Is the DNP a real threat, or a paper tiger?

[UMED122]

The PA model is fine by me. At least the board of medicine still has some oversight and control. With NP's, it's the lack of oversight that is a major problem, among other things.

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[Arch Guillotti]

You are COMPLETELY wrong about ANY physician being able to do ANY procedure on paper. Psychiatrists are physicians who can't put in central lines because guess what? their training doesn't require them to get certified in it. You haven't started medical school yet so i dont expect you to know this but for most major procedures such as central line, thoracocentesis, etc, you need to do a certain number in order to be certified. Not all docs are certified in all procedures and thus CANNOT even on paper do procedures.

You are missing the point. Upon completion of medical school and a certain amount of post graduate medical training you are issued an UNRESTRICTED medical license.

You will perform procedures that are commensurate with your specialty during residency. After residency you will apply for clinical privileges and credentials. You will be credentialed for procedures that are within your scope of practice.

If you felt like it after you received your UNRESTRICTED medical license you could go out and hang out a shingle and do whatever you damn well pleased. If it was out of your scope of practice the following would happen:

-you wouldn't get many patients
-insurance wouldn't cover you
-you couldn't get malpractice insurance
-you couldn't get credentials at a place to perform said procedures
-you would hurt somebody
-you would get sued
-you would end up in court or in jail
-you would have your medical license taken away

But you could do whatever you felt like doing because you have an UNRESTRICTED medical license.

 

[GeraldMonroe]

One of the ER's I moonlight at, is Waseca ER in Minnesota, it is staffed solely by PA's, no physician on site, although we have physician backup when needed. Interestingly, in the fall of 2008, we had the highest patient satisfaction scores in the entire country. Now, I am not naive enough to believe that that is solely due to PA's staffing the ED, but it is an interesting anomaly for sure.

Do you have more PAs than you would have MDs for an E.R. of that volume? If so, your wait times and time spent on each patient would be much shorter.

 

[GeraldMonroe]

But you could do whatever you felt like doing because you have an UNRESTRICTED medical license.

And, by extension, that's the reason we won't see PAs and DNPs doing dangerous procedures very often. The exact same set of limitations would apply to them. Doesn't matter how far their on paper privileges go.

 

[physasst]

Do you have more PAs than you would have MDs for an E.R. of that volume? If so, your wait times and time spent on each patient would be much shorter.

Nope, only one provider on at a time. We also cover the urgent care. Fact is, the volume is pretty low. It is considered a "critical access" hospital.

That doesn't mean we don't get sick patients. I had to intubate someone on the last shift I worked, of course, then they left on a helicopter.

 

[MOHS_01]

And that data is lacking, I would agree. I am actually trying to do a CE study on Consultant vs PA in the ED for a limited number of "Level 3" diagnoses. Including renal stones, headache, and minor head trauma with LOC.

However, one would think, that even in the absence of clear data, one would see a rise in malpractice rates for PA's and NP's, if they were practicing beyond their scope, or if they were mismanaging patients. To claim that we are not MD's is completely accurate, and appropriate, to claim that we "don't know what we are doing" is erroneous, and borderline libelous.

BTW, I don't advocate for complete independence.

One of the ER's I moonlight at, is Waseca ER in Minnesota, it is staffed solely by PA's, no physician on site, although we have physician backup when needed. Interestingly, in the fall of 2008, we had the highest patient satisfaction scores in the entire country. Now, I am not naive enough to believe that that is solely due to PA's staffing the ED, but it is an interesting anomaly for sure.

I'm with you on this one in large part. I like having PA's / NP's around, personally. The majority of the stuff that walks in off the street does not always require MD level training; in fact, their PCP really should have been able to do something rather than just "see derm", but I have no complaints about that either as they are happy and I am afforded the opportunity to pay my bills. If every patient that every specialist saw truly required specialist level MD support, then our reimbursement would be extraordinarily deficient.

I will also point out, however, that every PA/NP that I have worked around (and for years now I have allowed NP students and a couple of PA students do clinicals in my office) are very deficient in their knowledge base compared to the residents who I also teach. That is neither hateful, deceitful, or libelous -- it is a simple statement of fact that corresponds quite well with relative levels of training. Several years on the job and one picks up quite a bit, however, but this education process has to come at a cost to someone.

On the last point -- I'm not sure that patient satisfaction is a very good metric for quality of care. It's piss poor, quite honestly, as a clinical appropriateness or outcome measure unless we are only performing futile efforts for terminal disease (which would open a whole new can of worms for discussion). While it is very important in the overall picture, a point that many MD's have traditionally neglected or refused to acknowledge, it is quite subjective and open to all sorts of variability.

 

[deleted6669]

One of the ER's I moonlight at, is Waseca ER in Minnesota, it is staffed solely by PA's, no physician on site, although we have physician backup when needed. Interestingly, in the fall of 2008, we had the highest patient satisfaction scores in the entire country. Now, I am not naive enough to believe that that is solely due to PA's staffing the ED, but it is an interesting anomaly for sure.

I work several nights a month at a similar facility that is staffed 24/7 by pa's with a doc as double coverage on day shift only. as I only work nights I never see them but as with your system we do have a backup md available(who I have never called in 8 yrs there) and the ability to transfer pts to a higher level of care for trauma, cath lab, etc
our pt satisfaction rates are also higher than our affiliated major medical ctr.

 

[Instatewaiter]

Thank you for your "opinion". It was a very interesting read.


I'm advocating for DNPs to practice independently and expanding the scope of practice. Whenever I can, I'm actively lobbying for the nurses to gain more power, but at the same time, more and better education to provide an optimal care and treatment for the patients.

It will be done eventually. Constant revisions are being made, and I have a very good feeling that in the future, DNPs will have a lot of clinical hours for training and have more in depth knowledge in science.

Nurse practitioners do use critical thinking. They learn to think critically since nursing school.

Nowadays in numerous bachelor of science in nursing programs (spreading across the country), nursing students also take the following courses in addition to the nursing practice/theory courses: pathophysiology/pharmacology/pharmacodynamics/pharmacokinetics/anatomy & physiology/nutrition/psychology/child psychology/adult psychology/health assessment & physical examination.

There is a lot of misconceptions and underestimation about the skills that the trained specialist nurses can provide.

PAs are also valuable members of the health care team. I can't imagine a hospital running properly without them. They assist MD/DO/(& hopefully DNP in the future) run things in the clinic smoothly.

I would have no problems were the training sufficient. If nurses wanted to create a pathway that had the extensive amt of basic science foundation and especially the kind of formal, structured, defined clinical encounters that are required to make a competent clinician- fine.

What actually happened is that the curriculum was weighted down with 1/3 of the credits being essentially fluff courses... Nursing theory, epidemiology, nursing leadership, nursing advancement, nursing research etc. You end up having 30+ credits of crap and only make room for 3-5 credits of pathophysiology? 3 credits of pharm? Really?

Here is duke's curriculum:
http://nursing.duke.edu/modules/son_academic/index.php?id=109
Let me point out a few classes
Research methods, applied statistics, research utilization, epidemiology, health services program planning, data driven healthcare improvement, health systems transformation, effective leadership, evidence based statistics I and II, financial budget planning. I count >30 credits of BS that has little if anything to do with clinical practice. This is taking up 36/83 total credit hours!!

Add to that the tiny amount of clinical hours. It looks like under 1000 to me. In case you wanted a comparison, I will do over 3000 clinical hours just in my third year alone. That doesnt take my 4th year or my 3 years of residency.I have witnessed how disorganized some of the clinical education of NPs is. It astounds me after going through such a regimented system that is the 3rd year of medical education.

To add to that, much of the education is online. Frankly, you cannot have adequate clinical training with an online education system. Masters of Arts... fine, online works. Masters in a clinical discipline... doesnt work too well.

What bothers me is not the competition to doctors. It is that such half-assed attempt is being made to train providers. Were the curriculums even remotely similar, fine. But they are not. You cannot take shortcuts to knowledge.

Someone will get hurt.

 

[GeraldMonroe]

If I need someone to take a splinter out of my foot or sew up a scalp wound, I don't need a gold plated Harvard educated doctor to see me for 5 minutes after I wait for 6 hours. I'd much, much rather have an "adequately" trained PA or DNP get to me in 30 minutes and spend more time on me to get the procedure right with less pain. Maybe said provider would miss symptoms of some disease I have but I would bet a rushed MD would as well.

The pain thing is also notable : for minor procedures there's usually a way to numb the area with lidocaine, but it takes 5-10 minutes. (even for IV sticks) Guess what physicians like to skip doing.

 

[Arch Guillotti]

I
The pain thing is also notable : for minor procedures there's usually a way to numb the area with lidocaine, but it takes 5-10 minutes. (even for IV sticks) Guess what physicians like to skip doing.

Friend you must have some bad batches of lidocaine. The stuff that I give works very quickly and I always use it.

 

[GH253]

The entire controversy is a reflection of how society has placed too much faith in stardardized education. There is more than one way to learn about the practice of medicine, and I have absolutely no problem believing that a nurse or PA can, over time, develop skills equal or superior to an average medical school graduate. However, I have known too many incompetent MDs to believe that the current state of medical education justifies a monopoly on the practice of medicine, with nobody else being allowed to touch patients without supervision. I would actually prefer no standardization or regulation of any kind - anyone should be able to practice medicine, and consumers should assume the responsibility to choose qualified providers.

 

[MOHS_01]

If I need someone to take a splinter out of my foot or sew up a scalp wound, I don't need a gold plated Harvard educated doctor to see me for 5 minutes after I wait for 6 hours. I'd much, much rather have an "adequately" trained PA or DNP get to me in 30 minutes and spend more time on me to get the procedure right with less pain. Maybe said provider would miss symptoms of some disease I have but I would bet a rushed MD would as well.

The pain thing is also notable : for minor procedures there's usually a way to numb the area with lidocaine, but it takes 5-10 minutes. (even for IV sticks) Guess what physicians like to skip doing.

OK, now that's just plain f'ing wrong, inaccurate, erroneous..... The anesthetic effect of lido for superficial wounds is near instantaneous. Even nerve blocks don't take 5 minutes (assuming that you have someone who knows the where and how of doing them).

 

[Arch Guillotti]

I have absolutely no problem believing that a nurse or PA can, over time, develop skills equal or superior to an average medical school graduate.

lol



Nobody wants to go to medical school but everybody wants to be a doctor

 

[Instatewaiter]

I would actually prefer no standardization or regulation of any kind - anyone should be able to practice medicine, and consumers should assume the responsibility to choose qualified providers.

??? And the consumer is going to be able to tell who to go to how?

No standardization has already been tried- ie pre-flexner report. It was so bad that they moved to standardization.

 

[physasst]

OK, now that's just plain f'ing wrong, inaccurate, erroneous..... The anesthetic effect of lido for superficial wounds is near instantaneous. Even nerve blocks don't take 5 minutes (assuming that you have someone who knows the where and how of doing them).

Agreed.

PA education is standardized, based on the "medical model", and in my program, I got over 2500 clinical hours.

There seems to be, from my review, a lot more variance in NP educational models, with far fewer clinical hour requirements, and a lot more theory courses. I still haven't figured out what nursing theory courses add to a clinicians acumen. My other issue has to do with this proliferation of online NP courses. The doctoral degree I am currently completing is online, however, it is a policy/administrative degree, NOT clinical. I have a real problem with ANY clinical degree (PA or NP) being offered online.

Also, I agree about Press Ganey scores. They are arbitrary, and do not support any evidence of competence. I never, or at least never intended to suggest such. I just found it interesting that our "satisfaction" scores were higher. That is all.

 

[GeraldMonroe]

OK, now that's just plain f'ing wrong, inaccurate, erroneous..... The anesthetic effect of lido for superficial wounds is near instantaneous. Even nerve blocks don't take 5 minutes (assuming that you have someone who knows the where and how of doing them).

What I meant was, I have a fear of needles going into me (yes, yes, and I'm going to be a doctor...STFU I can't control how my hypothalamus responds) and IV sticks hurt intensely. But no one ever bothers to numb up my arm or hand with lidocaine, because getting the kit out and using the drug probably takes 5 extra minutes total.

The same goes with other minor procedures. I've seen a doc jab a patient with a 16 gauge needle repeatedly to drain an abscess. No anesthetic. Yes, the patient was hollering.

Given the fact that severe reactions to lidocaine are very, very rare (and nearly every adult has already been exposed to it several times in their life anyways, so they would know if they were allergic) there's no excuse but saving time.

And no, an 32 gauge from a slin syringe with pH buffered lidocaine does not hurt even a fraction as much, even to my wuss nervous system, as an 18 or 16 gauge needle into a vein.

 

[Arch Guillotti]

But no one ever bothers to numb up my arm or hand with lidocaine, because getting the kit out and using the drug probably takes 5 extra minutes total.

Uh, no. It takes a few extra seconds and many places have the syringes preloaded so you just have to grab one.

 

[Arch Guillotti]

The same goes with other minor procedures. I've seen a doc jab a patient with a 16 gauge needle repeatedly to drain an abscess. No anesthetic. Yes, the patient was hollering.

That is poor performance on the part of the physician although it is debatable how much it would help to put local in an abscess.

 

[GeraldMonroe]

Uh, no. It takes a few extra seconds and many places have the syringes preloaded so you just have to grab one.

I'll keep that in mind, and not let the mean nurse poke me because "you'll only feel a slight pinch" next time. Liar. Worse, what happens is that my hypothalamus goes ahead and reduces vascular tone BEFORE I get poked. Actually, just sitting here writing this post I'm feeling light headed. So I usually require several sticks because my smaller veins will collapse from lack of pressure right as the nurse jabs me.

The condition is learned, somehow...it's gotten worse with every needle stick.

And no, it doesn't apply even slightly when I'm holding the needle sticking someone else. I've done IV sticks and injections on other people, and feel just fine. Entirely possible I could do surgery (on other people) just fine.

 

[deleted6669]

That is poor performance on the part of the physician although it is debatable how much it would help to put local in an abscess.

that's why we do halo blocks around them. I probably do 2-3 I+D's/shift and most folks don't have more than minor discomfort from the initial block.

 

[Miami_med]

What I meant was, I have a fear of needles going into me (yes, yes, and I'm going to be a doctor...STFU I can't control how my hypothalamus responds) and IV sticks hurt intensely. But no one ever bothers to numb up my arm or hand with lidocaine, because getting the kit out and using the drug probably takes 5 extra minutes total.

The same goes with other minor procedures. I've seen a doc jab a patient with a 16 gauge needle repeatedly to drain an abscess. No anesthetic. Yes, the patient was hollering.

Given the fact that severe reactions to lidocaine are very, very rare (and nearly every adult has already been exposed to it several times in their life anyways, so they would know if they were allergic) there's no excuse but saving time.

And no, an 32 gauge from a slin syringe with pH buffered lidocaine does not hurt even a fraction as much, even to my wuss nervous system, as an 18 or 16 gauge needle into a vein.

Are you saying that you want lidocaine before every IV? I have no idea where you are, how you the people you work with were trained, or what problems you've had in your past, but I can tell you that on most even moderate sticks, my patients complain a lot more about the pain of raising an appropriate skin wheal with lidocaine than they ever have about a quick stick for blood or IV placement. I can also tell you that I have dumped excessive amounts of lidocaine on, into, around, and everywhere close the actual vicinity of an abcess that I have had to I&D, and it still hurts like hell.

I do agree that for simple needle sticks, there are many ancillary staff in the hospital (often LPNs or RNs) that are better at them than many docs (especially the non-proceduralists). I also have sutured simple skin lacs (and even some not so simple skin lacs) as a medical student with supervision similar to that described by Physassist, and I admit that these things do not require an MD (though an MD should know how to do them). That being said, I have never seen these things done without lidocaine, even at the local very busy trauma center that is often over-run and covered by minimally supervised harrowed residents.

 

[MOHS_01]

that's why we do halo blocks around them. I probably do 2-3 I+D's/shift and most folks don't have more than minor discomfort from the initial block.

"Halo" blocks (ring blocks) are limited by volume of injectable anesthetic, anatomic location, and pharacokinetics. You can only safely give so much lido, especially in an older person... while epi increases the amount that the books say is safe, it also creates the tachy that is limiting. Some locations they just don't work. The reason that lido does not produce effective anesthesia in abscessed wounds revolves around the pH of the local environment. Abscesses are acidic environs, rendering lido's MOA impotent. Post-doc level info, I suppose....

 

[GH253]

??? And the consumer is going to be able to tell who to go to how?

By findng out whether a provider has a medical degree or whatever other type of credential the consumer wants his provider to have. Market mechanisms would arise to help consumers verify medical credentials. Insurance would only cover providers with verified medical credentials. It would be fine.

No standardization has already been tried- ie pre-flexner report. It was so bad that they moved to standardization.

The Flexner Report was politically motivated. It was published with the intention of creating an entrenched structure of authority in medicine that would lead to an intellectual monopoly over the practice of such. I give it no credibility whatsoever.

 

[physasst]

"Halo" blocks (ring blocks) are limited by volume of injectable anesthetic, anatomic location, and pharacokinetics. You can only safely give so much lido, especially in an older person... while epi increases the amount that the books say is safe, it also creates the tachy that is limiting. Some locations they just don't work. The reason that lido does not produce effective anesthesia in abscessed wounds revolves around the pH of the local environment. Abscesses are acidic environs, rendering lido's MOA impotent. Post-doc level info, I suppose....

No, not really post doc info. I don't generally use lidocaine for I&D drainage for that exact reason, the decreased PH, results in much less effective anesthetic effect.

I even freaked out the nurses by placing two sutures the other night without (gasp) local. I asked the patient up front, and explained that it could be 2-3 pokes with a smaller anesthetizing needle, or I could simply place the 2 sutures. She said place the sutures. I did, and was done in about 30 seconds.

 

[deleted6669]

"Halo" blocks (ring blocks) are limited by volume of injectable anesthetic, anatomic location, and pharacokinetics. You can only safely give so much lido, especially in an older person... while epi increases the amount that the books say is safe, it also creates the tachy that is limiting. Some locations they just don't work. The reason that lido does not produce effective anesthesia in abscessed wounds revolves around the pH of the local environment. Abscesses are acidic environs, rendering lido's MOA impotent. Post-doc level info, I suppose....

I did know this but funny how mine always seem to work though, huh?
non-doc level info, I suppose.....

 

[deleted6669]

No, not really post doc info. I don't generally use lidocaine for I&D drainage for that exact reason, the decreased PH, results in much less effective anesthetic effect.

.

the trick is to place the lido outside the abscess(thus the halo or ring name) first on the proximal side then the distal side...I can't imaging draining anything but a tiny one without lido. effective exposure usually means a decent sized incision with a #11 scalpel if you are going to explore them for loculated pockets and pack them after. "stab incisions" or punctures with 18g needles usually close back up and don't facilitate good drainage.
the rc davis method which I like involves an incision which in most cases is close to 50% of the diameter or for truly large abscess 2 separate sites with an entry/exit penrose sutured in .
see his thread "how I do abscess I+D " with pix over at the pa forum. this is the method I have used for years.

 

[MOHS_01]

No, not really post doc info. I don't generally use lidocaine for I&D drainage for that exact reason, the decreased PH, results in much less effective anesthetic effect.

I even freaked out the nurses by placing two sutures the other night without (gasp) local. I asked the patient up front, and explained that it could be 2-3 pokes with a smaller anesthetizing needle, or I could simply place the 2 sutures. She said place the sutures. I did, and was done in about 30 seconds.

dude -- that's why I rolled the eyes... sarcasm defined. I did not say that they never work, just that they don't always work. I question the validity of the statement that "mine always works".

BTW, The reason I like PA's more than NP's? Their training models allopathic training, and they tend to think more like us.

 

[Instatewaiter]

By findng out whether a provider has a medical degree or whatever other type of credential the consumer wants his provider to have. Market mechanisms would arise to help consumers verify medical credentials. Insurance would only cover providers with verified medical credentials. It would be fine.

The Flexner Report was politically motivated. It was published with the intention of creating an entrenched structure of authority in medicine that would lead to an intellectual monopoly over the practice of such. I give it no credibility whatsoever.

Given the fact that the average person doesn't know much about medical education this info is going to be of limited use. Frankly, the consumer just doesnt have the knowledge to know what to look for in a good provider. They would look at the alphabet soup that the average RN has on their name badge and be impressed.

So... no standardization created poor care. More standardization created better training and better care. You want to go back to no standardization for what reason?

 

[GH253]

Given the fact that the average person doesn't know much about medical education this info is going to be of limited use. Frankly, the consumer just doesnt have the knowledge to know what to look for in a good provider. They would look at the alphabet soup that the average RN has on their name badge and be impressed.

So if you're saying that members of the general public are too stupid to figure out what kind of health care providers to patronize, you're saying that somebody else has to make the decision for them. But who is qualified to decide who is qualified?

A conflict of interest arises because, naturally, members of the established medical community believe that their school of thought is the authoritative one. Thus, the dominant ideology of the day becomes entrenched.

So... no standardization created poor care. More standardization created better training and better care. You want to go back to no standardization for what reason

Were you actually practicing prior to 1910, or do you just take for granted that standardization created better care because your educators told you as much? Don't assume that what was written in the Flexner Report was correct - the fact that it was published by the Carnegie Foundation should be a monstrous red flag.

 

[Arch Guillotti]

while epi increases the amount that the books say is safe, it also creates the tachy that is limiting.

If your patient is getting tachy because of the epi in the lido then maybe you should stop squirting it in a vessel

 

[Taurus]

The Flexner Report was politically motivated. It was published with the intention of creating an entrenched structure of authority in medicine that would lead to an intellectual monopoly over the practice of such. I give it no credibility whatsoever.

NEWSFLASH -- nobody cares what you think.

 

[GH253]

NEWSFLASH -- nobody cares what you think.

It's truly disheartening to see how so many doctors are unable to let themselves consider the possibility that something they were taught in medical school could be wrong.

 

[Cp22kjer]

I would actually prefer no standardization or regulation of any kind - anyone should be able to practice medicine,

Lol this would never work. Come on now!

 

[Instatewaiter]

So if you're saying that members of the general public are too stupid to figure out what kind of health care providers to patronize, you're saying that somebody else has to make the decision for them. But who is qualified to decide who is qualified?

A conflict of interest arises because, naturally, members of the established medical community believe that their school of thought is the authoritative one. Thus, the dominant ideology of the day becomes entrenched.



Were you actually practicing prior to 1910, or do you just take for granted that standardization created better care because your educators told you as much? Don't assume that what was written in the Flexner Report was correct - the fact that it was published by the Carnegie Foundation should be a monstrous red flag.

I dont even know why I am responding to this...

Perhaps a committee could be created that oversees medical education to ensure people are getting a proper education. They could make stringent standards that are to the point of being ridiculous so that they ensure each person coming out of medical school is competent. They would be a committee, really a liaison, for medical education. Perhaps we could call them the liaison committee on medical education.


As to your second point- Find me any historical account that says medical education at the turn of the century was better.

 

[Miami_med]

Lol this would never work. Come on now!

Actually, I would agree with this to a degree as well. Without the guise of "licensing" to assume competence, independent boards of review would arise. Only physicians should be able to claim that they are physicians, but anyone else should be able to practice medicine as long as they explicitly state that they are a non-physician practicing medicine. My problem with the DNP is and has always been the deception associated with fooling people into believing that there is equivalent education. I have always maintained that in a free society, people should have the right to make their own decisions, and if people knowingly want a nurse with added online coursework and a patchwork of random clinic hours to watch their health, more power to them.

 

[MOHS_01]

If your patient is getting tachy because of the epi in the lido then maybe you should stop squirting it in a vessel

Really??? That would make sense....

The only problem that I have ever have are complaints of nervousness in otherwise nervous individuals.... I will say that we are much more conservative (you can read chicken, if you like) with the amount of lido that we will give in a setting... which is why our complication rates are so low.

 

[MOHS_01]

Actually, I would agree with this to a degree as well. Without the guise of "licensing" to assume competence, independent boards of review would arise. Only physicians should be able to claim that they are physicians, but anyone else should be able to practice medicine as long as they explicitly state that they are a non-physician practicing medicine. My problem with the DNP is and has always been the deception associated with fooling people into believing that there is equivalent education. I have always maintained that in a free society, people should have the right to make their own decisions, and if people knowingly want a nurse with added online coursework and a patchwork of random clinic hours to watch their health, more power to them.

Miami,

It would seem to me that people can only be free to make their own decisions when they are equally free to face the consequences of those decisions. When there is only upside potential, and the downside risk is mitigated by federal backdrops or a consumer protection legal system out of control, I don't see how that system would hold together -- conceptually or in practice.

 

[Miami_med]

Miami,

It would seem to me that people can only be free to make their own decisions when they are equally free to face the consequences of those decisions. When there is only upside potential, and the downside risk is mitigated by federal backdrops or a consumer protection legal system out of control, I don't see how that system would hold together -- conceptually or in practice.

I certainly never disagreed with that. We could all argue as to exactly if or how we should define medical malpractice, but it is clear that it really ought to be applied equally to everyone practicing medicine. You really shouldn't give the more qualified group a market disadvantage by increasing their legal liability for doing the exact same thing as someone else. Qualifications shouldn't become a legal liability (though I know they often do).

 

[DNPDoctor]

NP and a PA are equivalent at our institution. We have one DNP on staff, and she is not allowed to use the title Doctor, and her degree is not recognized.

I supervise an NP in my own group, administratively. Anecdotally, I can tell you, that PA students, and PA graduates, at least in EM, tend to adapt and progress much faster than NP students, or NP graduates.

NP's are valuable members of the health team. But PA and NP education is AT BEST equivalent, I cannot imagine any scenario by which a PA would be supervised by an NP. Personally, I think the DNP is going to go the way of the ND....you do remember that nursing degree that was a doctoral level degree that was going to REVOLUTIONIZE advanced practice nursing. I do. What happened to that btw?

Hi physaast,

Thank you for your professional reply.

I understand that you're very knowledgeable and competent in your field of work.

I hope that someday, I will be able to hire a physician assistant who is as competent and knowledgeable as you.

Look, I am against completely independent practice for PA's and NP's. However, to suggest that we do not know what we are doing is a rather lofty charge.

You do of course have evidence to back up your assertions, correct? You have studies showing an increased rate of complications, poorer outcomes, decreased patient satisfaction, and/or increased malpractice rates?

If you do, I'd love to see them. Fact is, you don't have any data to support such a baseless accusation. Please let us know when you do. Otherwise, your statements are unfounded, and do not contribute anything of worth to the debate.

You're absolutely right. Let's see a study "showing an increased rate of complications, poorer outcomes, decreased patient satisfaction, and/or increased malpractice rates" before degrading the profession of and saying demeaning things about both PA and DNP.

The PA profession also has a clinical Doctorate.

The Baylor/Army EM residency program is 18 months long. It has a combined total of 5600 clinical hours, and 600 didactic hours, and awards a DSc degree upon completion. With that clinical hour load, I think you could most assuredly call it a "Clinical Doctorate"

http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/60863

Also, PA's, just like NP's do far more than merely help the clinic "run smoother". We function pretty much independently in most settings, and call in physician consult, or back up when needed.

That's great to hear. Perhaps, one day, you can hire a physician assistant of your own.

Have a good day sir.

 

[physasst]

Hi physaast,

Thank you for your professional reply.

I understand that you're very knowledgeable and competent in your field of work.

I hope that someday, I will be able to hire a physician assistant who is as competent and knowledgeable as you.



You're absolutely right. Let's see a study "showing an increased rate of complications, poorer outcomes, decreased patient satisfaction, and/or increased malpractice rates" before degrading the profession of and saying demeaning things about both PA and DNP.



That's great to hear. Perhaps, one day, you can hire a physician assistant of your own.

Have a good day sir.

That has to be one of the most trollish attempts at a post that I have seen, bravo on ingenuity at least. Not worth replying to, but bravo.

 

[MOHS_01]

That has to be one of the most trollish attempts at a post that I have seen, bravo on ingenuity at least. Not worth replying to, but bravo.

Yeah, some people create a username just to stir the pot.... iggy the trolls.

 

[DNPDoctor]

That has to be one of the most trollish attempts at a post that I have seen, bravo on ingenuity at least. Not worth replying to, but bravo.

Hi physasst,
Although, I haven't been trolling, I can understand why you feel like I have been.
I will refrain from saying things like "hire a PA under DNP" and such.
If it happens, then so be it. If it doesn't, then so be it as well.

I apologize for any insensitive words that may have hurt the feeling of physician assistants.

PA and NP (DNP) are an integral part of the health care team.
We have to remember the word "team".

Although we are proud of our own profession, let's not passive aggressivey attack each other's profession or say some demeaning things to degrade it.
I appreciate the constructive criticism of DNP. Like almost every other health care professions, it will not stay the same if there are faults in the system. Nurses are constantly thriving for excellence and will improve education and skills if and when needs arise. Patients are our number one priority.

If any nurses are endangering the patients, please contact your local nursing college so that they can take an appropriate action.

Thank you for your understanding and consideration.

 

[Taurus]

Hi physasst,
Although, I haven't been trolling, I can understand why you feel like I have been.
I will refrain from saying things like "hire a PA under DNP" and such.
If it happens, then so be it. If it doesn't, then so be it as well.

I apologize for any insensitive words that may have hurt the feeling of physician assistants.

PA and NP (DNP) are an integral part of the health care team.
We have to remember the word "team".

Although we are proud of our own profession, let's not passive aggressivey attack each other's profession or say some demeaning things to degrade it.
I appreciate the constructive criticism of DNP. Like almost every other health care professions, it will not stay the same if there are faults in the system. Nurses are constantly thriving for excellence and will improve education and skills if and when needs arise. Patients are our number one priority.

If any nurses are endangering the patients, please contact your local nursing college so that they can take an appropriate action.

Thank you for your understanding and consideration.

I think that all NP/DNP's should work under other NP/DNP's. If they think that they are better than physicians, then let them train themselves in their "nursing" model. Physicians shouldn't train them at all. Physicians should only hire and train PA's. If any PA allows themselves to be supervised by DNP's, they're fools.

 

[DNPDoctor]

I think that all NP/DNP's should work under other NP/DNP's. If they think that they are better than physicians, then let them train themselves in their "nursing" model. Physicians shouldn't train them at all. Physicians should only hire and train PA's.

I don't believe anyone has said that DNP/NP is better than a physician.
If one or a few individuals have said it, I sincerely hope that you do not take it by heart.
Our professions have to collaborate with one another to provide the best possible care and treatment for the patients.
We have so much to benefit by sharing information.

Thank you for your understanding.

 

[Taurus]

I don't believe anyone has said that DNP/NP is better than a physician.

Actually, Mary Mundinger, the founder of the DNP movement and de facto leader, said something to that effect.

you get the medical knowledge of a physician, with the added skills of a nursing professional​

It's even more laughable when you consider that the creme de la creme DNP's at Columbia had 50% failure rate on a watered-down step 3 exam whereas US MD's had a 96% pass rate first time on the real exam. You want more goodies? Read my signature.

I hope that your arguments for why we should look at DNP's as equivalent to physicians and why we should allow DNP's to supervise PA's to be based on real evidence and not just on some "feel good" crap. That's why nobody here takes you seriously. Your arguments have been all fluff.

 

[DNPDoctor]

Actually, Mary Mundinger, the founder of the DNP movement and de facto leader, said something to that effect.

you get the medical knowledge of a physician, with the added skills of a nursing professional​

It's even more laughable when you consider that the creme de la creme DNP's at Columbia had 50% failure rate on a watered-down step 3 exam whereas US MD's had a 96% pass rate first time on the real exam.

Yes, I agree that it is laughable and quite embarrassing.
I do hope that the passing rate will increase in the future and changes be made in the education for the better.
All the constructive criticisms are good.
Thank you.

 

[Taurus]

Yes, I agree that it is laughable and quite embarrassing.
I do hope that the passing rate will increase in the future and changes be made in the education for the better.
All the constructive criticisms are good.
Thank you.

Add to that they should stop allowing DNP's to earn their degree online and increase the clinical training hours from ~700 to say 2500. Gee, if you made those changes, DNP's may finally be equivalent to PA's. That's why it's laughable that you would even suggest that DNP's in the future should supervise PA's. That's like having a bona fide idiot for a boss.

 

[DNPDoctor]

Add to that they should stop allowing DNP's to earn their degree online and increase the clinical training hours from ~700 to say 2500. Gee, if you made those changes, DNP's may finally be equivalent to PA's. That's why it's laughable that you would even suggest that DNP's in the future should supervise PA's. That's like having a bona fide idiot for a boss.

Yes, I agree that online courses need to be gone, even though many are for the nursing theory type of courses.
Even though, unlike PA, we specialize, focus, master and spend all of our clinical hours in one field, I also believe that making an improvement to the number of clinical hours is important as well.

 

[Taurus]

Yes, I agree that online courses need to be gone, even though many are for the nursing theory type of courses.

Why do you like to pull things out of your a**? You can't pull a fast one on us here. If I did that, I would get chewed out by my attendings and probably get kicked out of residency if I repeatedly did it. SDNers are very well versed on the DNP curriculum. It's been discussed and picked over ad nauseum. Most of the coursework for an online DNP is done online, not just the nursing theory crap. It's not called an online DNP for nothing. I won't even go into detail how a large percentage of that coursework is made of fluff courses like research, stats, leadership. Others can post specific details about certain online programs. It's been posted many times on SDN.

 

[DNPDoctor]

Why do you like to pull things out of your a**? You can't pull a fast one on us here. If I did that, I would get chewed out by my attendings and probably get kicked out of residency if I repeatedly did it. SDNers are very well versed on the DNP curriculum. It's been discussed and picked over ad nauseum. Most of the coursework for an online DNP is done online, not just the nursing theory crap. It's not called an online DNP for nothing. I won't even go into detail how a large percentage of that coursework is made of fluff courses like research, stats, leadership. Others can post specific details about certain online programs. It's been posted many times on SDN.

Please post all the links to purely online dnp degree programs.
Thank you.