holy $hIt!!!Why isn't any of the AAD doing anything about this? Have you all heard about this? Are PD? the higher ups fighting this?
I haven't heard about this myself. Granted, it's not something we'd like to see, but having worked with mid-level care providers in dermatology, there's no comparison in terms of the knowledge base.Why isn't any of the AAD doing anything about this? Have you all heard about this? Are PD? the higher ups fighting this?
One deficiency in NP programs is dermatology education. There is no requirement for a standardized dermatology curriculum or practicum...Currently, there is minimal dedication toward dermatology training with respect to the clinical requirements of any advanced practice or nursing program. The Nurse Practitioner Primary Care Competencies in Adult, Family, Gerontological, Pediatric, and Women's Health by the U.S. Department of Health and Human Services (2002) do not specifically address the requirement for dermatologic curriculum and outcomes as a part of these specialty core competencies. In an earlier study that compared the ability of NPs to non-advanced practice dermatology and oncology nurses to detect melanoma and non-melanoma skin cancers, NPs had lower overall knowledge despite the higher level of formal education. The recognition of melanoma between the three groups was 54% to 68% sensitivity. Recognition of premalignant lesions and benign lesions scores were lower (Maguire-Eisen & Frost, 1994).
I Don't know how many people really follow through on these things (such as contacting the AAD). But, I think all of us need to contact them and spread the word about this as much as possible.I think someone already did. From the first post in that thread:
Ophtho resident here. I emailed the AAD about 5 hours ago. I'm not a member (obviously) so I just wrote a short email in the "contact us" section bringing the issue to their attention and sent it.I Don't know how many people really follow through on these things (such as contacting the AAD). But, I think all of us need to contact them and spread the word about this as much as possible.
With that second quote... could the AAD be involved in developing this program?
Appreciate the backupOphtho resident here. I emailed the AAD about 5 hours ago. I'm not a member (obviously) so I just wrote a short email in the "contact us" section bringing the issue to their attention and sent it.
We're not going down without a fight...
Sort them out by taking the initiative. Don't accept insurance, and that way society comes to associate government care with DNPs.Appreciate the backup
I have been following the thread in the general residency section with quite some interest. Obviously a lot of impassioned arguments there but I found SimulD's post to be the most calm and level-headed.
We can ultimately email the AAD and voice our displeasure as loudly as we want. But I have a feeling it will do little to stop the sprouting up of these programs.
In the end, we need to make sure we are providing the best possible quality care to our patients and if there's a way we can objectively prove that there is a difference between our care and independent mid-level care (I'm supremely confident there IS a difference), things will sort themselves out.
Given their performance on a dumbed down Step 3, asking them to take the derm boards would border on cruel and unusual punishmentIt would be interesting to have these DNPs fresh out of their program take the Derm Boards and compare scores to MDs fresh out of residency.
I'd love to see their "DNP degree" try to compete with the 260+ AOA brainiacs who are so prevelant in dermatology!Given their performance on a dumbed down Step 3, asking them to take the derm boards would border on cruel and unusual punishment
I believe it was just in the original post by ex-PCM, maybe he missed it as well.I clicked on the video and looked at the powerpoint presentation in PDF: http://health.usf.edu/nocms/nursing/AdmissionsPrograms/dnp_concentrations_derm.html
It's not the AAD (American Academy of Dermatology), it's the AADN (American Association of Dermatology Nursing). One letter makes ALL the difference in the world. Scary how much the video makes it seem like an advertisement for residency programs for physicians.
Where did they actually use the abbreviation AAD?
I'd love to see their "DNP degree" try to compete with the 260+ AOA brainiacs who are so prevelant in dermatology!
Their pass rate would hover < 1%.
As the anestheiologists have learned, superior education and service does not work. Political activism and actually doing something does work:don't take this lightly guys. to see how far this encroachment can really go , you just have to look as far as the rampant CRNA problem anesthesiologists deal with.
As the anestheiologists have learned, superior education and service does not work. Political activism and actually doing something does work:
1. Don't join a group that employs a "derm NP"
2. Don't join a university that trains them
3. Don't refer patients to a practice that employs or trains them (best way, especially if you let them know why they are losing your revenue)
4. Make sure you tell your PCP collegues that they are refering to a practice that has their patients seeing midlevels (maybe not initially, but on followup for sure)
5. Write the AAD now
6. Let the chairs/program directors who are training these NPs what you think
Easy to squelch now. We are the ones who are training them. Hard to squelch later.
Press Room / DNA in the News
DNA widens efforts to shine media spotlight on members and the dermatology nursing specialty.
You know the value of your work as a dermatology nurse. Now is the time to show it to the rest of the world.
DNA has an ongoing public relations program designed to get dermatology nurses in the news and gain exposure for the association. To do this, DNA National Office staff members contact reporters and editors in nursing, health care, and lay media, encouraging them to spotlight the role of dermatology nurses and the importance of this ever-changing specialty. DNA also sends press releases about the associations news and events to selected media lists.
News exposure helps fulfill one of the associations strategic goals: DNA and its members will be recognized and respected as experts in the field of dermatologic nursing care.
Getting in the news is always a challenge, and were asking you to help. Let us know if you have an idea to gain exposure for DNA, a DNA member, or dermatology nursing in general. You can contact Linda Woody ([email protected]; 856-439-0500). Linda will provide media training for you, and materials about DNA and dermatology nursing for the reporter. Also, please let Linda know if someone from the media calls you for an interview.
Your next question is most likely What is newsworthy? The foremost thing reporters and editors look for is something that affects many people. Some examples: a program to educate the public about skin cancer prevention; a new treatment for psoriasis; results of a research study on burns from laser hair removal; the effects of the iPledge program on Accutane patients. The media also looks for things that are unique, timely, and emotionally compelling.
DNA and its members have tremendous potential for media exposure, and there is increasing media interest in the specialty, according to DNA Past President Melodie Young, MSN, RN, A/GNP. She added that DNAs growing library of news clips demonstrates the value of our members to public information sources and will provide more opportunities for dermatology nurses to speak as experts in the field.
With today's nursing shortage, it has become essential to promote dermatology nursing practice, and nursing in general. Historically, nurses have been media shy and do not consider educating the public about nurses as part of their practice, but it is. It is up to you to help enlighten the world about what dermatology nurses do, as well as the importance of your role.
Shut them down early - we didn't do it with the CRNA-s...I posted this in the General Residency forum, but I wanted to stop by here in case you're missing out on the action.
Their organization is called Dermatology Nurses' Association (DNA)
The alphabets they hand out are:
DNC (Dermatology Nurse Certified)
DCNP (Dermatology Certified Nurse Practitioner)
.. . Finally, for our Derm colleagues, a sparkling gem:
In an acute manner, pressure needs to be exerted on four levels:
1. FSU Dermatology Program --> Contact dermatology physicians and residents at FSU. Unfortunately, this DNP program is going to hurt the reputation of FSU dermatology. It is only a matter of time before these DNPs will claim board certification (it will be a nursing board). Therefore, they will be FSU doctoral trained dermatologist residents who take boards at the end of residency. How does anyone in the lay public even differentiate a physician from DNP? If this goes unchallenged, it will spread.
2. Florida Medical Board --> Claiming competence in areas such as cutaneous oncology and basic dermpath is clearly the practice of medicine. At this point, I feel the only way to stop this may be in the courts. Similar to how pain medicine is hitting the courts to keep NPs out, we must be willing to do the same.
3. Academy of Dermatology --> They need to know that this is our #1 priority and future membership will be hit hard if they do not do everything in their power to effectively halt these programs. I have already contacted and spoken for an hour with the Washington office. I would suggest that you do likewise.
4. Residency Programs --> No one knows this is going on. We need to mobilize the residents across the country who actually have a stake in this fight. The older docs may not care as much because of obvious reasons, but the residents will be outraged when they find out about this.
* Disclaimer: If you can sit by and read these threads without doing anything, then you deserve what is coming to you no matter what field of medicine you are in. We need to take action right now. This matters TODAY! The problem is still at a level that can be managed if we ACT RIGHT NOW! If we can at least cut off physician support for these programs, then the battle will be won! ACT NOW!!!
Here is what I am hoping. I have created a petition letter (below) around this debate. I am hoping someone will edit it (it probably needs editing) and create it into a petition form (there are website out there to do this but I am unsure of how to do it). This way we can sign it online and send it around to everyone (medical students, attendings). I wrote this the best I could; please feel free to edit and change it around. This is as far as I can go with it but I feel it is a good start:
Dear Colleagues and Friends,
First, I want to say thank you for taking the time to read this letter and apologize for its length. I have written this letter for medical students, physicians, premedical students, patients, and their families. I hope you have the chance to read through it all and sign this petition.
The problem I am speaking to you about today is Doctors of Nurse Practitioning (DNP) and other nurse practitioners that are asking for medical equivalence in almost twenty-eight states around the United States. These practitioners serve a vital role in our healthcare system; however, the notion that these practitioners should be left to practice medicine alone and unsupervised throughout the country is scary to say the least. I will try to debunk some of the counterarguments and myths associated with this issue. There is a large amount of propaganda associated with this issue put out by various lobbying organizations that have a strong political agenda.
Myth 1: DNPs have equal to better outcomes than FP and other physicians. There have been very limited studies comparing the outcomes of DNPs and DO/MDs, most have significantly lacked power and have various endpoints. What should we measure as endpoints for patients in these studies---heart attacks? Strokes? High blood pressure control? Diabetes outcomes? This is an issue not easily solved, however, the fact that many organizations use that argument is both backhanded and incorrect.
Myth 2: The training of the DNP is equivalent to MD/DO. The average MD/DO goes through 4 years of undergraduate training, 4 years of medical school, 3-4 years of residency, and 1-2 years of fellowship. The DNP schooling requirements are not universal (aka they vary from institution to institution). Many of these programs can be completed completely online (never having to attend classes in person, one of many examples is the program at Ball State University). The path to be a DNP includes 4 years of undergraduate, 2 years for a Masters in Nursing, and the DNP program anywhere from 2-4 years (often part time). Comparing the number of years of training is 13-15 for MD/Dos, while the DNPs 8-11 years.
Myth 3: Many DNPs, advertise that they are board certified MDs must complete 3 sets of boards Steps 1-3, and then complete an individual exam for each specialty (e.g. a specialty exam for Dermatology or Rheumatology). Steps 1-3 consist of exams that are 8 hours in length and cover much of medical school in its entirety. The specialty specific exams are extremely intense and thorough and prepare practitioners to be leaders in their respective fields. DNPs recently undertook an exam to try and proof equivalence to MD/DOs. Essentially, it was a water-downed version of the medical boards Step 3 exam. (They have no equivalent examination to cover Steps 1-2). Only 50% of those that took the exam had a passing score (http://www.ama-assn.org/amednews/200...8/prl10608.htm).
Myth 4: Physicians are over trained for their job I have heard this argument often, and I feel the only way to dispel it is to give an example outside the realm of healthcare. I will give an example of my good friend John. John had always thought about law school but decided that it was too much time and energy. He worked as a paralegal for a patent law firm for 25 years and has gotten to know the business inside and out. He drafted documents, was involved even in negotiations and all aspects of the business. Now, should I ask John to be my patent attorney? Of course I shouldnt. He has much of the practical knowledge of the business (probably as good as an attorney in his office) but lacks a theoretical knowledge of the law. Therefore, his ability to adapt to new scenarios and difficulties will be severely limited. The axiom we must each understand is that that early in our training (in almost any career) we dont know how much we do not understand. Without that health understanding of our limited knowledge base we may be dangerous (in any career).
Myth 5: DNPs are only trying to fill the primary care void This is the argument I hear most often. However, the training new DNPs doesnt guarantee the appropriate distribution (thats right its a distribution of resources problem we have in healthcare) of healthcare resources. We need more primary care in rural and underserved areas and DNPs are just as likely not to practice in these areas as MD/DOs. The solution to this problem is increased debt forgiveness and payment for physicians (MD/DOs) to practice in areas that are underserved.
Myth 6: DNPs are only in primary care this will not effect me as specialized physician Many physicians are unfortunately terse and apathetic to one another. These are just some of the comments I have heard in my short medical career Family practice is easy, we dont need MD/DOs doing that. Mid-level practitioners are fine or Anesthesiology requires hours of sleeping with moments of panic, any nurse can handle that (in reference to CRNAs). I think each of us (because of our limited exposure to each field) do not understanding how much we dont know in terms of what it really requires to be a Family Physician or an Anesthesiologist. We must respect the knowledge and expertise of other physicians. But, to think that this will not/could not happen to your field is ignorant. Recently, DNPs tried creating Residency Programs that span 3-4 months (compared to the 3-4 years of Residency for MD/DOs) for Dermatology (http://health.usf.edu/nocms/nursing/...ions_derm.html). Clearly, the training in this program is no where near as rigorous as a MD/DO residency, and I hope you look at these programs in horror as these DNPs advertise themselves as Dermatologists
Final Thought: What would you do for your family members? I hope that I gave you some insight into some of the myths around this debate. Bottom line is that I like to live by one axiom in terms of medical treatment Would this care/intervention be good enough for my family member? (mother, father etc) If the answer is no than this is not something I can support. I cannot support these DNPs asking for independent practice and credentials that fake the public into believing their training is on equal par with physicians (MD/DOs). Please sign the below petition and we will be forwarding the petition to various news organizations. We are hoping to collect greater than five thousand signatures. Thank you for your support.
Your Concerned Future/Current Physicians.
P.S. I wrote this in hopefully an easy to understand way (aka not for physicians), so the general public could read it and understand what we were saying
I couldn't access the article you linked, so I don't have the context. However, depending on how he meant it, I wouldn't necessarily disagree. The well-trained PAs that I've worked with are about as good as an average resident at the beginning of their second year of training. But here's a couple of things to keep in mind:Interesting article about derm PAs:
"I look at PAs as having essentially the abilities of a second-year dermatology resident," he says.
Anyone else a little annoyed to hear this from the AAD President?
Please don't throw the PAs in with the NPs here. The PA model has the PA working under the supervision of a physician - PAs work for YOU to extend YOUR ability to care for patients, and to extend YOUR ability to make money. I'm sure everyone knows that, but seems like some folks resort to treating this like it is an issue with mid-levels in general, instead of being an issue with the DNP trying to expand into independent practice.4. Make sure you tell your PCP collegues that they are refering to a practice that has their patients seeing midlevels
This is nonsense IMO.Please don't throw the PAs in with the NPs here. The PA model has the PA working under the supervision of a physician - PAs work for YOU to extend YOUR ability to care for patients, and to extend YOUR ability to make money. I'm sure everyone knows that, but seems like some folks resort to treating this like it is an issue with mid-levels in general, instead of being an issue with the DNP trying to expand into independent practice.
This is nonsense IMO.
PAs are now lobbying to change their titles from "physician assistants" to "physician associates". Why do you think that is?
Read here . . .
PAs are learning from the nurses. This will not stop at the name change. Once they are associates they will ask to work independently.This is nonsense IMO.
PAs are now lobbying to change their titles from "physician assistants" to "physician associates". Why do you think that is?
Physician Associate: A Change Whose Time Has Come
A group of 50 prominent PAs have signed this open letter urging a name change.
Last updated on: April 13, 2010
Editor's note: The perceived inadequacy of the name "physician assistant" over the years has prompted numerous PAs to call for an official name change, without success. Now, however, 50 prominent PAs have staked their reputations by signing the following open letter urging a name change to "physician associate."
Click here to listen to a Webcast about the open letter.
We, the undersigned physician assistant leaders assert that the time to change the name of our profession has arrived. While we can debate much about a name change, we have all agreed to the below statements and thoughts. We also fully agree that the name change advocated below will advance the profession. We call on the leaders of the profession and all PAs to announce and start to implement this change as soon as possible. We are leaders who believe it is increasingly unwise to wait longer to make this long-needed change. Collectively, the below-signed PAs have given much of their lives to the profession and are dedicated to its advancement.
Why We Need a Change
Our profession's original name was physician associate. Physicians demanded that "associate" be changed on the grounds that it did not properly describe the desired scope of PA practice. Forty years later we have outgrown the "assistant" title. It no longer accurately represents the profession. It is inaccurate and confuses consumers. The title is misleading and carries negative connotations which we can and should avoid. As we move into a new model of healthcare delivery it is of the utmost importance that our profession's name accurately describes our role.
Why a Change Is Justified
The PA role is truly one of partnership; of association and collegiality. We work as associates and have for many years. Our profession's birth-name in 1965 was physician associate.
"Physicians assistant" is a generic term. It can mean anything: a person in the office that bills patients, a records assistant, the person that sets up and cleans the exam room, all the way to a certified, licensed PA. The profession must move from this generic name to one that aptly and more accurately describes our function.
In our society, "assistant" denotes a technical job, not a profession.
PAs are held to the same legal and medical standards as physicians.
The title is confusing and misleading to our patients and the public in general. Since the name practically guarantees that "physician assistants" will be confused with "medical assistants", patients are at risk of thinking they are receiving substandard care or expect that after the "assistant" a physician will also be seeing them. Most times this does not happen, nor does the physician or the PA expect it to happen. It is time to have the name mirror the reality that exists.
The internationalization of PAs is important to the profession. Having to explain that the common meaning of the name "assistant" under-represents our true practice is a barrier, in international forums, to full understanding.
The above problems also may keep prospective applicants and others away from becoming PAs as they would not want to go through extensive schooling only to become someone's assistant.
Almost all professions at the level of training of a PA (pharmacy, PT, OT, NP) are or soon will be at the doctorate level. Our education and practice is professional, as should be our title.
"Assistant" obscures the PA's true role in the practice. Physicians who might otherwise consider a PA do not hire one as they feel they need someone more than just another "assistant".
All professions should be able to name their profession. "Physician Assistant" both demeans and misrepresents our profession. It is time to claim the name that is both appropriate and our birthright and discard the one that was forced upon us.
The profession, ideally through the AAPA Board or HOD, should immediately adopt a policy that states that "Hereafter the profession will work to be retitled "Physician Associate," as it more accurately reflects the profession in the 21st century".
If the Board or House is reluctant to do this on their own, then the entire profession should be polled using the AAPA's full database.
This renaming can be done over a number of years, with the ability reserved to use either title in the interim if necessary, depending on state legislation, etc.
The PA profession should advise organized medicine that this change is not an effort for independent practice but is a move to more accurately describe the scope and status of the profession and place it at a level where it belongs. It should also be explained that the name physician associate had been chosen for us by organized medicine to represent the PA profession 45 years ago. PAs should stress that after 45 years of delivering quality medical care across the entire spectrum of practice, we are choosing a more appropriate name and that we would expect nothing less than the full support of organized medicine, which will also benefit from the change.
PA programs should include the name physician associate whenever possible--along with the title physician assistant if need be.
"Physician Associate" allows us continued use of the initials "PA", which are well-known to the public.
"Associate" does not imply that PAs are equal to physicians. Associate professors are not full professors. Associate deans are not full deans. There are precedents for this.
The profession should consider funding State-level efforts to effect this change