DNP versus MD?

[fab4fan]

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good luck with your NP pursuit fab4

Thank you! I really needed those well wishes today. Bad day. Baaaaaaad surgeon. That little post gave my spririts a boost.

 

[horsenurse25]

You're pretty strident at allnurses, too. JMO. It's kind of a drag to have a thread where those of us interested in becoming NPs encouraging each other humming along nicely, and then you come along and throw the proverbial brick through the window. But I've come to recognize that that is your MO, and take it for what it's worth.

I'm one of those slackers or whatever you think of them, "people who take online classes." Why online? Because there is no local university for me to attend. Not everyone lives in an urban area. So, I've got to finish my BSN, which will take me about 2y, then do the NP gig. Again, online because there is no place for me locally and I'm getting tuition reimbursement. I'm being picky about which schools I'm looking at; I've already narrowed my choices down to about three programs. Would I prefer to do standard education (bricks and mortar)? Sure, but I have to work, and as I said, there's a lack of facilities to choose from. So I'm going to have to put the extra effort into it, plus hope that 22y of experience will help a little. I know I am going to have to do some learning on my own. I plan to pick the docs' brains (the nice ones) every chance I can get; take every opportunity to listen in when they're rounding with students; ask lots of questions of the residents. We are a teaching hospital, after all.

I have no desire to be an independent practitioner, but I have no desire to remain a bedside nurse for the rest of my life. It's not enough. While I'm not the smartest nurse in the world, I do know my stuff. I figure if it's something I can figure out, then there's no excuse for a doc not to know it. So I will be perfectly happy in a midlevel position, with supervision but some latitude. Pretty much the way most NPs in my area work.

I could e-mail you my #1 choice for where I want to get my NP, and I am sure you would have nothing to say that wasn't negative. I think you see nurses the way most docs do: little handmaidens who fetch for you and clean up after you, other than that, pretty useless unless they're good eye-candy. Definitely not intelligent co-workers, or, heaven forfend, "colleagues/peers." We're just not worthy.

The way people are being educated is changing. Maybe you need to accept that things aren't the way they used to be. And that change isn't always bad. The programs I'm looking at are accredited by the major organizations that govern nursing practice. I'm sure things could be improved, and will be improved, but I've worked with several highly skilled NPs (cardiology). They must be doing something right since the docs let them come to the ED, work up the pt and write the admit orders. They didn't all go to the same program, but they did have one thing in common: several years of experience as a cardiology nurse. Experience that you seem to think is irrelevant.

You and I have polar views on this matter. I have my own questions/concerns about PA education, but I don't whang on and on about it in an attempt to humiliate/embarrass someone. You, however, go on and on, like a dog with a bone. I think you'd only be happy if it was announced that across the country advanced practice licenses for nurses were null and void as of 060607 @ MN.

Physicians barely respect RNs; it's of no surprise to me that they would dislike APRNs.

What you're saying about CRNAs is not what I am seeing in my area. Perhaps these struggles are going on in more urban facilities, but where I live we couldn't function without CRNAs. Our docs seem to interact well with them, and we get pts who specifically request certain CRNAs for their surgeries.

Eloquent as ever Fab4



Core0- I know you have some huge issues, many of which pertain to NP's. However, PLEASE try to get your facts straight.

NPs have full independent practice in 23, read it again 23 states not 15 (and I know I have told you this before). Actually, I just heard that 3 more states got on board and there are now 26 states that allow independent practice. But I am not entirely positive on that one, so we can go wtih 23 for now 🙂 .

They also get 100% physician rate Medicaid reimbursement in 20 states. The rest are between 80% - 85%.

Anyways. I said I was done bickering and I am. Really. But blatant misinformation must be corrected. 😡

 

[chimichanga]

sheesh...

just read all the diatribes...

glad I've been off since sunday, and am not working 'til sunday...

why has the sandbox become so complicated?

most of the country works 20 days/month and fights for their weekend free time (lake, camp, mall, etc)

i just want my 12 shifts per month...thank god for camping in the AZ mountains on a Tuesday, with NOBODY in sight, basking in my 6 figures, laughing at all you lemmings fighting for top dog at the hospital...you can have it...be it MD, DO, NP, PA, whatever...Trauma looks down on ortho, who looks down on the general, who looks down on the ER, who looks down on the FP...

DNP looks down on the FNP, who looks down on the RN, who looks down on the LPN...

Can we all just get over ourselves???

I know my place...It's starting an occasional IV, laughing at all the CTs, CBCs, D dimers, et freaking cetera, that you must order (and NOT thinking about the borderline belly pain that I discharged - Gosh, I hope he doesn't die)...

I respect your career choice, and the huge responsibility, please respect mine...I'm actually not worthy...

You have a nicer house...Yet I sleep just as comfortable as you...You have a bigger boat, yet I catch the same size trout as you, and still manage to land the hottie.

We are all the same...Education will not separate...

I'm glad to be ONLY an RN...

I'll be looking @ retirement at 53, sitting atop the mountain, cooler than thou, NO debt, and sucking on a Corona w/ lime...

can't we all get along??

thank god for baseball this, and every summer...


OUT!!!

 

[core0]

You're pretty strident at allnurses, too. JMO. It's kind of a drag to have a thread where those of us interested in becoming NPs encouraging each other humming along nicely, and then you come along and throw the proverbial brick through the window. But I've come to recognize that that is your MO, and take it for what it's worth.

I can see that point of view. I think that I take a critical point of view of most educational environments.

I'm one of those slackers or whatever you think of them, "people who take online classes." Why online? Because there is no local university for me to attend. Not everyone lives in an urban area. So, I've got to finish my BSN, which will take me about 2y, then do the NP gig. Again, online because there is no place for me locally and I'm getting tuition reimbursement. I'm being picky about which schools I'm looking at; I've already narrowed my choices down to about three programs. Would I prefer to do standard education (bricks and mortar)? Sure, but I have to work, and as I said, there's a lack of facilities to choose from. So I'm going to have to put the extra effort into it, plus hope that 22y of experience will help a little. I know I am going to have to do some learning on my own. I plan to pick the docs' brains (the nice ones) every chance I can get; take every opportunity to listen in when they're rounding with students; ask lots of questions of the residents. We are a teaching hospital, after all.

I wouldn't consider you a slacker. I am simply stating that the concept of an online medical education remains controversial. In the field of nursing the Excelsior program (to use one example) has a somewhat controversial reputation. I think that nursing educators also take a somewhat dim view of this and the DNP may be in part an effort to assert more control over the academic process. Like I said I don't necessarily think that all online programs are bad (and there are some very reputable schools doing this) but remain unproven. I would like to see some sort of studies that show that the educational environment is comparable. There is good data on BSN programs but I think the didactic component is different than that for a NP. I will admit that this information is mostly notional since I have not attended one of these programs (although I have helped edit several papers for MSN students here). As you know one my "bricks" is the lack of metrics in NP education (as well as programs taking liberties with the students that would never be tolerated on any other graduate program). I think your plan is probably a good one As an experienced RN you have an advantage in your environment.

I have no desire to be an independent practitioner, but I have no desire to remain a bedside nurse for the rest of my life. It's not enough. While I'm not the smartest nurse in the world, I do know my stuff. I figure if it's something I can figure out, then there's no excuse for a doc not to know it. So I will be perfectly happy in a midlevel position, with supervision but some latitude. Pretty much the way most NPs in my area work.

Pretty much the way most NPs and PAs work around here also.

I could e-mail you my #1 choice for where I want to get my NP, and I am sure you would have nothing to say that wasn't negative. I think you see nurses the way most docs do: little handmaidens who fetch for you and clean up after you, other than that, pretty useless unless they're good eye-candy. Definitely not intelligent co-workers, or, heaven forfend, "colleagues/peers." We're just not worthy.

Actually I have tremendous respect for nursing. It is tremendously challenging both physically and mentally. I am glad that nursing salaries are finally approaching a reasonable level for the work they do. I am not sure where you get this impression. Nurses have saved my happy butt many times. I worked as a critical care tech, CNA and OR tech prior to PA school. I understand the work nurses do very well. When I see a patient I have basically a four step process. Look at the chart and see what other providers think about the patient, look at the labs and radiology, look at the nurses notes and I&O and talk to the nurse. Of those talking to the nurse is the most important. They are with the patient 24/7. I see the patient for maybe 15 minutes a day. They have a better idea of what is going on with the patient. I always ask if there is anything they need order wise and try to make my orders nurse friendly if possible. I think that a lot of medical providers don't understand this.

The other part of this is always take time to educate. If a nurse wants an explanation for something or has a question about a procedure, I try to make the time to educate. This will usually pay you back in spades.

The way people are being educated is changing. Maybe you need to accept that things aren't the way they used to be. And that change isn't always bad. The programs I'm looking at are accredited by the major organizations that govern nursing practice. I'm sure things could be improved, and will be improved, but I've worked with several highly skilled NPs (cardiology). They must be doing something right since the docs let them come to the ED, work up the pt and write the admit orders. They didn't all go to the same program, but they did have one thing in common: several years of experience as a cardiology nurse. Experience that you seem to think is irrelevant.

I think that you should read my posts on this. In regard to NP education it is the opposite. My personal view is that all NP education should require a set number of years experience in the particular area of nursing that is appropriate for the NP specialty. Some APNs do this such as CNM, NNP and CRNA (See brick #2 on inconsistency in NP education). I will admit I am not sure what the appropriate nursing experience is for FNP. My personal opinion (again only my opinion) is that if you are not going to require the proper nursing background to build upon for the NP education, you need to structure the education so that it covers more information and provides more clinical experience. The cardiology NPs that I work with are also highly educated either cardiology nurses or ICU nurses. They do a great job. They are professional and great clinicians. They know way more about cardiology than I will ever know. I think they demonstrate the right way to do NP education.

I will be honest that what crystallized most of views on NP education was an incident that occurred while I was in school. My initial intention out of the army was to do nursing and NNP. That lasted as long as my first nursing theory class. When I did one of my family practice rotations there was an NP student in the same office. The student had a background in psych nursing for three years. For five weeks I got to listen to her NP preceptor rail about how the student didn't know pharmacology, disease process or lifespan issues (FNP student). What this taught me in a roundabout way was that not all nursing is equal in terms of nursing experience and the importance of a good nursing background as a foundation for NP practice. The NP that was the preceptor was excellent and a great clinical practitioner. Her complaints (at least about this particular program) are the basis of some of my initial conceptions about NP education.

You and I have polar views on this matter. I have my own questions/concerns about PA education, but I don't whang on and on about it in an attempt to humiliate/embarrass someone. You, however, go on and on, like a dog with a bone. I think you'd only be happy if it was announced that across the country advanced practice licenses for nurses were null and void as of 060607 @ MN.

I actually think that we have many similar views. I too have questions about PA education. We have some ways to go before we achieve complete transparency in reference to the PA educational system. Part of a profession is not only introspection and outside inspection. In the PA system we see a population that is getting younger with less medical experience. On the other hand the profession has a process to look at whether the educational process is adequately meeting the needs of the profession. There is also a unified enforced standard for programs and a monolithic educational approval and certification system (see brick #3).

My actual concern is that nursing will put a lot of very talented NPs out of a job. The recent move to MSN only for medicare potentially disenfranchises some very talented nurses. The push locally by ACNPs to take over inpatient jobs in my area threatens to put some very talented NPs out of work (the same Cardiology NPs we were discussing). The push by RNFAs threatens to force some NPs out of the operating room. I have been a state chapter and specialty president. Almost half my time was spent on nursing issues (see my godzilla post on allnurses). NPs are an important part of the medical community here and any radical change means that medical care will suffer.

Physicians barely respect RNs; it's of no surprise to me that they would dislike APRNs.

What you're saying about CRNAs is not what I am seeing in my area. Perhaps these struggles are going on in more urban facilities, but where I live we couldn't function without CRNAs. Our docs seem to interact well with them, and we get pts who specifically request certain CRNAs for their surgeries.

I think that the CRNA issue is more an urban phenomenon. In my areas there are few CRNAs employed (mostly in positions that physicians don't want like night OB call). In a lot of ways it is about money. In some ways it is also about the ACT concept which many MD's support. The MDs here see the drive for independence as a violation of the trust between the CRNA and the MD that developed in the ACT model. The ultimate outcome looks like it will be an AA program instead of a planned CNRA program in town.

As far as physicians barely respecting RNs I think that is a pretty unfair blanket statement. There are physicians that have problems with egos, but at least in private practice it is very rare. In private practice you live and die by your referral base. If you are an jerk to anyone it quickly dries up. At least in my area everyone gets along pretty well. I understand that in an academic area things may be different.

Most of my observations on NP education are along the lines that it almost impossible for an outsider (or a prospective NP student) to evaluate. I think that there are some great NPs produced but the inconsistencies in NP educational programs put a much greater burden on the individual student. The problem is that the poor performers put the entire profession in a bad light. I think that the combination of the range of instruction by individual programs and the range of experience in the students produces a much less consistent product in the case of the NP.

Best of luck,

David Carpenter, PA-C

 

[core0]

Eloquent as ever Fab4



Core0- I know you have some huge issues, many of which pertain to NP's. However, PLEASE try to get your facts straight.

NPs have full independent practice in 23, read it again 23 states not 15 (and I know I have told you this before). Actually, I just heard that 3 more states got on board and there are now 26 states that allow independent practice. But I am not entirely positive on that one, so we can go wtih 23 for now 🙂 .

They also get 100% physician rate Medicaid reimbursement in 20 states. The rest are between 80% - 85%.

Anyways. I said I was done bickering and I am. Really. But blatant misinformation must be corrected. 😡

If you define independent practice as no physician involvement in any aspect of NP practice including diagnosis, treatment and prescribing then there are 12 states with independent practice (13 if you don't want to prescribe schedule II or IIIs).

The report you are looking for is called the Pearson report:
http://www.webnp.net/ajnp.html
The table you are looking for is on page 24 and 25. This is current as of February. For those who do not have access I will encapsulate:
States that require no physician involvement to prescribe (12)
Alaska
Arizona
District of Columbia
Idaho
Iowa
Maine*
Montana
New Hampshire
New Mexico
Oregon
Washington
Wyoming
(Utah requires physician involvement only for schedule II and III drugs and Maine requires physician involvement only in the first two years of practice).

States that require no physician involvement to diagnose and treat (23)
Alaska
Arizona
Colorado
District of Columbia
Hawaii
Idaho
Iowa
Kentucky
Maine*
Michigan
Montana
New Hampshire
New Jersey
New Mexico
North Dakota
Okalahoma
Oregon
Rhode Island
Tennessee
Utah
Washington
West Virginia
Wyoming

As far as medicaid billing. Yes there are states that reimburse NPs 100% for medicaid. However, Federal rules require a collaborating physician to bill. The same applies to medicaid.

You can open a practice completely independent of physician involvement in 12 states with full ability to prescribe if you do not take Medicare/caid. You can open a practice completely independent of physician involvement in 23 states if you do not take medicare/caid and do not prescribe. Those are the straight facts from the AJNP. If you have information that contradicts this I would be happy to look at it.

David Carpenter, PA-C

 

[guetzow]

Yimmer-yammering aside, the Patients know what an MD is, and that's all that really matters.

 

[Taurus]

If we do not learn the examples of others, we're bound to repeat their mistakes. Watch the video on the right.

http://www.psanes.org/HB_1256.html

"Dr. Arthur Zwerling (Doctor of Nursing Practice, DNP), President-Elect, PANA stated that the PANA seeks independent practice for Certified Registered Nurse Anesthetists and he feels that an anesthesiologist is not necessary in most settings."

How much longer before we have some DNP saying that any physician is not needed in most settings?

 

[Taurus]

While Taurus does not represent the majority of physicians, some of the opinions he expresses exist right under the surface.

I believe that the nurses underestimate the understanding by physicians of the state of affairs. Those feelings may not be strong enough currently to elicit action by the majority, but if the nurses push too hard I wouldn't be surprised if there is a backlash. We watch and learn what happens in other specialties and we can imagine it happening to our own. I may be in the minority in expressing that we need to take action, but don't be surprised if that silent minority is growing.

Many of the nurses on here are hypocrites. I would like to see how they react if CNA's made a push for expanded scope. They probably go on strike.

Sorry to pop the nurses' bubble, but I think anesthesiology's troubles are somewhat unique. Anesthesiology got themselves into a real mess because they didn't have enough foresight to ramp up AA programs to serve as an effective counterweight to the CRNA's. That's why I'm so glad we have a strong PA group and why we need to promote them.

 

[zenman]

So is it time for a group hug?

-t

Incest alert

 

[villdkatta]

Ok first of all I have heard these arguments for many years. I have read various threads on this site and want to state some opinions, hope they are not taken wrong.

First a PA and NP are nowhere near the same, A PA only has 2-4 years of school and a NP has 6-8 and in most areas has to work at the BSN level for 5 years before they are able to pursue a FNP which is masters prepared.😱

No I do not think that a MD and NP are the same however with 6-8 years of school all of which is medical/nursing we are able to practice independently and do not require a physician back up in most states, yes we do like most doctors collaborate with other providers, and while we do not have a residency we are in training the whole time we are in school, I am pursuing a DNP degree and it is not to compete with a MD but to provide better care for my patients which is what all of us are supposed to be in the profession for, and while nursing school does incorporate a lot of theory classes we also have the anatomy, patho, physics, biology... etc, and to say nurses barely pass chemistry, I dont really know what programs you have looked into but the majority of nursing programs you have to graduate with at least a B in all classes.

If everyone would work together instead of thinking they are superior we would provide much better care for our patients 🙁

I'm sorry to beat a dead horse, but I had to respond to this. I agree wholeheartedly with your last sentence. Why can't we all work together instead of thinking some professions are inherently superior to others?

However, it doesn't seem that you're following that golden rule, having dismissed PAs in your second paragraph. Normally, I'm a stand-up-for-your-fellow-nurses kind of gal, but I have to say something about PAs here, since I'm feeling a bit defensive.

I worked side by side with PAs as a new NP in the ER. I am here to tell you, the PAs saved my butt in that busy ER. Some didn't like me from the start because I was an NP, but most took me under their wing and taught me how to suture, and how to perform almost every skill I needed to survive. Their knowledge of anatomy was flawless (while I, on the other hand, had completed my last anatomy class well over ten years ago in an ADN program). To single-handedly dismiss the PAs because of a perceived lack of education (which is different in each state, as I'm sure you're aware) is not only irresponsible but makes all NPs look bad. Futhermore, there are some NP programs now (not many, but a few) that are taking non-nurses with bachelor's degrees and putting them into a master's program to make them NPs - all without prior RN experience!

I will never think I can provide the same exact care as a physician without going through medical school and residency. I'm a great clinician in my own right, but to think NPs are on the same level as far as medical knowledge as a physician is absurd. I personally will never obtain a DNP but for those that want it, I support them.

I enjoy autonomy, and enjoy providing care to patients, and I enjoy collaborating with my peers, all who have different strengths and weaknesses than I do. That doesn't make them better or worse, just different.

Kim, NP

 

[tallcorn]

Kim,

I agree with you and you should read my next posts, my have already responded to what you said, I am not putting PA's down and I am not saying our education is like a doctors, I am saying there is a place for all of us!!🙂

tallcorn

 

[Round2]

I believe that the nurses underestimate the understanding by physicians of the state of affairs. Those feelings may not be strong enough currently to elicit action by the majority, but if the nurses push too hard I wouldn't be surprised if there is a backlash. We watch and learn what happens in other specialties and we can imagine it happening to our own. I may be in the minority in expressing that we need to take action, but don't be surprised if that silent minority is growing.

Many of the nurses on here are hypocrites. I would like to see how they react if CNA's made a push for expanded scope. They probably go on strike.

Sorry to pop the nurses' bubble, but I think anesthesiology's troubles are somewhat unique. Anesthesiology got themselves into a real mess because they didn't have enough foresight to ramp up AA programs to serve as an effective counterweight to the CRNA's. That's why I'm so glad we have a strong PA group and why we need to promote them.

This will certainly get me in trouble.
I suggest that one of the major issues with nurses is the extent of defferance that they continue to pay to physicians. The culture of nursing is still strong with the mindset of "the physicians handmaden" or "the woman's role" or the traditional role of the nun in the church community. This is supported by the hospitals who employ them becasue in almost every hospital it is the physicians who are the rainmakers. The socialization into the field still usually starts with how to properly make a bed and flatten a sheet. They are often trained to blindly follow the most absurd physician orders, even those they know are blatantly wrong and dangerious, to accept and scramble over unreadable or incomplete orders, to smoth over the poor relations between physician and patient, and cover for the physicians shortcomings.
Physicians have a lot to learn from nurses, but nurses will never be close to on par until they actually do begin to professionally assert themselves.
Reality is that that will not happen, there is too much division within the ranks of nurses, and many more that would be pushed lower rather than higher in the food chain by any new standards. In fact, nurses themselves have been pushing for new standards for over 20 years, but they can't get past their own internal divisions.
If you want to vomit, look at the whole area of "Nursing diagnosis." It appears to be largely about not offending or encroaching or being percieved as being a threat to the physician. If someone has a knife cut and a bleeding artery on their arm, the diagnosis isn't a cut, its Risk of ____ related to _____. There would be hell to pay is a nurse wrote a diagnosis of sepsis in many facilities, even a NP, who in many places is by institutional standards still to consult a ID physician to make that diagnosis. People trsined that way from inception don't change radically when they become DNPs.
The most radical chabge will likely come from men with degrees in other fields entering direct entry/accelerated MSN programs; and military trained RNs. unfortunately, my experience has been that they tend to fairly rapidly transition into managers and administrators and their clinical influance just isn't very strong.

 

[core0]

This will certainly get me in trouble.
I suggest that one of the major issues with nurses is the extent of defferance that they continue to pay to physicians. The culture of nursing is still strong with the mindset of "the physicians handmaden" or "the woman's role" or the traditional role of the nun in the church community. This is supported by the hospitals who employ them becasue in almost every hospital it is the physicians who are the rainmakers. The socialization into the field still usually starts with how to properly make a bed and flatten a sheet. They are often trained to blindly follow the most absurd physician orders, even those they know are blatantly wrong and dangerious, to accept and scramble over unreadable or incomplete orders, to smoth over the poor relations between physician and patient, and cover for the physicians shortcomings.

I guess you work in different hospitals than I do. Nurses rarely make beds here and I have never seen them flatten a sheet. What you are describing is a nursing culture that has not existed for 20 years. There are plenty of nursing and other initiatives to address physician orders. If I right an off label order I can expect a phone call from not only nursing but the pharmacy to check on the order. As far as following absurd or dangerous orders, nurses know that they can lose their license for this and will not hesitate to call to clarify a poorly written or illegible order. Once again you are describing a state of nursing that no longer exists (although I would acknowledge that it may exist in isolated areas).

Physicians have a lot to learn from nurses, but nurses will never be close to on par until they actually do begin to professionally assert themselves.
Reality is that that will not happen, there is too much division within the ranks of nurses, and many more that would be pushed lower rather than higher in the food chain by any new standards. In fact, nurses themselves have been pushing for new standards for over 20 years, but they can't get past their own internal divisions.

I would agree on the divisions withing nursing. There is no agreement on what an entry level degree is much less more important aspects of nursing.

If you want to vomit, look at the whole area of "Nursing diagnosis." It appears to be largely about not offending or encroaching or being percieved as being a threat to the physician. If someone has a knife cut and a bleeding artery on their arm, the diagnosis isn't a cut, its Risk of ____ related to _____. There would be hell to pay is a nurse wrote a diagnosis of sepsis in many facilities, even a NP, who in many places is by institutional standards still to consult a ID physician to make that diagnosis. People trsined that way from inception don't change radically when they become DNPs.
The most radical chabge will likely come from men with degrees in other fields entering direct entry/accelerated MSN programs; and military trained RNs. unfortunately, my experience has been that they tend to fairly rapidly transition into managers and administrators and their clinical influance just isn't very strong.

I have a different view on nursing diagnosis. It is not about encroachment it is about defining the value of nursing separately from medicine. There are nursing interventions that can be done without physicians orders. The nursing care plan is part of what guides a patients recovery from a nursing standpoint.

The problem with this is that in trying to differentiate themselves from medicine nursing diagnosis created an entire language that is so convoluted that it is unintelligible for most of its users. For example pain is labeled alteration in comfort. There are nursing interventions for pain such as positioning that are perfectly valid. However since nursing cannot diagnose they have to use euphamisms which destroys the credibility of nursing diagnosis. There is also a stilted syntax that must be used. Even within nursing there is considerable opposition to its use:
http://findarticles.com/p/articles/mi_qa3689/is_200001/ai_n8899146
http://www.nursingworld.org/ojin/tpc7/tpc7_6.htm
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2648.2005.03586.x?journalCode=jan

The NPs that I work with operate in a medical model (although there is a biomedical model of nursing that is similar). If an NP sees sepsis they treat it. If they need to consult ID it is no different than when a physician does the same thing. While an NP may start out using some element of nursing diagnosis, at least anectdotally the decision making processes for NPs and PAs are not substantially different after 1-2 years of practice.

David Carpenter, PA-C

 

[chimichanga]

... They are often trained to blindly follow the most absurd physician orders, even those they know are blatantly wrong and dangerious, to accept and scramble over unreadable or incomplete orders, to smoth over the poor relations between physician and patient, and cover for the physicians shortcomings.

good post, however, if a nurse "blindly follows the most absurd physician order even those they know are blatantly wrong and dangerous, to accept and scramble over unreadable or incomplete orders" then that nurse is an idiot. As idiotic as, when I was a new grad, the ED doc telling me to mix an insulin drip w/ D5

Point being, is, it's our duty and responsibility to question absurd, wrong, and dangerous orders.

 

[deleted87716]

Point being, is, it's our duty and responsibility to question absurd, wrong, and dangerous orders.

I'd certainly expect you to question mine. 😉

 

[oldbearprofessor]

As idiotic as, when I was a new grad, the ED doc telling me to mix an insulin drip w/ D5

Point being, is, it's our duty and responsibility to question absurd, wrong, and dangerous orders.

I hate to derail this fascinating thread, but in tiny preterm infants we routinely mix insulin drips in D5 for a variety of reasons that it would be derailing this thread to describe.

 

[core0]

I hate to derail this fascinating thread, but in tiny preterm infants we routinely mix insulin drips in D5 for a variety of reasons that it would be derailing this thread to describe.

Yeah its not like we put insulin in TPN or something.

David Carpenter, PA-C

 

[chimichanga]

I stand corrected...However, I tried it, and it resulted in a precipitate, I called the pharmacy, and the pharmacist was puzzled as to why the doc would suggest it. I asked the doc again, and he said he meant NS...

This was the same doc who had ordered 2 mg of methergine the day before...

patiently waiting for David to fire off some off label, FDA approved regimen of 10 times the normal methergine dose

 

[caroladybelle]

Many of the nurses on here are hypocrites. I would like to see how they react if CNA's made a push for expanded scope. They probably go on strike.

Speaking of hypocrisy.....

In the 1980s, as an "answer" to the nursing shortage, the AMA (you know, DOCTORS) pushed and was trying to enact a new group of "nursing care providers". I believe that they were to be listed as RCTs or Registered Care Technicians...with significant lower educational requirements, and therefore less ability to question orders.

Nurses have already had plenty of encroachment on their turf. Many states have enacted legislation permitting "Medication Aides", with no formal pharmacology education, limited class time to be permitted to pass meds.

Many states permit LPNs to administer IV meds, something that once was reserved to RNs.

At Johns Hopkins on some units, the CAs (clinical assistants - nurses aides) draw blood from central lines, using sterile technique and change some central line dressings on immunocompromised patients. Again, something once reserved for RNs.
--------------------------------------------------------------------------
And as far as it goes, I still believe that MDs should supervise prescriptive authority.

So why do I continue to get "Continue Home Meds" orders, despite the fact they have not been permitted for over 15 years in any legitimate facility.?

This week, another "Continue Home Meds". The meds: High dose coumadin, aspirin, a statin, oral steroids, and an ABX that is a serious GI irritant. The other orders : FFP, and vitamin K, NPO, Hold NSAIDs. The INR > 8. Stool for OB...well I didn't get a chance to see the result, but unless the patient gives himself raspberry preserve enemas, I would say it was definitely positive. LFT's significantly elevated.

The MD knew that the patient had a cardiac history and history of clots.

I suppose as a "handmaiden", I should have just followed orders and given the 10mg of coumadin along with the Vitamin K and FFP, but unlike RCTs and Med Aides, I actually had the education and the nerve to hold, despite those "Continue Home Meds Orders".

I page (per required hospital regarding the nonpermitted CHM order) ....and I page........and I page.....and I page. No one calls back.

MDs complain about NP prescriptive powers but routinely give "Continue Home Med" orders to LPNs and RNs, despite that is not permitted and quite dangerous.

I get orders all the time that fall WELL outside a nurse's role/scope.

My suggestion is that MDs need to clean up their house a bit, before complaining about others houses. You don't want nurses getting an NP or a DNP, then maybe you should stop giving orders that fall well outside our scope.

 

[fab4fan]

Interesting, isn't it?

Speaking of hypocrisy.....

In the 1980s, as an "answer" to the nursing shortage, the AMA (you know, DOCTORS) pushed and was trying to enact a new group of "nursing care providers". I believe that they were to be listed as RCTs or Registered Care Technicians...with significant lower educational requirements, and therefore less ability to question orders.

Nurses have already had plenty of encroachment on their turf. Many states have enacted legislation permitting "Medication Aides", with no formal pharmacology education, limited class time to be permitted to pass meds.

Many states permit LPNs to administer IV meds, something that once was reserved to RNs.

At Johns Hopkins on some units, the CAs (clinical assistants - nurses aides) draw blood from central lines, using sterile technique and change some central line dressings on immunocompromised patients. Again, something once reserved for RNs.
--------------------------------------------------------------------------
And as far as it goes, I still believe that MDs should supervise prescriptive authority.

So why do I continue to get "Continue Home Meds" orders, despite the fact they have not been permitted for over 15 years in any legitimate facility.?

This week, another "Continue Home Meds". The meds: High dose coumadin, aspirin, a statin, oral steroids, and an ABX that is a serious GI irritant. The other orders : FFP, and vitamin K, NPO, Hold NSAIDs. The INR > 8. Stool for OB...well I didn't get a chance to see the result, but unless the patient gives himself raspberry preserve enemas, I would say it was definitely positive. LFT's significantly elevated.

The MD knew that the patient had a cardiac history and history of clots.

I suppose as a "handmaiden", I should have just followed orders and given the 10mg of coumadin along with the Vitamin K and FFP, but unlike RCTs and Med Aides, I actually had the education and the nerve to hold, despite those "Continue Home Meds Orders".

I page (per required hospital regarding the nonpermitted CHM order) ....and I page........and I page.....and I page. No one calls back.

MDs complain about NP prescriptive powers but routinely give "Continue Home Med" orders to LPNs and RNs, despite that is not permitted and quite dangerous.

I get orders all the time that fall WELL outside a nurse's role/scope.

My suggestion is that MDs need to clean up their house a bit, before complaining about others houses. You don't want nurses getting an NP or a DNP, then maybe you should stop giving orders that fall well outside our scope.

 

[guetzow]

You could probably site such examples (Of incompetance) in virtually every profession. Just looks like chicken-**** nit-picking to me. The AMA also offered the PA profession to nurses before it came to be (Long before the 80s). They turned that down too. If you learn to play nice, the sky's the limit in your career. Oppositional-defiant disorder only motivates MDs to replace you with a tech.

 

[prairiedog]

You could probably site such examples (Of incompetance) in virtually every profession. Just looks like chicken-**** nit-picking to me. The AMA also offered the PA profession to nurses before it came to be (Long before the 80s). They turned that down too. If you learn to play nice, the sky's the limit in your career. Oppositional-defiant disorder only motivates MDs to replace you with a tech.

I was under the impression that Henry Ford MD started the first NP program in Colorado in 1965. Dr, Stead MD started the first PA program at Duke at about the same time. I agree every profession has incompetence.

 

[core0]

I was under the impression that Henry Ford MD started the first NP program in Colorado in 1965. Dr, Stead MD started the first PA program at Duke at about the same time. I agree every profession has incompetence.

The first PA is generally regarded as Buddy Treadwell who was trained by a Phyisician in NC in the 1940's. Nursing goes back to the 20's with Nurse Midwifes in the 20's. In 1961 an article in JAMA called for mid level providers from former medical corpsman. At that same time Stead approached the nursing faculty at Duke about developing a field which he called nurse clinicians. This was rejected by organized nursing. He then looked at using Navy Corpsman for a position that later became the PA. The first PAs were known as Physician Associates. At this same time Silver and Ford received a grant at CU to start the first PNP program. The first PA students and the first PNP students graduated in 1967. Silver went on to establish the CHA/PA program at CU which was the first PA program to grant a Masters degree. There is a lot of interesting correspondence between Stead and Silver about Steads problems with nursing in the original iteration of the nurse clinician.

"Prior to Charles Hudson's 1961 article published in the Journal of the American Medical
Association titled "Expansion of Medical Professional Services with Nonprofessional Personnel,"
Dr. Eugene Stead, Jr., then chairman of the Department of Medicine at Duke University, had tried
to use "professional" personnel, i.e., nurses, to expand clinical services within the Duke
University Hospital. The first step toward this goal was taken by Ms. Thelma Ingles, a RN
supervisor of medical and surgical nursing at Duke, who decided to take Stead's advice to spend
her sabbatical year in 1957-58 in the medical school completing clinical clerkships to expand her
clinical decision-making capabilities. After completing her sabbatical, Ingles and Stead created a
master's degree nurse clinician track within the Nursing School and presented the program to the
National League of Nursing for accreditation. They were summarily turned down, leaving Stead
with little recourse but to look elsewhere for individuals that might be used to expand physician
services."


David Carpenter, PA-C

For the PA history please see:
http://www.pahx.org/index.htm

 

[fab4fan]

You could probably site such examples (Of incompetance) in virtually every profession. Just looks like chicken-**** nit-picking to me. The AMA also offered the PA profession to nurses before it came to be (Long before the 80s). They turned that down too. If you learn to play nice, the sky's the limit in your career. Oppositional-defiant disorder only motivates MDs to replace you with a tech.

Like that's a newsflash? Of course we turned them down. They've tried to offer this in one form or another several times over. Thanks, but no thanks.

I guess the same could be said of all of your previous anti-nurse, anti-NP posts...nit-picking.

I'm not sure what you mean by "play nice." I have an idea, but I'd like to see you put it out there specifically.

 

[prairiedog]

The first PA is generally regarded as Buddy Treadwell who was trained by a Phyisician in NC in the 1940's. Nursing goes back to the 20's with Nurse Midwifes in the 20's. In 1961 an article in JAMA called for mid level providers from former medical corpsman. At that same time Stead approached the nursing faculty at Duke about developing a field which he called nurse clinicians. This was rejected by organized nursing. He then looked at using Navy Corpsman for a position that later became the PA. The first PAs were known as Physician Associates. At this same time Silver and Ford received a grant at CU to start the first PNP program. The first PA students and the first PNP students graduated in 1967. Silver went on to establish the CHA/PA program at CU which was the first PA program to grant a Masters degree. There is a lot of interesting correspondence between Stead and Silver about Steads problems with nursing in the original iteration of the nurse clinician.

"Prior to Charles Hudson's 1961 article published in the Journal of the American Medical
Association titled "Expansion of Medical Professional Services with Nonprofessional Personnel,"
Dr. Eugene Stead, Jr., then chairman of the Department of Medicine at Duke University, had tried
to use "professional" personnel, i.e., nurses, to expand clinical services within the Duke
University Hospital. The first step toward this goal was taken by Ms. Thelma Ingles, a RN
supervisor of medical and surgical nursing at Duke, who decided to take Stead's advice to spend
her sabbatical year in 1957-58 in the medical school completing clinical clerkships to expand her
clinical decision-making capabilities. After completing her sabbatical, Ingles and Stead created a
master's degree nurse clinician track within the Nursing School and presented the program to the
National League of Nursing for accreditation. They were summarily turned down, leaving Stead
with little recourse but to look elsewhere for individuals that might be used to expand physician
services."


David Carpenter, PA-C

For the PA history please see:
http://www.pahx.org/index.htm

Thanks, a well documented response!

 

[adamdowannabe]

I stand corrected...However, I tried it, and it resulted in a precipitate, I called the pharmacy, and the pharmacist was puzzled as to why the doc would suggest it. I asked the doc again, and he said he meant NS...

[/I]

I have been waiting for the day I can drop d5 and insulin for some hyperkalemia, but if it precipitates out, how are the two supposed to given, bolus and drip?

 

[deleted6669]

I have been waiting for the day I can drop d5 and insulin for some hyperkalemia, but if it precipitates out, how are the two supposed to given, bolus and drip?

D50 and insulin.....
separately.....

 

[RWill1]

Ah good job. Don't post the correct figures or anything--just act all indignant that he's sooo ignorant, and insure that he stays that way by not giving him the facts you're so outraged he doesn't have 🙄

You asked that others not be snippy and you in fact are that way now. I mean c'mon. Have you ever heard of the expression, it's not what you say, it's how you say it. Your dagars, as well as a few other's are coated with so much sugar its pathetic...

if someone said something about a MS-3...would you not become defensive??? Of course you would, because that is a sense of pride and joy for you. Something you have worked hard to achieve.

 

[njbmd]

Hey, I am from the pharmacy forum and looking into medical schools. I am confused between a DNP versus a MD degree. What is the difference between both besides the name? For example. a nurse practitioner in NYS can do pretty much everything a medical doctor can besides prescribe CII. I dont see much of a difference besides the wage they can commend. I used to think that in terms of a docterate, a docterate means the highest education level of a profession. I know that there are some people saying that it is bull s* for opt. and pharmacists to get a docterate degree. However both of these fields are autonomous and different from the medical profession. How does it work with DNP since both DNP and MD have blurry lines in their profession? Do DNP's look at the field differently as DO's do?

Before some people show their canabalistics nature of the medical field, I just want to say I meant for this topic to be purely informational. I tried googling it up and researching it but nothing pops up. This is an honest question. If I sound like a troll, sorry in advance.

This is the OP in this thread that is now so far off topic and getting less than professional. Let's try to get back on topic i.e. a discussion between of the differences/simularities/characteristics of DNP and MD and provide some information rather than the back and forth snips between a couple of people. If you have something directed at one person, please use the PM (private message) by clicking on their username and following the directions for sending a PM. Let's get back on topics. Thanks.

 

[feelingsleepyye]

Hello everyone. I recognize my limitations. I chose not to go to medical school. Am not a medical school drop out or flunk out. Kudos to all of you medical doctors. My hats off to you. As a CRNA, with a PhD in molecular biology and cellular physiology, I have a little more grasp on the way the body works and responds. In my CRNA program, although, I was already a PhD, at the time, having gone to a basic associates degree RN program, I audited the advanced pathophysiology and anatomy classes taken with the medical students. Yes! I said, taken with the medical students, as well as pharmacology. I didnt audit pharmacology. I actually had to take the class. But I did audit the physiology and pathophysiology classes and we did do gross anatomy. Baylor college of medicine CRNA graduate here. Just to throw out a tidpit of information, PhDs are the highest degrees in the land. They are scholarly bases and you are considered an EXPERT in that field and therefore, have reached your terminal degree. M.D.s, O.D.s, D.O.s, PharmDs and yes, DNPs are all technical doctorates. All technically based. You have not reached your terminal degree, which is, of course, the research bases PhD. So, when I interview my patients, do I introduce myself as Dr. "so and so", your nurse anesthetist who holds a PhD in molecular biology. The answer is NO. Why? Its confusing to the patient. And that my dear peers is who we should all put FIRST. Being called "Dr." to me, means nothing. Been there, done that. I taught briefly at the college level and was in academia for a brief stent. I also worked as an independent expert witness. I was bored. My parents are both nurses. I fell in love with nursing years ago and should have gone directly into nursing, instead I went off on a very very arduous tangent. But full circle, here I am. I am loving every day of my job. Sure I can put a name badge on that says my name, eiter Dr. John Doe (not real name), CRNA, RN, FAAN, PhD, CCRN but in the grand scheme of things, does that really matter to the patient? No! What matters to the patients is that I'll be having their lives in my hands and that is what I want to convey to them, not confusion. Now, am I doctor, hell Yes! Am I a physician, hell No! There is the distinction my peers. A PhD is doctor, just DPMs, OD, DO, PharmDs, and DNPs are. Hope this clarifies a bit. I have reached my terminal degree. Have you?

 

[Northerner]

Hello everyone. I recognize my limitations. I chose not to go to medical school. Am not a medical school drop out or flunk out. Kudos to all of you medical doctors. My hats off to you. As a CRNA, with a PhD in molecular biology and cellular physiology, I have a little more grasp on the way the body works and responds. In my CRNA program, although, I was already a PhD, at the time, having gone to a basic associates degree RN program, I audited the advanced pathophysiology and anatomy classes taken with the medical students. Yes! I said, taken with the medical students, as well as pharmacology. I didnt audit pharmacology. I actually had to take the class. But I did audit the physiology and pathophysiology classes and we did do gross anatomy. Baylor college of medicine CRNA graduate here. Just to throw out a tidpit of information, PhDs are the highest degrees in the land. They are scholarly bases and you are considered an EXPERT in that field and therefore, have reached your terminal degree. M.D.s, O.D.s, D.O.s, PharmDs and yes, DNPs are all technical doctorates. All technically based. You have not reached your terminal degree, which is, of course, the research bases PhD. So, when I interview my patients, do I introduce myself as Dr. "so and so", your nurse anesthetist who holds a PhD in molecular biology. The answer is NO. Why? Its confusing to the patient. And that my dear peers is who we should all put FIRST. Being called "Dr." to me, means nothing. Been there, done that. I taught briefly at the college level and was in academia for a brief stent. I also worked as an independent expert witness. I was bored. My parents are both nurses. I fell in love with nursing years ago and should have gone directly into nursing, instead I went off on a very very arduous tangent. But full circle, here I am. I am loving every day of my job. Sure I can put a name badge on that says my name, eiter Dr. John Doe (not real name), CRNA, RN, FAAN, PhD, CCRN but in the grand scheme of things, does that really matter to the patient? No! What matters to the patients is that I'll be having their lives in my hands and that is what I want to convey to them, not confusion. Now, am I doctor, hell Yes! Am I a physician, hell No! There is the distinction my peers. A PhD is doctor, just DPMs, OD, DO, PharmDs, and DNPs are. Hope this clarifies a bit. I have reached my terminal degree. Have you?

I'm not sure who you're trying to goad at the end, but yes, an MD is a terminal degree. A PhD is not the terminal degree for a physician. The distinction people have trouble with is that the "doctorate" degrees confer the title of "Dr.", but a physician is also called a "doctor" (as well as uses the title "Dr."). But you're absolutely right in your example - you illustrate that while your title is indeed "Dr.", using it in a clinical context is misleading and suggests someone of different training and therefore inappropriate. The question remains, however...since now NP's are pursuing "doctorates" in nursing (a clinical field), should they use the title "Dr." in a clinical setting? The answer should be clear to everyone: definitely not - for the same reasons you stated.

Perhaps the most clear way of stating it is that although some professionals may have a doctorate, they are not doctors. Although they may be able to use the title "Dr." in other settings, they should not in a clinical setting, when the understanding of the title "Dr." is of an MD/DO/DPM (or, setting appropriate, a dentist).

 

[lawguil]

I'm not sure who you're trying to goad at the end, but yes, an MD is a terminal degree. A PhD is not the terminal degree for a physician. The distinction people have trouble with is that the "doctorate" degrees confer the title of "Dr.", but a physician is also called a "doctor" (as well as uses the title "Dr.").

I would simply argue:

the MD/DO/DPM are entry level clinical degrees. To use the term "terminal" suggests to me that there is a masters or bachelors level MD/DO/DPM.

but, I guess it could be argued.....

 

[Dr.Millisevert]

Maybe you should refer to this:
http://en.wikipedia.org/wiki/First_professional_degree


by the way.. on the list I saw something called a Doctor of Napropathic medicine. What is that?

http://www.naprapathicmedicine.edu/what.htm

 

[Therapist4Chnge]

Perhaps the most clear way of stating it is that although some professionals may have a doctorate, they are not doctors. Although they may be able to use the title "Dr." in other settings, they should not in a clinical setting, when the understanding of the title "Dr." is of an MD/DO/DPM (or, setting appropriate, a dentist).

If this was, "they are not physicians", I would completely agree. It is up to each professional to clearly identify themselves in every setting, and if a person purposefully misrepresents themselves, then they should be held accountable.

-t

 

[brightness]

I agree. How can one say that many disciplines offer doctorates, but these programs do not produce doctors? They most certainly do; doctors of physical therapy, doctors of nursing, doctors of audiology...the list goes on. Its become clear that we don't want people to misrepresent themselves as physicians when they aren't; however, with the introduction of clinical doctorates, the term doctor isn't sacred anymore. Its just hard to tell people that they went to school to get the highest degree in their field and recieve a degree that says 'doctor of...' but they aren't really doctors and they are not allowed to call themselves doctors in certain settings....? Instead it seems necessary to have everyone explain exactly what they are; as in 'clinical psychologist' 'audiologist' ect.

If this was, "they are not physicians", I would completely agree. It is up to each professional to clearly identify themselves in every setting, and if a person purposefully misrepresents themselves, then they should be held accountable.

-t

 

[Northerner]

I agree. How can one say that many disciplines offer doctorates, but these programs do not produce doctors? They most certainly do; doctors of physical therapy, doctors of nursing, doctors of audiology...the list goes on. Its become clear that we don't want people to misrepresent themselves as physicians when they aren't; however, with the introduction of clinical doctorates, the term doctor isn't sacred anymore. Its just hard to tell people that they went to school to get the highest degree in their field and recieve a degree that says 'doctor of...' but they aren't really doctors and they are not allowed to call themselves doctors in certain settings....? Instead it seems necessary to have everyone explain exactly what they are; as in 'clinical psychologist' 'audiologist' ect.

Don't play dumb. You know what a doctor is.

 

[brightness]

Don't play dumb. You know what a doctor is.

I know what a physician is, and I know what an MD/DO is. To be quite honest, when I hear the word "doctor" I think of my college professors, since those are the "doctors" I see the most.

At least you said I was playing dumb, instead of just saying I was dumb.

 

[Therapist4Chnge]

Don't play dumb. You know what a doctor is.

Yes....someone who completes doctoral training.

The title of physician clarifies the title, much like clinical psychologist clarifies the title, and the same as a Pharmacist clarifies the title....etc. Your assumption is that in a medical setting, Doctor always equals a Physician....which is an incorrect assumption on your part. There are Pharmacists, Clinical Psychologists, and other doctoral level professionals there, all of which have been granted the degree and license to use the term. Just because you make an assumption, doesn't mean every else makes that same assumption.

-t

 

[Northerner]

Yes....someone who completes doctoral training.

The title of physician clarifies the title, much like clinical psychologist clarifies the title, and the same as a Pharmacist clarifies the title....etc. Your assumption is that in a medical setting, Doctor always equals a Physician....which is an incorrect assumption on your part. There are Pharmacists, Clinical Psychologists, and other doctoral level professionals there, all of which have been granted the degree and license to use the term. Just because you make an assumption, doesn't mean every else makes that same assumption.

-t

Yes it does. Everyone knows what a doctor is. Let's cut through the bull****, a PT is not a doctor, a nurse practitioner is not a doctor, a pharmacist is not a doctor. They may hold doctorates, but that does not make them a doctor. It's an unhappy coincidence that the word "doctor" is in the word "doctorate", but despite the semantics, earning a doctorate does not make you a doctor. You're really going out on a limb suggesting society doesn't use the term doctor to refer to a physician. Heck, even dentists don't call themselves doctors.

A doctor has clinical training distinct from other health professions. If you really want to muddy the waters with ridiculous claims that everyone's a doctor, we probably can't stop you. But I guess by the reasoning that you're using (that since they hold a doctorate, they're doctors), a Ph.D in english is a doctor. So good news, all you english professors out there, the next time someone asks what you do, you can tell them you're a doctor! Of course, they'll stop when they realize it's more confusing than anything else, but everyone else who actually wants to blur the lines between themselves and an actual doctor will be happy as a pig in **** that they can get away with it based on a misleading technicality of the english language.

The somewhat disappointing truth is that since degrees seem to be tacking on doctorate level training to their profession (which seems a little unnecessary when you could just revamp the current degree or add a different, less confusing distinction), it's likely you're right - we'll have to stop using the word "doctor" to describe ourselves anymore. But that means you can't use it either, since society still thinks doctor = physician. Actually, I'd be happy to stop using it if we could get a promise from everyone else to stop using it too. Sound fair?

 

[brightness]

I have never had any midlevels or other professionals- such as those who hold doctorates in audiology or PT- introduce themselves to me as "Dr. SO and SO, doctor of PT". Or, Dr. SO and SO, Doctor of audiology. Its mainly just the use of 'doctor' prior to your first name- Dr. Whatever, your physical therapist. I do wonder if and how one can regulate the use of this word, which is apparently very sacred to MD/DOs. But if everybody has a doctorate, how are they not a doctor?
And I don't think that very many people would come into a hospital or a car accident and introduce themself as Dr. Whatever if they have a PhD in English or History, or Molecular biology, or whatever. But psychologists do work in hospitals from time to time, and generally have been legitimatley able to call themselves 'doctor'- I am not sure how that fits in with the debate, either.
I am not really saying who should or shouldn't be able to use the word, or how to make "rules" about it. I don't want to mislead consumers- even as a DNP, I wouldn't be a physician, and I would know that. I would still want collaboration with an MD/DO, as well. I don't want to say "oh, I'm a doctor" but I am wondering how to say "I am Dr. Carlson, a nurse practitioner" or just "I am Lindsay Carlson, your nurse practitioner"- which one is OK? Who sets the rules? I don't feel like either one is midleading, necessarily, but for an uninformed patient (who doesn't understand the medical system very well) I can see how it would be.

Yes it does. Everyone knows what a doctor is. Let's cut through the bull****, a PT is not a doctor, a nurse practitioner is not a doctor, a pharmacist is not a doctor. They may hold doctorates, but that does not make them a doctor. It's an unhappy coincidence that the word "doctor" is in the word "doctorate", but despite the semantics, earning a doctorate does not make you a doctor. You're really going out on a limb suggesting society doesn't use the term doctor to refer to a physician. Heck, even dentists don't call themselves doctors.

A doctor has clinical training distinct from other health professions. If you really want to muddy the waters with ridiculous claims that everyone's a doctor, we probably can't stop you. But I guess by the reasoning that you're using (that since they hold a doctorate, they're doctors), a Ph.D in english is a doctor. So good news, all you english professors out there, the next time someone asks what you do, you can tell them you're a doctor! Of course, they'll stop when they realize it's more confusing than anything else, but everyone else who actually wants to blur the lines between themselves and an actual doctor will be happy as a pig in **** that they can get away with it based on a misleading technicality of the english language.

The somewhat disappointing truth is that since degrees seem to be tacking on doctorate level training to their profession (which seems a little unnecessary when you could just revamp the current degree or add a different, less confusing distinction), it's likely you're right - we'll have to stop using the word "doctor" to describe ourselves anymore. But that means you can't use it either, since society still thinks doctor = physician. Actually, I'd be happy to stop using it if we could get a promise from everyone else to stop using it too. Sound fair?

 

[Therapist4Chnge]

But psychologists do work in hospitals from time to time, and generally have been legitimatley able to call themselves 'doctor'- I am not sure how that fits in with the debate, either.

They are there quite a bit actually...whether they are in the rehab area (particularly traumatic brain injury), in peds doing child assessments, doing neuro assessments for geriatric patients, etc.

-t

 

[DogFaceMedic]

The whole debate about who can be called Doc in a clinical setting was discussed several pages ago -- 9&10. Bottom line is what do patients understand or expect. There are laws in several states limiting the use of Dr in clinics to prevent fraud and patient misinformation.

 

[Dr.Millisevert]

But I guess by the reasoning that you're using (that since they hold a doctorate, they're doctors), a Ph.D in english is a doctor. So good news, all you english professors out there, the next time someone asks what you do, you can tell them you're a doctor!

That was great..

Hey, at least someone with a PhD holds a true "doctorate" degree. 👍

 

[Taurus]

There is an active thread about DNP's in the allo forum. I wouldn't spend much energy on this thread because not many people peruse this forum.

 

[Therapist4Chnge]

There is an active thread about DNP's in the allo forum. I wouldn't spend much energy on this thread because not many people peruse this forum.

link?

-t

 

[Jawbone]

Woo- Hoo! I just finished my wild, bipolar ride through the 12 pages of this thread... I laughed, I cried, I almost crapped my pants from shock.....

Seriously guys, I'm glad I came here... We all chose the health care field to make a difference. It's great that we can all come here and vent, scream, and throw floor-pounding, eye-popping toddler tantrums, while still maintaining an attitude and respect for others worthy of our professions.

 

[Taurus]

link?

-t

I'll do better. There are two good active threads.

http://forums.studentdoctor.net/showthread.php?t=473240
http://forums.studentdoctor.net/showthread.php?t=474267

I think the NP's are trying to copy the CRNA's playbook, but I think they will regret it because the already large PA contingent will undercut their clout. It's not like the AA's.

 

[greytmedic]

Not to stir the pot or anything😉

I was just reading in my wife's copy of this months AAPA news, an article about the first Doctor of PA science is being awarded this month.

AAPA News, November 30th

Clinical Doctorate Program for PAs to Graduate First Class
Baylor University and the U.S. Army Medical Department Center and School will in December graduate its first class of four PAs, who by completing the 18-month program will have earned a clinical doctorate degree, known as a Doctor of Science in Physician Assistant Studies with a major in Emergency Medicine. The residency training program is closely based on requirements held by the American Board of Emergency Medicine, the American Council on Graduate Medical Education, and the Residency Review Commission, for physician residents in emergency medicine, just let me know.

The whole article goes into some of the details of the program and quotes the head guy as saying something about not being called doctors in clinical settings. I could type in the entire article if you are all interested, just let me know.

 

[core0]

Not to stir the pot or anything😉

I was just reading in my wife's copy of this months AAPA news, an article about the first Doctor of PA science is being awarded this month.

AAPA News, November 30th

Clinical Doctorate Program for PAs to Graduate First Class
Baylor University and the U.S. Army Medical Department Center and School will in December graduate its first class of four PAs, who by completing the 18-month program will have earned a clinical doctorate degree, known as a Doctor of Science in Physician Assistant Studies with a major in Emergency Medicine. The residency training program is closely based on requirements held by the American Board of Emergency Medicine, the American Council on Graduate Medical Education, and the Residency Review Commission, for physician residents in emergency medicine, just let me know.

The whole article goes into some of the details of the program and quotes the head guy as saying something about not being called doctors in clinical settings. I could type in the entire article if you are all interested, just let me know.

Or you could look at the other three threads on this subject.

David Carpenter, PA-C

 

[greytmedic]

Or you could look at the other three threads on this subject.

David Carpenter, PA-C

Thanks, I did a quick search and found this thread.

http://forums.studentdoctor.net/showthread.php?t=471736

I read the RN/NP/PA forums because my wife is in PA school and I like to keep myself somewhat updated on the professional climate. I don't normally read the Physician/Residency forums and I hadn't seen this info pop un here where there always tends to be a lot of interesting (although heated) discussions on similar topics.