DNP Autonomy: What's the Angle?

[OCDEMS]

Nurses can Practice Without Physician Supervision in Many States-Washington Post.

I'm an avid reader of the major dailies. I'm not someone who trolls around looking for DNP articles, but this caught my attention as it was posted on WaPo's main site tonight. You can read it through, but if you've read these DNP/NP articles before the content is mostly the same. The difference is that the Washington Post seems to slyly call out physicians for their obstinance on this issue. The AMA is made to look like a big bad protectionist lobby, never mind that the article implicitly mentions the juggernaut lobbies advocating on nursing's behalf.

Instead of this devolving into a DNP vs. MD/DO or a broader discussion about whether it's safe or not (that's been done on other threads), I'd like to get the opinion of current medical students and physicians about what specifically is or isn't being done to combat this. I read that article and immediately thought that the physician world is getting its butt handed to it by superior lobbying efforts and more money from thousands of grass roots organizations, right or wrong. So, with that in mind, I'd like people's thoughts with these questions in mind:

1) First, are the nurses right? I think any wise person should first concede that there is a possibility, however infinitesimal, that they may be wrong. Do physicians spend too much time training in the United States and is this onslaught the profession's doing? This can be a simple "No," but I think it's a useful exercise before answering the next few questions.

2) Is this something that should be fought? Is there a winning angle in this argument with the "Physicians are better trained" and "Better outcomes argument"? It seems clear that the NP lobby has been able to effectively neutralize this argument, despite it having merit.

3) Are nurses better organized? Are physicians opening up their checkbooks to combat this problem? Why are so many physicians seemingly found in support? Have nurses used the lucrative nature of physician-supervised mid-level practices to trap physicians into supporting their endeavor? Is it simply the right thing to support (see # 1)?

4) One of the things that the WaPo article mentions is that "nurses provide more holistic care." Is this the time for the AAMC and AOA to combine and/or greatly ally in this fight? Should osteopathic medical schools, and their graduates, be used to countermand this argument? Is there maybe some value in combining the education models in the best interest of the profession as a whole?

5) Where are the physician commercials? I'm literally watching a Johnson & Johnson "nurses are awesome" commercial right now.

6) Do you believe that this has a gender equality nature to it? I notice that the term "nurse" tends to be associated with female gender stereotypes and "physician" with men, despite women entering medical school in nearly equal proportions to men. Does anyone see any value in physician groups putting a female face on this argument by showing that women can, and do, become physicians in large quantities and that this is a viable profession for all women, i.e. if you want to be a "doctor" go to medical school.

7) Do any of you see value in saying, "OK, if you want to be physicians, fine. But, you need to be able to pass physician boards and you need to complete residencies"? Do you think this would deflate some of the argument. Wouldn't most Americans go, "Hey, that's pretty reasonable of those friendly-neighborhood physicians"? Would nurses be able to pass physician boards and complete competitive residencies?

8) For Students/Residents/Attending Physicians: If you were looking to go to medical school, and placing all other professional gripes and complaints aside, would you seriously consider forgoing medical education knowing that this encroachment of professional practice was occurring?

Disclaimer:This is meant to be a friendly discussion.

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[JourneyAgent]

1) First, are the nurses right? I think any wise person should first concede that there is a possibility, however infinitesimal, that they may be wrong. Do physicians spend too much time training in the United States and is this onslaught the profession's doing? This can be a simple "No," but I think it's a useful exercise before answering the next few questions.

They hang from our tree until they're juicy with knowledge an then they go independent. So it is and will never be an independent comparison. We use them to take a cut while they do the mundane stuff we don't like. Which is the bulk of what we do anyway.

In the current market we're overly invested in our education. Regardless of what that means for level of training.

2) Is this something that should be fought? Is there a winning angle in this argument with the "Physicians are better trained" and "Better outcomes argument"? It seems clear that the NP lobby has been able to effectively neutralize this argument, despite it having merit.

No. Not in the public sense. But quietly behind closed doors and in the negotiating tables with large employers yes we should fight it out.

3) Are nurses better organized? Are physicians opening up their checkbooks to combat this problem? Why are so many physicians seemingly found in support? Have nurses used the lucrative nature of physician-supervised mid-level practices to trap physicians into supporting their endeavor? Is it simply the right thing to support (see # 1)?

Yes most definitely. Yes. F@ck bro, you don't start a conversation by going congressional hearing on your potential participants.

4) One of the things that the WaPo article mentions is that "nurses provide more holistic care." Is this the time for the AAMC and AOA to combine and/or greatly ally in this fight? Should osteopathic medical schools, and their graduates, be used to countermand this argument? Is there maybe some value in combining the education models in the best interest of the profession as a whole?

What?...hell no. The holistic thing is code for has more time to bull**** because I get paid less. For DO's it means have a ****ty reason to deal with less clinical support in 3rd and 4th year. Slap yourself.

5) Where are the physician commercials? I'm literally watching a Johnson & Johnson "nurses are awesome" commercial right now.

Everybody wants to look good by praising the poor little down trodden mommies taken care of all of us in our time of great need. That's a no-brainer. I could write that PR in my sleep. But it's pretty effective.

Get this. We're not cuddly. Our old image craft is limping anemically into this millennium.

6) Do you believe that this has a gender equality nature to it? I notice that the term "nurse" tends to be associated with female gender stereotypes and "physician" with men, despite women entering medical school in nearly equal proportions to men. Does anyone see any value in physician groups putting a female face on this argument by showing that women can, and do, become physicians in large quantities and that this is a viable profession for all women, i.e. if you want to be a "doctor" go to medical school.

Yeah. A black woman. But your presumption is something like a political war room that runs strategic options. Remember many more of us currently are profiting off the status quo. Which is why the only place of alarm is here and in our lunchroom discussions.

7) Do any of you see value in saying, "OK, if you want to be physicians, fine. But, you need to be able to pass physician boards and you need to complete residencies"? Do you think this would deflate some of the argument. Wouldn't most Americans go, "Hey, that's pretty reasonable of those friendly-neighborhood physicians"? Would nurses be able to pass physician boards and complete competitive residencies?

Yes. Probably not.

8) For Students/Residents/Attending Physicians: If you were looking to go to medical school, and placing all other professional gripes and complaints aside, would you seriously consider forgoing medical education knowing that this encroachment of professional practice was occurring?

No not yet. It's still worth it. But questions are beginning to appear on the horizon particularly in certain fields.

 

[chemsmith]

What it means is that no med student in their right mind is going to want to enter a primary care field. Talk about a PCP shortage...

 

[goofball]

What it means is that no med student in their right mind is going to want to enter a primary care field. Talk about a PCP shortage...

I'm not going to med school to do a job that society somehow thinks a nurse can do. Simple as that. There are plenty of careers other than FM even for grads with meh STEP1 scores/rotation grades.


I think being a physician (as opposed to being an underemployed college grad with no certain future) is still worth it. But if the problems with reimbursement, scope of practice, and autonomy keep getting worse, maybe it won't be worth it anymore.


Nursing will never receive the respect that medicine receives because it is an overwhelmingly female-dominated profession, and as we know, society thinks female-dominated professions (nursing, library science, teaching, etc) are inherently less prestigious than male ones (Ibanking, engineering, surgical fields, etc).