There is actually a pretty good debate going on regarding this at SDN nursing doppleganger:
http://allnurses.com/forums/f34/doctoral-degree-become-np-160044.html?
http://allnurses.com/forums/f34/doctoral-degree-become-np-160044.html?
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DNP versus MD?
Started by Aznfarmerboi
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The first class of DNP's won't graduate until 2009. It's too early to tell what their scope of practice and malpractice premiums will be and whether they would want to be seen as equals to physicians. We can argue our views but it's just speculation in the end. If physicians do feel an impact by them, it probably won't be for another 10 years as we begin to see them on the wards and clinics, laws are changed to accomodate them, and studies are done to evaluate how they perform once they graduate. I, for one, take them very seriously and probably will specialize as much as I can. We will just have to wait and watch how this unfolds.
erasable said:
This is because, despite the fact that nurses do have technical insurance they are "agents" of a physician. Thus they carry little true responsibility and also fall under a doctor's insurance. Anything they say or do will be the responsibility of the Doc. Since they are not at the top, they are not the ones being sued. Now with a DNP, all the responsibility falls on their shoulders. I suspect, therefore, that no matter how hard they lobby, they will be forced to pay the same or higher insurance premiums if they expect to do similar work.
Instatewaiter said:
This is so profoundly untrue and uninformed it's laughable. Clearly, you have absolutely no working of knowledge of the accountability a nurse has. We ARE NOT covered by physicians for our mistakes. For the record, a nurse can be held liable for mistakes doctors make (such as an inappropriate med error) if the nurse does not catch it.
Nurses may not be sued as often as doctors, but that has nothing to do with the level of responsibility; it has everything to do with who has the deeper pockets. But that doesn't mean nurses aren't sued. They are, and it's happening more in an increasingly litigious society. And before someone brings up the "nurses are protected by the hospital's malpractice" objection, that's wrong, too. Hospitals will look for any way to say the nurse failed to follow hospital P&P and is therefore not eligible for protection. Or the hospital will countersue the nurse after a malpractice issue is settled.
I don't know where you got your "agents of the physician" impression, but you're dead wrong on that one, grasshopper. A nurse's license stands on its own. It is not dependent on a physician.
Some of you have some valid points, but Heavens to Mergatroid, some of you are just making fools of yourselves.
I just spent some time on the NP forum at http://allnurses.com/forums and I find it interesting that there seem to be (on the forum, anyway) at least as many NP's against the DNP as their are in favor of it. A good point brought up on there (my apologies to the OP on that forum as I don't remember his/her name) is that if the AANP pushes "too hard" on this topic then the AMA can make a powerful case to legislators that NP's are in fact practicing medicine, and not practicing nursing, and consequently be placed under the jurisdiction of the medical licensing boards or increase their own licensing reqs to resemble that of the AMA/AOA (again, not my own original thought).
The individual states ultimately determine who can/cannot practice medicine in their area and if the AMA, or any other lobbying body, can convince the politicians that DNP's are practicing medicine with inferior qualifications and education then "adios" independent practice rights. Now, whether or not DNP's go this far, and if so at what point their education (theoretical and clinical) begins to become inadequate with regards to how much independence they desire has yet to be answered.
Ultimately if DNP (or NP's or anyone else) can provide adequate healthcare in an independant setting they should be allowed to do so. Concern from the MD/DO point of view is understandable, but I don't think we should be squashing this simply to protect "our turf". Though that whole "do we call them doctor" thing is problematic, talk about confusing the public. 😕
The individual states ultimately determine who can/cannot practice medicine in their area and if the AMA, or any other lobbying body, can convince the politicians that DNP's are practicing medicine with inferior qualifications and education then "adios" independent practice rights. Now, whether or not DNP's go this far, and if so at what point their education (theoretical and clinical) begins to become inadequate with regards to how much independence they desire has yet to be answered.
Ultimately if DNP (or NP's or anyone else) can provide adequate healthcare in an independant setting they should be allowed to do so. Concern from the MD/DO point of view is understandable, but I don't think we should be squashing this simply to protect "our turf". Though that whole "do we call them doctor" thing is problematic, talk about confusing the public. 😕
Instatewaiter said:
Whoa.. thats where I stopped reading.
So one stupid nurse got a C in A&P and now you presume thats the "scientific foundation" DNPs will have. Ouch!
My A in undergrad A&P was just the tip of the iceberg to what I'm learning now in an NP program. We use many of the same texbooks as PAs and med students (dont hyperventilate yet), but clearly we wont appreciate or have an equally in depth understanding as those of you who have taken advanced biochem, molecular genetics, and all the other medschool classes.
No, we dont have the same knowledge as you, nor we do claim to, but please dont believe that our education level borders on a C.
With regard to the DNP, my humble opinion - I'm all for advancing education. Heck I'll have two undergrads and one graduate degree by the time I'm 22. One I get my MSN, I may go for the DNP but only because I like learning, not because I think I'll be more "doctorish". More education is always a good thing. I guess what you do with it afterwards is another story...
RNtoFNP said:
I think what is true about nurse practitioners from my experiences with my girlfriend who is an NP student and her NP student friends is that they in general have a fairly practical understanding of anatomy and physiology but lack a more scientific and pathological understanding of A & P. I guess what I mean to say is that most NP's certainly can't name every nerve, artery, and vein in the body but they understand how nerves, arteries, and veins work and what happens when they dysfunction. They may be able to differentiate the signs and symptoms of an MI but do not understand the pathology associated with the various stages of MI and the compensatory mechanisms that take place as a result. The knowledge is practical but less scientific and specific.
As someone who took nursing A&P, I assure you it is vastly different from what is covered in the relevant sections of the Step 1. Since it is not possible to catalogue everything that can go wrong in a human body, it is important to have a scientific and specific understanding of the human body so that we can correctly diagnose and treat cases which 'practical' knowledge does not adequately cover.RNtoFNP said:
Nobody is saying that every nurse had a C average in school, but the admission requirements, especially with the dearth of RNs, is *different*. I have been classmates with nursing students both at the university and community college level. There are certain things pre-nursing students can get away with that premeds cannot.RNtoFNP said:
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saradoor
Let's face it Primary Care is out for MDs who have lot of debts to repay. It is just scary to hear how much some FPs are taking home (NPR: http://www.npr.org/templates/story/story.php?storyId=5505837 ) So it may not be a bad thing for some DNPs to be sucked into this area. I don't think the AMA is that stupid to to let DNPs to share the pain (after all AMA is managed by MDs)
See AMA Board of Trustees: http://www.ama-assn.org/ama/pub/category/13396.html
One of the trustees Mr. Chris DeRienzo is a current MD student at Duke so I don't think the AMA can be that completely out of touch on any potential *threat* to the profession.
See AMA Board of Trustees: http://www.ama-assn.org/ama/pub/category/13396.html
One of the trustees Mr. Chris DeRienzo is a current MD student at Duke so I don't think the AMA can be that completely out of touch on any potential *threat* to the profession.
I'm not so worried about DNP's doing primary care. It's when they want to expand to other areas that worries me. Where do we draw the line?
Taurus said:
I do not want to get into this argument because it is pointless and will go on for eternity. However, I do want to clear up this misconception. CRNA programs include much more clinical experience than one semester. In my program, we are in the OR 2-3 days a week by the second quarter and then are in the OR full-time (usually 4 days a week plus one call shift) by the fourth quarter. So, we are in the OR everyday for the last 18 months of the program (and attend classes at the same time). We also do several rotations in specialties, including 2 months each of OB, Pediatrics, and Cardiac. Now, I know that this does not equal the 70-80 hours/week anesthesia residents spend in the OR for 3 years, I just wanted to clear up this confusion. 🙂
Taurus said:
I stumbled onto this forum and feel I must respond. First, as a DNP student, I have no intentions of entering any type of "medical" practice. I teach nursing and plan to continue to do this. One of the primary reasons for the DNP is that nursing boards require that a certain percentage of nursing faculty have doctorates. Since you are obviously all aware of the nursing shortage, more doctorates in nursing equals more spaces for students which equals more RN's. Have any of you checked out the "normal" doctorate in nursing (PhD). I'm too old for that. Research is not the primary love of my life. This doctorate helps us learn to analyze and disseminate research for evidence based practice. It is a way to earn a doctorate without having to spend 1-2 years (after 2 years of course work) doing research. I will finish in 15 months. As for NP's being required to have a doctorate, that is to keep up with PT's and OT's and some other allied health professions that are moving to require doctorates for entry into practice. When DNPs are talking about achieving parity, it is not with MD's. It is with other allied health professionals. The reason many NP's are against the move is because they don't want to have to have more schooling to practice as an NP. As for DNP's taking over family medicine, I don't see this happening since Nurse Practice acts require NPs to work under the supervision of an MD. Since very few MD's are willing to accept the pay in rural areas, NPs are allowed to practice "solo" as long as there is an MD available by phone. If the NP screws up and did not contact the MD to ask questions, the NP will likely lose his/her license (not just NP certification, but RN license).
I hope this helped to answer some of your questions/concerns. I will be more than happy to answer other questions that you have. Just ask (preferably in a professional manner).
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saradoor said:
Now you've done it. You couldn't keep it quiet. You had to go running your mouth. I hear the hoofbeats approaching even as I write.....
Take cover.
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deleted87716
Panda Bear said:
Those aren't hoofbeats, Gus...those are the growing hordes of patients who don't have primary care doctors stampeding your emergency department. Or didn't you notice this article ("Report Slams U.S. Emergency Care System") on the same page as the one that "saradoor" linked to?
"Take cover" indeed. 😉
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KentW said:
That's why we have triage. Some of them will just have to wait. This is also why we have a fast track.
DNP student said:
I must admit stumbling onto this website as well.
I agree 100% with this response. As an advanced practice nurse, I plan to pursue a DNP to improve the quality of care delivered to my patient population.
I've never had the intentions of working as an independent care provider. I work with a physician's practice where my knowledge, patient advocacy, and dedication are well recognized and rewarded.
I have a significant scientific knowledge base--but nowhere as in-depth as the physicians that I work along side.
I possess a Master of Science in Health Administration and I am the director of clinical research for our practice. My regulatory knowledge far exceeds the MDs--but that's my job.
Nursing is very diverse and has a great deal to offer to the medical arena.
Although all of my physicians are brilliant and manage patients very well they dont have the skills to manage financial ventures as well. As a result, a practice would benefit from a DNP with a focus in Health Administration or Health Finance. A medical practice benefits significantly from a "hybrid" such as myself.
The physicians in my practice respect that I am safely capable of managing a population that has been entrusted to me. I call them when I need to. They take advantage of the freedom that is afforded to them by having me.
We work together!
I must admit that I take pride in comforting the patient and clarifying questions regarding the care they receive. Im a nurse 1st. I dont want to be an M.DBUTI love working with a great group of physicians.
AngryBaby said:
This is a crucial point: NPs benefit from not quite being doctors. As NPs get even closer to being on par with doctors they'll run into the exact same issues (malpractice, insurance reimbursement, longer training being necessary) that doctors complain about. It's also important to keep this all in context: NPs have benefited from being in an economy where there is a shortage of doctors and nurses. In this situation, they've gained a lot of autonomy and can even specialize into some areas beyond primary care. But there are some real limits to how far this can go: beyond primary care needs, most people are going to demand that they see an actual doctor when there's something wrong with them. Most people just aren't willing to go to see an NP when they're having seizures, or when they need medication for depression, they've been diagnosed with cancer, etc.
Insofar as they're threatening the livelihood of some primary care physicians right now, NPs are but one among many factors that are hurting primary care physicians.
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deleted87716
mzeroapplicant said:
No matter how many times you repeat something that you've heard here on SDN, that doesn't make it true.
NP's are not "hurting" primary care physicians. I challenge you to cite a single actual example (not hearsay) where a primary care physician has been "hurt" by an NP. Just one. Be very specific, however....no, "Well, I heard that such-and-such happened to so-and-so." Urban legends don't count.
I'm waiting... 😉
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KentW said:
In fact, the only reason NPs and PAs are making inroads into primary care is that there is a shortage of doctors who want to do those jobs, particularly in the so-called underserved areas.
KentW said:
The decline of primary care as a viable career for MDs is a systemic problem, it's not a problem where one NP directly "hurts" a primary care doctor. It's cheaper for insurance companies to reimburse an NP or a PA than a doctor. This is the same thing that happened in the mental health field: as social workers began being licensed as therapists in more states, it became harder and harder for Phds. and psychiatrists to bill for therapy at a rate commensurable with the cost of their malpractice insurance, level of debt, etc. There isn't a single social worker who personally hurt a Phd. but rather the acceleration of social workers as therapists created a systemic effect. You're going to have a tough time arguing that being able to bill NPs and PAs in network at a lower rate doesn't have an effect on how insurance companies reimburse primary care doctors. If they get the chance to pay less, they will.
After looking at my post again, I hardly think it was an anti-PA tirade by any means. I was trying to say that doctors shouldn't overall feel threatened by the role of NPs in many medical specialties because people who get seriously ill are going to want to see a doctor. Also, I was saying that NPs are best off not trying to become equivalent to doctors. I think that there is a role for NPs in primary care to see patients for everyday problems. Some degree of physician supervision might advisable (for malpractice reasons, if nothing else). Now when we go beyond primary care and we have NPs who want to operate basically independently, I can think of at least a few examples where this can be problematic. But overall I don't think there is need for hysteria among doctors.
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deleted87716
mzeroapplicant said:
The fact that fewer medical school graduates are presently pursuing primary care careers in no way reflects upon the viability of primary care as a career option for those who do.
False. Insurers pay the same amount for covered services whether the patient was seen by an MD or a midlevel. Any cost-savings from the employment of midlevels benefits their employer, not third-party payors.
KentW said:
For many med students with a lot of debt, that simply isn't true. Salaries are and have been declining, while students are graduating with increasing debt. When you look at a profession where you might make 150K currently but this amount has been decreasing steadily over the last 20 years (and will in all likelihood continue to do so) and you're staring down at anywhere from 100K to 250K in debt (depending on undergrad debt, student loans, etc.) then other specialities such as dermatology, radiology, etc. start looking pretty damn good. Now we can quibble about just what we mean by "viable", but it's hard not to argue that this strongly discourages many people from going into primary care.
KentW said:
This doesn't make sense to me. Why would an NP working independently make less than a doctor if they were being reimbursed at the same rate? Even NPs who work independently in states like Oregon don't make as much as internists, so this seems a bit fishy.
But even if I did get this wrong, it does nothing to disprove the notion that NPs and PAs depress primary care salaries. Hypothetically if you're right and the rate of reimbursement is the same, it still stands to reason that PAs and NPs have less debt and usually didn't train for as long as MDs, which means they're willing to accept less from insurance companies, which in turn lower reimbursement for all primary care insurance claims.
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mzeroapplicant said:
It's complicated. Take Medicare, for instance. In a nutshell, if an NP works collaboratively with an MD in the same office, their services can be billed under the physician's Medicare number, and Medicare will pay 100% of the physician rate for services performed by the NP. However, if an NP works independently (as in Oregon), and bills under their own Medicare number, they will be reimbursed at 85% of the physician rate.
Refer to this link for more info: http://www.medscape.com/viewarticle/422935_4
KentW said:
Does this hold true for private insurers as well?
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deleted87716
mzeroapplicant said:
I never try to tell someone how much money it should take to make them happy. However, the fact of the matter is that I have never met a doctor who couldn't pay back his/her loans. I think a lot of students today are making decisions based on fear, not facts.
Half of the family medicine graduates in 2004 owed more than $100,000 in educational debt. More than 25% owed more than $150,000. Source: http://www.aafp.org/online/en/home/aboutus/specialty/facts/27.html
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mzeroapplicant said:
It depends on the insurer. This is also covered in the article I linked to:
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mzeroapplicant said:
Well, there's nothing hypothetical about the way things work.
This also applies to NPs working in all fields, including specialties. It's not a primary care issue.
mzeroapplicant said:
Having spent some time on the "dark side" (I was an HMO nurse for several years) 😱 Most private insurance companies follow the lead of Medicare. If Medicare can get away with something, then the other companies will try it.
I can't speak for privately owned NP clinics, but when working for an MD, NP care is billed for under the MD. The NP accepts a salary from the MD practice that has little or nothing to do with how much care is billed for by the NP. Most MD practices in this area love having NP's and PA's and make little or no differentiation between them. The NP/PA is paid a salary for working like a dog (taking call and calling the MD if necessary). The NP/PA often works much more after hours than the MD (once well-trained). The MD can bill for all this without having to see or talk to every patient that calls after hours. However, when the MD is called in, it is usually something pretty serious that is out of the scope of NP/PA. Also, the NP/PA sees all patients in the hospital prior to MD rounds. That way, all info is on the chart and ready for MD. The MD's I know love it. It takes a lot of work off of them and frees them up for more major procedures that bring in more money.And all this for the salary of the NP/PA.
Yes, they know the signs of an MI, but they CANNOT diagnose an MI. A regular RN anyway. I know because I was one. But I don't know how the law changes for an NP/DNP. I think that they can actually do medical diagnoses.fab4fan said:
I see that you are already a nurse and I assume you already know this. 🙂
DNP school takes a lot more than 2 years. DNP is the culmination of 9 years of school with thousands of hours of clinical time, class time and seminar. People need access to care [period]. Medicine and MDs/DOs do not own healthcare not now nor have they ever. Even medicine does not want credit the current disarray. If one wanted to judge the difference between NPs and MDs they should look no further than the AMA who has conducted extensive research that proves the outcomes are the same ~EQUAL. Some of those patients for some reason seem to prefer NPs. The value of the MD and DO is not in question, nor should the value of the NP be questioned by those that have not reviewed the research. Moreso those that either don't know or don't want to don't understand the educational differences between the discplines. The DNP will finally provide much needed parity across the healthcare continuum.
The State of Texas Attorney General decreed that the administration of anesthesia is an independent nursing function. Administration of anesthesia does not require any type of physician supervision or oversight. In fact no state requires an anesthesiologist. Nurses have been administering anesthesia longer than physicians and do a great job.
3 years of coursework and 1 year of "internship"
Let me see. New poster who comes on a forum for medical students who claims that NP's are just as good as MD's. I think I smells a troll. 🙄
3 years of coursework and 1 year of "internship"
Agreed. Allnurses is that way -------> www.allnurses.com
exactly! And hasn't this country always been against the "speparate but equal" ideology? If nurses want full equivalence to doctors...simply apply to medical school and try to get in. This whole separate but equal school of thought will just promote more contreversy and will further divide the medical field.
I've asked similar questions re: nursing diagnosis and nursing boards, and have gotten similar answers. I understand there is some debate in the nursing world over nursing diagnosis (which, if my Googling is correct, may include "energy field disturbance" if you follow the NANDA diagnosis), but we'll just ignore those and the therapeutic touch debate for now and whether nurses (RNs) are attempting to practice medicine through TT.
From what I've been told, an RN (not NP as in your example) can diagnose "pain" in the above scenario. But as others pointed out here and elsewhere, if h/she let that patient sit in a corner for hours with the kid who sprained his ankle, she might stand to have her nursing license revoked by the nursing board. A physician can order a nurse to give a med or do something else, but if the nurse knows the order is wrong or ludicrous (100 mg morphine iv when 10 mg iv is reasonable) h/she can loose her license - hence the license stands on its own. But this is all for RNs.
What about NP's? Their license to practice also comes from the board of nursing as I understand it. Are NPs held to a different set of standards than the RN's, ones that more closely resemble the standards of a medical board? Or is the board of nursing the same board with the same guidelines and standards for all nurses?
Are there any DNP gradutes yet? Last I heard this was a proposal.
Depending on your take on history, it was either the dentists (WTG Morton, or Horace Wells) or a surgeon (Crawford Long) or maybe even some of the chemists or party goers in the 19th century.
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njbmd
Moving to the Clinicians Forum. You can go over there, follow and comment.
This is beyond the planning stages. The first crop of graduates should start appearing this year or next. Eventually, all the NP programs will be converted to DNP's I believe.
Just where is this "research" that the AMA has done that "proves" the outcomes are the same? Almost all of the studies I have seen are done by RNs. I haven't seen any done by the AMA. Have you heard of the Scope of Practice Partnership? We'll see what the AMA says about NPs vs. MDs and their outcomes - and everyone knows that research done by physicians is given a lot more weight than research done by nurses.
Umm how do you get nine years. Since most programs are part time I guess you could take that long. Most are about a year longer than NP so BSN + DNP is around 7 years and the requirement is 1000 hours past the NP so about 1500 hours required (not sure if this counts as thousands of hours).
In regard to research please show us. There is no good study that shows that a NP is equal to a practicing physician. The closest is a htn study that compared NP's to physicians in one area. All of these studies have major problems. If you think that the DNP = parity to an MD you are much mistaken.
David Carpenter, PA-C
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Dr_Feelgood
Just an FYI, I don't know if nursing students are taught to use EBM to serve their patients but med students are. In the spirit of EBM, I have included a link to show how wrong you are.
1) Will DNP programs prepare nurses to assume roles as physicians?
No. Nursing and medicine are distinct health disciplines that prepare clinicians to assume different roles and meet different practice expectations. DNP programs will prepare nurses for the highest level of nursing practice. Transitioning to the DNP will not alter the current scope of practice for advanced practice nurses as outlined in each state's Nurse Practice Act.
http://www.aacn.nche.edu/DNP/DNPFAQ.htm
2) The program takes 4 years post-BS in nursing (so even if you add undergrad that is 8 years). They are already calling the final clinical training a residency.
http://cpmcnet.columbia.edu/dept/nursing/programs/drnpfaq.html#5
All in all, I don't care about this DNP. I think it is an overqualified nurse. The education that you receive in nursing is not the same as in medical school. The theories are completely different. Nurses care for the patients, while doctors treat the patient. It is a very different role in the health care system.
The market will determine the outcome in this debate.
If DNPs are not properly trained for roles they are trying to take on, then they will learn the intricacies of malpractice.
Having reviewed a several PA and NP programs, the NP programs that rely on prior RN experience will not meet the knowledge level of MD/PAs. My wife is a CCRN in ICU, and PA student. She is exceptional at pt management but learning more as a PA. A school RN is not capable of doing pediatric NP work because of the low level of acuity they see. So, NP education is far too variable as it relies on prior RN experience. (I also disagree with PA programs that do not require prior experience. But that was another thread.)
Don't take my theory as evidence. In my area some FP groups are not hiring PAs because they can get NPs cheaper to do pt education, like diabetes education and school physicals for 10-20K cheaper/yr than a PA. So, my wife did not want to spend more time in nursing theory classes, and potentially a year longer to get a DNP to get paid less than an ICU CCRN.
The market can be a powerful reality check on the ivory tower theorists that want to make a BSN and DNP entry level degrees.
If DNPs are not properly trained for roles they are trying to take on, then they will learn the intricacies of malpractice.
Having reviewed a several PA and NP programs, the NP programs that rely on prior RN experience will not meet the knowledge level of MD/PAs. My wife is a CCRN in ICU, and PA student. She is exceptional at pt management but learning more as a PA. A school RN is not capable of doing pediatric NP work because of the low level of acuity they see. So, NP education is far too variable as it relies on prior RN experience. (I also disagree with PA programs that do not require prior experience. But that was another thread.)
Don't take my theory as evidence. In my area some FP groups are not hiring PAs because they can get NPs cheaper to do pt education, like diabetes education and school physicals for 10-20K cheaper/yr than a PA. So, my wife did not want to spend more time in nursing theory classes, and potentially a year longer to get a DNP to get paid less than an ICU CCRN.
The market can be a powerful reality check on the ivory tower theorists that want to make a BSN and DNP entry level degrees.
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Dr_Feelgood
I agree that the market may determine the outcome. But nurses are not sued for malpractice at the level of an MD/DO/DPM ect. When was the last time you heard about a 6 million malpractice suit against a nurse? The public has a notion that doctors are rich and can afford to be sued for millions and nurses are only the assistant.
Don't get me wrong nurses are the backbone of medicine, but they are pushing for more and more responsibility and I do not see the training keeping up. As a podiatry student, we see a lot of big time mess ups from wound care given by nurses, NPs, and PTs. I feel that if you don't learn about how a treatment works and why it should be done, then you should not do it. The national associations (such as ANA and APTA) see the money, the market and insurance companies see a cheap alternative, so they train these people on how to do something. But when the poop hits the fan, they don't know what to do.
It always amazes me that in America we treat medicine different than any other market. Would you let a flight attendent fly your plane (maybe they took a month long course on how to fly)? Would you let a construction worker take the place of an engineer (he did an externship on bridge building)? Then why do we have this crap in medicine, where you are talking about life and death, morbidity and mortality?
Are you kidding. I learned every nerve, artery, vein and muscle in the body before I even went to nursing school in undergrad courses. I even learned some I didn't want to know such as in frogs and ***** cats! I would probably have to review in order to name them all again. I don't remember anything useful from zoology except the good experiences of drinking wine in the back of the class with my peers.
Yep, covered all this also in nursing school and as an NP student. We might understand pathology because we take courses called "pathophysiology. "Now, I haven't had, nor do I want to take, multiple hours in cellular biology because it's freaken boring to me. I understand the cell membrane and that's good for me. Plus how much will you remember after a few years in practice?
Do you value research published in the British Medical Journal, New England Journal of Medicine, Family Practice, Journal of the American Medical Association, and American Journal of Public Health?
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Dr_Feelgood
Put a link if you want to quote an article or cut and paste the article. Without these things, it is just heresay or opinion.
Nurses don't get sued for $6million but then neither do MD's (well outside of ob). NP (and PA) malpractice insurance has been rising for several years. This is one of the unintended consequences of pain and suffering limits. While the public has a notion that only the doctors are rich the lawyers understand where the money lies. That is why they will almost always name the midlevel anymore. My malpractice insurance has tripled in the last three years. While it is still about 10% of the physicians, I don't do procedures which are the main driver of malpractice in my specialty. In primary care NP/PA malpractice insurance is about 1/3 to 1/2 of the physician rates. I understand that CNM rates are approaching that of an OB.
David Carpenter, PA-C
As midlevels lobby and get independence, their insurance premiums should be higher than that of physicians' if they want to do similar work. They're at a higher risk category because they have less training and more likely to make mistakes, from the insurance companies point of view. I would also hope that lawyers don't give midlevels a pass when they commit malpractice, simply because they are midlevels. Lawyers will come after anyone who has insurance coverage. High insurance premiums and lawyers are two areas I hope will curb this desire by midlevels for independence.
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