Did I go through all this to be replaced by a nurse?

[schutzhund]

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I was just reading the MD vs. DNP thread on the allopathic forum and did a little surfing about the DNPs on the internet.

I'm really concerned. Think about this:

1) The nurses have made incredible strives to push for a completely autonomous profession. The majority of states allow for clinics run essentially only by NPs. Now they're adding a clinical doctorate. They plan on competing with (or taking over) the primary care specialties.

http://nursingworld.org/ojin/topic28/tpc28ntr.htm

2) As much as everybody's worried about "all" the DO schools popping up and concerns of lesser quality, I read they are talking about >100 nursing schools offering the DNP by 2015. Think of the numbers!!! BTW, I read about some that already exist that are basically all online with a few meetings per year.

http://www.utmem.edu/nursing/academic programs/DNP/index.php
http://www.case.edu/news/2005/8-05/dnp.htm

3) When you really think about it, nursing runs healthcare in the US. It used to be the physicians but now it's nursing. Look around at your hospitals administration and management. Look at JCAHO.


Think I'm crazy. Look at how fast things have changed in the last 10 years. If you haven't been around that long and have "grown up" with the NPs, ask the older docs.

The only thing that comforts me is, as a friend of mine says, you can only fake it for so long. I think malpractice and poor outcomes will slow them down a lot when they starting biting off more than they can chew. There is a reason we go through all that we do, you can't shortcut it.

Does this concern you?
Does this make you avoid primary care?
Does it make you want to leave medicine?

Thoughts?

 

[homeboy]

I was just reading the MD vs. DNP thread on the allopathic forum and did a little surfing about the DNPs on the internet.

I'm really concerned. Think about this:

1) The nurses have made incredible strives to push for a completely autonomous profession. The majority of states allow for clinics run essentially only by NPs. Now they're adding a clinical doctorate. They plan on competing with (or taking over) the primary care specialties.

http://nursingworld.org/ojin/topic28/tpc28ntr.htm

2) As much as everybody's worried about "all" the DO schools popping up and concerns of lesser quality, I read they are talking about >100 nursing schools offering the DNP by 2015. Think of the numbers!!! BTW, I read about some that already exist that are basically all online with a few meetings per year.

http://www.utmem.edu/nursing/academic programs/DNP/index.php
http://www.case.edu/news/2005/8-05/dnp.htm

3) When you really think about it, nursing runs healthcare in the US. It used to be the physicians but now it's nursing. Look around at your hospitals administration and management. Look at JCAHO.


Think I'm crazy. Look at how fast things have changed in the last 10 years. If you haven't been around that long and have "grown up" with the NPs, ask the older docs.

The only thing that comforts me is, as a friend of mine says, you can only fake it for so long. I think malpractice and poor outcomes will slow them down a lot when they starting biting off more than they can chew. There is a reason we go through all that we do, you can't shortcut it.

Does this concern you?
Does this make you avoid primary care?
Does it make you want to leave medicine?

Thoughts?

Concerned, yes.
Make me avoid primary care, probably, but for more reasons than just this.
Leave medicine, absolutely not.

 

[allendo]

Concerned, yes.
Make me avoid primary care, probably, but for more reasons than just this.
Leave medicine, absolutely not.

My mom is a nurse and she will not see a NP except for minor things... checkups, sniffles... Her total care is still managed by a PCP. I hope the general public is not ignorant enough to place their health in the hands of someone who can get their degree on the internet. And I'm only saying that b/c my mother knows nurses who have gotten their NP on the net. The problem is that these guys have never been taught why we do this treatment or that treatment, they have only been taught when you see this give this. This can get ugly with seriously ill patients and the answer isn't plug and chug.

 

[FutureNavyDOc]

Something has got to change when PA's are allowed (at least in Iowa) to operate their own clinics completely autonomously.

Someone should remind them the reason they can get through school in only 2 years is the reason there is an A in ther name "Assistant," you are not physicians. If you want to be a physician and have the powers and priviledges associated therein, go to med school.

 

[Dr Trek 1]

There are constant debates on other boards about NPs/PAs vs. MDs/DOs. When it comes down to it, a physician is a physician and no doctorate in nursing can change that. I have nothing against mid-level practicioners, I just abide by the fact that their education is nowhere near the education of a MD/DO.


I have even heard of PAs who had a PhD in some other subject and are thus called, "Dr." Still doesn't make them a physician.

If nurses want to be doctors so badly, they should go to medical school. The fact that they don't, and just make a new DNP degree says something about their motivation.

 

[schutzhund]

There are constant debates on other boards about NPs/PAs vs. MDs/DOs. When it comes down to it, a physician is a physician and no doctorate in nursing can change that. I have nothing against mid-level practicioners, I just abide by the fact that their education is nowhere near the education of a MD/DO.


I have even heard of PAs who had a PhD in some other subject and are thus called, "Dr." Still doesn't make them a physician.

If nurses want to be doctors so badly, they should go to medical school. The fact that they don't, and just make a new DNP degree says something about their motivation.

While I agree with your basic premise, I have to disagree with a few points.

The nurses are not trying to be autonomous midlevels, they are trying to establish them as an equal provider with a terminal doctoral degree. Read their policy statements.

Think of the consequences when all 200 NP schools start pumping out classes of "doctor" nurses at a rate 3 times as fast a MDs or DOs in the next 10 years.

This movement is NOT paralleled with the PAs. Sure there are individual PAs who really wanted to be doctors and try to act like it, the PAs as a group are nothing like the nurses.

 

[Daddydoc]

Where is their applicant pool coming from? Isn't there a shortage of nurses already? If all these nurses start becoming providers who is going to wipe all of the butts?

Not me! Been there, done that. Not doing it again!

 

[Raven Feather]

To tell ya the truth, I do not see them being able to start up that many schools--the desire maybe there, but like another poster said there is a shortage of RNs. Where I am from, it is not because there isn't a good number of applicants, rather, a lack of nurses with PhDs to teach them. In fact, there are long waitlists of people wanting to get in nursing school because they can't expand the programs due to lack of educators.

It is up to the various states how autonomous they will allow NPs to work. I think there should always be a DO/MD present--it is that way in my current state. DNPs might be better than no primary care at all in rural and/or underserved areas though.

I think they need to figure out what is more important to them, how 'bout spending some money on educating RNs through scholarships to get their Phds to teach. Class sizes could then increase and so would the RN pool to staff the hospitals? One would think that would be their main goal. But instead it seems that they aspire to invade into the physician territory. Let med schools handle increasing class size/starting med schools to give primary care to the underserved.

 

[Zerosixjt]

I have no problem with nurses pursuing an nursing doctorate. There is a lot to be said for a highly qualified nurse. More education is never a bad thing when it comes to medical care. Should they be able to have autonomous clinics, at this point no, but by all means get the degree.

 

[It'sElectric]

I have no problem with nurses pursuing an nursing doctorate. There is a lot to be said for a highly qualified nurse. More education is never a bad thing when it comes to medical care. Should they be able to have autonomous clinics, at this point no, but by all means get the degree.

If you check out the supplied links on the allopathic board, you'd see the primary problem with this. It's not that people are upset that there is a doctorate of nursing available, it's the very limited number of requirements to achieve said doctorate that is so disconcerning.

Most doctorates in anything require a great deal more than what is being asked of the nursing doctorate.

 

[Red Beard]

A lot of people are saying things like "If so-and-so wants to go to be a doctor, then they should go to medical school," and "they're training can't possibly be as strong as an MD/DO."

No one is commenting on the central concern here: the real possibility that the window of opportunity for becoming a primary care MD/DO is closing much more rapidly than many had guessed it would. It could become next to impossible to find employmeny as a PCP or to run a successful private practice as a physician if the market is flooded with these other "qualified" practioners. Cheap labor and service almost always wins out--look at Walmart. Actually, Walmart will probably be a siginificant employer of these DNPs.

So, my response to the OPs questions:

Yes, I am concerned at my ability to handle my debt and enjoy a successful and meaningful* career in primary care;
No, it doesn't make me want to avoid primary care;
No, it doesn't make me want to leave medicine.

*For me, 'meaningful' is not doing boutique medicine for wealthy people.

Thoughts?

 

[beastmaster]

There are several reasons that I'm probably not going into primary care, and this just adds to it.

I'm not smart enough to know whether this is a good or a bad thing, but think about this. There are MANY BAD md/do primary care docs. I've had docs miss stuff on me. My grandfather's doctor missed CHF and sent him home with corticosteroids. So it's not fare to just rip on the nurses for missed and mis-diagnoses. We need some form of quality control.

 

[jonb12997]

I just think about the clinics that are completely understaffed where a single mom sits with her two kids for 2 hours just to get a 5 minute rushed visit with a burnt out peds resident... why would adding more mid level practitioners with the right supervision and the right government oversight be a bad thing?

 

[It'sElectric]

I just think about the clinics that are completely understaffed where a single mom sits with her two kids for 2 hours just to get a 5 minute rushed visit with a burnt out peds resident... why would adding more mid level practitioners with the right supervision and the right government oversight be a bad thing?

My understanding is that they would not be considering themselves mid-levels, nor would they be practicing under any sort of supervision (MD/DO). That's the difference.

 

[schutzhund]

I just think about the clinics that are completely understaffed where a single mom sits with her two kids for 2 hours just to get a 5 minute rushed visit with a burnt out peds resident... why would adding more mid level practitioners with the right supervision and the right government oversight be a bad thing?

Exactly. They do not want supervision. They want to be independent practitioners. They want the same title, the same pay, and the same privileges as us without the same education. The "doctorate" is just one more step, and perhaps the last, to finally saying that they are just like MDs or DOs. The "oversight" that they are required to have now in most states is a joke. What do think is going to happen when they are "doctors?" BTW, as the consummate wordsmiths they are, no physician can “supervise” a NP, they “collaborate” with them.

Also, in response to your statement above, I have heard many arguments supporting the role of the NPs, "they can help out a practice" "they are cheaper than doctors" or "they will work in rural areas or other places that doctors won't." This is BS. They use these arguments to convince people to accept them, but in reality they are greedy humans just like everybody else. What makes anyone think that the NPs are so philanthropic that they want to live in the middle of nowhere? They use this as an argument for their existence but as time goes on they wind up moving to the cities just like everyone else. Pay? Right now, they get played 85% (used to be 80%) what a physician does. There is a tremendous effort to increase this to 100%. They say that they're doing the same job and should get the same pay.

If you give an inch, they will take a mile. As a future physician and consumer of healthcare, you better take this seriously.

 

[ImNoSuperman]

I have nothing against nursing. While I finished my undergrad I was a nurse's assistant at a small-ish hospital and sympathize with a lot of the complaints coming from the nursing field. I've known NP's and PA's and have had friends go to PA and NP school. Hell, my wife considered her M.S. for PA. But an NP or PA praticing autonomously and wanting the same PAY?!?! Oh hell no!!! I did not bust my a$$ in undergrad and spend sleepless nights studying biochem, physics, immunology, etc. to get into medical school so that someone with only a shred of the education that I am about to undergo in a month (yay!) can demand to make what I will be making and to do the things I will do! Ach!!! I haven't personally read the requirements to get into a DNP program, or even an NP program for that matter, but judging from the requirements needed to obtain an RN, or even BSN, they have no business operating a clinic without supervision from a trained PROFESSIONAL. Go ahead and rip me up... I know you're out there. But when your family member, or even your own child becomes critically ill because of some DNP running a clinic w/ no doc, I want to be the first to say I TOLD YOU SO!

 

[homeboy]

As I posted in an another thread...My Dad's a PA, and he pretty much ran the ER in the small rural town I grew up in. He persuaded me not to go PA because he said it's frustrating doing 85-90% of the same thing as a primary care doc but getting paid 1/2 as much.
Not that money is the be-all and end-all, but I think that's an important psychological aspect, and it would be very frustrating. I think the same logic goes for FP, as it would be frustrating that a PA is doing much of the same stuff and--from a clinic's perspective--might be a better allocation of $ (ie. cheaper).

As it is now, PAs fucntion as FPs in a primary care setting, particularly in rural parts of the country, and it's a more efficient appropriation of health care dollars to hire 1 or 2 docs and some PAs than staff an ER or clinic full of FPs.
I can understand that as frustrating from the FPs point of view (other people encroaching upon their territory), but the PA profession is one solution in the cost problem of health care today. I wouldn't want to start out as a PA with so little experience under my belt (and I just recently had quite a bad experience with an inexperienced PA not taking the appropriate treatment plan for a family member), but it's hard to argue that a PA with 20 yrs clinical medicine under his/her belt is any less knowledgeable than an FP with 10 yrs simply because the FP had more formal education.

The problem comes when they lobby for more practice rights because they ARE doing so much of the same stuff, and along with practice rights comes a demand for higher income.

I think the 4-yr DNP program is ridiculous, as would be a 4-yr DPA program, especially--as some have suggested--that the standards are quite lower.

 

[flymusician]

Exactly. They do not want supervision. They want to be independent practitioners. They want the same title, the same pay, and the same privileges as us without the same education. The "doctorate" is just one more step, and perhaps the last, to finally saying that they are just like MDs or DOs. The "oversight" that they are required to have now in most states is a joke. What do think is going to happen when they are "doctors?" BTW, as the consummate wordsmiths they are, no physician can “supervise” a NP, they “collaborate” with them.

Thats strange. The place where I used to work (less than a year ago) the NP's were the ones who saw the patients, however they reported exactly what they were doing with Attendings on a weekly basis. No, they did not have to find an MD to write an order, however the MD's did give a final ok in terms of the longer term care plans for each individual patient. Maybe it varies from hospital to hospital. 😕

 

[mj1878]

Think of this as being similar to the "immigration crisis" that's been hotly contested of late.

Many red-blooded (and, frankly, red-NECKED) Americans are absolutely insensed at the idea of granting illegal Mexican immigrants citizenship because they are afraid that they will "overrun" the country, taxing the bureaucracy and swooping in to take over the jobs that good tax-paying Americans could have. (Did I mention that many of these members of the Greek Chorus do NOT, in fact, have a job; most are proud members of the "You can have my Welfare card when you pry it from my cold dead fingers, and the fingers of my 10 illegitimate children" club?)

Americans are absolutely INSENSED that their jobs are going to a bunch of lazy Mexicans that can't speak English (mind you, these are highschool dropouts shouting the invectives).

Now, given all that, ask each and every one of the insensed if they would take a similar blue-collar job (such as construction or being a maid in a hotel) for half of what they currently make at their own job, and they'd tell you to kiss their a$$. However, if there were no people WILLING to work those jobs for a ridiculously small(we're talking 4 dollars an hour here folks, or less) amount, we'd have no garbage collection, dirty hotel rooms, no clean plates at restaurants, no FOOD because there would be no one to pick it, no clothes because there'd be no one to pick the cotton, and on and on and on(YES, I know that this is infringing on hyperbole but let me get to the point).

Certainly no self-respecting AMERICAN is going to work for no benefits, less than minimum wage, and for 12+hours a day, every day for the rest of their lives. They CERTAINLY aren't going to work TWO of those jobs simultaneously, like many Mexicans do.

My point(applause) is that, while many of us can point the finger and decry the infamy that is the advanced practice of nursing and their "wish" for autonomy, I'm grateful for it. Here's why:

1)I certainly don't want to work in a rural area, but I understand that rural areas are just as deserving of great healthcare as downtown New-Yorkers, and I'm glad that they will be able to, through APRNs and PAs, have access to better care than they would have gotten otherwise. I'd be more happy if these small towns could open small urgent care facilities so that people didn't have to drive 50 miles to get to an ER.

2)I don't want to spend my entire life in the clinic. I need to be in the hospital, getting my hands dirty and living in the trenches.

3)Here's the reality: There's a national healthcare shortage that far, far upstages the amount of providers currently available, and in the next 20 years there will be so much business that the healthcare system will probably fracture and crumble under its current paradigm. It's hard to imagine a physician, sitting alone in an empty office day after day, lamenting the scourge that is advanced practice RNs. Take my word for it, you won't be complaining about the LACK of patients; quite the contrary, in fact. Don't worry, YOU'LL STILL MAKE MONEY OFF OF THE SICK AND INJURED.


In summary, STOP WHINING. You're lucky enough to live in the country with the BEST-TRAINED physicians on the planet, and you're luckier still to be able to pursue the dream of becoming a physician. Stop complaining about other people trying to improve their lives. They're not doing it with the intention of taking patients AWAY from you. They're doing the same thing everyone on this planet is doing: the best they can.

 

[emtji]

the public isn't ******ed. when i was a kid, i went in to the doctor's office and saw a PA for what was an ear infection. Mom was annoyed. Why pay a $10 copay to see a PA when a $10 copay gets you a doctor? People want to see a GI doc for their diarrhea, an orthopedic knee surgeon for their knee pain and an ENT for their boogers.

 

[PublicHealth]

People want to see a GI doc for their diarrhea, an orthopedic knee surgeon for their knee pain and an ENT for their boogers.

But those specialists don't want to see those patients! That's why they all typically have PAs and NPs working for them to handle front-line, primary care issues. Complex cases are referred to the specialist doc. It's a more efficient model and one that will come to dominate medicine, especially primary care medicine, in years to come.

 

[homeboy]

Think of this as being similar to the "immigration crisis" that's been hotly contested of late.


In summary, STOP WHINING. You're lucky enough to live in the country with the BEST-TRAINED physicians on the planet, and you're luckier still to be able to pursue the dream of becoming a physician. Stop complaining about other people trying to improve their lives. They're not doing it with the intention of taking patients AWAY from you. They're doing the same thing everyone on this planet is doing: the best they can.

As an incoming first year, maybe this is something you'll realize through your education: every profession has it's lobbying groups, and those lobbying groups are good at what they do. Most people understand the 'healthcare professional shortage' argument, but when PAs/NPs try to expand their priveleges, 99.9% of the time that necessitates an increase in pay, which more or less defeats the purpose of having mid-level providers.

I think PAs and NPs have a definate role in the ever increasing healthcare shortage, but if they had their way, they'd be getting paid the same, doing much of the same, and only having a fraction of the education.

The salaries are not based on what you do, they're based on your education: by expanding practice rights of PAs/NPs, this logic is bypassed, and you essentially have everyong providing the same level of care and getting paid the same.

That said, I still don't think FPs should corner the market on primary care: PAs have historically done a majority of the same work, and they've historically got paid according their education, not their skill level. But as skill level / experience increases, practice rights are argued for, and the income gap lessens--in respect to both PA and FP salaries...though the educational process is still very different. This is the source of frustration.

 

[esposo]

The problem with the above analysis is that if illegals were not available then companies would pay higher salaries and offer benefits because they would be forced to if they wanted to hire people. And then people would occupy those jobs like they did 20 years ago. The only reason illegals work those jobs is because they are forced to since most respectable positions will not hire non-U.S. citizens and many of them came from poverty. Do you really think they would be cleaning toliets and working lawns if they could work elsewhere?

The technology sector is a perfect example of this. The national economy and technology sector was booming because companies were forced to hiring talent because a demand for labor surged in the 90's. Companies were forced to hiring and compensating college graduates because labor was needed. With so many people being employed, the consumer market rose and demand for goods and services also rose. Everyone benefitted until companies started to downsize because they began to outsource and find cheap labor elsewhere. The IT market crashed and so did the national economy since many other markets were closely tied to the IT market.

Granting a nursing doctorate will hurt physicians. By doing this, you are increasing the supply of talent and making cheaper services available to consumers aka illegal immigrants. Why would I wait for 2 hours at my doctors office and pay a 20 dollar co-pay and health insurance when I can go uninsured and pay fee for service to see a PA at a minute clinic at Wal-Mart.

The problem with physicians is they have too many naive bleeding hearts like yourself who are not aggressive enough in protecting their own turf. Lawyers have successfully fought tort reform and other measures to limit rewards to their clients. The reason for that is they lobby aggressively and acquire politicians on their side to ensure their territory is protected. Dentists have also done an amazing job to protect their turf. Dental Assistants do not have the same priviledges and powers afforded to PA. You don't see Dental Assistant Doctorates. Even foreign dentists have to repeat two years of dental school before they can practice here unlike foreign physicians who can just pass some exams and start residency.

Wake up, you and other physicians have to be aggressive and protect your turf otherwise it won't exist.

 

[schutzhund]

Think of this as being similar to the "immigration crisis" that's been hotly contested of late.

Many red-blooded (and, frankly, red-NECKED) Americans are absolutely insensed at the idea of granting illegal Mexican immigrants citizenship because they are afraid that they will "overrun" the country, taxing the bureaucracy and swooping in to take over the jobs that good tax-paying Americans could have. (Did I mention that many of these members of the Greek Chorus do NOT, in fact, have a job; most are proud members of the "You can have my Welfare card when you pry it from my cold dead fingers, and the fingers of my 10 illegitimate children" club?)

Americans are absolutely INSENSED that their jobs are going to a bunch of lazy Mexicans that can't speak English (mind you, these are highschool dropouts shouting the invectives).

Now, given all that, ask each and every one of the insensed if they would take a similar blue-collar job (such as construction or being a maid in a hotel) for half of what they currently make at their own job, and they'd tell you to kiss their a$$. However, if there were no people WILLING to work those jobs for a ridiculously small(we're talking 4 dollars an hour here folks, or less) amount, we'd have no garbage collection, dirty hotel rooms, no clean plates at restaurants, no FOOD because there would be no one to pick it, no clothes because there'd be no one to pick the cotton, and on and on and on(YES, I know that this is infringing on hyperbole but let me get to the point).

Certainly no self-respecting AMERICAN is going to work for no benefits, less than minimum wage, and for 12+hours a day, every day for the rest of their lives. They CERTAINLY aren't going to work TWO of those jobs simultaneously, like many Mexicans do.

My point(applause) is that, while many of us can point the finger and decry the infamy that is the advanced practice of nursing and their "wish" for autonomy, I'm grateful for it. Here's why:

1)I certainly don't want to work in a rural area, but I understand that rural areas are just as deserving of great healthcare as downtown New-Yorkers, and I'm glad that they will be able to, through APRNs and PAs, have access to better care than they would have gotten otherwise. I'd be more happy if these small towns could open small urgent care facilities so that people didn't have to drive 50 miles to get to an ER.

2)I don't want to spend my entire life in the clinic. I need to be in the hospital, getting my hands dirty and living in the trenches.

3)Here's the reality: There's a national healthcare shortage that far, far upstages the amount of providers currently available, and in the next 20 years there will be so much business that the healthcare system will probably fracture and crumble under its current paradigm. It's hard to imagine a physician, sitting alone in an empty office day after day, lamenting the scourge that is advanced practice RNs. Take my word for it, you won't be complaining about the LACK of patients; quite the contrary, in fact. Don't worry, YOU'LL STILL MAKE MONEY OFF OF THE SICK AND INJURED.


In summary, STOP WHINING. You're lucky enough to live in the country with the BEST-TRAINED physicians on the planet, and you're luckier still to be able to pursue the dream of becoming a physician. Stop complaining about other people trying to improve their lives. They're not doing it with the intention of taking patients AWAY from you. They're doing the same thing everyone on this planet is doing: the best they can.

As moving as that was and as much as I appreciate being told to stop whining, I think your post would carry more weight once you finish or even start medical school.

A few points to consider:

1) The whole "serving the needy in rural areas" is garbage. It's a red herring political move to propagate their agenda. Why would NPs want to live anywhere different than anyone else?

2) Just because you don't want to work in the clinic doesn't mean anyone else doesn't. Don't fool yourself into thinking you're protected in the hospital. You do realize hospitals are starting to use NPs and PAs as hospitalists don't you?

3) Just because there is a healthcare shortage that does not justify lowering the standards of medicine.

They're not doing it with the intention of taking patients AWAY from you. They're doing the same thing everyone on this planet is doing: the best they can.

BS. This is exactly their intention. How could you even argue this? If they were "doing the best they can" and want to practice medicine they should go to medical school instead of legislating an agenda.


I think you're going to have quite a change of heart after a few years.

 

[Red Beard]

Another subject I'd like to bring up is the oft asserted claim that we are facing a major "healthcare shortage." This is a prediction from one or two sources, and predictions are just that--they can be wrong, and they have been wrong.

Yes, few physicians are choosing to train in primary care specialities, and fewer still choose to serve in rural clinics and hospitals. However, this doesn't neccessarily mean that PAs and NPs are going to choose these practice situations either--why would they? And I have a sneaking suspicion that there is and will continue to be no shortage of physicians, PAs and NPs in our larger towns and cities.

It possible that allowing full practice practice rights to NPs and PAs will do nothing to change the relative concentration of practioners in urban vs. rural settings. So, instead of a fix for this "healthcare shortage," we'll just get higher competition for jobs in urban settings and a stifled level of compensation overall.

 

[Red Beard]

1) The whole "serving the needy in rural areas" is garbage. It's a red herring political move to propagate their agenda. Why would NPs want to live anywhere different than anyone else?

You beat me to it.


On another note, I can think of one HUGE advatage to allowing DNPs full practice rights:

MD vs. DO threads might finally die out on SDN, to be replaced by MD/DO vs. DNP! j/k

 

[It'sElectric]

The problem with the above analysis is that if illegals were not available then companies would pay higher salaries and offer benefits because they would be forced to if they wanted to hire people. The technology sector is a perfect example of this. The national economy and technology sector was booming because companies were forced to hiring talent because a demand for labor surged in the 90's. Companies were forced to hiring and compensating college graduates because labor was needed. With so many people being employed, the consumer market rose and demand for goods and services also rose. Everyone benefitted until companies started to downsize because they began to outsource and find cheap labor elsewhere. The IT market crashed and so did the national economy since many other markets were closely tied to the IT market.

Granting a nursing doctorate will hurt physicians. By doing this, you are increasing the supply of talent and making cheaper services available to consumers aka illegal immigrants. Why would I wait for 2 hours at my doctors office and pay a 20 dollar co-pay and health insurance when I can go uninsured and pay fee for service to see a PA at a minute clinic at Wal-Mart.

The problem with physicians is they have too many naive bleeding hearts like yourself who are not aggressive enough in protecting their own turf. Lawyers have successfully fought tort reform and other measures to limit rewards to their clients. The reason for that is they lobby aggressively and acquire politicians on their side to ensure their territory is protected. Dentists have also done an amazing job to protect their turf. Dental Assistants do not have the same priviledges and powers afforded to PA. You don't see Dental Assistant Doctorates. Even foreign dentists have to repeat two years of dental school before they can practice here unlike foreign physicians who can just pass some exams and start residency.

Wake up, you and other physicians have to be aggressive and protect your turf otherwise it won't exist.

THANK YOU, esposo. Thank you for properly explaining the problem. MJ1878, I respect your opinion and analogy, but it is seriously, seriously flawed. Things aren't so straightforward as your argument presents. Esposo put it perfectly, and I think everyone should read and then re-read what he just wrote, because if physicians/lawyers/whoever don't speak up now, then his words will end up being eerily prophetic.

Some very vital and important points made by schutzhund and others as well. What's so different about NPs and DNPs that will drive them to want to work in rural areas. Answer: Nothing, because they won't want to either. They're no different than the majority of everyone else.

 

[schutzhund]

On another note, I can think of one HUGE advatage to allowing DNPs full practice rights:

MD vs. DO threads might finally die out on SDN, to be replaced by MD/DO vs. DNP! j/k

 

[esposo]

I don't want to be all doom and gloom. There will be a need for primary care physicians but their role in large metropolitan cities is dwindling. I already think there is no role for family practice physicians in large cities because patients will just see internists, pediatricicians or specialists. If one is willing to live in a city of under 100,000 people, there will still be many opportunities for primary care physicians but in large metropolitan cities, primary care physicians will be competing with too many entities like Wal-Mart, Urgent Care, Nurse Practioners and others.

Physicians should be scared and while we are in a noble profession, we need to adopt some very dirty tactics if we are to survive. Give money to your local politicians. Hire attorneys and form class action suits to prevent these nursing doctorate degrees from becoming formalized. Don't sit there and be laid back. Be aggressive like attorneys and dentists. Protect your turf because no one else will. This is just a turf war for nurses to become empowered like physicians and nothing else. They are not going to move to the boonies. They will live where everyone else wants to settle down; why wouldn't they?

 

[esposo]

But those specialists don't want to see those patients! That's why they all typically have PAs and NPs working for them to handle front-line, primary care issues. Complex cases are referred to the specialist doc. It's a more efficient model and one that will come to dominate medicine, especially primary care medicine, in years to come.

Oh please, most hirers of PA's and NP's are primary care physicians not specialists. These clever docs hire these mid-levels to see a higher volume of patients and thus earn more money. It has nothing to do with it being a more "efficient model." These primary care physicians see the same problems their PA's see. Most patients have no clue they are seeing a PA because many of these PA's only wear a white coat and the patient can't tell the difference. PA's have been cheap labor and have enabled physicians to earn a lot of money. However, now, these PA's want to see patients autonomously and basically escape their limiting factor.

 

[the1doc]

I like to compare this to the "Bud Light" v. "More Expensive Beer" debate. On one hand, we have Bud Light, which offers a crisp, clean, refreshing taste, and manages to do so on at a price that even the poorest of medical students can afford on occasion. On the other hand, we have the more expensive beers, such as Heineken, Corona, or any of the various MicroBrews. These beers offer fullness of flavor, variety (aka the spice of life), and culture. However, they can not really satisfy a person's thirst for beer if he/she has less than $4.99 in his/her bank account, which has happened to many of us on more than one occasion.

There are many individuals in this world who look down upon Bud Light. These people, usually constituting the upper echelons of society, call Bud Light drinkers "Red Necks" and make frequent derogatory remarks about the "vermin who make Bud Light their favorite among Beers." These cultured, yet arrogant individuals much prefer a nice warm (or occasionally cold) import. These arrogant pricks have never had to go through severe financial difficulty, which often necessitates the use of cans of Bud Light for both gustatory pleasure and as a method of storing live bait while fishing on the lake. How dare they call us "Red Necks" for that! Some of us aren't even red!

This is very similar to the debate about illegal immigrants in the U.S. In fact, when I think about illegal immigrants in the U.S, I automatically think "Bud Light v. Expensive Beers." What it has to do with the DO/MD v. Nurses debate - I have no idea. That is my point. Applause.

 

[AngryBaby]

I like to compare this to the "Bud Light" v. "More Expensive Beer" debate. On one hand, we have Bud Light, which offers a crisp, clean, refreshing taste, and manages to do so on at a price that even the poorest of medical students can afford on occasion. On the other hand, we have the more expensive beers, such as Heineken, Corona, or any of the various MicroBrews. These beers offer fullness of flavor, variety (aka the spice of life), and culture. However, they can not really satisfy a person's thirst for beer if he/she has less than $4.99 in his/her bank account, which has happened to many of us on more than one occasion.

There are many individuals in this world who look down upon Bud Light. These people, usually constituting the upper echelons of society, call Bud Light drinkers "Red Necks" and make frequent derogatory remarks about the "vermin who make Bud Light their favorite among Beers." These cultured, yet arrogant individuals much prefer a nice warm (or occasionally cold) import. These arrogant pricks have never had to go through severe financial difficulty, which often necessitates the use of cans of Bud Light for both gustatory pleasure and as a method of storing live bait while fishing on the lake. How dare they call us "Red Necks" for that! Some of us aren't even red!

This is very similar to the debate about illegal immigrants in the U.S. In fact, when I think about illegal immigrants in the U.S, I automatically think "Bud Light v. Expensive Beers." What it has to do with the DO/MD v. Nurses debate - I have no idea. That is my point. Applause.

I thoroughly enjoyed your thoughtful and enlightening post. However I must mention that Miller Light has both fewer calories and carbs than Bud Light, yet maintains a more "traditional" hoppy, beer flavor as opposed to the filtered water they bottle under the "Bud Light" label at the Anheuser-Busch breweries. You call the snotty, import beer drinkers "arrogant pricks". That is frequently true, however I would simply call the proud Bud Light drinker fat and gustatorily challenged.

 

[It'sElectric]

Mmmmmm....that post just made me really thirsty. On a related note, if you're into some of the better microwbrews, try Bell's Oberon (Summer Seasonal) or pretty much any Great Lakes brew.

 

[MacGyver]

Wow i'm impressed guys....looks like after all these years I've finally gotten thru to you.

Whoever brought up the dental vs medical comparison was spot on. Do you see dental assistants lobbying to start their own dental clinics? Do you see dental assistants getting virtually the same script rights as dentists? Do you see any autonomous midlevels in their field? Hell no. Dentists have a monopoly on the practice of dentistry, and rightfully so. Average dentist now makes more money than the average primary care physician, according to US Labor Department. Dentists have at least 3 years fewer training than primary care docs.

Doctors lost our monopoly status a long time ago because we were too busy singing cumbayah with the people who are now stabbing us in the back (namely NPs) and trying to take more and more turf from us.

If we dont reverse this situation soon, then whats going to happen is that the medical school educational system is going to be tiered just like law schools. Harvard Medical grads will have their pick of any job/residency they want, and hte lower tier school grads will be left to fight for slim pickings with the NPs. Right now a graduate of any med school in the country has a decent shot at a neurosurgery residency. In the future, only the top grads from the top 5 or 10 med schools will have that luxury.

As for DNPs, consider that after they get these programs rolling, the next thing they will want to do is create their own residency slots for specialty training. You think they just want primary care? Think again. They want the whole damn thing. You will start seeing ENT residency programs for DNPs.

All you DO students who think they will escape this mess by picking surgery instead of primary care, think again. You'd better wake up, because the DNPs will start coming after your field next.

This isnt just about primary care, its about the whole damn healthcare industry.

 

[AngryBaby]

Wow i'm impressed guys....looks like after all these years I've finally gotten thru to you.

Whoever brought up the dental vs medical comparison was spot on. Do you see dental assistants lobbying to start their own dental clinics? Do you see dental assistants getting virtually the same script rights as dentists? Do you see any autonomous midlevels in their field? Hell no. Dentists have a monopoly on the practice of dentistry, and rightfully so. Average dentist now makes more money than the average primary care physician, according to US Labor Department. Dentists have at least 3 years fewer training than primary care docs.

Doctors lost our monopoly status a long time ago because we were too busy singing cumbayah with the people who are now stabbing us in the back (namely NPs) and trying to take more and more turf from us.

If we dont reverse this situation soon, then whats going to happen is that the medical school educational system is going to be tiered just like law schools. Harvard Medical grads will have their pick of any job/residency they want, and hte lower tier school grads will be left to fight for slim pickings with the NPs. Right now a graduate of any med school in the country has a decent shot at a neurosurgery residency. In the future, only the top grads from the top 5 or 10 med schools will have that luxury.

As for DNPs, consider that after they get these programs rolling, the next thing they will want to do is create their own residency slots for specialty training. You think they just want primary care? Think again. They want the whole damn thing. You will start seeing ENT residency programs for DNPs.

All you DO students who think they will escape this mess by picking surgery instead of primary care, think again. You'd better wake up, because the DNPs will start coming after your field next.

This isnt just about primary care, its about the whole damn healthcare industry.

Dude...have a beer. 😀

 

[It'sElectric]

We should all have a beer, but the dude is right. It really is frightening, and I pray that the AMA, AOA, and everyone else start doing something about it.

 

[AngryBaby]

We should all have a beer, but the dude is right. It really is frightening, and I pray that the AMA, AOA, and everyone else start doing something about it.

We'll see. This topic has been discussed pretty extensively on the Allo- board and their are quite a few hurdles they've still got to overcome before this becomes a serious infringement on MD/DO territory. The issue is a little disconcerting, but the idea of DNP's doing more than rudimentary primary care and having physicians pushed out of all sorts of specialties is pretty far fetched, I think.

 

[Taurus]

Wow i'm impressed guys....looks like after all these years I've finally gotten thru to you.

Whoever brought up the dental vs medical comparison was spot on. Do you see dental assistants lobbying to start their own dental clinics? Do you see dental assistants getting virtually the same script rights as dentists? Do you see any autonomous midlevels in their field? Hell no. Dentists have a monopoly on the practice of dentistry, and rightfully so. Average dentist now makes more money than the average primary care physician, according to US Labor Department. Dentists have at least 3 years fewer training than primary care docs.

Doctors lost our monopoly status a long time ago because we were too busy singing cumbayah with the people who are now stabbing us in the back (namely NPs) and trying to take more and more turf from us.

If we dont reverse this situation soon, then whats going to happen is that the medical school educational system is going to be tiered just like law schools. Harvard Medical grads will have their pick of any job/residency they want, and hte lower tier school grads will be left to fight for slim pickings with the NPs. Right now a graduate of any med school in the country has a decent shot at a neurosurgery residency. In the future, only the top grads from the top 5 or 10 med schools will have that luxury.

As for DNPs, consider that after they get these programs rolling, the next thing they will want to do is create their own residency slots for specialty training. You think they just want primary care? Think again. They want the whole damn thing. You will start seeing ENT residency programs for DNPs.

All you DO students who think they will escape this mess by picking surgery instead of primary care, think again. You'd better wake up, because the DNPs will start coming after your field next.

This isnt just about primary care, its about the whole damn healthcare industry.

At times, I think MacGyver goes overboard with his doom and gloom predictions, but I agree with him on this topic that physicians need to be worried about this. It is highly unlikely that allo or osteo residencies would permit DNP's to enter, but why can't the nurses create their own residencies? The current DNP curriculum includes a year of residency, but in the future they could break it out and make it into a full blown residency. If they do that, it doesn't make much sense because isn't that what medical school is for then? But there are lots of things in healthcare that don't make sense unless you look at it from the political angle.

Once DNP's start to hit the wards, they will lobby and demand from their hospitals equal privileges with physicians and it will be hard to argue against them. An important purpose of creating the DNP was to knock down some of the barriers that kept NP's out before. Whereas NP's were Master's degrees, now they can proclaim that they have doctorate degrees and they even went through their own version of residency. DNP's were intentially designed to blur the line between practicing medicine and nursing.

Since DNP's are under the jurisdiction of state nursing boards, medical organizations will have no control over what areas they can practice. I will use dermatology as an example of a field that has "low hanging" work such as treating acne or injecting botox that can be learned with little training. Physicians enjoy dermatology because of the high pay and lifestyle. Medical organizations tightly control how many specialists can enter a particular field by limiting residency slots. If there were too many physician dermatologists, then the pay would go down for everyone. For the same reasons as physicians, DNP's will no doubt also be attracted to this field. If the nursing groups do not tightly control who can do dermatology and if there is a large influx of DNP's into dermatology, then it will drive down the salaries for everyone. If we assume the reimbursements don't change, the pie (number of patients) is still the same size, but now you have more hungry mouths to feed (providers) and therefore everyone gets a smaller slice. What's to stop many of the DNP's from the first graduating class from specializing in dermatology? Nothing. DNP's don't have to be licensed in dermatology and they are not under the control of state medical boards. Other low hanging work I can think of is routine health maintenance, treating coughs and sniffles, annual physical exams, etc. Basically, the bread and butter of primary care.

Here is my response to posters who say that there is more than enough work for everyone, especially in primary care. I would agree with that. Physicians, DNP's, NP's, and PA's won't be starving. However, because there is a large increase in the number of providers who can do the same job, that will do 2 things. 1) job opportunities will be less 2) salaries will be under pressure. Why do you suppose that dentists have been able to increase their average salaries past primary care physicians? Because dental assistants aren't competing with dentists directly. In the future, primary care providers will be like engineers. Their demand will depend on the market, their salaries will rise to a certain level and then plateau, and they won't have great job security. That's the effect that mid-levels and DNP's will have on our profession - the lowest common denominator model.

I'm not optimistic that the momentum of the nurses can be slowed or stopped. Economically and from society's point of view, it makes sense to want professionals who can be trained faster and are more cost effective. For most conditions, the quality of care they provide is comparable to physician's because they primarily do the routine stuff. Physicians can whine all we want, but I don't think that will do much good. We have to recognize that we need to move up the specialist ladder and acquire knowledge that can only be obtained through accredited training programs and licensure.

 

[It'sElectric]

We'll see. This topic has been discussed pretty extensively on the Allo- board and their are quite a few hurdles they've still got to overcome before this becomes a serious infringement on MD/DO territory. The issue is a little disconcerting, but the idea of DNP's doing more than rudimentary primary care and having physicians pushed out of all sorts of specialties is pretty far fetched, I think.

I agree. I don't mean to imply that it's going to happen all at once. Honestly, I hope the general public is able to prevent it all from happening, but it's hard to have faith in the general public when shows like Nanny 911, Stacked, Wife Swap, etc. are picked up for new seasons and shows such as Arrested Development, Futurama, and many many others are dumped. 😱 There is just something to be said of the Dentistry analogy. You NEVER hear of dental hygienists overstepping their role.

I just don't want everyone to sit around content as the world slowly changes around them. It doesn't always have to be the vocal minority that's heard. There's nothing wrong with physicians' protecting what's theirs.

 

[Red Beard]

A recent response from the AMA

Sent: Monday, June 12, 2006 10:06 AM
To: NHNPA Listserve
Subject: [Npweb] Practice Alert: DNP Under Attack by AMA



AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution: 211
(A-06)

Introduced by: American Society of Anesthesiologists

Subject: Need to Expose and Counter Nurse Doctoral Programs (NDP)
Misrepresentation

Referred to: Reference Committee B
(John M. Zerwas, MD, Chair)

Whereas, The patient-physician relationship is the foundation of
effective medical care; and

Whereas, Patient trust is a cornerstone of good medical care delivery; and

Whereas, Quality medical care requires appropriate education, skills,
training and experience, as recognized and upheld in state laws; and

Whereas, State-based regulation of medicine should be aggressively
protected to ensure patient safety and optimal clinical outcomes; and

Whereas, Confusion, injury and a breakdown of quality medical care would
result from persons not trained as medical doctors and doctors of
osteopathy misrepresenting themselves as "doctors" in clinical settings;
and

Whereas, The American Association of Colleges of Nursing plans to
convert its advance nurse practice degree from master's programs to
"Doctor of Nursing Practice" (DNP) by the year 2015; and

Whereas, Four such "doctoral" nurse anesthesia programs currently are
offered in the United States and more are planned; and

Whereas, The Nurse Anesthesia Accreditation Council has mandated
doctoral training for all nurse anesthetists by the year 2015; and

Whereas, At least one of the DNP programs is advertising its programs as
"similar in concept to practice doctorates in other professions such as
medicine (MD), law (JD), and dentistry (DDM)"; and

Whereas, The quality of care rendered by individuals with a nurse
doctoral degree is not equivalent to that of a physician (MD or DO); and

Whereas, Nurses and other non-physician providers who hold doctoral
degrees and identify themselves to patients as "doctors" will create
confusion, jeopardize patient safety and erode the trust inherent in the
true patient-physician relationship; and

Whereas, Patients led to believe that they are receiving care from a
"doctor," who is not a physician (MD or DO), but who is a DNP may put
their health at risk; therefore be it

RESOLVED, That it shall be the policy of our American Medical
Association that institutions offering advanced education in the healing
arts and professions shall fully and accurately inform applicants and
students of the educational programs and degrees offered by an
institution and the limitations, if any, on the scope of practice under
applicable state law for which the program prepares the student (New HOD
Policy); and be it further

RESOLVED, That our AMA work jointly with state attorneys general to
identify and prosecute those individuals who misrepresent themselves as
physicians to their patients and mislead program applicants as to their
future scope of practice (Directive to Take Action); and be it further

RESOLVED, That our AMA pursue all other appropriate legislative,
regulatory and legal actions through the Scope of Practice Partnership,
as well as actions within hospital staff organizations, to counter
misrepresentation by nurse doctoral programs and their students and
graduates, particularly in clinical settings. (Directive to Take Action)

Fiscal Note: Implement accordingly at estimated staff cost of $10,836.

 

[Red Beard]

Another interesting recent article

http://www.asahq.org/Newsletters/2006/05-06/crowsNest05_06.html

....Assuming that the quality of care rendered by individuals with a nurse doctoral degree is not equivalent to that of a physician and that these health care providers would identify themselves to patients as “doctors” — thus creating confusion, jeopardizing patient safety and eroding the trust inherent in the true patient-physician relationship — there will be further fragmentation of care and more resentment against the health care delivery system. If patients are led to believe that they are receiving care from a “doctor” who is in reality a DNP rather than a physician, many of the trust issues in health care could worsen.

AMA is taking this issue very seriously. At the June AMA House of Delegates Meeting, there is likely to be at least one resolution on this topic. It is incumbent upon the House of Medicine to unite and play the same music if there will be any guarantee that patient care will not be adversely affected. Will AMA turn to the ASA delegation for help and advice? Undoubtedly, for we have had the longest experience in dealing with advanced-practice nurses. Yet that history clearly demonstrates that it may be impossible to contain this issue, in much the same way it has proved difficult to stop advertisements for “nurse anesthesiologists” or to question the qualification of nurse anesthetists to manage pain or intensive care unit patients with the skill and diagnostic acumen of the anesthesiologist, despite their protestations to the contrary and the clear limitations of state scope-of-practice laws relating to nursing....

 

[jonb12997]

if you're interested... http://www.aacn.nche.edu/DNP/pdf/DNP.pdf it's a policy statement by the American Association of colleges of nursing...

my feeling its something we're not going to get away from, so a good option would be to work as physicians with them to provide some oversight in help in setting up practice guidelines. If the standards of practice are up to par with what other providers are required to do, which is what we need make sure of, then they should be able to fill the care gap.

 

[PA-C]

I am quite appalled by all of the whining that is going on in here. I am a physician assistant and a third year medical student in an osteopathic institution so I think I am a qualified person to speak on what the real differences are between the two professions. Before I get into that I have a small comment... First of all... I have never seen a profession so insecure about their place in the world. If you all had confidence in your ability and your profession you wouldnt be scared of nurses taking it over. Do you really think you aren't going to be able to find a job when you graduate because too many PA's and NP's are out there? Come on... If we don't have confidence in ourselves then patients will not have confidence in us.

Anyway, the main difference between PAs and physicians as far as training goes is the depth in which they learn pathology and biochemistry. I found medical school to be fairly easy after my PA training. A lot of the material was review for me and I only had to really study hard in biochem. If you want a great idea of what the schooling was like, it was very similar to when a clinician gives a lecture on a topic like crohns in GI. Or, another idea of the level of understanding would be to look at an abridged version of Cecil's textbook of medicine. You learn some natural history, symptoms, diagnosis, treatment, and prognosis. So how does this translate to the real world? Like the guy who's dad is a PA said... You are capable of handling about 80-90% of what comes in and the rest you must rely on someone with a deeper understanding of the subject matter. Believe it or not you still don't know a damn thing about the practice of medicine when you finish your second year of medical school. Your knowledge and skills come about by being in practice and knowing how to apply these things. For example, I know how to manage an acute abdomen better than any medical student, intern, resident and probably most attending physician's that are not in surgery because I have 5 years of surgery experience. I functioned at my hospital at the level of a 3rd year resident and could manage 20-30 patients on the floors and put in central lines and chest tubes in emergent situations. As a matter of fact I did a lap chole on my own my last day there while the surgeon only retracted for me. Why??? Because of my PA schooling??? NO Because I learned it on the job from another person, just like you will when you are in residency. My entire point here is...Dont attack other professions. It shows a lack of class and confidence in our profession. PA's and NP's are enormously helpful but will never replace physicians because patients simply want to see 'the doctor' sometimes. It is true... We have more knowledge and a much deeper understanding but a lot of issues in medicine do not require such a deep understanding to treat. Bottom line...We can all live in harmony and I hope to hire a PA in my practice when I finish (if the laws change) because I believe they can help ease the burden of a busy practice.

 

[Red Beard]

...

Understood, however, this debate is specifically about the proposed autonomous practice DNP program that is soon to become widespread.

Setting aside the issue of whos more qualified than who, who's knowledge is broader, etc., what have you to say about NP's with a doctorate degree graduating in large numbers and competing for your job in the future? Where will this leave the large number of us primary care oriented physicians-in-training 10 and 20 years down the road? We are taking on a lot of debt and spending a lot of time on ou education.

 

[Red Beard]

if you're interested... http://www.aacn.nche.edu/DNP/pdf/DNP.pdf it's a policy statement by the American Association of colleges of nursing...

my feeling its something we're not going to get away from, so a good option would be to work as physicians with them to provide some oversight in help in setting up practice guidelines. If the standards of practice are up to par with what other providers are required to do, which is what we need make sure of, then they should be able to fill the care gap.

Agreed, but I refer you back to esposo's post. The "gap" exists in rural areas because physicians choose not to practice there. Why would a DNP choose to?

 

[MacGyver]

Right now, about 50% of med school grads go into primary care.

If this DNP thing goes thru unchecked, and teh nursing associations get all their demands met, then it will mean nothing less than the entire collapse of the physician side of primary care.

I see the % of med school grads going into primary care plummeting.

I see just about every single med student applying to specialties.

You thinnk the specialties are hard to get into right now? Wait till absolutely every single med student in the country is applying to them. You aint seen nothing yet.

Unless specialty residency programs are increased in size in response to the massive increase in med student demand, over hte long term what will happen is that the med school applicant pool will plummet. Premeds will figure it out that its pointless to go into med school unless you want to be a superspecialist. Med schools will become tiered like law schools.

DO schools and hte lower tier MD programs will be the huge losers if the DNP thing goes thru as the nurses want. I see a future when many med schools are forced to take every applicant that applies, because demand will plummet once people figure out that primary care is foolish for a med school grad to pursue.

 

[TBforme]

.

 

[Taurus]

I have never seen a profession so insecure about their place in the world. If you all had confidence in your ability and your profession you wouldnt be scared of nurses taking it over. Do you really think you aren't going to be able to find a job when you graduate because too many PA's and NP's are out there? Come on... If we don't have confidence in ourselves then patients will not have confidence in us.

Confidence in my own abilities is not a problem. When I devote myself to something, I get really good at it. I even dare to say even better than most people I know. However, no matter how good I am at something, if someone else can do the same job (even though not as well as me) or 90% of what I can do but cost only 50% of my salary, I can't compete against them. Some decision-making MBA at a hospital will make the decision that it is more cost effective to hire someone who can do 90% of my job but only cost half as much as I do. If you lower your salary demands substantially, then you become very competitve. Are you willing to do that? You may not have a choice.

You want a real world example? Do some research on the outsourcing of call centers, IT, accounting, financial analysis, etc. to countries like India and China and how it has changed the landscape for US white-collar workers. Or how about how some hospitals are using PA's instead of physicians as hospitalists. If DNP's are viewed as the equivalent of primary care physicians but cost less, this will give hospitals even more reason to replace physicians with lower cost alternatives.

Does this mean I am permanently out of a job? No. Remember that 10% that can only be done by someone like me. Hospitals will keep a few of us around as "senior" people to take care of the most complex cases. But this changes the mix of staff. Whereas before you had almost all physician staff, you may start to see to 4-6 mid-levels to every 1 physician ratios. Physicians won't disappear. We'll just be in less demand.

 

[It'sElectric]

I am quite appalled by all of the whining that is going on in here. I am a physician assistant and a third year medical student in an osteopathic institution so I think I am a qualified person to speak on what the real differences are between the two professions. Before I get into that I have a small comment... First of all... I have never seen a profession so insecure about their place in the world. If you all had confidence in your ability and your profession you wouldnt be scared of nurses taking it over. Do you really think you aren't going to be able to find a job when you graduate because too many PA's and NP's are out there? Come on... If we don't have confidence in ourselves then patients will not have confidence in us.

Anyway, the main difference between PAs and physicians as far as training goes is the depth in which they learn pathology and biochemistry. I found medical school to be fairly easy after my PA training. A lot of the material was review for me and I only had to really study hard in biochem. If you want a great idea of what the schooling was like, it was very similar to when a clinician gives a lecture on a topic like crohns in GI. Or, another idea of the level of understanding would be to look at an abridged version of Cecil's textbook of medicine. You learn some natural history, symptoms, diagnosis, treatment, and prognosis. So how does this translate to the real world? Like the guy who's dad is a PA said... You are capable of handling about 80-90% of what comes in and the rest you must rely on someone with a deeper understanding of the subject matter. Believe it or not you still don't know a damn thing about the practice of medicine when you finish your second year of medical school. Your knowledge and skills come about by being in practice and knowing how to apply these things. For example, I know how to manage an acute abdomen better than any medical student, intern, resident and probably most attending physician's that are not in surgery because I have 5 years of surgery experience. I functioned at my hospital at the level of a 3rd year resident and could manage 20-30 patients on the floors and put in central lines and chest tubes in emergent situations. As a matter of fact I did a lap chole on my own my last day there while the surgeon only retracted for me. Why??? Because of my PA schooling??? NO Because I learned it on the job from another person, just like you will when you are in residency. My entire point here is...Dont attack other professions. It shows a lack of class and confidence in our profession. PA's and NP's are enormously helpful but will never replace physicians because patients simply want to see 'the doctor' sometimes. It is true... We have more knowledge and a much deeper understanding but a lot of issues in medicine do not require such a deep understanding to treat. Bottom line...We can all live in harmony and I hope to hire a PA in my practice when I finish (if the laws change) because I believe they can help ease the burden of a busy practice.

This entire speech is just further proof that there are people still missing the point. Have you thoroughly read through this thread as well as the allopathic thread? If you haven't, please try again. You truly are missing the point. We're not attacking professions, we're questioning their methods and motives to assign theirselves a title that they are not deserving of.

 

[Sinnman]

PA-C, we aren't attacking PAs. As I have pointed out before, the PA profession, in general, is not trying to position themselves to supplant physicians. Also, in general, I feel that their education is far better than a NPs.

I feel that I can speak to the nursing side of this as that was my background. You better believe there is a very active political agenda by the nurses to obtain "equality" with physicians. Maybe it stems from the fact that the old-school nurses remember the days where they had to stand up when the doctor walked in the room and are now getting their revenge. Their agenda is patently obvious if you just read some of their position/mission statements and other BS. The DNP amounts to nothing less than a full-on assault to physicians.

Another thing, I can assure you that no matter what anyone else tells you or tries to convince you, the education is FAR different. You would be amazed at the superficiality of most NP programs. There are programs at good schools that lead to an MSN/NP license with little more than 3 classes or so in anything resembling "medicine" with the rest being nursing theory and other miscellaneous "fluff." It's absolutely frightening to me that these people can independently see patients and write scripts in some states.

I used to say that NPs have a great role in healthcare and that I would see one for something "simple" like a cold. After intimately seeing both sides I wouldn't recommend seeing a NP for a hangnail (and I'm not exaggerating). It's frightening because they don't know how much they don't know. They are filled with so much propaganda from their very first fundamentals of nursing class that they don't realize the HUGE difference in education and training.

I have no major beef with most PAs. I've definitely seen the "I really wanted to be a doctor but became a PA because it was easier and now I try to convince everybody that I'm as good as any physician" attitude from time to time, but in general I have no problem with most PAs. BTW, I think that if you choose surgery as a specialty and go through residency, you will want to edit a few of your earlier statements.