Three years ago, I wrote about the Dunning-Kruger effect, the phenomenon that makes beginners overestimate their abilities.
Fellow physician blogger Niran Al-Agba and Rebekah Bernard, MD are now on a crusade against Nurse Practitioners and Physician Assistants. They are implying that perhaps those professionals are more dangerous than doctors because of the Dunning-Kruger effect.
A beginner is a beginner, regardless of educational level, and even after years in practice there are strong clinicians and weak clinicians. I have seen Physician Assistants and Nurse Practitioners deliver better care than physicians.
The indisputable fact is that we have people with different educational levels delivering health care in this country. It gets us nowhere to argue an end to what used to be called midlevel practitioners. Instead, we need to face the facts that sometimes the wrong people are admitted to NP or PA school and once there, are often given the wrong messages during their training. And, possibly more important, sometimes the wrong staff category are placed in the wrong professional setting.
Diagnosing and treating common symptoms like abdominal pain, cough or headache are the hardest and most treacherous things we do in medicine. It takes more to do that than to do a routine physical, annual wellness visit or diabetes followup.
But what do many clinics do? They have their senior clinicians do the chronic care and their junior or less educated clinicians work the frontline triage functions.
I wrote about this six years ago in a two part essay titled It’s Time We Talk: Why Should Doctors Treat the Well and Nurses the Sick? (Part One and Part Two.)
There, I’ve said it again: Teach humility and put the right people in the right position in health care!
A Country Doctor Writes: 
No one is “bashing nurse practitioners.” Were rightfully pointing out the reality of their complete lack of training and education in what they do, and the fact that they consistently can’t even treat a UTI correctly, let alone anything more complex. If you point out that even doctors can make mistakes, you’re really just making the argument against nurse practitioners even more.
Dr. JDK, you’re talking from pure ignorance! I was misdiagnosed by several doctors. I know of NPs who are more qualified to be in healthcare than some doctors you considered well educated. The way you talked, I doubt you’re a real doctor. NPs follow the right protocol and get right results. Not only waa I misdiagnosed by several doctors, I was also given wrong medication. Take that and talk about incompetency among well educated doctors!
On whole, modern medicine is a disaster and covid proved just how much of a dumpster fire it really is….imho. There are both NP and MDs who are very very bright and some that are dumber than a stone. Given that NP and PA are here to stay …makes sense to try to help them deepen their well of knowledge. We are all in this fiasco called modern medicine together now.
👍
You are incorrect. I have been working with patients for 45+ years and as a NP for over 23 years. I am sorry that you feel threatened by people that can enhance your practice. That says more about you and not us. There are bad MDs,DOs, NPs and PAs. In my practice, I see patients and forward those. needing more care or surgery to the appropriate provider. That is the way it should work. Your senseless argument would leave many without care. Those that can’t afford care, travel to certain specialties, understand when you talk at them instead of with them. I don’t know you personally but I think you forgot that this is about the patient not your kingdom.
The NP’s and PA’s I have worked with (USAF and VA) have not at all been like what DrJKH describes. With much of routine medical care (diabetes, hypertension, etc.) being protocol-driven, they follow the same processes we do and get the same results. Yes, the wrong people sometimes get into NP/PA school, but some also get into MD/DO school too–I have dealt with them. How they managed to graduate I can’t tell, but they did. BTW, my Primary Care provider is an NP. I am basically healthy, visit once a year. Why take up a doctor’s time?
I see facts aren’t your strong suite. I promise you they’re ALL EXACTLY as I described. A lot of it is because they blindly follow protocols and “guidelines” because they have no education. I’ll bet if you came and got worked up by me, you’d find out you have medical issues that may not have bothered you yet, but eventually will. But any midlevel or any doc uneducated enough to blindly follow protocols and “guidelines” will NEVER find these problems. We keep dumbing medical education down for the worst, and the biggest part of that is letting uneducated people do physician tasks because they seem easy and hey, Didja die?
Remember, you can train a monkey how to cut (or prescribe), but you can’t train a monkey WHEN to cut (or prescribe)!
Wow do your research — many many excellent studies show that YOU don’t monitor and read the “facts” Maybe you want to care for everyone and are perfect? I think NOT! Stop your ignorance and bias and get read the research! NP and PA are an important part of the medical community caring for many who would otherwise not get care. Also, you should be ashamed of yourself for calling a colleague a monkey are you even licensed? Have you been drinking or are you just dangerous… I bet you don’t even believe in masking or COVID with that attitude. KNOCK it OFF!
Sure there are some that are not cut out for internal-medicine-type of diagnostic complexity, but your statement that they are “ALL EXACTLY” the same is gravely incorrect. Tell that to the woman who went through 2 physicians over 7 months with weight loss and abdominal pain, and within 3 days I (a proud and shameless NP) had her promptly and accurately diagnosed with celiac artery compression syndrome and set up with a surgeon that was comfortable to surgically treat the case (not the most common of cases as you must know). She has gained her weight back within months and is back to normal activities without abd pain. Brief case study but only 1 of many (let’s say 7-10 other blown off or inaccurately diagnosed cases by MD/DO/NP/PA, could be anyone) I’ve had the pleasure of providing newfound excellent care to. Funny how a good physical exam and excellent rapport with the patient during interview will most often bring you to the correct testing and confirmed diagnosis, when many clinicians (NP/PA and MD/DO alike) breeze over it to get the patient out, and collect the RVUs at the door. I’m privileged to work with a team of clinicians of all aforementioned titles that I would trust to provide most excellent care to myself or a family member.
You may want to retire so you don’t rupture an aneurysm when in 10 years NPs and PAs make up a large majority of primary care. I do think preparation standards and license and certification exams should be increased as the responsibility increases.
Well said.
While I understand your frustration DrJKH, I have to let you know not all NPs are the same just as physicians are not all the same. Part of our education besides “following protocols” is to think outside of the box. Being in practice as a NP for over 16 years (RN for over 25), I have found things my physician colleagues have not in caring for inpatients and outpatients. The physicians I work with see me as a competent member of the team, but they also know I will call on them when something is out of my scope.
Please know, I do not claim nor do I want to be a physician but I love being a nurse practitioner that is trusted by the physicians I work with that know I can think outside of the box while saving lives.
Please know DrJKH I understand your concerns with who is allowed into these programs. When I went to school, it was a different than what it is today.
I’m sorry you’ve had a bad experience (I guess) with NPs and PAs, but I hope you meet one that will change your point of view.
All the best and happy new year!
Tanya Bronzell-Wynder DNP, CRNP, NP-C, ANP-BC, AGACNP-BC, FNP-BC
Tanya, I was going to write my own original response but you covered what I wanted to say perfectly.
A happy and healthy new year to you as well.
Kathleen Brady, RN, ANP-BC, APRN
Thank you Dr. Bronzell-Wynder. I don’t know why some folks value one profession over another. I am a practicing NP with a PhD who is also an NP educator. I can assure everyone, the educational requirements are quite rigorous.
I agree- I may have come off a little aggressive in my reply, but there may have just been some very poor experiences driving the opinion. If I have nothing but poor experiences, I’d probably share the same outlook.
Our NP education is very focused- on what we need to do. As a primary care NP, I don’t need extra hours for surgery, delivering babies etc, my dtr is a MD and I saw all the extras that she will never use- and some things were less rigorous that what I had to learn. But I agree some graduate from all medical professions with no humility and think they are Gods gift to health care!
You don’t know what you don’t know… But I do! And I see all of you giving 10 days of cipro for a simple UTI in a teenage girl. I’m sure you’ll deny it, but it’s one of COUNTLESS examples!
Ok now I’m laughing. I’d deny it because I’ve never prescribed that regimen in any scenario remotely close to that.
~NP
DrJKH – You’re a terrible doctor if you are even really a doctor and an idiot at that!! And writing what you did, just shows how pathetic you are. You’re patients probably left you for a nurse practitioner and that’s why you are so salty towards us. Grow up and get a life!!
What a mature response Lora! And MUCH more telling about yourself and the side of the argument you’re on. 😉
Those who live in glass houses shouldn’t throw stones. And any respectable physician I know wouldn’t insult the profession of nursing as you did.
Yet here you are, throwing stones in your glass house because you don’t like facts. 🤦♂️🤦♂️
When I initially became an NP, one had to have been an RN for at least 10 years. I had been one for 20 years and it was the physicians with whom I worked that put me Through NP training and paid me while I went! I have diagnosed patients with conditions that they went to specialists for for 3-4 years in one 15 min visit, ie trigeminal neuralgia in a patient who had been to neurologists, neurosurgeons, psychiatrists, dentists etc. She actually wrote a newspaper article about how NPs are not given enough credit. I do not follow JUST protocols. There really are not protocols for the endocrine practice in which I work, but I follow Best Practices if they coincide with what I am seeing in person. You must be an insecure doctor to doubt the value of NPs. I am sorry for your patients. I practice within a team of wonderful doctors who value my expertise and years of experience. (now 20 years in endocrine)
My NP wife diagnosed a pheochromocytoma…
Over the years, I have been privy to some strong opinions on both sides regarding the competency and roles of nurse practitioners and physician assistants; however, the level of vitriolic hatred being spewed by a particular (presumed) physician in the comments probably takes the cake for the most passionate but baseless stance. It brought to mind some Oslerisms that continue to bear relevance in medicine and life in general to this day. Relax, DrJKH, Sir William Osler was a physician himself, not a brainless automaton programmed to unilaterally prescribe Cipro to teenage girls (though I have yet to encounter a practitioner like this), so maybe these aphorisms will give you pause.
1. “Perhaps no sin so easily besets us as a sense of self-satisfied superiority to others.”
2. “The greater the ignorance the greater the dogmatism.”
3. “Acquire the art of detachment, the virtue of method, and the quality of thoroughness, but above all the grace of humility.”
Or maybe you will continue to hurl invectives at entire professions. I hope not, but it is your choice. Anger and intolerance are twin enemies of correct understanding.