So I say, great. Let's let the cards fall where they may. With less than 2% of medical students entering a comprehensive care field, I say it's time to disband the teaching and training of outpatient internal medicine (and family medicine and pediatrics) to focus on the inpatient aspects. If we as a nation believe that NPs are capable of practicing their scope as equals in terms of diagnosis and management of acute or chronic or acute on chronic medical illness, with no decrease in quality or increase in cost, then it's time that us MDs bow to the will of the nation.
If there really is no change in quality for NP vs MD driven out patient comprehensive care, then our nation has been duped for years to believe that MD level training was necessary to provide a full scope of outpatient comprehensive care.
I recommend that all MD comprehensive care boards disband their outpatient teaching curriculum by 2012. It's time the MD boards focused all their energies on in patient medicine.It is unnecessary as a nation that we train MDs at exponential cost when compared with NPs when NPs are capable of providing the same service for much less cost.
In 2012, I recommend the discontinuation of all MD training tracks towards the purpose of outpatient comprehensive care. I recommend all current comprehensive care physicians be demoted in fee structure to 85% of current levels, the current standard billing practice. If the current MDs choose not to continue their practice at the lower fee schedule, they will be either forced to retire or to choose an alternative career pathway. That means either going into hospitalist medicine or retrain for another sub specialty field by undergoing an MD level fellowship.
After five years of NPs as the sole provider of outpatient comprehensive care, having proven their capability to practice independently, I recommend a natural progression of their capabilities. With hospital costs sky rocketing and the Hospital Insurance Trust Fund bankrupting by 2017, I recommend that all inpatient comprehensive care by turned over to the NP model in 2017. In 2017, the current hospitalist model should be fully converted to independently practicing NPs who provide care equal in quality. Intensive government research has indicated that their nursing degree and minimum of one year residency has prepared them well for the complexities of inpatient, most of which has now been converted into standard order sets and protocols.
With a training program but a fraction of time and cost, they will lead the charge in quality care for the large baby boomer population, just as the Hospital Insurance Trust Fund is bankrupting. At this point all MD hospitalists will have a choice, either retire or retrain to practice in a medical sub specialty by undergoing an MD level fellowship.
With NPs now functioning as the sole provider of inpatient and outpatient comprehensive care,in 2017 the the specialty boards of family medicine, internal medicine and pediatrics will be formally disbanded. All medical students pursuing a medical sub specialty will now proceed to a one year NP internship program before proceeding to their physician level sub specialty fellowship.
However, in 2022 the government realizes that the NP model is working great. There is no loss of quality. The training is cheaper. There are more bodies earning less money. The care is cheaper. They come to the realization that medical school and residency training is a farce. With the help of the NP lobby arm, starting in 2022, NPs will now be the sole providers of all medical sub specialties in this country.
With the invention of http://www.googledoctor.md, medical education has done away with the need for medical school and medical fellowships. Nurse practitioners will now be the sole providers of all medical comprehensive and sub specialty care. After completing a nursing degree, then a minimum of one year masters level training to become certified in comprehensive care, nurse practitioners will then be given the opportunity to expand their training for a minimum of one more year to become certified independent practitioners in the medical specialty of their choice. Cardiology. Gastroenterology. Neurology. You name it. They will be required to complete the same procedural training as their MD counter parts, but with only 1/5 the required volume.
In 2025 there is no such thing as a comprehensive care MD or a medical sub specialist MD. They have all either retired or been retrained into surgical medical residencies, the last frontier in NP progression.
By 2027 the government loves the current system. Large volumes of NPs who are much cheaper to train, cost less in salary and show no decrease in quality. Version 22 of googledoctor.MD is now available for NPs, nurse techs, medical assistants and patients alike. Most of medical care has moved into the technology arena. Most of it managed by protocols. Most of it unnecessary for medical school trained personnel. And since there is no money to pay for health care, cost is now used as the determining factor of quality.
2027 is also the year that the national lobbying arm of the 1,000,000 nurse practitioners petitioned the federal government for the right to provide independent practice in general surgical services. After completing their one year NP internship, NPs will now be allowed to practice independently as general surgeons after just a two year NP curriculum in general surgery, of just 48 hours a week. With most surgeries now performed by robots, based on self reading holographic x-ray technology. Current surgeons have the opportunity to specialize further in their training by undergoing further surgical fellowships or they can retire. Or they can accept a 70% reduction in their fee schedule, the current going rate for NPs. With all hospitals now under control by the federal government, government fee schedules determine pay scales. The take it or leave it attitude prevails.
After five years of NPs providing high quality general surgical care with no change in outcomes, the government realizes that the final frontier has now been achieved. In 2032 the federal government opens up all surgical sub specialties to the nurse practitioner model and disband all medical schools. No longer necessary, study after study petitioned by the federal government has proven the effectiveness of the nurse practitioner model for all of medical care with less training resources, less time to train and less money to pay.
The nurse practitioner model has proven its place in history. However, more change was coming. By 2035 the lobby arms for licensed practical nurses and medical assistants, who have completed minimum assessments skills testing, petitioned the government to provide independent comprehensive outpatient clinical care.
And the cycle was started all over againg.
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I agree with the notion that MDs are no longer needed in primary care settings. Physician Assistants or Nurse Practitioners could do this job as well or in many cases better than MDs. Increase the number of Nurse Practitioner Programs and PA programs and decrease medical schools to a handfull number. That would solve our escalating cost in health care, and provide patients with a higher quality of clinical and caring care. "Nurse K" is right.
Reductio ad absurdum . . . Works for me.
I accept this article with the "tongue in cheek" position it was intended. A couple of points I'd like to make. One, NPs train for much longer than a year. For example, in addition to my four year of nursing education and six ears as a practicing nurse, I also have three years of NP training before becoming certified. Most programs for NPs are two+ years I length, with many students, my self included, taking longer due to seeking additional training or for other personal reasons. So the one year frequently mentioned in your article is in error.
Second NPs are not trained or intended to replace physicians. Yes, there is overlap in our professions as there is in most medical professions. And yes, there are things we can do just a well as physicians (after all, I can take the training same as you.) But the intention is not to replace anyone, only to supplement and help fill the already-existing voids.
johnny. With all due respect. When your training is substandard to mine, and your scope of practice is undifferentiated from mine, either I need to certify with your standards or you need to certify with my standards.
Or your scope of practice must be defined as limited from mine. When you practice independently from supervision, your scope is defined as undifferentiated from mine.
BTW. Your three years you speak of is not the same as three years of residency. My reference of one year for NP training is the equivalent of less than one year for a three year MD residency program. That's what I mean by one year. And even then, the intensity of that "one year" of training,is I'm sorry to tell you, quite inferior to mine. It is not even close. If you even have the belief that it is similar, you don't know what you don't know.
Why am I so sure? Because I have trained NPs who are just about done with their training. And they are light years behind in foundation and knowledge and clinical decision making capability than many of the third year students I have worked with.
I'm sorry to be the one to tell you. Unless you have experienced a physician level training program, medical school, residency, you simply cannot comprehend the holes in your own training. And trust me, if you plan on practicing independent of any oversight, your holes will be huge. I am quite confident I could apply that statement to even the most experienced of NPs.
Do you come from a family of doctors?
first generation
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