Nurse Practitioner vs Doctor?

The NP licensing form indicates that the degree awarded from the 'advanced' school could be a certificate or BA. The education requirements for the RN license are listed in the RN app and mention offering an explanation in writing if you do not have a two year nursing degree.

http://www.maine.gov/boardofnursing/...pplication.pdf

ETA: If you lived here, you'd find it less hard to believe. You can also be a lawyer without a law degree here. Getting a teaching license requires a lot of schooling, but there's a huge loophole built in so many people just work under 'emergency' waivers for years.

It is not a BA to get the RNP.

Registered Nurse Practioners (RNP) in Maine must have at least a minimum of a two year or four year degree (bachelors degree) nursing degree to get their initial registered nurse (RN) license , PLUS AFTER more education a certificate program from a nurse practitioner school or masters program (which is more common, the other is rare, are either 2-3 year programs, and are required most places to get certified) are the advanced certificate programs they are referring to in the state of Maine, PLUS in addition to a two year residency of experience under a licensed physician or licensed nurse practitioner (the residency requirement varies by state) but in ME is it 2 years.

Interview them to determine their background just like you would any provider. I personally would choose one that had a four year RN degree and a masters to get their nurse practitioners license. Find out what their specialty was in their residency training as well, and if trained under a physician or other RNP.

hvert, you are reading way too much into an application form. I agree that it might lead one to the conclusions you've drawn. But those conclusions are contradicted by what the board of nursing in Maine states:

"The Maine State Board of Nursing requires that as APRN, you must hold at least a master’s degree with a concentration in the general role in which you intend to work (i.e., certified nurse practitioner, certified clinical nurse specialist, certified nurse midwife or certified registered nurse anesthetist)."

Source: How to Become a Nurse Practitioner in Maine - ME | APRN Certification and Jobs

Why that application form has the options for check-off that it has I don't know, but you can't go using it to surmise it must mean this or that. I've seen lots of weird things on application forms.

It is true that there are nurses who are RNs who do not hold even a two year academic degree, the ADN (associate degree in nursing.) Those nurses who have neither the ADN, nor the Bachelor of Science in Nursing, have a diploma instead. They are graduates of the old 3 year programs that were run by hospitals. Along with their hospital training, they were sent to neighboring universities/colleges for academic work, but did not earn even a two year college degree. Their training was very rigorous, and they typically outperformed both the ADN and BS nurses on the nurse achievement exams, given to all graduating nursing students by the National League of Nursing. Most of those programs have been discontinued. I doubt there is even one still in existence. But there are still older nurses out there who came out of those programs.

Getting back to NPs. The source linked above makes the following requirement in addition to having the Master's Degree:

"Nurse practitioner programs must be accredited by the appropriate national accreditation body related to your specific area of practice . . . " This tells you how standardized across the nation these whole process has become.

Thanks to Medicare, the federal government has long had a lot of power in compelling even backward states to conform to nationalized standards of education of primary care providers. Even insurance companies, for that matter, are not going to pay for diagnoses rendered by some practitioner who doesn't have both an academic degree and an appropriate certification from a legitimate certifying authority.

Ah, you are right - I just saw this: http://www.maine.gov/boardofnursing/...equirement.pdf

Here is a better source than the one I gave above. See: Maine State Board of Nursing Website - Licensing

"As of January 1, 2006, an applicant for initial approval as an advanced practice
registered nurse in Maine must hold a master’s degree with preparation in the specialty
area for which application is made.

As of January 1, 2006, an applicant from another U.S. jurisdiction seeking approval by
endorsement as an advanced practice registered nurse in Maine must have met
requirements comparable to what was current Maine law at the time of graduation."

Now, I just spotted a possible loop hole. What if the applicant is not seeking initial approval, but got approved as an Advanced Practice RN? (Like before 2006.) Okay, I can see the possibility for there being NPs who don't have Master's degrees.

Yeah, anyone who sought approval before 2006 could be grandfathered in... but at this point they have years of experience.

Does that second paragraph even make any sense? Anyone moving to Maine from another state has to meet the requirements in Maine as the requirements were the year the person graduated? Why make it so complicated? Who keeps track of what the law was in 1997 vs 2004 vs 2012?

Well, hvert, you weren't completely wrong, and the info below explains why those check off options existed on the form you were looking at:

I can't copy and paste, maybe because it is a PDF file. The source is: http://www.jblearning.com/samples/07...ch03_pass2.pdf (See page 135)

The NP programs mentioned would have had their own standards for who, among nurses, they would admit. They wouldn't necessarily have admitted just anyone who was an RN. Also, the rigor of the program might have narrowed down who could make it through. A program that issues a certification is not, necessarily, less rigorous than a program that issues an academic degree. (Just as diploma nurses from hospitals were often far better prepared than nurses coming out of colleges.)

They are wanting to show respect for nurses who became NPs under former regulations. They want to respect nurses from other states, in the same way they would wish older nurses from Maine to be accepted. It does make sense, and you can be sure that they can readily keep track of the changing requirements for any given year. It's not that hard to do. (And things probably didn't change every year. Just a few milestone years here and there.)

Nowadays, even Nurses' Aides have to be certified. When they first came out with these certification programs, the certification wasn't mandatory. So all the experienced nurses' aides didn't bother getting certified. The only people bothering to get certified were people who had no experience working as a nurses' aide and hoped that having that certification would make up for lack of experience when applying for a job.

This was in the mid 80's. At that time, if you wanted to hire a good nurses' aide, you'ld do best to look for one that didn't feel the need to get certified. Somebody like that was likely to have worked for years in nursing homes.

That is very true. I would rather consult with a professional (in any field) who had no degree but 20 year experience than someone fresh out of school.

I think a lot of professions (like medicine and law) set up ridiculous education requirements in order to limit the number of people in the field so wages can stay inflated. I read a book years ago called 'the screwing of the average man' that had a very interesting take on licensing bodies like the AMA.

My field works the same way. The 'winners' are the people selling the certificates. The people who obtain many of the certificates are people who are trying to break into the industry, but they have no real experience and passing a multiple choice cert test doesn't prove much. HR wants to see the certs, but hiring managers avoid those candidates.

I'm renewing a certificate right now - the issuing authority has just changed the rules so that actual work experience and community service no longer counts and 60 hours of coursework is required instead. It's ridiculous, just a money grab for the course providers.

I hear you. That's precisely what it is.

hvert,
I would have put your boyfriend on doxycycline. And I wouldn't have charged $200! Yikes.

Let me see if I can clarify a few things.

One of the problem is that nursing encompasses such a wide range of skill sets and educational levels. Some people call medical assistants "nurses" (they are not); and the field has a spectrum from vocational or practical nurses to PhDs and post-docs.

Registered Nurses
In the United States, one can practice in all states except South Dakota with an associate's degree. Due to prerequisites, it's usually a bit longer than two years.

Although there is strong research to support mandatory bachelors degrees, there are too few nurses and a massive shortage of nursing faculty. So it would paralyse the system to require a bachelor's degree.

Both associates degree and bachelor's degree RNs take the same licensure examination.

Nurse Practitioners
There are a handful of NPs in certain states who only earned a "certificate." This is legal in some states, but quite rare. Those NPs with certificates rather than masters degrees may have trouble getting privileges, credentials, etc. But we're talking about a very small population of NPs.

The majority of NPs are now educated as post-bachelor's students. Students earn a bachelor's degree, meet a range of basic science prerequisite courses, and take the GRE. The masters degree includes an accelerated RN component (the hours of clinical experience and course work are the same as a bachelor's degree in nursing to meet state requirements.) The remainder of the programme is spent learning to be an NP.

Although the initial goal was 2015, the doctoral requirement will take longer. . Again, the shortage of faculty and need for more NPs to be in practice has curtailed this effort. NPs have decades of research to show that they practice safely and effectively at the masters level. But a doctorate is still a good idea. There are also some dicey doctoral programs, but there are dicey medical schools and residency programmes too.

NPs must take the RN licensure exam. And then all NPs (masters or doctorate level) must take a national certification examination that is specific to an area of practice (family practice, paediatrics, neonatology, etc.)

NPs do not have "residencies" in all states (there are many terms used for this.) There are varying levels of supervision for new graduates. Some of this is state-regulated; some is self-regulated.

Regardless of the state, an NP practises under his or her own license.

What are the things that NPs cannot do compared with a physician?
A common question but almost impossible to answer. NPs and physicians all vary in their own expertise, comfort level, education, and practise environments.

Some states have arcane laws that limit NPs. These are slowly fading. And the research strongly supports removing these restrictions: these laws can inhibit access to care, increase costs, and actually increase malpractice risk.

Shouldn't a 'real doctor' be right there in case the NP doesn't know what he or she is doing?
ALL healthcare providers, regardless of professional designation, have a responsibility to know their limits. A physician can easily get in well over his or her head, and has a responsibility to consult. The same applies for NPs. The best clinicians collaborate in person, on the phone, in conferences, etc.

Although "teams" are in vogue right now, it's not necessary. I do not believe that you need a team of five people; but I think that it's always favourable to have a minimum of two clinicians in a practice (who like each other.) It doesn't matter if they're NPs, physicians, or any combination thereof.

Should I see the 'real doctor' intermittently to make sure that the NP isn't screwing up?
If you think that an NP is incompetent, you shouldn't be seeing him or her at all! I strongly support continuity of care and patient preference. See the provider who makes you feel comfortable, spends time with you, and helps you feel well.

Unless someone is a resident or a new graduate, be sceptical of a practise that requires you to switch around between providers. You deserve one person you can trust.

What do I call a nurse practitioner?
I got this question a lot. Since I predominantly saw young people, I was called "Dr." (and I have a doctorate, so that's both polite and correct.) But I preferred to be on a first-name basis with older patients. A smooth NP will ask you how you would like to be addressed, and then you can figure it out from there.

In a few states (Ohio and Maine come to mind), NPs cannot use the title "doctor." It's okay for chiropractors, optometrists, naturopaths, podiatrists, psychologists, dentists, just not NPs. It's distasteful because it discriminates against a particular profession. Do these people want to read my dissertation? Do they know how long it took? Or the $350,000 in tuition? (Sorry, chip on my shoulder.)

Why don't NPs go to 'real' medical school?
Advance practice nursing has a lot of appeal. There is a strong focus on prevention, patient education, and empowering patients to make decisions about their own health. There is a philosophical difference that draws many of us to the profession.

It has become exceptionally difficult to get in to NP programmes: they're small and there is a faculty shortage. So--just like med school--many prospective NPs apply for a couple of years before they are accepted to a programme.

What is the difference between nurse practitioners and physician assistants?
Since I'm not a PA, I don't want to speak for them. The biggest difference is that a PA is--by definition--an assistant or associate to a physician. The PA is tied to a physician and to the physician's license. A nurse practitioner is an autonomous healthcare provider.

PAs are educated under a strictly medical model whereas NPs are educated as nurses first, then as PAs. Although there are still some "certificate" PAs, most are educated with masters degrees.

Unlike NPs, PAs take a single licensure exam. Their license is general and versatile. NPs are licensed in particular areas of practice (neonatology, psychiatry/mental health, women's health, acute care, etc.)

Do they have nurse practitioners in countries other than the USA?
Yes. The UK, Canada, New Zealand, Australia, Israel, and the Netherlands all have established NPs. Although Canada is changing, the other countries have very strict limits. Most of the programmes are at the "certificate" level, not the masters or doctoral level. And the scope of practice is severely limited compared with the USA. Outside of the US, there is demand for NPs, but the educational and healthcare infrastructure are not yet in place.

I firmly believe that you can see an NP, PA, or physician and have good, bad, or mediocre experiences with any of them. Look for the right person, not the initials after his or her name. It may take some trial and error, but you're better off finding someone who will partner with you, and keep you at ease.

I would look into the particular nurse practicitioner setup. Mine have always worked in association with a doctor; perhaps you can try one (less expensive?) and see if you have questions whether you can see a doctor at the practice where they work, see what they think/get a second opinion, etc.

There are very few doctors in my area. A nurse practitioner ruined my life by forcing me onto a rapid taper off Klonopin. She didn't know or care I'd been on benzos for 30 years. She just didn't want to prescribe it. She wrote "drug seeking behavior" on my chart. I just keep hoping karma is real. I'm sorry for my bitterness but I have a feeling an MD would not have done that to me.

Now that we have pretty thoroughly discussed the training of Nurse Practitioners, I would like to reiterate that I, personally, would not care to have a NP as my primary care provider. Where I get my care, there is an MD who is my primary care provider. There are a few NPs in that same practice. If I call for an appointment with my MD and he is booked up for quite a while, I have the option of seeing a NP. There is usually an NP who is available right away. So I have taken that option when I wanted to get seen right away. I'm fine with that. I get seen quickly, but I know that I can always eventually see my MD, if I feel I want to. Right now I have an appointment to see an NP for a pap test. My MD simply doesn't do pap tests. He turns that job over to the NP who is advanced certified in women's health. I'm fine with that. Doing a PAP test is something that any bright person can be trained to do. It's a technical skill.

I don't mind NP's having technical responsibilities, like performing PAP tests. But I'm not having any diagnosis of mine made by an NP. I will always insist on an MD for that. I am a nurse, myself, and I see that NPs are often not in the same league as MDs in terms of education . . . and, quite frankly, in terms of I.Q. They are trained to follow decision trees . . . not so well trained to do independent, critical thinking.

Angelique67,
I'm so sorry to hear that happened to you! Benzodiazepines always require a slow taper. And one would have to be extraordinarily brave to write "drug-seeking behaviour" in a chart unless there was an overwhelming and compelling reason to do so.

I hope that you have found a competent healthcare provider who cares for you, provides appropriate medication, and who does not label you.

Thank you Roi5. Unfortunately since it happened ive been hiding in my apartment just sitting on my bed because anything else causes too much anxiety. I haven't been anywhere since I went back to the clinic for meds last July (other meds) and I might have to go this month and I'm praying I can get out of it. I feel like this is the last stop for me, like my life is truly over.

ETA: She wrote drug seeking because I asked to see different providers at the clinic hoping one would at least do a slow taper. An 8 week taper is not a slow taper.

Angelique67,

I know we're veering a bit off topic, but there are some patients who taper benzodiazepines over a 26-week schedule. It's true that it can be done at 25 percent reduction every two weeks, but it is equally legitimate to taper over a much longer period of time.

And the much bigger question: why taper at all? If you're struggling so much with anxiety, maybe tapering isn't such a good plan. But that's for you and your healthcare providers to discuss.

I think you should address the "drug-seeking behaviour" comment. I think it is reasonable for you to say, "I'd like to discuss the diagnosis in my chart." Have a discussion about it. Above all, ask if it was coded on your chart and therefore reported to your insurer. You also have the right to put an addendum in your chart, but I think it's best to aim for dialogue rather than be adversarial.

Again, best of luck. It sounds tremendously uncomfortable for many reasons.

roi

I would have no problem seeing an NP for something as simple as a physical. A physical exam isn't rocket science. If you need a more experienced eye after that, they can always refer you to their physician colleagues, and I am a physician.
I think a basic rule of thumb that a lot of people seem to either be maybe not aware of or not willing to do is; if you're unhappy with how someone is managing your care, regardless of who they are, see someone else. No one says you're beholden to one specific person. See another NP or PA or physician.
Do I disagree with the laws passing in several states that allow PAs and NPs to practice independently. Absolutely. I don't think there are any circumstances in which they shouldn't be under a physician's direct supervision. That being said, a first year med student could handle a general physical.

I recently went to urgent care and was seen by two nurse practitioners. Their conclusion was the one I wanted to believe, and so I happily left urgent care believing not much was wrong with me. A day later, I was in the emergency room at the hospital, where I got appropriately tested and diagnosed by a physician.

Those two NPs were young. They hadn't been grandfathered into their jobs, despite outdated credentials. They had to have had master's degrees. So they are representative of their trade. I now think even less of NPs than I did before.

The first one I saw said I couldn't be too sick, since I didn't have a fever. That was a red flag of stupidity right there. But, like I said - I wanted to believe I was basically fine. The second one showed me an xray of my abdomen and incorrectly identified the body parts. That was so unbelievably stupid, but I was so disbelieving that I, with my associate degree, could possibly read an xray better than a NP, that I figured I must be wrong. (Turned out I wasn't wrong.)

Folks, I will now, unequivocally, say that the training of a Master's level NP is very, very significantly inferior to that of a physician. This is true even beyond what I believed 3 days ago. I am absolutely astonished at the low level of education and critical thinking capacity shown by these two women. I shudder to think of the fate of others who depend on them and wouldn't see the red flags that I saw.

I now believe that nurse practitioners are are a monstrous hybrid of nurse and doctor. Doctors must constantly make guesses, knowing that they are merely guesses. Their training impresses upon them that reality and a sense of humility about it. Traditionally, nurses have been trained to deal with facts and leave the guessing to the doctors. NPs have usurped the doctor's privilege of making high-stake guesses, without having the intellectual equipment to hedge their bets. They are dangerous.

While I'm on my soap box, let me add another caveat. Some insurance plans are now trying to steer their subscribers toward Doctors of Osteopathy, as an alternative to Doctors of Medicine. Why do you suppose that would be? If you need more than one guess, you don't understand anything about insurance companies.

People tend to get paid commensurate with their talent and the resources invested in developing that talent. It costs less to go to a college of osteopathy than to a college of medicine, and you don't have to be as smart to get in. So do the math.

However, no rule of thumb is universally true. Paramedics spend less time in school than nurses and get paid less (at least, traditionally.) While in the ER, I got most of my care from a paramedic, who seemed superbly competent at what she was doing. In fact, I've gotten care from nurses in ERs who were notably less competent.

Rose,

I am sorry that you had such an unfortunate experience with NPs, but I think it's safe to say that it happens routinely with MDs as well. I'm sure a lot of us have been on the receiving end of a medical mess.

As far as the comments on DO vs MD. Why do you think that a DO is much less intelligent overall than someone who is doing MD? The last time I looked at the cost of DO school it still ruled out most of the population.

There is a reason they call it "practicing" medicine. Regardless of NP, DO or MD, they are human and science is every changing. The margin of human error is just as high regardless of education. Because they are constantly practicing. I would look more for things in these people than just credentials. I would look to see how thoroughly the individual is looking at my situation versus what the degree on their wall says. Being thorough saves lives, not credentials.

To the original poster: I have had more terrible doctors than I have NPs. In fact I saw a doctoral NP and she was terrible. But that was the only NP I've seen who was terrible. But I could list off all the doctors who misdiagnosed my kidney stones, strep throat, committed me for no reason, and the list goes on and on.

In the end, take a little time and look around for someone you TRUST, regardless of NP or MD. Someone you can tell everything so they can really give you a good diagnosis.

Seesaw