DNP versus MD?

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lawguil said:
I would love to see a system were the noun doctor is essentially eliminated. Surely, at this juncture, the term has been diluted. Medicine, dentistry, and the like are bachelors level degrees that have already gone through the inflation process. Now we have other less qualified clinicians who want to go through the process that physicians, dentists, and the like invented.

I would much rather see a system were we simply referred to ourselves as physician, surgeon, physical therapist, dentist, podiatrist, nurse, and the like. Would this help eliminate the confusion, inappropriate status and inflated degrees? Surely, it takes time for humans to de-program, but eventually, people would adjust, the system would identify who the real decision makers are and help eliminate this defiant system of political pandering that exists in our current healthcare climate.

Will it ever happen…probably not. It seems that nobody really wants to be viewed at face value.
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Even in this "system" it is confusing, why not go by your specialty. Orthopedic surgeon, cardiologist, vascular surgeon, peditrician, ect. Even MDs are so diverse in training that doctor or physician does not tell you what they do.

Many of the people that are bickering in this thread would bicker amongst there own. How many urologist argue with nephrologist about who is better at doing a bladder suspension, OR a spinal orthopedist and a neurosurgeon claming that they are the more qualified spinal surgeon.

I guess I'll say it again, judge the clinican not the letters behind the name.
 
Who here really thinks that this degree inflation is about ego boosting? 🙄

It's about money. Specifically, the right to bill independently.
 
Taurus said:
Who here really thinks that this degree inflation is about ego boosting? 🙄

It's about money. Specifically, the right to bill independently.
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FOR SURE!

Boosting the ego's of poor and unsuspecting clinicians and students is only part of the marketing sceme!
 
Dr_Feelgood said:
Even in this "system" it is confusing, why not go by your specialty. Orthopedic surgeon, cardiologist, vascular surgeon, peditrician, ect. Even MDs are so diverse in training that doctor or physician does not tell you what they do.

Many of the people that are bickering in this thread would bicker amongst there own. How many urologist argue with nephrologist about who is better at doing a bladder suspension, OR a spinal orthopedist and a neurosurgeon claming that they are the more qualified spinal surgeon.

I guess I'll say it again, judge the clinican not the letters behind the name.
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By the way, that's a good one. "Clinician". You should use "clinician" instead of "physician". That I agree on.
 
The idea of eliminating the term "doctor" is a the best one I have heard. However it is so firmly entrenched in our culture that it will never go away.
 
Taurus said:
PA's aren't that bad. They work under the medical model and I think that they respect each person's role.

My issue is more with the nurses. . I don't like "backdoor" doctors, period. It only requires a small fringe group to cause problems. Once this fringe group is able to lobby for expanded rights for themselves, everyone in that group gets the same rights.
Those bean counters in Washington, DC aren't stupid.

If you allow midlevels to take over your specialty, they will commoditize it. Medicare and insurance companies will start to say, "Gee, this is something that can be done by someone with just 2 years of training. If that's true, then I'm going to adjust my reimbursement levels to match your level of training."

I'll let you use your imagination to predict what DNP's will do to primary care.
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Using my imagination I see what would happen if you eliminated all of these backdoor doctors. As I understand it they are nearly 200,000 thousand “backdoor doctors” providing health care in the U.S. (PA, NP, CRNA, Midwife). I wonder why? Do you think it is secondary to the number of MDs actually seeking primary care positions? Even though a significant number of medical students claim they are seeking a role as a primary care provider, the last report I read had the real # around 4-7% once they actually graduate. These are not new numbers, these are the percentages since the early 90s and they are not improving over time.
Can you tell me who is going to provide care to all of these patients with the elimination of the "backdoor doctor"? Aren’t there continued reports of shortage of MDs now? I am not sure what you are trying to gain with an antagonist viewpoint towards these providers.
If these backdoor doctors are eliminated are you and your fellow MD colleagues willing to take a pay cut to do primary care?
 
KentW said:
I would not recommend that anyone continue to engage a member who has asked to have their account deleted (e.g., user name is "Guest.") You aren't going to get an answer.
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Psisci is gone???


😴
 
etf said:
i could be wrong, but i don't think an MD is considered a "doctorate degree" per se...which might be why going to medical school is considered your "undergraduate medical education" and that your internship/residency is your "graduate" work. then again, everyone goes through an internship/residency, so it might be a moot point. yet another reason to go for MD/PhD...
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What!!!?? Medical Doctor is not a doctoral degree!! You are very smart...:meanie:
 
prairiedog said:
Using my imagination I see what would happen if you eliminated all of these backdoor doctors. As I understand it they are nearly 200,000 thousand "backdoor doctors" providing health care in the U.S. (PA, NP, CRNA, Midwife). I wonder why? Do you think it is secondary to the number of MDs actually seeking primary care positions? Even though a significant number of medical students claim they are seeking a role as a primary care provider, the last report I read had the real # around 4-7% once they actually graduate. These are not new numbers, these are the percentages since the early 90s and they are not improving over time.
Can you tell me who is going to provide care to all of these patients with the elimination of the "backdoor doctor"? Aren't there continued reports of shortage of MDs now? I am not sure what you are trying to gain with an antagonist viewpoint towards these providers.
If these backdoor doctors are eliminated are you and your fellow MD colleagues willing to take a pay cut to do primary care?
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As long as there is direct physician supervision, I have no problem with midlevels. That was the original intent and the way it should be. Safety-wise, it's also the best for the patient.
 
Wasn't the original topic DNP vs. MD??​
 
hi taurus. although i am very new to this forum, i have read through the entire thread and have seen your opinions and points of view. i feel that your statement, "it is the nurses who are the insecure ones. They feel that they must create these artificial degrees to try to measure up to physicians...Sheesh, why don't they just go to medical school?" is unwarranted and just plain incorrect. as a soon to be new graduate nurse (looking to go on to become a CRNA or MD), i assure you we know the divsion between nursing and medicine. the creation of new degrees and programs is in no way trying to create "shortcuts" or "easy routes" to measure up to an MD. although advanced practice nursing degrees tend to lean more towards medical practice (as far as scope of practice and knowledge-base) it is still a nursing degree within the nursing field. to address the latter part of your statement, i would strongly consider you to reevaluate your negative attitude towards nurses. many individuals, like myself, realize the distinction between nursing and medicine. as a prospective medical student, i assure you that i do not feel i am "a step ahead" or anymore prepared than any other medical school applicant because of my background in nursing, because, as everyone knows, nursing does not equal medicine. i want to pursue medical school because i realize my scope of practice of a nurse does not equal the scope of practice of an MD, nor would i ever try to convince myself that it does. i just wish you could give a little more credit to the nursing population when it comes to your broad generalizations. although it may not measure up to medical school, nursing school is no easy walk through the park and a little more appreciation would be a step in the overall 'nurses-vs-doctors' conflict.
 
bsn2crnaormd said:
hi taurus. although i am very new to this forum, i have read through the entire thread and have seen your opinions and points of view. i feel that your statement, "it is the nurses who are the insecure ones. They feel that they must create these artificial degrees to try to measure up to physicians...Sheesh, why don't they just go to medical school?" is unwarranted and just plain incorrect. as a soon to be new graduate nurse (looking to go on to become a CRNA or MD), i assure you we know the divsion between nursing and medicine. the creation of new degrees and programs is in no way trying to create "shortcuts" or "easy routes" to measure up to an MD. although advanced practice nursing degrees tend to lean more towards medical practice (as far as scope of practice and knowledge-base) it is still a nursing degree within the nursing field. to address the latter part of your statement, i would strongly consider you to reevaluate your negative attitude towards nurses. many individuals, like myself, realize the distinction between nursing and medicine. as a prospective medical student, i assure you that i do not feel i am "a step ahead" or anymore prepared than any other medical school applicant because of my background in nursing, because, as everyone knows, nursing does not equal medicine. i want to pursue medical school because i realize my scope of practice of a nurse does not equal the scope of practice of an MD, nor would i ever try to convince myself that it does. i just wish you could give a little more credit to the nursing population when it comes to your broad generalizations. although it may not measure up to medical school, nursing school is no easy walk through the park and a little more appreciation would be a step in the overall 'nurses-vs-doctors' conflict.
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I'm glad that you respect each professional's role in the delivery of healthcare. That is what I have been saying all along. Again, my issue is when one group starts to blur those lines intentionally.

I admit that I use broad strokes to paint midlevels. I realize that may seem unfair. I'm sure the majority are content with the role and scope that were originally defined for them. It's the vocal fringe who rock the boat. However, once this fringe group lobbies successfully, the whole professional group gets the same benefits. If the majority would rein in their fringe members, then this discussion would be moot. By their reluctance or unwillingness to speak against their own fringe members, then the majority is passively cooperating with the fringe, probably in the hope of gaining expanded roles and scope. This is why I use broad strokes. If you become a midlevel, help rein in your vocal, militant members.

This thread was originally in the allopathic section. I made my points to raise awareness for future physicians. I suspect that some or many of you don't see the significance and consequences of expanded scope for midlevels. You may even think that it's even great. It's great, anyways, if you're a midlevel, but not as a physician.

Read this thread to get a sense of what expanded scope midlevels can do to a medical specialty. (It even happens to be about CRNA's. Isn't it ironic that CRNA's hate anesthesiologist assistants (AA's), who happen to also be midlevel anesthesia providers? Not really, because CRNA's look at them as competition. 🙄 ) Essentially, it becomes commoditized. Hard to believe, but medicine is a business. Oops, I said the "b" word. Medicine follows simple supply and demand economics, like any other industry in the world. That's why I am so vehemently against increasing the supply with midlevels. If the supply is low, we need to produce more physicians, not midlevels. If you grant a midlevel group privileges to help alleviate the supply shortage, do you think that they want to ever give it up?

http://gasforums.studentdoctor.net/showthread.php?t=382950

The saying that it is very important to pick your specialty wisely is probably truer now than ever before.

bsn2crnaormd said:
although advanced practice nursing degrees tend to lean more towards medical practice (as far as scope of practice and knowledge-base) it is still a nursing degree within the nursing field.
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Uh huh. 🙄 If it walks like a duck and quacks like a duck...

This will be my last post on this topic.
 
allosteric1 said:
The idea of eliminating the term "doctor" is a the best one I have heard. However it is so firmly entrenched in our culture that it will never go away.
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Perhaps with time, but maybe not. However, if healthcare personnel are trained and required to eliminate doctor as part of the title or greeting, might it more accurately identify to the patient who they are seeing.

Example: Hi, my name is Grant Thurmond, I'm a physician here at the clinic. What seems to be the problem?

Or, Hi, I'm Bill, a nurse or nurse practitioner, nice to meet you. I'm just going to take your blood pressure and ask you a few quick questions before the physician come in to see you.

Or high, I'm a medical student and I will perform a quick evaluation on you. After I'm done, the physician will be in to review my evaluation and findings.

Or, in the hospital, when a medical emergency is occurring, perhaps this system would eliminate any confusion that may exist. The fact is, too many people now think they are "doctors" and have inappropriately been awarded doctorate degrees. Since it's illegal in most states to miss-represent yourself as something that you are not, folks who are not physicians are not going to go around saying they are physicians. But many certainly don't mind saying they are doctors because of the degree inflation that is and has occurred.

If patient safety is really a concern, shouldn't the most direct and un-ambiguous system be used?

If your patient responds by calling you doctor, who cares. At the very least, it would eliminate confusion amongst hospital and clinical staffs and the patient would understand that there Dr. Physical Therapist who visited them in the hospital wasn’t an MD.

Does anybody really care about being called doctor anymore? I honestly think the best way for physicians to defend there profession is to just stop using the term. Once word got out to patients that physicians were going to stop using the term doctor and only call themselves physician to avoid confusion and expose those professions that were deliberately trying to blur the differences….well, patients might question a clinician when they introduced themselves as a “doctor”. Seriously, this might be the answer!
I seriously think this could catch on if it is marketed correctly. If you provider doesn’t introduce themselves as physician, physician assistant, nurse or whatever: patients beware!
 
lawguil said:
Perhaps with time, but maybe not. However, if healthcare personnel are trained and required to eliminate doctor as part of the title or greeting, might it more accurately identify to the patient who they are seeing.

Example: Hi, my name is Grant Thurmond, I'm a physician here at the clinic. What seems to be the problem?

Or, Hi, I'm Bill, a nurse or nurse practitioner, nice to meet you. I'm just going to take your blood pressure and ask you a few quick questions before the physician come in to see you.

Or high, I'm a medical student and I will perform a quick evaluation on you. After I'm done, the physician will be in to review my evaluation and findings.

Or, in the hospital, when a medical emergency is occurring, perhaps this system would eliminate any confusion that may exist. The fact is, too many people now think they are "doctors" and have inappropriately been awarded doctorate degrees. Since it's illegal in most states to miss-represent yourself as something that you are not, folks who are not physicians are not going to go around saying they are physicians. But many certainly don't mind saying they are doctors because of the degree inflation that is and has occurred.

If patient safety is really a concern, shouldn't the most direct and un-ambiguous system be used?

If your patient responds by calling you doctor, who cares. At the very least, it would eliminate confusion amongst hospital and clinical staffs and the patient would understand that there Dr. Physical Therapist who visited them in the hospital wasn’t an MD.

Does anybody really care about being called doctor anymore? I honestly think the best way for physicians to defend there profession is to just stop using the term. Once word got out to patients that physicians were going to stop using the term doctor and only call themselves physician to avoid confusion and expose those professions that were deliberately trying to blur the differences….well, patients might question a clinician when they introduced themselves as a “doctor”. Seriously, this might be the answer!
I seriously think this could catch on if it is marketed correctly. If you provider doesn’t introduce themselves as physician, physician assistant, nurse or whatever: patients beware!
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I agree with the spirit but I think every physicians need to clarify their training. I would not go to a physician trained in OB-GYN for a prostate issue. They have very little training in the area. I think it works best to say Herbie Hancock, kidney physician or nephrologist.

A great example is I am rotating with a group of vascular surgeons. A patient comes in today to get follow up care for a stroke.
The doctor says, " Told your neurologist that I could not operate on your husband's carotids."
The patient's wife says, " I thought you were the neurologist. Who should we talk to."
Vascular surgeon, "I'm just a surgeon. A neurologist was working with you in the hospital."
Patient's wife, "How were we supposed to know who did what?"
Vascular surgeon, "I don't know but there is nothing I can do for you."

That is patient confusion and they were both MDs. We need clarification of specialty not just doctor or physician.
 
Dr_Feelgood said:
I agree with the spirit but I think every physicians need to clarify their training. I would not go to a physician trained in OB-GYN for a prostate issue. They have very little training in the area. I think it works best to say Herbie Hancock, kidney physician or nephrologist.

A great example is I am rotating with a group of vascular surgeons. A patient comes in today to get follow up care for a stroke.
The doctor says, " Told your neurologist that I could not operate on your husband's carotids."
The patient's wife says, " I thought you were the neurologist. Who should we talk to."
Vascular surgeon, "I'm just a surgeon. A neurologist was working with you in the hospital."
Patient's wife, "How were we supposed to know who did what?"
Vascular surgeon, "I don't know but there is nothing I can do for you."

That is patient confusion and they were both MDs. We need clarification of specialty not just doctor or physician.
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Makes sense to me! I'm a family physician, i'm an ortho surgeon, I'm a general surgeon..................
 
emedpa said:
sure, we can all be "clinicians" 🙂
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No, I'd vote to eliminate that, too. We should call people what they are. I'm a family physician. You're an emergency medicine PA. There's nothing confusing or ambiguous about that. 😉
 
Dr_Feelgood said:
I agree with the spirit but I think every physicians need to clarify their training. I would not go to a physician trained in OB-GYN for a prostate issue. They have very little training in the area. I think it works best to say Herbie Hancock, kidney physician or nephrologist.

A great example is I am rotating with a group of vascular surgeons. A patient comes in today to get follow up care for a stroke.
The doctor says, " Told your neurologist that I could not operate on your husband's carotids."
The patient's wife says, " I thought you were the neurologist. Who should we talk to."
Vascular surgeon, "I'm just a surgeon. A neurologist was working with you in the hospital."
Patient's wife, "How were we supposed to know who did what?"
Vascular surgeon, "I don't know but there is nothing I can do for you."

That is patient confusion and they were both MDs. We need clarification of specialty not just doctor or physician.
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Hence, "podiatrist" is a better term than "physician" or "podiatric physician". It's simpler, more descriptive, less confusion.
 
Northerner said:
Hence, "podiatrist" is a better term than "physician" or "podiatric physician". It's simpler, more descriptive, less confusion.
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You must not read my posts. Since the beginning I have stated that we should all list our specialty.

But really more descriptive? I believe that a podiatric physician is more descriptive. You do realize that there are podiatric surgeons and podiatric physicians. So to just say podiatrist does not describe what they do. But you would rather split hairs.
 
KentW said:
But "podiatrist" is a lot easier to say. 😉

It's also quite descriptive. Adding "physician" to the end of it seems rather superfluous.
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I did not disagree with that. But as I stated many pods don't do surgery, or rarely do surgery. Some work as wound care specialist and are really into diabetic foot care. Others are big into orthopedics and foot surgery. So there really are podiatric physicians who use palliative care to treat LE pathology, and others that believe everyone will heal with steal. Some podiatrist a mix of each. That being said I could care less about the physician title (as I have always stated) I care more about using the term podiatric medical school. It is not Hogwarts and we are not magicians (I think that is called naturopathy :laugh: ). I just using Northerns logic against him.
 
Dr_Feelgood said:
I did not disagree with that. But as I stated many pods don't do surgery, or rarely do surgery. Some work as wound care specialist and are really into diabetic foot care. Others are big into orthopedics and foot surgery. So there really are podiatric physicians who use palliative care to treat LE pathology, and others that believe everyone will heal with steal. Some podiatrist a mix of each. That being said I could care less about the physician title (as I have always stated) I care more about using the term podiatric medical school. It is not Hogwarts and we are not magicians (I think that is called naturopathy :laugh: ). I just using Northerns logic against him.
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Well, I guess you're right. Why don't we all list a paragraph and a half after our names to REALLY be descriptive.

Instead of "dentist", we'll say "dental practitioner specializing in tooth care, cavity diagnosis, dental x-ray interpretation, and semi-surgical procedures involving the teeth." More descriptive. And it has a nice ring to it.
 
Northerner said:
Well, I guess you're right. Why don't we all list a paragraph and a half after our names to REALLY be descriptive.

Instead of "dentist", we'll say "dental practitioner specializing in tooth care, cavity diagnosis, dental x-ray interpretation, and semi-surgical procedures involving the teeth." More descriptive. And it has a nice ring to it.
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OK, but can it fit on a business card? 😕 😕 :laugh:
 
Northerner said:
Well, I guess you're right. Why don't we all list a paragraph and a half after our names to REALLY be descriptive.

Instead of "dentist", we'll say "dental practitioner specializing in tooth care, cavity diagnosis, dental x-ray interpretation, and semi-surgical procedures involving the teeth." More descriptive. And it has a nice ring to it.
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On-site property management including pest control, night-time security, non-arboreal gardening services, and tenant-related easements and liens.
 
jonwill said:
OK, but can it fit on a business card? 😕 😕 :laugh:
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Yeah, but the text has to wrap all the way around the card, spiralling down as it goes to allow several throws. The real question is, since everyone's wearing white coats these days, will Joe be able to fit "Healthcare specialist with expertise in diet portioning and proper preparation and administration of key nutritional components" over his breast pocket on that new white coat he proudly wears as he slops gravy onto half-cooked jiggling "chicken"....
 
You're all forgetting that you also have to specify your education as well.

So instead of "dentist", they'll say "dental practitioner specializing in tooth care, cavity diagnosis, dental x-ray interpretation, and semi-surgical procedures involving the teeth. I spent two years in preschool, one in kindergarden, twelve in primary education, four years in an accredited college and then four years in an accredited dental school. " Now that's MUCH more descriptive.
 
jonwill said:
OK, but can it fit on a business card? 😕 😕 :laugh:
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Biz cards need to keep it simple....how about, "Tooth Guy"!

:laugh:

I like the idea proposed above, though there will always be some people who don't know what some of the specialty areas are. Though it is tough to do everything to the lowest common denominator.

-t
 
Adcadet said:
You're all forgetting that you also have to specify your education as well.

So instead of "dentist", they'll say "dental practitioner specializing in tooth care, cavity diagnosis, dental x-ray interpretation, and semi-surgical procedures involving the teeth. I spent two years in preschool, one in kindergarden, twelve in primary education, four years in an accredited college and then four years in an accredited dental school. " Now that's MUCH more descriptive.
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HOW DARE YOU?! It's "dental medical school" you insensitive prick!!!!
 
Primary care docs don't have to make small salaries...

It's so easy, if you're a fam practice with a little biz sense, to clean house.

It's all about marketing and business practices.

Who said you have to take medicare/medicaid? Why not just take a $75 co-pay for every 30 min of practice like that guy in the NPR article? He said he banks $144k a year with a half-time FP practice, and does pro-bono the rest of the time.

Goodness, smart biz practice amongst doctors would really go a long way in helping cover the uninsured, not to mention decrease ER strain, and increase everyone's salaries...But, alas, med schools are more interested in teaching other things than the dirty "b word".

prairiedog said:
Using my imagination I see what would happen if you eliminated all of these backdoor doctors. As I understand it they are nearly 200,000 thousand “backdoor doctors” providing health care in the U.S. (PA, NP, CRNA, Midwife). I wonder why? Do you think it is secondary to the number of MDs actually seeking primary care positions? Even though a significant number of medical students claim they are seeking a role as a primary care provider, the last report I read had the real # around 4-7% once they actually graduate. These are not new numbers, these are the percentages since the early 90s and they are not improving over time.
Can you tell me who is going to provide care to all of these patients with the elimination of the "backdoor doctor"? Aren’t there continued reports of shortage of MDs now? I am not sure what you are trying to gain with an antagonist viewpoint towards these providers.
If these backdoor doctors are eliminated are you and your fellow MD colleagues willing to take a pay cut to do primary care?
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I'm not just basing my idea of fam practice dudes cleaning house based on the NPR (yuck) article. I know quite a few who have done urgent care/cash only practices, who are also integrating low-cost technology to drastically reduce overhead.

It's really not that difficult if you know what you're doing.
 
MacGyver said:
DNP is too new for anybody to know how to deal with it yet.

My guess is that the national nursing organizations, after they start putting out DNP grads, will start demanding FULL equivalence with doctors.

in other words, they will start sueing hospitals if only MDs are allowed to be dept chairs, or if DNPs are not allowed to do surgery.

Although NPs can do most of what primary care docs do, there are a couple of "last bastions" namely surgery that are closed to NPs. I believe that the national nursing organizations dreamed up the DNP program so they could infiltrate the remaining few areas that are closed to them.
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Oh boy, this would be the most hilarious thing ever. I think after that occurs they would have to close down all the DNP schools due to the obvious mass stupidity of its graduates 😆 :laugh:
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The Louisiana Supreme Court have stepped in to thwart scope expansion by CRNA's into pain management which is a medical specialty:

http://www.asahq.org/Newsletters/2007/05-07/stateBeat05_07.html

The Louisiana Supreme Court denied the Louisiana State Board of Nursing's petition to review the lower court's decision. The lower court ruled that the board's statement was a rule, subject to the Louisiana Administrative Procedures Act, and issued a preliminary injunction against the nursing board and nurse anesthetist who sought the statement. The "statement" authorized nurse anesthetists to perform interventional pain management procedures (for background, see www.ASAhq.org/Newsletters/2007/02-07/stateBeat02_07.html). The Louisiana Society of Anesthesiologists (LSA) and ASA continue to monitor this lawsuit as there are several unresolved issues at the trial court level. Congratulations to LSA for its hard work!

If midlevels, especially nurses, push too hard for scope expansion, the courts may have the final say.
 
prairiedog said:
Do you really think the insurance industry won't have the "final" say?
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It will be multi-prong, no doubt. Judicial, insurance, lawyers, free market, etc.

Nurses are pushing to practice medicine without a medical license. That's unlawful and the courts can see that. Politicians can be influenced with PAC money, but the judiciary system cares only about the facts and arguments. There will be many more such battles in the future.
 
Taurus said:
It will be multi-prong, no doubt. Judicial, insurance, lawyers, free market, etc.

Nurses are pushing to practice medicine without a medical license. That's unlawful and the courts can see that. Politicians can be influenced with PAC money, but the judiciary system cares only about the facts and arguments. There will be many more such battles in the future.
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I am afraid the judiciary system is already heavily influenced by politics and $$$ and thus the insurance industry. Who appoints members to the judiciary system? The $$$ will cause any changes, look at California and Pennsylvania, they want to save $$$. There plans call for increased use of midlevels.
 
Taurus said:
It will be multi-prong, no doubt. Judicial, insurance, lawyers, free market, etc.

Nurses are pushing to practice medicine without a medical license. That's unlawful and the courts can see that. Politicians can be influenced with PAC money, but the judiciary system cares only about the facts and arguments. There will be many more such battles in the future.
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Taurus: I've read every one of your insulting and paranoid posts in this thread.

When you finally get your M.D. degree, and begin your internship, a time will come when what you will surely consider to be a "stupid" nurse can either save your bacon, or hang you out to twist in the wind when you make some mistake... and you will since your M.D. won't make you immune from error.

Personally, I'm hoping for a tornado that day.

Paraphrasing your statement "If I could, I'd do away with all midlevels, I would" is a real insight into your psyche... and is an indictment of your ignorance. Midlevels provide a fine level of care for patients many thousands of times every day.

While I don't know what specialty you plan on, you might be right for surgery. Seems like you already have that particular "complex".

Good luck during your internship. You will need it. I have the distinct feeling that R.N.s are going to teach you a thing or two... and deservedly so, since you so obviously need to be brought down a few pegs.
 
qwerty1,

I have the utmost respect for nurses. They play a valuable and important role. So do doctors. Healthcare can't be delivered adequately without both groups. However, I don't do your job and you don't do mine. Why can't we respect our roles? That's all I'm asking.

The points I raise are valid and will rise to the forefront in time because I see more and more non-physicians wanting to practice medicine without a medical license.

Nonphysicians bypass legislatures, use own boards to expand scope
Legislatures are still the main avenue for change, but at least nine states have seen groups try to alter practice rules through regulatory boards.

NP's can claim to be practicing "advanced nursing", but we all know it's really medicine. Does an NP diagnose and treat a condition differently than an MD? You can save the holistic argument.
As one CRNA puts it, it's called nursing when a nurse does it, but when an anesthesiologist does the same thing it's called medicine. 🙄 Doesn't that sound foolish? The goal of my posts is to raise awareness among medical students, residents, and attendings about what could happen to their medical specialties if they are not vigilant to this threat to their profession and jobs. The leading example of where this is happening is in anesthesiology. The CRNA's have made the most advances of any nursing group. There is a very real turf war between the CRNA's and anesthesiologists. The MD's have tried again and again to work collaboratively with the CRNA's, but they have been stabbed in the back repeatedly. The MD's are in essence being forced to fight back because the nurses keep egging this on. Go to the anesthesiology forum and you'll see that I am hardly alone in my views. Practically every medical student, resident, and attending is worked up over the CRNA issue. This is a preview of what will happen with the NP's in other medical fields.

The issue boils down to this: midlevels want to increase their scope, gain independence, claim equivalence with MD's, increase their income as a result, but they don't want the liability that comes along with it. If autonomous midlevels want the same scope as a doctor, then they should be held to the same standards as physicians. Doesn't that sound fair? Too often insurance companies and lawyers assume that autonomous midlevels are somehow covered for liability by another physician provider. That's why some autonomous CRNA's claim their malpractice premiums are lower than an anesthesiologist's. Does that make sense unless the insurance carrier assumes that someone else is picking up the liability? CRNA's have less training and therefore should represent a higher risk category. Let midlevels go independent, but it should be more expensive and higher risk for them. That's how the free market will eventually settle this.

Physicians must wake up to this growing trend and protect their profession. The Louisiana Supreme Court decision is a good example. It won't be the last example.

Consider this, how would nurses feel if doctors created a new class of professionals who had the same scope as nurses but fell under the Board of Medicine? I bet the nurses would be up arms about it. So before you criticize me for wanting to protect my profession, consider that. Btw, the anesthesiologists have created such a class. They're called the anesthesiologist assistants (AA's) and not surprisingly CRNA's hate them.
 
prairiedog said:
I am afraid the judiciary system is already heavily influenced by politics and $$$ and thus the insurance industry. Who appoints members to the judiciary system? The $$$ will cause any changes, look at California and Pennsylvania, they want to save $$$. There plans call for increased use of midlevels.
Click to expand...

I guess the Louisiana Supreme Court missed your memo. :laugh:
 
Taurus said:
The goal of my posts is to raise awareness among medical students, residents, and attendings about what could happen to their medical specialties if they are not vigilant to this threat to their profession and jobs. .
Click to expand...


Hmmm. That is strange.

REAL doctors - including the ones that I work with every day, and even including the ones that have been interviewed for 20 questions on this board - feel exactly opposite. They realize the benefits of mid-levels. Realize how invaluable they can be and welcome and employ them.
Patients tend to prefer midlevels as well.
What insight and wisdom do you have that they who are actually in the field and know whereof they speak do not???

I think your paranoia is misplaced. Take a few deep breaths. It is going to be O.K. Really 🙂
 
horsenurse25 said:
Hmmm. That is strange.

REAL doctors - including the ones that I work with every day, and even including the ones that have been interviewed for 20 questions on this board - feel exactly opposite. They realize the benefits of mid-levels. Realize how invaluable they can be and welcome and employ them.
Patients tend to prefer midlevels as well.
What insight and wisdom do you have that they who are actually in the field and know whereof they speak do not???

I think your paranoia is misplaced. Take a few deep breaths. It is going to be O.K. Really 🙂
Click to expand...

:laugh: Oh really? I know of two anesthesiologists who lost their jobs to CRNA's. I bet they don't like midlevels too much.

The problem isn't midlevels per se. It's "autonomous" midlevels that I have a problem with. Midlevels are great, until they start taking your job from you.
 
Taurus said:
:laugh: Oh really? I know of two anesthesiologists who lost their jobs to CRNA's. I bet they don't like midlevels too much.

The problem isn't midlevels per se. It's "autonomous" midlevels that I have a problem with. Midlevels are great, until they start taking your job from you.
Click to expand...

http://www.youtube.com/watch?v=oSb1Orv_shE



Had to be done.
 
KentW said:
"Prefer?" What are you basing that on? 😕
Click to expand...

How about this:

BMJ 2002;324:819-823 ( 6 April )

Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors

Objective: To determine whether nurse practitioners can provide care at first point of contact equivalent to doctors in a primary care setting.
Design: Systematic review of randomised controlled trials and prospective observational studies.
Results: 11 trials and 23 observational studies met all the inclusion criteria. Patients were more satisfied with care by a nurse practitioner (standardised mean difference 0.27, 95% confidence interval 0.07 to 0.47). No differences in health status were found. Nurse practitioners had longer consultations (weighted mean difference 3.67 minutes, 2.05 to 5.29) and made more investigations (odds ratio 1.22, 1.02 to 1.46) than did doctors. No differences were found in prescriptions, return consultations, or referrals. Quality of care was in some ways better for nurse practitioner consultations.
Conclusion: Increasing availability of nurse practitioners in primary care is likely to lead to high levels of patient satisfaction and high quality care.


You guys (Primary Care) are so boned. :laugh:
 
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