DNP versus MD?

[schutzhund]

---

Members do not see this ad.

Zenman, you still don't get it do you? Myself and others have gone around and around about this with you. Your posts illustrate the problem I have with a lot of midlevels: you don't know how much you don't know. It's scary. It will result in injury to patients.

I will call your "covered all this also in nursing school and as an NP student" and "We might understand pathology because we take courses called 'pathophysiology'."

I'M A NURSE. I've taken both undergraduate and graduate (NP) "pathophysiology." I was a tenured track full time faculty at a school where I taught nursing classes. I also went to medical school. THERE IS NO COMPARISON IN THE LEVEL OR DEPTH BETWEEN THE TWO!!!!!

You think you understand the difference but you cannot. Talk to me when you finish medical school and tell me they are even close to the same. Every NP I know will tell you the same thing. They are the biggest critics of the expansion of midlevels (particularly NPs) because they realize, in hindsight, how little they knew and how much they thought they knew. Scary.

I am not against midlevels and certainly not against nurses. In fact, I probably value a good nurse MORE than most because I've been there. I am against under qualified people trying to play doctor without undergoing the equivalent education.

 

[Dr_Feelgood]

Zenman, you still don't get it do you? Myself and others have gone around and around about this with you. Your posts illustrate the problem I have with a lot of midlevels: you don't know how much you don't know. It's scary. It will result in injury to patients.

I will call your "covered all this also in nursing school and as an NP student" and "We might understand pathology because we take courses called 'pathophysiology'."

I'M A NURSE. I've taken both undergraduate and graduate (NP) "pathophysiology." I was a tenured track full time faculty at a school where I taught nursing classes. I also went to medical school. THERE IS NO COMPARISON IN THE LEVEL OR DEPTH BETWEEN THE TWO!!!!!

You think you understand the difference but you cannot. Talk to me when you finish medical school and tell me they are even close to the same. Every NP I know will tell you the same thing. They are the biggest critics of the expansion of midlevels (particularly NPs) because they realize, in hindsight, how little they knew and how much they thought they knew. Scary.

I am not against midlevels and certainly not against nurses. In fact, I probably value a good nurse MORE than most because I've been there. I am against under qualified people trying to play doctor without undergoing the equivalent education.

👍

 

[Dr_Feelgood]

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

I must disagree with you on this. While OB-GYN's pay the most malpractice insurance. That is b/c they a sued more. The big cases a generally against surgeons, ERs, anesthesia. When a teenager goes in for a minor surgery and things go wrong.

i.e. Missouri's largest case against a surgeonhttp://www.robbrobb.com/media_articles.jsp?article=30

i.e. NY's third largest case against the ER doctors http://www.law.com/jsp/article.jsp?id=1089315041445

There a lots more examples if you google the issue

The point being PA's and NP's work in many of these departments (including OB-GYN). Out of the 969 cases involving PAs in 2006. Only 1 was a million dollar verdict. http://www.brevardlawyer.com/blog/?cat=3

According to the USA Today, 1 in 12 physician malpractice suits are over 1 million dollars. http://www.usatoday.com/news/nation/2003-03-04-malpractice-cover_x.htm

While I agree that it is going up, when a PA or NP gets sued, so does the physician they work for. So, I guess malpractice insurers should double what they charge NPs and PAs b/c of the higher risk and double dipping. Right?

 

[core0]

I must disagree with you on this. While OB-GYN's pay the most malpractice insurance. That is b/c they a sued more. The big cases a generally against surgeons, ERs, anesthesia. When a teenager goes in for a minor surgery and things go wrong.

i.e. Missouri's largest case against a surgeonhttp://www.robbrobb.com/media_articles.jsp?article=30

i.e. NY's third largest case against the ER doctors http://www.law.com/jsp/article.jsp?id=1089315041445

There a lots more examples if you google the issue

The point being PA's and NP's work in many of these departments (including OB-GYN). Out of the 969 cases involving PAs in 2006. Only 1 was a million dollar verdict. http://www.brevardlawyer.com/blog/?cat=3

According to the USA Today, 1 in 12 physician malpractice suits are over 1 million dollars. http://www.usatoday.com/news/nation/2003-03-04-malpractice-cover_x.htm

While I agree that it is going up, when a PA or NP gets sued, so does the physician they work for. So, I guess malpractice insurers should double what they charge NPs and PAs b/c of the higher risk and double dipping. Right?

Well since the great majority of NP's and PA's are employees of physician groups that really doesn't track. Yes as a physician you have an increased risk when you supervise an NPP but this is more than made up for by the extra income to the practice. If you are talking about being the Supervising or collaborating physician for a NP in independent practice then that is a different story. There is not a lot of data on this but the trends do not look happy. The flip side is that unless you set up a protocol that is bad or did something inapproprate when you are consulted you are generally insulated. As far as who has greatest risk you have to remember that OB is the only surgery that you potentially put two lives at risk one of whom may require constant medical care for 50+ years.

If you look at the whole quote you get a true sense of the problem.
"The number of malpractice verdicts and settlements over $1 million is way up, according to the Physician Insurers Association of America. About one in 12 paid claims settles for $1 million or more these days vs. one in 50 a decade ago. That's a 400% rise.

But two-thirds of patients who file a claim don't get a dime, the insurance group's statistics show. About 61% of cases are dismissed or dropped; 32% are settled, with average payouts of $300,000, and only 7% go to trial. Patients prevail in only one in five of the cases that are tried — about 1.3% of all claims."

What this means is that if the case stinks the insurance companies don't pay to make it go away anymore. But if you screw up then they try to settle because they know they will lose big if they go to trial. The other part is that attornies are unlikely to file if they don't think that there is a chance that the payout is more than a certain amount (around 500k).

David Carpenter, PA-C

 

[Dr_Feelgood]

Well since the great majority of NP's and PA's are employees of physician groups that really doesn't track. Yes as a physician you have an increased risk when you supervise an NPP but this is more than made up for by the extra income to the practice. If you are talking about being the Supervising or collaborating physician for a NP in independent practice then that is a different story. There is not a lot of data on this but the trends do not look happy. The flip side is that unless you set up a protocol that is bad or did something inapproprate when you are consulted you are generally insulated. As far as who has greatest risk you have to remember that OB is the only surgery that you potentially put two lives at risk one of whom may require constant medical care for 50+ years.

If you look at the whole quote you get a true sense of the problem.
"The number of malpractice verdicts and settlements over $1 million is way up, according to the Physician Insurers Association of America. About one in 12 paid claims settles for $1 million or more these days vs. one in 50 a decade ago. That's a 400% rise.

But two-thirds of patients who file a claim don't get a dime, the insurance group's statistics show. About 61% of cases are dismissed or dropped; 32% are settled, with average payouts of $300,000, and only 7% go to trial. Patients prevail in only one in five of the cases that are tried — about 1.3% of all claims."

What this means is that if the case stinks the insurance companies don't pay to make it go away anymore. But if you screw up then they try to settle because they know they will lose big if they go to trial. The other part is that attornies are unlikely to file if they don't think that there is a chance that the payout is more than a certain amount (around 500k).

David Carpenter, PA-C

My point was not problems with malpractice my point was out of the cases that pay out:

physicians - 1/12 (8.3%) are over 1 million
PAs - 1/969 (0.10%) are over 1 million

If PAs and NPs are going round claiming that their training is as good as a MD/DO/DPM, then they should be paying out the same. The public and lawyers do not see them as equal b/c they are not.

I am impressed with PAs and nurses and the speed and intensity of the training. But they are trained on how to do something not why you do it. This is b/c there is a finite amount of time to educate a person in 2 years and still have clinical experience. Even with 4 years, most physicians learn the art of medicine during residency.

So it is makes no sense to compare DNP to any medical program. They will never be the same.

 

[TROYDNP]

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. 🙄

The site relates to being a doctor and healthcare site not a medical student site. Perhaps there needs to be a site where those type students can gather and tell each other what they want to hear. As long as this site is available there should be no reason why one should call another a troll, seems rather immature ~you should apologize. I suspect you just don’t know any better. Or is that there is fear of competition? Usually that type of childish name calling seethes of hidden incompetence and weakness. If your product is so much better you should have nothing to fear.

There are many disciplines that provide specific aspects of care and there are overlaps. No one discipline has the right to claim ownership over all of healthcare. The ultimate goal should be access to care. All of the previous writings on this site about limiting access to care so as to boost salaries are shameful and disturbing. Each discipline should do their best and provide care for sick patients. This is the kind of arrogance that causes litigation. Just keep telling yourself you are right.

 

[deleted87716]

I'd like to remind everyone to please keep your comments related to the topic, not each other. Thank you.

 

[njbmd]

The site relates to being a doctor and healthcare site not a medical student site. Perhaps there needs to be a site where those type students can gather and tell each other what they want to hear. As long as this site is available there should be no reason why one should call another a troll, seems rather immature ~you should apologize. I suspect you just don’t know any better. Or is that there is fear of competition? Usually that type of childish name calling seethes of hidden incompetence and weakness. If your product is so much better you should have nothing to fear.

There are many disciplines that provide specific aspects of care and there are overlaps. No one discipline has the right to claim ownership over all of healthcare. The ultimate goal should be access to care. All of the previous writings on this site about limiting access to care so as to boost salaries are shameful and disturbing. Each discipline should do their best and provide care for sick patients. This is the kind of arrogance that causes litigation. Just keep telling yourself you are right.

The quote that you referenced in your first paragraph was placed when this thread was under the Allopathic (medical student) site. I moved this thead at a latter date to this forum for better comment by people who might actually be in this type of program (certainly allopathic medical students are not interested in becoming DNPs).

The discussion has been interesting and lively by all participants thus far and it would be great to keep it going so that people who might be interested in entering this type of program might want to do more investigation.

To anyone who finds a post that is counter to a good discussion: Click on the little triangle under the avatar of the poster and report the post, otherwise let's keep this thread on track and get back to discussion whether or not you agree with the opinions of the poster.

 

[fab4fan]

Zenman, you still don't get it do you? Myself and others have gone around and around about this with you. Your posts illustrate the problem I have with a lot of midlevels: you don't know how much you don't know. It's scary. It will result in injury to patients.

I will call your "covered all this also in nursing school and as an NP student" and "We might understand pathology because we take courses called 'pathophysiology'."

I'M A NURSE. I've taken both undergraduate and graduate (NP) "pathophysiology." I was a tenured track full time faculty at a school where I taught nursing classes. I also went to medical school. THERE IS NO COMPARISON IN THE LEVEL OR DEPTH BETWEEN THE TWO!!!!!

You think you understand the difference but you cannot. Talk to me when you finish medical school and tell me they are even close to the same. Every NP I know will tell you the same thing. They are the biggest critics of the expansion of midlevels (particularly NPs) because they realize, in hindsight, how little they knew and how much they thought they knew. Scary.

I am not against midlevels and certainly not against nurses. In fact, I probably value a good nurse MORE than most because I've been there. I am against under qualified people trying to play doctor without undergoing the equivalent education.

Believe it or not, there are a few of us out there who still believe there is a difference between what a nurse (NP/DNP..whatever) knows and what a doctor knows. I hate it when a few of the vocal minority make it seem like most nurses feel like they do.

FWIW, when I get sick, I go to a doctor. So there...call me a traitor to my profession.

 

[Taurus]

The site relates to being a doctor and healthcare site not a medical student site. Perhaps there needs to be a site where those type students can gather and tell each other what they want to hear. As long as this site is available there should be no reason why one should call another a troll, seems rather immature ~you should apologize. I suspect you just don't know any better. Or is that there is fear of competition? Usually that type of childish name calling seethes of hidden incompetence and weakness. If your product is so much better you should have nothing to fear.

There are many disciplines that provide specific aspects of care and there are overlaps. No one discipline has the right to claim ownership over all of healthcare. The ultimate goal should be access to care. All of the previous writings on this site about limiting access to care so as to boost salaries are shameful and disturbing. Each discipline should do their best and provide care for sick patients. This is the kind of arrogance that causes litigation. Just keep telling yourself you are right.

I'll be the first to admit that I don't like midlevels, not at a personal level but at a professional one. If I had a wand, I would eliminate all midlevel programs. NP's and now DNP's are "backdoors" to practice medicine. The dirty little secret in medicine is that 90% of it is routine. That's why midlevels are able to finish so quickly and do a competent job under supervision of a physician. You just train them in the most common of diseases and their treatment. The problem is when they start lobbying for autonomy. If physicians had known that they were in fact creating and training a group of competitors, midlevels would never exist. Medicine seriously erred in not devoting more resources in training more physicians. Patients are not well-served either. It's that remaining 10% that worries me most when patients go see an independent midlevel. I'm sure most midlevels know their limits and know when to refer in a timely fashion, but what if that doesn't happen? The patient suffers and gets less than adequate care. 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. Then they lobby for autonomy and prescription rights. Sheesh, why don't they just go to medical school? NP or DNP, you're still a midlevel. Because NP's and DNP's fall under state BON's and not BOM's, medicine can't stop the inane degree inflation that is going on. PharmD, DPT, DOT, and DNP. The roles and responsibilities are still the same. A PharmD is still counting pills and a DPT is still giving massages. I personally believe that the true purpose of these new clinical "doctorates" is meant to convince Medicare and insurance companies to grant the degree holder billing rights. It always comes back to the same issue, money. I'm hoping that the checks and balance will be with the insurance premiums and lawyers. Midlevels are at a higher risk category to insure because they have less training. Is the insurance for 16 yo driver the same as a 40 yo? Lawyers should go after independent midlevels as aggressively as they would physicians. If midlevels want autonomy and play doctor, then let them. However, insurance companies and lawyers don't give a damn about state BON's, how you'll "increase access to care", or are more cost-effective; it's all about the bottom line with them. I hope they make it so risky and expensive for midlevels to practice independently that most will wisely choose not to.

 

[Dr_Feelgood]

Believe it or not, there are a few of us out there who still believe there is a difference between what a nurse (NP/DNP..whatever) knows and what a doctor knows. I hate it when a few of the vocal minority make it seem like most nurses feel like they do.

FWIW, when I get sick, I go to a doctor. So there...call me a traitor to my profession.

Traitor.

I think that you are right on this. The vast majority of nurses are happy to be nurses. Besides being the backbone of healthcare, I also think that nurses are the heart of healthcare. Doctors are the brain. While it is important to have good bedside manner. At times, a doctor must separate him/herself from the patient to do what is best for the patient. That is where nurses are at their greatest. They help maintain the close relationship and offer care while a doctor has to offer tough love.

I must agree that midlevels in design are a great idea but as the push for a larger and larger scope, some attempt to blur the lines between nurse and doctor. I think that midlevels should return to the original purpose a triage to help relieve a busy practice.

 

[fab4fan]

Yeah...I guess someone should hand me a blindfold and a cigarette.

It does take some brains as well to be a nurse; it's more than just being Ms. Nice Guy. I see it as sort of a team effort; we need each other to get pts. better. As a side note, if anything, nursing needs to shed some of that squishy, angelic, hand-holding imagery. It does us much more harm than good. But that's another topic for another day.

I'm really not sure it is in anyone's best interests to keep blurring the lines between levels of practice. I've thought about going back to school to become an NP. My reality check is, "If I myself wouldn't go to an NP for care, how can I justify becoming one?"

Quite the conundrum, isn't it?

 

[Dr_Feelgood]

It does take some brains as well to be a nurse; it's more than just being Ms. Nice Guy. I see it as sort of a team effort; we need each other to get pts. better. As a side note, if anything, nursing needs to shed some of that squishy, angelic, hand-holding imagery. It does us much more harm than good. But that's another topic for another day.

I'm really not sure it is in anyone's best interests to keep blurring the lines between levels of practice. I've thought about going back to school to become an NP. My reality check is, "If I myself wouldn't go to an NP for care, how can I justify becoming one?"

Quite the conundrum, isn't it?

I was not insinuating that nurses don't have brains. It was a metaphor for the health care system not a description of the people in each position. I know a lot of doctors that are dumb as a rock.

 

[fab4fan]

FWIW, Feelgood, your avatar was one of my all-time favorite SNL skits.

 

[schutzhund]

Believe it or not, there are a few of us out there who still believe there is a difference between what a nurse (NP/DNP..whatever) knows and what a doctor knows. I hate it when a few of the vocal minority make it seem like most nurses feel like they do.

FWIW, when I get sick, I go to a doctor. So there...call me a traitor to my profession.

Well said.

I haven't forgotten my roots. I realize that nurses are essential in good care and that a good nurse can save everyone's butt. I also appreciate when nurses catch things that I overlook. Nurses are very good at knowing what patients actually need.

I think some of the "minority" are destroying a noble profession and causing lots of animosity with other providers.

 

[schutzhund]

Another thing. A friend of mine called me today about getting into a nursing program. As many of you know, there is a long waiting list at most nursing schools. This really upset me.

Why is the nursing leadership pushing so aggressively for all these advanced practice nursing degrees and abandoning their fundamental role? Please people, MAKE MORE NURSES!! Stop trying to create pseudo-doctors and, oh I don't know, produce more competent bedside nurses!!!

I don't get it. There is a MILLION nurse shortage projected, thousands of people lined up all of the country wanting to go to nursing school, and the nursing schools are busy creating DNP programs.😕

 

[zenman]

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.

Someone made a comment that nurse practitioner outcome research studies were only done by nurses. So if you wish, go to the sites of these journals and search for "nurse practitioner outcomes" and you'll find studies that were deemed worthy of publication in the journals I listed.

 

[zenman]

Zenman, you still don't get it do you? Myself and others have gone around and around about this with you. Your posts illustrate the problem I have with a lot of midlevels: you don't know how much you don't know. It's scary. It will result in injury to patients.

What you still don't get is that I do get it. I've been at many levels and fully understand that with each higher level you understand more than you did with the previous level. Now when someone thinks learning every artery, vein and nerve is reserved for medical students, they need correction. Or if they think that an understanding of pathology is also reserved for medical students. Of course you learn more than I did. I understand that. Now what I want you to do is translate what percentage of patients you save with these extra courses in cell biology. I'm asking because every day I'm sitting with physicians ...well one physician now...who tells me about school verses actual practice. Heck, I have a friend (MD/Ph.D cell biology) who's in my shaman classes...as are many other physicians and psychologists...but that's another story, lol.

I will call your "covered all this also in nursing school and as an NP student" and "We might understand pathology because we take courses called 'pathophysiology'."

Like I said you coverd more than I did but we also had Guytons and some of the same textbooks you might have used and tore through every chapter.

You think you understand the difference but you cannot. Talk to me when you finish medical school and tell me they are even close to the same. Every NP I know will tell you the same thing. They are the biggest critics of the expansion of midlevels (particularly NPs) because they realize, in hindsight, how little they knew and how much they thought they knew. Scary.

I am not against midlevels and certainly not against nurses. In fact, I probably value a good nurse MORE than most because I've been there. I am against under qualified people trying to play doctor without undergoing the equivalent education.

I don't want to go to medical school especially after talking with docs who have been in practice many years. I'm doing FNP just for the additional knowledge and patient safety and will probably do psych NP also...but do not want to play doctor. Most of my clients are those who are medicines "failures" and that's my narrow little niche...so actually playing doctor would be a waste wouldn't it. Please take this respectfully.

 

[zenman]

Yeah...I guess someone should hand me a blindfold and a cigarette.

It does take some brains as well to be a nurse; it's more than just being Ms. Nice Guy. I see it as sort of a team effort; we need each other to get pts. better. As a side note, if anything, nursing needs to shed some of that squishy, angelic, hand-holding imagery. It does us much more harm than good. But that's another topic for another day.

I'm really not sure it is in anyone's best interests to keep blurring the lines between levels of practice. I've thought about going back to school to become an NP. My reality check is, "If I myself wouldn't go to an NP for care, how can I justify becoming one?"

Quite the conundrum, isn't it?

Yea, that "brain" comment was an insult. I'll join you if, instead of a cigarette, I can have some Bailey's Irish Cream, lol. Speaking of concundrum...I had dropped out of NP school due to difficulty in getting clinical placement among other things...but then three physicians drug me back...all of them saying they would be my preceptor. It's nice to be loved.

 

[Dr_Feelgood]

Someone made a comment that nurse practitioner outcome research studies were only done by nurses. So if you wish, go to the sites of these journals and search for "nurse practitioner outcomes" and you'll find studies that were deemed worthy of publication in the journals I listed.

I'm not the one making the argument, so I should not be the one looking up your research. As you can see, I use links and quotes to prove my comments as fact not opinion. I guess you don't get evidence base medicine in your training. David Sackett wrote a nice article in BMJ (British Journal of Medicine) on the topic. He defines EBM as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research."
((http://www.bmj.com/cgi/content/full/312/7023/71)

I would highly suggest you look into it. And start using evidence to back up your misguided comments. If you'd like to learn more about EBM, here are a few more links for you to follow:

http://ebm.bmj.com/

http://www.cebm.net/

Yea, that "brain" comment was an insult. I'll join you if, instead of a cigarette, I can have some Bailey's Irish Cream, lol. Speaking of concundrum...I had dropped out of NP school due to difficulty in getting clinical placement among other things...but then three physicians drug me back...all of them saying they would be my preceptor. It's nice to be loved.

Do you have Reiter's syndrome? The reason I ask, is I clearly stated below this comment that the comment was a metaphor. I was not sure if you could not see? Maybe you don't know what a metaphor was, I'll give you a link so that you can see that my definition is fact not opinion.

(metaphor met·a·phor (mt-fôr, -fr) NOUN: 1) A figure of speech in which a word or phrase that ordinarily designates one thing is used to designate another, thus making an implicit comparison; 2) One thing conceived as representing another)

 

[Taurus]

Now when someone thinks learning every artery, vein and nerve is reserved for medical students, they need correction. Or if they think that an understanding of pathology is also reserved for medical students. Of course you learn more than I did. I understand that. Now what I want you to do is translate what percentage of patients you save with these extra courses in cell biology.

Keep telling yourself that NP = MD.

I'll be more than happy to testify against you at your malpractice trial.

Cheers.

 

[Dr_Feelgood]

Keep telling yourself that NP = MD.

I'll be more than happy to testify against you at your malpractice trial.

Cheers.

Agreed but you can't. That is the sad thing. Each specialty can only testify against its own specialty. The courts have said that standard of care and training is not universal, even in the face of gross malpractice.

Makes a lot of sense, right?

 

[Taurus]

Agreed but you can't. That is the sad thing. Each specialty can only testify against its own specialty. The courts have said that standard of care and training is not universal, even in the face of gross malpractice.

Makes a lot of sense, right?

This "shield" won't last indefinitely. As more people are affected by gross malpractice by midlevel practitioners, laws will be rewritten so that midlevels can't hide behind the argument, "I didn't have enough training". If midlevels want the same autonomy as physicians, they have to face the same consequences as well. Lawyers are greedy that way. They won't let the midlevels get a pass. Any physician who supervises midlevels better keep a short leash on them. If the midlevel makes a mistake under your watch, it's your butt on the line.

 

[fab4fan]

Another thing. A friend of mine called me today about getting into a nursing program. As many of you know, there is a long waiting list at most nursing schools. This really upset me.

Why is the nursing leadership pushing so aggressively for all these advanced practice nursing degrees and abandoning their fundamental role? Please people, MAKE MORE NURSES!! Stop trying to create pseudo-doctors and, oh I don't know, produce more competent bedside nurses!!!

I don't get it. There is a MILLION nurse shortage projected, thousands of people lined up all of the country wanting to go to nursing school, and the nursing schools are busy creating DNP programs.😕

Because it takes a minimum of an MSN to teach in an entry level nursing program. People who teach make far less than most bedside nurses. All that education, all the $$$ invested to get it, minimal return...meh. It's a big problem. That's part of the waitlist issue. I don't think the issue is that there are so many DNP programs sprining up as there just aren't enough nurse educators out there to accommodate the students wanting to get into the entry level programs. Who can blame them?

Plus, you could crank out all the nurses you want. That won't change why so many abandon ship after just a few years. People like me who have been in the profession for 20+ years are becoming a rarity. Between people bailing out and people retiring, you're still going to have a shortfall, even if everyone who wanted to get into nursing school got accepted.

 

[core0]

Because it takes a minimum of an MSN to teach in an entry level nursing program. People who teach make far less than most bedside nurses. All that education, all the $$$ invested to get it, minimal return...meh. It's a big problem. That's part of the waitlist issue. I don't think the issue is that there are so many DNP programs sprining up as there just aren't enough nurse educators out there to accommodate the students wanting to get into the entry level programs. Who can blame them?

Plus, you could crank out all the nurses you want. That won't change why so many abandon ship after just a few years. People like me who have been in the profession for 20+ years are becoming a rarity. Between people bailing out and people retiring, you're still going to have a shortfall, even if everyone who wanted to get into nursing school got accepted.

Not sure if this is on topic (not sure what the topic is anymore). One of the points of a DNP is to increase the number of "Doctorally" prepared nurses. One of the problems is that to teach MSN's you need Doctorally trained nurses. You need MSN's to train RN's. So if you have another pathway to a "Doctorate" in nursing that doesn't involve a PhD then you have more teachers of teachers. Hence the "clinical" doctorate. In theory a "doctorate" in a program = more money for instructors. Not sure what the reality is.

David Carpenter, PA-C

 

[fab4fan]

Do you honestly think the DNPs want to be teaching? I mean, maybe I'm mistaken, but nursing is my gig, and from what I am reading, teaching is far from what most DNP programs have on their radar. Independent practice, that's the real drive for the DNP. Education of nursing instructors can still be done by a regular old PhD nurse.

I could be wrong, though. It's happened before...once.

 

[Dr_Feelgood]

Do you honestly think the DNPs want to be teaching? I mean, maybe I'm mistaken, but nursing is my gig, and from what I am reading, teaching is far from what most DNP programs have on their radar. Independent practice, that's the real drive for the DNP. Education of nursing instructors can still be done by a regular old PhD nurse.

I could be wrong, though. It's happened before...once.

👍

 

[deleted87716]

Independent practice, that's the real drive for the DNP. Education of nursing instructors can still be done by a regular old PhD nurse.

Of course, independent practice can still be done by a "regular old NP" (in some states, anyway.) You don't need a DNP for that.

 

[Taurus]

Do you honestly think the DNPs want to be teaching? I mean, maybe I'm mistaken, but nursing is my gig, and from what I am reading, teaching is far from what most DNP programs have on their radar. Independent practice, that's the real drive for the DNP. Education of nursing instructors can still be done by a regular old PhD nurse.

I could be wrong, though. It's happened before...once.

That's what I repeated again and again in this thread. DNP's were created to compete with physicians. Nurses suffer from an inferiority complex and they're hoping that DNP=MD. They will succeed up to a point. They're going to make life hard for the FP and PCP. They may try to target easy fields like derm.

 

[deleted87716]

They're going to make life hard for the FP and PCP. They may try to target easy fields like derm.

I'm not worried. I doubt many dermatologists are, either.

 

[zenman]

I'm not the one making the argument, so I should not be the one looking up your research. As you can see, I use links and quotes to prove my comments as fact not opinion. I guess you don't get evidence base medicine in your training. David Sackett wrote a nice article in BMJ (British Journal of Medicine) on the topic. He defines EBM as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research."
((http://www.bmj.com/cgi/content/full/312/7023/71)

I would highly suggest you look into it. And start using evidence to back up your misguided comments. If you'd like to learn more about EBM, here are a few more links for you to follow:

http://ebm.bmj.com/

http://www.cebm.net/

I'm very familar with EBM, but will not post links for those who should already know how look up the research before posting something like "all NP outcome studies are only done by nurses" so basically you have just gone off and wasted a lot of your own time.

Do you have Reiter's syndrome? The reason I ask, is I clearly stated below this comment that the comment was a metaphor. I was not sure if you could not see? Maybe you don't know what a metaphor was, I'll give you a link so that you can see that my definition is fact not opinion.

Think for a moment...maybe I answered the posts...as I did yours, in the order I read them. Cool, eh? You're not suffering from "excessive learning syndrome" are you...where you start losing common sense?

Actually I do use metaphors a lot...

 

[zenman]

Keep telling yourself that NP = MD.

I'll be more than happy to testify against you at your malpractice trial.

Cheers.

Work on your reading comprehension. I know NP does not equal MD. I get that. Just don't tell me I have no knowledge of pathology. I'm an old trauma nurse and you know we don't take crap from anyone.

If you ever had to testify against me, you'd be crying...I used to work with malpractice attorneys...helping them pick the correct healthcare person to sue. By the way I diverted them away from physicians when appropriate....you're welcome.

 

[fab4fan]

That's what I repeated again and again in this thread. DNP's were created to compete with physicians. Nurses suffer from an inferiority complex and they're hoping that DNP=MD. They will succeed up to a point. They're going to make life hard for the FP and PCP. They may try to target easy fields like derm.

I was responding to the question about DNPs being the solution to the lack of nursing educators. I don't see most of them going in that direction. I'm sorry if you found my answer redundant, but the question did come up again.

If someone is going to school to be a DNP to resolve some sort of inferiority issue, they have some waking up to do...it won't get better. Under all those titles will still be a license that says "nurse." Oh well.

 

[zenman]

Because it takes a minimum of an MSN to teach in an entry level nursing program. People who teach make far less than most bedside nurses. All that education, all the $$$ invested to get it, minimal return...meh. It's a big problem. That's part of the waitlist issue. I don't think the issue is that there are so many DNP programs sprining up as there just aren't enough nurse educators out there to accommodate the students wanting to get into the entry level programs. Who can blame them?

When I was teaching, I remember people spending a wad and a lot of effort getting a Ph.D. only to get a $2,000 a year raise for it. At that rate they would never pay off their student loans. Crazy...

 

[corpsmanUP]

Work on your reading comprehension. I know NP does not equal MD. I get that. Just don't tell me I have no knowledge of pathology. I'm an old trauma nurse and you know we don't take crap from anyone.

If you ever had to testify against me, you'd be crying...I used to work with malpractice attorneys...helping them pick the correct healthcare person to sue. By the way I diverted them away from physicians when appropriate....you're welcome.

Knowledge of pathology is not gained from experience as a nurse I assure you. The day you graduate from medical school, you are the smartest related to pathophysiology you will ever be, and even 10 years later, a lot of that knowledge is retained. But, you have to learn it to know what you are seeing in the real world. This is one area that cannot be learned on the job, unless of course you are a pathologist.

Pathophysiology is the one class that makes the physician different than any midlevel or DNP. I was a PA before I was a physician, and trust me, the difference is huge. I used to practice with unknowing ignorance, not knowing the things I did not know. Of course you can find some outcome study to show that a PA did almost as well as a physician in primary care. But the truth is, if you carry out any of these studies long enough and in enough depth, the physician will catch many things that the midlevel would have simply sent home or handled inapropriately. This is why the midlevels best place is practicing supervised medicine, and this is why the PA profession will thrive after the NP profession implodes. It will ultimately happen, no matter how good the lobby is from the NP end. You won't be able to loby past CNN and FoxNews who will undoubtedly portray the "Pretend doctor" as someone that should have never been allowed to practice medicine. It's just going to take a couple of disasters...thats all, and the more the N's flood the market, the more likely these will occur.

 

[prairiedog]

Knowledge of pathology is not gained from experience as a nurse I assure you. I was a PA before I was a physician, and trust me, the difference is huge. I used to practice with unknowing ignorance, not knowing the things I did not know. Of course you can find some outcome study to show that a PA did almost as well as a physician in primary care. But the truth is, if you carry out any of these studies long enough and in enough depth, the physician will catch many things that the midlevel would have simply sent home or handled inapropriately. This is why the midlevels best place is practicing supervised medicine, and this is why the PA profession will thrive after the NP profession implodes. It will ultimately happen, no matter how good the lobby is from the NP end. You won't be able to loby past CNN and FoxNews who will undoubtedly portray the "Pretend doctor" as someone that should have never been allowed to practice medicine. It's just going to take a couple of disasters...thats all, and the more the N's flood the market, the more likely these will occur.

Isn't this same dogma that has been used since 1965 when the 1st NP/PA programs developed? So why after 40+ years will CNN and FOX take on the "pretend doctors"? What is the explanation for the MD not "catching" things that a PA did? Your rant suggests you were never a PA, rather just a disgruntled MD or spouse of a disgruntled MD.

 

[corpsmanUP]

Isn't this same dogma that has been used since 1965 when the 1st NP/PA programs developed? So why after 40+ years will CNN and FOX take on the "pretend doctors"? What is the explanation for the MD not "catching" things that a PA did? Your rant suggests you were never a PA, rather just a disgruntled MD or spouse of a disgruntled MD.

If you have been around this forum long enough, you would know my story. I most certainly am a PA still (still licensed in fact until next month). I practiced for 8 years, 4 full time, and full part time in medical school. I am very protective in general of the PA concept because its roots make a lot of sense. The NP debate though is one you do not want to have with me. The reason that there have been few public disasters in medicine relating to midlevels is because they have been relatively supervised and kept predominantly in primary care. Specialization, and sheer number of midlevels in general will bring more focus on their mistakes though. It is already happening! PA malpractice insurance has quadrupled since I first started as a PA in 1998. NP's will eventually bite off the hand that feeds them (the collaborative physician), and they will eventually show their true colors in a public way. I am not worried about it as much as the primary care docs because an NP cannot possibly do what I do in emergency medicine. They will never replace me or my field. FP docs though better come up with a solution though!

 

[deleted87716]

FP docs though better come up with a solution though!

Why's that, exactly? You've got more mid-levels in your ED than I have in my office.

 

[Adcadet]

A friend recently saw an NP at an HMO. His appointment was scheduled for 20 minutes, just like like the MDs in the practice, and his actual face-time with the NP was very limited. If a major benefit of mid-levels was supposed to be longer appointments, that sure isn't happening, at least not in this particular clinic. And his co-pay and insurance premium is the same whether he sees an MD or NP, so he's not seeing the financial benefit other than perhaps having more appointment times.

 

[deleted6669]

Isn't this same dogma that has been used since 1965 when the 1st NP/PA programs developed? So why after 40+ years will CNN and FOX take on the "pretend doctors"? What is the explanation for the MD not "catching" things that a PA did? Your rant suggests you were never a PA, rather just a disgruntled MD or spouse of a disgruntled MD.

prarie- I know corpsmanup. he really is a pa with a long hx of working in medicine starting in the military, then as a paramedic then as a pa and now as a physician in em residency. we followed fairly similar steps until he made the choice to go to medschool and I made the choice to remain a pa( unless something changes dramatically in my financial world in the next few yrs allowing me to attend)

 

[fab4fan]

Of course, independent practice can still be done by a "regular old NP" (in some states, anyway.) You don't need a DNP for that.

True, but you can't call yourself "Doctor" either. Even though proponents of the DNP program claim that they won't try to muddy the waters with that title, I have my doubts. There are specific reasons why the push is on to make DNP the entry level to being a nurse practitioner. Being called "Dr." is one more way to attempt to gain equal footing with medical practitioners.

 

[deleted87716]

True, but you can't call yourself "Doctor" either. Even though proponents of the DNP program claim that they won't try to muddy the waters with that title, I have my doubts. There are specific reasons why the push is on to make DNP the entry level to being a nurse practitioner. Being called "Dr." is one more way to attempt to gain equal footing with medical practitioners.

Most patients know what a nurse practitioner is nowadays, even if you stick a "D" in front of it. They're already used to FNP, etc. If a DNP tried to impersonate a physician, I doubt they'd get away with it for long.

 

[zenman]

Knowledge of pathology is not gained from experience as a nurse I assure you.

I assure you that you were probably not thinking when you made this really dumb statement. Much is learned about patho...and much else from direct experience. You might remember what you learned from your residency(experience)...or was that considered a waste? I also had formal classes in pathophysiology but not to the level you did. My comments were originally directed to the below uninformed poster;

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.

But the truth is, if you carry out any of these studies long enough and in enough depth, the physician will catch many things that the midlevel would have simply sent home or handled inapropriately.

One of the reasons we need each other is to to cover each other. I could write a book on the things I've caught from the "experts"...and many times have been thanked for doing it...including ordering labs "by mistake" that
should have been ordered. And yes, I miss stuff.

 

[MacGyver]

Most patients know what a nurse practitioner is nowadays, even if you stick a "D" in front of it. They're already used to FNP, etc. If a DNP tried to impersonate a physician, I doubt they'd get away with it for long.

They're not trying to steal the title of "physician" they want the "doctor" title. And once they get DNPs, there's nothing you can do to stop them.

 

[Dr_Feelgood]

True, but you can't call yourself "Doctor" either. Even though proponents of the DNP program claim that they won't try to muddy the waters with that title, I have my doubts. There are specific reasons why the push is on to make DNP the entry level to being a nurse practitioner. Being called "Dr." is one more way to attempt to gain equal footing with medical practitioners.

They are not even trying to hide the fact that they want to be called doctor. Per the AACN website:

Will doctorally-prepared nurses confuse patients and the public?


No. The title of Doctor is common to many disciplines and is not the domain of any one group of health professionals. Many APNs currently hold doctoral degrees and are addressed as "doctors," which is similar to how other expert practitioners in clinical areas are addressed, including clinical psychologists, dentists, and podiatrists. In all likelihood, APNs will retain their specialist titles after completing a doctoral program. For example, Nurse Practitioners will continue to be called Nurse Practitioners. Of course, DNPs would be expected to clearly display their credentials to insure that patients understand their preparation as a nursing provider, just as many APNs, physicians, and other clinicians are required and currently do.​

http://www.aacn.nche.edu/DNP/DNPFAQ.htm

You can't tell me that this will not be confusing.

 

[deleted87716]

They're not trying to steal the title of "physician" they want the "doctor" title.

You can't tell me that this will not be confusing.

I don't know if this link has been posted previously, but there's some interesting commentary on the DNP degree here.

 

[50960]

It will only be perceived as confusing by those who do not want it to happen. I think the above description of their stance on the title "doctor" is right on and appropriate. I am Dr._____, and I work in primary care. I do Bx medicine as a clinical psychologist and have for years. Nobody has ever thought I was a physician. If they did after I said , Hi I am Dr. _____ a psychologist, what can I help you with today they probably need more care than a primary care office.

 

[deleted87716]

It will only be perceived as confusing by those who do not want it to happen. I think the above description of their stance on the title "doctor" is right on and appropriate. I am Dr._____, and I work in primary care. I do Bx medicine as a clinical psychologist and have for years. Nobody has ever thought I was a physician. If they did after I said , Hi I am Dr. _____ a psychologist, what can I help you with today they probably need more care than a primary care office.

I almost never introduce myself as "doctor." I prefer to just use my full name. To each his/her own.

 

[fab4fan]

They are not even trying to hide the fact that they want to be called doctor. Per the AACN website:

Will doctorally-prepared nurses confuse patients and the public?


No. The title of Doctor is common to many disciplines and is not the domain of any one group of health professionals. Many APNs currently hold doctoral degrees and are addressed as "doctors," which is similar to how other expert practitioners in clinical areas are addressed, including clinical psychologists, dentists, and podiatrists. In all likelihood, APNs will retain their specialist titles after completing a doctoral program. For example, Nurse Practitioners will continue to be called Nurse Practitioners. Of course, DNPs would be expected to clearly display their credentials to insure that patients understand their preparation as a nursing provider, just as many APNs, physicians, and other clinicians are required and currently do.​

http://www.aacn.nche.edu/DNP/DNPFAQ.htm

You can't tell me that this will not be confusing.

I'm completely in agreement with you.

 

[Adcadet]

I am Dr._____, and I work in primary care.

You don't think an NP/DNP introducing him/herself in that manner isn't confusing? That is exactly how an MD or DO could introduce him/herself. "I'm Dr. XYZ, and I'm a nurse practitioner" is a little better, but still "doctor" and "nurse" do not belong in the same sentence together given most people's understanding of "doctor" and "nurse".