NP wants the same level of compensation as a MD/DO.

[AnatomyGrey12]

Well, I think medicine should start focusing more on specialties that require extensive training. Focusing on PCP to me is kind of goofy. There are PCP physicians that refer patients out for uncomplicated hypertension and asthma to specialists. If the PCP can't treat asthma or hypertension, what is the point of going to one? A $250 referral, what a waste of money.

What I am saying is that you do not need to go to school for 7+ years to learn how to treat and monitor type II diabetes, prescribe albuterol or metoprolol. PCP is too expensive and could be managed by NPs in many scenarios. These aren't scenarios that require the hospitalization and specialist attention. This is part of the reason why healthcare is so expensive in America, and there is also over-utilization of many services in America as well.

Overtreatment in the United States

Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment.2,106 physicians from ...

www.ncbi.nlm.nih.gov

Do you know how PCP treatment works? The doctor writes a prescription and the patient then goes to the pharmacy, fills it, and manages it on their own until they see the doc again six months later. Do you think the PCP doc administers the medication in office, observes the patient for 24 hours while taking notes, and gives them a custom treatment plan? In reality the doc sees the patient for 5 minutes, bills them for an hour, does a dictation that takes 5 minutes, and then sends them on their way. Even in the hospital, the PCP docs will just review the chart or give telephone orders without ever seeing the patient. These are the realities of healthcare.

Been working in hospitals for the last 5 years. Come back when you have more experience than "president of my pre-med club." lol

So then you should know how much time the PCP spends with their patients.

In reality, many PCP spots could be replaced by NPs. This would free up more physicians to do the comprehensive research needed to push the current healthcare system forward. I think we are wasting physician talent by placing them in PCP roles.

Your post didn't answer the question of how much time the physician spends with the patient.

I do not think that NPs should make as much as physicians, I just believe that many PCP spots could adequately be filled by NPs under physician guidance. For example, there is a director physician that supervises and trains 5-6 NPs in a practice.

Lol someone is extremely out of their element....

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[MedicineZ0Z]

Well, I think medicine should start focusing more on specialties that require extensive training. Focusing on PCP to me is kind of goofy. There are PCP physicians that refer patients out for uncomplicated hypertension and asthma to specialists. If the PCP can't treat asthma or hypertension, what is the point of going to one? A $250 referral, what a waste of money.

And guess who you see nowadays when you get referred out? An NP.

Also, what in the world are you talking about? There are PCPs who manage a broad range of complex issues and will start more specialized meds. The stuff you describe happens due to sheer laziness, nothing more.

A bad doctor is a lazy one. A bad midlevel is an incompetent one. Two entirely different things.

I do not think that NPs should make as much as physicians, I just believe that many PCP spots could adequately be filled by NPs under physician guidance. For example, there is a director physician that supervises and trains 5-6 NPs in a practice.

Oh yeah you want 4 nps who don't know anything running around with a doctor in the back room to absorb all liability?

Imagine your mother was a patient at that clinic and being diagnosed by someone with very little training.

 

[BorderlineQueen]

And guess who you see nowadays when you get referred out? An NP.

Also, what in the world are you talking about? There are PCPs who manage a broad range of complex issues and will start more specialized meds. The stuff you describe happens due to sheer laziness, nothing more.

A bad doctor is a lazy one. A bad midlevel is an incompetent one. Two entirely different things.



Oh yeah you want 4 nps who don't know anything running around with a doctor in the back room to absorb all liability?

Imagine your mother was a patient at that clinic and being diagnosed by someone with very little training.

Yep and it if you're supervising mid-levels and they do something wrong. It's the doctor who loses their license not the NP.

 

[MedicineZ0Z]

Yep and it if you're supervising mid-levels and they do something wrong. It's the doctor who loses their license not the NP.

And the risk is drastically higher with generalist fields. EM/IM/Peds/FM are the first fields that midlevels pose the greatest threat to patients.

 

[Chibucks15]

Yep and it if you're supervising mid-levels and they do something wrong. It's the doctor who loses their license not the NP.

That's what drives me crazy. All the NPs and such talking about equal pay but yet they expect to continue to have zero liability? If they want to be able to get sued then sure why not. After the first few stories of malpractice against NPs that'll scare some people away. If they make the same salary as docs and I'm a hospital admin? I'm going with the person with more training every damn time.

 

[KeikoTanaka]

When you're a hammer, everything is a nail. This is the metaphor I use to describe how Chiropractors treat. Primary Care Physicians on the other hand are the entire mechanic who has to know what tool to use when (Same can be said for many other broad specialties like EM). The problem with NPs working in PC is that they're the mechanic with a lot of tools in their box, like the Physician, but they don't quite know how to use all those tools so probably won't use them.

I never want to oversee a MLP... Ik it'll probably happen eventually... but, there's so many pathways and differential paths to go down with even the most benign sounding thing.. but when you only know 40% of the possible pathways of a physician, there's no way to even know to do X Y Z Testing/examination... reviewing a MLP chart can be done and you read it and you're like "Oh wow, of course it was strep throat!" but that's only because the pertinent questions were only asked probably trying to rule in Strep throat.. for example, therefore the whole chart is catered to strep throat.

 

[Dr. Faust]

That's what drives me crazy. All the NPs and such talking about equal pay but yet they expect to continue to have zero liability? If they want to be able to get sued then sure why not. After the first few stories of malpractice against NPs that'll scare some people away. If they make the same salary as docs and I'm a hospital admin? I'm going with the person with more training every damn time.

It is quite difficult for a physician to lose their license. Have you heard of Christopher Duntsch? Other physicians were trying to get his license pulled and they didn't. Even if you disagree, there is a fascinating podcast about him.

 

[Chibucks15]

It is quite difficult for a physician to lose their license. Have you heard of Christopher Duntsch? Other physicians were trying to get his license pulled and they didn't. Even if you disagree, there is a fascinating podcast about him.

I’m not saying lose license. I’m saying deal with lawsuits that completely stem from NPs. Where on earth are you pulling that from?

 

[libertyyne]

So assume the nursing lobby gets this through.

What do you think would end up happening to the healthcare landscape after NPs can bill at the same rate physicans can to medicare and private insurance companies?

 

[VA Hopeful Dr]

So assume the nursing lobby gets this through.

What do you think would end up happening to the healthcare landscape after NPs can bill at the same rate physicans can to medicare and private insurance companies?

In the short term, nothing in most places. Very few NPs own their own practices so whoever employs them just makes more money. There's an oversupply of them at the moment so they have no bargaining power (which might be their downfall).

Long term you might see more emphasis paid to NP quality measures since they're costing more but probably no big changes.

 

[libertyyne]

In the short term, nothing in most places. Very few NPs own their own practices so whoever employs them just makes more money. There's an oversupply of them at the moment so they have no bargaining power (which might be their downfall).

Long term you might see more emphasis paid to NP quality measures since they're costing more but probably no big changes.

if I run a hospital, Why would I not decrease employed physician compensation since I can get NPs for cheap and bill the same, probably hire 2.5 for the price of one physican.

If I am an NP why wouldnt I just hang up a shingle probably siphon off patients from Physician practices where wait times are high.

If I am Private practice physician group, why would I take on another partner when i can just hire a bunch of NPs and bill the same ?

 

[Premed2295]

And I wish I had an attending salary as a student rather than paying for school.

Doesn’t mean it’s gonna happen and doesn’t mean I deserve it

 

[nimbus]

Part of why this doesn’t matter is because many patients don’t listen to their PCP anyway.

 

[VA Hopeful Dr]

if I run a hospital, Why would I not decrease employed physician compensation since I can get NPs for cheap and bill the same, probably hire 2.5 for the price of one physican.

If I am an NP why wouldnt I just hang up a shingle probably siphon off patients from Physician practices where wait times are high.

If I am Private practice physician group, why would I take on another partner when i can just hire a bunch of NPs and bill the same ?

Liability for all 3 to start.

Patients want to see doctors as a general rule for all 3 as well, it's why even in independent states you don't see huge numbers of mid-levels opening their own practices. plus, doing so is actually quite difficult. Trust me on this one, I've done it.

Doctors are hard to find so we have significant bargaining power for 1.

 

[scoopdaboop]

so If a np got paid the same, why would any hospital hire a np over a doc or patient go see a np over a doc. If you’re the hospital you just advertise “physician led or physician only” care etc vs that other hospital that has nps. So it costs the same and you take more risk with a np... don’t see hospitals picking that.

If you’re a primary care doc with his own practice battling it with a np led practice across the road and the patient has to pay the same, who would he go to? He reads that big sign saying md or do with the title dr. Instead of the np. Funnily enough the dnp was prolly invented just to confuse pts that don’t know any better that they’re well qualified to treat them as like a md or do.

 

[deleted480308]

During my general surgery rotation NPs were doing the bulk of the surgeries so the attendings could bill 2-3 rooms

Sorry didn’t do a nsg rotation but if you think the spread will just *poof* stop at nsg you are completely clueless

I call bull

 

[mwsapphire]

because most patients dont know any better. They see a person in a white coat and just assume its a doctor. Or they just want to get in quickly and get stuff looked at. They dont know the person who is acting like a doctor probably did a good portion of their training online and had no residency.

I honestly have considered IM outpatient as i enjoyed my time in the clinic, but I am going to be doing something that NPs cant do because i dont want to deal with this headache now or in the future and watch my training be devalued.

I feel like if we expanded how we train NP's- like actual in person classes/ in person clinicals and then something like a " pee-wee" residency ( like 1 year long or something) we could give them a bit more power but that online training with no residency at all is just bonkers.I'm just a lowly pre med but just my two cents.Also the same pay is just absurd. What , is 100k range not enough, you had to get 200k range like a doc?

 

[libertyyne]

Liability for all 3 to start.

Patients want to see doctors as a general rule for all 3 as well, it's why even in independent states you don't see huge numbers of mid-levels opening their own practices. plus, doing so is actually quite difficult. Trust me on this one, I've done it.

Doctors are hard to find so we have significant bargaining power for 1.

If it costs the same to insure, not sure why liability would stop anyone. I have not found anything that indicates that NPs get sued more often. (although part of this may be related to how liability gets assigned right now. But in a world where they have full practice rights the would also have full liability.

Patients just want to get seen the soonest they can, and not pay more then they have to.

I will trust you currently it is difficult to start a practice, but what else are the hoards of unemployed NPs going to do , some are going to take a gamble and open up shop.

so If a np got paid the same, why would any hospital hire a np over a doc or patient go see a np over a doc. If you’re the hospital you just advertise “physician led or physician only” care etc vs that other hospital that has nps. So it costs the same and you take more risk with a np... don’t see hospitals picking that.

If you’re a primary care doc with his own practice battling it with a np led practice across the road and the patient has to pay the same, who would he go to? He reads that big sign saying md or do with the title dr. Instead of the np. Funnily enough the dnp was prolly invented just to confuse pts that don’t know any better that they’re well qualified to treat them as like a md or do.

You go see an NP because its easier to get an appointment sooner, its less of a drive, its more conveinient, the NP is more likely to write what ever you ask for.

Most hospitals employ NPs in some capicty right now, I doubt advertising alone will be enough to deter people from going to NP hospitals as you claim .

 

[PieOHmy]

During my general surgery rotation NPs were doing the bulk of the surgeries so the attendings could bill 2-3 rooms

No they were not

 

[DO2015CA]

so If a np got paid the same, why would any hospital hire a np over a doc or patient go see a np over a doc. If you’re the hospital you just advertise “physician led or physician only” care etc vs that other hospital that has nps. So it costs the same and you take more risk with a np... don’t see hospitals picking that.

If you’re a primary care doc with his own practice battling it with a np led practice across the road and the patient has to pay the same, who would he go to? He reads that big sign saying md or do with the title dr. Instead of the np. Funnily enough the dnp was prolly invented just to confuse pts that don’t know any better that they’re well qualified to treat them as like a md or do.

If the DNP advertises as Dr. X then most wont know any different

 

[Splenda88]

NP Payment Parity Bill Signed into Law - Oregon Nurses Association

This is not new, this has been going on for a while and will continue. If anything this will deter physicans from further entering pcp. If someone with 1/3rd of my training can do the job while getting compensated the same why on earth would I be interested in doing something like that.

You are being very generous here... NP do not even have 1/4 of physicians' training. Don't look at things only in term of the # of years. Almost all NP schools require between 500-1000 clinical hours or preceptor hours. I logged in ~3500 hrs as PGY1 IM resident.

 

[PieOHmy]

I feel like if we expanded how we train NP's- like actual in person classes/ in person clinicals and then something like a " pee-wee" residency ( like 1 year long or something) we could give them a bit more power but that online training with no residency at all is just bonkers.I'm just a lowly pre med but just my two cents.Also the same pay is just absurd. What , is 100k range not enough, you had to get 200k range like a doc?

They do not have the fundamentals. They cant bein

You are being very generous here... NP do not have even 1/4 physicians' training. Don't look at things only in term of the # of years. Almost all NP schools require between 500-1000 clinical hours or preceptor hours. I logged in ~3500 hrs as PGY IM resident.

i agree they didnt even take general chemistry with a lab.

I remember pulling all nighters in college. No joke.

 

[VA Hopeful Dr]

If it costs the same to insure, not sure why liability would stop anyone. I have not found anything that indicates that NPs get sued more often. (although part of this may be related to how liability gets assigned right now. But in a world where they have full practice rights the would also have full liability.

Patients just want to get seen the soonest they can, and not pay more then they have to.

I will trust you currently it is difficult to start a practice, but what else are the hoards of unemployed NPs going to do , some are going to take a gamble and open up shop.

For non-independent practice states, its because the doctor gets sued not the NP. You do away with the doctors, that leaves the NP (and thus the employer) on the hook. And they will get sued more often, especially if they become the ones with the deep pockets.

Agree with part of your second part, its why the trend is to have midlevels in PCP offices primarily do acute visit overflow. But all other things being equal, they want physicians. I grow tired of saying this, but for the last 4 years I get several new patients/week who come to me specifically because they want to see a physician. This was even more common when I had my cash-only practice. People were leaving the office with midlevels that took their insurance and coming to see me for cash because they knew they would never be foisted off on a midlevel.

I'm love to see those hoards of NPs open up their own practices. It'll be a cute thing to watch for the year or so it takes them to fold and give up, and then the banks will stop loaning them money to do it.

 

[Dr. Faust]

Being that NPs can be churned out of schools relatively quickly, what if insurance companies caught on and started making adjustments to reimbursement where it would be cost prohibitive for the patient to see a PCP...for example, if the insurance company paid 100% coverage for NPs and only covered 65% of the PCP visit?

 

[Chibucks15]

Being that NPs can be churned out of schools relatively quickly, what if insurance companies caught on and started making adjustments to reimbursement where it would be cost prohibitive for the patient to see a PCP...for example, if the insurance company paid 100% coverage for NPs and only covered 65% of the PCP visit?

Why in the world would insurance companies open themselves up to litigation by sending patients to lesser trained people? You’re absolutely clueless about the nature of medicine. If you honestly think insurance companies already don’t monitor every single trend in healthcare you’re worse off than I thought. You have to be a troll.

The lawsuit if that ever happened would be so big it would put every insurance company out of business. That’s astonishing you even think this

 

[scoopdaboop]

If the DNP advertises as Dr. X then most wont know any different

lmao then you have to resort to "med-school trained"

 

[Medic741]

Why in the world would insurance companies open themselves up to litigation by sending patients to lesser trained people? You’re absolutely clueless about the nature of medicine. If you honestly think insurance companies already don’t monitor every single trend in healthcare you’re worse off than I thought. You have to be a troll.

The lawsuit if that ever happened would be so big it would put every insurance company out of business. That’s astonishing you even think this

Insurance companies don’t give a **** about the well being of patients.

https://www.google.com/amp/s/amp.fresnobee.com/news/local/article232478212.html

They’d jump on an opportunity to give cheaper worse care given the option to.

 

[Chibucks15]

Insurance companies don’t give a **** about the well being of patients.

https://www.google.com/amp/s/amp.fresnobee.com/news/local/article232478212.html

They’d jump on an opportunity to give cheaper worse care given the option to.

And they would open themselves up to a world of hurt through lawsuits out the ass. They may not care about patients but they care about their bottom line. It’s naive to think that this wouldn’t happen

 

[Splenda88]

@Dr. Faust


I am a PGY2 and I don't know or even understand most of the sh*** that go on in healthcare. Don't think that you know a lot because you have been around healthcare workers for 5 years

 

[scoopdaboop]

are PCP salaries even going down with states that have NP FPA? I know theres like 20 + states with FPA np's now.

 

[Splenda88]

Insurance companies don’t give a **** about the well being of patients.

https://www.google.com/amp/s/amp.fresnobee.com/news/local/article232478212.html

They’d jump on an opportunity to give cheaper worse care given the option to.

If these beancounters (insurance executives) could find a way to make a buck by shifting patients to midlevel only, they would. What would they say to the almighty lawyers when patients have a bad outcome at the hand of midlevel?

 

[Medic741]

If these beancounters (insurance executives) could find a way to make a buck by shifting patients to midlevel only, they would. What would they say to the almighty lawyers when patients have a bad outcome at the hand of midlevel?

They’d blame the midlevel hands down just like they take no liability or responsibility when people die because of care delays from drug denials.

 

[scoopdaboop]

If these beancounters (insurance executives) could find a way to make a buck by shifting patients to midlevel only, they would. What would they say to the almighty lawyers when patients have a bad outcome at the hand of midlevel?

if i was a lawyer i would be salivating at that case.

 

[libertyyne]

are PCP salaries even going down with states that have NP FPA? I know theres like 20 + states with FPA np's now.

Not really. The evidence I have seen is in independent practice states salaries have gone up.
But that analysis was a few years old and didn't really control for changes in underlying demand .

 

[BorderlineQueen]

if i was a lawyer i would be salivating at that case.

Yep maybe I should have gone into law instead. I imagine when nps get full practice in 50 states . A lot of lawyers will be making $$$.

 

[Dr. Faust]

@Dr. Faust


I am a PGY2 and I don't know or even understand most of the sh*** that go on in healthcare. Don't think that you know a lot because you have been around healthcare workers for 5 years

I'm just trying to observe trends. What ratio of NPs providing primary care were around in the 1980s compared to now? Is the ratio the same or is there a greater ratio of NPs filling the PC void? How far do you think this trend will continue? Is it reasonable to think that they will end the PC shortage anytime soon without NPs?

Also, I'm curious as to the evidence in the difference of outcomes between the PCP MD vs. NP. Does anyone have some articles they can post?

 

[nimbus]

if i was a lawyer i would be salivating at that case.

If independent midlevel practice becomes widespread within an area, the community standard of care becomes independent midlevel care. The standard by which liability cases are settled becomes whatever another reasonable midlevel would have done. They won’t be compared to some experienced internist. There has always been a large variation in quality of care delivered by board certified physicians. Throwing midlevels into the mix will undoubtedly increase the variation in quality.

In my opinion this train has left the station. Learn to live with it.

 

[Moko]

This is a result of the nursing lobby being quite robust and organized. The doctors' lobby, in comparison, is spineless.

I have no problem with PA/NPs having more autonomy as the need for more healthcare providers is there, but their argument that they are even remotely similar in qualification and deserve the same pay and scope of practice is laughable. Having worked with PA/NPs and having seen the wide variation in knowledge, I want a physician taking care of me if I was deathly ill.

 

[SterlingMaloryArcher]

The reason this alarms me as a premed is I know in this "progressive" society it will probably come a reality, and at some point in my career I will be crucified to criticize it.

 

[differentiating]

No they were not

I can confirm that NPs can be first assist on surgeries- I haven’t seen them be the primary surgeon as was claimed above, but I’ve certainly seen them do a large portion of the surgery. Both gen surg and vascular, on my gen surg rotation in med school. So surgical fields aren’t safe from midlevel encroachment either.

 

[AnatomyGrey12]

I can confirm that NPs can be first assist on surgeries- I haven’t seen them be the primary surgeon as was claimed above, but I’ve certainly seen them do a large portion of the surgery. Both gen surg and vascular, on my gen surg rotation in med school. So surgical fields aren’t safe from midlevel encroachment either.

Being first assist and “doing most of the surgery” are very different things...

 

[ciestar]

On the flip side of all of this..
If they’re getting equal compensation for “equal work” why even go to med school if you want primary care? I likely wouldn’t have if a NP is on equal footing at an MD.

I quit nursing school. They don’t compare.

 

[DO2015CA]

I'm just trying to observe trends. What ratio of NPs providing primary care were around in the 1980s compared to now? Is the ratio the same or is there a greater ratio of NPs filling the PC void? How far do you think this trend will continue? Is it reasonable to think that they will end the PC shortage anytime soon without NPs?

Also, I'm curious as to the evidence in the difference of outcomes between the PCP MD vs. NP. Does anyone have some articles they can post?

On the flip side of all of this..
If they’re getting equal compensation for “equal work” why even go to med school if you want primary care? I likely wouldn’t have if a NP is on equal footing at an MD.

I quit nursing school. They don’t compare.

Back in the 80s there were very little NPs. They were serving the role they were designed for. It was mainly the floor nurses of 20+ years experience going back to school to get off the floor. Their experience is very valuable. Today the schools have bloated with only requiring 1 year experience on the floor. This has led to a huge variation in clinical competency. Even the NPs with 10+ years experience on the floor prior to NP school think it’s crazy to hand these straight through 24-25 year old NPs solo practice rights. Start medical school, get through 1 semester, and then talk to the NPs at your hospital. You will see the thought process behind their decisions is lacking. NPs seemed super competent to me when I was a premed, but the veil gets pulled quite quickly.

@Dr. Faust you should look into nursing school and then NP school if after your observations you still believe there isn’t a huge difference in profession

 

[DO2015CA]

It’s really easy to play monkey see monkey do until monkey has never seen that presentation before and they are solo practice

 

[ciestar]

Back in the 80s there were very little NPs. They were serving the role they were designed for. It was mainly the floor nurses of 20+ years experience going back to school to get off the floor. Their experience is very valuable. Today the schools have bloated with only requiring 1 year experience on the floor. This has led to a huge variation in clinical competency. Even the NPs with 10+ years experience on the floor prior to NP school think it’s crazy to hand these straight through 24-25 year old NPs solo practice rights. Start medical school, get through 1 semester, and then talk to the NPs at your hospital. You will see the thought process behind their decisions is lacking. NPs seemed super competent to me when I was a premed, but the veil gets pulled quite quickly.

@Dr. Faust you should look into nursing school and then NP school if after your observations you still believe there isn’t a huge difference in profession

Oh, I am very aware of this. The difference is huge in clinical knowledge. It is ridiculous for anyone to think they’re as competent as a physician (in most cases, an NP can diagnose a kid’s AOM and id be satisfied with that, but nothing more complex than that..). Doctors go to school forever for a reason.

 

[DO2015CA]

Oh, I am very aware of this. The difference is huge in clinical knowledge. It is ridiculous for anyone to think they’re as competent as a physician (in most cases, an NP can diagnose a kid’s AOM and id be satisfied with that, but nothing more complex than that..). Doctors go to school forever for a reason.

Yes I agree. I quoted you to compound on your point to the other poster I quoted.

 

[ciestar]

Yes I agree. I quoted you to compound on your point to the other poster I quoted.

Following up on another point you made..
You’re right. NP programs don’t have the clinical experience requirements that they used to. There are accelerated programs that exist now that let you use the bachelor’s you already have and go straight into the CRNP route.

 

[differentiating]

Being first assist and “doing most of the surgery” are very different things...

I mean, they effectively acted like the residents did, which was my point. They did most of the hands-on portion with the attending supervising.

Edit: the confusion might be that, as someone who hates the or and avoided it like the plague, I might be using the terminology wrong.

 

[Dr. Faust]

Back in the 80s there were very little NPs. They were serving the role they were designed for. It was mainly the floor nurses of 20+ years experience going back to school to get off the floor. Their experience is very valuable. Today the schools have bloated with only requiring 1 year experience on the floor. This has led to a huge variation in clinical competency. Even the NPs with 10+ years experience on the floor prior to NP school think it’s crazy to hand these straight through 24-25 year old NPs solo practice rights. Start medical school, get through 1 semester, and then talk to the NPs at your hospital. You will see the thought process behind their decisions is lacking. NPs seemed super competent to me when I was a premed, but the veil gets pulled quite quickly.

@Dr. Faust you should look into nursing school and then NP school if after your observations you still believe there isn’t a huge difference in profession

I agree that the 1 year experience stipulation is not nearly enough time, with somewhere along 5 years of experience prior to entering school to be reasonable.

To reiterate a prior point, if physicians truly believe that NPs produce much poorer results in the PCP setting, why aren't they studying the outcomes? No one has yet to post an article for support.

 

[Dr. Faust]

The reason this alarms me as a premed is I know in this "progressive" society it will probably come a reality, and at some point in my career I will be crucified to criticize it.

You can criticize it. Another controversial point would be "is there a difference between NPs from US schools and MDs who obtained their degree from a third world country?" In these countries, doctors enter medical school directly out of high school and have lacking educational and medical institutions yet practice the same as an MD who achieved a bachelor's degree and MD degree in the US. Is a doctor who receives a degree from Vietnam the same as one who goes to a state school in the US?