MD vs. DNP: Why 20,000 Hours of Training and Experience Matters

MD vs. DNP: Why 20,000 Hours of Training and Experience Matters

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As southern states entertain legislation granting nurse practitioners independent practice rights, there are some finer details which deserve careful deliberation. While nurse practitioners are intelligent, capable, and contribute much to our healthcare system, they are not physicians and lack the same training and knowledge base. They should not identify themselves as “doctors” despite having a Doctor of Nursing Practice (DNP) degree. It is misleading to patients, as most do not realize the difference in education necessary for an MD or DO compared to a DNP. Furthermore, until they are required to pass the same rigorous board certification exams as physicians, they should refrain from asserting they are “doctors” in a society which equates that title with being a physician.

After residency, a physician has accrued a minimum of 20,000 or more hours of clinical experience, while a DNP only needs 1,000 patient contact hours to graduate. As healthcare reform focuses on cost containment, the notion of independent nurse practitioners resulting in lower healthcare spending overall should be revisited. While mid-level providers cost less on the front end; the care they deliver may ultimately cost more when all is said and done.

Nurse Practitioners already have independent practice rights in Washington State. In my community, one independent NP has had 20 years of clinical experience working with a physician prior to going out on her own. Her knowledge is broad and she knows her limits (as should we all); she prominently displays her name and degree clearly on her website. This level of transparency, honesty, and integrity are essential requirements for working in healthcare. Below is a cautionary tale of an independent DNP elsewhere whose education, experience, and care leave much to be desired. I thank this courageous mother for coming forward with her story.

After a healthy pregnancy, a first-time mother delivered a beautiful baby girl. She was referred to “Dr. Jones,” who had owned and operated a pediatric practice focused on the “whole child” for about a year.   This infant had difficulty feeding right from the start. She had not regained her birthweight by the standard 2 weeks of age and mom observed sweating, increased respiratory rate, and fatigue with feedings. Mom instinctively felt something was wrong, and sought advice from her pediatric provider, but he was not helpful. This mother said “basically I was playing doctor,” as she searched in vain for ways to help her child gain weight and grow.

By 2 months of age, the baby was admitted to the hospital for failure to thrive. A feeding tube was placed to increase caloric intake and improve growth. I have spent many hours talking with parents of children with special needs who struggle with this agonizing decision. It is never easy. A nurse from the insurance company called to collect information about the supplies, such as formula, required for supplemental nutrition. Mom was so distressed about her daughters’ condition, she could not coherently answer her questions. As a result, the nurse mistakenly reported her to CPS for neglect and a caseworker was assigned to the family.

Once the tube was in place, the baby grew and gained weight over the next three months. At 5 months of age, mom wanted to collaborate with a tube weaning program to assist her daughter with eating normally again. A 10% weight loss was considered acceptable because oral re-training can often be quite challenging. As this infant weaned off the tube, no weight loss occurred over the next two months, though little was gained. She continued to have sweating with feeds and associated fatigue. On three separate occasions mom specifically inquired if something might be wrong with her daughters’ heart and all three times “Dr. Jones” reassured her “nothing was wrong with her heart.”

However, “Dr. Jones” grew concerned about the slowed pace of weight gain while weaning off the feeding tube. Not possessing the adequate knowledge to recognize the signs and symptoms of congestive heart failure in infants, he mistakenly contacted CPS instead. After being reported for neglect a second time, this mother felt as if she “was doing something wrong because her child could not gain weight.” This ended up being a blessing in disguise, however, because the same CPS worker was assigned and recommended seeking a second opinion from a local pediatrician.

On the first visit to the pediatrician, mom felt she was “more knowledgeable, reassuring, and did not ignore my concerns.” The physician listened to the medical history and upon examination, heard a heart murmur. A chest x-ray was ordered revealing a right-shifted cardiac silhouette, a rather unusual finding. An echocardiogram discovered two septal defects and a condition known as Total Anomalous Pulmonary Venous Return (TAPVR), where the blood vessels from the lungs are bringing oxygenated blood back to the wrong side of the heart, an abnormality in need of operative repair.

During surgery, the path of the abnormal vessels led to a definitive diagnosis of Scimitar Syndrome, which explains the abnormal growth, feeding difficulties, and failure to thrive. This particular diagnosis was a memorable test question from my rigorous 16-hour board certification exam, administered by the American Board of Pediatrics. If one is going to identify themselves as a specialist in pediatrics, they should be required to pass the same arduous test and have spent an equivalent time treating sick children as I did (15,000 hours, to be exact.)

A second take away point is to emphasize the importance of transparency. This mother was referred to a pediatric “doctor” for her newborn. His website identifies him as a “doctor” and his staff refers to him as “the doctor.” His DNP degree required three years of post-graduate education and 1,000 patient contact hours, all of which were not entirely pediatric in focus. His claim to have expertise in the treatment of ill children is disingenuous; it is absolutely dishonest to identify as a pediatrician without actually having obtained a Medical Degree.

The practice of pediatrics can be deceptive as the majority of children are healthy, yet this field is far from easy. Pediatricians are responsible for the care of not only the child we see before us, but also the adult they endeavor to become. Our clinical decision making affects our young patients for a lifetime; therefore it is our responsibility to have the best possible clinical training and knowledge base. Acquiring the aptitude to identify congenital cardiac abnormalities is essential for pediatricians, as delays in diagnosis may result in long-term sequelae such as pulmonary hypertension which carry with it a shortened life expectancy.

Nurse practitioners have definite value in many clinical settings. However, they should be required to demonstrate clinical proficiency in their field of choice before being granted independent practice rights, whether through years of experience or formal testing. In addition, the educational background of the individual treating your sick child should be more transparent.

Raising our children is the most extraordinary undertaking of our entire lives. Parting advice from this resolute mother is to “trust your gut instinct, and no matter what, keep fighting for your child.” Choosing a pediatrician is one of the most significant decisions a parent will make. This child faced more obstacles than necessary as a result of the limited knowledge base of her mid-level provider. A newly practicing pediatrician has 15 times more hours of clinical experience treating children than a newly minted DNP.   When something goes wrong, that stark contrast in knowledge, experience, and training really matters. There should be no ambiguity when identifying oneself as a “doctor” in a clinical setting; it could be the difference between life or death.

When it comes to the practice of medicine, the knowledge and experience required are so vast that even the very best in their field continue learning for a lifetime.

Some graduating nurse practitioners believe they are equally as prepared as newly trained physicians to care for their patients. The numbers, however, in hours of hands-on training and experience, simply do not back up that assertion. Physicians have at least 11 years of education after high school. By the time we set off to practice independently, we have had a minimum of 20,000 supervised patient contact hours. Depending on the type of training and school attended, a nurse practitioner has had a minimum of 500-1,000 supervised patient contact hours.

Niran Al-Agba, MD

 

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61 Comments on "MD vs. DNP: Why 20,000 Hours of Training and Experience Matters"


Member
Jun 7, 2017

I am a PNP in a 4 provider practice of 3 pediatricians and myself. We all consult each other all the time. It makes the most sense for excellent patient care.
My question is if this baby was admitted to the hospital for failure to thrive at 2 months of age , weren’t the cause of this failure to thrive investigated them? Her cardiac defects should be been found at that admission and work up! It sounds like this was over looked at this time also. The provider at 2 weeks of age should have been concerned about the symptoms described as tachypnea, sweaty, fatigue with feeding- these are never normal in 2 week old.
All health providers need to listen to the concerns of their patients and families. Mothers know their children best and have mother intuition. This child and family were mistreated by numerous health care professionals. Thankfully, the mother trusted her intuition and went to a different provider which recognized the problem. An experience Pediatric Nurse Practitioner would have been able to recognize this babies symptoms and taken action.

Member
Jun 3, 2017

Super interesting discussion. I just graduated a FNP/DNP program, but the culture of the program didn’t necessarily promote the idea of pretending to be on par with MDs/DOs. In fact, lots of us advocated for a residency or fellowship process. Unfortunately, there is rarely financial or university backing for establishing one.

The program I was in and the clinical sites I did rotations in simply supported us to do what we *can* do, to the best of our ability. Meaning, if we hadn’t been thoroughly trained to do a procedure or make a certain diagnosis, we defer to those who can. In my experience, there was never any expectation of taking responsibility for the broader knowledge of the physician specialist. Our lab coat embroidery reads, Firstname Lastname, DNP, FAMILY NURSE PRACTITIONER. I think that’s super important.

In my clinic, the NPs and MDs very much work cohesively together. The NPs consult the MDs for things outside their training and expertise, and the MDs consult the NPs on things NPs *are* experts at-like patient care delivery. Having 17+ years at the bedside as an RN brought wonderful insight, and assisted me in the beginning of FNP training. But those RN years were *not* spent in the provider role-a COMPLETELY different role. By the end of my FNP training, my RN years actually wound up limiting my thinking in some ways.

As one of my professors, who started out as an MD, then later got his NP/DNP also said, “NPs better be careful what they’re pushing for…they just might get it, and then some.” Meaning, ultimate responsibility is overwhelming, and NP training is not designed for that type burden.

Super important to keep the dialogue open on this topic.

Member
Jun 3, 2017

Thank you so much for your insightful comments. This is exactly the kind of dialogue we should be engaging in. It would be ideal to collaborate and work together. We all should know our limits for the sake of patient safety. I think your MD/NP is right on. He knows enough to be worried, so am I.

Member

Physicians seem to forget that DNP has had hours and hours of practice at the bedside as RNs Prior to the additional hours in advanced practice education . RNs are not taught to diagnosis but still learn pathology,anatomy,treatment of disease,pharmacology as well as rotation in several areas; pediatric.obstetrics,psychology,internal medicine and others. Nurses are also taught to focus on the whole patient not just the disease.Can you explain to your readers why outcomes of patients who are cared for by advanced practice nurses have just as good outcomes or in some cases better. NP and MDs are held to the same standard of patient care. The focus should be on the patient and the outcome. We need to work together for the patient,collaboration has been shown to give the best outcomes. The model with the physician “in charge” dose not work well for the patient. Trying to insight fear and worry about names appears that focus is on someone beside the patient.

Member
May 31, 2017

No one is forgetting the fact that some ARNP’s or DNP’s have had hours of bedside experience, while others have not. What this post is pointing out is #1, they should have that experience prior to going out independently and #2, they should be honest about their educational background. I do not think those are unreasonable suggestions.

No one is trying to incite (not insight, btw) fear. The focus should absolutely be on the patient and the outcome. To that end, in this particular case, the DNP did not have many hours of bedside experience, did not specialize specifically in pediatrics prior to independently practicing, and was not forthright about his educational background. Doesn’t that concern you? Would it concern you more if it were an MD/DO opening up a pediatric practice when they completed training in internal medicine?

Member
Jun 1, 2017

I think that the DNP did not practice good medicine period. As a new PNP I would have realized something was wrong and gotten to the bottom of it asap. There was no critical thinking done on the specific part of this DNP. It was not about level of education or experience-it was lack of critical thinking. I know plenty of doctors with 20000 hours of clinical experience that still do things like this and I do not think that degree makes a difference.

Member
Jun 1, 2017

You are correct this is an example of not practicing good medicine period. I have been surprised that more PNP’s have not jumped up and down about this. He was not as qualified as a PNP to be managing pediatric patients. Isn’t that the whole point of becoming a PNP, so you can work in pediatrics?

Member
Allan
Jun 1, 2017

Are you trying to say that a DNP is as likely as a physician to be able to adequately treat all patients?

Member
May 31, 2017

I am also soon to be NP and have had ~40,000 hours hands-on patient care – way more than any physician. And physician’s 20,000 hrs of “training” are not even comparable to hands-on care of a patient at the bedside, learning subtle cues and trusting your gut when something isn’t right. The MD or DO “training” isn’t the same. There are terrible NPs, PAs, MDs and DOs, and there are also exceptional ones in every field. Don’t generalize. To be dismissed this way is ridiculous – why can’t we all collaborate to fulfill the increasing demand for providers and support each other?

Member
Jun 1, 2017

40,000 hours of patient care at 60 hours per week is equal to almost 13 years of practice. I believe you are making my point for me. I am not sure it is more than all physicians as you said, being that many had 20K in training plus have been in practice for 2-4 decades on top of that. However, the larger point is someone with clinical experience at the bedside, examining, diagnosing, and making treatment decisions is a good candidate for independent practice.

The point of the piece is #1 bedside experience matters whether that be as an RN, MD, DO etc. and #2 transparency is important regarding education. Those seem like reasonable suggestions.

This piece did not generalize, it actually focused on one story and one particular practitioner. No one “dismissed” NP’s as an entire group in any way, shape or form. Why couldn’t this individual have asked for help? (from someone besides CPS) Why did he not realize he was out of his league?

Member
concernedcitizen
May 30, 2017

In the modern age (in which we live, now), the term Doctor is a clinical title, when used in a clinical setting. When someone says, “I finally went to see my doctor this morning about my knee pain,” it’s understood that she isn’t referring to the academic PhD who lives down the street. It’s disingenuous to suggest otherwise, and the only people who are suggesting that “Doctor” in the clinical setting should be obscured are people who do not hold a medical doctorate and are trying to trick patients into thinking that they do.

Member

The term is physician

Member
jorge512
May 31, 2017

I have yet to meet a doctoral prepare nurse who wants to pretend to be a doctor or to suggest they are one. once we realize that the title Dr. is a legal term given to those who have earned the highest educational degree in their perspective field the territorial concerns will be significantly diminished.

as i have stated before no one owns the title of Dr. and no one can stipulate how it is used.

now the thing is that over many years the term Dr. has been associated with medical doctor but if we begin to address everyone that has the title of Dr. for those who have competed a doctoral degree in any setting the patients will begin to become educated and realize that the title Dr. is not only for medical Dr’s who as clarification have a doctorate in medicine.

as time passes the patients will begin to associate the title of Dr. with someone who has achieve the highest degree in their perspective field and will learn to ask, read name tags to see what level of care they are receiving.

i also want to add that the board of registered nursing has specific legal requirements that all nurses must have a name tag that clearly identifies in what capacity they are working.

for example in the clinic i work dnp’s are given a nametag which clearly identifies their legal title Dr. name and underneath the capacity they work under in my case it clearly in bold letters has the words nurse practitioner.

in our meetings we all address each other as Dr. in the clinical setting along with our name tags we call ourselves Dr. and add what capacity we work as.

i assure you that there are no doctoral prepared nurses who want to pass themselves as a physician.

also, as stated before, no one owns the title of Dr.and as a result cannot apply restricitons on how it is used.

finally, we can all begin to educate patients what the title of Dr. signifies and as time passes the title of Dr. will simply mean what it is intended to mean… a person who has achieved the highest level of education in their particular field. the title of Dr. is not exclusive to medical doctors.

Member
May 30, 2017

Concerned citizen, I couldn’t have said it any better than that! Exactly correct.

Member
May 30, 2017

*Sigh* So my response to Michael is the discussion is about DNP’s practicing independently in a private clinic setting. It is suggesting transparency be important for patients when choosing a private practice and that there is a significant difference in hours of experience prior to earning the ability to be independent.

Maybe you are too young to remember back when many of us trained, but we easily worked 100 hours per week on average, meaning many weeks we put in longer hours than that. Yes, we received 2 weeks vacation per year, so the calculation is correct multiplying by 50 weeks per year. We worked holidays, weekends and each month with a Saturday call we worked for 14 days straight. My longest stretch was 21 days without a single day off and that happened 3 times in three years. We did not attend out of town conferences; I missed my best friends wedding! If I was sick, I pulled an IV pole with fluids alongside me while pre-rounding on patients. I keep hearing non-physicians comment that the hours are unreasonable. Of course they were unreasonable! However, they were not illegal and therefore, this is not only possible, it is what most of us have actually done.

This is fact, my dear boy, not fuzzy math. You can continue to use a single, narrow example such as anesthesia, however pediatrics (which this post is actually about) is one year of internship and two of residency — all involving children. A DNP is not a pediatrician. Again, straightforward and simple fact.

Member
jorge512
May 30, 2017

Doctor is an academic title that originates from the Latin word of the same spelling and meaning. The word is originally an agentive noun of the Latin verb docēre [dɔˈkeːrɛ] ‘to teach’. It has been used as an academic title in Europe since the 13th century, when the first doctorates were awarded at the University of Bologna and the University of Paris.
This use spread around the world with European universities. Contracted “Dr” or “Dr.”, it is used as a designation for a person who has obtained a research doctorate (e.g. Ph.D.). In many parts of the world it is also used by medical practitioners, regardless of whether or not they hold a doctoral-level degree.
The primary meaning of Doctor in English has historically been with reference to the holder of a doctoral degree. These particularly referred to the ancient faculties of divinity, law and medicine, sometimes with the addition of music, which were the only doctoral degrees offered until the 19th century. During the 19th century, Ph.D.s became increasingly common in Britain, although to obtain the degree it was necessary to travel to continental Europe or (from 1861) to the United States, as the degree was not awarded in the UK until 1917.
Regulation of the medical profession also took place in the United States in the latter half of the 19th century, preventing quacks from using the title of Doctor. However, medical usage of the title was far from exclusive, with it being acknowledged that other doctorate holders could use the title and that dentists and veterinarians frequently did. The Etiquette of To-day, published in 1913, recommended addressing letters to
By the 1920s there were a great variety of doctorates in the US, many of them taking entrants directly from high school, and ranging from the Doctor of Chiropractic (DC), which (at the time) required only two or three years of college-level education, up to the PhD. All doctoral degree holders, with the exception of the JD, were customarily addressed as “Doctor”, but the title was also regularly used, without doctoral degrees, by pharmacists, ministers of religion, teachers and chiropodists, and sometimes by other professions such as beauty practitioners, patent medicine manufacturers, etc.
The title of Dr. is a legal title given to an individual who has completed the highest level of education in their field. Furthermore, Throughout much of the academic world, the term “Doctor” refers to someone who has earned the highest degree from a university. This is normally the Doctor of Philosophy, abbreviated PhD (sometimes Ph.D. in North America) from the Latin Philosophiae Doctor or DPhil from its English name.
To conclude no one owns the title of Dr. Also “doctor” is Latin for “teacher” and the title originally had no special connection with medicine. Instead, a doctor was anyone qualified to teach at a university (in medieval Europe teaching qualifications were typically determined by the church). The concept of a formal PhD degree came much later, but it continued this earlier terminology.

Dr. Jorge L. Trujillo, DNP

Member
May 30, 2017

Absolutely agree the term is an academic title when in an academic setting. In a private clinic setting, it does not seem to be about teaching; otherwise patients would be informed about the difference between different educational backgrounds of “doctors.” The DNP in this story was not teaching at a university; he was calling CPS on a mother while missing the case of heart failure due to congenital heart disease sitting in front of him.

Member
jorge512
May 31, 2017

the are two issues in the story: one is a concern of who uses the title of Dr. and secondly someone misrepresenting themselves as a medical Dr. anyone who misrepresents themselves should be prosecuted to the fullest extend of the law.

correction Dr. is not an academic title. Dr. is a legal title given to a person who has achieved the highest level of education in their given field (e.g. doctor of dentestry, doctor of veterinary medicine, doctor of education, doctor of medicine, etc).

Member
Jun 1, 2017

Doctor is an academic title denoting level of education. The legalities of using it are variable dependent upon in which country one lives. The point of this piece is that one was misrepresenting themselves as a medical doctor and not clarifying they were a nurse practitioner.

There really isn’t a concern about who uses the title if they have a doctoral degree; it is more about the setting in which they are using it without clarification. The second issue in this story is that someone who completes a DNP in general family medicine should not be billing themselves as a pediatric expert. It is dishonest. BTW, it is Dentistry, not Dentestry.

Member
May 30, 2017

*SIGH* Always with the fuzzy math.

ASA Claims of 12000-16000 hours of training and that CRNAs get an average of 1651 hours.

Lets start with the ASA Claims of 12000-16000 hours

So if they meant their residency in anesthesia that is only 3 years which is a total of 26,280 hours counting every hour in that 3 years.

With their claim of 12000 hours that would mean they would have had to work 11 hours every single day for 3 years straight. (365 x 3 = 1095, 12000/1095 = 11/day)
With their larger claim of 16000 hours they would have had to work 14.6 hours every day for 3 years straight. (365 x 3 = 1095, 16000/1095 = 14.6/day)

Now if they consider the hours of their intern year (PGY 1) which has nothing to do with anesthesia it might be a little more possible but still outrageous.

With their claim of 12000 hours that would mean they would have had to work 11 hours every single day for 3 years straight. (365 x 4 = 1460, 12000/1460 = 8.2/day)
With their larger claim of 16000 hours they would have had to work 14.6 hours every day for 3 years straight. (365 x 4 = 1460, 16000/1460= 11/day)

So when we review their clinical gross hours it is still quite unreasonable that they could possibly do 12000-16000 hours in either 3 OR 4 years (if we include the irrelevant intern scut monkey year). This would mean:

· They never took vacation
· They never took a day off for other educational opportunities (conferences, lectures etc)
· They never had a SINGLE DAY OFF during residency and intern year.

What we know is that the RULES say a resident cannot work more than 80 hours in a week. That is the rule. Therefore:

3 years of residency straight through maxing the 80 hours a week would be a total of 12480 hours. (52 wks/year x 80 = 12480).
This assumes no days off, no vacations, working an average of 11.4 hours PER DAY 7 days a week.

Again this does not appear reasonable or possible.

Per the UNC chapel hill residency program (https://www.med.unc.edu/anesthesiolo…y/copy_of_FAQ) here is what they say residents ACTUALLY do:

· Average 55 hours/week
· 2-3 weekends off a month
· When not on call, residents are typically relieved from the OR by 4:30pm
· 3 weeks off each year (15 working days) (weekend off before and after for 9 days off in a row)

5 sick days/year
5 days each year for attending national meetings and conferences

· Each resident will far surpass the minimum number of cases required by the ACGME and can expect to do more than 1,200 cases during their three years of Anesthesiology training. THERE IS NO CASE MINIMUM.

So now lets do the math with that information.

· 365 days a year – 5 sick days = 360
· 360 – 5 meeting days = 355
· 355 – 15 weekdays of vacation = 340
· 340 – 48 days (2 weekends a month off) = 292 or 340 – 72 (3 weekends off) = 268

So what we see here is that a resident could only possibly work between 268-292 days in a year and that depends on how many weekends off they get per month (2 or 3). So to be fair we will average the 2 and call it 280 days worked a year. Now lets do that math.

· 280 days per year worked / 7 days a week = 40 weeks worked a year
· 40 x 55 hrs/week = 2200 hours worked per year.
· 3 years x 2200 hours = 6600 hours worked during residency.

What we see here is the REAL amount of clinical time gained during an anesthesia residency. This 6600 hours does not include all the time spent at M&M meetings, resident meetings etc. However, we will forgive that and pretend that a resident spends 6600 hours in anesthesia clinical time over 3 years. We are also not removing the hours which could be spent during residency doing an ICU rotation.

What we now have to consider is how many cases residents do. The UNC program said more than 1200 cases in general for their ENTIRE residency. It is difficult to get exact numbers but the Stanford program does give averages which one can assume since most do not are higher than the average program. (http://med.stanford.edu/anesthesia/e…residency.html)

· Stanford: 600 anesthetics in the first year, 400 cases in each of the next two years
· That is a total of 1400 cases

A resident has an average of 6600 clinical hours in their entire 3 years so then one must do the calculation to figure per case hours.

If they counted hours like CRNAs do (time in the OR only) then the average case time would be 4.71 hours. (6600/1400 cases).
Clearly this is not the case, so one must conclude the 6600 hours are simply hours IN the hospital as a resident not actually doing cases.

So now lets look at CRNA education and do the same calculation.

· CRNAs are required to have a min of 600 cases in their training period
· Many Student CRNAs average 900 cases (like Stanford this is the higher end)
· CRNA programs are 2.5-3 years in length

Out of the 2.5-3 years of a CRNA program 1.5-2 years are spent in the OR doing cases, lets use the same numbers as UNC therefore:

· 280 days per year worked / 7 days a week = 40 weeks worked a year
· 40 x 55 hrs/week = 2200 hours worked per year
· 1.5 – 2 years x 3300 – 4400 hours during a CRNA training program

What are some caveats?

CRNA programs do not rotate 1-2 months in ICU but residency programs count these hours.
CRNAs come in with a minimum of 2080 hours of work experience (1 year full time) which would bring the “clinical hours” total up to 6080. The average CRNA has 2.5 years experience prior to anesthesia school which would push it to 5200 + 4400 = 9600 hours of ‘clinical hours’.
CRNA programs currently ONLY count hours doing an anesthetic not the time you are waiting between cases or just being in the facility (the MDA programs count it all)
It is clear that the ASA has chosen to count all the education from beginning of med school (and possibly pre med) to the end of residency (to reach 12000-16000 hours) and yet they do not count the same for CRNAs to minimize numbers
These calculations do not include holidays where less providers are needed in the OR and therefore many residents and Student Nurse Anesthetists could be off.

Conclusions:

The ASA claims of 12000-16000 hours of anesthesia training are considerably exaggerated
The ASA claim that CRNAs only get 1651 hours is impossible

THIS is the masters program, there are more hours for the DNP.

Member
Jun 3, 2017

Hmmmm…. Mike, it’s good to know this information. Puts your comments into better context. https://forums.studentdoctor.net/threads/rn-to-do-comments-suggestions.214665/

Member
Steve2
May 30, 2017

Dude. Your math skills suck. Really, they absolutely suck. Granted, I have a near Putnam scholar as a son, and we love math in our house, but this is awful. Anyway, hours worked vary by residency. Some adhere closely to the 80 hours/week, some don’t. And, no one really takes sick days. In the old days when I trained we really did start elective cases after midnight, on days when you were not on call. We averaged a bit over 120 call days/year, and averaged well over 100 hours /week. In theory we had 2 weeks off per year. In reality you didn’t always get the second week. You worked post-call. (Did my first thoracic aneurysm after doing 48 hours straight of call, granted I did get a few (meaning 3 or 4) hours of sleep.) So, NIran’s claims are possible. (Though I don’t remember residents at CHOP putting in anything like those kinds of hours once they were out of internship, though their hours were much, much longer than the internal medicine guys. They actually had time to moonlight!)

Member
May 30, 2017

Yep. You pretty much described my hours during residency minus the thoracic operations. Maybe CHOP had fewer hospitals to cover. 18 residents to cover 3 hospitals. University, children’s, and county hospital.

Member
dr.md12
May 30, 2017

1st year surgical internship 80 hr work week was a light week. ACGME rules are suggestions as anyone in medicine knows….. 20days off but worked 6am to 6pm post call. We did have an hour of lecture on Thursdays. I exceeded SRNA central line requirements at the end of the second month and also did a few trachs
52wks*80hr*3yrs for the remaining years is greater than 12000hr. We had core lectures of approximately 2-4 hrs a week, usually be senior staff within the rotation. I also wrote a book chapter and published 4 articles, writing mostly at 2am oncall on down time.
What is a sick day? Any time taken not as a scheduled vacation was either an extra 24 Saturday or tacked on at the end of residency. No exceptions.
Don’t underestimate my work. Every bit counted. Internship was learning how to recognize crisis and utilize the chain of command. Hours outside of the OR were used to take histories and optimize patients.

Member
May 30, 2017

Your garbageman is now an “Environmental Management Professional.” The ZIPcode Wilmington “bootcamp” now promises to churn out “Professional Software Engineers” in 12 (albeit 100 hr wk) weeks — no prior experience necessary.

Not making that up:

http://regionalextensioncenter.blogspot.com/2017/03/12-weeks-1200-hours-and-12000-and-youre.html

Member
Perry
May 30, 2017

Right. Doctors are now Medical Data Entry Specialists.

Member
Whuds1
May 30, 2017

I have read a lot of People defend DNP, Nurse Practitioner education hours as the similar to Physician training. It clearly is not. I Have been an RN since 1989. Graduated Medical School in 2011. I went to medical school instead of Nurse Practitioner training simply because the course outlines and the training was not the same as Medical School.

I strongly contest the notion that practicing as an RN gives me the same experience compared to a Medical Residency. Except for being in the same clinic and or hospital, there are vast differences between both. Nursing school did not prepare me for the level of practice of a physician. The course work in Nursing school is not the same as Medical school. Some of the subject matter is presented differently, from a nursing not a medical perspective. During Nursing School clinical time was a day an half a week not 24/7 during clerkships and not with physicians but nurses. We are taught care delivery not diagnosing and treatment. I practiced as a trauma nurse, ICU nurse and home care nurse during my career, non of this translated more than 50 to 60% into being a Physician for Patients, there was large gaps in my knowledge and experience despite the vast hours of working for 20 years gave me.

I get emails every week telling me I can go straight into DNP as an RN online from such schools as University of Arizona
http://www.nursing.arizona.edu/dnp

You can enter the DNP as a post-Bachelor of Science in Nursing (BSN) student or a post-master’s (nursing) student. Part-time and full-time options are available. Nurse anesthetist students must attend full-time.

The BSN-DNP curriculum is a 74-89 credits depending upon the practice specialty selected.
The MS (Nursing)-DNP curriculum to become a nurse practitioner (NP) is 71-74 credits depending upon the practice specialty selected. Most students will be able to transfer coursework to reduce the total number of credits needed to complete degree requirements.
The MS-DNP curriculum for those who already are NPs or CRNAs is a 43-credit program.”

These programs are not similar to medical school and the idea that this “Short cut” into practicing medicine” with the expectation of Physician level practice equality is problematic.

I see Nurse Practitioners as a vital part of the health care team. The push to be seen as equal to Physicians is misplaced in my opinion. Nurse practitioners should continue to put their efforts into working as part of the medical team, Physicians, Nurses, and pharmacists towards the goal of quality Patient care. WH RN MD.

Member
pjnelson
May 30, 2017

I suspect that Primary Healthcare will eventually be capitated with an associated all-other, stop-loss protected risk-pool. I wonder how many nurse-practitioners would be willing to take that on as an independent practice or even be allowed to participate. Medicaid support by the Federal government for state by state management of its Medicaid-eligible population might be the starting point. As a matter of professional priorities, I had a nurse practitioner as an associate for 20 years. Her nursing traditions kept us all “humble.”

Member
May 30, 2017

Dr. Nelson – We should all be humbled at every stage in health care period, from the CNA all the way through the ranks. That is not the point of this post. It really is about the importance of transparency. It is also a first step to asking the question of why DNP have independent practice rights and insurance contract abilities without MOC or other ridiculous regulation, for example. In Oregon, if they are going to pay the same rates for both, we should think about changing our designations as MD’s in order to side-step the MOC requirements after all. That is where I am heading with this….

Member
Jun 1, 2017

I realize that this may be an entirely separate can of worms, but what about the practice rights in Washington state of naturopathic physicians? Naturopaths get to call themselves “doctor.” Eek.

Member
Jun 2, 2017

Interestingly enough, Naturopaths tend to identify themselves as such quite readily. This is my larger point of concern. If someone owns a clinic, say Washington Pediatrics, then patients assume the “doctor” there is actually an MD/DO who completed training in pediatrics. Whereas, the “Natural Clinic” makes things a little more obvious that the “doctor” is not an MD/DO and likely a Naturopath. It is the same with most chiropractors, their business names are reflective of their specialty in general ie “Jones Chiropractic” so when a patient arrives they already realize they are seeing a Chiropractic Doctor. My real concern is transparency