Fruitology: In California, the Doctor is out

This blog is not directly about the article per say, but about a particular comment that shows a systemic fallacy in thinking among individuals who believe full practice authority among nurse practitioners (NPs) is needed. Often there is the belief that the training of physicians and NPs are equal. Often training hours are used for comparison. Having been through RN school, NP school and medical school, I can assure you that training hours cannot be used to establish equality in training. They can’t even compare. Hence, the fruitology: Apples and oranges. Maybe it’s conscience or unconscious fallacy or even a delusion, but they are not the same thing. The comment is this:

There is also the argument that NPs have less than 1000 hours of clinical hours which is not true. Most NPs actually have more that 500-1000 hours. I personally had 700 hours in my RN program, 5000 hours as an RN in emergency and ICU and 800 hours in my NP program. Plus I worked closely with a mentor for the first year after graduation which is another 1600hours.

            Here’s the fruitology. Physicians are apples. Apples are trained in the medical model where everybody system is broken down to the molecular, biochemical, and genetic level and built back up with normal anatomy and physiology and abnormal anatomy and pathophysiology, and then diagnosis, pharmacology, and treatment, evaluation, patient education/counseling, and disease prevention. Apples are further trained in the medical decision-making process. Apples are trained to practice medicine with thousands of clinical hours in medical school and thousands upon thousands of clinical hours in residency. All apple training to be apples. Nurse are oranges. Still a fruit (healthcare), but trained in the nursing model and the practice of nursing. The diagnosis and treatment of human responses actual and or potential health problems. Trained in the nursing process: assessment, nursing diagnosis, planning, implementation of interventions, and evaluation. Oranges are trained in nursing theory. Undergraduate clinical hours are nursing clinical hours and RN practice hours are nursing clinical hours. Up to this point apples practice apple clinical hours and oranges practice orange clinical hours. You cannot make the jump from orange clinical hours counting as experience for apple clinical hours. Now add the NP graduate education. Still nursing theory oriented, heavy on nursing theory study and papers and statistics and nursing research. Considered to be advance practice nursing – hence the letters I use to have behind my name called “APRN” (advance practice registered nurse). Sort of like an orange on steroids. While NP education may train in disease diagnosis and treatment (here’s the big lie – calling it advance practice nursing but really a disguise to practice medicine). In other words, an orange trained on steroids to be a super orange, to put on a disguise to play the role of an apple. A problem is that it is still not trained in the medical decision-making process. So an orange trained in orange theory playing the role of an apple – can you really count these clinical hours as that of an apple? No. Apple training is medical theory. Orange training is nursing theory. Playing the role of an apple with an orange operating system is still an orange. So the above quote outlining all the orange clinical hours and equating it to apple clinical hours is a fallacy. Have a blessed day. 

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Robert Duprey MD

Robert is a 2nd career physician (MD); a combat Veteran with the US Army; a former psychiatric nurse practitioner; an independent researcher; a medical writer; and now having passed USMLE Steps 1, 2CK, 2CS, and 3, is a residency applicant. 

  4 comments for “Fruitology: In California, the Doctor is out

  1. Jesse Belville,PA-C
    September 15, 2020 at 8:04 pm

    Very good.
    NOT NURSING,I applaude this clear article.
    Now ,nationwide go to every state legislator,every federal legislator,every agency to get laws changed,policies (like at VA), changed to provide Physician supervision..
    My national PA organization is pushing Team Practice but it to is another path to independent practice. I Oppose that. I am a PA-C, I chose to be a PA-C.Ilovewhat I do,Irespect my supervising Physican,my job is to handle his routine cases, and alert him/her if there is a problem.Along the way I get more training,more knowledge and am a valuable asset tothe practice. I like that,improving access to care,timeliness of care,quality of care. Entering my 44th year. It is still as much Fun as when I started. Got to do 6 more years then go get a real job….Lol.

  2. Natalie Newman, MD
    September 15, 2020 at 1:42 pm

    Love the elaborate analogy. Excellent… and accurate.

  3. Benjamin Van Raalte
    September 15, 2020 at 11:08 am

    My training. Undergraduate biology and chemistry which I would not dismiss, plus a stronger high school curriculum than most nurses. Medical school 3000 hours a year x 4 years. Plus additional summers of clinical experience. Residency 7 years of 5000 hours of clinical experience. Thus 40,000 plus hours of clinical education, and another 10,000 plus hours of education. That does not compare to APN with 4000 hours of education and 10,000 hours of employment and perhaps 1000 hours of clinical education.
    Not at all.
    Yet I compete with APN many of which end up either care over their head, or for pure monetary gain. Note the APN becoming Botox injectors. This is all about money, and the next argument is they deserve the same pay as physicians for the same service despite less training, less hours, and less debt.
    What we might see is a massive shift then of the brightest going to nursing school because they can make the same money with less training.

  4. Alfred M Jr Sadler
    September 15, 2020 at 8:50 am

    Excellent distinction between nursing and medicine – would like to see this expanded even more.
    PAs on the other hand are trained in the medical model – always have been. They don’t want to be independent practitioners separate from medicine but rather part of a team.

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