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How many hospital procedures does the distinction between NP & Doctor make a meaningful difference, though? I'm sure there's shortfalls but is it a matter where 98% is functionally identical treatment? Plus frankly what % of the remainder cases where there'd be a meaningful differentiation represent productive uses of resources versus using pure ingenuity and the light of god to get the 85 year old to 87 years old.
Procedures? Nearly all of them, although if for no other reason than the fact that midlevels don't do most types of procedures. This being for a variety of reasons including the fact that they don't get training in this area (or much training at all - NPs can be online degrees).
The best case data presented by the NP lobby will argue that MDs and NPs have the same outcomes, when MDs are handling complicated cases and NPs are handling basic ones. More balanced analysis is pretty lopsided.
The differences are stark. For instance a Child Psychiatrist has 23,000 hours of clinical training. An equivalent NP has 600. And the formers hours are predominantly work, with the NPs being shadowing. And if that Child Psychiatrist wants to switch to Emergency Medicine they'd need an additional 15,000 hours of training. The NP would need zero.
I understand that there are a lot of different procedures, but surely there has to be some sort of pareto principle involved in which the top 30 or so procedures cover 90% of the hospitalizations. I do agree that NPs will get the most basic cases, but what % of cases actually is that?
Is there that huge a difference between 23,000 hours of Child Psychiatry and 600? I work in a well-paid niche role and generally if somebody's got the right disposition towards it I'd be comfortable of allowing most fresh grads on the tools after about 50 hours of shadowing.
The word procedure in a medical context refers to physical tasks that must be performed on the patient, such as surgeries. PAs/NPs are allowed to do a very small subset of these, which makes sense because they don't have things like formal Anatomy Lab or years of supervised practice doing hysterectomies etc.
I'm guessing you don't want to get wrapped up in semantics on that though, so NPs, or my friend John who works in IT can handle the most basic admissions, but what we train for in medicine (and what you pay for in the hospital) is for correctly identifying if the patient is basic (which midlevels suck at) and for when a basic admission suddenly turns not (uncommon but not rare).
Midlevels typically extend the nursing model of "the blood pressure is high, we should fix it, let's use this medication" pattern recognition. The physician model emphasizes understanding the underlying physiological reason for the rise in blood pressure, and identifying a pharmacologic agent that addresses that physiologic response in a way that does not interfere with any other medication or pathology the patient has. "How" not "what." I know what emphasis I'd prefer if I was in the hospital and for my family. This may seem like a harsh characterization (although if you look at training material you'll see legitimate emphasis on "the nursing model") but this is also where that time gap comes into play. Doctors barely get all their learning in and that is with 7-12 years of 60-80+ hour weeks.
Most people don't realize what goes on in medicine because the majority of their interaction is an outpatient visit with the doctor rolling in and asking a few unsatisfactory questions before making some vague pronouncement and then leaving, and if they have a family member in the field it's a nurse who is high on her own supply.
Like with pilots and flight attendants most of the training and activity is invisible to you, but it's absolutely critically important for when things go wrong.
For the hours stuff think of it as more like a combat sport than normal on the train training. Who you putting your money on in a fight? The person with 600 hours of training or 23,000 hours, especially given the fact that the people with significant native talent go into one field preferentially over the other? This isn't something like a role where you have to learn how to use one machine that does the same thing every time, its something where you need experience blocking all kinds of attacks from all kinds of body types which takes year to build up.
Also keep in mind stuff like the fact that it takes years of practice to respond appropriately when someone starts actively dying in front of you, something which happens rarely in most types of finished practice, all the time in MD training, and not really at all in NP training. You need that in your tool belt.
I'll stop here.
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