DNP versus MD?

[Josh L.Ac.]

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Nursing is synonymous with chiropractic.....poorly trained and unscientific who are working at any cost to advance their profession.

This is such a ridiculous post that it is very difficult to restrain myself from making an ad hominem rebuttal.


Are you serious?

 

[kylek044]

Children, play nice.

Lawguil, that means you.

 

[alpha62]

This would be a non-issue if some professionals would respect each other's roles. Physicians aren't standing by idly and we aren't weak.

wanna bet ? You are weak as whole and you did sit idly by. You got replaced by a freaken nurse as head of the army medical corps.

 

[rmh149]

wanna bet ? You are weak as whole and you did sit idly by. You got replaced by a freaken nurse as head of the army medical corps.

Are you upset that it was a CRNA and not a PA? Besides, its only temporary.

 

[qwerty1]

TaurusWatch

As an insight into Taurus' mindset and declared "respect" for the R.N., I present the following Taurus quotes.

Taurus: "I can't claim to be the one who came up with this. The anesthesiologists did. They got tired of the backstabbing CRNA's and decided it's better to work with a group who actually wants to work collaboratively."

<"Backstabbing CRNA's" ... can't ya just feel the respect and his desire to work "collaboratively"?>

Taurus: "When a patient goes to see a doctor, who does the patient want to see? An NP who is playing doctor or a real doctor? "

<Yep... It's all about respect on Taurus' part. Certainly indicative of that spirit of collaboration that Taurus so yearns for... provided all midlevels weren't "done away with" as he's advocated previously up-thread>.

Stay tuned people. Surely there are many more examples of "respect" ....and expressions of that heart warming "spirit of collegiality" we so expect from this allopathic student.

 

[zenman]

Just an anecdotal remark: one of the poorest NP students I ever precepted was just last year. This guy was a military RN who worked in the ED and had done an online FNP program (can't remember which one, sorry) where he literally NEVER had to go on-campus. Thus no classroom interaction with other students. Thus no discussion with other students.
Lisa

I've got three degrees and working on another. Two were traditional and others are online. Traditional from a cost-benefit is very wasteful and inefficient. I can see the need for traditional for some classes but not all. Why would I want classroom interaction with other students in a pharm class, for example...just to waste my time with people who don't know how to study? I'll do my discussion with my preceptor. I'm already signed up for a year with a family practice doctor. After that, may I contact you as a possible preceptor? 🙂

 

[primadonna22274]

I'm flattered Zenman, but I'm no longer in primary care. I'm working in EM now and starting to see the appeal of EM (flexibility and more money mostly). I still think of going back to med school and eventually I may do it but the time isn't right now. We do take students occasionally in our ED but haven't had one since I started almost a year ago. As far as I know we've only had PA students but perhaps no NP students have inquired?
I'm a tough taskmistress though 🙂
Actually, if you want a really great preceptor, you should ask EMEDPA. He's been doing this a lot longer than I have.
Now, brief comment on online programs: I've looked into them myself for certain things (MPH, PhD in public health, PhD in Psychology, etc.) The didactic portion always seemed reasonable, and some programs are set up to encourage participation in chat rooms, etc. I just don't think I'm the right kind of student for an online program as I'm far too prone to procrastination! I know that I myself require the discipline of a classroom. I think some people can learn independently quite well, but I do think there's benefit to learning clinical medicine in a traditional setting where there's other people to bounce ideas off of. I'm very fond of PBL groups for this very reason and I've facilitated quite a few of those. I think it's a rare student who can really learn adequately how to practice medicine on his or her own. Medicine is such a community-based proposition anyway--we benefit from seeing how others practice and take what we like and use it for our own. This is perhaps one of the biggest benefits of clinical rotations--the socialization factor--that makes a clinician. My beef is when that's cut short in the interest of saving time and money. My bias is that you can't know enough without adequate exposure. Even my 2200 clinical training hours in my PA program was not enough IMHO. How could it be done in 600?!
But I digress, and I ramble. Time to let someone else speak.
Lisa

I've got three degrees and working on another. Two were traditional and others are online. Traditional from a cost-benefit is very wasteful and inefficient. I can see the need for traditional for some classes but not all. Why would I want classroom interaction with other students in a pharm class, for example...just to waste my time with people who don't know how to study? I'll do my discussion with my preceptor. I'm already signed up for a year with a family practice doctor. After that, may I contact you as a possible preceptor? 🙂

 

[Taurus]

qwerty1,

It's funny that you seem to have ignored the other posters who are against nurses doing medicine. Several nurses have also said that they think it's a bad idea too. But you seem to be that ignorant.

Physicians would have no issues if roles would be respected. Why do you have an issue with respecting roles? If you invade my turf, then expect a response. Duh, this is not rocket science. It may be to you though.

As I said, one of the best ways that physicians can handle this is by whom they choose to hire. Trying to change laws takes forever and is unpredictable. I hope that more and more physicians recognize it's in their profession's best interest to hire PA's and AA's.

 

[alpha62]

Are you upset that it was a CRNA and not a PA? Besides, its only temporary.

Army PAs don't do very well in air conditioning and regular bathing. Putting one inside the beltway would never work

 

[caroladybelle]

When a patient goes to see a doctor, who does the patient want to see? An NP who is playing doctor or a real doctor?

At the top of the healthcare pecking order, I bet the public support is on the physician side. You hear it again and again. "If it costs the same co-pay, I wanna see a doctor not a nurse."

That's the ultimate ad campaign. "Who do you want to be seen by?"

Actually prior to becoming a nurse, I frequently saw an NP. And was perfectly happy with the care.

And in many areas, during cold and flu season, or Florida during the Winter, if you call a general practice, you will be doing lucky to be seen within the week. I want to be seen by someone in the practice, frequently it will be the NP. And that's cool.

My Internist, is off on Tuesday afternoons for administrative duties and making NH rounds/home care rounds/charitible work/ etc on Wednesdays. That is a laudible thing, but may mean that the NP will see me if something occurs, plus does my gyn workup. Though he will usually fit me in if there is an emergency - he knows if I call, that it is a major issue.

As a matter of note, my NP found a breast mass (atypical hyperplasia)that did not even show on mammo.

However, a derm PA examined a lesion on my leg - a freckle that had changed - said it was no problem. Six monthes later, my NP asked about it (she was doing my PAP) re-referred me to a derm MD, who immediately removed it with some concerning findings.

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I respect all my separate groups of practitioners. But to get respect, you have to earn it and give it.

A couple of points:

How many times, have we seen MDs referring to CNAs/office secretaries/MAs/MTs as their "office nurse"? And then get all huffy when corrected on it? You want protection for the name "Doctor" but many MDs do not use the name "Nurse" appropriately.

I would love for MDs to do their jobs in full. So why don't they do them, instead pushing work on RNs that falls clearly out of our scope.

The order "resume home meds" has been barred from hospital use for ages...so then why is it still being written on a regular basis? Or the MD that doesn't ever write any DC meds/DC instructions. I've had MDs repeatedly tell patients that they are DC'd but not tell the nurse nor write anything in the chart to indicate DC. Which means we have page you all over creation, and the patient is pissed, and has questions about meds and there is NOTHING written.

You don't want NPs to prescribe, but many of these same MDs write "resume home meds" and tell the hospital RN to "use his/her judgement".

Then we have the ones that check mark everything on the admission med rec without looking at it. When the MD sees that the patient is on Lasix 40mg daily AND Fursemide 80mg daily (love those FL retirees with MDs in 2 states, and get 1/2meds in Canada and the others down here), the dehydration and fainting should be a clue not to reorder both. That comatose stroke patient got admitted - I could have crushed the viagra that the MD ordered continued from home and put it down the NG tube, but really don't think it mix well with the new cardiac meds, nor really been all that useful.

I have received orders at least 6 times for nursing to talc/pleuradese chest tubes - all in states where doing so is clearly against the nurse practice act. And they get so ticked when I tell them that. Then They ask me to do it anyway, as they are too busy to wait (or to bother writing for us to get the supplies before rounds).

Respect requires collaboration. You want to know why the 300lb drama queen that you admitted and did bilaterally knee replacements on hasn't gotten out of bed and keep writing snide notes to nursing about ambulation, crudy chest xrays and high blood sugars. Respect us enough to ask us and we will tell you about her refusal to move, the two staffers that got sent to the ER with back/neck injuries because she played the "you have to levitate me on to the bedpan" game, that she is too weak possibly lift her IS, but is fully capable of materializing three giant size snickers bars from the closet (4 feet away) and into mouth.

 

[lawguil]

This is such a ridiculous post that it is very difficult to restrain myself from making an ad hominem rebuttal.


Are you serious?

You know what's ridiculous? Nurses calling the practice of medicine advanced practice nursing.......and because they call it nursing, they can practice without the appropriate education or degree.

Nursing has created their own entry level standards and they leave something to be desired from my experience and inspection.



L.

 

[War Medic]

DNP is too new for anybody to know how to deal with it yet.

 

[War Medic]

The fact of the matter is, that most Doctors in private practice like hiring PAs and NPs more then MDs, because you can pay them less, and get the same end result for your patient. So a 2 year program on top of NP, wich takes 6 years can only benefit them and their patients. Really the heart of the matter is the people who spent 8 years of their life in school (best years of their life according to some, like ME). While the rest worked, made $$$ and had fun. And then on top of that to be able to assume the same roles and jobs. The nerve!!! LOL 🙂

 

[lawguil]

Children, play nice.

Lawguil, that means you.

Thanks for the warning cub master

 

[Taurus]

I found this article amusing. What goes around comes around.

http://www.stltoday.com/stltoday/ne...A6B8ADF657D0E5DE862572DC0011F960?OpenDocument

Under current law, midwifery is limited to certified nurse midwives, who must work in partnership with doctors. A midwife helps with prenatal care and childbirth, often assisting with deliveries in homes.

The new legislation would significantly reduce the requirements, allowing prospective midwives to get certified by a private entity, even if they lack formal medical or nursing training.

 

[Tired]

How many times, have we seen MDs referring to CNAs/office secretaries/MAs/MTs as their "office nurse"? And then get all huffy when corrected on it? You want protection for the name "Doctor" but many MDs do not use the name "Nurse" appropriately.

I have never heard this, but then again, I don't spend much time with the private practice guys in their office. If I were an RN, I'd be pissed, and I'd correct them. The RNs earned their title, and deserve the respect that it confers.

Respect requires collaboration. You want to know why the 300lb drama queen that you admitted and did bilaterally knee replacements on hasn't gotten out of bed and keep writing snide notes to nursing about ambulation, crudy chest xrays and high blood sugars. Respect us enough to ask us and we will tell you about her refusal to move, the two staffers that got sent to the ER with back/neck injuries because she played the "you have to levitate me on to the bedpan" game, that she is too weak possibly lift her IS, but is fully capable of materializing three giant size snickers bars from the closet (4 feet away) and into mouth.

I want you to chart that. I don't know how common it is, and I can't promise I'll do it forever, but I learned very early in med school to read every freaking nursing note in the chart. As an incoming intern, I plan to continue this.

Nursing has the same responsibility to chart significant events and post-op progress as physicians do. If that patient is non-compliant with a prescribed treatment regimen (ie - ambulating), I want every nurse who sees them to write that in the chart. Physician documentation isn't the only thing that keeps us out of court, and you don't want to be deposed any more than I do.

I would love for MDs to do their jobs in full. So why don't they do them, instead pushing work on RNs that falls clearly out of our scope.

This is the crux of the issue, and I agree with you 100%. Physicians have an obligation to take a leadership roles. Those who have farmed out their responsibilities to other providers are exactly the ones who have created the NP issue.

Docs enjoy pretending that the CRNA/NP/PA/midwife situation has been forced on them, but the truth is that they created the situation that allowed (or depending on your perspective, necessitated) their emergence. If physicians provided the same type of compassionate, timely care to their patients as the mid-levels, no patient would choose them over their physician.

 

[Taurus]

Docs enjoy pretending that the CRNA/NP/PA/midwife situation has been forced on them, but the truth is that they created the situation that allowed (or depending on your perspective, necessitated) their emergence. If physicians provided the same type of compassionate, timely care to their patients as the mid-levels, no patient would choose them over their physician.

Physicians created the midlevel positions to extend their abilities, to free up time. These were supervised positions and from the anecdotes posted on here there's a good reason why. They would not have agreed to creating the positions if they thought it would be a shortcut to practice medicine independently. Physicians should stand up for their profession and let it be known that they won't put up with this. They can do that by whom they choose to hire. PA's are instructed in the medical model and work under the BOM. Physicians should put a preference for them. Furthermore, who wants to hire an NP who got his/her degree online? Seriously, that's screwed up.

Physicians can look at what's happening to anesthesiology as an example of what will happen to their fields if they don't do something about it now.

 

[qwerty1]

qwerty1,

It's funny that you seem to have ignored the other posters who are against nurses doing medicine. Several nurses have also said that they think it's a bad idea too. But you seem to be that ignorant.

Physicians would have no issues if roles would be respected. Why do you have an issue with respecting roles? If you invade my turf, then expect a response. Duh, this is not rocket science. It may be to you though.

As I said, one of the best ways that physicians can handle this is by whom they choose to hire. Trying to change laws takes forever and is unpredictable. I hope that more and more physicians recognize it's in their profession's best interest to hire PA's and AA's.

Taurus,

Frankly, I'm surprised you speak to (aside from when circumstances require doing so) or listen to ("backstabbing"... your descriptor) R.N.s. After all, they are out to screw physicians, right?

It's all about position, role, authority and power with you.

In short, CONTROL.

You seem mired in fear, perhaps even paranoia, regarding the position of the physician. For example, you advocate the use of anesthesia assistants over the CRNA, a well defined nursing specialty that has been providing extremely high level care for many decades.

You have said here, on this website, matter of fact in this thread I believe, that were it up to you, you would do away with midlevels.

This is a demonstrably absurd, even irrational, position to hold. As such, everyone reading your posts should consider them highly suspect.

It's sad that a medical student, such as yourself, has such a suspicious outlook on those you will, when you graduate from medical school, depend on to care for your patients. You have fallen prey to the same paranoia that infected allopathic (M.D.) physicians in years past.

"In the 1960s in California, the American Medical Association (AMA), sensing increased competition from osteopathic medicine, spent nearly $ 8 million to end the practice of osteopathy in the state. With considerable financial support from the AMA, a state-wide referendum was passed (Proposition 22) ending the practice of osteopathic medicine in California. California D.O.s were offered the M.D. degree in exchange for paying $65 and attending a short seminar. The California Medical Association may have been attempting to eliminate osteopathic competition by a process of amalgamation by converting thousands of D.O.s to M.D.s. The College of Osteopathic Physicians and Surgeons became the University of California, Irvine, College of Medicine. However, the decision proved quite controversial. In 1974, after protest and lobbying by influential and prominent D.O.s, the California Supreme Court ruled that licensing of D.O.s in that state must be resumed."

In short, some 40 years ago, M.D.s, like you (well not yet, but a future M.D.), feared "competition" and sought to discredit those that could potentially "compete" with you. Osteopathic physicians were "witch doctors" and "medical frauds".

In my 13 years of practice, I've never heard an N.P. describe him/herself as "equal to" or "the same as" a physician.

When working with doctoral level R.N.s (and I routinely work with a neuro D.N.P.), I usually introduce her as Dr. So&So (to make the patient aware of her doctoral level of expertise), a nurse practitioner specializing in neurology". Aftercare info card returns have made it quite clear that patients are not so stupid as to be unable to discern R.N. from M.D. (oh yes... D.O.'s too).

I sure wish I could be a "fly on the wall" and remotely observe your internship... I expect it will be entertaining. You haven't even yet graduated from medical school yet but your ego allows you to make pronouncements like "I'd do away with midlevels".

Good luck buddy... because you will need it if your true nature peeks out and is seen by the R.N.s with whom you will work.

 

[Taurus]

In my 13 years of practice, I've never heard an N.P. describe him/herself as "equal to" or "the same as" a physician.

I am no fresh face college student who went straight to medical school. I've been working in the real world for a number of years. In my former life, I was a commodities trader. I understand the concepts of competition and supply and demand very well. In the business world, always looking over your shoulder to look out for the next threat is the key to your survival. Physicians are finally waking up to this reality. They're not immune.

NP's who want autonomy so that they can practice medicine independently are looking for a shortcut. Not only do they want to practice independently and have the same scope, they want to bill at the same rate! Do you think that's fair? Should the reimbursement be the same for a board-certified physician vs. a master's NP? Should malpractice premiums be the same or higher for professionals with shorter training? Think about it.

Why do you think that CRNA's hate AA's? Because they view them as competition. CRNA's try to hinder AA legislation in every possible way they can. They even use dirty politics. Do some reearch regarding North Carolina and Florida. If PA's were a new field, you can bet that NP's would try to do everything they can to stop PA legislation. Thankfully, PA's are a well-established group. Ooh ooh, I think I see you speaking from both sides of your mouth. How would you like it if CNA's increased their scope to include traditional RN roles? Are you applying a double-standard?

I hear CRNA's proclaim their equivalence to anesthesiologists all the time. You can go to the anesthesiololgy forum or allnurses.com to read their proclamations. Even their national organization implies it too. So you haven't heard an NP proclaim their equivalence to a physician. I have. When more of them get DNP's, you'll start hearing it more and more. As one poster mentioned, the DNP said, "we're all physicians". No, being called a physician requires taking the USMLE or COMLEX steps and full residency, not some online degree program. DO's are real physicians because they go through similar training as MD's. If DNP's go through similar training as MD's, I'll call them real physicians too.

You should look in the mirror. Your group is the one causing problems. We're just defending our profession from people who want a shortcut to do our work. Physicians are not helpless against this invasion. The first step is that we can place a hiring preference for PA's over NP's. That will send a clear and loud message. I am opening people's eyes and you don't like that. I understand. You'll be surprised by how many physicians understand what's happening.

 

[kylek044]

You have said here, on this website, matter of fact in this thread I believe, that were it up to you, you would do away with midlevels.

Not for nothing, but this IS the student doctor network.

 

[PhysioMan]

We are Physician Assistants/Nurse Practitioners. It is in our best interest to engage in conversation with our fellow healthcare professionals. We welcome all Physicians (MD/DO) and Med Students/Residents to our forum: http://www.physicianassistantforum.com/forums/ and http://www.clinicianforum.com/index.php
and some do join in on the conversation with us there. Unless you plan on practicing medicine in a bubble, I suggest you look around and see who the work horses are in the hospitals/clinics. You may be experiencing the stress (read: ) involved with medical education but remember that some day you do have to act human again. When you reach that point, you won't have the excuse of "My Chief is a $#%* !" or "I'm burned out" anymore. You will just be an a-hole...

 

[dilated]

When working with doctoral level R.N.s (and I routinely work with a neuro D.N.P.), I usually introduce her as Dr. So&So (to make the patient aware of her doctoral level of expertise), a nurse practitioner specializing in neurology". Aftercare info card returns have made it quite clear that patients are not so stupid as to be unable to discern R.N. from M.D.

Wait, I thought DNPs weren't going to call themselves "Doctors" in clinical settings because it would be misleading to patients. Glad to see that one held up a long time...

 

[JOYDNP]

I "signed up" only so I could comment, but I am truly a guest and will probably never be back on this forum again. As a practicing 50 year old DNP, I thought I'd seen and heard everything - from the days of getting up out of my chair to let the DOCTOR sit down to having to wear white hose. While I recognize that a fringe mentality of ignorance and condescending attitude still exists, I thought that we, as a society, had long ago determined that being a DOCTOR does not equate to being all/knowing all, etc. I was doing some research for an article and the SDNF link was one of the hits. I just spent the last 30 minutes reading this discussion and actually am embarrassed for some of you. You guys and gals have a long road ahead of you (especially Taurus) if you think you are even remotely on the right path. I can appreciate your views and, believe me, this is a discussion that has gone on for years and will continue to go on. You are even right about some things. But the level of vitriol just stuns me. I know from experience that you will carry those same attitudes and misconceptions and divisiveness into your careers and that saddens me. You will be disruptive and I suspect will go through several jobs and practices because of your anger and hostility and inability to have intelligent, even robust debates. Nothing like a newby who thinks he/she has all the answers. I hope me nor my family ever has to encounter you in a clinical setting. Sad, sad.

 

[Taurus]

I can appreciate your views and, believe me, this is a discussion that has gone on for years and will continue to go on.

I agree that it is sad that it has to come to this. If we respected our roles, this would be a non-issue. The professions are heading toward a collision and it is worst in anesthesiology. The nurses want the physicians to be passive and just accept it. If the physicians protest, the nurses say, "Oh, you're not being a team player". Isn't that funny? This is no longer strictly a discussion. Creating the DNP was an action by the nurses. Therefore, physicians need to respond with action. Our national organization, the AMA, and specialty organizations are doing a lot for us. We also need to help ourselves.

Do you really think the nurses would sit idly by if the CNA's made a move to increase their scope? Please don't apply double-standards.

Has anyone notice that *not one* NP or DNP proclaimed they were practicing advanced nursing when I said they were really practicing medicine? It's because they know that they are really practicing medicine.

 

[fab4fan]

Joy, it's actually gotten worse over the years. I graduated in 1985. For the most part, up until the last 5y we were treated "OK." The last couple of years though have been horrible. I have been shocked at some of the downright infantile--and I do mean infantile--behavior I have seen. So much so that the only rational response I have come up with is to go back to school so I can eventually get away from bedside nursing and get away from the youngsters who think that screaming, verbal abuse and publicly humiliating people is how one is to behave when one is a physician. I have reached my limit of what I can tolerate.

I may not agree some of the DNP agenda, but I agree with nurses empowering themselves.

 

[fab4fan]

I agree that it is sad that it has to come to this. If we respected our roles, this would be a non-issue. The professions are heading toward a collision and it is worst in anesthesiology. The nurses want the physicians to be passive and just accept it. If the physicians protest, the nurses say, "Oh, you're not being a team player". Isn't that funny? This is no longer strictly a discussion. Creating the DNP was an action by the nurses. Therefore, physicians need to respond with action. Our national organization, the AMA, and specialty organizations are doing a lot for us. We also need to help ourselves.

Do you really think the nurses would sit idly by if the CNA's made a move to increase their scope? Please don't apply double-standards.

Has anyone notice that *not one* NP or DNP proclaimed they were practicing advanced nursing when I said they were really practicing medicine? It's because they know that they are really practicing medicine.

Actually, we're ignoring you. We see you for what you are; no point in wasting our time with you.

 

[Taurus]

Actually, we're ignoring you. We see you for what you are; no point in wasting our time with you.

Yeah, it was more interesting when this thread was in the Allo forum. I'm among the unfriendlies down here.

 

[JOYDNP]

Yeah, it was more interesting when this thread was in the Allo forum. I'm among the unfriendlies down here.

And I hate the attacks from either side. "Can't we just all get along?" Apparantly not! I said I wasn't going to come back to this forum but here I am. To give you my full opinion would take a long, long time - and this is not the place to do that. Some brief thoughts...as an ED NP, I do practice medicine and nursing. There is overlap and we can't deny it. Think about it this way...you could bring in any intelligent person off of the street with no education and within a week teach them to do much of what we do in medicine and nursing. Procedures are not that difficult. With the computer, you can manage almost any disease process - sad, but true. But obviously, that isn't feasible, so each discipline (profession) comes up with a set of standards, including education and competency assessment, such as a standardized credentialing test. So, if each discipline comes up with a legitimate way to train and credential their own professionals, we can argue about how they got there, but we can't argue with what they do or don't do. My personal opinion is that there should be a standardized test for everyone who is a clinical health care provider - be it physician or nurse pracitioner or nurse anesthestist. I despise nurses who think they can go 2 more years and "do the same thing as physicians" (which is part of the reason that the minimal requirements for NP is going to be doctoral prepared). I am in my role to fulfill a need, and I take it very seriously. (If you ever come to my ED, ask anybody who they would rather take care of them, whether it's to manage your MI or intubate you or put in a chest tube - I'm fast, document well, skilled AND a nice person!) Two quick points...You are a physician, not just a doctor. I introduce myself as "Dr. So and So, a nurse practitioner." Face it, patients are always confused. The male nurses (which we have many of the in ED) are always "the doctor" and the females in our scrubs (NPs or MDs) are always "the nurses". It is very confusing and there are laws to protect patients (name tags, etc) and we have an obligation to say who we are. The term "doctor" helps no one - our specialty is what is important. And, if part of your fear is that nurse anesthestists and NPs are going to get equal reimbursement and run you out of a job, I think that is unfounded. There will ALWAYS be a place for ALL of us and I think if you embrace their expectations and just do your thing, you and your fellow physicians will not skip a beat. Here's a new can of worms...if Hillary becomes president, we will all be employees of the government, and it won't matter anymore anyway! Oh, I forgot to answer one major question - Was my training as difficult as medical school? No. many of our classes and clinicals overlapped, and my schooling was just as long, but not as intense. But does harder mean better? Not necessarily - pertinent is better! There are many problems with the medical model of education - mainly the concept of reductionism. And, there is a national endeavor to do away with nursing diagnosis, etc (we honestly don't use those - we use medical diagnosis) and eventually, I think most of our training will be entertwined. Hey, the physicians NEED to take some nursing courses! BUT, and here is a HUGE point - imagine the frustration for me that I do the same things as the physicians and get paid about half. If you ever go into practice, you'd want me as a partner - I'd make your business a butt load of money and I'm cheap labor! Love us, hug us, embrace us, we're not going away. (And I'll even get up and give you my seat if that makes you feel better).

 

[fab4fan]

Wow, so even you hate nurses who are master's prepared NPs? Sheesh, after reading that diatribe I put you right up there with the tantrum throwing baby docs I've been dealing with.

I happen to despise arrogant nurses who feel they have to put down their fellow nurses. I've seen some LPNs that could teach some ivory tower nurses a thing or two about patient care.

Face the facts Joy...at the end of the day, you are a NURSE! If you have some self-loathing issues regarding that (which come through loud and clear), get some therapy or go back to med school. I find it more than a little disturbing that you would say, "Pt's are confused anyway, so what if I add to the confusion by calling myself Dr." (to paraphrase) That's like saying since most of the public has the average of a 6th grade education, we shouldn't try too hard to do patient education, since they're all basically stupid.

Your post is a reminder of all that is offensive with the DNP scorched earth philosophy.

 

[deleted87716]

I introduce myself as "Dr. So and So, a nurse practitioner." Face it, patients are always confused.

You're certainly not helping with that.

The term "doctor" helps no one - our specialty is what is important.

So, why are you doing it? Saying that you're a nurse practitioner should be enough. It's certainly less confusing.

 

[chimichanga]

A DNP is an advanced practice nurse, period...Please stop calling yourself doctor.


signed,

a nurse

And for what it's worth, those with their doctorates in education, anthropology, etc. should please stop calling themselves doctor...It sounds silly...

 

[fab4fan]

A DNP is an advanced practice nurse, period...Please stop calling yourself doctor.


signed,

a nurse

And for what it's worth, those with their doctorates in education, anthropology, etc. should please stop calling themselves doctor...It sounds silly...

In an academic setting, those individuals certainly have the right to be called "Dr." if they have earned a doctorate. Outside that arena, it's just hubris.

 

[core0]

I would just appreciate if the DNP programs teach the use of paragraphs. My eyes are still burning.

David Carpenter, PA-C

 

[core0]

And I hate the attacks from either side. "Can't we just all get along?" Apparantly not! I said I wasn't going to come back to this forum but here I am. To give you my full opinion would take a long, long time - and this is not the place to do that.

Some brief thoughts...as an ED NP, I do practice medicine and nursing. There is overlap and we can't deny it. Think about it this way...you could bring in any intelligent person off of the street with no education and within a week teach them to do much of what we do in medicine and nursing. Procedures are not that difficult. With the computer, you can manage almost any disease process - sad, but true. But obviously, that isn't feasible, so each discipline (profession) comes up with a set of standards, including education and competency assessment, such as a standardized credentialing test. So, if each discipline comes up with a legitimate way to train and credential their own professionals, we can argue about how they got there, but we can't argue with what they do or don't do. My personal opinion is that there should be a standardized test for everyone who is a clinical health care provider - be it physician or nurse pracitioner or nurse anesthestist.

I despise nurses who think they can go 2 more years and "do the same thing as physicians" (which is part of the reason that the minimal requirements for NP is going to be doctoral prepared). I am in my role to fulfill a need, and I take it very seriously. (If you ever come to my ED, ask anybody who they would rather take care of them, whether it's to manage your MI or intubate you or put in a chest tube - I'm fast, document well, skilled AND a nice person!)

Two quick points...You are a physician, not just a doctor. I introduce myself as "Dr. So and So, a nurse practitioner." Face it, patients are always confused. The male nurses (which we have many of the in ED) are always "the doctor" and the females in our scrubs (NPs or MDs) are always "the nurses". It is very confusing and there are laws to protect patients (name tags, etc) and we have an obligation to say who we are. The term "doctor" helps no one - our specialty is what is important. And, if part of your fear is that nurse anesthestists and NPs are going to get equal reimbursement and run you out of a job, I think that is unfounded. There will ALWAYS be a place for ALL of us and I think if you embrace their expectations and just do your thing, you and your fellow physicians will not skip a beat.

Here's a new can of worms...if Hillary becomes president, we will all be employees of the government, and it won't matter anymore anyway! Oh, I forgot to answer one major question - Was my training as difficult as medical school? No. many of our classes and clinicals overlapped, and my schooling was just as long, but not as intense. But does harder mean better? Not necessarily - pertinent is better! There are many problems with the medical model of education - mainly the concept of reductionism. And, there is a national endeavor to do away with nursing diagnosis, etc (we honestly don't use those - we use medical diagnosis) and eventually, I think most of our training will be entertwined.

Hey, the physicians NEED to take some nursing courses! BUT, and here is a HUGE point - imagine the frustration for me that I do the same things as the physicians and get paid about half. If you ever go into practice, you'd want me as a partner - I'd make your business a butt load of money and I'm cheap labor! Love us, hug us, embrace us, we're not going away. (And I'll even get up and give you my seat if that makes you feel better).

Here I fixed it for you I think.

David Carpenter, PA-C

 

[zenman]

Here's a new can of worms...if Hillary becomes president, we will all be employees of the government, and it won't matter anymore anyway!

You mean "if Hillary becomes president again" She's already served two terms.

 

[fab4fan]

Here I fixed it for you I think.

David Carpenter, PA-C

Thank you, Dave. I was thinking the same thing.

 

[lawguil]

A DNP is an advanced practice nurse, period...Please stop calling yourself doctor.


signed,

a nurse

And for what it's worth, those with their doctorates in education, anthropology, etc. should please stop calling themselves doctor...It sounds silly...

I think "doctor" is a silly term in general.....unless it's used by the most talented and educated.......which is a rare find anywhere!

 

[PainDr]

Taurus,

Frankly, I'm surprised you speak to (aside from when circumstances require doing so) or listen to ("backstabbing"... your descriptor) R.N.s. After all, they are out to screw physicians, right?

It's all about position, role, authority and power with you.

In short, CONTROL.

You seem mired in fear, perhaps even paranoia, regarding the position of the physician. For example, you advocate the use of anesthesia assistants over the CRNA, a well defined nursing specialty that has been providing extremely high level care for many decades.

You have said here, on this website, matter of fact in this thread I believe, that were it up to you, you would do away with midlevels.

This is a demonstrably absurd, even irrational, position to hold. As such, everyone reading your posts should consider them highly suspect.

It's sad that a medical student, such as yourself, has such a suspicious outlook on those you will, when you graduate from medical school, depend on to care for your patients. You have fallen prey to the same paranoia that infected allopathic (M.D.) physicians in years past.

"In the 1960s in California, the American Medical Association (AMA), sensing increased competition from osteopathic medicine, spent nearly $ 8 million to end the practice of osteopathy in the state. With considerable financial support from the AMA, a state-wide referendum was passed (Proposition 22) ending the practice of osteopathic medicine in California. California D.O.s were offered the M.D. degree in exchange for paying $65 and attending a short seminar. The California Medical Association may have been attempting to eliminate osteopathic competition by a process of amalgamation by converting thousands of D.O.s to M.D.s. The College of Osteopathic Physicians and Surgeons became the University of California, Irvine, College of Medicine. However, the decision proved quite controversial. In 1974, after protest and lobbying by influential and prominent D.O.s, the California Supreme Court ruled that licensing of D.O.s in that state must be resumed."

In short, some 40 years ago, M.D.s, like you (well not yet, but a future M.D.), feared "competition" and sought to discredit those that could potentially "compete" with you. Osteopathic physicians were "witch doctors" and "medical frauds".

In my 13 years of practice, I've never heard an N.P. describe him/herself as "equal to" or "the same as" a physician.

When working with doctoral level R.N.s (and I routinely work with a neuro D.N.P.), I usually introduce her as Dr. So&So (to make the patient aware of her doctoral level of expertise), a nurse practitioner specializing in neurology". Aftercare info card returns have made it quite clear that patients are not so stupid as to be unable to discern R.N. from M.D. (oh yes... D.O.'s too).

I sure wish I could be a "fly on the wall" and remotely observe your internship... I expect it will be entertaining. You haven't even yet graduated from medical school yet but your ego allows you to make pronouncements like "I'd do away with midlevels".

Good luck buddy... because you will need it if your true nature peeks out and is seen by the R.N.s with whom you will work.

Using the term "Dr. So&So" is ONLY appropriate in the academic setting and NEVER in the clinical setting. Actually, I believe is it considered fraud. We all know the difference between a masters level and a doctorate level NP has NOTHING to do with clinical expertise so why should it even matter to pts? BTW, I'm a practicing physician (not a student) and if I EVER heard a NP being referred to as Dr., I'd raise hell. Am I territorial? Absolutely. I EARNED the right to be called Dr. and if someone else wants to pretend they have the same right, I'll be there to correct them.

 

[Noeljan]

Using the term "Dr. So&So" is ONLY appropriate in the academic setting and NEVER in the clinical setting. Actually, I believe is it considered fraud. We all know the difference between a masters level and a doctorate level NP has NOTHING to do with clinical expertise so why should it even matter to pts? BTW, I'm a practicing physician (not a student) and if I EVER heard a NP being referred to as Dr., I'd raise hell. Am I territorial? Absolutely. I EARNED the right to be called Dr. and if someone else wants to pretend they have the same right, I'll be there to correct them.

👍 Thank you. I got my BSN in UG and now starting medical school. I love and respect many nurses, but I think it is very ignorant for some to claim that they are the same thing as a Doctor, and call themselves doctor. If I ever heard a nurse do that in a clinical setting I would quickly correct them.
I must say though, despite all the talk on here from some people who think that a medical education should mean nothing (and various other things) most nurses I have worked with or know have a lot of respect for doctors and the education/training they go through. I remember our entire unit of nurses (not doctors) used to talk about the whole white coat thing (because janitors seem to sport them around the hospital), WE actually found it offensive and disrespectful to the doctors. My point is, there are plenty of nurses that do not have this "we want to take over medicine" attitude.

 

[Noeljan]

Wow, so even you hate nurses who are master's prepared NPs? Sheesh, after reading that diatribe I put you right up there with the tantrum throwing baby docs I've been dealing with.

I happen to despise arrogant nurses who feel they have to put down their fellow nurses. I've seen some LPNs that could teach some ivory tower nurses a thing or two about patient care.

Face the facts Joy...at the end of the day, you are a NURSE! If you have some self-loathing issues regarding that (which come through loud and clear), get some therapy or go back to med school. I find it more than a little disturbing that you would say, "Pt's are confused anyway, so what if I add to the confusion by calling myself Dr." (to paraphrase) That's like saying since most of the public has the average of a 6th grade education, we shouldn't try too hard to do patient education, since they're all basically stupid.

Your post is a reminder of all that is offensive with the DNP scorched earth philosophy.

👍

 

[PainDr]

And I hate the attacks from either side. "Can't we just all get along?" Apparantly not! I said I wasn't going to come back to this forum but here I am. To give you my full opinion would take a long, long time - and this is not the place to do that. Some brief thoughts...as an ED NP, I do practice medicine and nursing. There is overlap and we can't deny it. Think about it this way...you could bring in any intelligent person off of the street with no education and within a week teach them to do much of what we do in medicine and nursing. Procedures are not that difficult. With the computer, you can manage almost any disease process - sad, but true. But obviously, that isn't feasible, so each discipline (profession) comes up with a set of standards, including education and competency assessment, such as a standardized credentialing test. So, if each discipline comes up with a legitimate way to train and credential their own professionals, we can argue about how they got there, but we can't argue with what they do or don't do. My personal opinion is that there should be a standardized test for everyone who is a clinical health care provider - be it physician or nurse pracitioner or nurse anesthestist. I despise nurses who think they can go 2 more years and "do the same thing as physicians" (which is part of the reason that the minimal requirements for NP is going to be doctoral prepared). I am in my role to fulfill a need, and I take it very seriously. (If you ever come to my ED, ask anybody who they would rather take care of them, whether it's to manage your MI or intubate you or put in a chest tube - I'm fast, document well, skilled AND a nice person!) Two quick points...You are a physician, not just a doctor. I introduce myself as "Dr. So and So, a nurse practitioner." Face it, patients are always confused. The male nurses (which we have many of the in ED) are always "the doctor" and the females in our scrubs (NPs or MDs) are always "the nurses". It is very confusing and there are laws to protect patients (name tags, etc) and we have an obligation to say who we are. The term "doctor" helps no one - our specialty is what is important. And, if part of your fear is that nurse anesthestists and NPs are going to get equal reimbursement and run you out of a job, I think that is unfounded. There will ALWAYS be a place for ALL of us and I think if you embrace their expectations and just do your thing, you and your fellow physicians will not skip a beat. Here's a new can of worms...if Hillary becomes president, we will all be employees of the government, and it won't matter anymore anyway! Oh, I forgot to answer one major question - Was my training as difficult as medical school? No. many of our classes and clinicals overlapped, and my schooling was just as long, but not as intense. But does harder mean better? Not necessarily - pertinent is better! There are many problems with the medical model of education - mainly the concept of reductionism. And, there is a national endeavor to do away with nursing diagnosis, etc (we honestly don't use those - we use medical diagnosis) and eventually, I think most of our training will be entertwined. Hey, the physicians NEED to take some nursing courses! BUT, and here is a HUGE point - imagine the frustration for me that I do the same things as the physicians and get paid about half. If you ever go into practice, you'd want me as a partner - I'd make your business a butt load of money and I'm cheap labor! Love us, hug us, embrace us, we're not going away. (And I'll even get up and give you my seat if that makes you feel better).

You state that you are a nurse and that "the term doctor helps no one" so why do you call yourself "Dr. So and So" when talking to patients? In a clinical situation, not only is it ethically wrong to do this, it is fraud. Impersonating a physician is...I believe...a felony offense.

Your "schooling was just as long"? Really? So you have 12 yrs of formal education? The minumum is 12 yrs, mine was actually 15: 4 yrs undergrad, 2 yrs grad school, 4 yrs med school, 4 yrs internship/residency, 1 yr fellowship.

Lastly, I could care less about your frustration. If you want to be paid like a physician, GO TO MED SCHOOL.

 

[Taurus]

There will ALWAYS be a place for ALL of us

If this was only true. Why am I so vehemently against midlevels invading medicine? Because they will commoditize the profession and devalue my medical education. You can already see it in anesthesiology and primary care. If Medicare starts to see a field such as giving anesthesia as a nursing profession and not as a medical one, they will slash reimbursements drastically. You can apply the same logic to any field where nurses are trying to claim equivalence with physicians. Physicians can justify higher reimbursements because Medicare understands that our training takes forever, we take on a huge debt load to finance our education, and our certification process is very rigorous. Other professionals who have shorter training and less rigorous standards cannot justify that to Medicare. This country is in a financial bind and Medicare wants to find ways to cut costs.

Furthermore, if you have more professionals who can do the same job, salaries will decrease by the principle of supply and demand. Dentists now make more on average than primary care physicians. Why do you think that's so? There will be fewer job opportunities. In some medical specialties such as pathology and ophthalmology, the market is saturated. Pathology residents have to plan years ahead to find jobs and some ophthalmology graduates are making $90-120k starting. One SDN poster was saying how he submitted a job posting for a path tech position and got the resumes of 5 board-certified pathologists in the first few days. Like any other industry in this world, medicine obeys the laws of supply and demand and there is no guarantee of income or job even for physicians.

I know of two anesthesiologists who have lost their jobs to CRNA's. It will only get worse. Every physician in every specialty needs to stand up for their profession. I support PA's over NP's because even though they are midlevels they fall under the state board of medicine. The nurses seem to be doing everything they can to undermine the medical profession and advance their own agenda. We can't depend on politicians to get it right because most are lawyers and they aren't interested in protecting our profession. Do you see lawyers letting paralegals increase their scope? No way. We have to take responsibility for the future of our profession.

I do practice medicine and nursing. There is overlap and we can't deny it.

I would even argue that you practice more medicine than nursing. Heck, someone in your position does not even need the nursing background. Therefore, your role as well as CRNA's should fall under the Board of Medicine. Wouldn't you agree? If that were the case, there would be no need for this argument because the Board of Medicine would work to reduce the confusion of roles. But you and I know that the Board of Nursing will do anything they can to prevent that from happening. Hence, the term "advanced nursing practice".

 

[Taurus]

imagine the frustration for me that I do the same things as the physicians and get paid about half.

I think that it is fair and reasonable that someone with more training and experience should get a higher reimbursement level. Their differential list will be longer. Their knowledge of treatment plans is more expansive. They also take on more liability because patient expects a higher level of care.

If the billing rate is the same for physicians and midlevels, it's typically because it is assumed that the midlevel is working under supervision. If midlevels want independence, then their billing rate should be lower and their insurance premiums should be higher. It doesn't make sense for midlevels to expect to go independent and be treated equally as physicians. The market is waking up to the reality that more and more midlevels are working without supervision (physician groups are more than happy to educate insurance carriers on this). That's why for some their insurance premiums have skyrocketed over the last few years.

 

[kylek044]

I think that it is fair and reasonable that someone with more training and experience should get a higher reimbursement level. Their differential list will be longer. Their knowledge of treatment plans is more expansive. They also take on more liability because patient expects a higher level of care.

If the billing rate is the same for physicians and midlevels, it's typically because it is assumed that the midlevel is working under supervision. If midlevels want independence, then their billing rate should be lower and their insurance premiums should be higher. It doesn't make sense for midlevels to expect to go independent and be treated equally as physicians. The market is waking up to the reality that more and more midlevels are working without supervision (physician groups are more than happy to educate insurance carriers on this). That's why for some their insurance premiums have skyrocketed over the last few years.

Taurus, OK - now you're just like stirring **** with a stick.

 

[core0]

I think that it is fair and reasonable that someone with more training and experience should get a higher reimbursement level. Their differential list will be longer. Their knowledge of treatment plans is more expansive. They also take on more liability because patient expects a higher level of care.

If the billing rate is the same for physicians and midlevels, it's typically because it is assumed that the midlevel is working under supervision. If midlevels want independence, then their billing rate should be lower and their insurance premiums should be higher. It doesn't make sense for midlevels to expect to go independent and be treated equally as physicians. The market is waking up to the reality that more and more midlevels are working without supervision (physician groups are more than happy to educate insurance carriers on this). That's why for some their insurance premiums have skyrocketed over the last few years.

The medicare billing rate for NPP's is 85% of the physician rate. Medicare set this rate back in the 80's. At that time they noted the NPP expenses were less than the physician rate because of lower student loan debt and lower malpractice insurance rates.

There is an exception called incident to billing. In this case the reimbursement is 100%. To do this the physician must see the patient for the initial problem. The follow up care on that problem can then be seen by an NPP. As long as the physician is physicially present in the office, the after care is paid at 100%.

The real question is wether the 85% rate is a true indicator. In my practice, my malpractice is about 10% of the physcians. However, in family practice it is much closer (assuming no OB).

David Carpenter, PA-C

 

[horsenurse25]

I remember our entire unit of nurses (not doctors) used to talk about the whole white coat thing (because janitors seem to sport them around the hospital), WE actually found it offensive and disrespectful to the doctors. .

Oh honestly.

The amount of chest pounding and territory marking that happens on this forum is just hilarious. There should be a smilie - actually I am certain there is one somewhere.

I find it hard to believe that any nurses would care about white coats, much less find it disrespectful to doctors. It paints a very pretty mental picture though... I can just see it, all the submissive subordinates sitting quietly in a circle in their crowded staff room, faithfully upholding the sacred tradition, reverently falling silent when the Allmighty Physician shows up in the ward.... 😆


You guys really need to get out more. Believe it or not, health care is a team endeavour and quite honestly, the hierarchy system that you guys dream about is merely that...a dream. Once you become Physicians (if you ever do) you will learn humility. Believe me, you will.

I understand that you guys need to keep pumping yourselves up to justify the sacrifices you make on your quest to become physicians, but really, sometimes it is beyond ridiculous.

I am an NP and work at a busy medical center with several physicians. I am working on my DNP. And when I get it, I will greet my clients as "Hello there, I am Dr. Sally, a Nurse Practitioner".

🙂

 

[fab4fan]

If you think that some of these people will learn humility merely through the process of becoming physicians, you've got another think coming. That hasn't worked for quite a few "difficult" docs I deal with. If you've been a jerk most of your life, chances are med school isn't going to cure that; if anything, it will make it worse.

I'm probably showing my age, but I just cannot accept a nurse referring to herself as "Doctor" in a clinical setting. I really don't care how many doctoral degrees that nurse has, to me it just seems confusing to the patient and staff.

 

[Noeljan]

Oh honestly.

The amount of chest pounding and territory marking that happens on this forum is just hilarious. There should be a smilie - actually I am certain there is one somewhere.

I find it hard to believe that any nurses would care about white coats, much less find it disrespectful to doctors. It paints a very pretty mental picture though... I can just see it, all the submissive subordinates sitting quietly in a circle in their crowded staff room, faithfully upholding the sacred tradition, reverently falling silent when the Allmighty Physician shows up in the ward.... 😆


You guys really need to get out more. Believe it or not, health care is a team endeavour and quite honestly, the hierarchy system that you guys dream about is merely that...a dream. Once you become Physicians (if you ever do) you will learn humility. Believe me, you will.

I understand that you guys need to keep pumping yourselves up to justify the sacrifices you make on your quest to become physicians, but really, sometimes it is beyond ridiculous.

I am an NP and work at a busy medical center with several physicians. I am working on my DNP. And when I get it, I will greet my clients as "Hello there, I am Dr. Sally, a Nurse Practitioner".

🙂

Are you kidding me? Being able to respect the role and education of physicians has nothing to do with as you put it "submissive subordinates" Unlike you, who clearly has some sort of inferiority complex, there are many nurses who appreciate the differences between nursing and medicine. That is actually teamwork, not this "I am a doctor even though I'm not crap"
And it did happen, I was there. Listen, I got a great education in Nursing school. My professors and classmates were intelligent hardworking people. None of them had the attitude you have. Unlike you, I will in fact be a physician. If you would like to follow that route, please join me in medical school.

 

[horsenurse25]

And it did happen, I was there.

Uh-huh. I'll bet. 🙄 🙄 🙄 All the nurses (or other hospital personell) who wear white coats are traitors to the cause and the True Believers will rip them off the backs of those who dare defile them.

Anyways. I never claimed to be a physician. I am a NP and hopefully will get my doctorate. They are different, if complimentary fields. And both are equally valid.

There are lots of people in the health field that call themselves doctors... including psychologists, veterinarians, pharmacists etc. Are they more entitled to the word 'doctor' than a nurse who has gotten her doctorate degree? How about dentists? They 'only' go to school for about 8 years - about the same length of time it takes to get a DNP. Are they not qualified to use the term also?? How about doctor of physical therapy?

It is amusing to me that there are so many people both in and out of the health field that can use the sacred term, but not nurses. What are you guys afraid of?? Is the only thing separating you from nurses your beloved title?? If so, then maybe you need to look at that a little bit.

Fab4 (by the way, my son is an ultimate fan as well) I respect how you feel. I myself think the person behind the title is more important than the actual title. I introduce myself as an NP, and I will introduce myself as a doctor of nursing, but I do and will always have the patient address me by my first name anyways. And you are probably right; Once a jerk, always a jerk. Luckily I have found 95% of the docs to be great team members. There are always head cases, docs and nurses included.

Also- I know you have been going through some tough times lately. I hope you find a satisfactory resolution soon.

 

[Noeljan]

Uh-huh. I'll bet. 🙄 🙄 🙄 All the nurses (or other hospital personell) who wear white coats are traitors to the cause and the True Believers will rip them off the backs of those who dare defile them.

QUOTE]


are you calling me a liar?