ARNP Vs. MD/DO

[AlfonsTheGuru]

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If you have:

• Doctor of Nursing Practice (DNP)
• Doctor of Nursing (ND)

Vs.

• MD
• DO

Both are technically doctors, yet they vary in titles of physicians/nurses. What else is different, clinically?

 

[banthapug]

Are you actually curious? Or are you trolling? I think it's the latter.

 

[AlfonsTheGuru]

Are you actually curious? Or are you trolling? I think it's the latter.

What are you talking about?

 

[banthapug]

I can't tell if you really don't know why DNP and ND are different from MD and DO, or if you purposely made a thread with a loaded question for attention. I am assuming you are just doing it for attention, since the difference among those degrees are very obvious.

What are you talking about?

 

[Germanicus89]

OP's post history, lol...

 

[IlDestriero]

Everything.

 

[Psai]

The only nurses that are doctors are the ones that went through medical school. You notice how America doesn't have to call itself the "democratic republic of the united states of america". That's why doctors don't have to call themselves "advanced". Generally, your worth is inversely proportional to the number of letters you put behind your name.

 

[AlfonsTheGuru]

The only nurses that are doctors are the ones that went through medical school. You notice how America doesn't have to call itself the "democratic republic of the united states of america". That's why doctors don't have to call themselves "advanced". Generally, your worth is inversely proportional to the number of letters you put behind your name.

You're saying you can have a doctorate's degree and not be a doctor?

 

[deleted407021]

Yeaaah, docs don't need all that silly biochemistry or genetics.

They just need feeeelings cuz everyone knows nurses are the only ones who care.

 

[AlfonsTheGuru]

SDN is something else tonight jesus christ

 

[AlfonsTheGuru]

I can't tell if you really don't know why DNP and ND are different from MD and DO, or if you purposely made a thread with a loaded question for attention. I am assuming you are just doing it for attention, since the difference among those degrees are very obvious.

I don't know the difference... clinically at least.

 

[kmp0410]

There is a huge difference in what they can do clinically. There is maybe less difference in some states and only in a few specialities (like primary care). But overall, a large difference currently.

Training is vastly different. Like not even remotely similar.

Yes they have a doctorate. But if the training is really worthy of that title...there's quite some debate. Even if it is a legitimate doctorate, it's a bit misleading in a healthcare situation. Primarily due to the lay use of the word Doctor in those settings. Lawyers have a doctorate but no one calls them Doctor. So it's primarily semantics, but there's probably something to the thought that it can be harmful in Heath care.

It's unfortunate it's becoming an us vs them situation because there's value in the idea of a nurse practitioner. Some of the medical training is probably unnecessary in a lot of situations...and cost being a considerations...it makes sense to delegate some tasks. But the nurse lobbying, explosion of questionable programs, and more autonomy has led to quite the backlash from physicians.

 

[Cyberdyne 101]

I don't know the difference... clinically at least.

They have threads about this in the allo forum. IIRC, at least one is on the 1st page.

 

[AlfonsTheGuru]

There is a huge difference in what they can do clinically. There is maybe less difference in some states and only in a few specialities (like primary care). But overall, a large difference currently.

Training is vastly different. Like not even remotely similar.

Yes they have a doctorate. But if the training is really worthy of that title...there's quite some debate. Even if it is a legitimate doctorate, it's a bit misleading in a healthcare situation. Primarily due to the lay use of the word Doctor in those settings. Lawyers have a doctorate but no one calls them Doctor. So it's primarily semantics, but there's probably something to the thought that it can be harmful in Heath care.

It's unfortunate it's becoming an us vs them situation because there's value in the idea of a nurse practitioner. Some of the medical training is probably unnecessary in a lot of situations...and cost being a considerations...it makes sense to delegate some tasks. But the nurse lobbying, explosion of questionable programs, and more autonomy has led to quite the backlash from physicians.

The first appropriate response to this thread. Thank you 🙂 I'm aware that in surgery their clinical abilities would be much different. Nurses assist, physicians lead. I'm just a little more confused in the aspect of internal medicine. I would assume a physician would always handle the more difficult cases and would usually oversee a nurse's more independent (maybe?), less high risk work.

 

[image187]

Politics definitely dictates what different practitioners can legally do in terms of scope of practice, but this is separate from the actual education that different clinicians get. In the end, it's all a matter of what you want out of your career. If you want to learn, understand, and practice medicine, then go to medical school.

 

[Instatewaiter]

This is an obviously troll thread.

Alfons the Guru created an account and padded his post count until he could come off as less of a troll. Please close this thread. Review his post history

 

[AlfonsTheGuru]

Politics definitely dictates what different practitioners can legally do in terms of scope of practice, but this is separate from the actual education that different clinicians get. In the end, it's all a matter of what you want out of your career. If you want to learn, understand, and practice medicine, then go to medical school.

That was my plan originally and it still is. Just curious.

 

[image187]

For the past couple years, I've noticed how many more of our Medicine and Peds consults have notes signed by NPs.

Frankly, as I near the end of residency, I think I'm getting more (not less) confused about the distinction between an MD vs NP among our non-surgical colleagues.

Nurse practitioning is still in its infancy. This will be clarified much like the rest of case law. This confusion will end when a wealthy politician's child dies as a result of substandard care without proper physician supervision.

 

[Psai]

For the past couple years, I've noticed how many more of our Medicine and Peds consults have notes signed by NPs.

Frankly, as I near the end of residency, I think I'm getting more (not less) confused about the distinction between an MD vs NP among our non-surgical colleagues.

It seems that most of the time, the np is being used like a resident where they review the chart, present to the attending and the assessment and plan is made by the attending. The np then writes the note. But I have seen a mid level see the patient by themselves and write the note without the attending coming in to see the patient. That was completely inappropriate.

 

[IlDestriero]

But I have seen a mid level see the patient by themselves and write the note without the attending coming in to see the patient. That was completely inappropriate.

You say that's inappropriate, but that's exactly what's happened out in the real world, and that's what they are pushing for at the local, state, and national level. That's what they are pushing hard for at the VA right now. And then they want equal pay. Equal pay for "equal" service. It doesn't matter that the Ferrari mechanic bills at $199 an hour and the local Honda mechanic bills at $69. They are mechanics and should be paid the same to fix engines. They're just managing Old Joe's diabeetus and high blood pressure. No difference in the treatment. That's why it's a problem. A big one. And it will change the way we practice and get paid in the next 10-20 years. It will all be rolled up into a comprehensive "common sense" reform and we will be worse off for it. Well, those who can't afford a better standard will be.

 

[Dohnut]

If you have:

• Doctor of Nursing Practice (DNP)
• Doctor of Nursing (ND)

Vs.

• MD
• DO

Both are technically doctors, yet they vary in titles of physicians/nurses. What else is different, clinically?

I've been a practicing pharmacist for close to a decade, and this is what my work experience tells me: No matter what degrees the providers have, NP's, RN's, etc, in general they plain SUCK in prescribing meds and in the most basic medication therapy management so bad that even an average 3rd year pharmacy student can probably do better. The prescriptions they write have the most problems and the drugs & directions are most questionable and not very roomy for doubt to get the benefit of it in liability lawsuits. I do not doubt their specific skills in actually technically physically treating the patients though.

Technicality and the real thing are quite different, to put it mildly. Doctor of Nursing? Gimme a break, it's like a technical school or community college handing out doctorates & getting doctorate tuition money to make their budge look better. Wait until errors made by the NP's pile up and their employers get in legal & subsequent financial troubles for the "doctorate" quality of care.

There isn't and won't be the slightest chance NP's can replace MD's, DO's, and even PA's while maintaining similar levels of patient outcome, period.

There's definitely some good NP's out there, but they're so rare and so far in between.

 

[Dohnut]

For the past couple years, I've noticed how many more of our Medicine and Peds consults have notes signed by NPs.

Frankly, as I near the end of residency, I think I'm getting more (not less) confused about the distinction between an MD vs NP among our non-surgical colleagues.

The distinction is HUUUGE from pharmacists' point of view.

Edit: Just saw post #16, so I'll take his/her word for it

 

[allantois]

DNP is the fakest doctorate degree that exists in academia. Where else could your write a thesis on some nonsense nursing political activism (true story) and get a doctorate for it?

 

[Psai]

I wonder if they may have a point. In an era of shotgun testing and easily-available cross sectional imaging, there's not much left of the "art" that once defined non-surgical medicine. Difficult or rare diagnoses quickly get shunted off to subspecialists. It seems like most of the time they really are just managing garden-variety conditions.

I'm all about protecting MD turf, but at this point I genuinely don't know that I see a difference in day-to-day practice anymore.

Who is making those diagnoses? If the midlevel has never heard of the disease, how will they know to think of it and send it to the right person? Medicine should always be practiced by medical doctors. Do you really think that it would be better to have 3 nps who don't know how to think vs 1 hospitalist managing your patients?

 

[Cyberdyne 101]

Who is making those diagnoses? If the midlevel has never heard of the disease, how will they know to think of it and send it to the right person? Medicine should always be practiced by medical doctors. Do you really think that it would be better to have 3 nps who don't know how to think vs 1 hospitalist managing your patients?

In your opinion, what role should midlevels have in the treatment of patients?

 

[AnatomyGrey12]

Just thought I would step in and clarify something, A DNP is the one that can practice clinically, like prescribe meds, see patients etc. they have a degree in NURSING PRACTICE. A ND is just a nurse who went on get a PH.D. in NURSING and usually teaches at a university nursing program. They DO NOT have different practice privileges from an every day nurse. They need a DNP to do all of that stuff. Just a little tidbit, carry on


PS. I will never see an NP unless it's something super simple like a sports physical, a wart, or something like that. Otherwise I always ask for the doc, it just makes me feel more secure in their prescription, diagnosis, etc.

 

[Psai]

Maybe it's just not that complicated anymore? HTN defines itself. Pneumonia appears in the Radiology reports. Rheumatologic lab abnormalities prompt a Rheum referral, as do endocrine labs, PFT results, EKG abnormalities, etc. Even a sharp hospitalist/internist who makes these diagnoses won't actually manage the conditions.

When we consult medicine, it's nearly universally for med management. If it's HTN or DM, they do it themselves. If it's any more complicated, they shotgun the testing and then get "input" with subspecialty referral(s).

I used to be very suspicious of NP involvement. But after years of it, I just haven't seen a difference. There are no "House" scenarios with complex, confusing presentations that a generalist works up in systematic manner. Just more tests, more consultants.

From a surgical subspecialty point of view, what I value is the speed of the consult, the willingness to handle non-surgical aspects of the case, and responsiveness to unexpected changes in clinical status (eg - not telling the nurses to call me for chest pain, because medicine was only consulted for HTN management). The NPs seem to do this fine, and their physician overlords seem more than happy to have them do it.

As with FP and anesthesia, this is the system that more and more internists are creating. If it's good enough for them, why shouldn't it be good enough for me?

HTN is more complicated than it seems. You can have people who have high blood pressure in clinic or in the hospital but have normal pressures at home. Or you can have masked hypertension where they are normal in your office but high at home which you can catch with ambulatory monitoring. It's not just well your bp is 141/90 so let's start you out on some zestril. But I'm sure you know about this. Pneumonia does not appear in radiology reports. They all say something like "bilateral basilar infiltrates, likely pulmonary edema, cannot rule out pneumonia clinical correlation required." If you're practicing based on reports rather than clinical experience, something is wrong. The internist does manage the condition, the specialist's role is to make recommendations. They should discuss the case with the specialist to determine the best course of treatment as well as the patient, not just allow for management by the specialist. Much of the time, they already know what the specialist is going to say, especially if it's bs, but they get the consult anyway to buff the charts.

More tests and more consultants are not a good thing. That's how you catch incidentalomas, maybe a benign tumor that looks bad on imaging but wouldn't have done any harm to the patient. And whenever you have a carpenter wielding a hammer, every problem looks like a nail to them. It's also more expensive.

I don't see midlevel encroachment as a good thing and it makes me sad that you don't seem to care about your colleagues or getting the best care for your patients. I've seen the difference between teams of residents under an attending vs teams of PAs under an attending. The patients on the pa service were much more poorly managed with the physician in charge overwhelmed by the amount of work they have to do in reading all the notes and seeing all the patients themselves.

 

[banthapug]

I don't know the difference... clinically at least.

Look at how they are trained. When nurses go to school for DNP they don't get clinical exposure - they get academic exposure. ARNPs get a few thousand hours of clinical exposure at most, where at the end of a given MD/DO residency they have something like 15,000 hours of making diagnosis and treating. Where NPs and PAs start as far as their clinical knowledge goes is so vastly different from where MD/DOs start from. Mid-level providers are extremely useful and valuable, but to think NPs can give the same care MD/DO can is just not true.

Also, just because they have a doctorate in something doesn't mean they should call themselves a doctor in a clinical setting. In healthcare, "doctor" means something very specific. The title comes with the knowledge and responsibilities that midlevel providers do not have. Are DNPs doctors? Yes they are. Are they medical doctors? They are not.

 

[AnatomyGrey12]

Nothing you wrote here is correct.

As someone with family members in this field I beg to differ. What did I say that isn't correct?

 

[AnatomyGrey12]

Nothing you wrote here is correct.

Actually I know that what I wrote is correct... I guess technically you could say that I didn't say that you just need and NP and not a DNP to have clinical privileges but this thread is about DNPs and NDs and my thread was 100% correct on those points.

And no I am not referring to a naturopathic Doctor...

 

[banthapug]

Just thought I would step in and clarify something, A DNP is the one that can practice clinically, like prescribe meds, see patients etc. they have a degree in NURSING PRACTICE. A ND is just a nurse who went on get a PH.D. in NURSING and usually teaches at a university nursing program. They DO NOT have different practice privileges from an every day nurse. They need a DNP to do all of that stuff. Just a little tidbit, carry on


PS. I will never see an NP unless it's something super simple like a sports physical, a wart, or something like that. Otherwise I always ask for the doc, it just makes me feel more secure in their prescription, diagnosis, etc.

Edit: I misread what you wrote. You are correct and I was just arguing for you. As you said - carry on!

 

[Psai]

Your points are well taken, but I feel like a lot of these discussions about how care "could be" worse with primarily NPs or PAs ends up being more theoretical than actually true. I can't recall a single instance where a mid-level missed something or screwed something up adversely affecting patient outcome. Not saying it doesn't happen, just saying in 5 years of residency I haven't had that come up.

But what I do get on a fairly regular basis is unpleasant residents telling me that they don't need to see that patient because they have "no active issues". As if I'm the one who is actually asking for the consult, not my attending. Or the busy hospitalist who can't see my patient for preop clearance until tomorrow, even though we have OR time available tonight.

In these respects, the mid-levels actually provide much better customer service to us. (And don't get me wrong, I'm as guilty of being an a** on call as everyone else, but here I'm just soeaking of my experiences from the other side of the phone.)

Really? I have a few stories already, about how a np changed a manic guy who has been stable on lithium for years to an atypical for no reason (most likely drug rep visit) and he came in floridly manic. This happened more than once. An np in the ED diagnosed a 60 year old male guy with 5/10 abdominal pain as kidney stones despite boring into back without cva tenderness, not colicky, no nausea/vomiting, previous history of aaa repair, no history of stones, no relevant family history and fecal occult blood positive. Didn't realize that something was wrong until they started seeing massive amounts of blood coming from the rear and then the radiologist looked back at the ct and saw that you could see the aortoenteric fistula. Vascular surgeons saved the guy so there was no "adverse patient outcome" but I'd say that the np messed up big time.

Don't tell me that you've never been rude to the other residents or that you've never dismissed a legitimate consult as "not surgical". Sorry that the hospitalist has other things to do that for some reason does not seem to revolve around the or schedule.

 

[banthapug]

You're confused about the difference between a degree and scope of pratice. Scope of practice is determined by state nursing boards, and is not automatically conferred by holding a degree.

A DNP is an ARNP, while not all ARNPs are DNPs.

ARNP is a catch-all term for NPs (masters-level and DNP), CRNAs, nurse midwives, and clinical nurse specialists (CNS). The training for each is radically different. Once licensed, and depending on their state, scope of practice is radically different.

ND refers to naturopathic doctors. You seem to think this is an acronym referring to those with a PhD in nursing. You are incorrect.

A PhD in nursing is an academic degree, usually obtained by nursing instructors or researchers. Holding a PhD in nursing has no bearing on scope of practice, as it is not a professional qualification or training program like a DNP or CRNA program.

I think you guys are saying the same thing... OP did distinguish ND as Doctor in Nursing, so OP wasn't asking about Naturopathic Doctor.

 

[AnatomyGrey12]

You're confused about the difference between a degree and scope of pratice. Scope of practice is determined by state nursing boards, and is not automatically conferred by holding a degree.

A DNP is an ARNP, while not all ARNPs are DNPs.

ARNP is a catch-all term for NPs (masters-level and DNP), CRNAs, nurse midwives, and clinical nurse specialists (CNS). The training for each is radically different. Once licensed, and depending on their state, scope of practice is radically different.

ND refers to naturopathic doctors. You seem to think this is an acronym referring to those with a PhD in nursing. You are incorrect.

A PhD in nursing is an academic degree, usually obtained by nursing instructors or researchers. Holding a PhD in nursing has no bearing on scope of practice, as it is not a professional qualification or training program like a DNP or CRNA program.

Ah yes I thought this is what you would say, you are correct. I condensed all of this info into a shorter message which didn't convey that I meant all of this. By ND I meant a doctorate of nursing which does exist but, you are right, it isn't really referred to as a ND. And yes state is a huge determinate in scope of practice, I was speaking in a large generality.

So in short, we are in agreement, carry on!

 

[Instatewaiter]

Your points are well taken, but I feel like a lot of these discussions about how care "could be" worse with primarily NPs or PAs ends up being more theoretical than actually true. I can't recall a single instance where a mid-level missed something or screwed something up adversely affecting patient outcome. Not saying it doesn't happen, just saying in 5 years of residency I haven't had that come up.

But what I do get on a fairly regular basis is unpleasant residents telling me that they don't need to see that patient because they have "no active issues". As if I'm the one who is actually asking for the consult, not my attending. Or the busy hospitalist who can't see my patient for preop clearance until tomorrow, even though we have OR time available tonight.

In these respects, the mid-levels actually provide much better customer service to us. (And don't get me wrong, I'm as guilty of being an a** on call as everyone else, but here I'm just soeaking of my experiences from the other side of the phone.)

This is not necesarily directed at you but:
The pre-op clearance is an algorithm that anyone with even half a brain should be able to follow. This isnt rocket science. Even a surgeon should be able to figure it out. Plus, if the surgery is urgent enough that you need to take them in the middle of the night, it skips the algorithm all together. If it isn't urgent enough, then why didn't you and your attending have a little foresight and courtesy to think about talking to a cardiologist/hospitalist before the middle of the night. I have yet to see a pre-op consult in the middle of the night that really needed to happen.

 

[Instatewaiter]

This is kind of what I'm talking about. I don't really care about your opinion on preop clearance, and yes I can do my own risk stratification. However, either (1) my attending wants it, (2) anesthesia requires it, or (3) the hospital requires it as a matter of policy.

The NPs get this, residents often don't.

You may not consider "surgical delay" a good reason to do this at night, but if you actually understood how ORs function (and how they generate revenue), you wouldn't argue with me. Again, this is something NPs tend to understand.

Your attending gets paid. Your NPs understand why we call these consults. Only the residents give us trouble. And that's why I prefer when a mid-level answers the page.

This is the crap I am talking about. You just want to tick a box. This isn't about what is best for the patient and forget about the answer. You don't even care about the answer. You just want to move on. In the middle of the night, consults are ONLY for emergencies, unstable patients or stuff you can't manage. A consult because your team wants to take somone first round for an elective surgery is not appropriate. During the day, we'll come by with a smile. At night. F you. Perhaps you can give me your cell phone number so I can wake you up at 3am the next night just to chat... Remember, many people who are on consults at night, are also expected to work the whole day the next day and your worthless consult just wastes our time. Now, if you have something you truly can't manage or the patient is unstable, you'll have me there with a smile at 3am.

Don't even get me started on anesthesia wanting pre-op clearance... I feel like they have a dartboard in their break room and just throw darts at their OR schedule to determine who they want pre-op risk stratification on.

 

[Psai]

So basically you just want someone else to sign a paper saying that you can do the operation and will spread the blame around if something goes wrong, without much concern for if the clearance is done properly or at all.

 

[ChrisNP87]

Really? I have a few stories already, about how a np changed a manic guy who has been stable on lithium for years to an atypical for no reason (most likely drug rep visit) and he came in floridly manic. This happened more than once. An np in the ED diagnosed a 60 year old male guy with 5/10 abdominal pain as kidney stones despite boring into back without cva tenderness, not colicky, no nausea/vomiting, previous history of aaa repair, no history of stones, no relevant family history and fecal occult blood positive. Didn't realize that something was wrong until they started seeing massive amounts of blood coming from the rear and then the radiologist looked back at the ct and saw that you could see the aortoenteric fistula. Vascular surgeons saved the guy so there was no "adverse patient outcome" but I'd say that the np messed up big time.

Don't tell me that you've never been rude to the other residents or that you've never dismissed a legitimate consult as "not surgical". Sorry that the hospitalist has other things to do that for some reason does not seem to revolve around the or schedule.

You really are something else!!! Constantly arguing with everyone who disagrees with you or who advocates and promotes nurse practitioners and physician assistants. How was it exactly the NP's fault if the radiologist missed the aortoenteric fistula on the CT scan, or could it have been that a resident radiologist missed it? Did the attending physician properly assess the patient themselves? You continuously demean and slander the nursing profession and don't ever cite your facts. NP malpractice insurance ranges from $1500-$1700/year. I'm quite sure that the AANP states that; "Malpractice rates remain low; only 2% have been named as primary defendant in a malpractice case" https://www.aanp.org/all-about-nps/np-fact-sheet So that means 98% of the primary defendants in malpractice cases are either physician's or PA's. (Do correct me if I'm wrong please)

You're assumptions, like for example, "how a np changed a manic guy who has been stable on lithium for years to an atypical for no reason (most likely drug rep visits)" make you look like a *****. There clearly was more to the story that you left out. Why did the NP change his med to an atypical? Atypical meds cause less extrapyramidal side effects compared to the older typical antipsychotic drugs. You never provide us with citations or factual common knowledge that would make us believe what you say is in fact the truth.

Every single post I've read on this forum thus far, that involves something about nursing, NP's, and DNP/PhD's I see you comment negatively and completely inaccurately. You have the audacity to act like you're some expert in nursing and that you know better than anyone else. I've also even seen some of your other cocky and arrogant comments to other physicians and fellows on this site, again acting like you know more than them attitude.

You must have some sort of underlying insecurity or a genuine sense of superiority and grandiosity. I can see you as one of those "I know it all" god complex annoying medical students that no one likes to have around them. The nursing staff, fellows, and attending physicians must loathe you. I've said it once and I'll say it again, you truly are a disgrace to the medical profession and I hope you get put in your place one day by your superiors. Stop the puerile nonsense and grow up, act like a true professional, then you'll earn the respect of others around you and maybe you won't have to go seeking approval all the time.

 

[Mad Jack]

It seems that most of the time, the np is being used like a resident where they review the chart, present to the attending and the assessment and plan is made by the attending. The np then writes the note. But I have seen a mid level see the patient by themselves and write the note without the attending coming in to see the patient. That was completely inappropriate.

Outside of academic medicine, that sort of thing is extremely common. I'm actually surprised you haven't seen it more often.

 

[Psai]

You really are something else!!! Constantly arguing with everyone who disagrees with you or who advocates and promotes nurse practitioners and physician assistants. How was it exactly the NP's fault if the radiologist missed the aortoenteric fistula on the CT scan, or could it have been that a resident radiologist missed it? Did the attending physician properly assess the patient themselves? You continuously demean and slander the nursing profession and don't ever cite your facts. NP malpractice insurance ranges from $1500-$1700/year. I'm quite sure that the AANP states that; "Malpractice rates remain low; only 2% have been named as primary defendant in a malpractice case" https://www.aanp.org/all-about-nps/np-fact-sheet So that means 98% of the primary defendants in malpractice cases are either physician's or PA's. (Do correct me if I'm wrong please)

You're assumptions, like for example, "how a np changed a manic guy who has been stable on lithium for years to an atypical for no reason (most likely drug rep visits)" make you look like a *****. There clearly was more to the story that you left out. Why did the NP change his med to an atypical? Atypical meds cause less extrapyramidal side effects compared to the older typical antipsychotic drugs. You never provide us with citations or factual common knowledge that would make us believe what you say is in fact the truth.

Every single post I've read on this forum thus far, that involves something about nursing, NP's, and DNP/PhD's I see you comment negatively and completely inaccurately. You have the audacity to act like you're some expert in nursing and that you know better than anyone else. I've also even seen some of your other cocky and arrogant comments to other physicians and fellows on this site, again acting like you know more than them attitude.

You must have some sort of underlying insecurity or a genuine sense of superiority and grandiosity. I can see you as one of those "I know it all" god complex annoying medical students that no one likes to have around them. The nursing staff, fellows, and attending physicians must loathe you. I've said it once and I'll say it again, you truly are a disgrace to the medical profession and I hope you get put in your place one day by your superiors. Stop the puerile nonsense and grow up, act like a true professional, then you'll earn the respect of others around you and maybe you won't have to go seeking approval all the time.

It's not the radiologists job to make a good differential diagnosis for the clinician.
The whole point of the midlevel is that the attending doesn't have to redo everything, otherwise there's no point in having them. There's a big difference between supervising and seeing the patient yourself.
That means 2% of nps were sued, has nothing to do with pas or physicians. This is likely due to the fact that the cost benefit ratio makes it less lucrative to target them.
Lithium is not a typical antipsychotic.
You are obsessed with citations. Expert opinion trumps bad research any day of the week. All nursing research is bad research. They don't understand basic scientific principles, don't know how to design studies, don't know how to conduct studies, draw conclusions that don't follow, write very poorly, etc. as has been amply demonstrated by your posts or should I say you're?

 

[caffeinemia]

wow, did this shizz get necro or what

 

[Mansamusa]

You really are something else!!! Constantly arguing with everyone who disagrees with you or who advocates and promotes nurse practitioners and physician assistants. How was it exactly the NP's fault if the radiologist missed the aortoenteric fistula on the CT scan, or could it have been that a resident radiologist missed it? Did the attending physician properly assess the patient themselves? You continuously demean and slander the nursing profession and don't ever cite your facts. NP malpractice insurance ranges from $1500-$1700/year. I'm quite sure that the AANP states that; "Malpractice rates remain low; only 2% have been named as primary defendant in a malpractice case" https://www.aanp.org/all-about-nps/np-fact-sheet So that means 98% of the primary defendants in malpractice cases are either physician's or PA's. (Do correct me if I'm wrong please)

You're assumptions, like for example, "how a np changed a manic guy who has been stable on lithium for years to an atypical for no reason (most likely drug rep visits)" make you look like a *****. There clearly was more to the story that you left out. Why did the NP change his med to an atypical? Atypical meds cause less extrapyramidal side effects compared to the older typical antipsychotic drugs. You never provide us with citations or factual common knowledge that would make us believe what you say is in fact the truth.

Every single post I've read on this forum thus far, that involves something about nursing, NP's, and DNP/PhD's I see you comment negatively and completely inaccurately. You have the audacity to act like you're some expert in nursing and that you know better than anyone else. I've also even seen some of your other cocky and arrogant comments to other physicians and fellows on this site, again acting like you know more than them attitude.

You must have some sort of underlying insecurity or a genuine sense of superiority and grandiosity. I can see you as one of those "I know it all" god complex annoying medical students that no one likes to have around them. The nursing staff, fellows, and attending physicians must loathe you. I've said it once and I'll say it again, you truly are a disgrace to the medical profession and I hope you get put in your place one day by your superiors. Stop the puerile nonsense and grow up, act like a true professional, then you'll earn the respect of others around you and maybe you won't have to go seeking approval all the time.

I know you know that NP malpractice insurance isn't low because NPs don't make as many mistakes as doctors. Why would having more knowledge and more training make physicians more likely to make mistakes? Malpractice insurance is low because malpractice lawyers aren't looking to protect patients; they want to make money. They aren't going to go after a NP of the pay out isn't going to be high. Plus MDs are involved in more high risk cases

 

[hopefulERdoc251]

As somebody who works with NP's in both the outpatient and inpatient fields, I would like to disagree with many of the viewpoints on this thread.

From the outpatient aspect, in a cardiology office, the NP's have free reign. They will manage CHF, HTN, HLD, palpitations, arrythmias ect routinely without physician supervision and they have had excellent outcomes. When they are deficient in knowledge and do not know where or how to proceed, they will consult the physicians. Similarly, in inaptient cardiology, per the physicians that work here, the NP's do act like residents in the sense that they write up the note, ect, and the physician follows up afterwards personally, but there is rarely a change made in the plan.

On the ER side of things, the NP's that work here sure have to have an attestation where the physician co-signs the chart, but NEVER does a physican walk in unless it is a complex patient such as CP, obscure abd pain with positive findings on a CT scan ect. This isn't only the ER at my hospital, but hospitals across the board including "top hospitals" such as Penn, Jeff, UMPC.

Also..."All nursing research is bad research. They don't understand basic scientific principles, don't know how to design studies, don't know how to conduct studies, draw conclusions that don't follow, write very poorly, etc. as has been amply demonstrated by your posts or should I say you're?" According to who's opinion is Nursing Research bad.......Good luck working with midlevels in your practice. You are making broad generalized claims that have literally zero factual support whatsoever.

http://rheumatology.oxfordjournals.org/content/33/3/283.short
http://jama.jamanetwork.com/article.aspx?articleid=192259
http://www.bmj.com/content/324/7341/819.short
http://search.proquest.com/openview/24277706fa09c024d2f2364dfb59775c/1?pq-origsite=gscholar


This is just a small bit of evidence supporting the claim that NP's are adequate practitioners and provide comprable care to physicians.

 

[Psai]

As somebody who works with NP's in both the outpatient and inpatient fields, I would like to disagree with many of the viewpoints on this thread.

From the outpatient aspect, in a cardiology office, the NP's have free reign. They will manage CHF, HTN, HLD, palpitations, arrythmias ect routinely without physician supervision and they have had excellent outcomes. When they are deficient in knowledge and do not know where or how to proceed, they will consult the physicians. Similarly, in inaptient cardiology, per the physicians that work here, the NP's do act like residents in the sense that they write up the note, ect, and the physician follows up afterwards personally, but there is rarely a change made in the plan.

On the ER side of things, the NP's that work here sure have to have an attestation where the physician co-signs the chart, but NEVER does a physican walk in unless it is a complex patient such as CP, obscure abd pain with positive findings on a CT scan ect. This isn't only the ER at my hospital, but hospitals across the board including "top hospitals" such as Penn, Jeff, UMPC.

Also..."All nursing research is bad research. They don't understand basic scientific principles, don't know how to design studies, don't know how to conduct studies, draw conclusions that don't follow, write very poorly, etc. as has been amply demonstrated by your posts or should I say you're?" According to who's opinion is Nursing Research bad.......Good luck working with midlevels in your practice. You are making broad generalized claims that have literally zero factual support whatsoever.

http://rheumatology.oxfordjournals.org/content/33/3/283.short
http://jama.jamanetwork.com/article.aspx?articleid=192259
http://www.bmj.com/content/324/7341/819.short
http://search.proquest.com/openview/24277706fa09c024d2f2364dfb59775c/1?pq-origsite=gscholar


This is just a small bit of evidence supporting the claim that NP's are adequate practitioners and provide comprable care to physicians.

You are doing a great job of proving my point, thanks

 

[7331poas]

Why are you here? If you are insecure about your self worth then complain to your co workers. Why try and argue the fact that nurses are as important it educated as doctors on a forum for doctors and students in training to be them?

Why are we reviving this thread? I don't see doctors or med students trying to waltz into nursing forums to compare clinical hours.

 

[LivMoore]

When I saw this old thread was bumped I knew who did it, just from following that other hilarious DNP vs MD thread.

 

[WedgeDawg]

Please be respectful and professional in your posts. Thank you.

 

[hopefulERdoc251]

You are doing a great job of proving my point, thanks

HTN is more complicated than it seems. You can have people who have high blood pressure in clinic or in the hospital but have normal pressures at home. Or you can have masked hypertension where they are normal in your office but high at home which you can catch with ambulatory monitoring. It's not just well your bp is 141/90 so let's start you out on some zestril. But I'm sure you know about this. Pneumonia does not appear in radiology reports. They all say something like "bilateral basilar infiltrates, likely pulmonary edema, cannot rule out pneumonia clinical correlation required." If you're practicing based on reports rather than clinical experience, something is wrong. The internist does manage the condition, the specialist's role is to make recommendations. They should discuss the case with the specialist to determine the best course of treatment as well as the patient, not just allow for management by the specialist. Much of the time, they already know what the specialist is going to say, especially if it's bs, but they get the consult anyway to buff the charts.
More tests and more consultants are not a good thing. That's how you catch incidentalomas, maybe a benign tumor that looks bad on imaging but wouldn't have done any harm to the patient. And whenever you have a carpenter wielding a hammer, every problem looks like a nail to them. It's also more expensive.
I don't see midlevel encroachment as a good thing and it makes me sad that you don't seem to care about your colleagues or getting the best care for your patients. I've seen the difference between teams of residents under an attending vs teams of PAs under an attending. The patients on the pa service were much more poorly managed with the physician in charge overwhelmed by the amount of work they have to do in reading all the notes and seeing all the patients themselves.

First of all, nobody practices medicine this way lol. I have never seen somebody see an x-ray report showing this, followed by a "hey i'll discharge you with a diagnosis of pulmonary edema and no antibiotics or anything else". I think I did an adequate job at disproving your point that NP's have worse outcomes compared to physicians. Just look at those studies. For your N=3 or whatever it is of NP's being bad providers, I can provide you with an N=3 that shows NP provided better care than a physician did, and in some instances, diagnosed things that the physician could not diagnose.

1. We had a guy come in with a "string" sensation in the back of his throat and the NP saw him in the ER b/c it was listed as a "Foregn body sensation". He complained of a voice change the past year and half as well. She did an x-ray soft tissue of his neck, found that his trach was deviated slightly and narrow. Proceeded to CT scan him, found what the radiologist found concerning for lymphoma. Enlarged lymph nodes pressed against his vocal cords causing the voice change. Later PAN scan showed mets to the brain, and they attributed the string sensation as a hallucination. All of the physicians in the ER said that they would not have done the X-ray and further testing and would've written it off as psych because he has an extensive psych history.

2. Instance 2, patient followed-up to the ER for some random complaint of chronic back pain, but had a huuuuuge lonstanding h/o SI with attempt. When reviewing the PMHx, the NP saw him in the office multiple times the past 3-4 years, adjusted his meds (no consult made to the attending per multiple notes), and he had not had SI/depressive episode for 2 years.

3. Another PA who worked in the children's ER had a kid who had 4 days of URI sx with a vague headache. Since it was atypical and just sounded bizarre, he went with his gut, CT'ed his head, which showed a pineal gland tumor. Later oncology note stated that this explained his headaches. The physician overseeing the CHER at that time said that they would've chalked the headache up to the URI. Hell my NP dermatologist diagnosed me with a condition that affects 1 in a million and all the MD/DO's reviewed the case at Grand Rounds agreed and gave her mad props for it because they wouldn't have thought twice about it being a simple folliculitis and would've thrown me antibiotics rather than going through with a a punch biopsy.

Point is, yes NP's and PA's will not have the same knowledge base as physicians do, which is why the burden of more complex patients falls to physicians. But at the same time to think that PA's and midlevels have no place in Medicine and think that they harm patient care is absolute nonsense and BS. The future is actually pointing to a larger prevalance of midlevels in practice, esp outpatient practice. Keeping that attitude will get you absolutely **** on during your career in medicine and will probably lend you to be one of the more hated physicians in the community.

 

[7331poas]

First of all, nobody practices medicine this way lol. I have never seen somebody see an x-ray report showing this, followed by a "hey i'll discharge you with a diagnosis of pulmonary edema and no antibiotics or anything else". I think I did an adequate job at disproving your point that NP's have worse outcomes compared to physicians. Just look at those studies. For your N=3 or whatever it is of NP's being bad providers, I can provide you with an N=3 that shows NP provided better care than a physician did, and in some instances, diagnosed things that the physician could not diagnose.

1. We had a guy come in with a "string" sensation in the back of his throat and the NP saw him in the ER b/c it was listed as a "Foregn body sensation". He complained of a voice change the past year and half as well. She did an x-ray soft tissue of his neck, found that his trach was deviated slightly and narrow. Proceeded to CT scan him, found what the radiologist found concerning for lymphoma. Enlarged lymph nodes pressed against his vocal cords causing the voice change. Later PAN scan showed mets to the brain, and they attributed the string sensation as a hallucination. All of the physicians in the ER said that they would not have done the X-ray and further testing and would've written it off as psych because he has an extensive psych history.

2. Instance 2, patient followed-up to the ER for some random complaint of chronic back pain, but had a huuuuuge lonstanding h/o SI with attempt. When reviewing the PMHx, the NP saw him in the office multiple times the past 3-4 years, adjusted his meds (no consult made to the attending per multiple notes), and he had not had SI/depressive episode for 2 years.

3. Another PA who worked in the children's ER had a kid who had 4 days of URI sx with a vague headache. Since it was atypical and just sounded bizarre, he went with his gut, CT'ed his head, which showed a pineal gland tumor. Later oncology note stated that this explained his headaches. The physician overseeing the CHER at that time said that they would've chalked the headache up to the URI. Hell my NP dermatologist diagnosed me with a condition that affects 1 in a million and all the MD/DO's reviewed the case at Grand Rounds agreed and gave her mad props for it because they wouldn't have thought twice about it being a simple folliculitis and would've thrown me antibiotics rather than going through with a a punch biopsy.

Point is, yes NP's and PA's will not have the same knowledge base as physicians do, which is why the burden of more complex patients falls to physicians. But at the same time to think that PA's and midlevels have no place in Medicine and think that they harm patient care is absolute nonsense and BS. The future is actually pointing to a larger prevalance of midlevels in practice, esp outpatient practice. Keeping that attitude will get you absolutely **** on during your career in medicine and will probably lend you to be one of the more hated physicians in the community.

Once again. Ok? What does this have to do with people attempting to enter medical school?

 

[hopefulERdoc251]

It doesn't. But I'm simply refuting the fact that other members here believe that NP's/PA's are the devil when it comes to providing adequate healthcare.