AMA resolution to preserve the title "Doctor" in medical setting

[Sundarban1]

As much as I treat any new proposal that seeks to limit other medical professions with skepticism, I think this one is well directed. If anyone is up on nursing issues (Dr. Nurse, pretty soon) I'd like to hear feedback.

http://www.ama-assn.org/ama1/pub/upload/mm/471/303.doc

Whereas, Certain specialty societies recognize that many allied health care professions have improved their educational standards and incorporated doctorate designations in their training programs; and

Whereas, Many nursing schools have re-titled their training program as a Residency and their students as Residents, despite the traditional attribution of these titles to medical doctors and their training programs; and

Whereas, The growing trend of this title encroachment is of concern because patients will be confused when the titles of Doctor, Resident and Residency are applied to non-physicians who hold non-medical doctorates or to non-physicians in training; therefore be it

RESOLVED, That our American Medical Association adopt that the title “Doctor,” in a medical setting, apply only to physicians licensed to practice medicine in all its branches, dentists and podiatrists (New HOD Policy); and be it further

RESOLVED, That our AMA adopt policy that the title “Resident” apply only to individuals enrolled in physician, dentist or podiatrist training programs (New HOD Policy); and be it further

RESOLVED, That our AMA adopt policy that the title “Residency” apply only to physician, dentist or podiatrist training programs (New HOD Policy); and be it further

RESOLVED, That our AMA serve to protect, through legislation, the titles “Doctor,” “Resident” and “Residency.” (Directive to Take Action)

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[184013]

Sundarban1, great link, thanks.
I've been following the DNP chronicles on this thread:
http://forums.studentdoctor.net/showthread.php?t=526477&page=2
I didn't know the AMA watches out for the dentist and pods out there.. cool.

 

[narkotiks]

As much as I treat any new proposal that seeks to limit other medical professions with skepticism, I think this one is well directed. If anyone is up on nursing issues (Dr. Nurse, pretty soon) I'd like to hear feedback.

http://www.ama-assn.org/ama1/pub/upload/mm/471/303.doc

i agree that the Dr. nurse thing, which it could soon become, is kind of silly. i am especially annoyed when i make a Dr. appointment, and am seen by a nurse practitioner who ends up running back and forth b/t me and the dr. to answer questions, get a script, etc. what happened to the dr/assistant relationship a nurse and a doctor once shared? ah, just kidding, they were replaced by PA's so the nurses make a power play. i almost forgot that everyone wants to play dr. they do good work (im still alive) but i would prefer to see a real doctor. (for the record, my opinion is that parity, in any other form besides fee discrimination [because i do agree that a pro should get paid for that which said pro is professional at, whether that pro has MD or DO or DPM after his/her name] is largely unimportant. let's get real, even if we could treat systemic DM [as opposed to path/manifestations of DM in the lower extremity] would you want to?) i love parenthesis...

 

[spo01]

This boggles my mind, nurses should never be called doctors in a hospital setting unless they went back to pod/DO/MD/dent school and completed a residency. Nurses are damn important no doubt, but this is a joke.

 

[cool_vkb]

I agree Dr.Nursing title is amusing and very misleading but the main issue to be addressed is why did we in first place allowed Nurses to become Nurse practioner or Nurse anesthetist who now are actively competing with Anesthesiologists in states where they can practice & bill on their own, or Physician assistants (states like michigan) are giving a tough time to family practioners by operating & running the entire practice on their own (99% rule).

I think the first step to regain the Doctor status, AMA should first address the issue of shortage of physicians in areas of need either by opening more medical colleges or increasing seats. The reality is that, MDs/DOs dont really hold much sway in these cases because as long as shortage continues, the CRNA, NP, PA lobby will always be strong because of their involvement in areas of shortage and they can get anything pass in their favor. because right now a good amount of public and govt favors them for their role in providing healthcare to people where MD/DO physicians dont want to go. So today it might be Doctor of nursing tomorrow it could be Surgeon Nurse .
If we have enough MDs who are going everywhere then we automatically will not be requiring the help of allied healthcare workers and the whole issue of titles, scope,etc will disappear.

But as of today,With the present support on their side, i woudnt be suprised if many more titles and surgery priviledges are about to come. Because one cannot deny the shortage that exists in some areas in USA when it comes to healthcare providers. We should produce more MDs/DOs inorder to prevent other allied healthcare workers gaining more priveledges.

FYI: even dental hygenists are growing tremendously with regards to their scope because of the shortage of dentists in rural areas.

 

[184013]

Cool_vkb, interesting point. I agree with you on the correlation between the shortage and the lobbying influence. Their innovation and enterprising attitude during a time where other ideas or options are not present could definitely change past traditions...

 

[IPODiatrist]

Cool_vkb, interesting point. I agree with you on the correlation between the shortage and the lobbying influence. Their innovation and enterprising attitude during a time where other ideas or options are not present could definitely change past traditions...

another point to consider is the fact that even if you increase the number of seats at schools, the amount of residency spots has remained relatively unchanged in recent years due to Medicare funding restrictions. in other words, whats the point of having more physicians and not enough residencies? another point to consider is that most docs DO NOT want to practice in the boonies where a large portion of ppl go underserved. thats where u have a real lack of doctors/care at. everyone is all about lifestyle now. the following was an article i found online, really interesting stuff, in particular the thread of conversation/comments that follows with all the diff. docs posting.

http://blogs.wsj.com/health/2008/05/12/doctor-shortage-is-coming-on-like-a-freight-train/

 

[cool_vkb]

another point to consider is the fact that even if you increase the number of seats at schools, the amount of residency spots has remained relatively unchanged in recent years due to Medicare funding restrictions. in other words, whats the point of having more physicians and not enough residencies? another point to consider is that most docs DO NOT want to practice in the boonies where a large portion of ppl go underserved. thats where u have a real lack of doctors/care at. everyone is all about lifestyle now. the following was an article i found online, really interesting stuff, in particular the thread of conversation/comments that follows with all the diff. docs posting.

http://blogs.wsj.com/health/2008/05/12/doctor-shortage-is-coming-on-like-a-freight-train/

There are tons of residency spots when it comes to MD residencies. There are so many that even after filling American grads there are still empty spots remaining which Foreign Medical grads fill and even after that there are some that still go unfilled (ofcourse iam talking abt Primary care residencies here).

And if ever there is shortage, we can say bye bye to Foreign medical grads (like how they did in UK) and give preference to our own american grads.

I agree with you on lifestyle and money. You are right though, its more about lifestyles and money more than anything else for many docs.

 

[Oculomotor]

The AMA can put whatever they want in their bylaws but hospitals ( most are private) are businesses and will do what is best to maintain economic efficiency.....So what are they going to do about:

Doctors of Optometry (OD's) (Eye doctors!) 4 yrs of school just like DPM's and DDS's Most OD's and DDS's do not do a residency. lol 98% of the small % of hospital OD's are in the VA anyway.

Psychologists (PhD and Psy D)

Doctors of Audiology (AuD)

Doctors of Physical Therapy (DPT)



The AMA has no control over private run hospitals or government run VA Hospitals----it can make recommendations........

Another attempt of monopolization or degrading of non-MD doctors by the AMA.

 

[jonwill]

While I agree that it is definitely deceiving in the hospital setting, in the end people can only do what they are licensed and trained to do. I do think this is getting quite ridiculous though. Doctor of nursing, I mean come on.

 

[farnsworth]

While I agree that it is definitely deceiving in the hospital setting, in the end people can only do what they are licensed and trained to do. I do think this is getting quite ridiculous though. Doctor of nursing, I mean come on.

Yeah, this is the kind of thing doctors need to get together on to oppose. This is pretty reprehensible (the overexpansion and opportunism of midlevels).

 

[aphistis]

The AMA can put whatever they want in their bylaws but hospitals ( most are private) are businesses and will do what is best to maintain economic efficiency.....So what are they going to do about:

Doctors of Optometry (OD's) (Eye doctors!) 4 yrs of school just like DPM's and DDS's Most OD's and DDS's do not do a residency. lol 98% of the small % of hospital OD's are in the VA anyway.

Psychologists (PhD and Psy D)

Doctors of Audiology (AuD)

Doctors of Physical Therapy (DPT)



The AMA has no control over private run hospitals or government run VA Hospitals----it can make recommendations........

Another attempt of monopolization or degrading of non-MD doctors by the AMA.

Actually, dentists are by far the largest group of "non-MD doctors" in America, so your argument is pretty leaky in that regard. If what you claim was true, the AMA would be trying for all it was worth to marginalize dentistry, when in reality the exact opposite is happening.

 

[foraminal]

nothing new here. MDs will do whatever to protect its turft. Been fighting over 100 years. DC vs MD, OD vs MD, DPM vs MD, PA vs MD and any monent now DPT vs MD.

 

[farnsworth]

nothing new here. MDs will do whatever to protect its turft. Been fighting over 100 years. DC vs MD, OD vs MD, DPM vs MD, PA vs MD and any monent now DPT vs MD.

You make it sound like it's a mistake to protect our "turf". Lives are at stake here pal. We take our "turf" very seriously.

 

[Oculomotor]

Anybody would agree that protecting your "own" turf is one thing and using patient safety as a "scapegoat" for protecting turf is another. The AMA said (25-30) years ago that optometrists would "blind and kill" their patients from using atropine and tropicamide to dilate. They also said that optometrists would kill their patients if they prescribed systemic medications such as antibiotics or antivirals. Now optometrists have prescription rights in 50 states and no one has EVER died as a result! LOL Protecting patient safety is noble and just. I will as a future eye care physician (optometrist) hold patient safety in high regard BUT trying to prevent doctoral trained professionals from practicing to the level of their education is nothing short of monopolization in a capitalistic economy, predatory practice, and unethical (scaring the public for selfish political reasons), all perpetrated by the AMA and its satellite branches. This is why podiatrists can surgically treat an ankle in one state but may not be able to in another, why optometrists can prescribe narcotics for ocular pain in 43 states but not in New York or Florida, why dentists (many years ago) had to consult with a physician to prescribe post-dental work antibiotics----they have no restrictions now. The AMA needs to pick and choose its battles wisely----->fighting with optometrists, podiatrists, medical psychologists, is futile and distracting them from the real problem----> midlevels such as Doctor of Nursing Practice, Physician Assistants, etc.....taking over Medical Primary Care!!!!!!!!! You watch in the next 10-15 years many people will have DNP's and PA's as their primary care provider. In many cases now they already are! In 13 states nurse practitioners are totally autonomous and can prescribe at will, CRNA's are moving closer and closer to autonomy creating a DANP--Doctor of Anesthesia Nursing Practice to convince legislatures, the PA profession has created a DHSPA---Doctor of Health Science in Physician Assisting--still in its infancy but give it time!!!!! lol These are the biggest threats to the AMA and physicians alike.

 

[farnsworth]

Anybody would agree that protecting your "own" turf is one thing and using patient safety as a "scapegoat" for protecting turf is another. The AMA said (25-30) years ago that optometrists would "blind and kill" their patients from using atropine and tropicamide to dilate. They also said that optometrists would kill their patients if they prescribed systemic medications such as antibiotics or antivirals. Now optometrists have prescription rights in 50 states and no one has EVER died as a result! LOL Protecting patient safety is noble and just. I will as a future eye care physician (optometrist) hold patient safety in high regard BUT trying to prevent doctoral trained professionals from practicing to the level of their education is nothing short of monopolization in a capitalistic economy, predatory practice, and unethical (scaring the public for selfish political reasons), all perpetrated by the AMA and its satellite branches. This is why podiatrists can surgically treat an ankle in one state but may not be able to in another, why optometrists can prescribe narcotics for ocular pain in 43 states but not in New York or Florida, why dentists (many years ago) had to consult with a physician to prescribe post-dental work antibiotics----they have no restrictions now. The AMA needs to pick and choose its battles wisely----->fighting with optometrists, podiatrists, medical psychologists, is futile and distracting them from the real problem----> midlevels such as Doctor of Nursing Practice, Physician Assistants, etc.....taking over Medical Primary Care!!!!!!!!! You watch in the next 10-15 years many people will have DNP's and PA's as their primary care provider. In many cases now they already are! In 13 states nurse practitioners are totally autonomous and can prescribe at will, CRNA's are moving closer and closer to autonomy creating a DANP--Doctor of Anesthesia Nursing Practice to convince legislatures, the PA profession has created a DHSPA---Doctor of Health Science in Physician Assisting--still in its infancy but give it time!!!!! lol These are the biggest threats to the AMA and physicians alike.

Yeah, I initially put "Lives and livelihoods are at stake...", but changed it because I thought since it applies to everyone involved (we all want to protect our profession, career, income), it detracts from the bottom-line: the gold standard provider is a physician. If someone wants to lower the bar to let other healthcare workers perform some of our duties, the burden's on them to prove that no one will get hurt.

I'll make you a deal - you stop pretending that MD's defending our turf is pure elitism and greed and I'll stop pretending MD's defending our turf is pure altruism.

Bottom line is still that patients shouldn't have to bear the risk associated with opening medical practice to lesser trained practitioners.

 

[Oculomotor]

Regarding the Eye Optometrists are not "lesser trained"

• We get 4 years of eye/systemic correlation training
• Ophthalmologists get 3 yrs of Eye training (including surgery)
• Optometrists are THE primary eye doctors in this country
• Ophthalmologists are the Eye Surgeons and Medical Eye Experts in this country

Dentists are the only ones that train to do what they do

• No medical counterpart

Podiatrists are not "lesser trained" regarding the foot and ankle

• No one gets as much training about the foot and ankle
• Only Foot and Ankle Orthopods can compete here

You have to understand that all of these non-MD doctors are specially trained in their limited scope to provide safe effective care like they have been for many decades.

MD's/DO's have their role, so do DDS's, OD's, DPM's, etc.... All of these clinicians are independent doctors in different fields....When are you EVER going to understand that?

 

[farnsworth]

Regarding the Eye Optometrists are not "lesser trained"

• We get 4 years of eye/systemic correlation training
• Ophthalmologists get 3 yrs of Eye training (including surgery)
• Optometrists are THE primary eye doctors in this country
• Ophthalmologists are the Eye Surgeons and Medical Eye Experts in this country

Dentists are the only ones that train to do what they do

• No medical counterpart

Podiatrists are not "lesser trained" regarding the foot and ankle

• No one gets as much training about the foot and ankle
• Only Foot and Ankle Orthopods can compete here

You have to understand that all of these non-MD doctors are specially trained in their limited scope to provide safe effective care like they have been for many decades.

MD's/DO's have their role, so do DDS's, OD's, DPM's, etc.... All of these clinicians are independent doctors in different fields....When are you EVER going to understand that?

No arguments. You're absolutely right.

Except we're talking about scope expansion here, not "being content with current limited scope". If you open up eye surgery to optometrists, if you open up knee surgery to podiatrists, if you open up medicine to DNP's and if you upen up ENT procedures to DDS's, what are the consequences? That's the question. What fallout is associated with expanded scope of practice for midlevels and other practitioners.

 

[Oculomotor]

Fair enough,

The major difference though is that unlike the DNP's and other midlevels, OD's--DDS's---PODS are not looking to treat systemic disease. These doctorate trained professionals treat their particular system and manifestation of disease in that system----again NOT systemic disease. The DNP's and other midlevels seeking expansion are going to start in primary care (systemic disease treatment). Nevertheless they are going to be treating systemic disease. The 13 states that have completely autonomous nurse practitioners allow them to treat systemic disease! Even with a 2-3 optometric surgery residency in the future----> these OD's would only be treating the eye in a limited fashion again NOT systemic disease! lol The dentists already have OMFS and I am only for an optometric model that mirrors that.

 

[DPMstudent]

so whats farnsworths opinion on DOs?

 

[farnsworth]

so whats farnsworths opinion on DOs?

Are we speaking in the third person now? You can ask me using the word "you" if you want. Unless you were asking someone else to comment on my opinion on DO's? But seriously, if you're curious about that, you'll have to be more specific in your question. I respect them as colleagues and equals?

 

[DPMstudent]

Are we speaking in the third person now? You can ask me using the word "you" if you want. Unless you were asking someone else to comment on my opinion on DO's? But seriously, if you're curious about that, you'll have to be more specific in your question. I respect them as colleagues and equals?

i guess i don't really care what you think, but yes if you'd like me to rephrase the question:
so farnsworth, what is your opinion on DO's? do they endanger the lives of their patients everyday?
its just funny that you never address DOs although at one time they were probably in the same position as say chiropractors, etc.

 

[farnsworth]

i guess i don't really care what you think, but yes if you'd like me to rephrase the question:
so farnsworth, what is your opinion on DO's? do they endanger the lives of their patients everyday?
its just funny that you never address DOs although at one time they were probably in the same position as say chiropractors, etc.

Obviously I'm not going to respond to a post like this.

 

[Coastie]

Glad to see the AMA banding together with other professionals to fight off the clamoring gold-lettered horde at the gate.

 

[184013]

Gents - I have been enjoying this topic and see it as a very important decision point in upcoming health care 'socialization' and agree that the economics of the NP will likely place the cart ahead of the pony...

I have been very impressed at the implementation of the PA. I think the NP is a great role developed by the ANA but I do not feel it is defined, limited, or enforced at a national level within the job, the education or implementation. Granted this is not a dig on NP's I have personally only had good things to say about them. But the collaboration of the ANA with other organizations and giving them a more uniform scope of work, a more defined curriculum (there is a HUGE variance within approved programs...) and feel it will place them at risk with future law suits by being extended past the initial intentions. On the other side of the coin the AMA might benefit from coordinating the use of NP's and DNP's actively as to assist in certain areas and avoid a role collision. These are my only personal views and hope to continue the discussion you have been conducting!

Please look below I have pasted links to the AMA's resolution 214 and 303 which is to define the use of doctor in the medical work place and also to help define the use of DNP and the nomenclature of 'resident and residency'. I have also included the links to the ANA's response on each of the AMA's resolutions.

I hope that the good of the patient is heavily weighed upon as with the court system it is so easy to redefine a scope or definition and ..... lead us down a path that will be hard to return from.

AMA resolution 303

ANA Response to AMA Resolution 303
Re:American Medical Association House of Delegates Resolution 303 (A-08)
Protection of the Titles “Doctor,” “Resident” and “Residency”

AMA resolution 214

ANA Response to AMA Resolution 214
Re: American Medical Association House of Delegates Resolution 214 (A-08)
“Doctor of Nursing Practice”

 

[cool_vkb]

No arguments. You're absolutely right.

Except we're talking about scope expansion here, not "being content with current limited scope". If you open up eye surgery to optometrists, if you open up knee surgery to podiatrists, if you open up medicine to DNP's and if you upen up ENT procedures to DDS's, what are the consequences? That's the question. What fallout is associated with expanded scope of practice for midlevels and other practitioners.

My sincere advise for you as memeber of AMSA or AMA, you should atleast stop the development of further new careers like respiratory therapists or radiology assistants or Physcians assistants encroaching on surgical priveledges. Coz i assure you, 15yrs down the road it will be debates on SDN regarding radiology assistants giving headon competition to radiologists. Whats gone is gone, save what can be saved.lol! The power is yours! The whole issue starts with advanced training. you cut the training so goes down the demand. but as long as people encourage more and more training frm surgeries to advanced stuff for DPMs,NPs, ODs, DDS, DPTs,etc and then expect them still working with their 40yrs old scope of practice. then thats honestly an innocent thought. The higher the training and broad scope training someone gets, the more demands arises from increase in scope. havent u heard the saying "give an inch to the camel, and he will take the tent".

 

[farnsworth]

My sincere advise for you as memeber of AMSA or AMA, you should atleast stop the development of further new careers like respiratory therapists or radiology assistants or Physcians assistants encroaching on surgical priveledges. Coz i assure you, 15yrs down the road it will be debates on SDN regarding radiology assistants giving headon competition to radiologists. Whats gone is gone, save what can be saved.lol! The power is yours! The whole issue starts with advanced training. you cut the training so goes down the demand. but as long as people encourage more and more training frm surgeries to advanced stuff for DPMs,NPs, ODs, DDS, DPTs,etc and then expect them still working with their 40yrs old scope of practice. then thats honestly an innocent thought. The higher the training and broad scope training someone gets, the more demands arises from increase in scope. havent u heard the saying "give an inch to the camel, and he will take the tent".

Yes, that's the idea.

 

[Coastie]

I love the ANA responses. They want to practice medicine and call it "advanced nursing", keeping themselves far away from the state boards of medicine.

Terrible for patients, this "advanced nursing" takes away from the already massive shortage of floor nurses, and contributes to bad medicine by producing "providers" who have minimal basic science knowledge combined with laughable clinical experiences. After some online courses and shadowing, they are unleashed to work independently on an unsuspecting public.

The worst part about all of this is that they do not realize their fault. There are a lot of students going on to nurse practitioner school who truly want to help patients, yet they are completely misguided if they think they provide any where near the same primary care as a board-certified family practice physician.

Can you imagine the outcry from the nursing boards if medical students/residents were allowed to prn for floor nurses and make $40/hr?

What's the lesson, boys and girls? If you want to practice medicine, go to medical school.

Gents - I have been enjoying this topic and see it as a very important decision point in upcoming health care 'socialization' and agree that the economics of the NP will likely place the cart ahead of the pony...

I have been very impressed at the implementation of the PA. I think the NP is a great role developed by the ANA but I do not feel it is defined, limited, or enforced at a national level within the job, the education or implementation. Granted this is not a dig on NP's I have personally only had good things to say about them. But the collaboration of the ANA with other organizations and giving them a more uniform scope of work, a more defined curriculum (there is a HUGE variance within approved programs...) and feel it will place them at risk with future law suits by being extended past the initial intentions. On the other side of the coin the AMA might benefit from coordinating the use of NP's and DNP's actively as to assist in certain areas and avoid a role collision. These are my only personal views and hope to continue the discussion you have been conducting!

Please look below I have pasted links to the AMA's resolution 214 and 303 which is to define the use of doctor in the medical work place and also to help define the use of DNP and the nomenclature of 'resident and residency'. I have also included the links to the ANA's response on each of the AMA's resolutions.

I hope that the good of the patient is heavily weighed upon as with the court system it is so easy to redefine a scope or definition and ..... lead us down a path that will be hard to return from.

AMA resolution 303

ANA Response to AMA Resolution 303
Re:American Medical Association House of Delegates Resolution 303 (A-08)
Protection of the Titles "Doctor," "Resident" and "Residency"

AMA resolution 214

ANA Response to AMA Resolution 214
Re: American Medical Association House of Delegates Resolution 214 (A-08)
"Doctor of Nursing Practice"

 

[narkotiks]

No arguments. You're absolutely right.

Except we're talking about scope expansion here, not "being content with current limited scope". If you open up eye surgery to optometrists, if you open up knee surgery to podiatrists, if you open up medicine to DNP's and if you upen up ENT procedures to DDS's, what are the consequences? That's the question. What fallout is associated with expanded scope of practice for midlevels and other practitioners.

...if you open up knee surgery to podiatrists...

that's a funny comment about the knee/DPM thing. (the foot is FAR MORE complex than the knee by the way). while i am not a proponent for DPM scope expansion to include the knee, your down play on DPM isn't working. whether or not you meant to phrase it the way you did, you are essentially saying that a podiatrist should be limited to the foot, inferring that a knee procedure would be far too complex for a DPM. thats hilarious!

 

[farnsworth]

...if you open up knee surgery to podiatrists...

that's a funny comment about the knee/DPM thing. (the foot is FAR MORE complex than the knee by the way). while i am not a proponent for DPM scope expansion to include the knee, your down play on DPM isn't working. whether or not you meant to phrase it the way you did, you are essentially saying that a podiatrist should be limited to the foot, inferring that a knee procedure would be far too complex for a DPM. thats hilarious!

No, I was just saying it's beyond podiatry training and should probably be left to the orthopedists. Just like brain surgery is beyond ortho training, etc. Didn't mean any offense, it was just an example of scope expansion.

 

[spo01]

...if you open up knee surgery to podiatrists...

that's a funny comment about the knee/DPM thing. (the foot is FAR MORE complex than the knee by the way). while i am not a proponent for DPM scope expansion to include the knee, your down play on DPM isn't working. whether or not you meant to phrase it the way you did, you are essentially saying that a podiatrist should be limited to the foot, inferring that a knee procedure would be far too complex for a DPM. thats hilarious!

I didn't gather that from his post, but I wholeheartedly agree that podiatrists should not touch the knee no matter how easy/difficult the surgery is.

I do have a question for Oculomotor though because I am fairly ignorant on the training/education of optometrists. I always considered 4 yrs of 'medical school' AND some type of residency as the most rigorous training for a doctor (I use that word very loosely). This then applies to MD/DO/most podiatrists/some DDS. And then pharmacists/most DDS/optometrists/DC etc as 'super specialized' (for lack of better word) from the start. As a podiatrist one of the first things I was told on my interview day was that I would be trained to be a physician first, a podiatrist second. Our knowledge of the whole body is quite extensive, and even though we are (as we should) be limited to the F&A we must be incredibly educated on the whole body and systemic illnesses. My question then is this, are you trained as a physician first and an optometrist second, and how extensive is your knowledge of the whole body in terms of systemic illnesses and rotations through a hospital (ex: medical surgery, internal medicine, etc)?

 

[narkotiks]

I didn't gather that from his post, but I wholeheartedly agree that podiatrists should not touch the knee no matter how easy/difficult the surgery is.

I do have a question for Oculomotor though because I am fairly ignorant on the training/education of optometrists. I always considered 4 yrs of 'medical school' AND some type of residency as the most rigorous training for a doctor (I use that word very loosely). This then applies to MD/DO/most podiatrists/some DDS. And then pharmacists/most DDS/optometrists/DC etc as 'super specialized' (for lack of better word) from the start. As a podiatrist one of the first things I was told on my interview day was that I would be trained to be a physician first, a podiatrist second. Our knowledge of the whole body is quite extensive, and even though we are (as we should) be limited to the F&A we must be incredibly educated on the whole body and systemic illnesses. My question then is this, are you trained as a physician first and an optometrist second, and how extensive is your knowledge of the whole body in terms of systemic illnesses and rotations through a hospital (ex: medical surgery, internal medicine, etc)?

good question. i was talking with an ER doctor recently about the topic of Dr. Nurse. he made a few interesting points. first, he commended all of the podiatry residence except for one that rotated through his ER. his opinion is that we are more functional out of school than the MD/DO interns. obviously those who are doing the ER rotation for their residency become more proficient, but that was, if nothing else, a very nice observation/compliment that made me think about our overall training, or the training we receive in terms of being a physician, then a podiatrist. i personally don't see it that way, but many do.
secondly, in regards to Dr. Nurse, his opinion is that NP's, etc, jump to diagnosis (with "lacking" differential Dx skills) due mostly to the breadth of their training, or lack thereof. that, in essence, is exactly what we are all trying to say...scope of practice is good, and a specialty is chosen so that a person can focus in on a skill set and become very proficient with those skills. specialties are great and very important. i think we all can agree that no one should be doing everything.

 

[narkotiks]

No, I was just saying it's beyond podiatry training and should probably be left to the orthopedists. Just like brain surgery is beyond ortho training, etc. Didn't mean any offense, it was just an example of scope expansion.

none taken. its just funny, and i can see where proponents for parity draw ideas. in general, a knee and an ankle/foot share a very similar complexity. if you work your way up the body, all sorts of justifications could be made and it becomes ridiculous! that is a problem with overlap and scope: everyone wants more, and no one wants less.

 

[narkotiks]

good question. i was talking with an ER doctor recently about the topic of Dr. Nurse. he made a few interesting points. first, he commended all of the podiatry residence except for one that rotated through his ER. his opinion is that we are more functional out of school than the MD/DO interns. obviously those who are doing the ER rotation for their residency become more proficient, but that was, if nothing else, a very nice observation/compliment that made me think about our overall training, or the training we receive in terms of being a physician, then a podiatrist. i personally don't see it that way, but many do.
secondly, in regards to Dr. Nurse, his opinion is that NP's, etc, jump to diagnosis (with "lacking" differential Dx skills) due mostly to the breadth of their training, or lack thereof. that, in essence, is exactly what we are all trying to say...scope of practice is good, and a specialty is chosen so that a person can focus in on a skill set and become very proficient with those skills. specialties are great and very important. i think we all can agree that no one should be doing everything.

ttt

 

[farnsworth]

good question. i was talking with an ER doctor recently about the topic of Dr. Nurse. he made a few interesting points. first, he commended all of the podiatry residence except for one that rotated through his ER. his opinion is that we are more functional out of school than the MD/DO interns. obviously those who are doing the ER rotation for their residency become more proficient, but that was, if nothing else, a very nice observation/compliment that made me think about our overall training, or the training we receive in terms of being a physician, then a podiatrist. i personally don't see it that way, but many do.

Did you say this in retaliation or something? If you're trying to start a MD/DPM pissing match, I refuse to participate.

 

[cool_vkb]

Why dont we move this thread to a neutral venue or student lounge section or someplace else where other professions can also participate actively and we get more input.

Whats the point of discussing something far related to Podiatry in a podiatry section and wasting a thread. We can get much more exposure and more input if we put in a place frequented by different professions.

 

[narkotiks]

Did you say this in retaliation or something? If you're trying to start a MD/DPM pissing match, I refuse to participate.

if i were to state that which i did in "retaliation" to something you stated, i would have included your quotation as to avoid any confusion. i was sharing a pro-podiatry conversation i was having with an MD in a podiatry friendly environment; in a forum dedicated to podiatric students. if you don't like this or can't handle an MD speaking nicely about his colleagues, you are invited to leave.
please don't flatter yourself by thinking I would ever want to piss on you.

(read my quote. it has two parts, an observation made by an MD about podiatrists, and a comment made by an MD about nurses. nothing more.)

 

[Dr 14220]

I know MDs and DOs are typically against increasing scope for NPs PAs, etc.....unless these providers help to increase profit, in which case they are a welcome addition.

How are DPMs typically viewed amongst MDs and DOs? are they seen as colleagues, or as yet another class of medical professionals with inferior trianing possessing the title of "doctor"?

I ask because this past semester in one of my cancer pathology lectures, an MD pathologist went out of his way to point out how frequently podiatrists misdiagnose acral lentiginous melanoma as a fungal infection. his disdain was pretty apparent. is this common?

Another concern I have is the scope of practice, which i understand is terrible in NY. If podiatrists are physicians.....shouldnt there be a universal scope of practice???

 

[MaseratiGT]

I know MDs and DOs are typically against increasing scope for NPs PAs, etc.....unless these providers help to increase profit, in which case they are a welcome addition.

How are DPMs typically viewed amongst MDs and DOs? are they seen as colleagues, or as yet another class of medical professionals with inferior trianing possessing the title of "doctor"?

I ask because this past semester in one of my cancer pathology lectures, an MD pathologist went out of his way to point out how frequently podiatrists misdiagnose acral lentiginous melanoma as a fungal infection. his disdain was pretty apparent. is this common?

Another concern I have is the scope of practice, which i understand is terrible in NY. If podiatrists are physicians.....shouldnt there be a universal scope of practice???

The American Podiatric Medical Association is working on creating universal scope for the entire country. It's called Vision 2015.

Podiatrists get a lot of referrals from M.D.'s and D.O.'s. As we become more well trained, other professionals notice. Some people, (like a very young pharmacy intern at my pharmacy), have no idea what a pod can do. There are both types of people out there. Some who don't know about our training and think of us as para-professionals, and some who are focused on the patient and want their foot/ankle ailments taken care of by the pros.

On the topic of the thread, I had a discussion with my mom about whether or not she would see a Doctor of Nursing. She is adamant about seeing a physician. If she were to go under for surgery, but a CRNA was putting her to sleep, she'd opt out.

 

[MaseratiGT]

We can all read, ad nauseam, on SDN about the effects of mid-levels on the current health system.

But, how many of you, especially the students on a budget, would be 100% comfortable with letting an independent NP or DNP work on you, if the law allowed for it? Say...in an E.R. and you knew the clinician was an NP? (I sometimes think that NP's give more individual attention to the patient).

I'm more than happy to see a NP or DNP for something minor, even in the E.R.. But if I have, for example, a derm. issue, I'm skipping the primary care and heading to the dermatologist.

 

[hyperpodia]

We can all read, ad nauseam, on SDN about the effects of mid-levels on the current health system.

But, how many of you, especially the students on a budget, would be 100% comfortable with letting an independent NP or DNP work on you, if the law allowed for it? Say...in an E.R.? (I sometimes think that NP's give more individual attention to the patient).

I'm more than happy to see a NP or DNP for something minor, even in the E.R.. But if I have, for example, a derm. issue, I'm skipping the primary care and heading to the dermatologist.

Many times patients don't know that their doctor is a nurse

 

[MaseratiGT]

Many times patients don't know that their doctor is a nurse

Yeah I know. That DNP degree is so sketchy.

Anyway...I edited my question to be a little less ambiguous.

 

[cool_vkb]

.

 

[Creflo]

for all who believe the ama is so genuinely concerned with the quality of care given by other degree holders, don't worry. just look at your local yellow pages under "attorneys" - there are plenty of them around to ensure that the quality of care given by non md's will be adequate.

 

[cool_vkb]

for all who believe the ama is so genuinely concerned with the quality of care given by other degree holders, don't worry. just look at your local yellow pages under "attorneys" - there are plenty of them around to ensure that the quality of care given by non md's will be adequate.

Absolutely true!

 

[aminoacid]

I know MDs and DOs are typically against increasing scope for NPs PAs, etc.....unless these providers help to increase profit, in which case they are a welcome addition.

How are DPMs typically viewed amongst MDs and DOs? are they seen as colleagues, or as yet another class of medical professionals with inferior trianing possessing the title of "doctor"?

I ask because this past semester in one of my cancer pathology lectures, an MD pathologist went out of his way to point out how frequently podiatrists misdiagnose acral lentiginous melanoma as a fungal infection. his disdain was pretty apparent. is this common?

Another concern I have is the scope of practice, which i understand is terrible in NY. If podiatrists are physicians.....shouldnt there be a universal scope of practice???

I would take the pathologist's comment with a grain of salt. Pathologists are considered "the doctor's doctor" because many docs misdaignose lesions (that's why they consult pathologists). I've worked with pod residents and they know their stuff. For the most part, most docs think of podiatrists as colleagues.