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Dr. Pedo

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I recently came across this situation in my residency for Pediatric Dentistry. I asked a parent who they use for their primary physician; she responded with Ms. X an advanced nurse practitioner and a board-certified family nurse practitioner. I looked it up and she has an independent office and she claims to provide the same care for children and adults as a family doctor. Including but not limited to: physicals, ob-gyn, RXs, laser-hair reduction :eek: .

I'm having to contact her regarding the little one's SBE coverage for a pathological heart murmur and I feel like I should have a MD/DOs input---obviously I'll be contacting the Cardio for review of the echo cardio-----but I typically enjoy having the added confidence of being able to call the primary anytime--am I crazy here! Is this a new thing-----I thought the NP needed to have direct supervision from an MD/DO. I think this is a scary development and I'm all for nurses but they cannot and should not be practicing outside of their educational parameters. What is the inside information that I'm missing?
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Dr. Pedo said:
I recently came across this situation in my residency for Pediatric Dentistry. I asked a parent who they use for their primary physician; she responded with Ms. X an advanced nurse practitioner and a board-certified family nurse practitioner. I looked it up and she has an independent office and she claims to provide the same care for children and adults as a family doctor. Including but not limited to: physicals, ob-gyn, RXs, laser-hair reduction :eek: .

I'm having to contact her regarding the little one's SBE coverage for a pathological heart murmur and I feel like I should have a MD/DOs input---obviously I'll be contacting the Cardio for review of the echo cardio-----but I typically enjoy having the added confidence of being able to call the primary anytime--am I crazy here! Is this a new thing-----I thought the NP needed to have direct supervision from an MD/DO. I think this is a scary development and I'm all for nurses but they cannot and should not be practicing outside of their educational parameters. What is the inside information that I'm missing?
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Depends on what state. Here in Pennsylvania, a PA has to have an MD on premise. With NP the doctor (MD) doesn't have to physically be on premise but should be reachable (pager, beeper).
This brings up a pet peeve of mine, why do dentists expect us MD's to RX antibiotics for their pt's w/ heart mummur? I get calls that pt x is about to see her dentist and needs antibiotics...my reply? Ask the dentist for the script or find a dentist who knows how to prescribe for SBE prophylasix...its really not that hard.
On the flip side, my sister in CA sees a totally independent dental hygenist for her oral care. Charges less than the local dentist and apparently booking out months in advance due to demand.
 
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With the rare exception, a NP and a PA who advertise they are an FP replacement are kidding the public and/or themselves. Their training is far inferior to the average board certified FP. They are flying by the seat of their pants if they think they can handle the same complexity of cases a trained physician sees.

Not saying their isn't a place for mid-levels, my wife is one. But the scope of practice issue will never end and more people (pharmacists, chiros, etc.) will continue looking for a piece of the shrinking healthcare pie.

So if you feel good about the extra 10 minutes the NP spends with you, then by all means keep going. If you're really sick, you'll end up seeing a doc, or at least I hope you are smart enough to realize you need one.
 
Newdoc2002 said:
With the rare exception, a NP and a PA who advertise they are an FP replacement are kidding the public and/or themselves. Their training is far inferior to the average board certified FP. They are flying by the seat of their pants if they think they can handle the same complexity of cases a trained physician sees.

Not saying their isn't a place for mid-levels, my wife is one. But the scope of practice issue will never end and more people (pharmacists, chiros, etc.) will continue looking for a piece of the shrinking healthcare pie.

So if you feel good about the extra 10 minutes the NP spends with you, then by all means keep going. If you're really sick, you'll end up seeing a doc, or at least I hope you are smart enough to realize you need one.
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You and I are both "new" enough docs so we may be blameless in the whole midlevel quagmire. The only reason for the creation of midlevels was b/c the older docs succombed to greed. No doubt about it, midlevels properly utilized are one of the most financially smart moves a PCP can do. BUT now they think they can replace us. All due respect to your wife, but if you want to be captain, go to captain school.
 
FamilyMD said:
The only reason for the creation of midlevels was b/c the older docs succombed to greed.
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Not at all. Both the P.A. and N.P. fields arose primarily to address the needs of the medically underserved. The history of the physicians assistant may be reviewed in detail here, and the history of the nurse practitioner may be found here.
 
KentW said:
Not at all. Both the P.A. and N.P. fields arose to address the needs of the medically underserved. The history of the physicians assistant may be reviewed in detail here, and the history of the nurse practitioner may be found here.
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LOL, I don't know your background but as an actively practicing FP dr I can assure you FP dr's one generation back viewed these midlevels as money making opportunities, and they are! The problem is they looked around and said "wait a sec, why should I make money for Dr X when I could be billing for myself (instead of under his #)", and hence the current turf battle. You are a fool if you buy into that whole underserved bit. These midlevels don't want to practice in Timbukto and Hazzard County any more than Dr's do, so please unless you are an actively practice FP dr who hang out in the Dr's lounge and listen where Dr's can speak candidly, please spare us more "my cousin's, sister, best friend's aunt said....." It's just not true in the trenches.
 
FamilyMD said:
I don't know your background.
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If you'd read my profile, you would.

I can assure you FP dr's one generation back viewed these midlevels as money making opportunities, and they are!
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I never disputed that (I actually made no comment about it whatsoever). However, this is not the original reason that these fields were created, contrary to what you have stated.
 
KentW said:
If you'd read my profile, you would.
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Sorry, new to this so didn't know how. Anyways, I still stand by the fact that midlevels do not want to live in "underserved" areas anymore than WE do. They bill and collect for us the same amount as if the pt saw a Dr., yet we only have to pay them 1/3 to 1/2 the salary of a new physician. Some of the docs around here complain they can only legally supervise 3 midlevels per doc!
 
FamilyMD said:
I still stand by the fact that midlevels do not want to live in "underserved" areas anymore than WE do.
Click to expand...

They might, if they want to take advantage of loan repayment programs like this one in your home state of Pennsylvania.
 
A rural Family Doc I know in PA has a DNP working for him. Punchline is that her labcoat which she wears when seeing patients says Dr. XXXXX. Her patients think she is a physician not a nurse. Hell when I first met her I thought she was a physician. She was telling me how she only practices at this office a few days a week b/c the other days she spends teaching future doctors. She also said in a few years she was going to move and start her own practice. I inquired what medical school she taught at and she said XYZ nursing program. Needless to say I was a bit confused for a minute. She had intentionally misled everyone into thinking she was a doc.
 
raptor5 said:
A rural Family Doc I know in PA has a DNP working for him. Punchline is that her labcoat which she wears when seeing patients says Dr. XXXXX. Her patients think she is a physician not a nurse. Hell when I first met her I thought she was a physician. She was telling me how she only practices at this office a few days a week b/c the other days she spends teaching future doctors. She also said in a few years she was going to move and start her own practice. I inquired what medical school she taught at and she said XYZ nursing program. Needless to say I was a bit confused for a minute. She had intentionally misled everyone into thinking she was a doc.
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The intention and lobbing efforts of the NP's are CLEAR. People can argue whatever they want re:midlevels, the majority feel they are interchangeable with us.
 
raptor5 said:
A rural Family Doc I know in PA has a DNP working for him. Punchline is that her labcoat which she wears when seeing patients says Dr. XXXXX. Her patients think she is a physician not a nurse.
Click to expand...

It would be more appropriate to display her name followed by the initials "DNP" (Doctor of Nursing Practice), as this would prevent confusion as well as any accusation of fraud or impersonating a physician. IMO, the physician working with her should not allow her to misrepresent her credentials, lest he be accused of complicity.

All that aside, the DNP degree itself is controversial within the nursing community, as is the general shift towards advanced degrees in other allied health fields. For the P.A.'s perspective on this trend, check out this article.
 
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FamilyMD said:
Depends on what state. Here in Pennsylvania, a PA has to have an MD on premise. With NP the doctor (MD) doesn't have to physically be on premise but should be reachable (pager, beeper).
This brings up a pet peeve of mine, why do dentists expect us MD's to RX antibiotics for their pt's w/ heart mummur? I get calls that pt x is about to see her dentist and needs antibiotics...my reply? Ask the dentist for the script or find a dentist who knows how to prescribe for SBE prophylasix...its really not that hard.
Click to expand...

:eek:
FamilyMD---I realize you are a new doc; however, you should be very cautious about your comments regarding SBE prophy for heart murmur and dentists in general. It isn't the complexity of the situation that makes us take time out of our day for the hassle of talking with you-----any ***** can RX a SBE prophy! :laugh: The reasoning for the call is if we BELIEVED every person who said they had a heart murmur we'd be handing out ABX like candy. The investigation is to confirm DX and the question of Abx is due to the fact you are the case manager for all systemic conditions and medications. Obviously you won't be giving an Abx if they don't have a pathological murmur---so if you get it from your MD than we know it is confirmed. I can't begin to tell you the poor medical historians that come through the door, especially with medications. You know, "I take this little white-pill with another purple long one in the morning." Or "I had a murmur when I was young, but now, well, I think it's ok."

That said, as med professionals we should work synergistically. I rarely get upset when I get a consult request at the hospital regarding a traumatic alvulsion of 3 primary teeth and the ER doc doesn't know what to do. Or the Family MD who see a blue thing on the gums of a 2 year old and asks for a consult to confirm what I consider a simple diagnosis (of an eruption cyst). I don't get upset when a doc RX an antibotic for a toothache with localize swelling; even though its absolutely contraindicated in nearly all cases outside cellulitis-------nope I don't say a word nor do I throw my arms-up and say find a "MD that knows how to take care of whole body, like they're suppose too and stop bothering me with this simple stuff.!"

You should be thrilled that a dentist or dental specialist confirms their pt's. HX or asks the patient to bring their Abx----it prevents over RXing, the investigations, and the "bothering" of important people like you :laugh: not to mention simplifies everyone's life. I wish you luck in the future and I hope you don't find the dentist "That will just take care of this SBE issue and not bother you with such non-sense." ;)

I am comforted by the fact your attitude regarding this issue is more the exception than the rule.

__________
Dr. Pedo

Never argue with an idiot; they'll bring you down to their level and beat you with experience.
 
KentW said:
It would be more appropriate to display her name followed by the initials "DNP" (Doctor of Nursing Practice), as this would prevent confusion as well as any accusation of fraud or impersonating a physician. IMO, the physician working with her should not allow her to misrepresent her credentials, lest he be accused of complicity.

All that aside, the DNP degree itself is controversial within the nursing community, as is the general shift towards advanced degrees in other allied health fields. For the P.A.'s perspective on this trend, check out this article.
Click to expand...
If this nurse ever was involved in a malpractice suit the lawyers would have a field day. "But I thought I WAS SEEING A DR, she said so!". It is pure deception to introduce yourself as "Dr. X" when the average person in that environment takes it to mean a physician. Deception, pure and simple and for the supervising doc to allow it is reprehensible.
 
FamilyMD said:
If this nurse ever was involved in a malpractice suit the lawyers would have a field day. "But I thought I WAS SEEING A DR, she said so!". It is pure deception to introduce yourself as "Dr. X" when the average person in that environment takes it to mean a physician. Deception, pure and simple and for the supervising doc to allow it is reprehensible.
Click to expand...

It is likely that some states allow DNPs to legally use the title "Doctor."
 
PublicHealth said:
It is likely that some states allow DNPs to legally use the title "Doctor."
Click to expand...
Again, another student just posting opinions.
Here are the facts. I worked with a large FP group that utilized midlevels, one of whom was an ND. Our hospital lawyer said in no circumstances is she ever to refer to herself as Dr or for any staff to call her Dr. She was "Mrs X", precisely for the reason I stated above. What do you expect a pt to assume when someone shakes your hand and says, "Hi, I am Dr. X". The prudent pt assumes this person is a physician and if s*t ever hit the fan, the hospital would have NO leg to stand on.
Contrast this with a nursing school, I am sure in this environment she can call herself "Dr" w/no ramifications as the prudent person there may assume she is a nurse.
 
So...after this whole post, what's the bottom line? I am a pre-med right now and going to medical school with the notion of becoming an FP doc or at least primary care.

So are these NP/PAs a threat to the FP profession? Is it career suicide for any med student to go into primary care with these NPs and PAs out there calling themselves doc and setting up their "own" practices?
 
Whatsamatta U said:
Is it career suicide for any med student to go into primary care with these NPs and PAs out there calling themselves doc and setting up their "own" practices?
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No, of course not. Believe me, there are enough patients out there for everyone.
 
At my school the PT program is now doctoral...No changes in the curriculum, they just decided to start calling themselves Dr. With all of these mickey mouse doctoral degrees the value of ours will only continue to decrease
 
zippy81 said:
At my school the PT program is now doctoral...No changes in the curriculum, they just decided to start calling themselves Dr. With all of these mickey mouse doctoral degrees the value of ours will only continue to decrease
Click to expand...

To the OP: while PAs are supervised by MDs, and you can request to speak to the supervising MD (who may or may not know the patient too well, but that is another story...), no such requirement is required for NPs and you essentially must interact with them as if they are the MD. But you are absolutely wise to have them fax documentation of a pathological mumur, or have the NP deal with Abx.

Cheers
 
zippy81 said:
At my school the PT program is now doctoral...No changes in the curriculum, they just decided to start calling themselves Dr. With all of these mickey mouse doctoral degrees the value of ours will only continue to decrease
Click to expand...

Anyone can get a doctorate degree and refer to themself as Dr. BlahBlahBlah but there are only two degree that allow people to become Physicians (DO & MD). Same with Dentists (DDS & DMD).
 
PublicHealth said:
It is likely that some states allow DNPs to legally use the title "Doctor."
Click to expand...


Quit talking out of your ass.

There is ZERO regulation controlling the title "doctor"

I can go out and refer to myself as doctor right now and I promise you I wont be arrested or fined or subject to any punishment.

Hell PhDs in English can use the "doctor" title.
 
I think NPs suck a**. I was asked to see a patient who was hypertensive with c/o of SOB and feelings of "drowning". Patient had a history of asthma.
I checked her meds and the idiot NP had her on 100mg atenolol PO QD.

idiot.
 
however, toughlife loves CRNA's.
 
MacGyver said:
Quit talking out of your ass.

There is ZERO regulation controlling the title "doctor"

I can go out and refer to myself as doctor right now and I promise you I wont be arrested or fined or subject to any punishment.

Hell PhDs in English can use the "doctor" title.
Click to expand...

Try that in a hosptial when dealing with patients buddy, that's what people are talking about here...the use of the title in a HEALTHCARE setting.
 
Whatsamatta U said:
So...after this whole post, what's the bottom line? I am a pre-med right now and going to medical school with the notion of becoming an FP doc or at least primary care.

So are these NP/PAs a threat to the FP profession? Is it career suicide for any med student to go into primary care with these NPs and PAs out there calling themselves doc and setting up their "own" practices?
Click to expand...

Yes. Although "career suicide" might be too strong a phrase. You will always have a job as an FP, it's just that the market being what it is there wil be continued downward pressure on your salary potential as the people who pay the bills decide that FPs, NP, and PAs are roughly equivalent.

As people have noted, the salaries of a NPs and PAs are not too much less than those of FPs. I'm sure there are some NPs and PAs that make more than the low-end FP salary.

I also want to caution you not to do FP at a big academic medical center. Your training will suffer because it is so easy to punt even your slightly complicated patients to specialists. This is why NPs and PAs function interchangebly with physicians at our clinic (the only difference being that the PAs get offices and the residents don't).

You either need to do FP at an unopposed program (the smaller the better) or at a large institution who's FP program takes itself seriously and, more importantly, is taken seriously by the insitution.

The biggest threat to your career goals in FP is "community medicine." I know all of the propaganda but the upshot is that the focus of community medicine is to make the FP nothing more than a glorified social worker with a medical degree doing things only slightly more complicated than are usually handled by the community health nurse.
 
I had to visit our medical school's health clinic today and a woman walked in, shook my hand and said "I'm Dr.X, a nurse practitioner..." "Oh, you are a medical student?" Yep, and I know the difference. This is intentionally misleading in my opinion. Unless you have an MD or DO, do not walk into an exam room and introduce yourself as Dr. anything. I have seen many NP's who introduced themselves as N.P. X and they provided excellent care. No need for the inferiority complex, if you are good, you are good, however, do not undermine the many more years of training and experience that practicing MD's and DO's have. If you want to walk into a room and introduce yourself as the doc, go to medical or osteopath school.
 
zippy81 said:
At my school the PT program is now doctoral...No changes in the curriculum, they just decided to start calling themselves Dr. With all of these mickey mouse doctoral degrees the value of ours will only continue to decrease
Click to expand...

Obviously, you don't fully appreciate the advances made in technology and practice that REQUIRE a doctoral level education - personally, I'm working on my PhlebD - Doctorate of Phlebotomy - so that my level of skill and knowledge is understood by my patients. :rolleyes:
 
zippy81 said:
At my school the PT program is now doctoral...No changes in the curriculum, they just decided to start calling themselves Dr. With all of these mickey mouse doctoral degrees the value of ours will only continue to decrease
Click to expand...

While I agree with you in part, KID, I disagree with your attitude. I'm an MD and JD, two very difficult professional doctoral programs. However, to classify other professional degrees as "Mickey Mouse" degrees is pretty ignorant. Dentists (DDS), pharmacists (PharmD), psychologists (PhD/PsyD), vets (DVM), podiatrists (DPM), and even optometrists (OD) go through almost as much (and in some cases more) education as an MD/DO and learn a great deal of information. I don't know anything about the DPT or AuD degrees, and don't believe NPs or PAs should have doctorates, but I would never call any advanced degree in the health professions a "Mickey Mouse" degree. Well, that is of course, you're talking about a chiropractic degree. In that case, even Goofy could earn one of those. :)
 
I also posted this on the internal med forum, but here it is again. Hope you enjoy.

I think that it is scary for all areas of medicine. In order to help prevent the unknowing lay-public from endangering themselves with sub-par medical care, do what you can to fight it. Speak out and let your opinions be heard. Join the AMA - they are trying to fight these same issues. (For all of you who read this post in disbelief, I mean every word.) Please correct me if I am wrong, but I believe that the reason that programs like this are allowed to happen is that there is no one who tells the nursing profession that they are not adequate to provide total healthcare for patients. They only answer to individual state nursing boards. If you have a group of nurses who get together and believe that they know everything there is to know about healthcare and no one, more specifically, physicians, do not tell them otherswise, of course they think they are justified. Why would they not? Certainly they don't think that they're undereducated...as a general rule most people (not just nurses, this applies to almost all walks of life) don't ever think they're inadequate.
I do think there is a place for nurses...the healthcare system certainly could not exist as it does without them. However, nursing school plus a "masters" that includes pharmacology, pathophysiology, and several "nursing theory" classes is a total joke. (Plus 500 hours of clinical experience!! as I've seen advertised for several nurse practitioning programs...if you average that to 40 hours a week, that is only 12.5 weeks...VERY COMPARABLE to the 2 entire years medical school provides, huh.) I am only a third year medical student but I have already seen numerous patients who have left their inadequate "doctors" who actually turned out to be nurse practioners, which obviously wasn't explained to them. I find this heartbreaking that all of these people had trusted their lives to incompetent providers and that they paid for it with their health.
 
i'm not looking to sling mud, but i'd like to emphasize the small differences between PA's and NP's for the sake of where this thread's angst flows. PA's are too often lumped together with NP's in discussions like these.

i'm a PA and i don't see at all where family practice physicians are forced to compete with PA's. We are truly physician allies because of our dependent relationship. The vast majority of PA's are quite comfortable in this role too. Our practicing freedoms have not been aggressively advanced largely due to lack of interest in the voting/lobbying population.

The PA's that do want more freedom, or want to be called doctor, actually go back to med school. i've got many friends/colleagues that have or are currently doing this (myself included). We've got no other option really. So that pain in the ass, gunner-PA probably won't stay a PA very long. NP's on the other hand, having the status of independent practitioners... well you're stuck with them playing doctor, mismanaging patients, and thinking they're on your level for the length of their (or your) career. I've worked with NP's. I don't plan on hiring one in my practice.

there's also a big difference in the training. PA's are trained in the medical model- hell i was shoulder to shoulder with med students in some of my classes (my PA program was at a medical school). NP's follow the nursing model and want to govern themselves both in practice and education.

i get a big kick out of the Doctoral NP programs that are popping up. what a joke. i'm not a doc yet and i see this as a threat. it's not that different from the Doctoral PT programs on the rise to compete with the Doctor of Chiropractics out there. And speaking of such, how many time have you heard chiropractors refer to themselves as primary care physicians!? yup, that's right. i've seen plenty of it in California. Bottom line: patients are being mislead. PERIOD.

flame away :horns:
 
ProZackMI said:
While I agree with you in part, KID, I disagree with your attitude. I'm an MD and JD, two very difficult professional doctoral programs. However, to classify other professional degrees as "Mickey Mouse" degrees is pretty ignorant. Dentists (DDS), pharmacists (PharmD), psychologists (PhD/PsyD), vets (DVM), podiatrists (DPM), and even optometrists (OD) go through almost as much (and in some cases more) education as an MD/DO and learn a great deal of information. I don't know anything about the DPT or AuD degrees, and don't believe NPs or PAs should have doctorates, but I would never call any advanced degree in the health professions a "Mickey Mouse" degree. Well, that is of course, you're talking about a chiropractic degree. In that case, even Goofy could earn one of those. :)
Click to expand...

Hey, KID...What I was calling Mickey Mouse was the fact that all of the sudden the program is doctoral instead of masters with no change in the curriculum. That is mickey mouse. I never said anything about dentists, vets ect. they definitely have earned Dr. before their name
 
krust3 said:
i'm not looking to sling mud, but i'd like to emphasize the small differences between PA's and NP's for the sake of where this thread's angst flows. PA's are too often lumped together with NP's in discussions like these.

i'm a PA and i don't see at all where family practice physicians are forced to compete with PA's. We are truly physician allies because of our dependent relationship. The vast majority of PA's are quite comfortable in this role too. Our practicing freedoms have not been aggressively advanced largely due to lack of interest in the voting/lobbying population.

The PA's that do want more freedom, or want to be called doctor, actually go back to med school. i've got many friends/colleagues that have or are currently doing this (myself included). We've got no other option really. So that pain in the ass, gunner-PA probably won't stay a PA very long. NP's on the other hand, having the status of independent practitioners... well you're stuck with them playing doctor, mismanaging patients, and thinking they're on your level for the length of their (or your) career. I've worked with NP's. I don't plan on hiring one in my practice.

there's also a big difference in the training. PA's are trained in the medical model- hell i was shoulder to shoulder with med students in some of my classes (my PA program was at a medical school). NP's follow the nursing model and want to govern themselves both in practice and education.

i get a big kick out of the Doctoral NP programs that are popping up. what a joke. i'm not a doc yet and i see this as a threat. it's not that different from the Doctoral PT programs on the rise to compete with the Doctor of Chiropractics out there. And speaking of such, how many time have you heard chiropractors refer to themselves as primary care physicians!? yup, that's right. i've seen plenty of it in California. Bottom line: patients are being mislead. PERIOD.

flame away :horns:
Click to expand...

Agreed. I think a lot of student doctors here do not know that PA boards are the state medical boards, but the NP boards are the state nursing boards. They also don't know that most PA programs are affiliated with an MD or DO school.
PAs just cannot compete with those who employ and SUPERVISE them. That's right I said it. The definition of a PA is a health care provider who practices medicine with physician SUPERVISION. THat doesn't mean they accompany on all my rounds or redo all my exams and orders. What is means is I cannot start a hospitalist practice or a FP clinic for that matter. There is no competition. There is also never going to be PA-D. That is just berzerk (sp?)
Don't tangle up PAs with all of this Nurse-Dr stuff.
 
I agree with you. I have a lot of respect for PAs...more of them are needed. I think that patient care is in lot better hands with PAs than NPs...PA school is largely standardized, the classes are more science-based and like medical school, they certainly seem to get much more of an education than nurse practioners, and they make a point to work with doctors, not against them as NPs have fought so hard to do. Keep up the good work, PAs!

P.S. Those of you who feel that NPs need to be limited and controlled, SPEAK OUT. The AMA is trying to fight it. If more patients understood the difference, I think they would be disgusted!!! The truth is that there are NPs (not all, but a lot) who let their patients think that they are the doctor and the patient knows no difference. Disgusting.

krust3 said:
i'm not looking to sling mud, but i'd like to emphasize the small differences between PA's and NP's for the sake of where this thread's angst flows. PA's are too often lumped together with NP's in discussions like these.

i'm a PA and i don't see at all where family practice physicians are forced to compete with PA's. We are truly physician allies because of our dependent relationship. The vast majority of PA's are quite comfortable in this role too. Our practicing freedoms have not been aggressively advanced largely due to lack of interest in the voting/lobbying population.

The PA's that do want more freedom, or want to be called doctor, actually go back to med school. i've got many friends/colleagues that have or are currently doing this (myself included). We've got no other option really. So that pain in the ass, gunner-PA probably won't stay a PA very long. NP's on the other hand, having the status of independent practitioners... well you're stuck with them playing doctor, mismanaging patients, and thinking they're on your level for the length of their (or your) career. I've worked with NP's. I don't plan on hiring one in my practice.

there's also a big difference in the training. PA's are trained in the medical model- hell i was shoulder to shoulder with med students in some of my classes (my PA program was at a medical school). NP's follow the nursing model and want to govern themselves both in practice and education.

i get a big kick out of the Doctoral NP programs that are popping up. what a joke. i'm not a doc yet and i see this as a threat. it's not that different from the Doctoral PT programs on the rise to compete with the Doctor of Chiropractics out there. And speaking of such, how many time have you heard chiropractors refer to themselves as primary care physicians!? yup, that's right. i've seen plenty of it in California. Bottom line: patients are being mislead. PERIOD.

flame away :horns:
Click to expand...
 
nebrfan said:
Obviously, you don't fully appreciate the advances made in technology and practice that REQUIRE a doctoral level education - personally, I'm working on my PhlebD - Doctorate of Phlebotomy - so that my level of skill and knowledge is understood by my patients. :rolleyes:
Click to expand...

:laugh:

A few years ago, a few of my pharmacist buddies (both PharmD's and B.Sc. pharmacists) where I worked were joking about the whole "everyone's a doctor nowadays" and noticed a bulletin about the new executive chef hired at our instititution to head up cafeteria services. We conferred upon this guy an "official" Doctor of Culinary Science degree and began to refer to him as James XXXXX, Cul. D.
 
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