Two Year Degree and the "Doctor Nurse"

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A quick search on the internet and I am coming up with completely different results than those you have stated.

http://www.nurseweek.com/news/Features/05-03/Malpractice.asp

Nurses once were, for the most part, outsiders in the physician-led fight to reduce malpractice insurance rates. Sheltered no more, nurse practitioners are finding their annual malpractice costs tripling, nurse-midwives are facing annual premiums as high as $35,000, and only one company is willing to write policies for nurse anesthetists, says Janet Selway, RN, DNSc, CRNP, instructor at Johns Hopkins University School of Nursing, Baltimore.
Selway, a state affiliate representative and board member of the American College of Nurse Practitioners, was among the nurse leaders who, out of concern, quickly convened a recent meeting in Washington on the topic.
"We wanted to have a dialogue between the insurance industry and representatives of the major national nursing organizations, just so we had a clear idea of what was going on," Selway says.
Nursing industry legal experts, representatives from the American Association of Nurse Anesthetists and American College of Nurse Midwives, as well as representatives from three nurse practitioner malpractice insurers, met to discuss the problem of rising rates and why rate hikes are hitting advanced practice nurses. Representatives from several nursing associations attended, including the American Association of Critical Care Nurses, the National League for Nursing, and the Emergency Nurses Association.
The meeting was successful in that representatives of the national nursing organizations in attendance are now armed with information to take back to their memberships, Selway says.

Some key points from the roundtable:
  • Malpractice suits against advanced practice nurses are rising in number and increasing in severity, according to malpractice insurers. APNs need to learn about the basics of malpractice, including their liability, options with malpractice coverage, and legislative issues like tort reform. Associations, colleges, and societies are often good resources.
  • Some 20% to 30% of nurse practitioner care is delivered by phone, exposing APNs to a liability that they might not have previously considered.
  • In deciding these cases, courts must establish what's reasonable for a prudent APN. They establish "reasonable" by looking at policies and procedures and the literature existing at the time of the event, then look at national standards and causation: Was the action or inaction actually caused by the APN?
  • APNs named in lawsuits should consider calling the American Association of Nurse Attorneys for counsel or advice even if they are covered under their employers' malpractice policies. Nurse attorneys might have a better grasp of the legalities involved with nursing practice.
  • Malpractice insurers' profitability in covering APNs has dropped, perhaps because more nurses are being sued these days.
  • APNs working in practices and clinics should ask to see their employers' malpractice policies to make sure they're named in the documents. They should consider having their own policies as well, especially if they moonlight.
  • APNs should be aware that if they practice with a physician who is under- or uninsured, the nurse might become the deep pocket — the one who is covered for the highest amount and, therefore, is the more attractive to name in a lawsuit. Lawyers representing the injured have been known to go after anyone who might have provided care to the patient — anyone whose name is on the chart.
  • Factors resulting in more malpractice claims and higher premiums aren't all due to big jury awards — experts say the nursing shortage is putting undue stress on hospital staffs, increasing the chances for drug errors and medical mistakes. What's more, fewer physicians are going into practice nowadays, which means a bigger patient load for current health care workers. The greater the patient load, the greater the chance for error and, ultimately, liability.
Sadly, state boards of nursing may be underreporting unprofessional behavior and incompetence to the National Practitioner Data Bank, according to one government representative who spoke at the meeting. APNs who've had a lot of claims against them and have settled out of court can often work in different states without fear of retribution because of confidentiality agreements.

In short, the Washington roundtable was an eye-opener for many nurses. Selway herself is quick to admit to that. "I think I have a better understanding of why the premiums are going up, and it's not just greed," she says. "

The sad fact is that [because of increased lawsuits] we're not a profitable group to insure anymore."
Lisette Hilton is a freelance health care writer.
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MedicineDoc said:
How far along are you in your medical training? Truthfully, I am beginning to think you're just one of those types of people that enjoy "tweaking" other people by taking contrary positions. Hence the multiple smiley emoticons. It's not like we all haven't seen a ton of those types in medical school.
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You make some great points. Like I said, time will tell if they're prepared enough for what they do. I completely understand that your position is that they will never be.

So why are you commenting on my posts without seeming to read or understand the points I make? You asked for me to produce my study, but I've made no reference to a study. I've only stated that NPs already practice independently in many states and you can query the NPDB filings for malpractice. If you suspect bias in malpractice under-reporting, OK. Like I said, time will tell. But, speaking of studies, can you provide studies that show NPs don't do better?

I'll say this: I do think the ad hominem posts are completely unnecessary. I mean, really. You're criticizing my use of an emoticon because I wanted to indicate I liked your "married to a NP" question? If you want to respond to my comments, please read them and respond in form, not by deducing who I must be from using emoticons, which, IMO is similar to refuting an argument based on a person's spelling or grammar.

And how am I being a rabble-rouser by stating my opinion that the nurse profession shouldn't be blamed for taking advantage of an opportunity the medical profession helped to create? Would you rather some other profession rise to the occasion? If it isn't the nurses, it will be others because, for whatever the reason, people seem to think we need more primary care providers.

Or by stating that I think some medical care is better than no medical care?

Finally, I'm not taking contrary opinions. I'm sure there are plenty of folks who could agree with my two points above. But it's obvious they don't post here. [Emoticon omitted because, apparently, only contrarians use them.]

JD
 
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A few years ago I worked with a DNP on a medical mission and went to meetings where she attended.

It would kill me whenever she was introduced as "Dr. X" and about 1/2 the people in the audience were physicians.

Though technicially true, her medical acumen was definitely not on par with the physicians. She had to consult numerous times other physicians working with her.

I'm all about helping those in need, but what really ticked me off was her arrogance. She enjoyed being called "Dr. X" and even at meetings came off as a total ass. She introduced herself to physicians as "Dr. X"! And when people eventually found out she was a DNP, people just started talking smack. But the physicians among themselves knew she just could not think outside the box. But for the sake of helping others, they kept it among themselves as best they could.
 
MedicineDoc said:
A quick search on the internet and I am coming up with completely different results than those you have stated.

http://www.nurseweek.com/news/Features/05-03/Malpractice.asp

Nurses once were, for the most part, outsiders in the physician-led fight to reduce malpractice insurance rates. Sheltered no more, nurse practitioners are finding their annual malpractice costs tripling, nurse-midwives are facing annual premiums as high as $35,000, and only one company is willing to write policies for nurse anesthetists, says Janet Selway, RN, DNSc, CRNP, instructor at Johns Hopkins University School of Nursing, Baltimore.
Selway, a state affiliate representative and board member of the American College of Nurse Practitioners, was among the nurse leaders who, out of concern, quickly convened a recent meeting in Washington on the topic.
“We wanted to have a dialogue between the insurance industry and representatives of the major national nursing organizations, just so we had a clear idea of what was going on,” Selway says.
Nursing industry legal experts, representatives from the American Association of Nurse Anesthetists and American College of Nurse Midwives, as well as representatives from three nurse practitioner malpractice insurers, met to discuss the problem of rising rates and why rate hikes are hitting advanced practice nurses. Representatives from several nursing associations attended, including the American Association of Critical Care Nurses, the National League for Nursing, and the Emergency Nurses Association.
The meeting was successful in that representatives of the national nursing organizations in attendance are now armed with information to take back to their memberships, Selway says.

Some key points from the roundtable:
  • Malpractice suits against advanced practice nurses are rising in number and increasing in severity, according to malpractice insurers. APNs need to learn about the basics of malpractice, including their liability, options with malpractice coverage, and legislative issues like tort reform. Associations, colleges, and societies are often good resources.
  • Some 20% to 30% of nurse practitioner care is delivered by phone, exposing APNs to a liability that they might not have previously considered.
  • In deciding these cases, courts must establish what’s reasonable for a prudent APN. They establish “reasonable” by looking at policies and procedures and the literature existing at the time of the event, then look at national standards and causation: Was the action or inaction actually caused by the APN?
  • APNs named in lawsuits should consider calling the American Association of Nurse Attorneys for counsel or advice even if they are covered under their employers’ malpractice policies. Nurse attorneys might have a better grasp of the legalities involved with nursing practice.
  • Malpractice insurers’ profitability in covering APNs has dropped, perhaps because more nurses are being sued these days.
  • APNs working in practices and clinics should ask to see their employers’ malpractice policies to make sure they’re named in the documents. They should consider having their own policies as well, especially if they moonlight.
  • APNs should be aware that if they practice with a physician who is under- or uninsured, the nurse might become the deep pocket — the one who is covered for the highest amount and, therefore, is the more attractive to name in a lawsuit. Lawyers representing the injured have been known to go after anyone who might have provided care to the patient — anyone whose name is on the chart.
  • Factors resulting in more malpractice claims and higher premiums aren't all due to big jury awards — experts say the nursing shortage is putting undue stress on hospital staffs, increasing the chances for drug errors and medical mistakes. What’s more, fewer physicians are going into practice nowadays, which means a bigger patient load for current health care workers. The greater the patient load, the greater the chance for error and, ultimately, liability.
Sadly, state boards of nursing may be underreporting unprofessional behavior and incompetence to the National Practitioner Data Bank, according to one government representative who spoke at the meeting. APNs who’ve had a lot of claims against them and have settled out of court can often work in different states without fear of retribution because of confidentiality agreements.

In short, the Washington roundtable was an eye-opener for many nurses. Selway herself is quick to admit to that. “I think I have a better understanding of why the premiums are going up, and it’s not just greed,” she says. “

The sad fact is that [because of increased lawsuits] we’re not a profitable group to insure anymore.”
Lisette Hilton is a freelance health care writer.
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Interesting! This is good stuff, though hardly the prime research you wrote about earlier (with apologies to Lisette Hilton, freelance health writer).

Of course the real question is not, "are NP malpractice claims rising", but "are they rising out of proportion to physician malpractice claims?" I don't think Ms Hilton addresses that question.

As to the first bolded comment, about only one company writing for nurse anesthetists, I thought this was also a problem for physicians in some areas, especially in high risk specialties?

As to your last bolded comment, about the underreporting to NPDB, well, it seems that is very damning to the nurse practitioner cause--though the question is still, "are NPs sued in higher proportion than docs?" As I said previously, if this becomes apparent to me, my posting will take on a completely different tone.
 
Obviously some medical care is better than none. My issue will continue to be an informed patient making the decision on who to see. As of now patients have no idea how to evaluate quality of care or differences in care. The only thing they can rely on is the word of the provider. Can you imagine buying a car or house with only the word of the person trying to sell you the car or house? Thats the problem we have in medicine. People should be able to choose from a true Doctor (semantic nazies don't even bother speaking), a NP, or even alternative medicine providers. As long as the patient is informed of what he or she is getting in a provider they should be able to make that choice, not the insurance companies or Uncle Sam.

The problem we are currently facing is the attempt to commit fraud by some in the DNP movement. This includes use of the term doctor and their slogan of "All the knowledge and skills of a doctor plus the benefits of a nurse."
 
AwesomO said:
Obviously some medical care is better than none. My issue will continue to be an informed patient making the decision on who to see. As of now patients have no idea how to evaluate quality of care or differences in care. The only thing they can rely on is the word of the provider. Can you imagine buying a car or house with only the word of the person trying to sell you the car or house? Thats the problem we have in medicine. People should be able to choose from a true Doctor (semantic nazies don't even bother speaking), a NP, or even alternative medicine providers. As long as the patient is informed of what he or she is getting in a provider they should be able to make that choice, not the insurance companies or Uncle Sam.

The problem we are currently facing is the attempt to commit fraud by some in the DNP movement. This includes use of the term doctor and their slogan of "All the knowledge and skills of a doctor plus the benefits of a nurse."
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And this I would agree with fully, especially bolded part. :thumbup: It's also the reason I'm still pursuing med school and primary care. I think lots of people will still choose the better trained provider if they can afford it.
 
Jack Daniel said:
Interesting! This is good stuff, though hardly the prime research you wrote about earlier (with apologies to Lisette Hilton, freelance health writer).

Of course the real question is not, "are NP malpractice claims rising", but "are they rising out of proportion to physician malpractice claims?" I don't think Ms Hilton addresses that question.

As to the first bolded comment, about only one company writing for nurse anesthetists, I thought this was also a problem for physicians in some areas, especially in high risk specialties?

As to your last bolded comment, about the underreporting to NPDB, well, it seems that is very damning to the nurse practitioner cause--though the question is still, "are NPs sued in higher proportion than docs?" As I said previously, if this becomes apparent to me, my posting will take on a completely different tone.
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It was your assertion that malpractice claims were on par with physicians and that this was evidence of roughly equivalent medical practice by NPs (which is a pretty big premise to swallow in the first place). As I indicated I just did a quick search (seconds) and came up with the article from the nursing journal using the keywords NP and malpractice. As far as I know that is a reputable nursing journal if not feel free to inform us otherwise. I was simply asking for the study (your "prime research not mine as I didn't make an assertion about malpractice) you were citing to back up your assertion so that we can know you are "talking out your ass" so to speak.
 
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AwesomO said:
Obviously some medical care is better than none. ."
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What makes you think that the shortage of rural primary care is related to a lack of nurse "practictioners" and "Doctor" nurses and not the declining reimbursements in primary care? Obviously, foreign medical graduates are going to gravitate to the big cities and medical students from rural areas with huge student loans and declining reimbursements are at the root of the shortage. Why not fix the real problem rather than creating sham licensures?
 
MedicineDoc said:
It was your assertion that malpractice claims were on par with physicians and that this was evidence of roughly equivalent medical practice by NPs (which is a pretty big premise to swallow in the first place). As I indicated I just did a quick search (seconds) and came up with the article from the nursing journal using the keywords NP and malpractice. As far as I know that is a reputable nursing journal if not feel free to inform us otherwise. I was simply asking for the study (your "prime research not mine as I didn't make an assertion about malpractice) you were citing to back up your assertion so that we can know you are "talking out your ass" so to speak.
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I wasn't citing a study! It's a fact that NPs already practice independently in some states and their malpractice claims are available for anyone interested through the NPDB. I suppose if you're looking for a document, this information is listed in the Pearson Report: http://www.webnp.net/downloads/pearson_report08/ajnp_pearson08.pdf

Yes, I asserted that their malpractice reports don't seem any higher than physicians.
Yes, you did a quick search and came up with a nursing article that said nurse malpractice claims were increasing.

To me, the most interesting part of the article you posted wasn't "that claims are rising for NPs", but rather "that those claims are underreported." That needs to be stopped!

Otherwise, the fact that claims are rising is interesting, but it does nothing to show that NPs put their patients in danger. However, if their claim rate is a much higher proportion than physicians in the same area, then that's evidence. But your article didn't show that, so I'm not sure why you posted it. Other than show off your "quick search" (seconds) Google search skills.
 
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Jack Daniel said:
I wasn't citing a study! It's a fact that NPs already practice independently in some states and their malpractice claims are available for anyone interested through the NPDB. I suppose if you're looking for a document, this information is listed in the Pearson Report: http://www.webnp.net/downloads/pearson_report08/ajnp_pearson08.pdf

Yes, I asserted that their malpractice reports don't seem any higher than physicians.
Yes, you did a quick search and came up with a nursing article that said nurse malpractice claims were increasing.

To me, the most interesting part of the article you posted wasn't "that claims are rising for NPs", but rather "that those claims are underreported." That needs to be stopped!

Otherwise, the fact that claims are rising is interesting, but it does nothing to show that NPs put their patients in danger. However, if their claim rate is a much higher proportion than physicians in the same area, then that's evidence. But your article didn't show that, so I'm not sure why you posted it. Other than show off your "quick search" (seconds) Google search skills.
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I see you changed your post and now cite an article. YOU HAVE GOT TO BE KIDDING. The article you cite in the "American Journal of Nurse "Practicioner"" written by a NP doesn't even claim to address the issue. It's a 60 page article on legislative barriers to autonomous NP practice broken down by state with a propaganda introduction and only devotes one or two sentences to numbers of malpractice suits broken down by state against NPs with no interpretation for example I saw for one state "0 claims against NP and 760 against physicians" which was obviously because the physicians in that state were getting sued as they were overseeing the NP's. It's completely worthless for the purpose you are attempting to use it. Additionally, I find it hard to believe that you make a habit out of reading the "American Journal of Nurse Practitioner" as if that were the basis of your assertion. I don't even think that you believe to any significant degree anything you are stating here.
 
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MedicineDoc said:
What makes you think that the shortage of rural primary care is related to a lack of nurse "practictioners" and "Doctor" nurses and not the declining reimbursements in primary care?
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I never said it was

Why not fix the real problem rather than creating sham licensures?
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Every time we talk about "fixing the problem" it's nothing more than a band aid. And thats if anything actually gets done. If Physicians want to fix the problem they are going to have to do it themselves by overhauling the system. Not telling the monster that got us here to give us a 10% pay raise.
Thats why I believe that primary care should be totally free market with no insurance coverage. Part of that system is competition. Having price fixing and a monopoly over the industry is what got us into this mess. I say let NPs, chiros, etc etc compete as long as the patient is informed of what they are getting. When consumer reports comes out their would be a section between Cars and Dryers for health care and where the patient could see where they get the best bang for their buck. And what they are missing if they choose to go a cheaper or alternative route.
If a patient decides to see a NP they do so knowing that there is a risk that they miss diagnose them or what not. It's a risk they willingly take. Just like you can buy a Volvo SUV that is basically a tank in collisions or you can chose a Honda Civic that will fold like a deck of cards. But the choice is the individual's.
They key is an informed patient. As long as they know what they are getting they should be able to choose.
So you can either go free market and have competition or you can go completely socialized where someone can dictate what level of care is acceptable, in the end the country will have to settle on one. Especially for primary care.
 
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AwesomO said:
Thats why I believe that primary care should be totally free market with no insurance coverage. Part of that system is competition. Having price fixing and a monopoly over the industry is what got us into this mess. They key is an informed patient. As long as they know what they are getting they should be able to choose.
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When you have no insurance, you get people buying what their personal finances allow. In case you didn't notice (to borrow your volvo/honda analogy), people buy hondas (that you say "fold like a deck of cards")because they can't afford volvos ("built like a tank"). So it would go with healthcare. Regardless of what kind of "car" the patients may want, they'll settle for the honda if that's all they can afford. Totally free market without any form of insurance coverage for people ensures a healthcare system full of hondas.

The NP's will initially present to health insurance companies as a lower cost alternative, and the insurance companies will load their already restrictive provider directories with NP's, not MD's. People won't have a choice.

No matter how you approach it, we will have to fight to win this. It isn't going to go away via some passive-aggressive stance by PMDs.
 
MedicineDoc said:
I see you changed your post and now cite an article. YOU HAVE GOT TO BE KIDDING. The article you cite in the "American Journal of Nurse "Practicioner"" written by a NP doesn't even claim to address the issue. It's a 60 page article on legislative barriers to autonomous NP practice broken down by state with a propaganda introduction and only devotes one or two sentences to numbers of malpractice suits broken down by state against NPs with no interpretation for example I saw for one state "0 claims against NP and 760 against physicians" which was obviously because the physicians in that state were getting sued as they were overseeing the NP's. It's completely worthless for the purpose you are attempting to use it. Additionally, I find it hard to believe that you make a habit out of reading the "American Journal of Nurse Practitioner" as if that were the basis of your assertion. I don't even think that you believe to any significant degree anything you are stating here.
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andwhat said:
Jack Daniels does indeed seem to instigate fights and arguments, and tries his level best to aggravate people.

"so I'm not sure why you posted it. Other than show off your "quick search" (seconds) Google search skills"

This is obviously childlike and inappropriate behavior exhibited above, and throughout Jack Daniel's posts. It severely deviates from the topic.

Clearly he is trying to inflame the previous poster.

I mean this type of talk is clearly an instigation.

I do not understand his gripe, and what he gets out of it.

What do you want exactly? DNPs rule!

If you think that NPs are great and outstanding clinicians, then good for you.

Bottom line is, that they are FAR from independent practitioners, and do not at all deserve to see patients independently -- out of respect to patient care issues.

However you take it as a 'competition' thing which in itself reveals insecurity.

Maybe perhaps you have a spouse or a family member who is a DNP, or you are training to be one.

Please stick to the topic, out of respect to the others.

You obviously wholeheartedly support Nurse Practitioners as independent clinicians -- from what basis I do not know or care to know.
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You guys should get together and have lunch.

As the OP, it's MedicineDoc's thread, so I'll respect it enough to keep it on topic. I've made my points as clearly as I can in the previous posts if anyone is interested in what I actually said, so I'm bowing out. Good day.
 
DNP's, NP's, PA's, etc, if allowed to practice independently, should have a limited scope of practice with defined clinical care guidelines. I personally do not believe that is should be allowed to occur at all, but arguing with medical students about it is about as productive as beating my head against a wall.....

Next, let me say that I am from a rural area and have an intimate understanding of the unique challenges facing rural practice. While I am sure that the reasons for provider shortages in rural areas are somewhat dependent upon the area in question, in the vast majority of instances it distills down to a few key points:

1. Population density
2. Payer mix
3. Social and personal factors.

In rural areas the population density is low, decreasing the carrying capacity of docs. This is not to say that they will not be busy, but call pools will be smaller, and one cannot tailor their practice in a manner that is possible in larger settings. The payer mix is often not as strong in rural settings, with much higher percentages of Medicare and Medicaid, thus decreasing earning potential. Lastly, the number of good schools for your children, breadth of extracurricular activities, cultural (if you are into that sort of thing) activities are all limited in rural settings.


(Half-a**ed) Training of uber-mid-level providers will do nothing to fix the maldistribution problem unless there is some form of mandatory service requirement (which won't work) because this does nothing to address the fundamental deficiencies that create the problem to begin with. The only answer is to offer significant incentives to providers to practice in HSA's, which few are willing to do... and good ol' MC is attempting to remove the floor from the geographic index, which will only further the problems.
 
racerx said:
When you have no insurance, you get people buying what their personal finances allow.
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Um yes thats how a free market system works. When everything isn't on someone else's dime you shop carefully.
In addition lets look at the basic math here because your understanding is wrong.
If a patient goes with insurance his payments must
1) Pay the doctor Bill
2) Provide a profit for the insurance company
3) Pay for the payroll of the insurance company
If a patient pays cash all he has to pay is the physician's fee.
How is it that a patient is able to do 1-3 above and have it be cheaper than just paying the physician's fee? Would a patient not be able to buy more by going free market on primary care?


So it would go with healthcare. Regardless of what kind of "car" the patients may want, they'll settle for the honda if that's all they can afford.
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If thats how a free market system works explain why everyone isn't driving a stripped down Kia? Why are there still BMWs on the road?
Why is it that Bed Bath and Beyond is still open despite the fact you can get like merchandise at Wal Mart for much cheaper.
Why are 5 star restaurants open when I can eat off the 99 cent menu at Wendys?
How are stores like Dillards and Macy's able to sell clothes when you can go to good will and buy clothes cheaper?

Totally free market without any form of insurance coverage for people ensures a healthcare system full of hondas.
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First going off of how you describe Honda's, NONSENSE! The free market ensures high quality at affordable prices across the board. In addition creating more choices.

Second if health care is indeed a bunch of Honda's then great! Honda's as a whole are efficient, well built, relatively safe, and reliable all at a great price. Thats what physicians should be striving for.

The NP's will initially present to health insurance companies as a lower cost alternative, and the insurance companies will load their already restrictive provider directories with NP's, not MD's. People won't have a choice.
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Yeah thats YOUR SYSTEM. I advocate no primary care insurance and just high deductable catastrophic insurance in most cases. Your the one trying to take away the choices not me.

No matter how you approach it, we will have to fight to win this./QUOTE]

I'll fight anything along the lines of fraud. ie DNPs referring and advertising themselves as doctors or making false claims of their training.
I would also be highly in favor of public education campaigns.
But in the end it's the informed patients choice on who they see. All I can do is provide them with the information and hope that I offer an attractive enough package of quality service and affordable price.
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racerx said:
The NP's will initially present to health insurance companies as a lower cost alternative, and the insurance companies will load their already restrictive provider directories with NP's, not MD's. People won't have a choice.

No matter how you approach it, we will have to fight to win this. It isn't going to go away via some passive-aggressive stance by PMDs.
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Agreed. FM docs need to construct a true, real, cogent counter-argument to this phenomenon and then clearly articulate it at EVERY chance. If true that primary care can be done more cheaply with less training, we need to be worried. You can't argue with money.

One strong argument should be, I think, that DNP's won't actually save the system money because they will be trained to have a lower referral threshold ("coordinating care" is a major aspect of their training). Shunting more people to high-cost specialists will not save anybody money - not government, not insurance, not patients.

The beauty of FP's - even ones that don't do OB - is that they can handle so many things that lesser-trained providers need to hand off. Specialists and their high-cost tools are a huge reason that the American medical system is so expensive.

The systemic cost-savings offered by well-trained FP's must NOT be underestimated and needs to be lucidly and passionately described at every opportunity.
 
secretwave101 said:
One strong argument should be, I think, that DNP's won't actually save the system money because they will be trained to have a lower referral threshold ("coordinating care" is a major aspect of their training). Shunting more people to high-cost specialists will not save anybody money - not government, not insurance, not patients.

The beauty of FP's - even ones that don't do OB - is that they can handle so many things that lesser-trained providers need to hand off. Specialists and their high-cost tools are a huge reason that the American medical system is so expensive.

The systemic cost-savings offered by well-trained FP's must NOT be underestimated and needs to be lucidly and passionately described at every opportunity.
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Excellent tactic. I hope someone in the leadership of AAFP, ACP, etc. uses the points you have made in their arguments. That is, if they ever bother to get off their butts and pretend they care about the future of primary care.

Sometimes, I get the feeling many of the leadership in these groups don't really care. They've gotten their's and will be retired before it threatens their livelyhood.
 
andwhat said:
Rural areas are severely lacking physicians, and this trend will only continue.
<snip>

Doctor Nurse Practitioners? Why not, could things possibly get any worse?
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It's an international trend also. Wife and I had dinner last night with three primary care docs (two Americans and one Bangladeshi) and they were discussing how Australia and New Zealand were importing Bangladesh docs to cover underserved areas in those countries.

Now I don't know about you but I'd want an NP over the typical Bangladeshi doc.:D
 
zenman said:
It's an international trend also. Wife and I had dinner last night with three primary care docs (two Americans and one Bangladeshi) and they were discussing how Australia and New Zealand were importing Bangladesh docs to cover underserved areas in those countries.

Now I don't know about you but I'd want an NP over the typical Bangladeshi doc.:D
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At least they pass steps 1, 2, and three and attended medical school. I'd take that over someone with an on-line degree following community college.
 
zenman said:
Now I don't know about you but I'd want an NP over the typical Bangladeshi doc.:D
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Why? Their training even in foreign countries is superior to pretty much any NP program in the US.
 
andwhat said:
http://www.earnmydegree.com/index.c...ermat&sid=6438578C-9056-621C-7AC4294ADF032BF1

there you go, your opportunity to earn your nursing degree online, and fool patients into thinking that they are obtaining real medical care.
You can very easily earn your Doctorate of Nursing Degree online, or Nurse Practitioner degree online, and be able to pretend to be a doctor,
UNSUPERVISED
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I think you weaken your argument by continuing with this line. While it is true you can get online nursing degrees, you can't be trained to be a nurse practitioner from an online degree. If someone understands this distinction, then they might doubt your other points, too.

In the larger sense, this is engaging the same tactic you're criticizing DNPs for doing: misleading people about their training.
 
AwesomO said:
Why? Their training even in foreign countries is superior to pretty much any NP program in the US.
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Their "practice" isn't. We have a weekly medical meeting of embassy docs and nurses and American corporate nurses and go over the horror stories of the week. It's like some physicians are just not trained to think. Ex. Pt with chest pain who goes to a hospital who specializes in cardiac care. Doctor on duty didn't even think about doing an ECHO even though the machine was in his view. Doctor friend of mine chewed him out for that and for not ordering some labs...I forget which ones.

Friend of mine woke up with neck pain one morning and came over for a shiatsu session. She had pain in her left shoulder and neck and tingling/numbness in her arm and fingers. After checking out her neck, I told her to go get an MRI as that was her problem. I put a soft collar on her and gave her 800 of Ibuprofen and she wound up with an MRI of the neck and one of the shoulder. Of course the shoulder was negative and the neurosurgeon recommended surgery for her bulging cervical discs. She's getting a second opinion from a Singapore neurosurgeon and will most likely wind up in the OR, but not here.

Then there are the really bad ones...

But there are some good physicians. One IM guy treated my wife and I was impressed by his diagnostic skills and treating what he thought was her problem in spite of what the tests showed. Turns out he was correct.
 
zenman said:
Friend of mine woke up with neck pain one morning and came over for a shiatsu session. She had pain in her left shoulder and neck and tingling/numbness in her arm and fingers. After checking out her neck, I told her to go get an MRI as that was her problem. I put a soft collar on her and gave her 800 of Ibuprofen and she wound up with an MRI of the neck and one of the shoulder. Of course the shoulder was negative and the neurosurgeon recommended surgery for her bulging cervical discs. She's getting a second opinion from a Singapore neurosurgeon and will most likely wind up in the OR, but not here.
Click to expand...

Not to derail the thread, but...what?

You ordered an MRI of two separate areas after less than 24 hours of pain and paresthesia? No motor symptoms, I presume. No trial of conservative therapy. Just send 'em to the neurosurgeon (who, not surprisingly, recommended surgery). Geebus.

You may not realize it, but you're making our point for us.
 
KentW said:
Not to derail the thread, but...what?

You ordered an MRI of two separate areas after less than 24 hours of pain and paresthesia? No motor symptoms, I presume. No trial of conservative therapy. Just send 'em to the neurosurgeon (who, not surprisingly, recommended surgery). Geebus.

You may not realize it, but you're making our point for us.
Click to expand...

No, I told her she would need an MRI *and the neurosurgeon ordered one, plus an unneeded one of her shoulder. I referred her prior to seeing the neurosurgeon to our sports medicine guy for conservative treatment. Her pain was increasing rapidly and she went to see the neurosurgeon. After she gets her second opinion from Singapore she will decide what to do next. Personally, I always advise people to stay away from the knife if possible. She's able to walk and not peeing or pooping on herself. However, she's in a great deal of pain now and can't move her head at all.

* I just know when one is needed or when there is a fracture for example but we won't discuss that.

Do you feel better now...
 
andwhat said:
well it goes without saying, as Zenman clearly pointed out earlier.
Credibility? Coming from someone that would prefer a NP over a Physician? I think that you have to wonder about the validity of the source in the first place.
I was quite shocked at the MRI also. The irony of it, and I totally agree with Kent, ordering an MRI for neck pain of less than 24 hours -- and then stating that NPs are more highly qualified than Physicians.
Unbelievably strange individuals here.
Click to expand...

You really smart guys have reading and comprehension problems don't you? Did I say anything about 24 hrs? My point was that an MRI of the shoulder was unnecessary and if the doc knew how to touch someone he wouldn't have ordered it, except to make money for the hospital.. I didn't fill in the blow by blow details since that was the only point I wanted to make. I work with a FP doc so if I was gonna screw up I'm sure she would step in.

FYI, I'm not an NP, but I'm also a bodyworker for Christ's sake. If I tell you someone with a non-deformed injured body part needs an x-ray you better get it cause I've never been wrong. My FP wanted me to let teach her how to do it since she's missed a few but I insisted they get an xray. So face it; I've had training you don't get.
 
andwhat said:
I agree with you Jack Daniels, DNPs are revolutionizing Medicine, they are incredibly gifted diagnostically. I am so happy that you go out of your way continuously to point that out to everyone here.
You are so correct Jack Daniels, thank you again so much for pointing out the flaws in my statements.
Doctor Nurse Practitioners are incredibly talented as you have pointed out a billion times here, and should practice Medicine independently.
I take it you are a Doctor Nurse Practitioner student?



Jack Daniel's Avatar

I am sorry for being uninformed. Are these nurse doctors really harming people at such an alarming rate that we need to create a lobbying organization to help the public sue them?
To read some of the posts on various SDN threads, you'd think so, because the posters all seem to know instances of a NP seriously jeopardizing patient care.

Funny thing, despite all the anecdotes, few--if any--studies exist that suggest NPs harm their patients. I can, however, find many studies suggesting they do quite well treating patients.

So, no. IMO, we don't need a lobbying organization to help the public sue them.[/B]

Jack Daniels is personally attacking everyone and anyone that has anything at all and whatsoever pertinent to negatives untowards Doctor Nurse Practitioners.
One suggestion to you Jack Daniels, PRESENT FACTS OR MOVE ON. You seem to enjoy fabrication and exaggeration, of nurse practitioner capabilities. Provide some facts, evidence, anything.
Click to expand...

He's not attacking anyone personally -- you are. And he did present facts -- you're not. All he did was inform you that one cannot become an NP or a DNP solely online. This is a fact. While it may be possible to earn some sort of master's degree online, NPs and DNPs have clinicals they must complete prior to certification.
 
andwhat said:
ha ha ha oooooooooh man I just knew it somehow, NewMan's own would appear and support Jack Daniels. Lol.
Click to expand...


No. Nope. We aren't doing this again. Not in this thread and not anywhere else. Posters will please address the topic of the thread and not the other posters participating in the thread.

If anyone has questions or concerns or needs help figuring out what IS and ISN'T a personal attack, you can PM me.

Fair warning. :)
 
NewmansOwn said:
He's not attacking anyone personally -- you are. And he did present facts -- you're not. All he did was inform you that one cannot become an NP or a DNP solely online. This is a fact. While it may be possible to earn some sort of master's degree online, NPs and DNPs have clinicals they must complete prior to certification.
Click to expand...

Most DNP programs require 1000 clinical hours. At 80 hours/week, an intern would do that in under 13 weeks. I don't think I would want an intern providing independent care for my loved ones 3 months into residency. And most allow for the clinicals to be independently arranged by the 'student' - I wonder how many teaching sessions, grand rounds, etc. they attend?
 
andwhat said:
If NPs are so intelligent and truly capable NewMan's own, then tell them to take ATLS, USMLE and other Medicinal examinations, and then we can see how they fare.
I know, if they have to do that, then lets have doctors take their examinations also.
It will never happen will it?
My point is, that if they are truly capable of treating patient ailments like a Physician, then they should have to take equal examinations.
Again, present FACTS FACTS FACTS I do not care at all about random quality reports based SOLELY upon subjective data -- I want stone cold FACTS that state that Nurse Practitioners are comparable to Physicians -- in Treatment and Physical Examination, Diagnosis -- in residency and medical school we are literally grilled on these aspects, and nurses probably are not even 100th of a percentile expected to be on the same footing.
If I am so called 'attacking' someone, by kindly requesting Objective data, that supports your claims that Nurse Practitioners are equally comparable Clinically, as well as Diagnostically to Physicians -- in Medical knowledge, Treatment and Physical Examination, then I wholeheartedly welcome this educational opportunity, fruitfully presented by NewMan's Own and Jack Daniels.
Please I request NewMan's Own and Jack Daniels to either present cold stone Objective data, or stick to the point.
Click to expand...

nebrfan said:
Most DNP programs require 1000 clinical hours. At 80 hours/week, an intern would do that in under 13 weeks. I don't think I would want an intern providing independent care for my loved ones 3 months into residency. And most allow for the clinicals to be independently arranged by the 'student' - I wonder how many teaching sessions, grand rounds, etc. they attend?
Click to expand...

Look, I understand for at least one of you English isn't your first language. That being said, if you're going to engage me in intellectual conversation, I would appreciate it if you would read my posts carefully AND distinguish them from the posts of others.

andwhat, you have attached to me the belief that DNPs and/or NPs are equal to physicians in terms of patient care abilities. You will notice, if you care to check, that I have never once put forth this position. Neither, furthermore, has Jack Daniels. My defense of him was offered simply because his words (some of the most intelligent on this wacky thread) were being misconstrued.

To nebrfan, I offer the same point -- I have said nothing in this post regarding my opinion of NPs and DNPs to provide independent care. Believe me, I understand that reading close to 100 posts is tedious, but it's worthwhile so that you can be sure the opinions you ascribe to individuals are accurate.

All4, I'm sorry this fire got lit again -- I'm just trying to support intellectual discussion and defend those who offer it.
 
All4MyDaughter said:
No. Nope. We aren't doing this again. Not in this thread and not anywhere else. Posters will please address the topic of the thread and not the other posters participating in the thread.

If anyone has questions or concerns or needs help figuring out what IS and ISN'T a personal attack, you can PM me.

Fair warning. :)
Click to expand...

Ditto.

Seriously, it's getting very old.
 
NewmansOwn said:
Look, I understand for at least one of you English isn't your first language. That being said, if you're going to engage me in intellectual conversation, I would appreciate it if you would read my posts carefully AND distinguish them from the posts of others.

andwhat, you have attached to me the belief that DNPs and/or NPs are equal to physicians in terms of patient care abilities. You will notice, if you care to check, that I have never once put forth this position. Neither, furthermore, has Jack Daniels. My defense of him was offered simply because his words (some of the most intelligent on this wacky thread) were being misconstrued.

To nebrfan, I offer the same point -- I have said nothing in this post regarding my opinion of NPs and DNPs to provide independent care. Believe me, I understand that reading close to 100 posts is tedious, but it's worthwhile so that you can be sure the opinions you ascribe to individuals are accurate.

All4, I'm sorry this fire got lit again -- I'm just trying to support intellectual discussion and defend those who offer it.
Click to expand...

Well I do not at all feel that this sort of insulting behavior is appropriate.
Then again I am not the moderator.
Its really unbelievable what is -- and what is not considered appropriate here, nonetheless I will bow out thats fine.
I will not go along with the insulting theme here.
I am not sure what is tolerated and what is not -- clearly if this is tolerated and other things are not, then I can say confidently
"ok then"
 
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