Navigating Healthcare: MDs vs. NPs – Dr. Treece Unveils the Differences
Introduction
Uncovering a Patient’s Experience
As I prepared a 60-year-old patient for surgery this week, her medical history raised some red flags. While going through her history and physical, I discovered that she had undergone the removal of multiple warts from her fingers and was grappling with toenail fungus. Additionally, she had recently experienced a cough and an eye infection. Concerned about her immune status, I asked about these health issues. To my surprise, she revealed that during her recent yearly physical, she had specifically inquired about these concerns.
In response, she was informed that her conditions were unrelated to her immune system. The explanation given was that one issue was fungal, another bacterial, and the third viral. Despite her father’s premature death due to a heart attack at the age of 42 and her mother’s history of blood clots, crucial aspects of her health were seemingly overlooked. To delve deeper, I asked about the results of her EKG from the yearly physical, only to discover that no EKG had been conducted. This revelation left me astonished.
Further inquiry revealed that the individual responsible for her assessment was not a medical doctor but a Nurse Practitioner (NP). The patient had attempted to see the doctor, only to find out that they were on leave. Unfortunately, this narrative is not uncommon, as I encounter similar stories at least once a week. It is disheartening that patients are often unaware of what constitutes acceptable healthcare and are consequently not empowered to demand proper care.
Disparities in Healthcare
The Motivation Behind the Article
The motivation behind writing this piece stems from the absence of comprehensive articles outlining the exact differences between NP and MD roles. While acknowledging that there are competent NPs, just as there are incompetent MDs, it is evident that our healthcare standards are in disarray. It is crucial to dissect the disparities between MDs and NPs, exploring the legal boundaries defining their respective roles in the healthcare landscape.
Lack of Patient Empowerment
It is imperative for patients to be well-informed about the nuances of healthcare providers and to advocate for their right to receive thorough and competent care. Only through understanding and demanding appropriate standards can we hope to rectify the issues plaguing our healthcare system.
Training Journey: MDs vs. NPs
Rigorous Path of Medical Doctors
In the journey to becoming a medical doctor, individuals undergo a rigorous four-year medical school program, which comprises two years of intensive classes followed by two years dedicated to clinicals. These clinicals demand a seven-day commitment, with on-call night hours included. Upon completing this phase, all MDs face the standardized United States Medical Licensing Exam (USMLE), a comprehensive assessment spanning three parts over three days, with each day lasting 8 to 9 hours, covering specific testing areas. For detailed information on the USMLE, I recommend searching “USMLE” on Google.
Family Practice Physician Residency vs. Nurse Practitioner Education
Following successful completion of the USMLE, MDs proceed to a residency program of varying duration. In the context of comparing MDs to NPs running their own practice, the closest equivalent is the Family Practice Physician. The residency program for a Family Practice Physician (MD) is a three-year, post-medical school training that is comprehensive and intense, covering various medical specialties. In contrast, the educational path for a Family Practice Nurse Practitioner involves a Master’s or Doctorate program in Nursing, with clinical rotations, but it is not as extensive or rigorous as a medical residency.
To shed light on the flip side, I’ve gone through a six-year residency, and trust me, it’s not because surgeons are sluggish learners.
MDs: Beyond Residency
Board Certification and Continuing Education
Post-residency, MDs, myself included, undertake another significant challenge by taking a comprehensive exam to attain board certification in their chosen specialty. Additionally, an annual commitment to continuing education is mandatory, and every decade, board certification in Family Practice must be renewed. This arduous journey shapes the foundation of medical expertise, ensuring ongoing competence and commitment to providing high-quality care.
NP’s Path to Practice
Varied Routes to Nurse Practitioner
Let’s uncover the intricate journey of how a Nurse Practitioner (NP) comes into being. The routes are diverse. You can kick things off by getting a Bachelor of Science in Nursing or an Associate Degree in Nursing. The BSN takes the lead in sophistication, but fear not, you can upgrade an ADN to a BSN through online training—yes, online magic. Once armed with this “degree,” all registered nurses (RNs) embark on the common rite of passage: the NCLEX test. Passing this milestone signals that you’re ready to dive into the world of entry-level nursing.
Testing and Time Commitment
But the journey doesn’t end there. To morph into an NP, you have choices. You can pursue a master’s or a doctorate degree and cap it off by taking either the AANP or ANCC test. Now, the pass rate for these NP tests stands at 85%, a shade lower than the formidable 98% achieved by medical students tackling the USMLE. The time commitment varies, with some estimating 6 to 8 years, but there’s a swift express lane that can get you there in 3-5 years. Most of the academic hustle can be done online, except for the hands-on clinical training.
Speaking of clinical training, NP programs mandate a minimum of 500 hours. Now, let’s stack that up against the 10,000 to 16,000 hours a Family Practice MD racks up. Mind you, that’s only counting the 4 years of residency, excluding the 2 years of medical school clinicals. Let’s get bold and imagine a super-aggressive NP doing five times the minimum training hours. That’s still only 2500 hours, a far cry from the average 13,000 hours an MD chalks up.
Unfortunately, I couldn’t uncover any hard data on exactly how many hours most NPs complete, but perhaps some go above and beyond, charting their own course in the realm of medical education.
Voices from the Field
Insights from Sylvia Estrada, NP
To quote Sylvia Estrada, an NP at Cedars–Sinai:
“We can handle pretty much anything a doctor does, except solo surgical procedures.”
This implies that NPs might still engage in surgery, just not independently. In the spirit of trimming healthcare costs, why not position an experienced MD in the corner and let the capable NP take the surgical reins!
HOW DID THIS HAPPEN?
Addressing the Predicted Physician Shortage
The AMA is throwing some wild numbers—predicting a shortage of physicians between 37,800 and 124,000 in the next 12 years. It’s a head-scratcher, right? Picture this: after pouring years of dedication and a boatload of cash into becoming a Family Doc, you’re hit with the idea that a nurse claims they can do your job just as well. Talk about a plot twist in the physician’s playbook these days—it’s not the same game it was 25 years ago. Here’s the breakdown:
Impacts of the Pandemic
The COVID calamity unveiled a stark reality—we were short on doctors! Was it really a surprise, or were we just unprepared to tackle a global disaster? Then, swoops in the American Nursing Association with a solution: let Nurse Practitioners (NPs) run the show with full practice privileges. Sure, it probably seemed like a smart move at the time. COVID had doctors scratching their heads, and we hastily crafted standardized protocols that didn’t demand a full-blown medical degree to follow. But, as with many other policies I could expand upon, the cat is now out of the bag.
Financial Realities
MDs: Financial Challenges and Debts
Trading in our precious 20s and 30s for what feels like a decade of delayed financial freedom has become the new normal for us MDs. Salaries have flatlined, trampled by the relentless march of inflation. Rewind 20 years, and 66% of MDs were grappling with a debt load of 66k to 100k. Fast forward to today, and that number has skyrocketed to a daunting 300k to 500k.
NP Salaries
Speaking of dreams, the notion of running a private office is a financial Everest—best left untouched. In Louisiana, the average family MD clocks in at 170k per year, while their NP counterparts achieve 116k a mere 54k difference.
Corporate Influence
The healthcare landscape has been thoroughly corporatized. Big corporations, shrouded in legal armor, make them nigh untouchable. Are they genuinely invested in securing the most qualified minds, or is it more about pocketing a cool 54k per recruited healthcare “professional,” which is a pretty nice bonus for a CEO.
For salaried physicians, it’s a scripted dance dictated by the evidence-based protocols of corporate whims, all within the stifling confines of bureaucratic red tape. For someone fueled by a passion to make a difference after years of learning the ropes, it’s nothing short of a professional purgatory.
Medical-Legal Landscape
The world of medical-legal affairs seems to have a penchant for targeting physicians—SUING them that is! The strategy of practicing ‘get every test to cover your a$$ medicine’ might have improved malpractice insurance rates, but it comes at a hefty cost, with those costs eventually trickling down to the patients.
Malpractice Insurance Discrepancies
For Family Doctors who steer clear of surgery, the malpractice insurance bill falls within the range of $7,154 to $12,550. On the flip side, Nurse Practitioners (NP) in private practice pay a more modest sum of around $1,000. The mystery of why this discrepancy exists is currently on my investigative agenda. Stay tuned for updates…
Changing Societal Perceptions
Depreciation of Physicians
With the advent of nurses stepping into the ‘doctor’ shoes, the societal value assigned to physicians seems to have taken a nosedive, almost reaching the status of teachers, firefighters, and other public servants. Now, don’t get me wrong—I’m not downplaying the significance of these noble professions. However, the disparity lies in the fact that they don’t come with the same financial investment, decades of learning, and a demand for above-average intelligence that physicians do.
Paperwork Predicament
Overwhelming Administrative Burden
In the past 25 years, the realm of paperwork and documentation has ballooned beyond measure. A staggering 75% of our time now dances to the paperwork tune.
Legal Consequences of a Misdiagnosis: Qualification Matters
Recently, I found myself plunged into the depths of reviewing a lawsuit at a local hospital. Imagine my dismay when handed a mountainous 11,000-page stack. Alas, only a mere 32 pages harbored any semblance of pertinent medical information. The rest, a monotonous chorus of electronic health record (EHR) checkboxes and recycled, worthless details. Notably, this legal debacle involved a Nurse Practitioner (NP) who misinterpreted SVT as Superior Ventricular Tachycardia, despite the physical exam explicitly noting Subclavian Vein Thrombosis. In her defense, the exam was buried in a heap of redundant data, the crucial examination became a needle in a haystack, but these are very different problems with very different solutions, easily discerned by, you guessed it, LOOKING at the patient! Oh well…
The True Motivation for Practicing Medicine
Beyond Financial Incentives
Now, let’s take a virtuous stance and proclaim that we don’t practice medicine solely for the money. Indeed, some might argue that very intelligent folks could opt for a more comfortable lifestyle, greater respect, less time and money investment, reduced stress, and certainly more freedom to actually practice what they trained for outside of the world of MDs and corporatized medicine. A very smart person who went to medical school for the money is the ultimate dummy…
Conclusion
The Unspoken Dilemma
Eureka! It’s hitting me that I’ve basically cracked my own case here. Why am I diving deep into this research, working myself into a tizzy just to make a point? If medicine has become so disheartening, well let the NP’s have it!
But, reality check—I’m in my 50s, and I anticipate needing top-notch specialists in the future. No biggie. If an NP tells me my viruses, fungi, and bacterial infections are not related, I might just have a spontaneous coronary event right then and there, and my insurance company will throw confetti for getting rid of me before my golden years ramp up the bills!
Advocacy for Informed Patient Choices
Alright, let’s dial it down and shift gears (because honestly, I’d prefer a doctor for anything more than a pesky sore throat). Now, what are NPs actually allowed by law to do? Well, that’s a real rollercoaster, folks, with laws zigzagging all over the place from state to state. Being in Louisiana, I’ll zero in on the Bayou State.
Stay tuned for more mind-blowing revelations… Part 2 coming soon.
What fuels our curiosity in this matter? Well, not only are we passionate about advocating for enhanced healthcare practices across the medical industry as a whole, but we are also delving deep into the cosmetic sector. Our aim is to elucidate the qualifications of those authorized to administer Botox and Fillers.
