In another thread someone mentioned we need more doctors, and it brought me around to this, I will post my answer later, but wondered what the vibe was here.
Would you be okay seeing a Family Nurse Practitioner. In any of those situations or will you only see a General Practice DR.
I have to declare a significant conflict of interest here first and foremost:
My wife is a GP and I am an Anaesthetist who practices in a sub-specialized state referral hospital.
It is GP all the way for me with the questions you have posed.
Where I live and work (Australia) there is a push for more “Physician Associates†(ie non doctors) doing certain roles and for more nurse practitioners.
There are areas I have worked in before where the NPs beat the junior doctors hands down (think highly specialized neonatal intensive care), but others where I would always want to see a doctor.
However, I realize I bring a biased viewpoint to things, I am fortunate that when I need to see a doctor and will see those who are some of the most highly regarded in the state for the areas I may see them. Most people don’t have this luxury.
Depending on where you are based and the quality of the medical system around you, there may situations where you are better off seeing a nurse practitioner over the local GP.
In the situations you describe, the third one is where sometimes you may be better going to ED (depending on local set ups) as the GP can only do so much and if you are unwell enough then sometimes you need to skip the GP.
Don’t know if it’s unique to Texas, but I’ve gone to a physician’s assistant. He’s seemed every bit as capable as a doctor.
Might be along the same lines as a nurse practitioner.
Well for me, in America, hands down the FNP for all 3 of those issues. In case 3 both are just going to send you to a Specialist based on whats wrong (or ER). Most NP keep more up to date then the GP’s I have seen. Because they learn about family medicine while getting there Doctorate, they really know more about what your going in for than a GP, who spent a lot of time in med school on things they no longer do.
And the issue in America is GP’s don’t make as much as the specialist so less Dr’s want to go into GP. Which is why the FNP is becoming more popular in Dr. offices (my current doctors office has 2 GP’s and 3 FNP) want to see a GP a week or more wait, FNP we can get you in same day maybe the next.
If you really presented to the FNP with something they didn’t know what to do, they are going to go talk to the GP anyhow.
GP only.
M.D. definitely. Except maybe just a routine well-person physical exam (which my work used to require).
I say this as an M.D. who trained for 8 years after college.
There are probably some decent NPs out there, but there are also NP diploma mills, where they have maybe a couple of years of training and little clinical experience in training, and if I am actually in need of a diagnosis, I want the better trained professional in charge.
Sadly, at least 2 NPs missed a significant diagnosis in a family member. Ugh. One even asked me, “what do you think it is?”… um, it was not in my specialty, nor my job to work up the patient.
Don’t know if it’s unique to Texas, but I’ve gone to a physician’s assistant. He’s seemed every bit as capable as a doctor.
Might be along the same lines as a nurse practitioner.
https://www.usa.edu/blog/np-vs-pa/
Interesting read, sounds like similar range of scope, education is different, as the PA gets the same broader education of a Dr.
Using my Daughter (4th yr med student) as an example, year 3 was all clinical 3 or 6 weeks, so she did ER, GP, OB, GYN, Surgery, Psych, Internal Med, (and I probably missed some) and of course in the first 2 yrs also learned all about that. Year 4 is more focused clinicals on area of interest.
A NP they actually have a separate degree for FNP (Family, so the GP) there is a different title area of study for OB/GYN (sorry forgot what it is) so they spend all their time, just on Family medicine. — this is my understanding, If I am wrong I am sure someone will tell me.
But overall yeah a PA a NP are trying to take the work load’s off GPs
I have to declare a significant conflict of interest here first and foremost:
My wife is a GP and I am an Anaesthetist who practices in a sub-specialized state referral hospital.
It is GP all the way for me with the questions you have posed.
Where I live and work (Australia) there is a push for more “Physician Associates†(ie non doctors) doing certain roles and for more nurse practitioners.
There are areas I have worked in before where the NPs beat the junior doctors hands down (think highly specialized neonatal intensive care), but others where I would always want to see a doctor.
However, I realize I bring a biased viewpoint to things, I am fortunate that when I need to see a doctor and will see those who are some of the most highly regarded in the state for the areas I may see them. Most people don’t have this luxury.
Depending on where you are based and the quality of the medical system around you, there may situations where you are better off seeing a nurse practitioner over the local GP.
In the situations you describe, the third one is where sometimes you may be better going to ED (depending on local set ups) as the GP can only do so much and if you are unwell enough then sometimes you need to skip the GP.
I’ve seen:
so for me it’s more dependent on the practice and getting to know the specific providers within it.
Even in terms of specialists - a specialist who does EMGs (whatever that specialty is called. Neurology?) didn’t put electrodes on my supraspinatus muscle and told me my shoulder was “fine.” A second EMG identified a nerve palsy and complete muscle atrophy in that muscle and a bunch of atrophy in the infraspinatus. The first neurologist’s mistake cost me 6 months… it was 6 more months my shoulder deteriorated. So, that guy can go F himself. Same w the first shoulder surgeon I saw, who wanted to do a complete labral repair. Second guy said I didn’t need that - and I didn’t.
More degrees doesn’t ALWAYS mean better. The same is true for people who say “I want to go to bc it’s all profs that teach, no grad students.” I know profs who are excellent teachers, profs who are shitty teachers (they’re profs bc they are stellar researchers, and it’s a shame we have to inflict them on students), and GTAs who are fantastic teachers. Yes, there are GTAs who are poor teachers, but a PhD doesn’t make one a good teacher.
I suspect it’s like that in every field… more degrees isn’t always more competence.
Well for me, in America, hands down the FNP for all 3 of those issues. In case 3 both are just going to send you to a Specialist based on whats wrong (or ER). Most NP keep more up to date then the GP’s I have seen. Because they learn about family medicine while getting there Doctorate, they really know more about what your going in for than a GP, who spent a lot of time in med school on things they no longer do.
And the issue in America is GP’s don’t make as much as the specialist so less Dr’s want to go into GP. Which is why the FNP is becoming more popular in Dr. offices (my current doctors office has 2 GP’s and 3 FNP) want to see a GP a week or more wait, FNP we can get you in same day maybe the next.
If you really presented to the FNP with something they didn’t know what to do, they are going to go talk to the GP anyhow.
Can relate to much of this, with my wife as a GP, however it’s important to relate the Australian experience.
For my wife GP was a four year dedicated training program with exams that were on par for difficulty with my very hard anaesthesia exams.
On top of this my wife has done a lot of time in gen med. cancers services, emergency medicine, women’s health etc prior to her stating her GP training. That’s the same for a lot of GPs who train under this model in Aus and NZ.
You simply can’t get that experience as a NP.
Lots more I can add.
Lots of medicine has changed and become so different today that many of the younger generations do not have the same intuition when it comes to recognizing that someone is actually sick and something unusual is going on. Heck, a colleague and I had a 1:50,000 complication happen recently that could easily have resulted in permanent life changing outcomes for a young patient if we hadn’t picked up on it super quickly post op.
Dr. Debbie is the best there is. Unless there is a reason I can’t see her, usually because she is busy, I want to see her.
Not sure what 1) is, but I think I’d be just fine FNP for all three. Preference for GP for 3), but I don’t have a hard line.
In another thread someone mentioned we need more doctors, and it brought me around to this, I will post my answer later, but wondered what the vibe was here.
Would you be okay seeing a Family Nurse Practitioner. In any of those situations or will you only see a General Practice DR.
Physician…any other answer is asshattery
I’m a physician, my partner is an FNP, and my mom is an NP…
I’ve taught at numerous NP and PA programs as well as conferences.
“sometimes maybe good, sometimes maybe shit”
There are almost no requirements for getting admitted to a DNP program. Literally most of them have a 100% admissions rate. There are no requirements for previous nursing experience. The curriculum itself has almost no national standards (500 hours of clinical rotations…that’s a joke…I did that in 6 weeks on a surgery rotation). Further the national licensing exam is also a joke. My partner left it fuming because of how ridiculous and ridiulously easy it was.
The online schools have ruined what was once a proud profession.
The difference in training is striking from an hours and experience standpoint. The only NPs who argue otherwise don’t know what they don’t know.
I was presenting at a state NP association conference two years ago and sat in on a Q&A session after. When one NP raised her concerns about the education standards she was told to “shut up and sit down”. It was like they gave the reigns to a bunch of sorority mean girls.
Some are very very good. They take medicine seriously and recognize they have a lot to make up for with their training. Most just blindly trudge forward.
In my place of work, a Physician’s Assistant ¶ and NP have the same roles, grouped as Advanced Practice Provider (APP).
I work with a great group of NP/PAs, generally as part of the surgical team. Fantastic in an ICU/critical care, I got my knee injected by a PA last week.
As an APP myself, I echo the minimal barrier to entry for nursing, minimal clinical hours. No idea on PA school—I’m guessing it’s more difficult.
Well for me, in America, hands down the FNP for all 3 of those issues. In case 3 both are just going to send you to a Specialist based on whats wrong (or ER). Most NP keep more up to date then the GP’s I have seen. Because they learn about family medicine while getting there Doctorate, they really know more about what your going in for than a GP, who spent a lot of time in med school on things they no longer do.
And the issue in America is GP’s don’t make as much as the specialist so less Dr’s want to go into GP. Which is why the FNP is becoming more popular in Dr. offices (my current doctors office has 2 GP’s and 3 FNP) want to see a GP a week or more wait, FNP we can get you in same day maybe the next.
If you really presented to the FNP with something they didn’t know what to do, they are going to go talk to the GP anyhow.
Can relate to much of this, with my wife as a GP, however it’s important to relate the Australian experience.
For my wife GP was a four year dedicated training program with exams that were on par for difficulty with my very hard anaesthesia exams.
On top of this my wife has done a lot of time in gen med. cancers services, emergency medicine, women’s health etc prior to her stating her GP training. That’s the same for a lot of GPs who train under this model in Aus and NZ.
You simply can’t get that experience as a NP.
Lots more I can add.
Lots of medicine has changed and become so different today that many of the younger generations do not have the same intuition when it comes to recognizing that someone is actually sick and something unusual is going on. Heck, a colleague and I had a 1:50,000 complication happen recently that could easily have resulted in permanent life changing outcomes for a young patient if we hadn’t picked up on it super quickly post op.
Well I had a 1:200,000 tumor that my GP didn’t run a simple blood test for (when I first pointed out my low T levels, after telling them to run the test) ( low as in just over 100) until 5yrs later when I had more severe symptoms, as the endocrinologist said when he saw me then, wow your like the guy who sees his cardiologist the day before he has the widow maker. (My tumor was growing up to but not yet in the Cordaid artery. Yeah I advocate for myself a lot stronger now. No one knows my body better than me. So when I am going to the DR. I know either what is wrong or what test need to be run to figure it out. Maybe sometime I will get some more complex thing, which of course they will send me of to the specialist for anyhow.
In my place of work, a Physician’s Assistant ¶ and NP have the same roles, grouped as Advanced Practice Provider (APP).
I work with a great group of NP/PAs, generally as part of the surgical team. Fantastic in an ICU/critical care, I got my knee injected by a PA last week.
As an APP myself, I echo the minimal barrier to entry for nursing, minimal clinical hours. No idea on PA school—I’m guessing it’s more difficult.
Not sure what defines minimal Clinical hours for you but 500 doesn’t seem like minimal to me. FNP’s are degrees after nursing, some are master’s degrees, and I think some universities now offer them as doctorate programs.
Both the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners Certification Program (AANPCP) require family nurse practitioners and adult-gerontology primary care nurse practitioners to complete 500 hours of supervised clinical practice in order to qualify for their national
Sure Dr’s have far more, but this is also counting residency so probably 9k - 12k is residency.
Between medical school clinical rotations and residency, physicians get between 12,000 and 16,000 hours of patient-care experience.
(500 hours of clinical rotations…that’s a joke…I did that in 6 weeks on a surgery rotation).
12 hours a day for 42 days. Seems very bad for retaining what you were supposed to be learning. I would have hated to be your patient on day 41, hour 11.
(500 hours of clinical rotations…that’s a joke…I did that in 6 weeks on a surgery rotation).
12 hours a day for 42 days. Seems very bad for retaining what you were supposed to be learning. I would have hated to be your patient on day 41, hour 11.
It may have been that xcmntgeek trained back in the days before work hour restrictions were put into place. When I was completing my surgical internship, it was very common to work 120 hours per week. It sucked but you actually did learn, and became very efficient at getting things done (especially trauma and in hospital codes).
In another thread someone mentioned we need more doctors, and it brought me around to this, I will post my answer later, but wondered what the vibe was here.
Would you be okay seeing a Family Nurse Practitioner. In any of those situations or will you only see a General Practice DR.
I’ve seen an FNP the last couple of years for my annual check up. Sometimes when we talk about things I feel like I know just as much or more than she does, which isn’t very reassuring.
Depends …
#2 doesn’t matter who is seen if labs are fine and feeling no issues.
#3 could be really off from the patient’s pov, but be routine from the medical provider’s pov. E.g kidney stone pain.
#1 could turn into #3… in which case it’s not a one and done visit. Or the issue’s not resolving. For those, a second and third opinion’s warranted with someone more specialized in these cases is how I’d go about it.
I think a lot of people tend to see the one person and one type (NP, GP, PA, MD) when stuff isn’t always black and white.