NPs can now do dermatology residencies

Interesting, I wasn't aware that we had such a shortage of dermatological care. What is the DNP's excuse this time?

I'm sure a lot of medical students will be upset that their crown jewel is under attack.

I've always wondered though, what exactly do dermatologists do? A lot of it just doesn't seem that connected to medicine to be honest. Biopsy, antibiotics, steroids... seems like a waste for the best and brightest medical students to inject botox in clinic 4 days a week. I don't think it's a stretch to train a few pseudo-docs to spot melanoma or sell wrinkle creams.

filter07 said:

Interesting, I wasn't aware that we had such a shortage of dermatological care. What is the DNP's excuse this time?

Click to expand...

Try getting an appointment with one

VA Hopeful Dr said:

Try getting an appointment with one

Click to expand...

About a 5-7 day wait where I am. Depends on your location.

filter07 said:

I don't think it's a stretch to train a few pseudo-docs to spot melanoma or sell wrinkle creams.

Click to expand...

Agree. I think it should be like that everywhere. Computer firms decide for themselves whether they want someone with a certain level of education, or whether candidates can prove their mettle in other ways. It should be like that in Medicine as well, more ways to get a job in treating patients, less regulation preventing people from working according to their competence. Today's system is authority over competence, though often correlating, it isn't necessarily so. Remove the MD, remove the nurse profession, let there be health workers who have to document their specialized abilities, and let market be the carrot driving the development of new specialized abilities forward. If they want someone who can recite Ganong-physiology, a biochemist, a biologist who knows how to suture, or an someone formerly educated as a nurse to work in the e.g ER, be my guest. They will get their bums sued, and inevitably learn how to pick candidates, and what to look for.

VA Hopeful Dr said:

Try getting an appointment with one

Click to expand...

This is a poor excuse to allow nurses to be practicing medicine/dermatology.

I've been following this DNP issue for over a year now. Many physicians predicted that once they are given independent rights, they will fight for equal pay. Once they get equal pay, they will infiltrate the high paying specialties. And that is EXACTLY what is happening now. Almost like clock work.

THEY MUST BE STOPPED.

Interestingly enough, looking at their main website (http://health.usf.edu/nocms/nursing/AdmissionsPrograms/dnp_concentrations.html) they offer more than just a dermatology "residency concentration"

Dermatology*
Cardiovascular
Family Practice
Occupational Health *
Internal Medicine
Endocrinology
Neurology/Pain Management
Psychiatry
Pediatrics
Neonatology
Emergency Medicine
Acute Care

Click to expand...

So now they can be cardiologists too! The derm and cardiology residencies are extra tough, though - they require 1000 hours of clinical work (25 '40 hour' work weeks, or 12.5 '80 hour' weeks) -- the rest require 500 hours ... You too can be a pediatrician in just 12 short weeks!

I think because the gov doesn't want to create more residency spots, now NPs are going to fill the void.

Here is an article I found:
http://www.azcentral.com/news/articles/2009/02/21/20090221nursepractitioners0220.html

For many, a nurse practitioner is The doctor
With physicians in short supply, highly trained nurses fill void

by Ginger Rough - Feb. 21, 2009 12:00 AM

The Arizona Republic

Kathryn Kaiser doesn't think she actually has seen her doctor, even though she went to his office three times last year. When she made an appointment, the Scottsdale resident was directed instead to a nurse practitioner for an exam and prescription.

"I feel like it's hard enough to get an appointment with her," said Kaiser, 25, who suffers from chronic ear infections. "I can't even imagine how long it would take for me to get in to see my actual doctor."

Kaiser is among an increasing number of patients who are entrusting much of their routine health care to nurse practitioners, who are registered nurses with advanced training and expertise.


During the past five years, the number of nurse practitioners in the United States has increased by nearly 40 percent, to 125,000, according to estimates by the American Academy of Nurse Practitioners. Arizona's rate of growth has been slower in recent years, but since 2000, the number has jumped by 46 percent, to 3,000 practitioners, which is faster than population growth.

The trend is being driven in large part by a shortage of primary-care doctors or general-practice physicians, medical experts say.

Although most nurse practitioners work in settings supervised by physicians, more are striking out on their own, opening and staffing their own clinics apart from doctors. That has generated some controversy in the medical community, as physicians worry about the risk of misdiagnosis if NPs don't work collaboratively with licensed physicians.

"The nurse practitioner replacing the family doctor is not good for America," said Dr. Ted Epperly, president of the American Academy of Family Physicians. "To say a nurse practitioner can fill the shoes of a family physician, in terms of the total comprehensiveness of care, is just not true."

Nurse practitioners say such concerns are overblown. They maintain that most NPs are careful to stick to treatments that they are licensed to provide and that they send patients to doctors for any serious problems.

They say they are filling a void for many Americans who have trouble getting timely and unhurried doctor appointments.

"There is a need," said Sharon Campbell, a Tucson nurse practitioner who opened her own practice in 2004. "We fill that need."

Role of the NP

Arizona is among about a dozen states that allow nurse practitioners to treat and diagnose patients, order tests and prescribe medications without collaborating with a physician.

That means they can work independently in almost any field, including family practice, pediatrics and women's health. Some own practices that specialize in psychiatry, dermatology and managing or preventing heart disease.

State law doesn't limit what services nurse practitioners can provide, but it does say they should consult with an outside health provider when dealing with a condition that exceeds their expertise.

Most NPs have at least a master's degree and have completed 500 to 1,000 hours of supervised hands-on training, under guidelines set by the American Association of Colleges of Nursing.

Nurse practitioners in a growing number are getting doctorate degrees because accredited programs are requiring them, including those at Arizona State University and the University of Arizona.

By 2015, all NP programs will require a doctorate, said Mary Jo Goolsby, director of research and education for the American Academy of Nurse Practitioners.

Doctor shortage

The growth in the number of nurse practitioners has coincided with a decline in primary-care physicians, a troubling trend that experts say is leaving many patients without rapid access to medical care.

Today, medical students are more apt to choose a higher-paying specialty field like ophthalmology or dermatology over the main primary-care fields of pediatrics, internal medicine and family practice.

A study published in September in the Journal of the American Medical Association found that only 2 percent of students planned to go into primary care. In 1990, it was 9 percent.

The result is that more patients say they can't find nearby doctors or have to wait weeks or months for an appointment.

In 2007, only 30 percent of Americans said they were able to get same-day appointments with their doctors when they were sick, a survey by the New-York based Commonwealth Fund indicated.

Arizona ranks 43rd in the nation in number of physicians per capita, with 208 for every 100,000 residents, according to 2006 statistics from the U.S. Census Bureau.

"If we're going to be honest, the increase of nurse practitioners is a symptom of the disease," Epperly said. "The disease is a lack of a robust, family, primary-practice physician network."

Pros and cons

Nurse practitioners say they are well-equipped to provide holistic care with a focus on communication and bedside manner.

"The education is there, the need of the public is there, and I don't think there will be enough physicians to do the job," said Mark Burns, a nurse practitioner who cares for transplant patients at Mayo Clinic Hospital. "I think the quality of care that nurse practitioners give is really good."

Agnes Oblas, a nurse practitioner who opened her own family practice in Ahwatukee in 2001, agrees.

Oblas had worked with a group of physicians for several years before striking out on her own. She said her setup offers patients a personal, one-on-one experience. Same-day appointments are available, and visits last 30 to 60 minutes.

"I only see maybe seven patients a day, which was unheard of where I was," Oblas said. "There, it was sometimes 25 a day, in and out quick."

Too often "things fall through the cracks" in today's health-care system, she said. "People wait days or weeks for a referral. That's not going to happen to my patients."

Epperly agrees that nurse practitioners play a valuable part in today's health-care system. But his organization, the American Academy of Family Physicians, as well as the American Medical Association, have taken the position that NPs should not be practicing on their own.

"I don't want to come across as slamming practitioners," Epperly said. "My office has two. But to become a family physician, you need anywhere from 10,000 to 14,000 clinical hours."

Dr. Tiffany Nelson, a family-practice physician in north Phoenix, also believes that practitioners should work in collaboration with a doctor.

Like Oblas' office, Nelson's offers same-day appointments. There are no practitioners on staff; all patients see their primary-care doctor.

"I think primary care is probably the hardest place for nurse practitioners to work because there is such a wide variety of problems and conditions we have to deal with," Nelson said. "The common (problems) are easy to treat, but not everything is common."

Nelson believes NPs are "well-utilized in a specialist's office, where they are seeing the same thing over and over again."

Reimbursement rates

For Oblas and other nurse practitioners, the struggle for autonomy goes beyond earning respect in the medical community. It includes parity in payments and insurer reimbursements.

Nurse practitioners say that insurance companies reimburse them 60 percent to 85 percent of what physicians receive for the same treatment typically.

"I am not doing anything different, anything different at all," she said. "But I am getting less."

Still, there are signs the reimbursement gap is narrowing.

The ASU Health Center, a nurse-managed clinic in downtown Phoenix, is the first non-physician-staffed office in Arizona to receive 100 percent reimbursement from an insurer, United Healthcare, said Bernadette Melnyk, dean of the university's College of Nursing and Healthcare Innovation.

"I think my feeling is, if we deliver the exact same service, then we should be reimbursed at the exact same rate," said Melnyk, who is a licensed NP.

Still, more important, nurse practitioners say, there are too many patients in need to be arguing about who is best able to serve them.

"People are so underserved in so many areas of our state," Melnyk said. "There is no need for territorialism here.

"We all have a job to do, and that is to provide quality care."

From the video on the website:

http://health.usf.edu/nocms/nursing/AdmissionsPrograms/dnp_concentrations_derm.html


I feel like it's a bit misleading to introduce herself as "doctor" leading a "residency program" without using the appropriate modifiers and making clear it's a nursing program.

why can't they make it so I can get a derm position or any other position for that matter? I'm an MD! They're not as harsh on NPs as they are on medical doctors in residency I am sure!

so an NP can get in residency, why can't I?

DOCTORSAIB said:

This is a poor excuse to allow nurses to be practicing medicine/dermatology.

I've been following this DNP issue for over a year now. Many physicians predicted that once they are given independent rights, they will fight for equal pay. Once they get equal pay, they will infiltrate the high paying specialties. And that is EXACTLY what is happening now. Almost like clock work.

THEY MUST BE STOPPED.

Click to expand...

The same could be said about doctors of osteopathy. It was designed to supply primary care in underserved areas but many go on to specialize. And most are beginning to accept DO as equivalent to MD. Let's face it, being a doctor isn't rocket science. The hardest part of medicine is getting into medical school.

filter07 said:

The same could be said about doctors of osteopathy. It was designed to supply primary care in underserved areas but many go on to specialize. And most are beginning to accept DO as equivalent to MD. Let's face it, being a doctor isn't rocket science. The hardest part of medicine is getting into medical school.

Click to expand...

I wasn't aware primary care/ primary care shortage/ underserved areas were very prevalent, or even terms back in the 1800's when osteopathy came about. you clearly have no idea what you are talking about. And I believe the argument concerning DNP's is why should they be given full rights to practice medicine as physicians when they have not even half of the education or clinical hours. DO's go to four years of medical school, during which they do their clinical years alongside allopathic students, and then continue to do residencies alongside MDs, sharing every bit of call, responsibility, and completing the same exact number of hours before they go out into practice.

The expansion of medical schools in this country is largely from the establishment of new osteopathic schools. They state that their purpose is to train primary care providers and treat patients in a holistic manner. Now that they are well established, they do neither.

filter07 said:

The expansion of medical schools in this country is largely from the establishment of new osteopathic schools. They state that their purpose is to train primary care providers and treat patients in a holistic manner. Now that they are well established, they do neither.

Click to expand...

It has been stated that about 65% of DO students go into primary care. at my school, much more. if not for them, this "primary care shortage" would be a lot more serious than it is now. at three separate allopathic schools in my area, there were FOUR matches each into family practice this past year... that makes 12 total. not too many going into IM either, and most of those who do plan to specialize. wow, you MDs are doing a great job at promoting primary care in your schools.

this is very scary to the medical establishment. I can see in 15-20 years doctors been outnumbered by DNP's in the hospital and outpatient setting. How many med schools are running right now 120's? How many DNP's program have surface in the first 5 years of the DNP existence? I think its close to 100

The other day we were talking about board certification for IM and one person stated: "Why do we care for certification when you have NP's doing the job of a MD?". It didnt strike me at first but then I read this and its all falling into place.

Blue Dog said:

Why this isn't obvious to everyone, I have no idea.

Click to expand...

I agree that primary care is one of the most challenging specialties... to do well. I think the confusion is partly because it's fairly easy to be a mediocre PCP, and partly because it doesn't elicit the attention of the hero-worship culture that surgeons do.

The problem with NP takeover of primary care is that it's very easy to sweep things under the rug in primary care, where patients are usually seen in outpatient clinics and are usually not critically ill. You can hide a lot of faults and shortcomings in this type of setting, and outcomes studies have to be extremely detailed, comprehensive, and span a number of years to decades to tease these differences out. That's a lot different than outcome studies for surgery, where we often look at complication rates and in-hospital mortality... those are not as subtle.

Although there are many easily diagnosed and treated conditions in primary care (that's easily handled by PA/NP), I now think it is very difficult to become a good PCP. There are so many conditions that you need to know in primary care, and some of them involve procedures you only do a few times in a career. I remember my family medicine rotation where I essentially shadowed a private practice FP. Sure he saw a bunch of common and boring things, but he also dealt with a lot of things I've never heard of before, and are not in any basic medical student text. He had to diagnose and treat random things in almost every area of the body, and do it quickly. He didn't have the luxury of seeing patients, going back to his office, and using UpToDate to figure things out. Were these problems life and death? Hardly, but they were problems nonetheless and he handled them with skill and efficiency, two qualities especially impressive to a future surgeon like myself. He did have a NP, but the NP dealt strictly with common problems, and whenever she had uncertainty, the other doctors were right there to come to the rescue.

I used to clown primary care all the time when I was a medical student because the only thing I saw in primary care was a doctor doing physical exams and adjusting medications for chronic illnesses. It is, on a superficial level, not very glamorous or exciting, compared to say, trauma or neurosurgery. Primary care can't really compete with bedside thoracotomies or a craniotomy in terms of the wow factor. Good PCP care is less like a summer action flick and more like wine appreciation. The distinction of good wine is lost on most...

NYCDO1 said:

It has been stated that about 65% of DO students go into primary care. at my school, much more. if not for them, this "primary care shortage" would be a lot more serious than it is now. at three separate allopathic schools in my area, there were FOUR matches each into family practice this past year... that makes 12 total. not too many going into IM either, and most of those who do plan to specialize. wow, you MDs are doing a great job at promoting primary care in your schools.

Click to expand...

Stating 65% and being 65% are two different things. Your anecdotes don't impress me. Osteopathic schools are almost as bad as allopathic schools in getting people into primary care.

http://en.wikipedia.org/wiki/Osteop..._States#Osteopathic_medicine_and_primary_care

filter07 said:

Stating 65% and being 65% are two different things. Your anecdotes don't impress me. Osteopathic schools are almost as bad as allopathic schools in getting people into primary care.

http://en.wikipedia.org/wiki/Osteop..._States#Osteopathic_medicine_and_primary_care

Click to expand...

Comparing DNP to DO does a disservice to the DOs out there.

DOs undergo 4 years of med school of similar intensity and with similar (if not identical) classes to MDs, and then undergo residency similar to MDs (and many do allopathic residencies and take the USMLE in addition to the COMPLEX). In short, the only differences between DO and MD is the very rarely practiced OMM and the less prestigous and less selective nature of DO schools, not the material taught.

DNPs can take classes online, the classes are far less strenuous/detailed, undergo much much less clinical training, the clinical training is of far lower intensity, and are much easier to get into even than DO schools.

filter07 said:

The same could be said about doctors of osteopathy. It was designed to supply primary care in underserved areas but many go on to specialize. And most are beginning to accept DO as equivalent to MD. Let's face it, being a doctor isn't rocket science. The hardest part of medicine is getting into medical school.

Click to expand...

Why are you wasting your time making absurd comparisons between DOs vs DNPs, and not worrying that a bunch of nurses are about to do what your primary care colleagues (and specialists now) do with less training and the same pay?

They are basically saying your degree and your education are worth toilet paper b/c we can do what you do but better.

Medicine isn't rock science but it's also not easy and shouldn't be delivered by people who were not meant to be in medical school to begin with!

Is this a fu*cking joke??? Honestly. What the hell is this? I don't even get how doctors can just bend over and take it up the ass in what feels like monthly intervals.

It's starting to be pretty clear that the role of a doctor with regard to clinical practice is over. The only hope is to manage people in what used to be a doctor's job. They stepped aside and let insurance companies, government, and mid-levels take it over, with very, very little fight.

I'm sitting here with an acceptance in hand, trying to physically convince myself to consider diving into this mess, and I really don't know if I even can. It's a joke.

Somehow the fu*cking nurses were able to lobby enough power to get absolutely everything they wanted, but there isn't a single organization that can muster up enough defense to stop this bull****?

The AMA can't stand up and represent docs for once? The LCME can't threaten to pull the accreditation of schools like USF that set up these - f*uck around in undergrad, become a DNP, skip the debt, get a derm residency, and make 300k a year programs???

This is a joke?

I'd like to thank everyone who made this possible ... I wonder how long before they are performing surgery???

So their "residency" in Derm requires 1000 hours. So working a 10 hour day M-F it'll take them 20 weeks to complete their "residency". Nice, for the same pay as a physician too right? Sweet, so one could complete their entire formal education online, and then do 20 weeks of M-F 10 hour days, and expect to make the same as a physician who has trained for atleast 11 years? Let me make this clear.......THIS IS A COMPLETE JOKE...A FARCE...IT MAKES THE PRACTICE OF MEDICINE LOOK LIKE A COMPLETE JOKE!!!

Here's the problems folks, and it's extremely simple. This will continue until physicians stand together and put a stop to it. It will continue until the Board of Medicine takes a friggin' stand once and for all. It will continue until physicians start respecting one another's field (as opposed to making light of one another's hard work and efforts...evident even in this thread!). We can type the keyboard all day long about how frustrated, fed up, and angry we are. But this crap continues until physicians make a unified stance and put an end to it.

The poor impressional public will eventually believe they are bonafide doctors, because they call themselves doctors. I know someone who told me that an NP wrote a referral to a qualified MD doctor and the patient kept calling the DNP his doctor to this doctor. It just goes to show that some people aren't educated enough to realize that the care they're receiving is not standard as per USMLE licensed doctors. These patients sometimes don't even know the training a doctor is required to go through and think they're being treated by a real doctor since they call themselves doctor and don't make a patient realize the distinction between them and an MD or DO. The public has no clue sometimes. The residency spots are staying stagnant, because the current doctors think they'll make less money, and an explosion of Doctor NP's is what happened as a result!

Southpaw said:

So their "residency" in Derm requires 1000 hours. So working a 10 hour day M-F it'll take them 20 weeks to complete their "residency". Nice, for the same pay as a physician too right? Sweet, so one could complete their entire formal education online, and then do 20 weeks of M-F 10 hour days, and expect to make the same as a physician who has trained for atleast 11 years? Let me make this clear.......THIS IS A COMPLETE JOKE...A FARCE...IT MAKES THE PRACTICE OF MEDICINE LOOK LIKE A COMPLETE JOKE!!!

Here's the problems folks, and it's extremely simple. This will continue until physicians stand together and put a stop to it. It will continue until the Board of Medicine takes a friggin' stand once and for all. It will continue until physicians start respecting one another's field (as opposed to making light of one another's hard work and efforts...evident even in this thread!). We can type the keyboard all day long about how frustrated, fed up, and angry we are. But this crap continues until physicians make a unified stance and put an end to it.

Click to expand...

You want to know the best part ... it 100% will continue with absolutely no end in sight. Who's going to represent docs? Why would they band together now? Everything else came and went???

It's just done. Screw it ... it's seriously over.

turquoiseblue said:

why can't they make it so I can get a derm position or any other position for that matter? I'm an MD! They're not as harsh on NPs as they are on medical doctors in residency I am sure!

so an NP can get in residency, why can't I?

Click to expand...

Since the likelihood is that in the upcoming years more and more physicians won't be able to get into residencies, I think that anyone who has graduated medical school should be allowed to do the work that NPs and PAs do.
And yet, somehow, while NPs and PAs are considered qualified to do the same work that physicians do, physicians who actually have graduated med school (even those who have completed an internship in many cases) are viewed as incompetent to practice clinical medicine and their degrees are basically worthless without a residency. I think that makes no sense. It is ridiculous that you can go through college and med school only to wind up with worse job prospects than an NP with half the training.

peppy said:

Since the likelihood is that in the upcoming years more and more physicians won't be able to get into residencies, I think that anyone who has graduated medical school should be allowed to do the work that NPs and PAs do.
And yet, somehow, while NPs and PAs are considered qualified to do the same work that physicians do, physicians who actually have graduated med school (even those who have completed an internship in many cases) are viewed as incompetent to practice clinical medicine and their degrees are basically worthless without a residency. I think that makes no sense. It is ridiculous that you can go through college and med school only to wind up with worse job prospects than an NP with half the training.

Click to expand...

Can you imagine someone with a 260 Step I, AOA, Honors, etc, who didn't get into derm reading this thread???

I agree about the degree thing as well. It's unfortunate that without a residency, the degree doesn't mean much.

And yet ... there is still no point in doing one.

filter07 said:

Interesting, I wasn't aware that we had such a shortage of dermatological care. What is the DNP's excuse this time?

I'm sure a lot of medical students will be upset that their crown jewel is under attack.

I've always wondered though, what exactly do dermatologists do? A lot of it just doesn't seem that connected to medicine to be honest. Biopsy, antibiotics, steroids... seems like a waste for the best and brightest medical students to inject botox in clinic 4 days a week. I don't think it's a stretch to train a few pseudo-docs to spot melanoma or sell wrinkle creams.

Click to expand...

well, it would have served you well to educate yourself 1st rather than just wonder about what dermatologists do by rotating with one rather than making ignorant statements like this on a public forum

This is not funny anymore. This is a real threat to the practice of medicine and patient welfare. In reading the NP Derm residency presentation (PDF), it states the following:

A minimum of 1000 doctoral level clinical hours in Dermatology will be required for the residency program.

Click to expand...

A real dermatology residency requires several fold more clinical hours more than this for each of the three years of residency. Moreover, there is a required one year of internship in an accredited PGY-1 program. This is mockery of medicine. Why aren't medical board enforcing their own laws that government the practice of medicine?

Can anyone contact the Florida Board of Medicine to determine if this program violated Florida statutes of practicing medicine without a medical license?
http://www.doh.state.fl.us/mqa/medical/index.html

medsRus said:

This is not funny anymore. This is a real threat to the practice of medicine and patient welfare. In reading the NP Derm residency presentation (PDF), it states the following:



A real dermatology residency requires several fold more clinical hours more than this for each of the three years of residency. Moreover, there is a required one year of internship in an accredited PGY-1 program. This is mockery of medicine. Why aren't medical board enforcing their own laws that government the practice of medicine?

Can anyone contact the Florida Board of Medicine to determine if this program violated Florida statutes of practicing medicine without a medical license?
http://www.doh.state.fl.us/mqa/medical/index.html

Click to expand...

Why isn't the AAD flipping out over this???

I seriously feel like I'm losing my mind there.

JaggerPlate said:

Why isn't the AAD flipping out over this???

I seriously feel like I'm losing my mind there.

Click to expand...

Bring it to their attention. They will look into it...

If they are allowed to specialize why would they go into primary care? If the reason for this is to increase PCP's then don't let them specialize!

They don't have to pass the derm specialty boards, not to mention the USMLE 1,2, and 3 ??? Are they just there for only the minor-est of ailments and there to make referrals? Maybe they're just people that stand in the place of a dermatologist, so that the patient feels like they're being taken care of right away as their appointments come around faster and then they refer to a real dermatologist if it gets really bad?

turquoiseblue said:

They don't have to pass the derm specialty boards, not to mention the USMLE 1,2, and 3 ??? Are they just there for only the minor-est of ailments and there to make referrals? Maybe they're just people that stand in the place of a dermatologist, so that the patient feels like they're being taken care of right away as their appointments come around faster and then they refer to a real dermatologist if it gets really bad?

Click to expand...

No ... they aren't going to act in any minor role, not in their mind's at least. They are dermatologists. They will do whatever the hell they want. You want to know what I think 99% of them will do:

Cosmetic Dermatology - Botox, Restaline, Dysport, Lasers, Peels, etc - by Dr Fakey McNurse, Board Certified Dermatologist.

The kicker is that technically, nothing will be inaccurate with that statement:

They are a Dr ... a DNP
They are BC in Dermatology through the American Academy of Doctorate in Nursing South Florida Derma-Nursing, Dermatology Society.

They aren't going to solve any 'problems' in dermatology. You aren't going to see wait times go down, they aren't going to start doing complex MOHS reconstructions, nor are they going to become experts in diagnosing skin cancer.

Southpaw said:

So their "residency" in Derm requires 1000 hours. So working a 10 hour day M-F it'll take them 20 weeks to complete their "residency". Nice, for the same pay as a physician too right? Sweet, so one could complete their entire formal education online, and then do 20 weeks of M-F 10 hour days, and expect to make the same as a physician who has trained for atleast 11 years?

Click to expand...

Sounds like a great deal to me.

They would know a lot more about dermatology than I do. It is kinda funny, finding nurses that know more about stuff in medicine that I do myself, but I guess that is just something one has to get used to.

There are few really acute diseases in derm, so as long as the nurses have the personality to ship the patient to hospital if they suspect steven johnson / lyell syndrome, then honestly, what's the big deal. Patient gets care, and maybe for less dough.

Integrity said:

Sounds like a great deal to me.

They would know a lot more about dermatology than I do. It is kinda funny, finding nurses that know more about stuff in medicine that I do myself, but I guess that is just something one has to get used to.

There are few really acute diseases in derm, so as long as the nurses have the personality to ship the patient to hospital if they suspect steven johnson / lyell syndrome, then honestly, what's the big deal. Patient gets care, and maybe for less dough.

Click to expand...

Big deal is that you're next.

You think any specialty of medicine is safe from these vultures?

Chairman Maobama pushes them on us, they push themselves on us: When are we going to stand together and push back?

JaggerPlate said:

No ... they aren't going to act in any minor role, not in their mind's at least. They are dermatologists. They will do whatever the hell they want. You want to know what I think 99% of them will do:

Cosmetic Dermatology - Botox, Restaline, Dysport, Lasers, Peels, etc - by Dr Fakey McNurse, Board Certified Dermatologist.

The kicker is that technically, nothing will be inaccurate with that statement:

They are a Dr ... a DNP
They are BC in Dermatology through the American Academy of Doctorate in Nursing South Florida Derma-Nursing, Dermatology Society.

They aren't going to solve any 'problems' in dermatology. You aren't going to see wait times go down, they aren't going to start doing complex MOHS reconstructions, nor are they going to become experts in diagnosing skin cancer.

Click to expand...

But Jagger, now that the nurses have the doctors jobs it will allow the doctors to serve in other roles such as taking blood, placing IVs, and giving baths (under the nurse's close supervision of course)

Finally something good coming from the NPs.

Didn't something similar happen in optometry, where optometrists can do certain eye surgeries like ophthalmologists in certain states? Ophthalmologists likely still get their same piece of pie.

Nurse Anesthetists also have built their niche, but Anesthesiologists still get paid well and find jobs easily.

I guess it won't be such a big deal overall as long as they're competent at what they do. Derm isn't a high risk field (I'm guessing).

The residencies are specifically for them--If they're not taking over our medical doctor residency spots and put us out of a job, and using their own money, i'm okay.

Some people can't afford standard of care, so they get whatever else exists to help them.

Hopefully these DNPs know their limits and when to refer to an actual medical doctor.

Maybe it will make medicine more fun--where we are referred more difficult cases bypassed by an NP.

FAIL.

Either you're an undercover nurse or...well, the alternative has many descriptions, most of which are SDN TOS.

turquoiseblue said:

Didn't something similar happen in optometry, where optometrists can do certain eye surgeries like ophthalmologists in certain states? Ophthalmologists likely still get their same piece of pie.

Nurse Anesthetists also have built their niche, but Anesthesiologists still get paid well and find jobs easily.

I guess it won't be such a big deal overall as long as they're competent at what they do. Derm isn't a high risk field (I'm guessing).

The residencies are specifically for them--If they're not taking over our medical doctor residency spots and put us out of a job, and using their own money, i'm okay.

Some people can't afford standard of care, so they get whatever else exists to help them.

Hopefully these DNPs know their limits and when to refer to an actual medical doctor.

Maybe it will make medicine more fun--where we are referred more difficult cases bypassed by an NP.

Click to expand...

turquoiseblue said:

Didn't something similar happen in optometry, where optometrists can do certain eye surgeries like ophthalmologists in certain states? Ophthalmologists likely still get their same piece of pie.

Nurse Anesthetists also have built their niche, but Anesthesiologists still get paid well and find jobs easily.

I guess it won't be such a big deal overall as long as they're competent at what they do. Derm isn't a high risk field (I'm guessing).

The residencies are specifically for them--If they're not taking over our medical doctor residency spots and put us out of a job, and using their own money, i'm okay.

Some people can't afford standard of care, so they get whatever else exists to help them.

Hopefully these DNPs know their limits and when to refer to an actual medical doctor.

Maybe it will make medicine more fun--where we are referred more difficult cases bypassed by an NP.

Click to expand...

No offense, but this is the type of *****-footing attitude that gets docs into problems in the first place.

Oh well they've invaded here ... and that worked out okay.

BTW - it hasn't. Look at the OD vs O-MD war rants on SDN in states that allow ODs to do surgery. Furthermore, look at ODs attitude towards O-MDs ... they want more, and you bet they're going to keep pushing. Check out a thread in Gas regarding CRNAs ... it's a bloodbath, and the role of an Anesthesiologist is going to be managing CRNAs in multiple surgery rooms - ie non-clinical - in the very near future.

It's not going to make medicine more fun, it's not going to cut costs, or alleviate stress, it's just people wanting a piece of the pie without doing any of the work. The problem is that in this case ... they are going to get it, and essentially everyone, but them, suffers.

It's pathetic that docs can't just squash this BS before it even makes a single news headline. We can't just adopt your attitude and make room when someone shoves ... it's probably the most dangerous precedent I can think of.

The new derm residencies prove this in spades. They pushed for PC under the guise that we needed help in PC. Got it ... OH well now were going to be dermatologists because of the money ... OH I mean, uhh we need more derms.

Anyone who thinks their field is isolated or wants to share on an equal level is, frankly, wrong.

Jihad said:

But Jagger, now that the nurses have the doctors jobs it will allow the doctors to serve in other roles such as taking blood, placing IVs, and giving baths (under the nurse's close supervision of course)

Click to expand...

Seriously! I did enjoy changing sheets a ton while volunteering in undergrad. It's nice to know I'll be able to get back to my roots, but this time with 200k floating over my head. Maybe I'll get to shadow a Dr-Nurse-Neurosurgeon while I'm there. Although he/she may be busy finishing up their 200 hour, 6 month residency ... so I don't want to be too bothersome.

JaggerPlate said:

No offense, but this is the type of *****-footing attitude that gets docs into problems in the first place.

Oh well they've invaded here ... and that worked out okay.

BTW - it hasn't. Look at the OD vs O-MD war rants on SDN in states that allow ODs to do surgery. Furthermore, look at ODs attitude towards O-MDs ... they want more, and you bet they're going to keep pushing. Check out a thread in Gas regarding CRNAs ... it's a bloodbath, and the role of an Anesthesiologist is going to be managing CRNAs in multiple surgery rooms - ie non-clinical - in the very near future.

It's not going to make medicine more fun, it's not going to cut costs, or alleviate stress, it's just people wanting a piece of the pie without doing any of the work. The problem is that in this case ... they are going to get it, and essentially everyone, but them, suffers.

It's pathetic that docs can't just squash this BS before it even makes a single news headline. We can't just adopt your attitude and make room when someone shoves ... it's probably the most dangerous precedent I can think of.

The new derm residencies prove this in spades. They pushed for PC under the guise that we needed help in PC. Got it ... OH well now were going to be dermatologists because of the money ... OH I mean, uhh we need more derms.

Anyone who thinks their field is isolated or wants to share on an equal level is, frankly, wrong.

Click to expand...

I didn't know it was that bad. Thanks for informing me!

and i never knew there was a fight between DO's and MD's. I've always thought of them as equivalent. They can get MD spots. I just wish MD's could get DO spots because I sure need to get into residency! Maybe they should combine all of them to make more spots for MD's too. I have nothing against DO's though...My first rotation in medschool in IM was with DO's and they were great!

Podiatry sure has its own niche though! They run their own clinics and do surgeries, with O.R. time to debride and cut feet!

So can someone tell me if there is anything we can do about it or should we just live with whatever comes our way?

filter07 said:

I don't think it's a stretch to train a few pseudo-docs to spot melanoma or sell wrinkle creams.

Click to expand...

I KNOW!!!!

I was just thinking the same thing myself.

Especially since DermPath Fellowship-trained Board Certified Dermatologists have a hard time calling some cases of melanoma gross and microscopically.

I guess they're just so un-smart.

Eta Carinae said:

I KNOW!!!!

I was just thinking the same thing myself.

Especially since DermPath Fellowship-trained Board Certified Dermatologists have a hard time calling some cases of melanoma gross and microscopically.

I guess they're just so un-smart.

Click to expand...

Seriously. Those DermPath docs are such partying slackers. Honestly, who CAN'T do their job.

And if there's anything nurses aren't it's un-smart.

BC-derms (MD)- who needs them?





PS: I never thought the day would come that I would have to affix the credentials, MD to a dermatologist for clarification.

turquoiseblue said:

I didn't know it was that bad. Thanks for informing me!

and i never knew there was a fight between DO's and MD's. I've always thought of them as equivalent. They can get MD spots. I just wish MD's could get DO spots because I sure need to get into residency! Maybe they should combine all of them to make more spots for MD's too. I have nothing against DO's though...My first rotation in medschool in IM was with DO's and they were great!

Podiatry sure has its own niche though! They run their own clinics and do surgeries, with O.R. time to debride and cut feet!

So can someone tell me if there is anything we can do about it or should we just live with whatever comes our way?

Click to expand...

DO vs MD ... what are you talking about??/

Are you messing with me?

Are you really a resident???

turquoiseblue said:

I didn't know it was that bad. Thanks for informing me!

and i never knew there was a fight between DO's and MD's. I've always thought of them as equivalent. They can get MD spots. I just wish MD's could get DO spots because I sure need to get into residency! Maybe they should combine all of them to make more spots for MD's too. I have nothing against DO's though...My first rotation in medschool in IM was with DO's and they were great!

Podiatry sure has its own niche though! They run their own clinics and do surgeries, with O.R. time to debride and cut feet!

So can someone tell me if there is anything we can do about it or should we just live with whatever comes our way?

Click to expand...

Reread Jaggers post you....

for oblas and other nurse practitioners, the struggle for autonomy goes beyond earning respect in the medical community. It includes parity in payments and insurer reimbursements.

Nurse practitioners say that insurance companies reimburse them 60 percent to 85 percent of what physicians receive for the same treatment typically.

"i am not doing anything different, anything different at all," she said. "but i am getting less."

still, there are signs the reimbursement gap is narrowing.

The asu health center, a nurse-managed clinic in downtown phoenix, is the first non-physician-staffed office in arizona to receive 100 percent reimbursement from an insurer, united healthcare, said bernadette melnyk, dean of the university's college of nursing and healthcare innovation.

"i think my feeling is, if we deliver the exact same service, then we should be reimbursed at the exact same rate," said melnyk, who is a licensed np.

Still, more important, nurse practitioners say, there are too many patients in need to be arguing about who is best able to serve them.

"people are so underserved in so many areas of our state," melnyk said. "there is no need for territorialism here.

"we all have a job to do, and that is to provide quality care."

Click to expand...

lol

i can just imagine the day 10-15 yrs later where future IM residents or FM residents have to present DNP at the outpt setting clinic on their pts.

you might as will kill me now if one i have to do that!

JaggerPlate said:

DO vs MD ... what are you talking about??/

Are you messing with me?

Are you really a resident???

Click to expand...

Not messing with you...lol...I generally like DO's. they seem pretty nice and they know what MD's know. I dont see the difference between a DO or an MD at all, except that DO's can do osteopathic manipulations and can go to a DO residency. There are even DO/MD residencies where they both do residency together, so what is the difference?

(Um well its scary because some people will be bred to think that NPs are real medical doctors, but people just need to remember and realize they don't go to the exact same residency as an MD or DO, so it is not the same thing)....i bet the person that developed that was having manic bipolar delusions, but what are we supposed to do now that it has come into play? it is dangerous to call them doctor as if they're a medical doctor because its not the same thing.

BTW I was a resident..trying to find residency again..I'm an MD but Im an IMG. I took all the USMLE's though. ;D