DNP (doctor of nursing practice) vs. DO/MD

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My prediction is that the first step after DNP will be DNP residency programs, tremendously weak watered down versions of what real doctors go thru. After that, you will see them start expanding the nursing scope laws. In less than 20 years, we will see at least one state nursing board write surgery into their scope of practice, defining it as "nursing" practice and ergo immune from any medical board interference.

PAs are in a different boat. They are regulated by state medical boards. In order to escape that, they would have to convince state legislatures that they dont practice medicine, but instead practice something else.

That statement was made in 2006. Wise beyond his years. Too bad he was banned.

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hate to break it to everyone, our country is PUSSIFIED.

Slowly over the years the gov has moved to do that. You will not win this fight. Nurses have numbers to influence your corrupt and ******ed representatives in congress.

Nobody stands up and fights for what they want, they lay back, complain, but ultimately get walked all over. That is what being an American has become.

There are people in nursing with PhD. Most NP do not want the DNP. The DNP is the result of the out of control education system in this country forcing advanced degrees where not necessary.

Masters NP vs DNP

RPh vs PharmD

It discredits the degrees because graduates are pumped out in large numbers to maintain profits for the schools where as not many would go on to earn those degrees.

If you want it to stop, you need to get on it and act upon it. The mandatory undergraduate degree in the USA is useless. How many of you use what you learned in undergrad? Not many. Don't ask me about the philosophy classes I had freshman year. I think the problem is the education system that needs to be examined.

Primary care is going to be taken over by DNP plain and simple.

cheers
 
I'm just going to put another opinion out there and hope people have blown off enough steam and take it seriously.
I graduated from college with a 3.98 GPA and got a 39 on my MCATs. I started to apply to med school, but my heart just wasn't in it. I had heard from enough miserable docs not to go into medicine that I just couldn't do it, and I wasn't ready yet to make the commitment.
So, I did the fun Europe thing for a couple of years and came back and started nursing school. I know that health care is where I want to be, and nursing is just another gateway into it. And one day, when I am ready, I probably want to take the next step in my profession and become an NP, probably with a DNP based on the new requirements (I don't get the big difference either between NP and DNP, by the way. It's probably just for all us overachievers, myself and most MDs included, who want to push themselves as far as they can in their education/credentials).
Anyway, I have NO intention or pretense to ever be as clinically experienced as a doctor. I can't imagine MDs ever being threatened by NPs! We are not going to take your jobs, or your titles, or your prestige.
Also, I know my scope of practice will be much much smaller than yours, and I will be constantly aware of it. I will educate myself as much as possible, but I will know my own limitations. I will work under an MD, and use them as a resource when I need advice. I do consider myself a very intelligent person, so I am expecting to do a very good job WITHIN MY SCOPE OF PRACTICE. Which includes knowing which specialist to pass my patients off to.
I know that all of you MDs have given so much of your lives to medicine and you deserve every bit of recognition and respect that your years of work, study, and experience merits you. I don't think nurses (at least not this one) are wanting to take that away from you.
What if we decide to work together in this system that is growing and transforming so quickly? If you treat us in a way that respects our choices and our abilities as clinicians (which I repeat, will never approach yours), then life will just be easier for all of us. I plan to look up to MDs as mentors, not as competitors. And I hope to find MDs who are willing to share some of their experience with me, respect me and my intelligence, and help me become a better clinician one day.
And please don't give me any of that "wah,wah,wah" bull****! I'm just trying to present a perspective a lot of docs might not have heard from nurses.
 
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I'm just going to put another opinion out there and hope people have blown off enough steam and take it seriously.

Allow me to second your entire post.

I walked away from a successful career in IT to become a Nurse Practitioner (in a BSN program now). I'm wrapping up my first semester and an I'm as irritated as anyone about the nurses who somehow think their knowledge/training somehow approaches that of a physician. I do, however, think that most nurses don't think that way, but I could be wrong.

The original post was about the DNP, and it is an absolute waste of time for NP's. It is simply a way to, 1) generate revenue for the schools 2) give something to show legislators to expand APN scope of practice further and, 3) further the old, ongoing attempt to justify nursing as a profession independent of medicine.

My BSN program is full of nursey-nursey fluff, as all BSN programs are (ADN and diploma programs cut to the chase!). The DNP is the same thing. Again, the fluff stuff is there simply to try to justify nursing as a practice/profession independent of medicine.

As for the argument of only 2 or so years of training in an MSN program, that's does overlook the clinical experience gained at the RN level. No, RN's are not practicing medicine, but you do get relevant clinical exposure at the RN level, thus why the MSN is considered an extension of the RN. In a nursing, you get a lot of exposure to pharmacology, labs, therapies, treatment modalities, presentation/manifestations of disease, nonmedical management of illness, etc. all of which the smart RN can carry with them and build on in an advanced practice degree. In the end, however, it is advanced nursing practice. I do think that the 4 years (not 2) or so years of training that you receive with a BSN/MSN is adequate for basic primary care. This is often overlooked in APN vs. PA debate, but that's another thread. I think PA's rock, BTW. :)

As for the use of "doctor" in the clinical setting, I would never use it personally, but I don't see it as that big of deal. I don't know what standard practice is at eye clinics where opthamologists and optometrists work side by side, but I see a similar situation there. When it comes to refractions, who cares? Likewise, when it comes to treating a sore throat, a URI, UTI, rash, etc., I don't think its that big of a deal. Different deal if dealing with a diabetic with PVD, decreased renal function, and CHF taking 10+ meds who walks into a family practice clinic presenting with acute neuro symptoms. But the APN role was/is never meant to independently deal with that, except, perhaps, for the very bright few. In such a case it would be wrong to give the impression that you are a physician (because you have "doctor" in your degree title) and lead the patient to believe you are as able to handle his/her condition as adequately as a physician.

My goal and desire is to extend and offer basic primary and preventative care to rural populations. The key here is basic. I have no aspirations (or delusions) of replacing a physician. Any nurse (short of going to med school) that has such aspirations (delusions), DNP or not, is dangerously ignorant, not to mention an embarrassment to nursing.
 
Residents take all cases, work more hours than NP's, have more education and responsibility and get paid less than an an inferior group of practitioners (NP's). That's a joke.

Residents work more hours to learn. They get paid to learn. They earn less, because they are essentially getting paid for an education.

There is a solution. Finish residency, and get paid a full wage;).
 
NP's (and PA) do not undergo post-graduate training yet the minute after graduation are paid full scale wages despite needing time to learn how to to do their job.

Further, residents, while being educated, still have more responsibility and work more hours than a NP or PA. Just because we will make more money in the future doesn't mean we should be paid less than a PA/NP while we are training if we are more educated, working more hours, and taking more responsibility.

Its more appropriate to say, after graduation, that a midlevel is paid beginning scale wages. Ultimately, the pay is going to be linked to productivity, and if you don't produce, you are gone;). I get paid what I get paid to be a permanent scut monkey and bring in over $350,000 of collections per year. To my boss, its worth it.

Its a fact, residency positions, whether its physician or PA, pay less because you are essentially getting paid for an education.

The solution to your jealousy problem is simply to finish training. You will then get paid twice what a midlevel gets for a general med position, and a LOT more for a surgical specialty.
 
That speaks volumes to me as to what they view as a superior provider of medical care. If someone is providing superior care, regardless of their educational status, shouldn't they be paid more.

Hey, I don't disagree necessarily. But that's not the fault of PA's or APN's, or RN's, or PT's or OT's, etc. many of whom get paid more than residents. In fact they have nothing to do with it. It's a problem with the structure of medical education.
 
My problem with your statement is 2 fold:

1. I would argue your basic education (and it is truly basic compared to that of a physician) means that you do not have the knowledge to truly understand when those simple cases as you call them (sore throat, URI, UTI, rash) is something more. Part of being a doctor, is being able to understand the implications beyond the algorithm based pathways that NP's use.

Those simple cases, most of the time, are just that. Physicians make diagnostic decisions everyday based on statistical probabilities. What presents as a cystitis could be bladder cancer, but the odds are against it and most docs would treat it as such and instruct the patient to return if it doesn't improve, at which point a more thorough diagnostic assessment would be completed.

Based on your reasoning, it would be smarter for someone with symptoms of a URI to go straight to a pulmonologist instead of their family practice doc because the pulmonologist might pick up something the family doc misses because the pulomonlogist has substantially more training in the respiratory system than the family doc.

2. If you want to simply pick off the "simple stuff", why should NP's be compensated the way they are. Residents take all cases, work more hours than NP's, have more education and responsibility and get paid less than an an inferior group of practitioners (NP's). That's a joke.

I addresses this in a separate post, but let me add: physical therapy assistants get paid more than physical therapy students do when they are in their clinicals. CNA's get paid more than master's degree nursing students doing their clinicals. College football players get paid nothing, yet generate millions in revenue for their schools. Not saying I agree with any of it, but that's just the way it is. Hate the game, not the players, I guess. ;)

Here's a couple of questions for you:

1) Should optometrists only be allowed to refract? After all, when doing an eye exam, might they not miss a subtle case of optic neuritis (which could suggest MS) that an ophthalmologist might pick up?

2) Should APN's be allowed to do any primary care at all, if not, what should their scope of practice be?
 
While you may think that the simple cases are usually the easy ones, having seen these cases go bad has taught me that a physician needs to be managing these cases. When it's your child who is diagnosed with the flu but has meningitis by a PA/NP then you might understand. Have i seen it, yea. Could the same thing happen with a MD evaluating, absolutely but the likelihood is significantly less due to the level of training.

Look, I agree it is less likely for an MD to miss such a case, as you said. However, anytime there is an atypical presentation there's a risk for misdiagnosis, whether by NP's, PA's and MD's. Also, you have no idea if the pt you mention above in your example would have gotten the correct diagnosis if they were seen by a physician. Both meningitis and influenza are infectious diseases, and thus share symptoms and the patient may not have had symptoms that would differentiate (e.g. nuchal rigidity). You and I could trade anecdotal stories all day (such as the physician I know of that diagnosed a pt with sinusitis who then died two weeks later from leukemia), but that'll get us nowhere.

As for the referrals for everything, I don't believe that. I believe that a well trained PCP can be the best front line defense in medicine and can manage almost anything.

OK that you believe that, and that's fine, but my point still stands. Your argument is that more training = more ability to recognize subtle signs that might indicate serious disease. Using that logic, anyone with respiratory issues should see a pulmonologist. Anyone with urinary problems should see a urologist. Anyone with neuro symptoms should see a neurologist, etc. Specialists, by definition, have significantly more training in their areas than a family doc and therefore are more able to deal with symptoms related to a particular body system. That is where your reasoning leads, even if that is not where you intended to go with it.

As to your comments about students (i.e. pt students, nursing students) realize that residents are not students, having graduated medical school and being licensed physicians. They are charged with significant amounts of responsibility in patient care which is not the case with your examples.

Look, I don't know that we really disagree about anything here. I think your arguments that residents should get better pay is valid. My original point was only that it's not the fault of mid-levels that resident pay is poor - they really have nothing to do with it.

As for midlevels (PA/NP), I don't think any should have independent practice rights. As physicians, the rigors of our training allow us to treat patients; I find the training of NP's to be not appropriate to allow for independent practice.

Ah, so you are arguing against independent practice. That's the first that word has come up (unless I missed it from your earlier posts) and is a different animal altogether. It sounded to me like you were arguing NP's (and maybe PA's) should not be involved in providing any primary medical care/treatment at all. Then again, I'm not sure what you mean by "independent."

I am not in support of NP-run clinics that offer the whole gamut of primary care services with no physician involvement (my definition of independent). But, I have no problem with a) "retail" clinics that offer limited, predefined, basic services such as the treatment of colds, sore throats, school physicals, etc. that are independent, or b) NP's/PA's that work in family practice clinics under the oversight of a physicians where the physician decides how much autonomy the NP/PA has. From what I know, situation B is overwhelmingly the norm.
 
Allow me to second your entire post.

As for the use of "doctor" in the clinical setting, I would never use it personally, but I don't see it as that big of deal. I don't know what standard practice is at eye clinics where opthamologists and optometrists work side by side, but I see a similar situation there. When it comes to refractions, who cares? Likewise, when it comes to treating a sore throat, a URI, UTI, rash, etc., I don't think its that big of a deal. Different deal if dealing with a diabetic with PVD, decreased renal function, and CHF taking 10+ meds who walks into a family practice clinic presenting with acute neuro symptoms. But the APN role was/is never meant to independently deal with that, except, perhaps, for the very bright few. In such a case it would be wrong to give the impression that you are a physician (because you have "doctor" in your degree title) and lead the patient to believe you are as able to handle his/her condition as adequately as a physician.
QUOTE]

My problem with your statement is 2 fold:

1. I would argue your basic education (and it is truly basic compared to that of a physician) means that you do not have the knowledge to truly understand when those simple cases as you call them (sore throat, URI, UTI, rash) is something more. Part of being a doctor, is being able to understand the implications beyond the algorithm based pathways that NP's use.

2. If you want to simply pick off the "simple stuff", why should NP's be compensated the way they are. Residents take all cases, work more hours than NP's, have more education and responsibility and get paid less than an an inferior group of practitioners (NP's). That's a joke.

So you want to go there? OK. They are residents they are not fully licensed yet, or board certified, and they cannot enter certain official documented orders for patient care without the attending's approval. But I completely agree they should get paid more, though do not see how their low pay is in any way related to what NP's get paid, which is a fair salary for their level of responsibility. Why does crap minimum wage resident pay get "blamed" on another service?

Come on, people, get some balls and post threads in every forum to gather support for raising resident pay and reducing the ridiculous, unsafe number of hours they are forced to work instead of picking on a popular service that has had to pay their dues in a major way, no thanks to folks like yourself. That would be helpful to a lot of people, including the patients.

You don't have to mention another service in the platform to get attention, it makes you look bitter and I am sure that is not how you really feel.

Secondly - how exactly do you "know" what a NP has knowledge of and does not? I am very curious to learn what your source of evidence is for this claim. Facts please, some real medical science here would be helpful, not information gathered by sixth sense intuition and crystal balls. Did I say balls again?
 
Every second that this thread, with this title, exists... is a moment that makes me feel even sadder for the state of medicine in America.
 
Secondly - how exactly do you "know" what a NP has knowledge of and does not? I am very curious to learn what your source of evidence is for this claim. Facts please, some real medical science here would be helpful, not information gathered by sixth sense intuition and crystal balls. Did I say balls again?
Here's a post of mine that you seem to have missed in the preallo thread:

Here's a sample curriculum from a BSN-DNP program (at Duke): http://nursing.duke.edu/wysiwyg/down...t_MAT_Plan.pdf

You need 73 credits to go from a college degree to a doctorate. That turns out to be less than 3 years.

Now, let's look at the fluff courses that aren't really clinically useful: Research Methods (3 credits), Health Services Program Planning and Outcomes Analysis (3 credits), Applied Statistics (2 credits), Research Utilization in Advanced Nursing Practice (3 credits), Data Driven Health Care Improvement (4 credits), Evidence Based Practice and Applied Statistics I & II (7 credits, since you told me medicine is not evidence based), Effective Leadership (2 credits), Transforming the Nation's Health (3 credits), DNP Capstone (6 credits), Health Systems Transformation (3 credits), Financial Management & Budget Planning (3 credits).

Here are the clinically useful courses: Population-Based Approach to Healthcare (3 credits), Clinical Pharmacology and Interventions for Advanced Practice Nursing (3 credits), Managing Common Acute and Chronic Health Problems I (3 credits), Selected Topics in Advanced Pathophysiology (3 credits), Diagnostic Reasoning & Physical Assessment in Advanced Nursing Practice (4 credits), Common Acute and Chronic Health Problems II (3 credits), Sexual and Reproductive Health (2 credits), Nurse Practitioner Residency: Adult Primary Care (3 credits), Electives (12 credits).

So, out of the 73 credits needed to go from BSN to DNP, 37 credits are not clinically useful. In addition, the number of required clinical hours is 612 hours (unless I miscounted something)!! Wow! And the NP program is designed the same way, with a bunch of fluff courses (11 credits out of 43 required are fluff) and requires 612 hours as well: http://nursing.duke.edu/wysiwyg/down...rriculum_2.pdf

Here are the curricula to several other programs:

* University of Arizona: http://www.nursing.arizona.edu/OSA/P...ndout_2008.pdf 31/74 credits are fluff.
* Loyola's MSN to DNP: http://www.luc.edu/nursing/dnp/curriculum.shtml (where are the basic science classes? They're all public health classes!!)
* MGH BSN to DNP: http://www.mghihp.edu/nursing/postpr...ulum.html?cw=1 (35/72 credits for Adult DNP are fluff while 46/83 credits for DNP in FM are fluff)

It's kinda scary how inadequate that training is in order to practice medicine independently. You can't really count prior nursing experience as time practicing medicine because you weren't practicing medicine during that time nor were you thinking in a medical manner (ie. the way a physician would). Nursing clinical hours might help you transition into medicine but they are NOT a replacement for medical clinical hours.

Now, just for comparison, let's look at a med school curriculum. I'll point out all the fluff courses here too. Here's an example from Baylor School of Medicine for M1/M2 (http://www.bcm.edu/osa/handbook/?PMID=5608) and for M3/M4 (http://www.bcm.edu/osa/handbook/?PMID=7463):

Fluff courses at Baylor School of Medicine during M1/M2 years ONLY: Patient, Physician, and Society-1 (4.5 credits), Patient, Physician, and Society-2 (6 credits), Bioethics (2.5 credits), Integrated Problem Solving 1 & 2 (10 credits).

Useful courses at Baylor School of Medicine during M1/M2 years ONLY: Foundations Basic to Science of Medicine: Core Concepts (14.5 credits), Cardiovascular-Renal-Resp (11.5 credits), GI-Met-Nut-Endo-Reproduction (14 credits), General Pathology & General Pharmacology (6.5 credits), Head & Neck Anatomy (4.5 credits), Immunology (5 credits), Behavioral Sciences (6.5 credits), Infectious Disease (13 credits), Nervous System (14 credits), Cardiology (4.5 credits), Respiratory (3.5 credits), Renal (4 credits), Hematology/Oncology (5 credits), Hard & Soft Tissues (3 credits), Gastroenterology (4 credits), Endocrinology (3.5 credits), GU/Gyn (3 credits), Genetics (3 credits), Age Related Topics (2.5 credits).

For only the M1/M2 years at Baylor, there's 162.5 total credits. Out of these 162.5 credits, 23 credits are fluff.

Core Clerkships during M3 (useful clinical training): Medicine (24 credits, 12 weeks), Surgery (16 credits, 8 weeks), Group A selective (8 credits, 4 weeks), Psychiatry (16 credits, 8 weeks), Neurology (8 credits, 4 weeks), Pediatrics (16 credits, 8 weeks), Ob/Gyn (16 credits, 8 weeks), Family & Community Medicine (8 credits, 4 weeks), Clinical Half-Day (includes Clincal Application of Radiology, Clinical Application of Pathology, Clinical Application of Nutrition, Clinical Evidence Based Medicine, Longitudinal Ambulatory Care Experience, and Apex -- 23 credits).

So, without even taking into consideration M4 electives and required subinternships (which are usually in Medicine and Surgery), medical students already have a far superior medical training than NPs or DNPs. Other examples of med school curricula:

* UMich M1/M2: http://www.med.umich.edu/lrc/medcurr...gram/m1m2.html
* UMich M3/M4: http://www.med.umich.edu/lrc/medcurr...gram/m3m4.html
* Duke: http://medschool.duke.edu/modules/so...index.php?id=2

You can get a BSN to DNP in about 3 years according to many programs I've looked at. Medicine involves 4 years of medical school and a minimum of 3 years of residency before allowing independent practice. Here's the math:

BSN to DNP: 2.5 - 3 years of training; longer if courses taken part-time; 600-1000 clinical hours!
BS/BA to MD/DO: 4 years med school + 3-5 years residency: 7-11 years of training; not possible part-time; clinical hours > 17000
So, as you can see, NPs/DNPs seem to receive less than 25% of the clinically relevant training that physicians get. It would be literally impossible for NPs/DNPs to gain the same level of knowledge as an attending physician in the same specialty; the rigorous training a physician goes through is there to ensure a high level of competency. Fourth-year med students have more basic science and clinical training than NPs/DNPs receive. Should we allow M4s to practice independently? Shortcutting through that under the guise of "patient care" is deceptive.

Is that good enough evidence for ya?
 
You mean the physician-residents who are less skilled at nursing? Are you a skilled nurse? I'm just wondering about your nursing skills presuming you practice them on a daily basis, as a medical resident. Or do you mean the nurses who are less skilled at doctoring because they are nurses and not doctors? Do you mean the "less responsible" nurses or the less responsible residents who are actually still students? What? Who is responsible for residents not getting decent cash and not being able to practice independently?

Who decides what is superior care? You?

You can shout out your opinions all you want but it is very likely that Nurse Practitioners as a whole don't care that so-and-so doctor-resident attending thinks that their training is "sub par" or wholly insufficient for independent practice. You just do not have the level of expertise in that area to make an educated assessment of nursing practice, so opinions from medical students/residents and attendings are just not substantiated with enough professional qualification to be taken seriously. A physician's training in even basic, associates level registered nursing is not only sub-par, it is actually non-existent. (I bolded this cause that's what the smarter actual doctors here do when they want to make a point about how stupid other people are) How you are actually qualified for serious discussion on this matter is not clear.

I don't remember hearing anyone from nursing bodies officially ask medical students, medical residents, or the medical licensing boards what their opinion is on the matter of Nurse Practitioner. That is what really pisses off folks. They don't care, really, what you think, because it does not actually matter to them, does it. Casual comments and observations are welcome, however. Put them in writing and drop them in the suggestion box.



There are several studies that have shown that resident productivity is on par with the productivity numbers you cite. Residency position, while education for physicians, grant us significant independence and responsibility exceeding that of a PA.

No Jealousy here, I am at the other end of the residency pool and nearly out. I still think there is a signficant problem when less educated, less skilled, and less responsibile providers are being compensated more than a resident, educational status or not. At my institution, attendings request resident over PA/NP coverage hand over fist with the exception being PA's who work solely with one attending full time. That speaks volumes to me as to what they view as a superior provider of medical care. If someone is providing superior care, regardless of their educational status, shouldn't they be paid more.
 
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I totally LOLed at this it is so funny. You are so totally right that medical students get more hours studying medicine than nurses get for their nursing degrees. How can that be? I am shocked beyond belief. Can you try to use more of the correct, medical kind of science that is hard to understand here because it is unclear what point other than the obvious you are getting at.

I had to get help with the big, medical words, but it looks to me that your post proves that you spend many, many idle hours trolling nursing program websites copying and pasting curriculum from programs, then add up lots of credit hours and calculate percentages and multiply things. Most guys are more interested in the pictures of the lady nurses.

Why would you do that?


Here's a post of mine that you seem to have missed in the preallo thread:
Here's a post of mine that you seem to have missed in the preallo thread:

Quote:
Here's a sample curriculum from a BSN-DNP program (at Duke): http://nursing.duke.edu/wysiwyg/down...t_MAT_Plan.pdf

You need 73 credits to go from a college degree to a doctorate. That turns out to be less than 3 years.

Now, let's look at the fluff courses that aren't really clinically useful: Research Methods (3 credits), Health Services Program Planning and Outcomes Analysis (3 credits), Applied Statistics (2 credits), Research Utilization in Advanced Nursing Practice (3 credits), Data Driven Health Care Improvement (4 credits), Evidence Based Practice and Applied Statistics I & II (7 credits, since you told me medicine is not evidence based), Effective Leadership (2 credits), Transforming the Nation's Health (3 credits), DNP Capstone (6 credits), Health Systems Transformation (3 credits), Financial Management & Budget Planning (3 credits).

Here are the clinically useful courses: Population-Based Approach to Healthcare (3 credits), Clinical Pharmacology and Interventions for Advanced Practice Nursing (3 credits), Managing Common Acute and Chronic Health Problems I (3 credits), Selected Topics in Advanced Pathophysiology (3 credits), Diagnostic Reasoning & Physical Assessment in Advanced Nursing Practice (4 credits), Common Acute and Chronic Health Problems II (3 credits), Sexual and Reproductive Health (2 credits), Nurse Practitioner Residency: Adult Primary Care (3 credits), Electives (12 credits).

So, out of the 73 credits needed to go from BSN to DNP, 37 credits are not clinically useful. In addition, the number of required clinical hours is 612 hours (unless I miscounted something)!! Wow! And the NP program is designed the same way, with a bunch of fluff courses (11 credits out of 43 required are fluff) and requires 612 hours as well: http://nursing.duke.edu/wysiwyg/down...rriculum_2.pdf

Here are the curricula to several other programs:

* University of Arizona: http://www.nursing.arizona.edu/OSA/P...ndout_2008.pdf 31/74 credits are fluff.
* Loyola's MSN to DNP: http://www.luc.edu/nursing/dnp/curriculum.shtml (where are the basic science classes? They're all public health classes!!)
* MGH BSN to DNP: http://www.mghihp.edu/nursing/postpr...ulum.html?cw=1 (35/72 credits for Adult DNP are fluff while 46/83 credits for DNP in FM are fluff)

It's kinda scary how inadequate that training is in order to practice medicine independently. You can't really count prior nursing experience as time practicing medicine because you weren't practicing medicine during that time nor were you thinking in a medical manner (ie. the way a physician would). Nursing clinical hours might help you transition into medicine but they are NOT a replacement for medical clinical hours.

Now, just for comparison, let's look at a med school curriculum. I'll point out all the fluff courses here too. Here's an example from Baylor School of Medicine for M1/M2 (http://www.bcm.edu/osa/handbook/?PMID=5608) and for M3/M4 (http://www.bcm.edu/osa/handbook/?PMID=7463):

Fluff courses at Baylor School of Medicine during M1/M2 years ONLY: Patient, Physician, and Society-1 (4.5 credits), Patient, Physician, and Society-2 (6 credits), Bioethics (2.5 credits), Integrated Problem Solving 1 & 2 (10 credits).

Useful courses at Baylor School of Medicine during M1/M2 years ONLY: Foundations Basic to Science of Medicine: Core Concepts (14.5 credits), Cardiovascular-Renal-Resp (11.5 credits), GI-Met-Nut-Endo-Reproduction (14 credits), General Pathology & General Pharmacology (6.5 credits), Head & Neck Anatomy (4.5 credits), Immunology (5 credits), Behavioral Sciences (6.5 credits), Infectious Disease (13 credits), Nervous System (14 credits), Cardiology (4.5 credits), Respiratory (3.5 credits), Renal (4 credits), Hematology/Oncology (5 credits), Hard & Soft Tissues (3 credits), Gastroenterology (4 credits), Endocrinology (3.5 credits), GU/Gyn (3 credits), Genetics (3 credits), Age Related Topics (2.5 credits).

For only the M1/M2 years at Baylor, there's 162.5 total credits. Out of these 162.5 credits, 23 credits are fluff.

Core Clerkships during M3 (useful clinical training): Medicine (24 credits, 12 weeks), Surgery (16 credits, 8 weeks), Group A selective (8 credits, 4 weeks), Psychiatry (16 credits, 8 weeks), Neurology (8 credits, 4 weeks), Pediatrics (16 credits, 8 weeks), Ob/Gyn (16 credits, 8 weeks), Family & Community Medicine (8 credits, 4 weeks), Clinical Half-Day (includes Clincal Application of Radiology, Clinical Application of Pathology, Clinical Application of Nutrition, Clinical Evidence Based Medicine, Longitudinal Ambulatory Care Experience, and Apex -- 23 credits).

So, without even taking into consideration M4 electives and required subinternships (which are usually in Medicine and Surgery), medical students already have a far superior medical training than NPs or DNPs. Other examples of med school curricula:

* UMich M1/M2: http://www.med.umich.edu/lrc/medcurr...gram/m1m2.html
* UMich M3/M4: http://www.med.umich.edu/lrc/medcurr...gram/m3m4.html
* Duke: http://medschool.duke.edu/modules/so...index.php?id=2

You can get a BSN to DNP in about 3 years according to many programs I've looked at. Medicine involves 4 years of medical school and a minimum of 3 years of residency before allowing independent practice. Here's the math:

BSN to DNP: 2.5 - 3 years of training; longer if courses taken part-time; 600-1000 clinical hours!
BS/BA to MD/DO: 4 years med school + 3-5 years residency: 7-11 years of training; not possible part-time; clinical hours > 17000
So, as you can see, NPs/DNPs seem to receive less than 25% of the clinically relevant training that physicians get. It would be literally impossible for NPs/DNPs to gain the same level of knowledge as an attending physician in the same specialty; the rigorous training a physician goes through is there to ensure a high level of competency. Fourth-year med students have more basic science and clinical training than NPs/DNPs receive. Should we allow M4s to practice independently? Shortcutting through that under the guise of "patient care" is deceptive.

Is that good enough evidence for ya?

I am also truly appreciative that you pointed out which of the nursing courses are useful and which are not, and which of the Baylor courses are useful and which are not. Since you are not a nurse, I would wager that pretty much all of the nursing courses will never be useful to you, am I right? You did pick out a few, though, which is kind of cute. Kashuik, have I ever told you how cute you are? Well you are very sweet, all your passion...
 
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I totally LOLed at this it is so funny. You are so totally right that medical students get more hours studying medicine than nurses get for their nursing degrees. How can that be? I am shocked beyond belief. Can you try to use more of the correct, medical kind of science that is hard to understand here because it is unclear what point other than the obvious you are getting at.

I had to get help with the big, medical words, but it looks to me that your post proves that you spend many, many idle hours trolling nursing program websites copying and pasting curriculum from programs, then add up lots of credit hours and calculate percentages and multiply things. Most guys are more interested in the pictures of the lady nurses.

Why would you do that?
Sure, I'd be more than glad to spell it out for you. :)

When NPs/DNPs claim to be equivalent to physicians (as a lot of quotes in past and recent articles suggest), you would expect them to have a similar level of training. Unfortunately, even a cursory glance at NP/DNP curricula reveals that there is a vast difference in training. I can assure you it did not take me hours to put together that post, nor do I troll nursing websites. A simple search was revealing enough. It doesn't take rocket science to realize that nursing activism, stats, nursing theory, business management, DNP capstone, etc courses do not contain any clinically relevant information.

I can understand that you've found it amusing that physicians receive much greater medical training than nurses. Unfortunately, NPs/DNPs are blurring the lines between nursing and medicine and are essentially practicing medicine while calling it advanced practice nursing. You can't say you're equivalent to a physician and then say you're practicing nursing. I'm sorry. You can't have it both ways.

Hope this clarified things for you!
 
Every second that this thread, with this title, exists... is a moment that makes me feel even sadder for the state of medicine in America.

Just having some good, clean medicine fun shooting flames out my fingers and looking for a victim to slay with my sub-par knowledge...

Fortunately, I cannot figure out where these bizarre, hostile nurse-hating-resenting-disparaging people come from, because as far as I know, they don't exist in the real world where they have to show their faces and reveal their names and credentials. I truly believe they are few and far between. Most all I have met are pretty nice and not as willing as I to step in the ****.
 
Well, I never, ever said that did I? And someone like I who wastes far too much time on this message board posting inane **** on useless, unimportant topics has not much of a leg to stand on calling you out for spending time on websites adding up nursing credit hours.

Really, did you have a traumatic encounter with a nurse practitioner who ***gasp*** dared to masquerade as a real doctor? No wonder you are so... upset about this stuff. Maybe all y'all should start a support group so you can share your outrage at these renegade nurses who are trying to f**k you up, and you will feel at peace that finally some real, smart, top-notch people who matter are actually taking this stuff seriously.

Sure, I'd be more than glad to spell it out for you. :)

When NPs/DNPs claim to be equivalent to physicians (as a lot of quotes in past and recent articles suggest), you would expect them to have a similar level of training. Unfortunately, even a cursory glance at NP/DNP curricula reveals that there is a vast difference in training. I can assure you it did not take me hours to put together that post, nor do I troll nursing websites. A simple search was revealing enough. It doesn't take rocket science to realize that nursing activism, stats, nursing theory, business management, DNP capstone, etc courses do not contain any clinically relevant information.

I can understand that you've found it amusing that physicians receive much greater medical training than nurses. Unfortunately, NPs/DNPs are blurring the lines between nursing and medicine and are essentially practicing medicine while calling it advanced practice nursing. You can't say you're equivalent to a physician and then say you're practicing nursing. I'm sorry. You can't have it both ways.

Hope this clarified things for you!
 
Just having some good, clean medicine fun shooting flames out my fingers and looking for a victim to slay with my sub-par knowledge...

Fortunately, I cannot figure out where these bizarre, hostile nurse-hating-resenting-disparaging people come from, because as far as I know, they don't exist in the real world where they have to show their faces and reveal their names and credentials. I truly believe they are few and far between. Most all I have met are pretty nice and not as willing as I to step in the ****.

A lot of pre-meds/med students/residents/attendings are sore about the fact that nursing organizations are pushing for the right to use "Dr" in a clinical setting (for those with DNPs). Personally, I think it's outrageous. I'm not a nurse-hater, but I would not tolerate a nurse attempting to pass herself/himself off as a doctor IN A CLINICAL SETTING just because they got a doctorate in NURSING. By the time I'm an attending, I will have spent 10 years in college (undergrad, masters, med school) and at least 3 in residency, working 80 hrs a week to learn to care for my patients. I do NOT want an NP telling my patient anything to give them the idea they have an equivalent education/training.

You're taking things too personally here. Kaushik isn't necessarily saying that YOU said these things, he's talking about DNPs as a whole because of the agendas put forth my their organizing bodies. Like it or not, many NPs and DNPs actually contend that they are equivalent to Drs. This has even shown up in journalism reports from major news sites! DNPs telling patients they are "just like doctors but see patients as a whole person," meanwhile claiming patients know the difference. It's all just hogwash. Nursing is nursing, medicine is medicine. Blurring the lines is a stupid idea.
 
First off,

I think that comparing roles is important when looking at pay scales. When you compare a resident to a PA/NP you realize that the resident is

1) More educated
2) Works more hours
3) Is given more responsibility

It stands to reason that residents should therefore be making more than midlevels. While you may say that residents are training, these are post-graduate years, something a PA/NP does not do. Are you trying to tell me that a PA/NP in their first few years out is more prepared than a resident?

Reading your first paragraph tells me you are a bit uninformed. Yes, residents are not board certified but residents can put orders in for just about anything. They are entrusted with patient care when no attendings are around overnight often.

As for my experience with NP's and their knowledge, I work in a hospital with a fair number and my experiences have ranged from excellent to down right embarassing. For example, the NP that works in my department (Radiation Oncology), only covers patients/cases after all the residents cover at the request of the attendings. Why? Because attendings have stated over and over that the NP despite her decade of experience is not as knowledgeable as junior residents. While this is 1 example, I've worked at a few hospitals and multiple services and can say that this has been the case always. THe only exception I have seen is when 1 midlevel works with one attending always and knows their routine down pat, then things can be pretty efficient.

Actually when comparing roles and pay scales there is really only one important attribute. The ability to bill. The primary reason that there is a difference in pay scale is that NPs/PAs can bill for their services and residents cannot. I don't think that anyone disagrees that residents are horribly underpaid compared to their responsibility and work hours. However, when you look at sources of revenue, its limited to what Medicare pays for resident training. For NPs and PAs its limited to what they bring in for E/M services. The money for E/M services is almost always going to be more than what Medicare pays for resident training (even considering the hours residents work).

David Carpenter, PA-C
 
Reading your first paragraph tells me you are a bit uninformed. Yes, residents are not board certified but residents can put orders in for just about anything. They are entrusted with patient care when no attendings are around overnight often.

Wow, talk about uninformed. You need to learn something about reimbursement. At the moment, you're clueless.
 
First off,

I think that comparing roles is important when looking at pay scales. When you compare a resident to a PA/NP you realize that the resident is

1) More educated
2) Works more hours
3) Is given more responsibility

It stands to reason that residents should therefore be making more than midlevels. While you may say that residents are training, these are post-graduate years, something a PA/NP does not do. Are you trying to tell me that a PA/NP in their first few years out is more prepared than a resident?

Reading your first paragraph tells me you are a bit uninformed. Yes, residents are not board certified but residents can put orders in for just about anything. They are entrusted with patient care when no attendings are around overnight often.

As for my experience with NP's and their knowledge, I work in a hospital with a fair number and my experiences have ranged from excellent to down right embarassing. For example, the NP that works in my department (Radiation Oncology), only covers patients/cases after all the residents cover at the request of the attendings. Why? Because attendings have stated over and over that the NP despite her decade of experience is not as knowledgeable as junior residents. While this is 1 example, I've worked at a few hospitals and multiple services and can say that this has been the case always. THe only exception I have seen is when 1 midlevel works with one attending always and knows their routine down pat, then things can be pretty efficient.


What you stood next to a few and your attending slams then all the time? They don't know much because the attendings say so. I don't think that is a very reliable source. Even though they have a legal scope of practice, the attending refuses to let them practice their job and is constantly undermining them... imagine what fun it must be to work in those conditions. I have only seen this happen, and it is one of the reasons not to want that job, because too many of the MD docs still have their noses out of joint about it and can make it difficult to function. Try to think of this situation from the other person's POV and experience - having to constantly prove yourself and deal with difficult attitudes... I don't think all places are like that thankfully.

If a person is actually unreliable there must be a better way to handle that. I feel bad for them to have to put up with all that. It sounds awful.
 
What you failed to realize is that I wasn't criticizing nursing skills. NP's are claiming that they can practice independently which in my books fall into the practice of medicine. When it comes to practicing medicine, the training provided to a NP is inadequate when compared to that of a resident physician.

A grammar school student can tell that an NP has less medical education than a physician. That is not the point. When you use the word inadequate you are expressing your opinion, which comes across as very condescending. There is a difference between inadequate and different level of practice. "This person's training is inadequate for the job they are degreed and licensed for" is a very grandiose statement coming from a non-expert, even though it may actually be true - I do not know, but tend to disagree. Ive seen unreliable people hold all kinds of high-level jobs with a lot of responsibility MD and RN included.

What I was saying is that the licensing boards for Nurse Practitioners don't base their scope of practice decisions on the opinions of MD/DO's and especially residents or medical students, and that is understandably what I think really gets their noses out of joint, so instead of just saying that, as it would make them appear weak, as you see here, most on the MD/DO side go after nursing credibility on all levels instead. I have an idea that if the licensing boards were to include experts from the medical licensing side to at least consult, and give them a voice at the very least there may not be as much contention.

It is possible that has been attempted, and the resounding noise, as seen here on SDN, is one of outrage seeking to just shut them down and silence them. So you can see why they aren't interested. Plus, they really don't have to be. That's the way it is going to be.
 
A lot of pre-meds/med students/residents/attendings are sore about the fact that nursing organizations are pushing for the right to use "Dr" in a clinical setting (for those with DNPs). Personally, I think it's outrageous. I'm not a nurse-hater, but I would not tolerate a nurse attempting to pass herself/himself off as a doctor IN A CLINICAL SETTING just because they got a doctorate in NURSING. By the time I'm an attending, I will have spent 10 years in college (undergrad, masters, med school) and at least 3 in residency, working 80 hrs a week to learn to care for my patients. I do NOT want an NP telling my patient anything to give them the idea they have an equivalent education/training.

You're taking things too personally here. Kaushik isn't necessarily saying that YOU said these things, he's talking about DNPs as a whole because of the agendas put forth my their organizing bodies. Like it or not, many NPs and DNPs actually contend that they are equivalent to Drs. This has even shown up in journalism reports from major news sites! DNPs telling patients they are "just like doctors but see patients as a whole person," meanwhile claiming patients know the difference. It's all just hogwash. Nursing is nursing, medicine is medicine. Blurring the lines is a stupid idea.

I want to see you say all those outrage things you wrote in the first paragraph with a clown suit on. :laugh:
 
What I was saying is that the licensing boards for Nurse Practitioners don't base their scope of practice decisions on the opinions of MD/DO's and especially residents or medical students, and that is understandably what I think really gets their noses out of joint, so instead of just saying that, as it would make them appear weak, as you see here, most on the MD/DO side go after nursing credibility on all levels instead. I have an idea that if the licensing boards were to include experts from the medical licensing side to at least consult, and give them a voice at the very least there may not be as much contention.

I think part of the problem is that NP licensing boards take the same view as many of the leaders of the NP movement in that they are practicing nursing instead of medicine and therefore they do not need to consult physicians or any physician organizations regarding scope of practice. Many physicians feel that this is an issue because NPs are practicing medicine, period.

In addition, there is no unified body, standardized testing & standardized curriculum for NP or DNP students. Medical education, testing & curriculum (by comparison) is very standardized and has a common endpoint. It may not be perfect, but it does (for the most part - yes I know there are exceptions) produce competant physicians that have a comparable knowledge base. In contrast, a student in a direct entry NP program with little or no nursing experience has a different knowledge base than a critical care nurse with 5-10 years of experience who then becomes an NP (regardless of DNP vs. NP education).

I definitely agree that if licensing boards would be integrated with physicians & NPs then there would be more consensus. Until the liberal side of the DNP movement (who think DNP = physician) and the conservative side of the AMA (NP <<<<< MD) can move a little more towards the middle there won't be any progress.
 
I want to see you say all those outrage things you wrote in the first paragraph with a clown suit on. :laugh:

I would just settle for an intelligent debate between a real live representative of the AMA or even a physician and one of the leaders of the DNP movement. So far every TV interview has been a one-sided ad with people who frankly scare everyone.
 

It's not the fault of mid-levels at all. However, in medicine we are trying to be more fiscally responsible. My though is that if it's well accepted that residents are more educated, work more, and have more responsibility then some of the funds being spent on PA/NP should be shifted by institutions to their residents.

QUOTE]


What funds are you talking about? I thought residents were funded by our tax dollars not institutions ? Did something change?
 
I would just settle for an intelligent debate between a real live representative of the AMA or even a physician and one of the leaders of the DNP movement. So far every TV interview has been a one-sided ad with people who frankly scare everyone.


Add in a practicing NP who is reasonable and understands the role of NP vs. the role of physician vs. the role of an RN and you might actually be on to something :thumbup:
 
I can understand why all you MDs are so angry about this, but you are not going to eliminate the NP profession or restrict their scope anytime soon. instead of seething and insulting your NP colleagues, why don't you be proactive and help solve the problem? If NPs are really practicing medicine but are not educated enough, as you claim, then why not help educate them just like you educate med students and residents? Not in a structured, classroom setting of course, but just throughout the day. And treat them with respect so they aren't scared to ask you questions. The goal is to protect patients and make sure they get the best care possible.

The majority of medical training is clinical, and that is why MDs are such good clinicians. Also, the medical profession by nature involves life-long learning. Yes, maybe NPs don't get enough clinical hours in school to prepare them, but they also don't stop learning when they graduate. MDs can either facilitate that, or hinder it.

Unfortunately, there are not enough primary care docs to meet society's needs, and that is why the NP role was able to come into existence. So the argument that all patients should see MDs for primary care is irrelevant - there just aren't enough docs to go go around. Is it better for a patient to see an NP for their symptoms, or not see anyone because the last time they saw their MD PCP they only got 5 minutes of face time? That was my last check-up.

Currently, NPs can practice independently as PCPs, but I think one issue that has not been addressed here is when they can start doing that. I don't know the current regulations or statistics, but I think NPs should have to work in a hospital setting or at least in a physicians office for x number of years before doing that. In my opinion (and I am a future NP) an NP would be completely irresponsible to go straight from NP school to independent practice. Perhaps lobbying should focus on creating some sort of time period where hospital work is mandatory (which, I guess, is similar to a residency - further boundary blurring - sorry docs!)

Moral of the story, NPs are not going to go away. Medicine today is interdisciplinary, and that is not going to change. Our responsibility is to the patients, not to our professional boards and associations. Why don't we stop arguing what our roles are and resisting change, and do the best we can to treat patients?
 
I can understand why all you MDs are so angry about this, but you are not going to eliminate the NP profession or restrict their scope anytime soon. instead of seething and insulting your NP colleagues, why don't you be proactive and help solve the problem? If NPs are really practicing medicine but are not educated enough, as you claim, then why not help educate them just like you educate med students and residents? Not in a structured, classroom setting of course, but just throughout the day. And treat them with respect so they aren't scared to ask you questions. The goal is to protect patients and make sure they get the best care possible.

The majority of medical training is clinical, and that is why MDs are such good clinicians. Also, the medical profession by nature involves life-long learning. Yes, maybe NPs don't get enough clinical hours in school to prepare them, but they also don't stop learning when they graduate. MDs can either facilitate that, or hinder it.

Unfortunately, there are not enough primary care docs to meet society's needs, and that is why the NP role was able to come into existence. So the argument that all patients should see MDs for primary care is irrelevant - there just aren't enough docs to go go around. Is it better for a patient to see an NP for their symptoms, or not see anyone because the last time they saw their MD PCP they only got 5 minutes of face time? That was my last check-up.

Currently, NPs can practice independently as PCPs, but I think one issue that has not been addressed here is when they can start doing that. I don't know the current regulations or statistics, but I think NPs should have to work in a hospital setting or at least in a physicians office for x number of years before doing that. In my opinion (and I am a future NP) an NP would be completely irresponsible to go straight from NP school to independent practice. Perhaps lobbying should focus on creating some sort of time period where hospital work is mandatory (which, I guess, is similar to a residency - further boundary blurring - sorry docs!)

Moral of the story, NPs are not going to go away. Medicine today is interdisciplinary, and that is not going to change. Our responsibility is to the patients, not to our professional boards and associations. Why don't we stop arguing what our roles are and resisting change, and do the best we can to treat patients?

The problem is that you can't educate an NP if they are in independent practice. As irresponsible as it may be, there is absolutely nothing from preventing a direct-entry NP with no real amount of experience who did their education via the internet from going out and setting up shop (in some states). That's what physicians are concerned about.

No one is complaining about the current collaborative model where that does indeed happen (i.e. physicians educating NPs/midlevel providers). In addition, no one wants the role of an NP to go away. We need more practitioners, that's not an issue (everyone acknowledges that fact). Midlevel providers are very useful in primary care and you would be hard pressed to find anyone that would argue that. However, instead of ensuring that NPs can take over primary care, call them doctors, equal reimbursement, etc., what physicians want is to get more medical students into primary care because when it comes down to it a physician is the highest level of care and everyone wants to ensure that patients get the best care possible.
 
The problem is that you can't educate an NP if they are in independent practice. As irresponsible as it may be, there is absolutely nothing from preventing a direct-entry NP with no real amount of experience who did their education via the internet from going out and setting up shop (in some states). That's what physicians are concerned about.

No one is complaining about the current collaborative model where that does indeed happen (i.e. physicians educating NPs/midlevel providers). In addition, no one wants the role of an NP to go away. We need more practitioners, that's not an issue (everyone acknowledges that fact). Midlevel providers are very useful in primary care and you would be hard pressed to find anyone that would argue that. However, instead of ensuring that NPs can take over primary care, call them doctors, equal reimbursement, etc., what physicians want is to get more medical students into primary care because when it comes down to it a physician is the highest level of care and everyone wants to ensure that patients get the best care possible.

I'm not defending the NPs here, but all the direct entry NP programs I've seen require on site class and clinical with the first year to get your RN and the last 2 for the NP. The only online NP programs I've seen are post MS programs for RNs. Just sayin'.
 
I'm not defending the NPs here, but all the direct entry NP programs I've seen require on site class and clinical with the first year to get your RN and the last 2 for the NP. The only online NP programs I've seen are post MS programs for RNs. Just sayin'.
Accepting that this is the case (I'm not sure if there is various in direct-entry programs), can someone actually think that is enough training for INDEPENDENT practice? Direct entry and online training are both huge areas of concern (in my opinion).
 
While the billing issue is true, multiple studies have shown that residents generate income and save hospitals money to the tune of over 200,000 per year (1 current article is up in the general residency forum now). Further, residents often due work that ends up being billed, i.e the H + P that the attending then signs off and dictates to be billed. If you factor in what Medicare pays and what they generate, I would argue they should definately be better paid than a PA/NP.
I can't find the article you referred to but most of the people that I've talked to say that residencies at best make the hospital a little money. There are definitely hospitals that need residents to stay in business.

As far as attendings billing for work, that would be work that they normally would do. If they are billing for work that they didn't do (ie didn't participate in the critical portions of the encounter) then thats fraud. Hardly a good example.

Residents have advantages including the fact that they work more hours and more off hours than PA/NPs. Depending on where they are in their residency they will require less or more physician supervision.

PA/NPs have the advantage that they can bill with or without the physician being present. They also may have the advantage of institutional longevity.

Bottom line, under the current system collections will almost always be higher with a PA or NP than with a resident unless the system has a large amount of uninsured.

David Carpenter, PA-C
 
Accepting that this is the case (I'm not sure if there is various in direct-entry programs), can someone actually think that is enough training for INDEPENDENT practice? Direct entry and online training are both huge areas of concern (in my opinion).

MD INDEPENDENT practice

NP INDEPENDENT practice

Now, do they both mean the same thing? Anyone cleared that up yet or is the argument just over the word, "INDEPENDENT?"
 
I'm not defending the NPs here, but all the direct entry NP programs I've seen require on site class and clinical with the first year to get your RN and the last 2 for the NP. The only online NP programs I've seen are post MS programs for RNs. Just sayin'.


Very true. They are post-baccalaureate (for BSN holders) programs culminating in DNP degrees. That is just wrong for the level of autonomy they have and the pay they're lobbying for. These online doctorates don't have much in the way of further clinical education and training. There's no advanced training in some. But maybe they'll have a Nurse Residency (complete with matching) someday. :eek:

It's sad. PA programs aren't online and they aren't nearly as autonomous as the NP. I still believe that NP's are constantly seeking the easy way out. And ultimately those very shortcuts are going to hurt someone. All mid-level practitioners are necessary and do serve a very damn fine purpose.

For the most part, healthcare providers are paid according to a level of training and education received. An NP program, whether online or in a brick-and-mortar institution, usually lasts 3 years. Up until recently it was a master's degree. With perhaps little to no change in length in education or depth of knowledge it will be mandated that NP's migrate to the doctorate level. They'll want to be paid like a PCP to the tune of $140k or more as well. Maybe they should be, not for me to decide. Personally I believe Primary Care doctors are grossly underpaid.

I don't want to keep a gripe going. There's enough of that as is. I do have a PERSONAL war with a local CRNA (and very close and dear friend so lay off, we go at it often) and she does get under my skin. The biggest issue here between MD/DO vs NP is scope of practice. That directly will affect pay.

I would like to see the PA's regulate their training and be as aggressive as NP's. Their education seems more diverse. NP programs are the "foot wide and mile-deep" in that the degree is very much tailored into a specific area (FNP, ACNP, CNS, etc). PA's are the opposite in that they're a "mile-wide and foot deep". Covering a broader spectrum, which is perhaps why there isn't a specific "Emergency Room Physician Assistant" concentration (although I'm thinking you can prefer to specialize).

I see and hear a lot of shooting down of the ANA's proposal but no alternative solutions. I have one.

How about this: if an RN does in fact decide to become a Nurse Practitioner that's awesome! I'd like to see training programs do away with the specialties at the onset. Just be a DNP program. Have a one-year didactic portion to learn advanced sciences. Build upon prior undergraduate knowledge and follow with two years of clinical rotations. Then pass a certifying exam and allow the graduates to pursue various specialties and complete a requisite training program in their chosen field.

There's gonna be a few PA's scratching their head saying "that sounds like my training"..... In looking at it you may be right. You'd know better than I. Regardless of what anyone decides to pursue the keys are clear-cut definitions on scope, standardized training and standardized certification.

It seems that as of now the battle is in the fields of anesthesia (Anesthesiologist vs CRNA), Eye care (Ophthalmologist vs Optometrist) and primary care (IM/Peds/FP vs FNP/ACNP). No turf wars in surgery. No way you learn that online.

Please do away with the online schooling for advanced nursing care. Web-based education is fine for getting an MBA but not for learning how to care for people. You learn that by actually caring for people.

Perhaps I can be a paralegal and in a few years, get a doctorate and say that I can stand in front of a judge (or jury) and plead my case as well as a JD. Damn the state bar. To hell with torts, contracts, civ pro, con law, ethics and the like. Why learn about legal precedence? I am tired of making less than my supervisors and I do research along with many of the summer interns and 1st year associates. Only thing is I don't want to take the LSAT and go to law school for three years... I just want the same pay.
 
I can't find the article you referred to but most of the people that I've talked to say that residencies at best make the hospital a little money. There are definitely hospitals that need residents to stay in business.

As far as attendings billing for work, that would be work that they normally would do. If they are billing for work that they didn't do (ie didn't participate in the critical portions of the encounter) then thats fraud. Hardly a good example.

Residents have advantages including the fact that they work more hours and more off hours than PA/NPs. Depending on where they are in their residency they will require less or more physician supervision.

PA/NPs have the advantage that they can bill with or without the physician being present. They also may have the advantage of institutional longevity.

Bottom line, under the current system collections will almost always be higher with a PA or NP than with a resident unless the system has a large amount of uninsured.

David Carpenter, PA-C

http://www.aafp.org/online/en/home/...ident-student-focus/20090702acgme-tstmny.html

Family Medicine Leaders Urge ACGME to Resist Call for More Limits on Residents' Duty Hours
"The testimony from Epperly -- who also is program director and CEO of the Family Medicine Residency of Idaho -- and others came in response to recommendations contained in a report released by the Institute of Medicine, or IOM, in December 2008. In the report, the IOM recommended that continuous on-site duty periods for residents not exceed 16 hours unless a five-hour uninterrupted sleep period is provided between 10 p.m. and 8 a.m.
Other recommendations in the IOM report, "Resident Duty Hours: Enhancing Sleep, Supervision and Safety," proposed reducing residents' workloads and increasing the number of days they would have off each month.
The IOM estimated that the cost of shifting resident work to other clinicians to comply with the proposed changes would be $1.7 billion a year. A later report from the nonprofit research organization RAND Corp. and the University of California, Los Angeles, estimated those costs at $1.6 billion a year."
 
Please do away with the online schooling for advanced nursing care. Web-based education is fine for getting an MBA but not for learning how to care for people. You learn that by actually caring for people.

I would like to address this point. Online or distance education has a lot of research to back it up. Since those of us in healthcare tend to think EBM, then we need to consider the research in education. Granted there is a lot of negative opinions about distance education. Saying that PA schools or medical schools do not subscribe to distance education might just mean that they are years behind everyone else. Now, is there specific distance education research on NP programs. Probably not, but you have to look at the distance education research to make some kind of informed judgment. I'd love to see a comparison of tradition and distance ed students from the same school. But, I bet no one has done it yet. As my educator wife says, "If I teach a kid how to study for geography, they should be able to transfer those same concepts over to an English class."

I've done two masters, one in nursing and one in business. I'm now doing a post masters distance ed psych NP program. I'm trying to rack my brain trying to figure out if my education in learning to care for people has suffered.

I had two courses where I had to go on campus. One was one day during the first of two psychiatric interviewing classes and the second was two days of doing episodic physical exams.

I can see my instructors wanting to observe me interviewing a client. However, they videotaped the session. I could have done the same back home and sent them the video. For the physical exam class I had to video tape two exams as well as do the two days in person. It was nice meeting everyone on campus and having NPs from different areas do a review prior to us knocking out 4 exams and having a "live" pelvic exam. However, I'd just as soon sent in more videos of me doing physicals from my home 2,000 miles away. For, homework in that class, we had a lot of videos, including some of my favorites which were online at several medical school sites. Now, that I'm in clinical, has my education served me well? My physician preceptor told me he was impressed with my H & P skills but that I didn't have to "be so comprehensive in real life." He's also told me he has no trouble with my patient skills.

So, I'm trying to figure out what kind of classes must not be taught via distance education. Give em an example.

You learn how to care for people...then you actually care for them.

Would I like to see changes in NP education? You bet. As a psych person, I griped about learning how to do physical exams. I can see the benefits of learning it, and I'm having to do them here on a military base, but I've never seen a psychiatrist in civilian life even think about doing a physical exam. Personally, I'd have rather spent more time on differential conditions that cause psych symptoms.
 
I can understand why all you MDs are so angry about this, but you are not going to eliminate the NP profession or restrict their scope anytime soon. instead of seething and insulting your NP colleagues, why don't you be proactive and help solve the problem? If NPs are really practicing medicine but are not educated enough, as you claim, then why not help educate them just like you educate med students and residents? Not in a structured, classroom setting of course, but just throughout the day. And treat them with respect so they aren't scared to ask you questions. The goal is to protect patients and make sure they get the best care possible.

Jesus, this is ridiculous.

Hey guys, we're going to put out a bunch of nurses with joke degrees in hospitals and let them do your job...also make sure you catch them & correct them when they **** up or patients will suffer...it's all about patient care after all.

The majority of medical training is clinical, and that is why MDs are such good clinicians. Also, the medical profession by nature involves life-long learning. Yes, maybe NPs don't get enough clinical hours in school to prepare them, but they also don't stop learning when they graduate. MDs can either facilitate that, or hinder it.

In general, we're good people who will point someone in the right direction when they're off...and we come into contact with them. This is not the same as receiving clinical training (i.e. residency), this is just making sure people don't kill your patients. This informal "hey let's lend them a hand" is not the same as clinical training, and it's scary....SCARY that anyone's even asking us to "facilitate" this kind of bush-league medical practice.

Unfortunately, there are not enough primary care docs to meet society's needs, and that is why the NP role was able to come into existence. So the argument that all patients should see MDs for primary care is irrelevant - there just aren't enough docs to go go around. Is it better for a patient to see an NP for their symptoms, or not see anyone because the last time they saw their MD PCP they only got 5 minutes of face time? That was my last check-up.

Well, the only way we're REALLY going to tell how many people are getting hurt is by letting them go hog-wild with full autonomy, then do studies looking at relevant outcomes. It's unethical to just give some new treatment the benefit of the doubt and unleash it on the populace (especially when there's already evidence that it's really unlikely it's as good as the gold standard), likewise it's unethical to just say hey sure take some patients see how you do then if you **** up too bad we'll try to take away your autonomy later (yeah right).

Currently, NPs can practice independently as PCPs, but I think one issue that has not been addressed here is when they can start doing that. I don't know the current regulations or statistics, but I think NPs should have to work in a hospital setting or at least in a physicians office for x number of years before doing that. In my opinion (and I am a future NP) an NP would be completely irresponsible to go straight from NP school to independent practice. Perhaps lobbying should focus on creating some sort of time period where hospital work is mandatory (which, I guess, is similar to a residency - further boundary blurring - sorry docs!)

Well look - medical boards and specialty organizations have by far the most experience determining what components of knowledge, experience, and training are required to be a competent medical provider in a given field. What makes you think just throwing in a few years here or there in some hospital willy-nilly is sufficient, when doctors (the gold standard), are subject to RIGOROUS and high levels of scrutiny to become licensed and board certified? You know how we go about making sure everyone providing care is competent? We have them pass muster from the same, expert, experienced oversight body. And no, they're not going to be happy and willing to all of a sudden say sure, I know you didn't graduate from an LCME accredited medical school, I know you don't have a medical license, I know you never even took licensing exams, not a day in an ACGME residency, but I feel like you were a good nurse before you set your sights on contributing to the "nursing shortage", you seem pretty sharp and you spent a year working at St. Someplace Hospital, that should be fine, yeah why not.

Moral of the story, NPs are not going to go away. Medicine today is interdisciplinary, and that is not going to change. Our responsibility is to the patients, not to our professional boards and associations. Why don't we stop arguing what our roles are and resisting change, and do the best we can to treat patients?

Throw around as many fun buzzwords as you want, it doesn't change the fact that what is happening is COMPROMISING STANDARDS. If society is comfortable with that, then okay. If society really tells us, "look, we know you're all well-meaning but we really don't think a FP (or whatever else they choose to force themselves into) needs that much training and we're willing to take the risks on a lower standard of care and the fallout that may occur" for whatever reason, whether it's financial or access to care or whatever, then fine, we'll step aside (or be forced aside). If this were really an "interdisciplinary team", we wouldn't have members trying to jockey for higher position in the team like it's some kind of Machiavelli game.

And we ARE trying our best to treat patients the best we know how - and guess what? The PRIMARY reason we're upset isn't because we're ticked that you're trying to replace us with your lesser training and call yourself doctor and saunter around in your white coat and grin in our faces (although that is offensive and causes resentment), it's because we are trained to critically analyze care paradigms in a way that puts the burden of proof on the NEW, ALTERNATIVE treatment to prove itself as being as good as the gold standard, and that's the way it should be. We believe we give the best care to patients. We believe that a medical degree is necessary, a medical license is necessary, medical residency is necessary, and together they create doctors with the ability to treat patients in a way that is substantially better than having nurses with inflated degrees and fluffy buzzwords and lobby groups push for them to do our job too. Every indication suggests that independent practice NPs and the whole DNP concept is compromising on standards we use to train doctors and honestly, I really don't see how a person can sleep at night knowing they're part of it.
 
Well look - medical boards and specialty organizations have by far the most experience determining what components of knowledge, experience, and training are required to be a competent medical provider in a given field. What makes you think just throwing in a few years here or there in some hospital willy-nilly is sufficient, when doctors (the gold standard), are subject to RIGOROUS and high levels of scrutiny to become licensed and board certified? You know how we go about making sure everyone providing care is competent? We have them pass muster from the same, expert, experienced oversight body.

And yet you have the gold standard do this: My Navy chaplain friend just told me that two of his family practice physician buddies diagnosed him with pneumonia and gave him a paper sack of meds. My chaplain friend just didn't believe he had pneumonia so he went to a third FP. This guy didn't listen to my friend's chest through his shirt like the other two "cream of the crop" physicians did, but actually lifted his shirt, where he noticed an amazingly hairy chest. So sad indeed that such a basic mistake was made.

Do we need another Flexner report on medical education?
 
And yet you have the gold standard do this: My Navy chaplain friend just told me that two of his family practice physician buddies diagnosed him with pneumonia and gave him a paper sack of meds. My chaplain friend just didn't believe he had pneumonia so he went to a third FP. This guy didn't listen to my friend's chest through his shirt like the other two "cream of the crop" physicians did, but actually lifted his shirt, where he noticed an amazingly hairy chest. So sad indeed that such a basic mistake was made.

Do we need another Flexner report on medical education?

Yeah, I read your little anecdote in the other thread too. I'm not sure what you're trying to prove - we could probably go back and forth all day with stories about how everyone's incompetent. But if you're suggesting the medical field would benefit from more self-regulation and research, I wholeheartedly agree.

...hopefully the irony that no "Flexner report" even exists for DNP/advanced practice midlevels even in spite of the scary lack of standardization and....uh...."interesting" curriculum isn't lost on everyone. There's a reason the whole concept is under fire.
 
Would I like to see changes in NP education? You bet. As a psych person, I griped about learning how to do physical exams. I can see the benefits of learning it, and I'm having to do them here on a military base, but I've never seen a psychiatrist in civilian life even think about doing a physical exam.

Maybe, but don't think for a second that s/he in any way graduated from a US medical school without ever having done one.


Personally, I'd have rather spent more time on differential conditions that cause psych symptoms.

A psychiatrist (MD/DO) and most others, including myself, would agree with you. And they have done that. It's called a residency.
 
Mr Zenman, I have read some of your bio. A rather lengthy road. But I look and see this:

"After training as a medic I then challenged the California state boards and became a registered nurse...without going to nursing school. Working as a registered nurse was good practice for when I actually entered a program to become a registered nurse!"

You got a pass from CA to be a RN without attending a formal training course. You said you worked as an orderly not a nurse. How did you challenge the NCLEX-RN exam without graduating from an accredited program?
 
I would like to address this point. Online or distance education has a lot of research to back it up. Since those of us in healthcare tend to think EBM, then we need to consider the research in education. Granted there is a lot of negative opinions about distance education. Saying that PA schools or medical schools do not subscribe to distance education might just mean that they are years behind everyone else. Now, is there specific distance education research on NP programs. Probably not, but you have to look at the distance education research to make some kind of informed judgment. I'd love to see a comparison of tradition and distance ed students from the same school. But, I bet no one has done it yet. As my educator wife says, "If I teach a kid how to study for geography, they should be able to transfer those same concepts over to an English class."

This isn't specifically addressing NP programs, but it is a start.

Brown and Liedholm (2002) found significant differences between online and residential classroom learning. They compared three different introductory microeconomics classes-a live class, a hybrid class, and a virtual class. They found that scores on simple test questions were similar for the three classes, but students in the traditional class did much better on questions involving complex material. Most people would argue that prescribing is not cookbook, so more complex learning is needed to utilize the learned information, particularly the synthesis and application of the knowledge.
 
Mr Zenman, I have read some of your bio. A rather lengthy road. But I look and see this:

"After training as a medic I then challenged the California state boards and became a registered nurse...without going to nursing school. Working as a registered nurse was good practice for when I actually entered a program to become a registered nurse!"

You got a pass from CA to be a RN without attending a formal training course. You said you worked as an orderly not a nurse. How did you challenge the NCLEX-RN exam without graduating from an accredited program?

I believe at one time certain military medics were allowed to board as practical and perhaps registered nurses?
 
Yeah, I read your little anecdote in the other thread too. I'm not sure what you're trying to prove - we could probably go back and forth all day with stories about how everyone's incompetent. But if you're suggesting the medical field would benefit from more self-regulation and research, I wholeheartedly agree.

...hopefully the irony that no "Flexner report" even exists for DNP/advanced practice midlevels even in spite of the scary lack of standardization and....uh...."interesting" curriculum isn't lost on everyone. There's a reason the whole concept is under fire.

Why are you even using the word, "anecdote" here? What I'm suggesting is that if you scream "gold standard" too loudly, there are a lot of people who will confront you and say, "Well, this physician killed my xxxxxx" or "I love my PA/NP." I know it's the gold standard but it probably could benefit from a good one-over to see if it needs over-hauling...same goes for nursing.
 
Maybe, but don't think for a second that s/he in any way graduated from a US medical school without ever having done one.

Not saying this is one, but are there areas in medical education that could be cut...

A psychiatrist (MD/DO) and most others, including myself, would agree with you. And they have done that. It's called a residency.

And I'm on a unit seeing patients also...only I wished for a longer period of time. I do have a psychiatrist preceptor who keeps me from killing patients.:)
 
Mr Zenman, I have read some of your bio. A rather lengthy road. But I look and see this:

"After training as a medic I then challenged the California state boards and became a registered nurse...without going to nursing school. Working as a registered nurse was good practice for when I actually entered a program to become a registered nurse!"

You got a pass from CA to be a RN without attending a formal training course. You said you worked as an orderly not a nurse. How did you challenge the NCLEX-RN exam without graduating from an accredited program?

I went though an ARMY corpsman program and at that time, some medics were able to challenge CA and NY state boards. I just sat a pile of nursing books in front of me and read them all. Ironically, after finishing formal nursing school, I had to take the boards again. My scores were slightly lower.

I still have a pile of books around me, including this damn "Stahl's Essential Psychopharmacology." Sure glad it has a lot of pictures....
 
As a psych person, I griped about learning how to do physical exams. I can see the benefits of learning it, and I'm having to do them here on a military base, but I've never seen a psychiatrist in civilian life even think about doing a physical exam. Personally, I'd have rather spent more time on differential conditions that cause psych symptoms.

The Army psychiatrist that I did clinicals under at Fort Bragg would choke on this. He always did, and expected you to do, a good neuro exam in addition to the psychiatric exam on each of the patients as they were admitted. Not doing them is just as lazy as the example you cite of not lifting up the patient's shirt....
 
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