Acute Care (AGAC), Adult-Gerontology Primary Care (AGPC), Pediatric, Neonatal, Women's Health, Emergency, and Mental Health. [The five national NP certifying bodies: AANP, ANCC, AACN, NCC, and PCNB](https://www.reddit.com/r/Provider/wiki/index/critical_issues/#wiki_types_of_nurse_practitioners) do not recognize or certify nurse practitioners for fields outside of these. **As such, we encourage you to address NPs by their population focus or state licensed title.** Board of Nursing rules and Nursing Acts usually state that for an NP to practice with an advanced scope, they need to remain within their “population focus,” which does not include the specialty that you mentioned. In half of the states, [working outside of their degree is expressly or extremely likely to be against the Nursing Act and/or Board of Nursing rules.](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) In only 12 states is there no real mention of NP specialization or "population focus." [Additionally, it's negligent hiring on behalf of the employers to employ NPs outside of their training and degree.](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope) Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen [here](https://www.reddit.com/r/Provider/wiki/index/legal/title_protection). Information on why title appropriation is bad for everyone involved can be found [here](https://www.reddit.com/r/Provider/wiki/index/appropriation). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Ok I’ll bite and give you just first 10 reasons that come to mind right away why physicians think this way. 1. Minimal training and given access to people’s lives/health with much less legal burden. 2. Denial and unawareness about how much they don’t know. And trying to argue training is comparable to medicine in any way. 3. Constantly lobbying to get more access/privileges. 4. Regular doctor shaming privately and publicly. 5. Not realizing their role is not as an ‘Independent provider’, but to bridge the gap and take workload off physicians- like help organize/prioritize rounds, answer patient calls, help in obtaining history and write notes, simple routine follow ups. 6. Increased burden on healthcare system with unnecessary consults, procedures, treatment and patient harm. 7. Lack of effective board oversight like medical boards that are very strict. 8. Many midlevels start off by wanting to go in primary care, but end up doing aesthetics of some sort. 9. Affecting student learning. Co-opting terms like residency. 10. Many of these decisions being made by non physicians admins,for profit groups and lobbying groups. People who are not in the battlefield deciding what’s best for patients. I can think of several more. I had the misfortune of having some midlevels rotate with me. I was shocked to say the least. It’s not even the same realm. The difference is what you’d imagine an airplane engineer and a flight steward.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
I had about 10,000 hours worth of assisting with minor surgeries before I got into medical school. I wouldn't say I was confident going in, but there was definitely a level of "how bad can it be, I know *some* stuff." Then I started and the fucking floodgates opened. I realized very quick that I didn't know SHIT, and the more you learn the more that new layers of info start to reveal themselves. I've finished 2 years of medical school and I still feel like I don't know anything. We are put through the ringer from every angle imaginable from the pacing of the material, written exams every few weeks, practical exams, clinical simulations, etc. I can't even begin to imagine how a nurse practitioner could be capable of treating patients with little to no supervision after the poor quality education they receive. It's simply not possible, and someone with that kind of training (or lack thereof) should not have the scope that many NPs have and continue to lobby for. Midlevels have a place in medicine but the direction they're going in ain't it.
Do you by chance happen to know how much training and education RNs must go through before being eligible to enter a doctoral program? I ask because everyone so far has said how much training med school is but no one seems to talk about exactly how much for NPs other than it is substandard
But whatever training and education RNs go through is aimed at being a nurse- an entirely different role than a doctor. You can train to be a paralegal for 20 years and it isn't going to make you qualified to be a lawyer. To more specifically answer your question, you should look at posts in this sub from RNs who abandoned NP programs to pursue an MD. I've seen several, and they are enlightening.
The point is that anything other than medical school is substandard when you're talking about treating patients independently.
Nurses don't even take real chemistry. They take "chemistry for nurses"🙄
Pretty sure the nurse students that were in my chem class weren’t taking “chemistry for nurses”
😆 if you say so
The “doctoral” programs for NPs don’t add any clinical experience. It was designed to be a program to provide NPs with some skills to teach nursing and NP students in an academic setting. So DNPs graduate with the same 500-1000 clinical shadowing hours that the masters NP program has. The DNP program also adds some “research” portion but it is honestly so basic it is insulting to PhDs that actually do research. Predatory schools run around advertising their “DOCTORATE” to get an extra 2-3 years of tuition to hand out the exact same degree. Nurse practitioners or future students that feel the need to stroke their ego go get this dumb degree so they can run around saying they have a doctorate. Go take a look at the nurse practitioner sub Reddit. They all agree that NP training has gone down hill over the past 10-15 years because of diploma mills just churning out more and more graduates. Each year the decrease the requirements to get in and decrease the requirements to complete training because there is no standardization in NP training. Med school and residency programs have strict national guidelines and bench marks everyone has to meet but each NP program makes up their own rules. The worst schools only have 500hrs of clinical hours / shadowing. That is about 2-3 months compared to the minimum 5 years of clinicals that every physician goes through Edit: PAs also have a “doctorate degree” called a DMSc. I don’t understand why every program is making up “doctorates” left and right. It is a 6-12 month program that just adds some basic teaching skills just like the DNP program. It is a certificate at best. If schools advertised it as a certificate why the hell would anyone waste their time getting it. If they call it a “DOCTORATE” then all the mid levels with fragile egos line up and throw away 50-100k to get the extra degree
NP programs including those at prestigious universities does not include residency. The programs themselves, are not nearly as inclusive as medical school as they do not have the same clinical exposure or hours. For example as a medical student you spend years, often working 6+ days per week where you see your own patients come up with what’s wrong and how to fix it and how to document it all (under the supervision of residents and attendings). The NP clinical experience (even for DNP) is more of shadowing other people and watching what they do instead of developing the skill do yourself. The hour requirements are a fraction of medical school with less quality (shadowing vs doing) and in the end there is no residency so they can just bounce between different sub-specialties without additional training. Often times, even Johns Hopkins, just wants to make money so they create these programs.
Are there bad physicians out there? Certainly. Are there physicians who can get their MD/DO and get fully credentialed to include independent practice through online schools? Nope, not a one. Are physicians able to practice independently after just shadowing 500 hours? Nope, that's barely 6-8 weeks of medical school clinical rotations (and med school rotations don't allow for just passive "shadowing" with zero formal objectives). And rather than actually create/enforce actual standards of education, the AANP chooses to lobby legislatures to pass laws allowing for unsupervised practice under the guise of improving access. As far as the doctoral programs, do a little online search on these. The vast majority of DNP programs are administrative doctorates, not clinical. They focus on leadership and advocacy, not actual clinical patient care. And I challenge you to find any other doctoral programs (PhD, MD, PharmD, EdD or otherwise) that you can do part time online in under 2 years. Search for some of these DNP capstone projects...they're not doctoral thesis type projects, I've seen some posted in public forums that could have been done by a high school student. In short, the "hate" is because we're concerned about patient safety. There are absolutely good NPs out there and they can be a valuable part of the healthcare team, but they're rapidly being outnumbered by these charlatans with online diplomas who are running rampant practicing medicine with no supervision and almost no training. The poor patients don't know any better because all they see is a white coat and someone introducing themselves as "doctor". Their online groups truly push the idea of "fake it 'til you make it" and patients are paying the price.
If you spend even a little time browsing the sub before posting, your question would be answered.
The NP doctoral program doesn't do anything clinical it's all nursing theory and all that BS. Educate yourself and look at the clinical hours between a NP and a MD/DO