DNPs will eventually have unlimited SOP

[FunnyDocMan1234]

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they annoying thing about that is NONE of those qualities are due to training. They are personality traits which are independent, and therefore more than likely equal between the two professions er.... profession and vocation 😉 lets not give them too much credit until they stop the BS propaganda machine.

Are you even in med school? The personality traits are not close to even (and these are one of the most important attributes of treatment). From what I've seen, the average med student thinks smokers are terrible humans and takes time to always laugh at fat people - they are judgmental and arrogant as hell and it shows. Nurses on the other hand can actually relate to patients.

 

[peteB]

Are you even in med school? The personality traits are not close to even (and these are one of the most important attributes of treatment). From what I've seen, the average med student thinks smokers are terrible humans and takes time to always laugh at fat people - they are judgmental and arrogant as hell and it shows. Nurses on the other hand can actually relate to patients.

This is totally unfair. I don't know where you go to med school, but med students aren't all judgmental and arrogant, and nurses aren't all wonderful people. I certainly don't laugh at fat people or hate smokers. Are you in med school? I am actually in med school and I have met plenty of really nasty nurses. Some of them are way more arrogant than the doctors.

Why do I feel like I just fed a troll?

 

[Bacchus]

they annoying thing about that is NONE of those qualities are due to training. They are personality traits which are independent, and therefore more than likely equal between the two professions er.... profession and vocation 😉 lets not give them too much credit until they stop the BS propaganda machine.

Aye. When someone says an NP is more personable than the physician its because either a) the patient has an awful personality or b) the physician has an awful personality. It is completely independent of training model.

I just had a patient before lunch get upset because her next followup won't be with me as I'll be on a new rotation. That's because of my personality, not because I'm training to be an NP or a DO.

 

[peteB]

Aye. When someone says an NP is more personable than the physician its because either a) the patient has an awful personality or b) the physician has an awful personality. It is completely independent of training model.

I just had a patient before lunch get upset because her next followup won't be with me as I'll be on a new rotation. That's because of my personality, not because I'm training to be an NP or a DO.

Could also be your looks. I mean, I have no idea what you look like, but it's a possibility. Maybe the NPs are better looking?

 

[Bacchus]

It could be. But my personality is second to none. (I know, that's a bit conceited)

The patients I do see seem to like me a lot. The interviews I've been on so far have had interviewers bring this up everytime that my LORs convey my patient interactions and relationships.

*shrug*

 

[peteB]

It could be. But my personality is second to none. (I know, that's a bit conceited)

The patients I do see seem to like me a lot. The interviews I've been on so far have had interviewers bring this up everytime that my LORs convey my patient interactions and relationships.

*shrug*

Could you give me some personality pointers? 🙂

 

[SpecterGT260]

From my experience, it's true. I try to see my NP always instead of my MD simply because my MD is kinda creepy and makes me feel very uncomfortable to be talking about private issues with him. Usually when I am coming in a have a pretty good idea of what I need (e.g. I have lots of dandruff and the non-prescription shampoos don't work - I need a prescription shampoo) and I sure as heck don't need an MD to look up which prescription is the best for me - so I feel like I am doing good by saving the healthcare system some waste. At least I did before I started med school haha

I find incompetence creepy so I guess I would disagree here.

Also..... are you in medical school? If so look around the class and count out how many people with this personality you see. Not very many.

The thing at work here is that people tend to strongly remember bad experiences and people are on average too uninformed to know when their provider doesnt know what the heck s/he is doing. So we criticize the few jerks even though such a trait is ENTIRELY unrelated to the actual quality of your care

 

[SpecterGT260]

Aye. When someone says an NP is more personable than the physician its because either a) the patient has an awful personality or b) the physician has an awful personality. It is completely independent of training model.

I just had a patient before lunch get upset because her next followup won't be with me as I'll be on a new rotation. That's because of my personality, not because I'm training to be an NP or a DO.

😱
you're actually an NP! I figured this out... see, since they are "doctors' and we are trying to be "doctors" pretty much when you graduate they give you a personality test.

If you are a sarcastic jerk you get the MD.
If you are a little too handsy you get the DO
and if you are super nice and caring (think golden retriever) you get the DNP


I can't wait for my DNP 😀

 

[cbrons]

Relevant NYTimes article from today:

The Family Doctor, Minus the M.D.
https://www.readability.com/articles/7yciasqv?legacy_bookmarklet=1

Wow

Are you even in med school? The personality traits are not close to even (and these are one of the most important attributes of treatment). From what I've seen, the average med student thinks smokers are terrible humans and takes time to always laugh at fat people - they are judgmental and arrogant as hell and it shows. Nurses on the other hand can actually relate to patients.

all of us are, huh?

 

[SpecterGT260]

Are you even in med school? The personality traits are not close to even (and these are one of the most important attributes of treatment). From what I've seen, the average med student thinks smokers are terrible humans and takes time to always laugh at fat people - they are judgmental and arrogant as hell and it shows. Nurses on the other hand can actually relate to patients.

lol, ok.

What is it that makes med students that way? And.... I'm fairly certain you are not in medicine in any capacity if you think this way. The selection process, at least at my school, is such that we have people who are sweet enough to make a puppy puke.

And... what makes you think that "nurses can actually relate"? Nurses can be some of the most jaded and abrasive people in a hospital. I am going to go out on a limb and say you have precisely ZERO experience in any of this and are just swept up by the hearsay. For the record, that is a sign of true ineptitude. I'd invoke burnette's law here but I don't think you will make it far enough to make it valid anyways 😉

 

[Cizzen]

I am a retired doc, and at the off chance I sound like a troll, forgive me, I am not. I have read this thread a few times, and it brings to mind issues that were rumored and prevailed half a century ago. There was a similar situation when I graduated medical school pertaining to what was then a field we were wary of, they were infringing on our territory, and were met with suspicion, some disdain, and the AMA, which was much stronger then concurred: How could they do what we did? They spent more time with patients, they could watch and wait as an illness ran its course. Some were surgically trained, but they were different. A different degree. As the years passed gradually they became more accepted, patients took to them, and it seemed inevitable we would coexist. Today DOs are the norm. Change is part of what you'll come to expect as you mature. Hopefully you won't become so enamored with technology that you believe anything can ever substitute the patience, and value of your roll as a physician. You are not going to be you patient's friend, substitute for family, clergy, or anything else but that trusted confidant, and guide though life's most intimate and sacred times. Spare yourself time wasted looking at what some other endeavor is doing and focus on what, and why you chose to become a physician.

 

[peteB]

I am a retired doc, and at the off chance I sound like a troll, forgive me, I am not. I have read this thread a few times, and it brings to mind issues that were rumored and prevailed half a century ago. There was a similar situation when I graduated medical school pertaining to what was then a field we were wary of, they were infringing on our territory, and were met with suspicion, some disdain, and the AMA, which was much stronger then concurred: How could they do what we did? They spent more time with patients, they could watch and wait as an illness ran its course. Some were surgically trained, but they were different. A different degree. As the years passed gradually they became more accepted, patients took to them, and it seemed inevitable we would coexist. Today DOs are the norm. Change is part of what you'll come to expect as you mature. Hopefully you won't become so enamored with technology that you believe anything can ever substitute the patience, and value of your roll as a physician. You are not going to be you patient's friend, substitute for family, clergy, or anything else but that trusted confidant, and guide though life's most intimate and sacred times. Spare yourself time wasted looking at what some other endeavor is doing and focus on what, and why you chose to become a physician.

That was quite beautiful. Thank you.

 

[calvnandhobbs68]

Are you even in med school? The personality traits are not close to even (and these are one of the most important attributes of treatment). From what I've seen, the average med student thinks smokers are terrible humans and takes time to always laugh at fat people - they are judgmental and arrogant as hell and it shows. Nurses on the other hand can actually relate to patients.

Uh I have to say I don't think you are considering you were just asking how grading works in H/P/F schools in August...

 

[joeDO2]

I am a retired doc, and at the off chance I sound like a troll, forgive me, I am not. I have read this thread a few times, and it brings to mind issues that were rumored and prevailed half a century ago. There was a similar situation when I graduated medical school pertaining to what was then a field we were wary of, they were infringing on our territory, and were met with suspicion, some disdain, and the AMA, which was much stronger then concurred: How could they do what we did? They spent more time with patients, they could watch and wait as an illness ran its course. Some were surgically trained, but they were different. A different degree. As the years passed gradually they became more accepted, patients took to them, and it seemed inevitable we would coexist. Today DOs are the norm. Change is part of what you'll come to expect as you mature. Hopefully you won't become so enamored with technology that you believe anything can ever substitute the patience, and value of your roll as a physician. You are not going to be you patient's friend, substitute for family, clergy, or anything else but that trusted confidant, and guide though life's most intimate and sacred times. Spare yourself time wasted looking at what some other endeavor is doing and focus on what, and why you chose to become a physician.

👍 very well said sir.

 

[duckie99]

Usually when I am coming in a have a pretty good idea of what I need (e.g. I have lots of dandruff and the non-prescription shampoos don't work - I need a prescription shampoo) and I sure as heck don't need an MD to look up which prescription is the best for me

generally healthy adults who only have minor issues here and there do not need MDs. But older adults with multiple medical conditions should see their physician at least every other visit and especially if there is a problem.



and again I don't understand why people here are so worried. NPs are not going to be competing at all with any cardiologists or surgeons or [insert subspeciality]. They are probably not even going to be competing with EM or peds or FM... They are going to be in more rural areas where there are no physicians. They are going to be employed where physicians are around just in case.

Once you guys actually see them work and their level of knowledge it will be very evident they cannot function as a physician. Residency training is what makes a physician a physician. Medical school prepares you for residency training. PA/NP school would not adequately prepare you.

 

[jl lin]

easy solution

we should be welcoming the midlevels and transforming ourselves into their managers
have our lobbyists make it so all midlevels have to have a doctor supervise them to get full insurance reimbursement

we become more valuable
DNPs do all the dirty work
we work less hours
spend more time with our family
make more money

brb lifelong residents in my private practice

Yes but that is exactly what advanced practice nursing is fighting to achieve--absolute autonomy. I am surprised there isn't more of unified stand by physicians politically speaking. Is it that they don't have time with their own work and practices?

It's very troubling. . .and really kind of depressing.

 

[calvnandhobbs68]

Yes but that is exactly what advanced practice nursing is fighting to achieve--absolute autonomy. I am surprised there isn't more of unified stand by physicians politically speaking. Is it that they don't have time with their own work and practices?

It's very troubling. . .and really kind of depressing.

It's because of things like the clinics in that NYT article that NPs are getting more autonomous. If the choice is between no health care at all and health care provided by NPs...well I'd go to the NPs too. Yeah, maybe most NPs don't work in these settings but these are the heartwarming stories that will propel them on their way. Physicians (rightly I think) say "I didn't train for 7 years after college to make <100K because I'm seeing all self pay and Medicaid patients out in the middle of nowhere as an FP" but NPs can do just that.

 

[TooMuchResearch]

Surgery matches at average step1 scores. It will be the last to go for sure. But I don't think physician practice will really be encroached upon too much. Even if we give full practice rights to these other disciplines, those patients with insurance will still prefer a physician 9 times out of 10.

Patients don't know the difference much of the time. And that includes when the doc explicitly says "Hi, I'm Dr. Smith. I am your physician." Ever notice how most patients don't seem bothered if the attending introduces the med student as Dr. Smoth? The routes available and training completed are not well known to those outside of our corner of the world.

 

[jl lin]

Oh and Dr. Kevin,MD at http://www.kevinmd.com/blog/2011/10...ification-solve-doctor-nurse-controversy.html has suggested universal boards.

While that could be one part of it, the other should be more stringent and longer residency requirements for all NPs and CRNAs. In other words, there should be NO short cuts. Then they will have to see if it is worth it for them.

It can't be both ways. If you want to practice on the level of physician, you need to go to medical school and go through all the other hoops. If, OTOH, you want to expand nursing practice, stay within the confines of SofP for advanced practice nursing. It's illogical that anyone would want to make one essentially equivalent with the other. There may be some overlap at times, but it's apples and oranges. Why would you want to be a nurse in order to practice like a doctor?

If I wanted to become an electrical engineer, why would I simply take some advanced courses in being an electrician in order to function as an electrical engineer? Yea. I know. Not the best example.

Personally I wonder if a big part of this whole issue is the fact that secondary schools want to make money with all these other kinds of disciplinary programs. I love education, but let's be honest. Schools of learning, especially on the tertiary level, are huge businesses.

And yes, the big healthcare mandates in the US will force the issue of mid-level and DNP saturation. If things stay as they are, it's inevitable.


Also, I wonder if the adversarial relationship between physicians and lawyers is a factor. That is, more physicians should take a collective stand and get lawyered up on this.

Nurses aren't afraid to get lawyered up. And nursing organizations are not afraid of this either. That's how they have made so much headway politically speaking.

Finally more PR awareness through media vehicles should be used in order to reach the general public. They need to know the DISTINCT differences, period.

Being a nurse for a good period of time, I was always of the belief that if you wanted to practice as a physician, you should go to medical school and through the rest of the hoops. It's one thing when there are reasonably applied limits to advanced nursing practice. When the boundaries are stepped over, it's problematic for everyone.

 

[ArcGurren]

I am a retired doc, and at the off chance I sound like a troll, forgive me, I am not. I have read this thread a few times, and it brings to mind issues that were rumored and prevailed half a century ago. There was a similar situation when I graduated medical school pertaining to what was then a field we were wary of, they were infringing on our territory, and were met with suspicion, some disdain, and the AMA, which was much stronger then concurred: How could they do what we did? They spent more time with patients, they could watch and wait as an illness ran its course. Some were surgically trained, but they were different. A different degree. As the years passed gradually they became more accepted, patients took to them, and it seemed inevitable we would coexist. Today DOs are the norm. Change is part of what you'll come to expect as you mature. Hopefully you won't become so enamored with technology that you believe anything can ever substitute the patience, and value of your roll as a physician. You are not going to be you patient's friend, substitute for family, clergy, or anything else but that trusted confidant, and guide though life's most intimate and sacred times. Spare yourself time wasted looking at what some other endeavor is doing and focus on what, and why you chose to become a physician.

I can't particularly understand the flow of what you're saying, but it seems like you're comparing the fact that DOs have become as important and prevalent as MDs and trying to compare that to the same situation that NPs are going through.

DOs have an almost identical curriculum to MD schools (with the addition of OMM) and they take (and pass with high rates) the USMLE exams for allopathic residencies. The COMLEX is on a similar level of competency with the addition of OMM. And above all, they go through the same level of training through residency - both in allopathic and osteopathic programs - across ALL specialties. Beyond a somewhat philosophical difference and an extra class, there is zero difference.

When DNPs have an identical curriculum, are able to pass the REAL USMLE licensing boards, and have the same level of postgraduate training that MDs and DOs have, then you can make that comparison. But until then, the comparison is utter BS and it is ridiculous to claim that it's anywehre near the same circumstance.

What a nonsensical comparison.

 

[jl lin]

Spare yourself time wasted looking at what some other endeavor is doing and focus on what, and why you chose to become a physician.

I mean I understand that principle, in general--focus on why one wants to be a physician, but there is still a reasonable concern here with the overstepping of practices. It does matter. Physicians have to be advocates for patients and the public too. It's not simply a matter of territorial protection. It's a matter of patient and public safety, and it's a matter of functional principle. I mean why not just start downsizing the education and preparatory standards for all professions and fields? Wonder how teachers and engineers and various PhD-prepared scientists would feel about that? Gee, what is this equivalency with regard to dentists? Why is this less of a problem for them or for orthodontists that use PAs? At some point, it all becomes utterly ridiculous.

I can't particularly understand the flow of what you're saying, but it seems like you're comparing the fact that DOs have become as important and prevalent as MDs and trying to compare that to the same situation that NPs are going through.

DOs have an almost identical curriculum to MD schools (with the addition of OMM) and they take (and pass with high rates) the USMLE exams for allopathic residencies. The COMLEX is on a similar level of competency with the addition of OMM. And above all, they go through the same level of training through residency - both in allopathic and osteopathic programs - across ALL specialties. Beyond a somewhat philosophical difference and an extra class, there is zero difference.

When DNPs have an identical curriculum, are able to pass the REAL USMLE licensing boards, and have the same level of postgraduate training that MDs and DOs have, then you can make that comparison.

As much as I appreciate the fundamental sense of Cizzen's latter comment in particular, I still have to agree with Arc's post above.

 

[deleted6669]

If residency is what really matters in our training, why do we have 4 years of med school? That seems like an absurdly long time to pick a field and prepare for residency. Why don't we cut it down to 2 years and spend more time in residency? The PAs seem to be doing fine with just 2 years in school and learning the rest on the job. 4 years is a lot of time and a lot of money to spend when you're saying that it doesn't even really matter that much and it doesn't actually train you to become a physician.

there are now a handful of accredited programs, both md and do, which are 3 years and prepare you to enter a primary care residency. lecom has such a program. I know there is one in texas but don't remember where. much of the world does undergrad+ medschool in 5 years(the brits for example).
during ww2 u.s. medschools were allowed to graduate physicians faster to ramp up the # of practicing docs. opinions vary on what can be cut out. I think the programs above have demonstrated you can prepare someone for residency in 3 years or do medschool + undergrad in 5 years.

 

[peteB]

there are now a handful of accredited programs, both md and do, which are 3 years and prepare you to enter a primary care residency. lecom has such a program. I know there is one in texas but don't remember where. much of the world does undergrad+ medschool in 5 years(the brits for example).
during ww2 u.s. medschools were allowed to graduate physicians faster to ramp up the # of practicing docs. opinions vary on what can be cut out. I think the programs above have demonstrated you can prepare someone for residency in 3 years or do medschool + undergrad in 5 years.

The question is, if someone goes to the 3 year MD school which is meant to prepare you for a primary care residency, is it going to illegal for them to apply to non primary care residencies? Or is it just a guideline? If they can actually apply to any residency legally, then it's a bit unfair that everyone else has to do 4 years.

 

[deleted6669]

The question is, if someone goes to the 3 year MD school which is meant to prepare you for a primary care residency, is it going to illegal for them to apply to non primary care residencies? Or is it just a guideline? If they can actually apply to any residency legally, then it's a bit unfair that everyone else has to do 4 years.

I can only speak to the program at lecom. they have affiliated hospitals that one rotates at during the program and you agree to attend one of them for residency after.. there is no time built into the schedule for interviews, etc like in a typical 4 yr program. a shifty person probably could get around it just like the very few dmd/md folks who choose anesthesiology instead of omf....
http://lecom.edu/college-medicine.php/Primary-Care-Scholars-Pathway/49/2205/612/2393
the primary care track (above) requires you to sign a legally binding contract with financial penalties if you break the deal.

 

[peteB]

I can only speak to the program at lecom. they have affiliated hospitals that one rotates at during the program and you agree to attend one of them for residency after.. there is no time built into the schedule for interviews, etc like in a typical 4 yr program. a shifty person probably could get around it just like the very few dmd/md folks who choose anesthesiology instead of omf....
http://lecom.edu/college-medicine.php/Primary-Care-Scholars-Pathway/49/2205/612/2393
the primary care track (above) requires you to sign a legally binding contract with financial penalties if you break the deal.

That's actually a great deal if you're looking to do primary care because you'd be guaranteed a residency. Then again primary care is not that hard to get into. Do you know what exactly they cut out to go from 4 years to 3 years?

 

[SpecterGT260]

Patients don't know the difference much of the time. And that includes when the doc explicitly says "Hi, I'm Dr. Smith. I am your physician." Ever notice how most patients don't seem bothered if the attending introduces the med student as Dr. Smoth? The routes available and training completed are not well known to those outside of our corner of the world.

Many hospitals are implementing clear designations of profession because this has been a problem. The patients tend to get pissed off after the fact when they find out their doctor was a nurse.

 

[45408]

how are you sure about that?

Just a feeling.

To echo the poster above, how do you know? Do you speak for all surgeons in America?

Do either of you know any surgeons willing to do it? It doesn't really help to say "I'm sure someone would do it," if you can't find anyone who would.

Have any physicians (let alone surgeons) suggested that it's plausible/reasonable for DNPs to do surgical procedures? I don't care if they're excising a mole from someone's neck under local, but the majority of operations seem pretty minor until they're not. I've seen some pretty nasty complications from some pretty "minor" procedures, and if you can't manage your complications, then you are not qualified to be doing the procedures. Hospitals won't give privileges, malpractice companies won't cover it, and surgeons are definitely going to raise hell if they're expected to repair a bowel injury several days after a DNP put a trocar into it during a lap chole.

 

[SpecterGT260]

and surgeons are definitely going to raise hell if they're expected to repair a bowel injury several days after a DNP put a trocar into it during a lap chole.

There is a lot of this sort of thing already happening. Not midlevels doing surgeries, exactly, but physicians, including surgeons, getting pissed off when they have to fix someone elses mess. The Nsurg guys get pissed when the ortho-spine guys bolt a 2x4 into someone's back, the ortho guys get pissed when the ER guy or ER PA/NP splints a break inappropriately requiring surgical correction, the anesthesiologist gets pissed when he wakes up after sucking his own gas and realizes he completely automated the CRNAs job 👍

Scope of practice is expanding within the medical community as well as lines are blurred between different specialties. I think you are right that surgery is completely safe from NPs, but all in all this "raising hell" doesn't seem to be doing much to curb other expanses in scope

 

[peteB]

Do either of you know any surgeons willing to do it? It doesn't really help to say "I'm sure someone would do it," if you can't find anyone who would.

I actually know a surgical resident who said he would more than willing to do it (after he finishes his training) for the right price. I also know many people in my class who are pursuing surgery and are the type of people who would do anything for $$$.

 

[peteB]

Just a feeling.
Have any physicians (let alone surgeons) suggested that it's plausible/reasonable for DNPs to do surgical procedures? I don't care if they're excising a mole from someone's neck under local, but the majority of operations seem pretty minor until they're not. I've seen some pretty nasty complications from some pretty "minor" procedures, and if you can't manage your complications, then you are not qualified to be doing the procedures. Hospitals won't give privileges, malpractice companies won't cover it, and surgeons are definitely going to raise hell if they're expected to repair a bowel injury several days after a DNP put a trocar into it during a lap chole.

Isn't the same true for treating patients as a PCP? The majority of issues people come in with are minor, until the DNP misses an important finding or doesn't ask a question because they just don't have enough training to know better, and then they're not. Posters above have given real examples of this. How are we allowing them to practice independently in this situation (which they already do in rural areas)? Why aren't malpractice companies concerned about that?

 

[deleted6669]

That's actually a great deal if you're looking to do primary care because you'd be guaranteed a residency. Then again primary care is not that hard to get into. Do you know what exactly they cut out to go from 4 years to 3 years?

most of 4th yr + vacations and interview time....

 

[2012Aggie]

http://www.ttuhsc.edu/som/fammed/fmat/

Eliminate some electives in 4th year, take out vacation time, and go to class in the summer between first and second year. The students are free to apply to any residency they wish, although any program outside of family medicine would be highly skeptical if an applicant from the program was not applying FM.

 

[cbrons]

http://www.ttuhsc.edu/som/fammed/fmat/

Eliminate some electives in 4th year, take out vacation time, and go to class in the summer between first and second year. The students are free to apply to any residency they wish, although any program outside of family medicine would be highly skeptical if an applicant from the program was not applying FM.

It always irritated me how so many schools don't have classes during the summer. You could knock out a lot just by not giving M1s a vacation.

 

[Bacchus]

It always irritated me how so many schools don't have classes during the summer. You could knock out a lot just by not giving M1s a vacation.

I'm pretty sure if I didn't get a vacation after M1 I would be inpatient at the county hospital.

 

[88845]

It always irritated me how so many schools don't have classes during the summer. You could knock out a lot just by not giving M1s a vacation.

Agreed. I can see the three-year model becoming highly appealing if it was further adopted for those that are bee lining toward FM. Have an accelerated track with 1.5 years of preclinical and knock out M1 summer. University of the Pacific has done it for dentistry - they squeeze in a four-year curriculum into three by doing a similar schedule.

 

[swamprat]

I think with a good 2-3 week break after M1 I'd been fine starting up M2 and getting done earlier with med school.. I def didnt need an 8 week summer I got really bored.

 

[45408]

I actually know a surgical resident who said he would more than willing to do it (after he finishes his training) for the right price. I also know many people in my class who are pursuing surgery and are the type of people who would do anything for $$$.

Not exactly compelling evidence here, pete.

Isn't the same true for treating patients as a PCP? The majority of issues people come in with are minor, until the DNP misses an important finding or doesn't ask a question because they just don't have enough training to know better, and then they're not. Posters above have given real examples of this. How are we allowing them to practice independently in this situation (which they already do in rural areas)? Why aren't malpractice companies concerned about that?

Uh, no. There are not many situations in which you are likely or even capable of missing something in outpatient medicine that will rapidly result in the patient's death, let alone right in front of you in the office.

As for malpractice, ask the insurance companies why internists pay a fraction of what a surgeon pays.

 

[peteB]

Not exactly compelling evidence here, pete.

Fair enough, but it's also not nothing. The point is there are surgeons willing to do it. You don't really need that many on board to do it.

 

[peteB]

Have any physicians (let alone surgeons) suggested that it's plausible/reasonable for DNPs to do surgical procedures? I don't care if they're excising a mole from someone's neck under local, but the majority of operations seem pretty minor until they're not. I've seen some pretty nasty complications from some pretty "minor" procedures, and if you can't manage your complications, then you are not qualified to be doing the procedures. Hospitals won't give privileges, malpractice companies won't cover it, and surgeons are definitely going to raise hell if they're expected to repair a bowel injury several days after a DNP put a trocar into it during a lap chole.

Do you really think all DNPs would be incapable of doing surgery? Surgical technique is not really a large component of medical school- you learn almost all of it in residency, so a DNP could learn to be quite proficient at simple procedures without getting an MD, if they went through a rigorous "residency" with trained surgeons and got lots of practice managing complications. Why do you think that they can't handle any sort of operation? Is it their lack of basic science knowledge? or do you think they lack dexterity? or do you think they are just not intelligent enough?

 

[45408]

Fair enough, but it's also not nothing. The point is there are surgeons willing to do it. You don't really need that many on board to do it.

No, the point is that you have not shown me any surgeons willing to do it. A couple med students and a resident are not surgeons. I also think that you would need quite a few "on board" to do it, or else it would be pretty pointless to have a handful of DNPs walking around with some hodge-podged surgical experience.

Do you really think all DNPs would be incapable of doing surgery? Surgical technique is not really a large component of medical school- you learn almost all of it in residency, so a DNP could learn to be quite proficient at simple procedures without getting an MD, if they went through a rigorous "residency" with trained surgeons and got lots of practice managing complications.

Why the hell would we create a surgery residency system completely separate from the fully functional surgery residency system we have now? This is just asinine. If we need more surgeons, we should just increase the number of residency positions accordingly. Creating "separate but equal" scenarios doesn't make much sense, especially since it would take just as long to create both types of "surgeons."

Why do you think that they can't handle any sort of operation? Is it their lack of basic science knowledge? or do you think they lack dexterity? or do you think they are just not intelligent enough?

Because of their lack of training. If you trained them enough, then why not just go through the well-established route we already have?

 

[peteB]

Why the hell would we create a surgery residency system completely separate from the fully functional surgery residency system we have now? This is just asinine. If we need more surgeons, we should just increase the number of residency positions accordingly. Creating "separate but equal" scenarios doesn't make much sense, especially since it would take just as long to create both types of "surgeons."


Because of their lack of training. If you trained them enough, then why not just go through the well-established route we already have?

Both of these arguments also apply to DNPs doing primary care. If we need more family docs, why don't we just open up more residency positions for family medicine, instead of training nurses to become DNPs and then increasing the scope of practice of DNPs and allowing them to function as family docs (which they already do in many areas)? See how that's the same argument? Why not just go through the well-established route we already have (MD -> FM residency)?

There are even DNP "residency programs" now allowing DNPs to specialize in fields like dermatology. They are also expressing the intent to fight for autonomous practice rights. Again, why do we need this when we already have a path to become a dermatologist?

Since we now have "separate but equal" paths for Family Docs (or so they claim by their outcome studies), why not "separate but equal" paths for general surgeons too? (of course we know they really won't be equal, but they seem to be able to convince lawmakers they are)

The reason we have separate paths is because one is controlled by the medical boards and the other is controlled by the nursing boards. The nurses want to do what doctors do, but they can't because they're not doctors and probably can't get into medical school even if they tried, so what they're doing is creating their own paths that the medical board has no jurisdiction over.

I agree with you that the whole thing is ridiculous. But it's happening, and none of us can predict where it will go.

 

[peteB]

No, the point is that you have not shown me any surgeons willing to do it. A couple med students and a resident are not surgeons. I also think that you would need quite a few "on board" to do it, or else it would be pretty pointless to have a handful of DNPs walking around with some hodge-podged surgical experience.

I've shown you a surgical resident who is only a couple years away from becoming a surgeon who is more than willing to get involved. That's something. You haven't shown me any evidence at all to back up your assertion that no surgeon would get involved. You've said yourself that it was "just a feeling". We have no idea how many would be on board, but I am quite sure it won't be zero. You only need enough to train the first couple batches of DNPs. Then those DNPs can train the next batch, and so on. Eventually, you don't need MD surgeons at all in the training process. I'm actually not the only one to point this out- there was another person in this thread who said the same thing.

 

[SpecterGT260]

I've shown you a surgical resident who is only a couple years away from becoming a surgeon who is more than willing to get involved. .

no you havent...... You said you know a guy. I know a guy who knows a guy who says you don't know a guy. See how that works?

 

[peteB]

no you havent...... You said you know a guy. I know a guy who knows a guy who says you don't know a guy. See how that works?

Ok, then, I guess we shouldn't have arguments on forums because there's no way to prove any story anyone has.

 

[kpcrew]

Ok, then, I guess we shouldn't have arguments on forums because there's no way to prove any story anyone has.

Yeah I guess it would be impossible to prove any story because as we all know that you can't take a recording of someone saying something since it's not like everyone carries around some sort of portable picture taking device that has the ability to record sounds at the same time while also being capable of long-range data transmission.

 

[peteB]

Yeah I guess it would be impossible to prove any story because as we all know that you can't take a recording of someone saying something since it's not like everyone carries around some sort of portable picture taking device that has the ability to record sounds at the same time while also being capable of long-range data transmission.

Sure we could do that. But that would destroy the anonymity of the forum. Isn't that the great thing about an internet forum? You can speak your mind freely and not have to worry about it being used against you.

 

[SpecterGT260]

Ok, then, I guess we shouldn't have arguments on forums because there's no way to prove any story anyone has.

That is why we typically deal in facts and evidence rather than anecdote. Things progress more smoothly

 

[SpecterGT260]

Sure we could do that. But that would destroy the anonymity of the forum. Isn't that the great thing about an internet forum? You can speak your mind freely and not have to worry about it being used against you.

Exactly...... PETER! mwahahahahaha

 

[peteB]

Exactly...... PETER! mwahahahahaha

Wow you figured out my first name. Not like anyone else has the same name 🙂

 

[peteB]

That is why we typically deal in facts and evidence rather than anecdote. Things progress more smoothly

Well prowler didn't have facts either. He said no surgeon would train a DNP, but he doesn't have any facts to prove that.