Doctor of Nursing Practice?

[ProZackMI]

I can't even imagine being a PharmD or DPT and calling yourself Dr anywhere...I would be embarrassed to say I'm DR. Lawguil- you physical therapist. LOL, that's just funny. A PhD is called Dr. in academia and a MD/DO is called DR in the clinical setting - that's all it should be! After all, there really aren't any other types of doctor no matter what all these allied health organizations mandate! In my book, the next closest thing in clinical training to an MD/DO is a PA, but they don't call themselves doctor. Does a DPT or PharmD think they have exceeded the training of a PA because there respective organization mandated it in order for a school to keep its program accreditation?

My, aren't we pretentious? I'm an MD and I completely disagree with you. A PharmD is a Doctor of Pharmacy and therefore entitled to the title "Doctor", whereas a PA is NOT a doctor of anything, unless he/she holds a PhD or DPH or some other doctorate.

A clinical pharmacist would not be fired, or precluded from using the doctor title in any context...that's bull****. I have no idea where you people work or what kind of ***** admins and patients you have, but context is everything.

DOCTOR denotes an academic or professional degree, NOT a profession or occupation. A PharmD should be addressed as 'doctor' in the appropriate context, just like anyone else who holds a doctorate (whether professional or academic). Now, the person who holds the degree should realize that the general public assumes one is a physician and therefore should use the title sparingly in a clinical setting, OR qualify it with a statement like "I'm Dr. X, the clinical pharmacist who will be monitoring your Coumadin level" or "the Nurse Practitioner".

I personally do not think PAs or NPs should go the clinical doctorate route; it's unnecessary and given the scopes of practice and function, why not just attend medical school?

BTW, I know many PA's who allow patients to call them "doctor" when they only have a BS degree, not a PhD, MD, DO, PharmD, etc. THAT is not only misleading, but unethical and arrogant. I have corrected patients in front of PAs who have said nothing by saying "Mr. X is a Physician Assistant; his job is to assist doctors, and he is not a doctor."

I have never met an NP who lets his/her patients call her/him doctor...nor have I heard of such a situation happening. PAs do it quite frequently, however.

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[lizzied2003]

I think that you are right, but so was the OP. There is no need for a Doctor of Nursing Practice (in the sandbox or anyplace else).

Funny you bring that up...as an NP of course I've entertained this whole DrNP thing. However; I'm not sure what the heck I'd do with such a degree. It wouldn't change my current practice, I'm happy with my salary, I like my boss quite a bit, and I'd have to listen to some sort of academic nonsense before I'd even have to 'shadow' someone in residency for a year. Well, why don't I just go to medical school? I believe in the academia of nursing, confussing as it is. I believe that many nursing theories and research studies are valuable to practice. I think that the PhD in nursing is the only Doctorate that's neeeded. Perhaps as I learn more I'll change my mind. For right now...I find the role confusing and though I wish those well who are going for it...I'm not sure what will change in your practice. Even if you 'want' admitting privledges for your PCP patients you still have to go before a medical board that may not be quite as open to the idea.

Hopefully no one will develop a 'fast track' dr. np program. $$$$$

 

[ProZackMI]

I have to say that no I don't think a PharmD thinks thier training surpasses as pa. In fact I'd say their training has nothing to do with a PA. It's apples and oranges. However, I would not be going out on a limb by saying that the Pharm D in our hospital knows much more about pharmacokinetics and what not than MD/DO/PA/MD and usually is the first to note when the MD/PA/DO/NP has given a dose of vanco to kill a gorilla, or perhaps even the very common colchcine tid in someone with crappy kidneys...but hey the provider read it in their drug book.

I think overall it is very disrespectful that individuals use this forum to boost their own egos. It is always turned so negative and I'd even go so far as to say the original post was meant to start some antagonist discussion...and a lot of you fell for it.

Everyone is good at something for god's sake and everyone's training is different. Get out into the real world and practice. You'll see no man is alone working and the care starts (gasp) with that paramedic or EMT out in the field and continues on to include the darn nurses aide who may not even have college education.

Get off your high horse people and get along...now back in the sandbox and play nicely.

That was a great post. You really summarized my sentiments well and I appreciate it. Lawguil seems to think that only an MD/DO (and...veterinarians and dentists) deserve to be called "doctor". I agree with his/her sentiments about chiros and PTs, but PharmDs, PhDs, DPMs, and other professsionals have gone to school a long time and provide valuable medical services to patients.

To say that only a physician can be called "doctor" in a hospital setting is absolutely false in MOST places. Your average patient is not that stupid and addleminded that he/she cannot figure out there are different types of doctors with different roles. Mrs. Johnson knows that Dr. X, her dentist, is going to fill her cavity, not replace her mitral valve. Mr. Smith knows that Dr. X in the anticoag clinic is a pharmacist, not a physician. John knows that Dr. Y who prescribed his contact lenses and fitted them is an optometrist, not a neurologist. Not all people are stupid.

HOWEVER, in the hospital or clinic setting, it can be confusing, especially to elderly patients. I'm an MD, but I usually introduce myself by saying my full name and telling the patient or family member that I'm a psychiatrist. If I was an NP or PA, I would use my first name even if I had a doctorate, but that's just me. If I had a doctoral degree, as an NP (not a PA), I would consider the patient and the context before using the title.

 

[lizzied2003]

That was a great post. You really summarized my sentiments well and I appreciate it. Lawguil seems to think that only an MD/DO (and...veterinarians and dentists) deserve to be called "doctor". I agree with his/her sentiments about chiros and PTs, but PharmDs, PhDs, DPMs, and other professsionals have gone to school a long time and provide valuable medical services to patients.

To say that only a physician can be called "doctor" in a hospital setting is absolutely false in MOST places. Your average patient is not that stupid and addleminded that he/she cannot figure out there are different types of doctors with different roles. Mrs. Johnson knows that Dr. X, her dentist, is going to fill her cavity, not replace her mitral valve. Mr. Smith knows that Dr. X in the anticoag clinic is a pharmacist, not a physician. John knows that Dr. Y who prescribed his contact lenses and fitted them is an optometrist, not a neurologist. Not all people are stupid.

HOWEVER, in the hospital or clinic setting, it can be confusing, especially to elderly patients. I'm an MD, but I usually introduce myself by saying my full name and telling the patient or family member that I'm a psychiatrist. If I was an NP or PA, I would use my first name even if I had a doctorate, but that's just me. If I had a doctoral degree, as an NP (not a PA), I would consider the patient and the context before using the title.

Thanks for the positive note. It is so confusing even to figure out who the nurse is or the nurses aide or the dietician or the speech therapist.

Thank goodness for the name badges the have the big black letters...but even then a simple introduction and reinforcement of your role on the next visit is usually the best way. Sooner or later they'll get it but it's up to us to explain the differences and overlap .

By the way, this makes me think that I do have one elderly lady who can not summon up the nerve to call me by my first name alone. ( I can't possibly be the only midlevel in this position can I???) She feels I'm too young to be a Mrs. and we have gone back and forth and she really does get it that though I'm her PCP it doesn't mean Primary CAre PHYSICIAN. I think her term 'my doctor sue' has now become a term of endearment. I find it embarrassing more than flattering and it bothers me that I always feel I need to explain to staff that she just won't stop calling me this. My staff is less bothered than this than I.
I don't feel like an imposter or a poser in this case nor do I feel i'm falsely representing myself. It's just the way this lady is. At every visit though I tell her, No, please call me Sue...I'm a nurse practitioner. I guess I could get pretty stern with her but I choose not to scold a 82 year old.

Funny, my mom tells her friends I'm a Physician's Assistant...so go figure.

 

[deleted87716]

She feels I'm too young to be a Mrs.

What ever became of "Ms.?" Is womens' lib truly dead?

 

[fab4fan]

But you did the right thing, lizzie. You tried, but your pt. just won't listen. I agree, I certainly wouldn't scold her, either. You and your staff know that you're not intentionally misleading her.

 

[fab4fan]

What ever became of "Ms.?" Is women's lib truly dead?

The pt. is in her 80's. She's probably never used "Ms." to address anyone.

 

[deleted87716]

The pt. is in her 80's. She's probably never used "Ms." to address anyone.

I wouldn't assume that, as she was only in her 50's in the 1970's. My point is simply that there's little cause for confusion here, unless we're the ones perpetuating it.

It sounds as if Lizzie has tried her best to correct the misperception, but many people will not bother. FWIW, I don't think encouraging patients to call us by our first names will make it any easier.

 

[lizzied2003]

I'm not even going to say...'gee seeing how you can't figure to call me by my first name I'd prefer you call me Ms.". And actually even though I've called you Bertha for the last 34 months I'm going to change that to Mrs. Jones. And I don't believe that it's because i'm young (because I'm not) it's a generational thing or something I don't understand. She feels that because she is my senior and because I'm providing a service to her that demands some sort of 'higher respect'. I don't feel that way. I'm happy with my first name and what my office door says. jeepers !!

She's an elder. I'm not going to speak like that to her or insist we change our relationship to a more formal level. She knows who I am. I know who I am. I'm her Nurse Practitioner. .

 

[deleted87716]

Sounds like you're a lot more emotionally invested in this argument than I am, Lizzie.

 

[lizzied2003]

Sounds like you're a lot more emotionally invested in this argument than I am, Lizzie.

(laughing...)
oh you're so right.
but you made me laugh at myself a bit so thanks for that.

 

[deleted87716]

(laughing...)
oh you're so right.
but you made me laugh at myself a bit so thanks for that.

Glad I could help.

 

[lizzied2003]

Glad I could help.

And in this life, that's what it's all about.

It's always amazing to me how 'carried' away we can all get. Sometimes one thoughtful sentence allows you to take a breath and lighten up.

 

[zenman]

DOCTOR denotes an academic or professional degree, NOT a profession or occupation. A PharmD should be addressed as 'doctor' in the appropriate context, just like anyone else who holds a doctorate (whether professional or academic). Now, the person who holds the degree should realize that the general public assumes one is a physician and therefore should use the title sparingly in a clinical setting, OR qualify it with a statement like "I'm Dr. X, the clinical pharmacist who will be monitoring your Coumadin level" or "the Nurse Practitioner".

And with this we can now go to sleep.

 

[niko327]

My, aren't we pretentious? I'm an MD and I completely disagree with you. A PharmD is a Doctor of Pharmacy and therefore entitled to the title "Doctor", whereas a PA is NOT a doctor of anything, unless he/she holds a PhD or DPH or some other doctorate.

A clinical pharmacist would not be fired, or precluded from using the doctor title in any context...that's bull****. I have no idea where you people work or what kind of ***** admins and patients you have, but context is everything.

DOCTOR denotes an academic or professional degree, NOT a profession or occupation. A PharmD should be addressed as 'doctor' in the appropriate context, just like anyone else who holds a doctorate (whether professional or academic). Now, the person who holds the degree should realize that the general public assumes one is a physician and therefore should use the title sparingly in a clinical setting, OR qualify it with a statement like "I'm Dr. X, the clinical pharmacist who will be monitoring your Coumadin level" or "the Nurse Practitioner".

I personally do not think PAs or NPs should go the clinical doctorate route; it's unnecessary and given the scopes of practice and function, why not just attend medical school?

BTW, I know many PA's who allow patients to call them "doctor" when they only have a BS degree, not a PhD, MD, DO, PharmD, etc. THAT is not only misleading, but unethical and arrogant. I have corrected patients in front of PAs who have said nothing by saying "Mr. X is a Physician Assistant; his job is to assist doctors, and he is not a doctor."

I have never met an NP who lets his/her patients call her/him doctor...nor have I heard of such a situation happening. PAs do it quite frequently, however.

Then you said......

That was a great post. You really summarized my sentiments well and I appreciate it. Lawguil seems to think that only an MD/DO (and...veterinarians and dentists) deserve to be called "doctor". I agree with his/her sentiments about chiros and PTs, but PharmDs, PhDs, DPMs, and other professsionals have gone to school a long time and provide valuable medical services to patients.

To say that only a physician can be called "doctor" in a hospital setting is absolutely false in MOST places. Your average patient is not that stupid and addleminded that he/she cannot figure out there are different types of doctors with different roles. Mrs. Johnson knows that Dr. X, her dentist, is going to fill her cavity, not replace her mitral valve. Mr. Smith knows that Dr. X in the anticoag clinic is a pharmacist, not a physician. John knows that Dr. Y who prescribed his contact lenses and fitted them is an optometrist, not a neurologist. Not all people are stupid.

HOWEVER, in the hospital or clinic setting, it can be confusing, especially to elderly patients. I'm an MD, but I usually introduce myself by saying my full name and telling the patient or family member that I'm a psychiatrist. If I was an NP or PA, I would use my first name even if I had a doctorate, but that's just me. If I had a doctoral degree, as an NP (not a PA), I would consider the patient and the context before using the title.

You also said (This was taken from another thread)

If you want to see puffery and self-laudatory behaviour, however, chiros and optometrists take the cake. I still remember being at Belle Tire two years ago, getting my tire repaired, and the clerk calls out "Mr. Smith?" and this pompous ass yells back, "That's DOCTOR Smith." I was called next ("Mr. S?), and went up to pay. As I was giving the clerk my credit card, I saw the ***** (DOCTOR Smith) next to me write a check; it said "Dr. John R. Smith, D.C." I laughed out loud and said, "Figures; he's a chiropractor."

Last year, as I was at the optometrist, getting my yearly vision exam, the receptionist said to me, "Mr. S, the DOCTOR will see you now!" Mind you, I'm an MD and JD, but I never corrected her. However, I did say, "You mean, the optometrist will me, right?" She said, "Dr. McCreery is an optometrist." I had to laugh. The DOCTOR will see me. Talk about insecurity and puffery.

What are you trying to say exactly???? Don't you think Optometrists provide a valuable service?

 

[Adcadet]

What ever became of "Ms.?" Is womens' lib truly dead?

Everybody over age ~16 is either Mr or Ms to their face and in conversations with others unless I have a darn good reason to call them otherwise.

 

[Adcadet]

What are you trying to say exactly???? Don't you think Optometrists provide a valuable service?

ProZacMI - your complaining about your optometrist's office staff referring to him/her as doctor, in his/her office?

 

[ProZackMI]

ProZacMI - your complaining about your optometrist's office staff referring to him/her as doctor, in his/her office?

I guess my point was, why not just say (A) "Dr. X" (the optometrist) will see you now; or (B) You can go in now. Rather, the receptionist made a big deal about saying "THE DOCTOR" will see you now. I don't know why, but it was off-putting. I don't think it's puffery for the staff to say "Dr. X will see you now", but it's rather pretentious to say "THE DOCTOR" will see you. Why? I don't know, but it's...unseemly IMO.

That's just me, however. I really think all this hoo-hah about titles is a little off the topic. The original topic invited discussion about the DNP degree. Here is my take on this matter. You can say what you want about the various professional doctorates out there. The PharmD, DVM, DDS, DPM, OD, PsyD, DPT, AuD, and other degrees are oft compared to the MD/DO. For better or worse, right or wrong, this comparison is inevitable and invites varied opinions.

The holders of those degrees are all DOCTORS in the technical sense of the word. Whether in a clinical, retail, or academic setting, each of the aforementioned providers has a function that is decidedly and obviously different than that of a physician. Even folks with a basic middle school level education can differentiate between a dentist and an internist; a podiatrist and a gastroenterologist; a pharmacist and a surgeon. It's a little more difficult for some to distinguish between an optometrist and an ophthalmologist or psychiatrist and psychologist or otologist and audiologist or physiatrist and physical therapist, but generally speaking, with little exception, most confused patients/clients are set straight with a little explaining.

These professions have a scope of practice that is different from that of a physician and this makes it easier to set them apart from allo/osteo med. However, that's not true about an NP or PA. The job duties of an NP are the exact same as that of a GP/FP and even internists. The PA's job is essentially the same as the physician's job, but to a lesser extent. So, calling the pharmacist or PT or OT or audiologist or dentist "doctor" is not really misleading or confusing to most patients because with some basic clarifying statements and qualifying remarks, the confusion can be cleared up quickly. Can you say that about the NP with a DNP or PHD? The NP's job is the same as the FPs job, with little exception. So, this situation could really cause confusion with patients and the general public.

It also begs the question...if one wanted to be a primary care provider and had to attend 8 years of school plus a residency, why not just go to medical school? Why would anyone get a BSN and then DNP plus a 1-2 year residency when you could get a BS and MD + 3 year residency? The DNP would save you some money and maybe a year or two of schooling (maybe), but no matter what, you'd always be a "lower" provider. The DNP wouldn't really provide you with any higher status because no matter what your degree was (MSN or DNP or DNSc), you'd still be a NP and not a physician.

I don't mean that to be disrespectful either. I'm asking a serious question. Why bother distinguishing between NPs and physicians? At one point in time, we had MDs and DOs...both types of physicians were treated differently and had differents scopes of practice. Eventually, the DO's became like the MDs and today they are practically the same with the same scopes of practice in all states. Would the DNP mean we'd have three types of physicians 15-20 years from now: MD, DO, and DNP?

Again, why bother? Why create more confusion out there? DNPs would become just like MDs and DOs...they'd require the MCAT for entrance into their programs. Eventually, the nursing model would be replaced by the medical model. I think it would be pointless to create the DNP degree for NPs who practice. NPs who want to teach or do research should get PhDs or DNSc degrees, not clinical practitioner degrees at the doctoral level.

So, in sum, the PharmDs, dentists, ODs, pods, etc., all have their place out there and have their unique role in the health care system. They have jobs that are distinct and different from physicians, although they have some duties and roles that overlap. NPs do almost the same work as physicians, but to a lesser level. The DNP degree would beg the question, what's the difference? More importantly, if there is a difference, why not just go to medical school and get the highest level of authority, scope of practice, and prestige? Why spend 7-8 years in school, 1-2 years in a residency and only be an NP?

The other question is, if NPs can do the job for less money while providing care that has the same level of quality as care provided by physicians, why go to an MD or DO?

This argument is even stronger for a doctorate in PA. Why would you need a doctorate to be an assistant to a doctor? That would be fundamentally wrong. It would be like a paralegal having to go through another form of law school to be able to be subservient to lawyers. No sense in doing that; just go to law school and cut out the middle man!

 

[MissMuffet]

Why spend 7-8 years in school, 1-2 years in a residency and only be an NP?

I think one reason is that we femmes tend to accommodate husbands and that baby/soccer mom thang.

Med school can't be done part-time, piece-mill, or by distance-ed, like I understand BSN/NP nursing school can be.

I wish it could. I'd love to be at least part-way through by now, instead of trying to find an exit ramp from the mommy hwy, after years on cruise, cleaning peanut-butter outta my outfits.

(not that the little buggers aren't worth it. )

 

[lizzied2003]

I think one reason is that we femmes tend to accommodate husbands and that baby/soccer mom thang.

Med school can't be done part-time, piece-mill, or by distance-ed, like I understand BSN/NP nursing school can be.

I wish it could. I'd love to be at least part-way through by now, instead of trying to find an exit ramp from the mommy hwy, after years on cruise, cleaning peanut-butter outta my outfits.

(not that the little buggers aren't worth it. )

I think that you point out such a valid point. Many women who change career paths still are the caregivers of the family and in today's day perhaps aging parents. Children don't stand still and can't be put on a back burner.
Nursing allows a good income and flexiblity while getting your degree. Not so with medical school. It is a full time job.

I believe that if my husband went to med school my life wouldn't change terribly (that is I'd still be sort of running the house) where if I had gone to med school my husbands life would have had to change quite a bit. I'm not sure how to explain this but in short...I totally agree with Miss Muffett.

 

[lawguil]

I guess my point was, why not just say (A) "Dr. X" (the optometrist) will see you now; or (B) You can go in now. Rather, the receptionist made a big deal about saying "THE DOCTOR" will see you now. I don't know why, but it was off-putting. I don't think it's puffery for the staff to say "Dr. X will see you now", but it's rather pretentious to say "THE DOCTOR" will see you. Why? I don't know, but it's...unseemly IMO.

That's just me, however. I really think all this hoo-hah about titles is a little off the topic. The original topic invited discussion about the DNP degree. Here is my take on this matter. You can say what you want about the various professional doctorates out there. The PharmD, DVM, DDS, DPM, OD, PsyD, DPT, AuD, and other degrees are oft compared to the MD/DO. For better or worse, right or wrong, this comparison is inevitable and invites varied opinions.

The holders of those degrees are all DOCTORS in the technical sense of the word. Whether in a clinical, retail, or academic setting, each of the aforementioned providers has a function that is decidedly and obviously different than that of a physician. Even folks with a basic middle school level education can differentiate between a dentist and an internist; a podiatrist and a gastroenterologist; a pharmacist and a surgeon. It's a little more difficult for some to distinguish between an optometrist and an ophthalmologist or psychiatrist and psychologist or otologist and audiologist or physiatrist and physical therapist, but generally speaking, with little exception, most confused patients/clients are set straight with a little explaining.

These professions have a scope of practice that is different from that of a physician and this makes it easier to set them apart from allo/osteo med. However, that's not true about an NP or PA. The job duties of an NP are the exact same as that of a GP/FP and even internists. The PA's job is essentially the same as the physician's job, but to a lesser extent. So, calling the pharmacist or PT or OT or audiologist or dentist "doctor" is not really misleading or confusing to most patients because with some basic clarifying statements and qualifying remarks, the confusion can be cleared up quickly. Can you say that about the NP with a DNP or PHD? The NP's job is the same as the FPs job, with little exception. So, this situation could really cause confusion with patients and the general public.

It also begs the question...if one wanted to be a primary care provider and had to attend 8 years of school plus a residency, why not just go to medical school? Why would anyone get a BSN and then DNP plus a 1-2 year residency when you could get a BS and MD + 3 year residency? The DNP would save you some money and maybe a year or two of schooling (maybe), but no matter what, you'd always be a "lower" provider. The DNP wouldn't really provide you with any higher status because no matter what your degree was (MSN or DNP or DNSc), you'd still be a NP and not a physician.

I don't mean that to be disrespectful either. I'm asking a serious question. Why bother distinguishing between NPs and physicians? At one point in time, we had MDs and DOs...both types of physicians were treated differently and had differents scopes of practice. Eventually, the DO's became like the MDs and today they are practically the same with the same scopes of practice in all states. Would the DNP mean we'd have three types of physicians 15-20 years from now: MD, DO, and DNP?

Again, why bother? Why create more confusion out there? DNPs would become just like MDs and DOs...they'd require the MCAT for entrance into their programs. Eventually, the nursing model would be replaced by the medical model. I think it would be pointless to create the DNP degree for NPs who practice. NPs who want to teach or do research should get PhDs or DNSc degrees, not clinical practitioner degrees at the doctoral level.

So, in sum, the PharmDs, dentists, ODs, pods, etc., all have their place out there and have their unique role in the health care system. They have jobs that are distinct and different from physicians, although they have some duties and roles that overlap. NPs do almost the same work as physicians, but to a lesser level. The DNP degree would beg the question, what's the difference? More importantly, if there is a difference, why not just go to medical school and get the highest level of authority, scope of practice, and prestige? Why spend 7-8 years in school, 1-2 years in a residency and only be an NP?

The other question is, if NPs can do the job for less money while providing care that has the same level of quality as care provided by physicians, why go to an MD or DO?

This argument is even stronger for a doctorate in PA. Why would you need a doctorate to be an assistant to a doctor? That would be fundamentally wrong. It would be like a paralegal having to go through another form of law school to be able to be subservient to lawyers. No sense in doing that; just go to law school and cut out the middle man!

Sorry buddy, the curriculum for training a pharmacist has changed very little from when it was a BS to the current PharmD. Same with the DPT! You seem to have a lot of baseless opinions that are all over the stratosphere! Why don't we just go back and give the pharmacist with a BS or the BSPT a "clinical doctorate" because they completed nearly identical coursework! By the way, I don't care if you're an MD, PhD, or PharmD...On these forums I could give myself whatever credentials I want too. Later!

 

[ProZackMI]

Sorry buddy, the curriculum for training a pharmacist has changed very little from when it was a BS to the current PharmD. Same with the DPT! You seem to have a lot of baseless opinions that are all over the stratosphere! Why don't we just go back and give the pharmacist with a BS or the BSPT a "clinical doctorate" because they completed nearly identical coursework! By the way, I don't care if you're an MD, PhD, or PharmD...On these forums I could give myself whatever credentials I want too. Later!

You seem to forget that historically, physicians were educated at the bachelor's level, and when the MBBS or MB degree converted to the MD degree in the US, there was little or no change in the curriculum. The primary reason why medical schools in the US converted from the archaic British MB model was to actually make doctors doctors and attempt to make physicians on par with PhDs, who truly had the doctor title. Dentists, vets, and others followed suit thereafter. Others like optometrists and pods didn't convert to the "doctorate" until the mid 1900s, around 1950 I believe.

The PharmD changed from a BS degree due to significant changes and advances in pharmacological tx. How many Rxs were written in 1970 compared to 1990 and then compared to 2000? Pharmacists need to know much more than they did in the past, so the PharmD was a natural evolution. To some extent, I suppose there is some element of puffery included in the change, but you don't really find many PharmDs going around insisting on being called "doctor" like others (e.g., ODs, DCs, vets).

I'm not sure about the DPT and know very little about it, but I imagine the primary impetus in such degree inflation is to gain direct access to patients w/o MD/DO authorization, increased status/prestige, and perhaps increased scope of practice. I don't see any reason for PTs to change, but that's just MY opinion. I have seen a few DPT program descriptions (Western Michigan University and Oakland University as examples) and you are right in stating that they seem essentially the same as the MPT program with some additional coursework in pharm, etc.

I have also seen Central Michigan University's AuD curriculum and thought a great deal of it was puffed up (i.e., busy work or filler material) to justify the doctoral title. Based on what an audiologist does, the AuD is overkill, IMO, but then again, I'm not an expert in this area.

I really don't see the need for the DNP degree to exist. I think NPs do a great job and have a great deal of respect for them. However, I think the MSN degree they earn is adequate and does a good job preparing them. I think PAs do a great job as well and do a great job with their current educational backgrounds. There is no need to "enhance" these professions by adding more years to their training and giving them a fancy title. They do a great job with the current training that they possess.

So, you make some valid points about some of these professions. Nevertheless, those that have earned such degrees should be addressed as doctor just as much as a dentist or podiatrist or vet should. Why not? None of those professions were historically trained at the graduate level; they changed and you seem to accept them as legitimate "doctors", so why differentiate? In one of your previous posts, you said somethig about vets, dentists, and physicians being the only ones who should be called "doctor", excluding all others. A veterinarian who treats animals deserves more respect than a psychologist who treats people (and in some states, prescribes meds and orders labs, etc.)?

I think your view is a little narrow-minded and makes me wonder if you have some form of "doctor" envy. In case you don't know what that is, it's a condition where someone, usually an mid-level professional or paraprofessional, who possess an undergrad or maybe a master's degree, downplays the education of others in order to make himself feel superior. You knock PharmDs and PsyDs and others, but it's doubtful that you've ever attended a rigourous professional program like that.

And I will not even justify your comments on the chiropractic thread since it was very undignified and attacked me directly. Do you have something against psychiatrists?

 

[Jengirl18]

ProZachMI,

I find it interesting that you find a lot of PAs allowing their pts to call them doctor. That's not right, and also illegal. I wonder if it is because they have already corrected the pt 2-3 times. More than that gets redundant (some pts would still say that after being corrected 20 times). I find it interesting how you find NPs level and quality of care to that of a physician, but PAs are just"assistants to a doctor." Have you ever compared the two curriculums? On another note, I dont think PAs will ever try for their degree level to be Doctorate. They work collaboratively with a physician, and think that NPs are going to shoot themselves in the foot with this DrNP title b/c they want complete autonomy..away from a physician. How does that help the pt? If you go to a nursing forum, it is filled with NPs wanting to go for the DrNP, who find nothing wrong with being called "Dr" in a clinical setting....I think this is dangerous. I have also looked at the curriculum for the DrNP, and its filled with nursing theory classes...not any academic classes to broaden their knowledge of clinical medicine. Don't get me wrong, I know we are on the same page with the DrNP thing, but it just seems as though you think NPs are superior to PAs, and I would like to know the reasons. (where I'm from they compete for the same jobs, and when both PA and NP students are "pimped" by physicians during clinical year, the PA students seem to have a heads up.

 

[ProZackMI]

ProZachMI,

I find it interesting that you find a lot of PAs allowing their pts to call them doctor. That's not right, and also illegal. I wonder if it is because they have already corrected the pt 2-3 times. More than that gets redundant (some pts would still say that after being corrected 20 times). I find it interesting how you find NPs level and quality of care to that of a physician, but PAs are just"assistants to a doctor." Have you ever compared the two curriculums? On another note, I dont think PAs will ever try for their degree level to be Doctorate. They work collaboratively with a physician, and think that NPs are going to shoot themselves in the foot with this DrNP title b/c they want complete autonomy..away from a physician. How does that help the pt? If you go to a nursing forum, it is filled with NPs wanting to go for the DrNP, who find nothing wrong with being called "Dr" in a clinical setting....I think this is dangerous. I have also looked at the curriculum for the DrNP, and its filled with nursing theory classes...not any academic classes to broaden their knowledge of clinical medicine. Don't get me wrong, I know we are on the same page with the DrNP thing, but it just seems as though you think NPs are superior to PAs, and I would like to know the reasons. (where I'm from they compete for the same jobs, and when both PA and NP students are "pimped" by physicians during clinical year, the PA students seem to have a heads up.

I have had several PAs work under me over the last 5 years, and I've had to correct three of them for allowing patients (usually the older ones) to call them 'dr'. I suspect that some of the older patients do not understand the difference between a doctor, PA, or NP. One PA in particular actually encouraged patients of all ages to call him "doc", which upset myself and the other physicians in our practice.

I heard similar complaints about PAs allowing patients to call them 'dr" from other physicians in different specialities. I haven't experienced this from the NPs I've worked with, nor have I heard stories about NPs allowing it to happen. That doesn't mean it doesn't happen, or hasn't happened, but I'm basing my comments on my personal experience.

No, I don't think NPs are superior to PAs. PAs are trained in the medical model, whereas NPs are trained in the nursing model. I believe that NPs are better communicators and establish a great rapport with the patients, especially in my line of work (psych). The psych NPs do a fantastic job and the patients seem to really like working with them.

 

[lawguil]

You seem to forget that historically, physicians were educated at the bachelor's level, and when the MBBS or MB degree converted to the MD degree in the US, there was little or no change in the curriculum. The primary reason why medical schools in the US converted from the archaic British MB model was to actually make doctors doctors and attempt to make physicians on par with PhDs, who truly had the doctor title. Dentists, vets, and others followed suit thereafter. Others like optometrists and pods didn't convert to the "doctorate" until the mid 1900s, around 1950 I believe.
The PharmD changed from a BS degree due to significant changes and advances in pharmacological tx. How many Rxs were written in 1970 compared to 1990 and then compared to 2000? Pharmacists need to know much more than they did in the past, so the PharmD was a natural evolution. To some extent, I suppose there is some element of puffery included in the change, but you don't really find many PharmDs going around insisting on being called "doctor" like others (e.g., ODs, DCs, vets).

Agree with your point about physicians - I've made this point a number of times and I see medical school as just another entry level program. As far as your reasoning for the transition to a PharmD - it's crap. These subtle changes you describe could have easily evolved in an undergraduate program (just as they always had). With your reasoning, what are we going to call the pharmacists in 2015? God maybe? PA education is still 24-28 months and god knows the provisions and practice material hasn't changed in for them in the last 30 years has it! Just because a professional organization mandates entry level as a "clinical doctorate" doesn't mean that they are educated to the doctoral level! Awarding somebody a doctorate is not the same as earning a doctorate! Get it? L.

 

[lawguil]

I have had several PAs work under me over the last 5 years, and I've had to correct three of them for allowing patients (usually the older ones) to call them 'dr'. I suspect that some of the older patients do not understand the difference between a doctor, PA, or NP. One PA in particular actually encouraged patients of all ages to call him "doc", which upset myself and the other physicians in our practice.

I heard similar complaints about PAs allowing patients to call them 'dr" from other physicians in different specialities. I haven't experienced this from the NPs I've worked with, nor have I heard stories about NPs allowing it to happen. That doesn't mean it doesn't happen, or hasn't happened, but I'm basing my comments on my personal experience.

No, I don't think NPs are superior to PAs. PAs are trained in the medical model, whereas NPs are trained in the nursing model. I believe that NPs are better communicators and establish a great rapport with the patients, especially in my line of work (psych). The psych NPs do a fantastic job and the patients seem to really like working with them.

Do you think this is a reflection of the NP (professional background) or the individual?

 

[ProZackMI]

Agree with your point about physicians - I've made this point a number of times and I see medical school as just another entry level program. As far as your reasoning for the transition to a PharmD - it's crap. These subtle changes you describe could have easily evolved in an undergraduate program (just as they always had). With your reasoning, what are we going to call the pharmacists in 2015? God maybe? PA education is still 24-28 months and god knows the provisions and practice material hasn't changed in for them in the last 30 years has it! Just because a professional organization mandates entry level as a "clinical doctorate" doesn't mean that they are educated to the doctoral level! Awarding somebody a doctorate is not the same as earning a doctorate! Get it? L.

Perhaps. PAs, historically, were trained on the job as field medics in the armed services. Typically, while PAs had good hands-on training, they held no formal degrees; in fact, many did not even have high school diplomas. From that, they developed two-year diploma programs, which evolved into associate's degree programs (still two-year programs), which evolved into undergraduate programs, and now, today, they have a two-year master's program that remarkably hasn't changed much from the two-year associate's program. Fancy that. Such little formal education, yet pretty extensive prescriptive authority.

So, how do you feel about chiros and optos? What's your take on vets and pods?

 

[ProZackMI]

Do you think this is a reflection of the NP (professional background) or the individual?

If you know anything about the nursing model, you would know the answer to this question. Nurses are trained to ask questions AND to listen to the answers. Physicians are trained to investigate symptoms and evaluate signs/sx by examining and asking questions, but often (especially MDs) aren't skilled listeners. NOT always, but often. The nursing model, IMO (based on my subjective experience) teaches nurse-patient interaction. I find that many DOs (especially FPs and IMs) tend to be better listeners than my fellow MDs (exception, of course, for psychiatrists who are trained listeners regardless of degree), but even DO specialists tend to tune the patient out more often than necessary.

So, while individual differences are surely influential in establishing patient rapport, I would say that overall NPs are trained to be more effective communicators due to their nursing model roots.

You really seem to have a bias toward the PA. I feel both have their place in the health care world, but PA training, overall, is not superior to the training NPs receive. From what I've read/seen/observed/heard, both do equally well in providing quality primary care to their patients. What's your take on the differences between the two providers?

 

[lawguil]

If you know anything about the nursing model, you would know the answer to this question. Nurses are trained to ask questions AND to listen to the answers. Physicians are trained to investigate symptoms and evaluate signs/sx by examining and asking questions, but often (especially MDs) aren't skilled listeners. NOT always, but often. The nursing model, IMO (based on my subjective experience) teaches nurse-patient interaction. I find that many DOs (especially FPs and IMs) tend to be better listeners than my fellow MDs (exception, of course, for psychiatrists who are trained listeners regardless of degree), but even DO specialists tend to tune the patient out more often than necessary.

So, while individual differences are surely influential in establishing patient rapport, I would say that overall NPs are trained to be more effective communicators due to their nursing model roots.

You really seem to have a bias toward the PA. I feel both have their place in the health care world, but PA training, overall, is not superior to the training NPs receive. From what I've read/seen/observed/heard, both do equally well in providing quality primary care to their patients. What's your take on the differences between the two providers?

I personally like the medical model and that a PA is generalist first vs. the NP model with less clinical training and who specializes without ever having the generalist training. I think much of the nursing theory is political so that they can clearly define their differences from other practitioners. Many nurses that I have contact with have little use for nursing theory and practice much like any other provider. Equals?I think with experience in the same setting, both are equals, but I still prefer the more rigorous curriculum content of PA training!

 

[lawguil]

Perhaps. PAs, historically, were trained on the job as field medics in the armed services. Typically, while PAs had good hands-on training, they held no formal degrees; in fact, many did not even have high school diplomas. From that, they developed two-year diploma programs, which evolved into associate's degree programs (still two-year programs), which evolved into undergraduate programs, and now, today, they have a two-year master's program that remarkably hasn't changed much from the two-year associate's program. Fancy that. Such little formal education, yet pretty extensive prescriptive authority.

So, how do you feel about chiros and optos? What's your take on vets and pods?

Exactly my point! In case you are still figuring this out the degree means nothing. It's the content of the training. I believe it was Dr. Stead from Duke who developed the first PA program with field medics from the military. My understanding is that there are still certificate programs that exist today (and should). In my opinion, all professional programs should award certificates. Are you suggesting that if a PA (for instance) had 7 years of "formal education", they would be better than the two year certificate program that effectively taught the students the same thing? Perhaps the student in the seven year path would find the coursework outside of his PA education enriching and consequently enjoy some type of life-long intellectual journey that may result from it. I don't know! I do know that one's social and interpersonal skills aren't taught in a book and would be interested in learning more about nurse-patient interaction training that nurses learn that is so unique.

 

[Jengirl18]

This is only to educate those about the different curriculums between PAs and NPs

Duke's Adult NP Program

Required Core Courses Credits
Course # Description Credits
N301 Population-Based Approaches to Health Care 3
N303 Health Services Program Planning and Outcomes Analysis 3
N307 Research Methods 3
N308 Applied Statistics 2
Total 11
Research Options (Select One) Credits
N312 Research utilization in Advanced Nursing Practice 3
N313 Thesis 6
N314 Non-Thesis Option 6
N315 Directed Research 3-6
Total 3-6
Practitioner Core Courses Credits
N330 Selected Topics in Advanced Pathophysiology 3
N331 Clinical Pharmacology and Interventions for Advanced Nursing Practice 3
N332 Diagnostic Reasoning and Physical Assessment in Advanced Nursing Practice 4
N333 Managing Common Acute and Chronic Health Problems I 3
N334 Managing Common Acute and Chronic Health Problems II 3
Total 16
Adult Nurse Practitioner-Primary Care Credits
N442 Sexual and Reproductive Health 2
N459 Nurse Practitioner Residency: Adult Primary Care 3
Clinical Elective 3
Elective 5
Total 43-46

Barry U. PA Program
Fall Credit Hours
The PA Role in Modern Health Care 1
Physical Diagnosis I 3
Basic Research Methodology 2
Physiology 4
Neuroanatomy 2
Clinical Microbiology and Infectious Disease 2
Gross Anatomy 6
Clinical Pharmacology I 1
Service Learning Projects will be integrated into existing courses.
Spring Credit Hours
Human Behavior and Psychiatry 3
Medical Pathophysiology I 6
Physical Diagnosis II 4
Clinical Pharmacology II 2
Surgical Principles 2
Obstetrics / Gynecology / Pediatrics / Geriatrics 3
Medical Spanish I or Medical Creole I 2
Service Learning Projects will be integrated into existing courses.
Summer Credit Hours
PA Role in Modern Health Care 1
Medical Pathophysiology II 3
Physical Diagnosis III 4
General Radiology 3
Emergency Medicine 2
Clinical Orientation 1
Public Health Issues: Health Promotion and Disease Prevention 1
Clinical Pharmacology III 2
Medical Spanish II 2
Service Learning Projects will be integrated into existing courses.
Clinical Phase-an entire year FULL TIME
Emergency Medicine
Internal Medicine
Obstetrics / Gynecology
Pediatrics
Primary Care
Psychiatry
Surgery
Orthopedics
Elective

Advanced Didactic Phase (an additional 3 months)
Fall Credit Hours
Clinical Therapeutics 2
Biomedical Ethics/Health Care Delivery 2
Clinical Epidemiology and Evidence-Based Medicine 1
Library Research and Paper 7
Thanatology 1
Barry University Primary Care Review 3
Service Learning Projects will be integrated into existing courses.

 

[lizzied2003]

Re: the duke NP/PA programs. You can't measure competence in classroom/clincial hours.

I think what is not captured is that the NP Duke outline is that the nursing program requires a professional RN/BSN degree at the entry level. Hopefully these nurses have worked so they bring clinical expertise that will never be captured in a classroom. I would venture then that the best PA's are likely those who were first a nurse or worked in the field as oppossed to classroom----->clinical----->job. Same would go for NP.

Has anyone ever won this PA/NP argument?

 

[lawguil]

Re: the duke NP/PA programs. You can't measure competence in classroom/clincial hours.

I think what is not captured is that the NP Duke outline is that the nursing program requires a professional RN/BSN degree at the entry level. Hopefully these nurses have worked so they bring clinical expertise that will never be captured in a classroom. I would venture then that the best PA's are likely those who were first a nurse or worked in the field as oppossed to classroom----->clinical----->job. Same would go for NP.

Has anyone ever won this PA/NP argument?

YES! The PA (easy)

 

[fab4fan]

This argument is so lame, if it were a horse it would be shot.

Yes, the previous experience a nurse has prior to an NP program doesn't matter at all if you listen to PAs. Meanwhile, they see nothing wrong with someone going for a PA with an undergrad degree in anything but a healthcare related field (e.g. accounting).

 

[lizzied2003]

This argument is so lame, if it were a horse it would be shot.

Yes, the previous experience a nurse has prior to an NP program doesn't matter at all if you listen to PAs. Meanwhile, they see nothing wrong with someone going for a PA with an undergrad degree in anything but a healthcare related field (e.g. accounting).

Agreed. Unfortunately individuals who continue to tout one professional practice over another only make that discipline look petty and insecure.

Does negativity have a place in professional practice? PA or otherwise?
Unless one has worked as a nurse they will never understand what that experience brings to a patient, family, and to professional practice .

 

[Kwasaki28]

For what it's worth, there was some androgenous "chief of nursing" on the show ER, who asked Kovac (the Croation doc) to refer to her as "Doctor" because she had a Ph.D.

I think the DNP is equivalent to the DPT in physical therapy. No real difference in scope of practice, just trying to show that the level of clinical training is "doctoral-level" in order to compete in the healthcare marketplace. Sure it sounds funny now, but once it's around for a several years, no one will even think twice about it: "Oh yeah, I go to Dr. Jones, a nurse practitioner in town, he's really good."

As a soon to be physician, I would NEVER go to a DNP for my own medical care and I would certainly not want my own family or my future patients to be subjected to lesser medical care. There is a reason why physicians go to MEDICAL SCHOOL with numerous years of residency thereafter. I think real Drs. (MD and DO) should start calling themselves physicians to differentiate and individuals with Phd should be the only people called doctors albeit in an academic setting.

And I agree with what was said above, it is fraudulent and more importantly UNETHICAL for any person besides a physician to address themselves as “doctor” in a given health care facility. I don’t care if you’re a DPT, DNP, OD, or Pharm.D.; when you are in a hospital/clinic you are not THE doctor. You are simply ANCILLARY staff. When at home, feel free to stroke your ego and glorify your lesser degree by having your family members and friends call you “doctor” all you want. What’s next: DPHL, DJS, DLS, DBPC, DDW (Dr. of phlebotomy, janitorial services, laundry services, bed pan changing, dishwashing)? Give me a break….

 

[50960]

Another ignorant newbie. Shall we call you Dr. Housestaff??

 

[RAMPA]

i stroke my ego whenever i can at home, in the car, at work, before i eat, etc, etc

DrPA baby, Doctor of Physician Assisting!

 

[lizzied2003]

As a soon to be physician, I would NEVER go to a DNP for my own medical care and I would certainly not want my own family or my future patients to be subjected to lesser medical care. There is a reason why physicians go to MEDICAL SCHOOL with numerous years of residency thereafter. I think real Drs. (MD and DO) should start calling themselves physicians to differentiate and individuals with Phd should be the only people called doctors albeit in an academic setting.

And I agree with what was said above, it is fraudulent and more importantly UNETHICAL for any person besides a physician to address themselves as “doctor” in a given health care facility. I don’t care if you’re a DPT, DNP, OD, or Pharm.D.; when you are in a hospital/clinic you are not THE doctor. You are simply ANCILLARY staff. When at home, feel free to stroke your ego and glorify your lesser degree by having your family members and friends call you “doctor” all you want. What’s next: DPHL, DJS, DLS, DBPC, DDW (Dr. of phlebotomy, janitorial services, laundry services, bed pan changing, dishwashing)? Give me a break….

Do a quick referral to this guys 1 previous post.
Either he's really that much of a pompus jerk or he's just a troll.
why bother responding.

 

[lawguil]

Do a quick referral to this guys 1 previous post.
Either he's really that much of a pompus jerk or he's just a troll.
why bother responding.

Why is he a troll if he's right!

 

[zenman]

And I agree with what was said above, it is fraudulent and more importantly UNETHICAL for any person besides a physician to address themselves as “doctor” in a given health care facility.

Well, if you want to be picky, it is even unethical to be a physician. Almost everything you do harms the patient. How's that for some reality therapy?

 

[deleted87716]

Well, if you want to be picky, it is even unethical to be a physician. Almost everything you do harms the patient.

The potential for harm doesn't create an ethical problem, so long as the benefits of treatment outweigh any potential risks, precautions are taken to mitigate those risks, and informed consent is obtained.

Of course, I know you wrote that tongue-in-cheek.

 

[lizzied2003]

Why is he a troll if he's right!

Yeah, whatever.

 

[gregMD]

the very idea that a nurse or a PA would be using the salutation "Dr" when dealing with a patient or other hospital staff is misleading, and over representing your qualifications. Its the same reason that medical students do not introduce themselves as Dr ______ . Why? Because they're not Medical Doctors (yet). Nurses and PAs (PhD or no PhD) are not medical doctors and for them to use the professional designation Dr in a clinical setting is fraudulent.

You dont like it? Go to medical school. Otherwise - deal with it.

 

[50960]

Oh OK, we have all changed our minds...thanks. Actually that was really not the point being argued or the OP's point.

 

[lizzied2003]

Oh OK, we have all changed our minds...thanks. Actually that was really not the point being argued or the OP's point.

Yup, me too. Glad that was cleared up.

 

[ProZackMI]

It's obvious that lawquil is a PA, who despite his lack of a graduate degree, wishes he was some kind of 'doctor'. A PA is an assistant, hence the ASSISTANT part of PA. A PA is not an independent profession and there is no such thing as the profession of physician assisting. A PA is a paraprofessional just like a teacher's aide or legal assistant.

An NP has more autonomy and more skill, IMO. Does that mean I advocate for a doctorate in NP? No, I don't and think it's overkill and somewhat pretentious.

 

[Kwasaki28]

Another ignorant newbie. Shall we call you Dr. Housestaff??

Yes, "doctor" housestaff would be entirely appropriate...thanks for proving my point.

 

[Kwasaki28]

Do a quick referral to this guys 1 previous post.
Either he's really that much of a pompus jerk or he's just a troll.
why bother responding.

Use the following principle:

Who gives the orders and who takes them? If you find yourself in the latter end of the equation...you shouldn’t be calling yourself a doctor in front of a patient. This may just save your job someday. Again, at home, be my guest.

Also, to whom do you answer on the floors? Other PAs? NPs? Or the physician? Tell me "doctor" when a PA/NP F's up who is ultimately responsible? Maybe if we allowed you guys to call yourselves doctors, you would also be liable for your mistakes. Only then, the public would catch on to the farce which has slowly infested our health care system.

Its not arrogance…it’s the truth…get used to it…you have voluntarily chosen an occupation to assist people like me.

Troll, MD

 

[fuegorama]

Actually biggkat I'm afraid ya got it wrong here.
NPs (the original point of the thread) enjoy tremendous autonomy these days.
They are overseen by boards of nursing. Medical licensing boards are not in the loop.
Many NPs are still employees in physician directed environments, but that is changing at an alarming rate. Here in the hinterlands of the northeast, NPs can open completely autonomous practices w/no physician oversight 24 months after completing their degree.
In legislatures in >30 states there are now bills being worked up or in the voting process to make a semantic change from physician "supervision" to "collaboration". This implies equality which is exactly the goal of the advanced practice nursing profession.

Scary?-yep
Insulting?-depends how ya wear your skin
Medicine's fault?-99%