where are you comming up with this crap. vaccines don't just cost what they cost. They cost what they cost + administration fee for administering the vaccine (last I checked it was from 15-30$).
DNPs will eventually have unlimited SOP
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where are you comming up with this crap. vaccines don't just cost what they cost. They cost what they cost + administration fee for administering the vaccine (last I checked it was from 15-30$).
yes but those are celebrity lawyers & they are charging for fame, not because they can do the work any better. Healthcare doesn't work the same, you don't need some high powered doctor to tell you to exercise & take statins.
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That may be, but you are still oversimplifying things.
For example with zoster boosters for seniors: we have it set up that they can get their vaccine in the pharmacy but not all insurances allow it. For those patients they must return to the outpatient clinic where the physician gives it. The cost to the patient is the same(actually I saw a woman who saved $10). Your example was just bad because costs to the patient reflect reimbursement. It isn't as simple as saying "oh if your doctor does it it costs more". More than anything the lack of scope is why DNPs make less, not because they just charge less for everything they do.
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In my very limited observation, NPs and PAs really aren't that jazzed up about primary care.
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health care field is changing for the worse..
this is what happens when we have lawyers in government (quite a few of which are malpractice lawyers) making decisions on healthcare..
another thing going against us is the public perception that doctors are getting paid too much money and that they should be willing to accept less money for a noble duty..i know im preaching to the choir but what the average person doesn't realize though is amount of training/education required, the hours worked, hundreds of thousand dollars in debt that accrues with interest throughout undergrad, med school, residency and fellowship before doctors start making that amount of money, not to mention malpractice insurance coverage, declining reimbursements, etc...there was even a highly publicized study that was picked up by the media last year that blamed high health care costs primarily on doctor's high salary..our field has really failed in changing this perception among the public which will come back to bite us
in terms of DNPs, i dont see DNPs getting the same salary that MDs are getting now, what I see happening is the reverse..once DNPs start doing jobs that MDs were once doing and making only >80% of the salary of MDs, then there will be even more pressure for MDs to make less, and with hospitals trying to cut costs and maximize "profit", they will naturally hire more DNPs at the fraction of the cost of hiring a MD for the same job...and with more med schools being opened, and more international students applying for residency here, the competition for jobs will be intense in the future..once we are forced to compete for jobs with each other and DNPs then the MDs will also lose any bargaining power..the employers will be dictating the terms then..hospitals/government will have absolutely no incentive to pay a MD a $300,000+ salary when they can get the same work from a DNP at <$100,000 (some nurse anesthesiologists make over $150,000 which is still a fraction of the salary of an anesthesiologist with a MD)...simple economics and capitalism at work
i have absolutely nothing against DNPs, i think they can play a very important role as part of a medical team but as their autonomy increases, MDs will eventually get into turf wars with them that we are bound to lose:
(1) DNPs will naturally try to keep pushing the boundaries for more autonomy/power, may even start referring patients to "specialized' DNPs (they're already developing fellowships for DNPs), something akin to what cardiologists and interventional cardiologists did to cardiac surgery, leaving the MDs with the more complicated, sicker patients and if the government decides to base reimbursement on performance and outcomes then we're definitely screwed;
(2) the lawyers in the government will be cutting health care costs by cutting reimbursements, instead of addressing the real issues that are driving up health care costs, such as defensive medicine due to fear of malpractice lawsuits, but have you wondered why that has rarely been brought up as an issue by our government officials??;
(3) with declining reimbursements, hospitals will encourage the hiring of DNPs and other mid-level practitioners over MDs to minimize their costs;
(4) AMA is worthless so we essentially dont have a lobbying group in government which seems to be the only way to get a so-called democratic government to listen to you...pharmaceutical and insurance companies have very powerful lobbying groups, so guess who's going to get shafted at the end? Yup, the doctors;
(5) and public perception is and will be against us also..
this is purely my own opinion/speculation (some of which I admit can seem far-fatched and unlikely to happen but it is something that we should all actively keep an eye out on, especially since DNPs are being so aggressive in promoting their field and interests, we should be doing the same)..i hope i'm completely wrong
this is what happens when we have lawyers in government (quite a few of which are malpractice lawyers) making decisions on healthcare..
another thing going against us is the public perception that doctors are getting paid too much money and that they should be willing to accept less money for a noble duty..i know im preaching to the choir but what the average person doesn't realize though is amount of training/education required, the hours worked, hundreds of thousand dollars in debt that accrues with interest throughout undergrad, med school, residency and fellowship before doctors start making that amount of money, not to mention malpractice insurance coverage, declining reimbursements, etc...there was even a highly publicized study that was picked up by the media last year that blamed high health care costs primarily on doctor's high salary..our field has really failed in changing this perception among the public which will come back to bite us
in terms of DNPs, i dont see DNPs getting the same salary that MDs are getting now, what I see happening is the reverse..once DNPs start doing jobs that MDs were once doing and making only >80% of the salary of MDs, then there will be even more pressure for MDs to make less, and with hospitals trying to cut costs and maximize "profit", they will naturally hire more DNPs at the fraction of the cost of hiring a MD for the same job...and with more med schools being opened, and more international students applying for residency here, the competition for jobs will be intense in the future..once we are forced to compete for jobs with each other and DNPs then the MDs will also lose any bargaining power..the employers will be dictating the terms then..hospitals/government will have absolutely no incentive to pay a MD a $300,000+ salary when they can get the same work from a DNP at <$100,000 (some nurse anesthesiologists make over $150,000 which is still a fraction of the salary of an anesthesiologist with a MD)...simple economics and capitalism at work
i have absolutely nothing against DNPs, i think they can play a very important role as part of a medical team but as their autonomy increases, MDs will eventually get into turf wars with them that we are bound to lose:
(1) DNPs will naturally try to keep pushing the boundaries for more autonomy/power, may even start referring patients to "specialized' DNPs (they're already developing fellowships for DNPs), something akin to what cardiologists and interventional cardiologists did to cardiac surgery, leaving the MDs with the more complicated, sicker patients and if the government decides to base reimbursement on performance and outcomes then we're definitely screwed;
(2) the lawyers in the government will be cutting health care costs by cutting reimbursements, instead of addressing the real issues that are driving up health care costs, such as defensive medicine due to fear of malpractice lawsuits, but have you wondered why that has rarely been brought up as an issue by our government officials??;
(3) with declining reimbursements, hospitals will encourage the hiring of DNPs and other mid-level practitioners over MDs to minimize their costs;
(4) AMA is worthless so we essentially dont have a lobbying group in government which seems to be the only way to get a so-called democratic government to listen to you...pharmaceutical and insurance companies have very powerful lobbying groups, so guess who's going to get shafted at the end? Yup, the doctors;
(5) and public perception is and will be against us also..
this is purely my own opinion/speculation (some of which I admit can seem far-fatched and unlikely to happen but it is something that we should all actively keep an eye out on, especially since DNPs are being so aggressive in promoting their field and interests, we should be doing the same)..i hope i'm completely wrong
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So the moral of the story is specialize and/or go into a surgical field.
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Or get an MBA and do something like management.
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Or just enjoy your schooling and choose a field you enjoy.
Midwives have total autonomy and are paid the same as an obgyn with obamacare.
Dnps are paid 85% of a docs fee and are paid directly so they cant be employed by a physician and are just required to have a "collaboration". Id take a 15% cut in fees for 30k of debt vs 300k, not to mention the heavier tax burden a physician falls in with more income from higher fees.
Dnps are paid 85% of a docs fee and are paid directly so they cant be employed by a physician and are just required to have a "collaboration". Id take a 15% cut in fees for 30k of debt vs 300k, not to mention the heavier tax burden a physician falls in with more income from higher fees.
There are actually less residency spots for img grads and the number of spots has been stagnate for years. They dont want more physicians they want more dnp, pas, clinical paychologists/social workers, physical therapists, occupational therapists, and other healthcare workers they can pay less to do the same job. The science of medicine suffers as science has. We are in no way making the innovative progress we should be because the government funds research that is ear marked for only certain diseases or results. Tons of garbage and false clinical research to please the hand that feeds
Im pretty sure thomas edison did not get a research grant from the fed asking for the motion picture camera.
Im pretty sure thomas edison did not get a research grant from the fed asking for the motion picture camera.
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This seems to be the current trend in healthcare as a whole. It doesn't seem to matter who is better trained and equipped. All they care about is who is cheaper and can produce "about the same results". I think it's a shame. As a student on an educational crossroad the current trend actually discourages education and becoming the "most skilled" in the field you want. If all you want is family medicine then just become a np, if all you want is psychotherapy in a clinical setting just become a sw and so on (in a cost benefit sense). I wonder how healthcare is going to be like in the future. And I mean no disrespect to mid level professionals. We all have a role to play and I have nothing but respect for every profession in healthcare field. Okay that is enough of me ranting.
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Once nurses demand equal pay they have essentially lost the war. A patient will always prefer to see a doctor over a nurse.
Have you ever been in a crisis situation? If you have, you know you want to see a physician.
The only leverage nurses can ever have over physicians is them doing the same or similar work for less.
In my opinion there need to be real physician lobbying organizations that focus on educating the public and government. In reality the population is getting screwed here if they see a nurse instead of a doctor in questionable situations. Every physician should donate 1-2.5% of his/her salary to lobbyist organizations and the problem would be fixed in a couple of years.
Have you ever been in a crisis situation? If you have, you know you want to see a physician.
The only leverage nurses can ever have over physicians is them doing the same or similar work for less.
In my opinion there need to be real physician lobbying organizations that focus on educating the public and government. In reality the population is getting screwed here if they see a nurse instead of a doctor in questionable situations. Every physician should donate 1-2.5% of his/her salary to lobbyist organizations and the problem would be fixed in a couple of years.
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My question is this: why would anyone WANT to have complete responsibility and autonomy of care with suboptimal education? I'm a fourth year medical student, and I doubt that in a few years I'll want to start taking full responsibility when I'm not through with training. If someone told me I could skip 3rd and 4th year of med school, and do a 1 year residency and be an attending (with sick people who could die if I miss something), I would say no. Why would a DNP want this?
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Ignorance is bliss.
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Yeah. The biggest threat to the M.D./D.O. degree in my view is the specialization and residency training for NP's, DNP's, and PA's, which are sprouting up everywhere. What's a little depressing is that there really is no reason (knowledge-wise) why they can't enter these programs, and once they are done they'll probably be close to as good as an M.D. trained in the same specialty.
Think of a NP doing a 4 year residency in dermatology- they'll be just as experienced and probably just as effective as an M.D. dermatologist.
It's just not fair to the people who opted to take the harder route to the same ends.
Think of a NP doing a 4 year residency in dermatology- they'll be just as experienced and probably just as effective as an M.D. dermatologist.
It's just not fair to the people who opted to take the harder route to the same ends.
D
deleted6669
at least for pa's the postgrad training programs train one to supplement the work of a physician. a pa who does a 1 yr postgrad program in surgery learns to be a great 1st assist, not a primary surgeon.
a pa who does a 1 yr em postgrad program still recognizes the need to have some degree of physician oversight even if they work without a physician in house.
for pa postgrad programs see here:
www.appap.org
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I choose to believe you are being sarcastic. Because the alternative is more depressing than anything you alluded to.
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Anyone see this op-ed? http://www.nytimes.com/2012/12/16/opinion/sunday/when-the-doctor-is-not-needed.html
i don't think that was the moral of the story...
bro it's not just experience that determines competence. If you have ever actually seen how any of this works in the real world you would understand this.
To be brief: the NPs I've seen and worked with on my derm rotation were seeing younger, otherwise healthy patients, treating things like acne.
Also you have to understand a few things:
1. physicians will NOT train NPs to be at their level. They won't let NPs into their residencies (and especially derm).
2. If physicians thought NPs were taking away patients (i.e. money) then NPs/PAs would not be hired.
3. Regular average patients want to see a "doctor" and not a "nurse" regardless of whether the issue requires a physician.
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Correctomundo. Patients in a private metro setting practice prefer a doc. When patients get their EOBs and start picking apart what was paid and to whom for services rendered if it's an extender ... It gets messy. Patients in real life pay very close attention to their bills. They don't want to see a non physician reimbursed for a doc's service. Payers DO audits, and things can get really sticky if you're in that pickle. Paying back for upcoming, etc..,a real nightmare. The only way to stop the takeover is to keep on top of your practice management skills. Know your coding, and keep yourself engaged. It's no sweat off an employees back if they use improper icd and CPT - you must stay on top of what is billed out in your name.
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So you're not worried about this "mid-level creep" trend at all then? I'd feel a lot better if an attending who actually knows how this all works doesn't feel threatened. I'm an MS-4 so I don't really talk to my attendings about this topic.
In the VA at my school, midlevel specialists serve seemingly unsupervised on the consultation services. The government doesn't seem to see a difference between an MD and DNP, though I agree a metro area patient would. What do you think will happen if in the next 10 years we move to a single payer system, where all of medicine is a giant VA?
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It's different in a private practice setting and you are one of the principals. I wouldn't freak - the DNPs are no competition. I meant to type up coding. I do not think there will be a single payor in our life times, too much politics and far too many docs are against it. Many PCPs stopped taking Medicare NPs, and that represents a large population of patients who vote, Americans want quality care, MD/DO, not anything less and will always seek out a doc. Really, don't concern yourself with that, just do well, and I am serious, KNOW the ins and outs of the business of medicine. Guts come out clueless, you are a step ahead if you know what is what in the billing world.
If by some miraculous merging of politicians and insurance companies occur, there will always be specific fees for every procedure-simple bookkeeping. Don't let the rumors get to you, In another 20 years it will be just more of the same. Just stay on top of trends in the business of medicine.
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the dnps dont think their education is sub optimal
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This.
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I agree with the part that says pharmacists are underutilized. They now have a doctorate, but it doesn't seem like their roles have expanded much, even though there is room for it. I think that they could be the ones titrating a drug to effect, once a physician has prescribed it. Let's say someone has post-cholecystectomy diarrhea and gets put on cholestyramine. They still have diarrhea after two weeks? Go up on the dose. They get constipated? Go down a bit. Still having problems? Go back to the physician, but a dose change or two could be in the purview of someone whose expertise is pharmacology and dosing.
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At the VA primary care clinic, this is largely how it worked. Physicians would initiate therapy, but follow-up appointments would be with PharmDs who would optimize the HTN/DM/HL/whatever medications, handle smoking cessation therapy, run the anticoagulation clinic, etc.
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I agree with this, as long as the patients in questions are only taking 2-3 medications for fairly simple conditions. It seems like it would take a lot of busy work off of the physician so that he could focus on patients with more complicated problems.
I'm not familiar with pharmacy curriculum, and am only an MS-1, but would there be cases of multiple co-morbitidies that would require prioritizing the regimens, which would mean managing one or more conditions sub-optimally? If this happens, the pharmacist certainly should not be making changes in the meds, as the majority (if not all) of the liability is going to come down on the physician.
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Also - I think it will all come down to who is willing to bear liability. Right now, physicians are liable for anything done under their supervision, including the work of PA-Cs and NPs. If/When DNPs start maintaining independent practices, they bear full responsibility and liability for malpractice. Are they willing to do that? IMO that will be the limiting factor.
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Pharmacists in some states are incredibly helpful, and pick up interactions, side effects, and other meds patients "forget" to mention, and call you in case you didn't catch something. In some states they go out of their way to help if you have pain patients who signed a pain contract who deviate from a treatment plan. Had a pharmacist call about a pain patient reeking of ETOH. Little things can become big things, and changing roles, affording more scope will increase liabilities. I have not heard of any legislature that grants extenders rx of schedule IIs. Am I missing something? Is there a movement in the DNPS community lawyering for this? That would be insane. It's nuts enough out here. I truly doubt it.As an aside weren't pharmacists in some state awarded the PharmD ten, fifteen years back? We need some real leadership in the AMA.
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Has anyone considered the possibility that DNP will one day be equivalent to the MD/DO? Is it possible that one day SDN users will write MD/DO/DNP instead of the current MD/DO when they refer to "physicians"?
I think what you'll find is that nurses are well organized and have engrained much of modern American society with a belief that the "nursing approach" is better. I think that within 20 years you'll see them practicing equally with physicians in almost all medical specialities. I wouldn't even be surprised if you see them gaining ground in surgical specialities. Having worked beside nurses, I wouldn't underestimate their ability to make progress on the professional front.
I think physicians will need to take responsibility for their profession. Instead of being exclusive, they should be inclusive in much the same way that they eventually allowed DOs into the mix. They should demand equal training, a competitive application process, and residency training. This will be the most effective argument against the encroachment of these professions, because frankly, they don't want to put in the time. I have respect for advanced practice nurses, but most of them will tell you that they took the route that they did because of economic factors, a desire to enjoy their lives, or personal commitments. They enjoy being able to work and advance slowly toward advanced practice. If you demand equal training, all the while bringing them into the fold as physicians, I believe you'll see a dramatic push-back. Let them keep the "nursing theory" and other stuff, but make them emulate the rigorous science education and clinical requirements of normal physicians. Like DOs, they can have their own special classes and techniques. They can market themselves as "separate, but equal." Let the "mid-level" practitioners be trained at the Master's level and the DNP degree be a entry pathway into nurse physicians.
What will happen? There will be a push back. Osteopathic physicians embraced the idea of equal training for the purposes of being...well, equal. I think most nursing schools will balk at the idea of such hefty requirements and finally bring the public to question motives. Physicians should also aggressively court their little brothers (and sisters). Medical schools should create accelerated entry pathways for Physician Assistants, not unlike what LECOM has done. They should promulgate the idea that there is a "medical model" of theory and link respective practitioners into the mix. Paramedics and other allied-health workers (including active RNs) should be encouraged to seek advanced practice through the physician assistant model and physician assistants given a way to complete medical school. By doing so, physicians will create their own allied health industrial complex for which they can then have ultimate say for the standards of their profession. Let the two sides fairly compete and see which side the public prefers.
Lastly, the MD/DO debate needs to end. Both the allopathic and osteopathic stake holders should come together and decide how to make the professions as "together" as possible. Osteopathic physicians should be able to keep their history, beliefs, and identity and allopathic physicians should be encouraged, through joint education, to acknowledge them as truly equal (because they are). Likewise, DOs should extend an olive branch to accept discussion from the MD side. DO schools, who have a history of accepting many of this nation's very qualified non-traditional applicants, should study how their admission process succeeds, because it does. Clearly, DO students are capable of high board scores and make excellent physicians and researchers. And yes, the entire profession needs to closely evaluate how they admit students. Nurses have successfully marketed themselves as the more holistic healthcare option. They know well enough that measuring such qualities is near impossible, is subjective, and harder to refute. While there may be a broad agreement that high MCAT scores correlate with high USMLE scores, it doesn't mean that schools should wage a war against applicants with lower scores. DO schools have proven that these people can be good bets and can practice safe and sophisticated medicine. Other qualities should be emphasized in the admission process WITH MCAT scores, ECs, and GPA. The extracurricular battle has become almost farcical, with many students "accumulating" ECs just to be admitted. What type of doctor does this produce? MDs and DOs should pool their collective resources, and considerable money, to wage a public relations battle against the idea of "less is more."
If physicians don't rally together to create standards, backed by empirical evidence, then the day of the MD vs. DO flame war will be eclipsed by the MD/DO vs. DNP flame war. Even if DNP scope equality is an eventuality (and I think it probably is), physicians should take the time now to exercise their influence on how the process will go down.
I think what you'll find is that nurses are well organized and have engrained much of modern American society with a belief that the "nursing approach" is better. I think that within 20 years you'll see them practicing equally with physicians in almost all medical specialities. I wouldn't even be surprised if you see them gaining ground in surgical specialities. Having worked beside nurses, I wouldn't underestimate their ability to make progress on the professional front.
I think physicians will need to take responsibility for their profession. Instead of being exclusive, they should be inclusive in much the same way that they eventually allowed DOs into the mix. They should demand equal training, a competitive application process, and residency training. This will be the most effective argument against the encroachment of these professions, because frankly, they don't want to put in the time. I have respect for advanced practice nurses, but most of them will tell you that they took the route that they did because of economic factors, a desire to enjoy their lives, or personal commitments. They enjoy being able to work and advance slowly toward advanced practice. If you demand equal training, all the while bringing them into the fold as physicians, I believe you'll see a dramatic push-back. Let them keep the "nursing theory" and other stuff, but make them emulate the rigorous science education and clinical requirements of normal physicians. Like DOs, they can have their own special classes and techniques. They can market themselves as "separate, but equal." Let the "mid-level" practitioners be trained at the Master's level and the DNP degree be a entry pathway into nurse physicians.
What will happen? There will be a push back. Osteopathic physicians embraced the idea of equal training for the purposes of being...well, equal. I think most nursing schools will balk at the idea of such hefty requirements and finally bring the public to question motives. Physicians should also aggressively court their little brothers (and sisters). Medical schools should create accelerated entry pathways for Physician Assistants, not unlike what LECOM has done. They should promulgate the idea that there is a "medical model" of theory and link respective practitioners into the mix. Paramedics and other allied-health workers (including active RNs) should be encouraged to seek advanced practice through the physician assistant model and physician assistants given a way to complete medical school. By doing so, physicians will create their own allied health industrial complex for which they can then have ultimate say for the standards of their profession. Let the two sides fairly compete and see which side the public prefers.
Lastly, the MD/DO debate needs to end. Both the allopathic and osteopathic stake holders should come together and decide how to make the professions as "together" as possible. Osteopathic physicians should be able to keep their history, beliefs, and identity and allopathic physicians should be encouraged, through joint education, to acknowledge them as truly equal (because they are). Likewise, DOs should extend an olive branch to accept discussion from the MD side. DO schools, who have a history of accepting many of this nation's very qualified non-traditional applicants, should study how their admission process succeeds, because it does. Clearly, DO students are capable of high board scores and make excellent physicians and researchers. And yes, the entire profession needs to closely evaluate how they admit students. Nurses have successfully marketed themselves as the more holistic healthcare option. They know well enough that measuring such qualities is near impossible, is subjective, and harder to refute. While there may be a broad agreement that high MCAT scores correlate with high USMLE scores, it doesn't mean that schools should wage a war against applicants with lower scores. DO schools have proven that these people can be good bets and can practice safe and sophisticated medicine. Other qualities should be emphasized in the admission process WITH MCAT scores, ECs, and GPA. The extracurricular battle has become almost farcical, with many students "accumulating" ECs just to be admitted. What type of doctor does this produce? MDs and DOs should pool their collective resources, and considerable money, to wage a public relations battle against the idea of "less is more."
If physicians don't rally together to create standards, backed by empirical evidence, then the day of the MD vs. DO flame war will be eclipsed by the MD/DO vs. DNP flame war. Even if DNP scope equality is an eventuality (and I think it probably is), physicians should take the time now to exercise their influence on how the process will go down.
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With all due respect, I really don't think that this will ever happen. I think you're underestimating how much training DNPs lack in terms of medicine. Let's start with pre-medical courses. Most nursing schools only require one semester of either biology or chemistry. You're talking a MINIMUM of two semesters chemistry and biology (plus one of whichever they took as part of their pre-nursing stuff in undergrad), two of physics, two of ochem. That's before they would have to take virtually every course in medical school. Even subjects like anatomy that are taught in nursing schools are nowhere near as detailed as the medical school counterpart.
I just really don't see how there could be an "accelerated" pathway for nurses to become physicians.
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Well said. This is all academic and theoretical. MD is branded in the American psyche. Despite all the lobbying, marketing, and organizing, the public won't buy it. Maybe some alternative medicine will catch on, but the level of education will preclude nurse doctors from becoming ABMS brand specialists. Market forces will prevail, and this will pass until the next wave rolls in. Just pick a specialty and when you get going OUTSIDE of a hospital setting, in the real world middle class USA, the patients want docs. I remember when DOs got some undue disrespect but that is history, Mail order/online DNPs?
Not a threat. Then watered done basic science, like the post says, shows. Every med school class has plenty of rumors and myths about an uncertain future, your wasting your time worrying about it. Then again the world could end in a few days, in that case none of this matters.Study!
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If you're not aware of how powerful a well-run lobby that utilizes modern media (tv, radio, social media) can become, take a look at the NRA (which is one of the strongest forces in politics).
Don't be foolish, government doesn't think in terms of how rational things are but what pays them the most. Likewise, the public believes whatever it is spoon-fed.
Don't be foolish, government doesn't think in terms of how rational things are but what pays them the most. Likewise, the public believes whatever it is spoon-fed.
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Respectfully, I admire your faith, but this is 'Merica: where money and constant media attention buys whatever you want. When you have papers like the NYTimes basically spewing that they have equal outcomes in an editorial every other month, people will eventually come around.
Also, I think the prerequisite course load depends on the school. BSN students typically take 2 semesters of "Chemistry for Allied Health Professionals," 2 semester of biology (generally including microbiology), 2 semester of A & P, two semester of psychology (typically including childhood development), and one semester of nutrition. Generally, the second semester of chemistry is a watered down hybrid of organic chemistry and biochemistry. It wouldn't be a stretch for DNP programs to say, "Hey, by the way, starting in 20xx we'll be a full fledged doctor school. So, take all of this stuff." Then they'd implement a similar curriculum to medical schools and voila, doctors! I mean all it takes is a few sympathetic state legislatures.
I understand the confidence, particularly from the attending who posted. Clearly he/she is confident in the future of the physician profession. Unfortunately, these dynamic shake-ups happen in other industries all of the time. Medicine is probably due for some controversy.
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Obviously everything we're discussing is hypothetical. But there's a few points that I'd make.
First, even though the NYT does have a track record of publishing op-eds sympathetic to NPs, on this particular article, a strong majority of the top rated comments were basically saying that NPs were out of their depth trying to do independent primary care. So that's encouraging.
Second, yes, they do take courses with the same names, but that's about it. The chemistry and biology courses that nurses have to take are TREMENDOUSLY watered down compared to the corresponding pre-med classes. And the A&P they take is even more a shadow of what med students get. Case in point: my fiancee is a nurse (BSN from a well-regarded school). Her A&P book is ~1000 pages. For comparison, my anatomy syllabus ALONE is ~1000 pages. Next semester, the physiology syllabus is ~4000.
And that's okay. Nurses don't necessarily need to know how GPCRs work. My point is that they would have a very hard time arguing any sort of equivalence degree or accelerated pathway. And I don't think state legislatures are quite as accommodating to nurses as you indicate.
Call me a wool-over-the-eyes optimist, but I just don't see nurses encroaching to the extent that you do. Primary care in some geographic areas might see a push, and CRNAs will probably continue to give anesthesiologists headaches, but I don't see anything more than that.
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I think your post is very insightful. I dont see it as far fetched at all.
Physicians DO have to rally together and fight back but the problem is when these policies are being made the physicians who are at the table are worthless. They have been bought by policy makers for a seat at the table. If they went against the policy makers, they would not have a seat at the table. The working day to day physician doesnt have time for all this ****.
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I think you are wrong. The nurses are clamoring that all those pre med courses are not relevant to the practice or medicine. They are saying what is the difference between a new intern and a new np student. Nothing. They are studying from the same books.
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Pre med? Who ever said pre med was relevant? There is a massive difference between a new intern and new NP. They do not study the same things.
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This is the silliest post ever. I have worked with "brand new" interns and NPs as a medical student. Anyone with any real floor experience would not even compare these two groups.
As a 4th year medical student, I remember, sitting down with the newly minted NP to teach her basic EKG reading (and informed her she should read Dubins--my fav book). This was an NP with years of experience in the ICU. In my third year rotation, I remember my intern absolutely schooling me on the "seemingly unimportant" (but actually very important) aspects of EKG reading (very informative)
I would also argue these premed courses ARE IMPORTANT. I know, blasphemy right? It's not the content of the courses but the ability to think and the thought process behind the courses.
Anyone that has taken real organic chemistry or physics understands to do well in these classes (in general) its the application of principles. Furthermore, the ability to understand a new drug, ICU physiology, etc., all depends on your understanding of basic biology/physiology/sometimes chemistry and physics! (diffusion of gases etc)
Finally, I want to reiterate that NP students and Med students are NOT studying from the same book. Most NP students have not heard of Goljan, Robbins, Rubin, Costanzo etc., but it would be hard-pressed to find a medical student who hasnt heard of these authors.
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I assume Rubin and costanzo are more relevant to clinical years?
Back on topic: if you guys look at DNP curriculum you would see it is in no way similar to med school. Its closer to vocational training than professional. It is essentially RN + team leadership type stuff. I detailed this in an earlier post in here I believe (pre revival)
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Back on topic: if you guys look at DNP curriculum you would see it is in no way similar to med school. Its closer to vocational training than professional. It is essentially RN + team leadership type stuff. I detailed this in an earlier post in here I believe (pre revival)
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That's our point. We know that the education isn't the same, but it doesn't matter. We can lambast all day about how they're not equivalent, but if society decides that it doesn't matter... The ability to practice medicine is decided by law and laws can be changed as society's values change. There is a discussion happening, as other posters have proposed. Many Americans are questioning the length and detail of a medical school education. I read the NYTimes comments on the DNP article and arguably many of the anti-DNP post were obviously by physicians. Several people referenced the shorter training of some European physicians as evidence that the professional doctorate model in the U.S. was unnecessary or "elitist."
Americans admire people who challenge the status quo. Look at Steve Jobs or any other "innovator." If nurses can adequately convince the public that they are "rising up" to challenge their oppressors, then you can bet physicians will be engaged in a serious discussion about their value in society. This is a overly dramatic take on the matter, but I believe it summarizes the sentiments in popular culture.
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Kind of an out-of-the-box idea and maybe it's completely ridiculous, but what if someone made NP-PA programs for RNs to get. That would be something actually more sensical in that PA curriculum would be more relevant to being a stand-in PCP, so that would be a concrete thing we could point to and say "this is what they should be getting since it is in line with the medical model rather than just the nursing model", but would give doctors a little more control as it avoids of the odd "doctor" of nursing practice degree and has a stronger implication of working under a physician. Because really, if we wanted to replace family practice doctors with midlevels anyway, PAs would make more sense than nurses. I get the impression though that a lot of people would have gone the PA route but sort of get stuck in nursing as you can jump into it quicker and start a full nursing job right out of undergrad BSN.
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True, but I don't think that was the focal point of what was being discussed. It was said that they will get expanded scope because the training is equivalent. That statement is false. All of that means nothing if people decide for themselves that they want mid-level expansion and legislate it. However, I don't think that can really happen. Americans are arrogant and the only thing they expect over "cheap" is "quality". I don't think medicine can be practiced proficiently at the level of training that DNPs have. The only reason it looks that way currently is because physicians stand as a safety net for them. If they get expanded scope it will be important for physicians to distance themselves from DNP patients, because liability tends to follow he with the largest wallet rather than he with the most blame. Once they are legitimately flying solo..... Ever read the story of Icarus?
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