Doctor Nurse (NP). Does it matter?

red-rat said:

Many dont know about the future plan to make all graduate prepared nurses recive a doctorate degree instead of masters degree. Thus earning the title doctor. Whether you think it is bad or not is up to you.

This is a press release

"Currently, advanced practice nurses (APNs), including Nurse Practitioners, Clinical Nurse Specialists, Nurse Mid-Wives, and Nurse Anesthetists, are prepared in master's degree programs that often carry a credit load equivalent to doctoral degrees in the other health professions. AACN's newly adopted Position Statement on the Practice Doctorate in Nursing calls for educating APNs and other nurses seeking top clinical roles in Doctor of Nursing Practice (DNP) programs."

Reference:
http://www.aacn.nche.edu/Media/NewsReleases/DNPRelease.htm

The fact is midlevels scope of practice (in some states) and number of practioners is increasing.The title of doctor is now something that NPs will gain. This could be confusing and misleading to patients.

What do you (residents & Med students) think about this? Does it matter?

Click to expand...

I think it is a travesty. APNs just don't have the same mindset as Doctors. Ask them to make a decision and they always defer to the doctor. More like they are afraid of making the wrong decision. Plus their training is so dogmatic and protocol driven. Ask them to think "out of the box" and they blow a gasket.

Pardon me if I read it incorrectly, but it seems that the reference is only talking about another route to a doctoral degree for nurses. There have always been PhD programs in nursing, but this article seems to advocate more advanced and clinically-oriented education for APNs rather than the more academic oriented degree.

I'm not sure what the concern is, because there are lots of allied health professionals with doctorate level degrees but very few of them actually use the title "Dr" because it confuses patients and because it simply isn't accepted. So why would one worry about an RN continuing his/her education to a doctorate level and being awarded a doctorate degree anymore than one worries about the Pharm D, PsyD or any othe basic or clinical science PhDs floating around the medical center?

Most of the APNs who will eventually seek this training will do so for more luster to an academic or management career, IMHO. I do not forsee them working with patients and introducing themselves as "Dr So and So."

While we need to protect our careers and our practices, I doubt that an APN with a doctoral degree will be taking over a substantial portion of a physician's work load or skills.

Kimberli Cox said:

I do not forsee them working with patients and introducing themselves as "Dr So and So."

Click to expand...

And WHEN they do?

I ask because a nurse colleague of mine is taking this route and swears that will be her title in the Urgent care in which she now works.

Kimberli Cox said:

I do not forsee them working with patients and introducing themselves as "Dr So and So."

Click to expand...

I question what would be the true motive of getting this more advance degree. Though many may not feel comfortable being called doctors, there will be nothing stopping them from using that term. The scope of ANPs has seemed to expand to compass more a physician role, and i think a "Doctor of Nursing Practice" will give them more lobbying power to further expand their scope of practice.

If midlevels what to do "doctor's" work, let them go through the traditional route, rather then create new pathways to the same endpoint.

JMK

fuegorama said:

And WHEN they do?

I ask because a nurse colleague of mine is taking this route and swears that will be her title in the Urgent care in which she now works.

Click to expand...

Sure there will always be idiots or those who try and confuse others. Using the term Doctor, especially in a medical setting, IMPLIES to almost any reasonable person that one is an MD or DO.

I don't know what the answer is - we've all met Pharm Ds or PhDs that insist on being called doctor. Outside of some institutional warnings or banning of this behavior, I'm not sure there's much one can do unless patients or others start complaining about it.

OTOH, if she's female, she can just forget about patients assuming she's a doctor, even if she tells them she is, they STILL think she's a nurse. Happens everyday to REAL female doctors. Tell her THAT!

JMK2005 said:

I question what would be the true motive of getting this more advance degree. Though many may not feel comfortable being called doctors, there will be nothing stopping them from using that term. The scope of ANPs has seemed to expand to compass more a physician role, and i think a "Doctor of Nursing Practice" will give them more lobbying power to further expand their scope of practice.

If midlevels what to do "doctor's" work, let them go through the traditional route, rather then create new pathways to the same endpoint.

JMK

Click to expand...

Well, it wasn't clear to me that their duties would change or that they would be doing "doctor's work". You're right in that some will take advantage and start to encroach on a physician's traditional role, but then they don't need a doctorate to do that, do they?

I'd rather take a wait and see attitude - then again, I'm not much of a worrier and don't see it as much of a challenge yet (except those APNs with a doctorate who will be calling themselves Dr. So and So).

"wait and see" got us into this midlevel mess in the first place. PA's have changed their titles in many schools from Physician Assistant to Physician Associate.
Nurses continue to lobby and lobby and lobby until one day, that person standing next to you with the 2.5 gpa through college will be wearing the long coat and want to be called doctor.
Listen, we think midlevels are a pain in the ass to deal with as residents and medical students now...wait till some former candy striper that got her night class Doctor of Nursing degree attempt to push you around. Yeah, that will be great.
This is POLITICS boys and girls. THIS HAS NOTHING TO DO WITH PATIENT CARE.
NURSING has attempted to break away from the shadow of medicine for years and years...they see the time is ripe. They want to be independent...they want to be doctors.

Only in the US is this tolerated. I have yet to hear of another country where someone other than a doc treats patients. I feel it is this "let's be politically correct and make sure that no one feels left out" attitude that is taking medicine in the wrong direction. Also, the greed by many docs to make more money is allowing many NPs to take power away from docs. So, in the end, docs will dig their own grave due to their own greed.
I for one, plan to live frugally, invest my money wisely and get out of medicine.

Kimberli Cox said:

Sure there will always be idiots or those who try and confuse others. Using the term Doctor, especially in a medical setting, IMPLIES to almost any reasonable person that one is an MD or DO.

I don't know what the answer is - we've all met Pharm Ds or PhDs that insist on being called doctor. Outside of some institutional warnings or banning of this behavior, I'm not sure there's much one can do unless patients or others start complaining about it.

OTOH, if she's female, she can just forget about patients assuming she's a doctor, even if she tells them she is, they STILL think she's a nurse. Happens everyday to REAL female doctors. Tell her THAT!

Click to expand...

I'm sorry, I really do not want to start a flame war, but Ph.D.s are doctors. There are many degrees that give one the privilege of being called doctor. The only group I know of who have this and do not use it are JDs who are called esquire, at least the men are.

The issue here is whether or not these newer degree holders will try to usurp our position as physicians. As somebody pointed out elsewhere, most states have laws about who is ultimately responsible for patient care in hospitals and that is the physician. Throughout the application process and med school I have made the semantic point of when being asked to reply that I am in training to beceome a physician.

On the thread about possible furthur reduction in work-hours due to a new law suit it has been pointed out that resident hours may be shorter but the patients are sicker. The patients aren't only our patients. The are also the nurses patients. So the nurses are also taking care of sicker and sicker people. The nurses today are probably more capable then they were forty years ago. They have to have more training. If the upper leverl nurses complete as many post graduate hours of training as any doctoral degree candidate, why shouldn't they have the academic title doctor?

Kimberli Cox said:

While we need to protect our careers and our practices, I doubt that an APN with a doctoral degree will be taking over a substantial portion of a physician's work load or skills.

Click to expand...

I disagree. Take for example the PA's making $150K and the CRNA's making $180K annually. It's all about economics. They will have the money to lobby for independent practice legislation in Washington. It is only a matter of time. MDs and DOs better get their sheat together soon and start lobbying against such legislation otherwise they will be hitting the unemployment lines in the next 10 years.

MD'05 said:

I disagree. Take for example the PA's making $150K and the CRNA's making $180K annually. It's all about economics. They will have the money to lobby for independent practice legislation in Washington. It is only a matter of time. MDs and DOs better get their sheat together soon and start lobbying against such legislation otherwise they will be hitting the unemployment lines in the next 10 years.

Click to expand...

You overexaggerate! Most PAs make half and most CRNAs make about two-thirds of what you quoted! No matter how outrageous mid-levels get with lobbying for power, physicians will always be on top! Non-socialized healthcare is what allows limited license practitoners and mid-levels to thrive but it will also keep them in check. If more Ophthamologists were available, the general public would choose them over an Optometrist. How many people actually choose Nurse Practioners (outside of the psychiatry) or CRNAs? Next to none is the answer. Most nurse practitioners see patients in a physican's office. Most CRNAs anethetize patients in a hospital. If these mid-levels become independents then the media will likely inform the public of the "scary state of healthcare" with some over the top news report. In turn, the general public will check the credentials to the right of the healthcare provider's name.

A wolf in sheep's clothing. Yes they will be APN's, but on the door it will say DR. and you think the patient will stop to ask, what med school she/he went to? This is absolutley dangerous to pateint care and the MD profession. But one of the other posters is right. We can blame no one but ourselves and our pin-headed leadership in AMA, AAMC. The only things they have done over the past decade is: 1)reluctantly given in to JUST an 80 hour work week 2) fought the Match change so we can all still be underpaid medical slaves 3) and now allowed introduction of Step 2CS. So while they are busy busting every med students balls (ovaries), the nurses amd PA's have snuck in the back door and are about to smack us over the head with a two-by-four. Those fat heads in DC should be thrown out on there asses. They sold us out for a few quick bucks and now, there's no going back! we're F---!

chicoborja said:

You overexaggerate! Most PAs make half and most CRNAs make about two-thirds of what you quoted! No matter how outrageous mid-levels get with lobbying for power, physicians will always be on top! Non-socialized healthcare is what allows limited license practitoners and mid-levels to thrive but it will also keep them in check. If more Ophthamologists were available, the general public would choose them over an Optometrist. How many people actually choose Nurse Practioners (outside of the psychiatry) or CRNAs? Next to none is the answer. Most nurse practitioners see patients in a physican's office. Most CRNAs anethetize patients in a hospital. If these mid-levels become independents then the media will likely inform the public of the "scary state of healthcare" with some over the top news report. In turn, the general public will check the credentials to the right of the healthcare provider's name.

Click to expand...

Actually I do not exaggerate. A PA working for a lucrative electrophyiology Cardiology group can make that much. CRNAs who work their asses off can make that much.

APACHE3 said:

A wolf in sheep's clothing. Yes they will be APN's, but on the door it will say DR. and you think the patient will stop to ask, what med school she/he went to? This is absolutley dangerous to pateint care and the MD profession. But one of the other posters is right. We can blame no one but ourselves and our pin-headed leadership in AMA, AAMC. The only things they have done over the past decade is: 1)reluctantly given in to JUST an 80 hour work week 2) fought the Match change so we can all still be underpaid medical slaves 3) and now allowed introduction of Step 2CS. So while they are busy busting every med students balls (ovaries), the nurses amd PA's have snuck in the back door and are about to smack us over the head with a two-by-four. Those fat heads in DC should be thrown out on there asses. They sold us out for a few quick bucks and now, there's no going back! we're F---!

Click to expand...

Like minded residents and medical students must infiltrate the AMA. The AMA is comprised of a bunch of fat and happy bureaucrates that have sold out the medical profession. If we can take over the AMA, we can put some of the dues monies to good use and lobby in Washington for legislation that favors physicians.

APACHE3 said:

A wolf in sheep's clothing. Yes they will be APN's, but on the door it will say DR. and you think the patient will stop to ask, what med school she/he went to? This is absolutley dangerous to pateint care and the MD profession. But one of the other posters is right. We can blame no one but ourselves and our pin-headed leadership in AMA, AAMC. The only things they have done over the past decade is: 1)reluctantly given in to JUST an 80 hour work week 2) fought the Match change so we can all still be underpaid medical slaves 3) and now allowed introduction of Step 2CS. So while they are busy busting every med students balls (ovaries), the nurses amd PA's have snuck in the back door and are about to smack us over the head with a two-by-four. Those fat heads in DC should be thrown out on there asses. They sold us out for a few quick bucks and now, there's no going back! we're F---!

Click to expand...

I agree completely with you.

What would happen if every fourth year medical student refused to take the CS? That would sure be heard.

We need to unite as a strong, forceful voice if we want others to respect medicine, the title we've all worked so hard to earn.

APACHE3 said:

A wolf in sheep's clothing. Yes they will be APN's, but on the door it will say DR. and you think the patient will stop to ask, what med school she/he went to? This is absolutley dangerous to pateint care and the MD profession. But one of the other posters is right. We can blame no one but ourselves and our pin-headed leadership in AMA, AAMC. The only things they have done over the past decade is: 1)reluctantly given in to JUST an 80 hour work week 2) fought the Match change so we can all still be underpaid medical slaves 3) and now allowed introduction of Step 2CS. So while they are busy busting every med students balls (ovaries), the nurses amd PA's have snuck in the back door and are about to smack us over the head with a two-by-four. Those fat heads in DC should be thrown out on there asses. They sold us out for a few quick bucks and now, there's no going back! we're F---!

Click to expand...

I mostly agree, but remember one of the reasons PAs are becoming so prevalent is the 80 hour work week. Somebody needs to take up the slack and they are less expensive than physcians.

All of you must be 1. a member of your professional organization, be it AMA, AOA, AMSA, or specialty organizations 2. BE POLITICALLY ACTIVE 3. Donate time and money 4. WRITE TO YOUR CONGRESSMEN/WOMEN 4. Don't Hire PA's or NP's if such practices go against your thinking. I have had no problems with PA's in the past, but Medicine did survive prior to their existence. As far as NP's, I have no intention of hiring one. In fact the group I have joined will be getting rid of ours in the near future.

The word "doctor" is actually derived from a Greek word that means teacher. This is a completely irrelevant statement, but I guess that physicians or nurses don't really deserve to be called doctor in the truest sense of the word (unless they are teaching people). Oh well I look for nurses and PAs to eventually have more rights and privileges than physicians. I mean lets face it an ARNP or whatever a nurse practicioner is called can work as an RN type floor nurse or she can practice as a primary care physician. PAs can work in surgery, psyche or primary care. Let's see an internist try that. I guess MDs are just outdated or soon to be outsourced (radiology). Midlevels will stop coming in when medicine gets socialized and starts to pay like social work (which is ineveitible since costs keep rising at 3% per year (of GDP) and companies will eventually twist the arms of politicians to insure that they don't have to provide health insurance "the gov't needs to do it"). I don't really care anymore after this year I am just hoping for enough to pay my loan payment, rent a room and buy some rot gut gin. I have been taking orders for so long that I don't even really care who they come from any more. Man or woman. RN or resident. God or satan. The government or insurance companies.

Just remember, when an expert witness nurse practicioner is on the stand testifying against me, I told you that the republicans wouldn't save us.

lesstewert said:

Just remember, when an expert witness nurse practicioner is on the stand testifying against me, I told you that the republicans wouldn't save us.

Click to expand...

Amen to that. However, I'm not going to lie down and let those midlevels screw me over, least of all in court.

njbmd said:

Hi there,
In the clinical setting, the term Doctor refers to Doctors of Allopathic Medicine and Doctors of Osteopathic Medicine and Doctors of Dental Science that is M.D., D.O. and D.D.S.

In the academic setting anyone with a Doctorate (Pharm D., Ph.D and the above may be addressed as "Doctor". I am not negating the values of these degrees, I am just saying that using the title of "Doctor" outside of the academic environment is pretty lame.

A nurse practictioner, no matter how many hours is not the same as an MD/DO/ DDS in the clinical setting. The same goes for a Pharm D. The patients know the difference and the rest is an attempt at "ego massage" at the expense of the patient. If you want the title, go to medical/dental school.

Click to expand...

I refer to my dentist as a doctor, i refer to my optometrist as a doctor. I think anyone in a healthcare field that is clinically licensed to provide a certain level of services should be called doctor. If I have to talk to my pharmacist, i call him doctor. It just makes sense. You're not going to go into an optometrists office and be like "hi mr. so and so." he's the one providing the complete level of care. He's the doctor. I think anyone in a healthcare field that has gone through a professional school program and who provides services based on a scientific background should be called doctor. A PharmD is still a doctor. They just provide a different type of services. Dentists dont provide teh same services as MD's, but we call them doctors. Pharmacists deal with drugs instead of diseases, but this doesnt mean they're not at the highest level of expertise. They have extensive training and are at the top of their field, having gone through a rigorous professional proram, and deserve to be called doctor too, because in their field (drugs), they are the head honchos.

I dont think, however, that nurses should, simply because nursing is different from all of these other fields (as nursing is more social science and "caring" based than treatment based). A PhD nurse in academia could be called doctor, but in practice, while a PhD nurse has gone through an extensive academic training, like other PhD's, they still havent gone through a clinical professional degree. I wouldnt call a PhD Pharmacologist doctor in a medical setting, as they do not have a professional degree that gives them license to provide services, either.

lesstewert said:

The word "doctor" is actually derived from a Greek word that means teacher. This is a completely irrelevant statement, but I guess that physicians or nurses don't really deserve to be called doctor in the truest sense of the word (unless they are teaching people).

Click to expand...

Aren't we supposed to be doing just that with patients? You know, risk factor modification, compliance with meds, why they shouldn't be loading up on their T4s while driving a forklift...

I was annoyed by a pharmacist who was dispensing medical advice at a CVS near my home. He told this elderly lady with a nasty cough that if her sputum turned green that was when she needed an antibiotic. Other than that her cough would probably go away.

I looked the guy in the eye and stated directly to him "you have got to be kidding me." He quickly backpeddled and told the woman that he does not dispense medical advice and she should see her doctor.

Damn straight. Woman could die from a "walking" pneumonia with that kind of advice. Green sputum.

Tell me that physicians are safe. Everyone is trying to be a physician these days.

red-rat said:

It is not PHD that NPs will be geting. This new degree is a clinical based degree they call the Doctorate of Nursing Practice (DNP). About 10 of these programs exist now and 40 are currently under development

Click to expand...

Do you have a website where the curriculum is listed?

Nevermind.

http://cpmcnet.columbia.edu/dept/nursing/academics-programs/drnpfaq.html#1

F*cking insurance companies driving this I am sure.

DocWagner said:

All of you must be 1. a member of your professional organization, be it AMA, AOA, AMSA, or specialty organizations 2. BE POLITICALLY ACTIVE 3. Donate time and money 4. WRITE TO YOUR CONGRESSMEN/WOMEN 4. Don't Hire PA's or NP's if such practices go against your thinking. I have had no problems with PA's in the past, but Medicine did survive prior to their existence. As far as NP's, I have no intention of hiring one. In fact the group I have joined will be getting rid of ours in the near future.

Click to expand...

My hat off to you!. Here's is an example of what we should all be doing. DO NOT hire NPs. Hire PAs. I for one will be very aggressive about this and will always be a hawk watching out for NPs and try to bust their balls whenever I get a chance

toughlife said:

My hat off to you!. Here's is an example of what we should all be doing. DO NOT hire NPs. Hire PAs. I for one will be very aggressive about this and will always be a hawk watching out for NPs and try to bust their balls whenever I get a chance.

Click to expand...

No. You need to contact your professional organization and ask them what they plan to do to stem this infringement upon practice rights.

I myself will go on a letter writing campaign.

MD'05 said:

No. You need to contact your professional organization and ask them what they plan to do to stem this infringement upon practice rights.

I myself will go on a letter writing campaign.

Click to expand...

Don't we already have the answer to that?

toughlife said:

Don't we already have the answer to that?

Click to expand...

After seeing the website I am more concerned than ever.

I also read the website and am overall less concerned now, and I'm an MD. Here's why:
1) Part of the push is to simply aggregate all doctoral degrees into one, eliminating the ND (shared with naturopathic) and several others into the DNP.
2) It fairly plainly stated that potential employers were interested mainly for administrative type positions, even with the practice focused degree. This as opposed to the PhD's who don't stray far from acadamia.
3) It's only a position paper, not law.
4) Another of their main reasons seems to be that other professions (read pharmacy) have the doctoral degree as the entry point to clinical practice. I don't see why this is important.
5) It states that coursework will be added, to make it a true doctoral degree, as well as a dissertation. Thus keeping more people out of the field.
6) Even with 40 more schools opening up numbers are going to be small. It's still a big time commitment.
7) The licensing laws and scope of practice will be exactly the same. If I were into pharmacy, I would have hopped on the last of the BS degrees and got a job at Walgreens. Why go through more school to do the same job? Same thing here. Will those APN's already certified take the extra coursework to be called Dr.? Sure, some will, but the majority won't.

In the end though the fight is for scope of practice, not degree. The doctorate degree already means nothing in my opinion. Anyone is a Dr. if they want to be one. Hunter Thompson did his through mail order, and was eulogized on the cover of Rolling Stone as 'Dr. Hunter S. Thompson' last month. I guarantee we will see an erosion of all health care providers going to more and more doctorates. At the end of the day, the only thing that matters is the job. If the jobs are there then they will succeed. We're the ones who decide if jobs are there. Physician groups are the responsible party.

The DrNP, or clinical doctorate, prepares the graduate to practice independently with the most complex patients, in any setting where the patient requires care, utilizing complicated informatics and evidence-based decision-making.

It is expected that students will accomplish the requirements of the Residency within one calendar year.

Click to expand...

Wow, one year? I guess my 4 yrs of residency is a bit overkill huh?

Looks like everyone wants to play doctor...but no one wants to go to medical school for it. NPs, CRNAs, PTs, Psychologists, Chiropractors, Optometrists...

Can't really blame them though, if the Medical Profession allows it...why wouldn't they push for it?

I'm sure the DNPs will secretly smirk at us when they realize they can make about the same amount of money as we do

1. In less time
2. With less debt
3. And the same end goal of being called "Doctor".

Whodathunkit said:

Wow, one year? I guess my 4 yrs of residency is a bit overkill huh?

Looks like everyone wants to play doctor...but no one wants to go to medical school for it. NPs, CRNAs, PTs, Psychologists, Chiropractors, Optometrists...

Can't really blame them though, if the Medical Profession allows it...why wouldn't they push for it?

I'm sure the DNPs will secretly smirk at us when they realize they can make about the same amount of money as we do

1. In less time
2. With less debt
3. And the same end goal of being called "Doctor".

Click to expand...

Another question is how do physician's distinguish themselves? Not so much the specialists, but the PCPs?

No one has mentioned yet that patients and doctors are not the people making the decisions about whether to hire NP's and PA's as primary care providers-- it's the insurance companies. Why shouldn't they? The NP's/PA's are cheaper, and seem to do just as good of a job.

I think we need a little "non-PC" research to see if they really do as well as doctors in these settings. If they are not as safe as doctors and the general public starts to understand that, they'll demand change or start suing the mid-levels more often, and the insurance companies will see a reason to change. Here are a few

This one reports a difference in anesthesia complication rates between MD's and CRNA's:
www.upenn.edu/ldi/issuebrief6_2.pdf

This one shows no difference in outcomes when patients in a primary care clinic are treated by NP's or MD's:
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=10632281

Everyone gets to be called doctor now-- the naturopaths, chiropractors, pa's, midwives, whatever... it's confusing for patients. We need to be more aggressive in protecting our role while letting other people provide assistance.

red-rat said:

I think that midlevel practitioners will take most or almost ALL of the primary care pie. Most people in medicine want to specialize and on average there is less money in primary care. This is decreasing the incentive to go into primary care. My NP friend says that her profession is positioning themselves to corner a large percent of the marketbecause the vine is ripe and managed care is willing. The plan is to make their education at the doctorate level and practice independently within their scope of practice and making referrals as needed. Thus the MD/DOs stick to specialties and let the NPs deal with the boring basic cases (which make up the majority). In many states NPs can already do this and are. Most states just require a collaborating physician. This can amount to as little as one signature.

Click to expand...

Even if less fewer MEDICAL SCHOOL graduates enter primary care fields, there will always be interest in the profession. Many would say that if given a choice between physician vs NP, most would choose to see a physician to take care of them. But if NP become the new wave of primary care "docs" then many insurance plans will force them to be assigned to the cheaper NPs.

Personally, I am uneasy about having a two-tier primary care system. See an NP first. IF the NP thinks it needs to be referred, then... hmmm... let's call the physician primary care specialist.

I read over the position statement and the FAQ. True, the DNP degree won't give them more power. But with more people earning that degree and itching to use it to the fullest potential, they'll find a way to change the law and expand their scope of practice.

Everyone wants good medical care, but no one wants to pay for it.

Furrball said:

I'm sorry, I really do not want to start a flame war, but Ph.D.s are doctors. There are many degrees that give one the privilege of being called doctor. The only group I know of who have this and do not use it are JDs who are called esquire, at least the men are.

The issue here is whether or not these newer degree holders will try to usurp our position as physicians. As somebody pointed out elsewhere, most states have laws about who is ultimately responsible for patient care in hospitals and that is the physician. Throughout the application process and med school I have made the semantic point of when being asked to reply that I am in training to beceome a physician.

On the thread about possible furthur reduction in work-hours due to a new law suit it has been pointed out that resident hours may be shorter but the patients are sicker. The patients aren't only our patients. The are also the nurses patients. So the nurses are also taking care of sicker and sicker people. The nurses today are probably more capable then they were forty years ago. They have to have more training. If the upper leverl nurses complete as many post graduate hours of training as any doctoral degree candidate, why shouldn't they have the academic title doctor?

Click to expand...

I"m sorry I wasn't clearer in my earlier post. I have no problem with PhDs being called Doctor; they have earned the degree just as much as someone who earns an MD or DO degree. You are preaching to the choir; or to someone who was enrolled in a PhD program prior to medical school.

And in addition, I have no problem specifically with nurses earning an academic degree and being called doctor. Again, they have earned the degree. There are already PhD nurses around and I respectfully call them "Doctor" just as I would any other professor with a PhD.

The problem as I see it comes in using it in a clinical setting with patients who will not know who is the MD/DO and who is the nurse with a PhD. I find that troubling. The atmosphere in the hospital is already confusing for patients.

toughlife said:

Only in the US is this tolerated. I have yet to hear of another country where someone other than a doc treats patients. I feel it is this "let's be politically correct and make sure that no one feels left out" attitude that is taking medicine in the wrong direction. Also, the greed by many docs to make more money is allowing many NPs to take power away from docs. So, in the end, docs will dig their own grave due to their own greed.
I for one, plan to live frugally, invest my money wisely and get out of medicine.

Click to expand...

Thank You!!

We've already agreed that physcians brought this on themselves.. It is the US system that has created this. Anytime you have greedy lawyers and insurance companies trying to save a buck no matter what it takes, combined with competitive doctors who are trying to make as much money and have as much power as possible. Your going to open up this venue for midlevels to take primary care jobs. Instead of trying to get all docs to boycott NPs and/or PAs. Why don't you try to make Primary care more attractive for Medically trained doctors!!

JMK2005 said:

Personally, I am uneasy about having a two-tier primary care system. See an NP first. IF the NP thinks it needs to be referred, then... hmmm... let's call the physician primary care specialist.

I read over the position statement and the FAQ. True, the DNP degree won't give them more power. But with more people earning that degree and itching to use it to the fullest potential, they'll find a way to change the law and expand their scope of practice.

Everyone wants good medical care, but no one wants to pay for it.

Click to expand...

Pretty scary stuff!!

Ross434 said:

I refer to my dentist as a doctor, i refer to my optometrist as a doctor. I think anyone in a healthcare field that is clinically licensed to provide a certain level of services should be called doctor. If I have to talk to my pharmacist, i call him doctor. It just makes sense. You're not going to go into an optometrists office and be like "hi mr. so and so." he's the one providing the complete level of care. He's the doctor. I think anyone in a healthcare field that has gone through a professional school program and who provides services based on a scientific background should be called doctor. A PharmD is still a doctor. They just provide a different type of services. Dentists dont provide teh same services as MD's, but we call them doctors. Pharmacists deal with drugs instead of diseases, but this doesnt mean they're not at the highest level of expertise. They have extensive training and are at the top of their field, having gone through a rigorous professional proram, and deserve to be called doctor too, because in their field (drugs), they are the head honchos.

I dont think, however, that nurses should, simply because nursing is different from all of these other fields (as nursing is more social science and "caring" based than treatment based). A PhD nurse in academia could be called doctor, but in practice, while a PhD nurse has gone through an extensive academic training, like other PhD's, they still havent gone through a clinical professional degree. I wouldnt call a PhD Pharmacologist doctor in a medical setting, as they do not have a professional degree that gives them license to provide services, either.

Click to expand...

Agree..

A doctorate is the highest degee awarded in a field. Goes to the one with the most expertise. Makes sense for pharmacy, law, dentistry....even medicine. So why confuse things? In the clinical setting the person who completed years of medical school, residency, sometimes fellowship clearly has the highest expertise around and deserves the doctorate. I dont care how many hours of nursing shool they rack up. I wonder if pharmacists would sit back and watch as the pharmacy tech working for him lobbys for doctorates just cause they have done X amount of hours. This is crazy people!

I'm confused. You will call your optometrist "dr." But an optometrist is far from being the expert in his field - I would call him the equivalent of a PA or NP. An ophthalmologist would be the expert. An optometrist is just a wanna-be who can only do the basic things and make things easier. They do not deserve the title of doctor any more than a NP does.

MAC10 said:

Agree..

This is crazy people!

Click to expand...

Yup. What is an academic PhD nursing degree exactly? We already have a doctorate in the field of medicine, called an MD. How is their focus different, and do we need a separate academic degree to cover it? Otherwise, this seems to be more about power and status rather than an advancement of healthcare.

This is the real deal. And the nursing schools aren't shy about it. The following are a few alarming quotes from Columbia's DNP programme. See for yourself the consequences of having such entities...independent MD-substitute.

http://cpmcnet.columbia.edu/dept/nursing/academics-programs/drnpfaq.html#1

"DrNP curriculum focuses on the knowledge needed for independent, advanced nursing practice" (independent!)

"...expanded curriculum will focus on the utilization of evidence-based decision-making to admit and co-manage hospitalized patients, to provide advice and treatment initiated over the phone while taking call, and to initiate specialist referrals and evaluate the subsequent advice and initiate and participate in co-management" (CO-management implies same level)

"Requirements for independent reimbursement of DrNP nurses will mirror requirements for physicians and will include: standard competencies, certification, scope of practice and a doctoral degree." (same requirements as physicians or should I say the ones with the MD)

"Why is this degree necessary?" (i paraphrased the following) "because we needed a degree title to make us seem legitimate in the eyes of the public, the payers, and the policy makers." (the PUBLIC, the PAYERS, and THE POLICY MAKERS).

They are playing hard ball.

friendlyfriend said:

"Why is this degree necessary?" (i paraphrased the following) "because we needed a degree title to make us seem legitimate in the eyes of the public, the payers, and the policy makers." (the PUBLIC, the PAYERS, and THE POLICY MAKERS).

Click to expand...

LMAO, this is outta control.

sb_MD said:

I'm confused. You will call your optometrist "dr." But an optometrist is far from being the expert in his field - I would call him the equivalent of a PA or NP. An ophthalmologist would be the expert. An optometrist is just a wanna-be who can only do the basic things and make things easier. They do not deserve the title of doctor any more than a NP does.

Click to expand...

An optometris has a doctoral degree, hence doctor. Naturopaths and chiropracters are also awarded doctoral degrees from institutions that have been accredited to award doctoral degrees. So calling them doctor is entirely appropriate. I've finished my fourth year of medical school and I am currently waiting for graduation. My downstairs neighbor is a naturopathic medicine student. He is busting his @ss right now. I will never personally use the servies of a ND, but I'll call them doctor.

fang said:

Yup. What is an academic PhD nursing degree exactly? We already have a doctorate in the field of medicine, called an MD. How is their focus different, and do we need a separate academic degree to cover it? Otherwise, this seems to be more about power and status rather than an advancement of healthcare.

Click to expand...

They go to graduate school, take courses, write and defend a scholarly dissertation. I do not know what level of research they do. At the end they receive their PhD. It doesn't change their scope of practice other than they often are professors at nursing schools or in their area of study for their PhD.

sb_MD said:

I'm confused. You will call your optometrist "dr." But an optometrist is far from being the expert in his field - I would call him the equivalent of a PA or NP. An ophthalmologist would be the expert. An optometrist is just a wanna-be who can only do the basic things and make things easier. They do not deserve the title of doctor any more than a NP does.

Click to expand...

Thats a pretty good point...

i think the sentiment of some of the earlier posters is correct. we shouldn't worry so much about who gets to be called doctor. we lost that debate anyway. this is really about the scope of practice. did anyone read the excerpts from the position paper posted above? for all of their bullsh** about nursing being different, a separate but equal profession, being the "caring" profession, etc., the aim of this effort is abundantly clear. they are trying to take the cheap and easy route to becoming full-fledged doctors, fully independent, and out from under the guidance of an MD/DO. i say the cheap and easy route because, compared to acquiring an MD/DO, that's exactly what it is. in the allied health/nursing forum a similar debate has been going on for a while now. there i posted curriculum excerpts from two of the current programs, columbia and tennessee. highlights: 40 hours of coursework above the masters in one case completed by 2-3 days per week on campus and in the other largely over the internet, to be followed by a one year residency. that residency, according to the columbia website, will be around 28-40 hours per week and may be solely outpt.

i agree with previous posters in that i believe the motivation for this effort is two-fold. first, of course, is the almighty buck. second is prestige. the second point may be even more important for the nursing profession which (sadly) has had a huge inferiority complex with regard to their position in healthcare.

who's to blame? it's easy and obvious to pin this on nurses and insurance companies. the former working towards the goals listed above and the latter looking to save bucks. physicians are also to blame and in this case i tag primary care docs as the worst offenders. (i'm one so i claim the right to say this.) i mean, it is lovely after all to be able to "work with" (hire) an np to treat all the sniffles in the office, right? you don't have to see the sniffles, you sign a chart now and then and have this mini-doc generating revenue for you. hell, in a lot of states the mini-doc could be out roaming the landscape for sniffles generating revenue for you while you sit in your office taking care of the "important" stuff. just come on in once a month and you'll sign the papers.

but guess what, now the mini-docs have figured (rightly or wrongly) that they can keep more of the bucks for themselves if they can knock your ass out of the picture. who knows if this strategy will pan out; they look serious about trying it though.

finally, part of the blame has to go to the woefully undereducated american public. the public that says "good morning doctor" to every white coat that comes in through the door be it MD, DO or CNA. the public that generates as many visits to alternate health care providers as primary care providers on a yearly basis. the public that reads two lines from billy bob's online medical-cosmetology encyclopedia and comes in wanting purple eyeliner to treat their multiple myeloma. they are also to blame and perhaps when the deaths start racking up, they will wake up and do something about this.

solutions? well, we should lobby. that hasn't gotten us very far though. i think a far more effective strategy would be to start playing economic hardball ourselves. (this is exactly what's going to happen anyway when enough docs start feeling threatened.) don't teach their students, don't hire the graduates, refuse admitting rights when they start clamoring for them, don't make referrals to them...put the blinding spotlight of science on them to really look into their pt outcomes...and finally market the hell out of ourselves. is this cut-throat and "ungentlemanly"? you bet. but hey, they're bringing the fight to us. and i don't know any group of more cut-throat mfers than us. might as well use that to our advantage.

holy cow! i re-read my post just now...bitter much??? still i'll float it out there. happy easter!!!

-drgiggles