Status
Not open for further replies.

PharmDr.

Senior Member
7+ Year Member
15+ Year Member
Apr 15, 2004
175
0
Status
What do you guys think about the new DrNP (DNP) and ND degrees. Theres only a few DrNP (doctor of nursing practice) programs available now (Columbia and Kentucky that I know of). ND programs are all around the country. From what I know, the DrNP degree is more clinical and has a strong curriculum and includes a residency. The ND is more about nursing theory and such and focuses on a NP specialty. I know MD's and DO's are probally in disagreement about these programs cause of "nurses" being referred to as doctor. Dentists are referred to as doctor and patients know the diff. between the two. Same with pods and opts. Nurses will be able to be fully independent with the DNP. I think for once, nurses will get the recognition they deserve with these degrees becoming more prevelant in the healthcare community b/c of their long training and "prestigous" lol, doctoral degree.
 
OP
PharmDr.

PharmDr.

Senior Member
7+ Year Member
15+ Year Member
Apr 15, 2004
175
0
Status
I found that all advanced practice nursing schools must change to a DNP program by 2015. 8 schools are already in approval stages for their DNP programs. This is another entry-level doctoral degree to the list with the ranks of the newer DPT,PharmD, I can only hear the tempers in the medical comm. flaring!
 

jwk

CAA, ASA-PAC Contributor
15+ Year Member
Apr 30, 2004
3,654
795
Atlanta, GA
PharmDr. said:
What do you guys think about the new DrNP (DNP) and ND degrees. Theres only a few DrNP (doctor of nursing practice) programs available now (Columbia and Kentucky that I know of). ND programs are all around the country. From what I know, the DrNP degree is more clinical and has a strong curriculum and includes a residency. The ND is more about nursing theory and such and focuses on a NP specialty. I know MD's and DO's are probally in disagreement about these programs cause of "nurses" being referred to as doctor. Dentists are referred to as doctor and patients know the diff. between the two. Same with pods and opts. Nurses will be able to be fully independent with the DNP. I think for once, nurses will get the recognition they deserve with these degrees becoming more prevelant in the healthcare community b/c of their long training and "prestigous" lol, doctoral degree.
What makes you think that nurses will be fully independent (whatever that means) with a DNP? They must still function under the current nurse practice act or advanced practice nursing regs for their state. Those won't magically change with a DNP just because of a different degree. Of course after 25 years, they're still trying to make a BSN the entry level for an RN, and they can't even accomplish that. There are plenty of ASN programs around.

Did anything really change with a PharmD besides the initials? Just curious - I really don't know.
 

emedpa

GlobalDoc
10+ Year Member
15+ Year Member
Aug 25, 2001
6,014
301
Taking an Away team....
Status
Post Doc
jwk said:
What makes you think that nurses will be fully independent (whatever that means) with a DNP? They must still function under the current nurse practice act or advanced practice nursing regs for their state. Those won't magically change with a DNP just because of a different degree. Of course after 25 years, they're still trying to make a BSN the entry level for an RN, and they can't even accomplish that. There are plenty of ASN programs around.

Did anything really change with a PharmD besides the initials? Just curious - I really don't know.
I agree. this is just an ego thing and won't change anything clinically. np's in states that require a collaborating/supervising doc still will require one.
 
OP
PharmDr.

PharmDr.

Senior Member
7+ Year Member
15+ Year Member
Apr 15, 2004
175
0
Status
I have gone to columbias website and it says that with their DrNP degree, graduates will be able to be fully independent practitioners that will be more prepared for opening up their own practices. I am assusming that no doc supervision as with NP but with even more expanding role. This is a good question that I am curious about. I am still a soph. undergrad. so I dont have the exp. to back my statements up. I do believe that this could become the entry level degree just how pharmacists went from a bacc. in pharm. (RPH) to PharmD b/c it is an advanced level doctorate just like the pharmD. In my opinion, I believe this will be a great advancement in nursing education. Lets face it, NP curriculum is kind of lacking with the amount of autonomy they can have in practice. There is only good things that come with a more in depth educational background. A residency is included in this program and is greatly needed.
 

lawguil

Senior Member
10+ Year Member
7+ Year Member
Jun 24, 2004
461
1
Florida
Status
I agree that the current education of an NP is lacking, however a name change doesn't solve the problem and a residency in nursing doesn’t qualify a person as a "doctor". Why not make an effort to improve the quality of the training and stop all efforts to become autonomous.

It sounds to me that these nursing organizations want to be physician like, but want to do it without attending medical school or adopting the standards, principles, or training of a physician. I have a hard time understanding how the provisions of nursing would warrant a "doctoring degree." Let’s face it; osteopathy and allopathy are light years ahead of any nursing practitioners that exist. Adding a Dr. before there name isn't going to change that.

I would like to compare this to master's degrees. I think you can buy them in the mail at this point. There are so many types of master’s degrees from one year programs that a sixth grader could complete to 3 year research program that require a thesis. It's difficult to separate the people who have actually earned a masters degree from the people who think they have one. Why continue to tamper with doctorates. Up until the DPT's and PharmD's, it was the only sacred thing we had in out higher educational system and medicine. We're certainly making it a whole lot easier for people to achieve their dream.
L.
 
OP
PharmDr.

PharmDr.

Senior Member
7+ Year Member
15+ Year Member
Apr 15, 2004
175
0
Status
How is extending the education a bad thing. Let me see, yes you could change the current curriculums in NP school but that would decrease the amount of classes that are req. to take. Dont you guys think that the longer you are in school the more you will eventually learn. Of course there has to be an end to formal degree programs though. Nursing is in fact a lot different than medicine. Yes, nurses do want to become healthcare providers that have the skills to solve anything within their scope. Why is it that non-nurses have such negative connotations toward the nursing profession? In a way, nurses are taking over docs. But only partly. All other health professions are starting to take over doctor only roles. Nurses have a totally diff. philosophy than medicine. It does include medicine in its approach though. NP's with their nursing background do spend more time with patients and are not only concerned with the patients patho. There has been studies showing that patients seen by NP's and Docs (MD/DO) have the same outcomes in health, but patients were more satisfied by the NP's b/c they have more empathy,concern about their overall health. Docs still have there place in healthcare so why is there such concern about these nurses. Specialization is where the docs will go as they have a more extensive background. These nurses are willing to work for half of what a GP doc does and what does that say to docs? Money is not everything in life. Why cant there be some kind of concensus within the health comm? These DNP programs are 8 yrs. in length plus 1 yr. residency. How are they not entitiled to the over glamoured term "doctor". The term doctor will benifit the nursing profession so much. More respect from patients, society, and yes other healthcare providers. No, you dont earn respect by your degree, but its true that people can be superficial. If you are capable of a job than why does it matter if you are called nurse or doctor. This change is happening as we speak and we must all learn to accept it. Life is too short to argue over "whos better than who".
 

rn29306

Drugs are bad, m'kay?
10+ Year Member
7+ Year Member
Oct 30, 2004
422
1
Dirty South
Status
Post Doc
I cannot believe the stink this is making. JWK has some nice points about it, especially since there isn't even a concensus on the entry level of nursing, be it associate's or bsn. Both schools still exist as nursing education and the AS schools aren't shutting down anytime soon. So now a decision has been made to push nursing further, beyond the master's level. What logically falls next up on the line of education for every other program above master's?..........(drumroll).......doctorate. Why is it such a big deal that a nurse wants to get a doctorate?
I can tell you that in all settings besides the hospital, these individuals will have earned the prefix "dr". I firmly believe that calling anyone besides an MD a "dr" in a hospital setting is deceiving at best and is downright wrong. Patients and lay public at large associate the term "dr" with physician and that is just how it is.
As far as egos go, the proposed plan should weed anyone out wanting a boost in ego. Our PhD (research) director laid out the tentative plan for CRNAs going for the DNP.
1. BSN nurse enters after working in ICU/CCU as applicants are admitted now for CRNA programs.
2. Completion of A program about the time that most grads come out with their masters. This particular graduate will be able to work and provide a salary for his/her family, loans, etc and will earn about 1/2 to 3/4 what the typical CRNA salary currently is. Work part to full-time in a hospital setting. Part-time residency starts during this time period, specializing in a field of choice, be it dedicated open-heart or trauma experience.
What this equates to is a better prepared graduate, who just so happens to be a nurse with a clinical doctorate, that can handle just about anything thrown at them. I believe these individuals should not be called "dr" in the hospital setting, even though they have busted their arses and earned it. I cannot speak for the NP profession and how theirs might be aligned, but I honestly feel (no flames NPs) that the NP education overall is not standardized and could use some structure.
I don't have an ego about being misunderstood to be a Dr. I absolutely hate wearing my lab coat, dictated by my department, when going all over the level 1 trauma center where I am located. People cower in the halls, they are hesitant to walk in front of you for fear of getting in your precious space, and everyone goes out of their way to kiss your butt. It is almost sickening. I am a nurse, have worked hospital and prehospital, and now work as a SRNA. I am proud to be a nurse and for anyone who thinks they don't earn just a little recognition should visit an ICU sometime and take a gander. Pay is pittiful and then to go into CNRA school, live unsubsidized (yes residents, unsubsidized by Medicare with no option of working for money past 3pm or weekends) for 2.5 years, school loans (out of state), welcome to being in debt for over 100K, probably 120-130K in my instance. Getting off my soapbox now, sorry. But so what if someone wants to continue their education, who just so happens to be a RN? Get over yourselves who think this is an ego trip because being mistaken for an MD is overrated.
 

PACtoDOC

1K Member
7+ Year Member
15+ Year Member
Aug 2, 2002
1,057
3
Visit site
Status
Maybe one of you nurse-hugging fanatics can answer this for me. Tell me one thing a nurse does differently than a physician when it comes to treating diabetes, sinusitis, or low back pain. Don't even bother answering, because you cannot come up with ONE thing that warrants calling it practicing advanced nursing, because in fact it is medicine. Doctors spend the same amount of time with patients as NP's or PA's. That is the biggest misconception of all. Plus, the BS about how nurses are more empathetic and educating is simply myth as well. You can't possibly educate better than a physician in regard to a MEDICAL diagnosis if you don't practice MEDICINE. The whole DNP thing is just going to blow up in the face of nurses, and provide more oportunities for less threatening PA's. Don't kid yourselves, physicians run medicine. And don't call a DNP "extra year" some sort of residency. That is offensive. My residency will be 3 years minimum, and many of my friends will complete 5-7 year residencies. When was the last time someone met a nurse practitioner that practiced independently? See, they work for docs 95% of the time. Its not a good idea to screw with the boss!!
 

jwk

CAA, ASA-PAC Contributor
15+ Year Member
Apr 30, 2004
3,654
795
Atlanta, GA
PharmDr. said:
How is extending the education a bad thing. Let me see, yes you could change the current curriculums in NP school but that would decrease the amount of classes that are req. to take. Dont you guys think that the longer you are in school the more you will eventually learn. Of course there has to be an end to formal degree programs though. Nursing is in fact a lot different than medicine. Yes, nurses do want to become healthcare providers that have the skills to solve anything within their scope. Why is it that non-nurses have such negative connotations toward the nursing profession? In a way, nurses are taking over docs. But only partly. All other health professions are starting to take over doctor only roles. Nurses have a totally diff. philosophy than medicine. It does include medicine in its approach though. NP's with their nursing background do spend more time with patients and are not only concerned with the patients patho. There has been studies showing that patients seen by NP's and Docs (MD/DO) have the same outcomes in health, but patients were more satisfied by the NP's b/c they have more empathy,concern about their overall health. Docs still have there place in healthcare so why is there such concern about these nurses. Specialization is where the docs will go as they have a more extensive background. These nurses are willing to work for half of what a GP doc does and what does that say to docs? Money is not everything in life. Why cant there be some kind of concensus within the health comm? These DNP programs are 8 yrs. in length plus 1 yr. residency. How are they not entitiled to the over glamoured term "doctor". The term doctor will benifit the nursing profession so much. More respect from patients, society, and yes other healthcare providers. No, you dont earn respect by your degree, but its true that people can be superficial. If you are capable of a job than why does it matter if you are called nurse or doctor. This change is happening as we speak and we must all learn to accept it. Life is too short to argue over "whos better than who".
You're a sophomore in college and incredibly naive about the real world.
 

Docgeorge

Bent Over and Violated
10+ Year Member
15+ Year Member
Apr 1, 2002
1,538
3
Not on the Beach
Visit site
Status
Fellow [Any Field]
PharmDr let me give you a hint with regards to quoting studies.Dont simply say a study found xyz and leave it at that. Find the study your are talking about and cite it so others can check it's validity. That way you give some weight to your argument otw you end up sounding like a chump. Additionaly call a physician a health care provider at your own peril most dont take too kindly to that term.
 
OP
PharmDr.

PharmDr.

Senior Member
7+ Year Member
15+ Year Member
Apr 15, 2004
175
0
Status
Why is it that someone cannot make a statement or opinion without getting such grief from others? Yes, I am only 20 yrs. old and am a soph., but does that make me a naive person? I have worked in the hospital as a pharm tech and have talked with everyday docs and nurses and have found that a lot of the docs have their noses up their asses. Not all of them of course, but I have found that nurses can be real people and relate to others better. I have also volunteered in other hospitals in my area in ER and OR as just a extra hand that runs arrands. I have seen how NP's practice. I need to get this straight, I highly respect docs for the training they go through and commitment to the profession. However, this only goes so far. I am sorry I cant remember where I saw the studies showing NP's get same outcomes with patient health as docs. From being in the hospital a lot in my short life, I have found that docs do not spend as much time with the patient as they should. They write the script and they say when the next check up is. They are more worried about seeing "x" amount of patients a day than actually caring for the patient in all aspects. Yes, I do know one really cool doc and all he could say to me was to not become a MD. He said verbatim "PA/NP is the way to go". He loves the patient contact and making a diff. in patient health and making a decent living. Those are all things that a PA/NP have. Maybe my reasons are more pure for going into healthcare, I dont know. Dont get me wrong, MD/DO are indeed the top of the medical foodchain. Please lets stop arguing as we are all stated to our own opinions.
 
OP
PharmDr.

PharmDr.

Senior Member
7+ Year Member
15+ Year Member
Apr 15, 2004
175
0
Status
Yes, I acknowledge that docs go through a longer and more intense residency. That is why they are the top dawgs. How am I being disrespectful? Because you guys are in med school or residency or are practicing, you want to hear how hard it has been for you and this and that. I dont doubt the difficulty in what you guys are going through. I am not comparing nursing school diff. to med school. Good for you that you guys have it the hardest. Guess what....there is more to life than the all mighty medical education. Yes NP's practice medicine, but the way in which they treat a patient is indeed different. They are not just concerned about the disease at hand. Doctors are indeed healthcare providers. How else do you want me to describe them-"all mighty kings of medicine".Give me a break guys. Egos are at stake here it seems.
 

ThreadkillerMD

10+ Year Member
5+ Year Member
Feb 6, 2005
27
0
Status
PharmDr. said:
Why is it that someone cannot make a statement or opinion without getting such grief from others? Yes, I am only 20 yrs. old and am a soph., but does that make me a naive person?
Yes :thumbup:
 

Freeeedom!

Senior Member
10+ Year Member
15+ Year Member
Feb 21, 2001
698
2
I am a ninja
Visit site
Status
This is politics...you wanna practice medicine go to MEDICAL SCHOOL...you wanna be a nurse go TO NURSING SCHOOL...if you want to practice medicine and you can't get in...TRY AGAIN don't open another political venue that supports your lack of ability.

Good Lord, I was thinking about opening a Chiropractic Nursing Program in which the general chiropractic principles are brought to nursing...calling them Nurspractors and eventually they will bump out all the nurses.

Hey PharmDr...get a clue dude.
 

jwk

CAA, ASA-PAC Contributor
15+ Year Member
Apr 30, 2004
3,654
795
Atlanta, GA
PharmDr. said:
Yes NP's practice medicine
No, they practice nursing.

PharmDr. said:
Why is it that someone cannot make a statement or opinion without getting such grief from others? Yes, I am only 20 yrs. old and am a soph., but does that make me a naive person?
Statements and opinions should have a basis in fact. As a sophomore in college, you simply have no idea what you don't know about the politics of these issues. Making statements like "...nurses are taking over docs..." are absurd on their face.

PharmDr. said:
I have gone to columbias website and it says that with their DrNP degree, graduates will be able to be fully independent practitioners that will be more prepared for opening up their own practices.
Here's an example of your naivete.

Just because Columbia, or any other university says their graduates will be able to be independent DOESN'T MEAN THEY CAN BE! That is a function of state law, not the PR folks at Columbia's Nursing School.

And just because an individual nursing organization WANTS a doctorate do be the entry level for advanced practice nursing, it doesn't mean it will happen. Again, ASN nurses are a prime example.

PharmD and DPT are just two examples of a fancy title and a "doctorate" with no real increase in responsibility or scope of practice. DNP will be more of the same. And any provider that refers to themself as "doctor" in a medical setting, by and large, is attempting to mislead the patient into thinking they're something that they're not.
 
OP
PharmDr.

PharmDr.

Senior Member
7+ Year Member
15+ Year Member
Apr 15, 2004
175
0
Status
Yes..your right there will be ADN programs still.Because they are not even the same job. They are not advanced practice nurses. They are associate degreed RN's. There is a need for them in healthcare. Why cant you guys step off your podiums(sp.) for a second and see why someone like myself does not want to go to med school. It is not because of my lack of ability. I am actually very bright thank you very much. My gpa is not very high because of circumstances that are personal. I am CHOOSING to be a "nurse". So what if I prefer nurses care. Docs have their place and so do nurses. NP's are a very vital part of the healthcare system.Let me see, they are payed half of docs, see the easier cases, and make more money for the docs. I am willing to do the "routine" diagnoses because that will pacify me. Your immature comments are not needed. How about we cut out all the midlevels and see what happens to healthcare. Not good. In more of a way, they are assisting the doctors in some way or another. For your guys info...I dont ever want to practice independently if that arises cause that is why I want to become a NP. If there is something I dont know...I will refer to the doc I work with. I would never refer to myself as doctor in a clinical setting as it is misleading. These doctoral programs will better prepare me though and there is nothing wrong with a more competent practitioner. I am not a doctor wannabe. I am content and happy with my career choice.
 

ThreadkillerMD

10+ Year Member
5+ Year Member
Feb 6, 2005
27
0
Status
PharmDr. said:
Yes..your right there will be ADN programs still.Because they are not even the same job. They are not advanced practice nurses. They are associate degreed RN's. There is a need for them in healthcare. Why cant you guys step off your podiums(sp.) for a second and see why someone like myself does not want to go to med school. It is not because of my lack of ability. I am actually very bright thank you very much. My gpa is not very high because of circumstances that are personal. I am CHOOSING to be a "nurse". So what if I prefer nurses care. Docs have their place and so do nurses. NP's are a very vital part of the healthcare system.Let me see, they are payed half of docs, see the easier cases, and make more money for the docs. I am willing to do the "routine" diagnoses because that will pacify me. Your immature comments are not needed. How about we cut out all the midlevels and see what happens to healthcare. Not good. In more of a way, they are assisting the doctors in some way or another. For your guys info...I dont ever want to practice independently if that arises cause that is why I want to become a NP. If there is something I dont know...I will refer to the doc I work with. I would never refer to myself as doctor in a clinical setting as it is misleading. These doctoral programs will better prepare me though and there is nothing wrong with a more competent practitioner. I am not a doctor wannabe. I am content and happy with my career choice.

We don't CARE why a person like you is not going to medical school (even though it would be hard to get in with a low GPA :smuggrin: ), we just don't want you spouting off a bunch of misinformation like it is fact.

Yes, NPs perform a valuable role, but the vast majority of them function under a physician's (MD or DO) supervision. A phony "doctorate" is not going to change that one bit.
 

jwk

CAA, ASA-PAC Contributor
15+ Year Member
Apr 30, 2004
3,654
795
Atlanta, GA
PharmDr. said:
Yes..your right there will be ADN programs still.Because they are not even the same job. They are not advanced practice nurses. They are associate degreed RN's. There is a need for them in healthcare. Why cant you guys step off your podiums(sp.) for a second and see why someone like myself does not want to go to med school. It is not because of my lack of ability. I am actually very bright thank you very much. My gpa is not very high because of circumstances that are personal. I am CHOOSING to be a "nurse". So what if I prefer nurses care. Docs have their place and so do nurses. NP's are a very vital part of the healthcare system.Let me see, they are payed half of docs, see the easier cases, and make more money for the docs. I am willing to do the "routine" diagnoses because that will pacify me. Your immature comments are not needed. How about we cut out all the midlevels and see what happens to healthcare. Not good. In more of a way, they are assisting the doctors in some way or another. For your guys info...I dont ever want to practice independently if that arises cause that is why I want to become a NP. If there is something I dont know...I will refer to the doc I work with. I would never refer to myself as doctor in a clinical setting as it is misleading. These doctoral programs will better prepare me though and there is nothing wrong with a more competent practitioner. I am not a doctor wannabe. I am content and happy with my career choice.
Well, uhhhhhh, lets ask the obvious question. Why is your screen name PharmDR if you're going to be a nurse? I don't see that you've described yourself anywhere as a nursing student - maybe I just missed it.

No one has said anything about nurses being unnecessary - you've somehow read that into the discussion yourself. No one has said that advanced practice nurses are unnecessary - you've made that jump as well.

The point is that a nursing doctorate means virtually nothing. Same training, same scope of practice as the current master's degree nurses, just a different title in an attempt to be called "doctor". And not even all advanced practice nurses have any degree. Many thousands of CRNA's around the country have no degree at all.

I have no problem with nurse practitioners. I work with advanced practice nurses every day - CRNA's, CNM's, and NP's. I have no problem with nurses, or anyone else, earning doctorate degrees in their field. What I do have a problem with is simply changing the title and the degree, with no real additional work, and no change in the LEGAL scope of practice, in a political power play to claim that nurses are the equal of physicians, and hey, BTW, call me doctor, I've earned it. Hell, you don't even need a doctorate to play that game. Some CRNA's already claim they are the equal of anesthesiologists.
 

windsurfr

Member
7+ Year Member
15+ Year Member
Feb 9, 2002
67
0
Minneapolis, MN
Visit site
Status
I am a fourth-year med student... however am 43 years old and have worked in healthcare for 15 years.

There has been an interesting progression of 'mid-level' providers (I actually dont like the term) over the past 15 years. The original role was to provide care where adequate care was not readily available (rural, etc). The applicants were established, professional nurses/paramedics/etc who were trained to provide medical care to these underserved areas. Jump forward 15 years....
Now we have college/High School students deciding that they want to go into nursing/PA school instead of medical school. The big three reasons that I have seen:

1. Less school time and less debt
2. More predictable hours
3. Very little liablilty

Yet being fully aware of the above three, I continue to hear about 'mid-levels' wanting to be "physician equivalents". I am not intending to start a bash-fest on either side of the fence.... but it does seem that if one wants to assume the role of a physician, one should go to medical school and do a 3-8 year residency. Only then is that person a 'doctor'. I dont wear a white coat, and I hate heirchical systems... but NP's and PA's should not have the title 'doctor'. Consider the following:

1. Should LPN's be able to take several advanced classes and earn an RN degree without going to school? Most RN's that I have encountered are very protective of the RN degree.
2. Should an EMT be able to take a few extra classes and be allowed to do all that a Paramedic can?

The above logic may not be perfect (as I am sure further posters will point out) but it is at least similar. Those who wish to practice medicine need to start from the begining with a disease-based model of physiology/pathophys.... and incorporate these into the formation of differential diagnoses. This is not what is learned in nursing school, and cannot be 'made up' in several years of training (even with a one-year residency).

As an end.... my spelling is horrible and I did not have time to spell check so please no "you spelled this wrong so you are ignorant" replies. However I am looking foreward to thoughtful replies/discussions. Sorry to be so long...
 

emedpa

GlobalDoc
10+ Year Member
15+ Year Member
Aug 25, 2001
6,014
301
Taking an Away team....
Status
Post Doc
excellent post windsurfr.
I agree with your statements about midlevels. It used to be the norm that applicants had years of experience in another healthcare field before applying. now programs are recruiting folks out of high school to do 4-5 year programs and become midlevels. when I applied to pa school having been an er tech for 5 years and a paramedic for 5 years I was one of the youngest students accepted that year.I mourn the current trends in pa applications where an 18 yr old can get into a bs level program and a 22 yr old with a degree and nothing else can get into a ms level program.
 

PACtoDOC

1K Member
7+ Year Member
15+ Year Member
Aug 2, 2002
1,057
3
Visit site
Status
Great Post Windsurf and Emedpa.
But Windsurf, please do not lump all midlevels together. I am only one year behind you in medical school and being a PA, I see that my education as a PA was indeed very disease based and differential based. Med school has simply included more of it. PA's are not like NP's in that we have a unique base of support in the physician population. Physicians govern us as we are created in most states to exist under the state medical board. NP's by virtue of practicing "advanced nursing" (whatever smoke and mirrors that is!!) attempt to remain out of the jurisdiction of physician groups and governing boards. And if you head over to allnurses.com and stealthly hang out in their NP forum, you will see what most NP's think of physician oversight. THEY WANT TO BE INDEPENDENT and everyone knows it. PA's are not pushing for this, have not pushed for this, and they have gained every priviledge they have due to collaboration and agreement with state medical boards. Quite honestly it would be nice if their existed a true heirarchy in medicine whereas people could advance up the chain to finally become physicians if they chose to.
I have been a military medic, and LVN, and EMT, and EMT-P, and a PA-C. I will soon be a doctor, and each level has been easier because of the previous level's training. This will never happen, but it only makes sense that adding to a knowledge base provides for more and more skills at subsequent levels.
 
OP
PharmDr.

PharmDr.

Senior Member
7+ Year Member
15+ Year Member
Apr 15, 2004
175
0
Status
You are absolutely right windsurfr, why wouldnt I want to have the benefits of being a midlevel. I dont want to be designated as "doctor". That term should be used for those like MD/DO that have gone through the full medical training. I do believe however, that those extra credentials for nurses would open up more oppurtunities. I want to work in conjunction with a physician, not be a physician wannabe. I was affended by some of your guys comments and tried to prove my desire for nursing. I just dislike how some of you present a well-biased opinion. I am not trying to state facts...just my own personal exp. and research. I have just calc. my gpa with most of the pre-med classes and nursing classes, 74 cr. to be 3.3. There are plenty of students who get in to med school with that gpa. Yes...not too competetive, but as I am only a soph. or I guess jun. if you count my cr. hrs., I still have a chance at med school admissions. The point I am trying to make is that this is not my goal. When I made the statement that PA/NP are slowly taking over I meant they are taking over the FP doc.
 

ThreadkillerMD

10+ Year Member
5+ Year Member
Feb 6, 2005
27
0
Status
PharmDr. said:
You are absolutely right windsurfr, why wouldnt I want to have the benefits of being a midlevel. I dont want to be designated as "doctor". That term should be used for those like MD/DO that have gone through the full medical training. I do believe however, that those extra credentials for nurses would open up more oppurtunities. I want to work in conjunction with a physician, not be a physician wannabe. I was affended by some of your guys comments and tried to prove my desire for nursing. I just dislike how some of you present a well-biased opinion. I am not trying to state facts...just my own personal exp. and research. I have just calc. my gpa with most of the pre-med classes and nursing classes, 74 cr. to be 3.3. There are plenty of students who get in to med school with that gpa. Yes...not too competetive, but as I am only a soph. or I guess jun. if you count my cr. hrs., I still have a chance at med school admissions. The point I am trying to make is that this is not my goal. When I made the statement that PA/NP are slowly taking over I meant they are taking over the FP doc.

It seems like you keep ratcheting back your opinion everytime someone makes a comment.

Also, midlevels will NEVER "take over" the FP doc's practice. :sleep: No educated patient would prefer the NP's care over the physician's. All "research" that says otherwise has undoubtedly been conducted by pro nursing groups who constantly try to mislead the public to get themselves a bigger piece of the pie.

A nurse by any other name is still a nurse
 

PACtoDOC

1K Member
7+ Year Member
15+ Year Member
Aug 2, 2002
1,057
3
Visit site
Status
There you go again, inserting your foot into that pie hole of yours. So now you say that you are taking over FP docs scope pf practice and jobs? I am a PA turned family physician and I can tell you that there is a world of difference. See, you just keep dreaming up ideas that you have obviously read on some pro-nursing website. To take over FP, you have to be independent. Yet you say you don't advocate for independence. FP's hear about this trend, and it just infuriates them more regarding NP's. This will only strengthen the relationship with PA's who FP's have historically had a great working relationship with. You guys go get your DNP's or your PhD in nursing theory, but remember, if you piss off the FP's whom you say you are taking over, you will find yourselves without any jobs. The majority of NP's in this country work for FP's, Peds, or IM docs, and when you piss on one group of these physicians, you piss on all of us. I am actually loving this development by NP's to attain DNP status, because it just means more jobs for PA's who know what it means to be subordinate and respectful to their physician colleagues. A subordinate stance goes a long way toward enhancing acceptance and gaining priviledges. I thought a 3 year old kid new this principle. I can forsee the DNP group to be the most highly unemployed group of allied health professionals with the highest debt ratio of any group in ages. That is because it doesn't matter if you have a doctorate if you have no job. And speaking for myself, I might have considered hiring an NP prior to this mess (though only because I could pay them less and let them see the rhinorrhea patients...as a PA would not tolerate this BS), but now I will never consider such. And I will be a strong advocate against the NP profession ever gaining any form of independence in my state. In fact, I already sit on my state's AAFP committee for Legislative Affairs, and this issue is on the docket next week at out bi-annual meeting. I can tell you it is not being looked at favorably by the 5000 FP's in my state that NP's want to change their base degree to DNP. It provides for resentment and suspicion, which as I said before, does not gain NP's any jobs in the end.



PharmDr. said:
You are absolutely right windsurfr, why wouldnt I want to have the benefits of being a midlevel. I dont want to be designated as "doctor". That term should be used for those like MD/DO that have gone through the full medical training. I do believe however, that those extra credentials for nurses would open up more oppurtunities. I want to work in conjunction with a physician, not be a physician wannabe. I was affended by some of your guys comments and tried to prove my desire for nursing. I just dislike how some of you present a well-biased opinion. I am not trying to state facts...just my own personal exp. and research. I have just calc. my gpa with most of the pre-med classes and nursing classes, 74 cr. to be 3.3. There are plenty of students who get in to med school with that gpa. Yes...not too competetive, but as I am only a soph. or I guess jun. if you count my cr. hrs., I still have a chance at med school admissions. The point I am trying to make is that this is not my goal. When I made the statement that PA/NP are slowly taking over I meant they are taking over the FP doc.
 
OP
PharmDr.

PharmDr.

Senior Member
7+ Year Member
15+ Year Member
Apr 15, 2004
175
0
Status
PACTODOC why are you letting this discussion change your views on NP's as a whole? I am just stating what I have found. Whether it be from nurses,pharmacists,doctors,pa's. I have heard this argument about midlevels taking over FP docs for yrs. and even from docs. I would get defensive also if I heard this. Please educate me about this as you have a different view. You have first hand exp. in healthcare for numerous yrs. and I do not, so I am willing to hear what you have to say. I am not "retracting" my statements. I was never defending nurses that highly originally. I WANT TO WORK UNDER A DOCTOR. The point of this thread was to get your guys opinions on the advancement on nursing education. I would never pawn myself as a doctor as I am not. Why are you making such blatant statements about nurses being soo inferior? All of the docs I have talked to have said that they would hire a PA or NP and allow them to do the same things. Please dont lecture me on the diff. in training as I know PA's are better trained in school. However, I can make up that diff. in training by my willingness to learn.
 

tupac_don

Senior Member
10+ Year Member
5+ Year Member
May 16, 2004
881
3
Status
jwk said:
What makes you think that nurses will be fully independent (whatever that means) with a DNP? They must still function under the current nurse practice act or advanced practice nursing regs for their state. Those won't magically change with a DNP just because of a different degree. Of course after 25 years, they're still trying to make a BSN the entry level for an RN, and they can't even accomplish that. There are plenty of ASN programs around.

Did anything really change with a PharmD besides the initials? Just curious - I really don't know.
Not really, the only thing that changed, is that now you may have provided more exposure to the clinical/hospital side of pharmacy. Which may force more people than before to abondan retail and maybe do a residency. But that's about it. There is still a large proportion of individuals who are not thrilled with the extra year of clinical when all they want to be is a retail pharmacist.
 

diabeticfootdr

10+ Year Member
May 14, 2004
534
103
41
Los Angeles, CA
Status
Attending Physician
PACtoDOC said:
NP's by virtue of practicing "advanced nursing" (whatever smoke and mirrors that is!!) attempt to remain out of the jurisdiction of physician groups and governing boards. And if you head over to allnurses.com and stealthly hang out in their NP forum, you will see what most NP's think of physician oversight. THEY WANT TO BE INDEPENDENT and everyone knows it. Quite honestly it would be nice if their existed a true heirarchy in medicine whereas people could advance up the chain to finally become physicians if they chose to.
I agree, NP's are governed by the State Board of Nursing (or however it may be called in other states), not by the Board of Healing Arts. To allow DNPs to practice independently would require a CHANGE in law --- which comes LONG after a change in education.

There is nothing wrong with actually being a nurse! It seems to me like a lot of nurses (~25%) prefer to doctor the patient as opposed to nursing the patient.

If you want to be the top of the food chain in medicine -- be an MD/DO
If you want to make a nice living, spend less time in school, hold the patient's hand when they are dying, comfort the patient with pain, be a NURSE
If you want to clip toenails all day long, be a podiatrist (just a joke for PACtoDOC -- I don't clip toenails, ha ha).

LCR
 

OSURxgirl

Senior Member
10+ Year Member
5+ Year Member
May 23, 2004
343
0
Status
It's these kind of stupid arguments that have our healthcare system in the state its in. I am a PharmD student. I believe that with the work and training I'll be doing that I do indeed deserve a doctorate degree. Does that mean I want to function as a medical doctor?? No. Instead of health professionals really zeroing in and focusing on what they do best, it seems like everyone is trying to take a piece of someone else's job. We have nurses with 2 to 4 year degrees trying to take dispensing and medication management services away from pharmacists who train 6+ years specifically on medications. Some pharmacists are trying to get prescribing rights. We have psychologists with virutally no medical background trying to prescribe psychiatric meds. I think that if everyone takes on everyone else's jobs, no one is going to do anything well. It will hurt patients. However, lack of collaboration is also hurting our patients. Why can't pharmacists, nurses, doctors, etc all work together to acheive the best outcome for the patient and the lowest cost for the healthcare system? This is much better than bickering about initials after names and what we can and cannot do.
 

PACtoDOC

1K Member
7+ Year Member
15+ Year Member
Aug 2, 2002
1,057
3
Visit site
Status
OSURxgirl said:
It's these kind of stupid arguments that have our healthcare system in the state its in. I am a PharmD student. I believe that with the work and training I'll be doing that I do indeed deserve a doctorate degree. Does that mean I want to function as a medical doctor?? No. Instead of health professionals really zeroing in and focusing on what they do best, it seems like everyone is trying to take a piece of someone else's job. We have nurses with 2 to 4 year degrees trying to take dispensing and medication management services away from pharmacists who train 6+ years specifically on medications. Some pharmacists are trying to get prescribing rights. We have psychologists with virutally no medical background trying to prescribe psychiatric meds. I think that if everyone takes on everyone else's jobs, no one is going to do anything well. It will hurt patients. However, lack of collaboration is also hurting our patients. Why can't pharmacists, nurses, doctors, etc all work together to acheive the best outcome for the patient and the lowest cost for the healthcare system? This is much better than bickering about initials after names and what we can and cannot do.
Why can't we all just get along?? :laugh:
Why can't Israel just abandon that flat of dead sand and relinquish power to the Arab world?
Why can't the north African republics become democracies over night?
Why can't we find Osama Bin Laden and force him to apologize?
Why is the world round?
Why can't people stop drinking and doing drugs?
How come all things in life are not perfect?

I think you are being a bit naive with this statement, but I would expect that from a student. Its a great master plan, and I applaud you for wanting to make it work, but in reality this debate and discussion is what makes America great.
 

lawguil

Senior Member
10+ Year Member
7+ Year Member
Jun 24, 2004
461
1
Florida
Status
OSURxgirl said:
It's these kind of stupid arguments that have our healthcare system in the state its in. I am a PharmD student. I believe that with the work and training I'll be doing that I do indeed deserve a doctorate degree. Does that mean I want to function as a medical doctor?? No. Instead of health professionals really zeroing in and focusing on what they do best, it seems like everyone is trying to take a piece of someone else's job. We have nurses with 2 to 4 year degrees trying to take dispensing and medication management services away from pharmacists who train 6+ years specifically on medications. Some pharmacists are trying to get prescribing rights. We have psychologists with virutally no medical background trying to prescribe psychiatric meds. I think that if everyone takes on everyone else's jobs, no one is going to do anything well. It will hurt patients. However, lack of collaboration is also hurting our patients. Why can't pharmacists, nurses, doctors, etc all work together to acheive the best outcome for the patient and the lowest cost for the healthcare system? This is much better than bickering about initials after names and what we can and cannot do.
I agree that each profession should do exactly what they are trained to do (i.e. pharmacist dispense and council about medicine, psychologist provide psychological care, physicians prevent and treat disease and illness, physical therapist provide rehabilitation (with referral), ect.ect.ect.) Understand that this is what a major part of the argument is about with respect to clinical doctorates. Understand that clinical doctorates are a political maneuver to capture more autonomy! Clinical doctorates have VERY little to do with better education for entry level into a professional field. You said "I think if everyone takes on everybody else's job, no one is going to do anything well." This is exactly the problem with the "clinical doctorates." Everybody thinks they are qualified.
 

JohnDO

MS III
7+ Year Member
15+ Year Member
Oct 14, 2003
655
0
Visit site
Status
I'm not sure I understand the purpose of all this. If people wanted to be physicians or function like physicians, why didn't they just go to medical school?
 

NPtobe

Junior Member
10+ Year Member
Feb 11, 2005
6
0
Status
The rights of Nurse Practitioners (NPs) vary from state to state. If you look in The Nurse Practitioner , January 2005 journal you will see how roles vary from place to place. For example, NPs can prescribe controlled substances independent of physician involvement in AK, AZ, DC, IA, ID, ME, MT, NH, NM, OR, UT, WA, WI, and WY. Or NPs cannot prescribe controlled substances in AL, FL, KY, and MO.

Here are a few research publications of NPs providing equal or if not better care than primary care MDs,

Horrocks, S., Anderson, E., Salisbury, C. (2002). Systemic review of
whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal. Retrieved January 30, 2005 from http://bmj.bmjjournals.com/cgi/content/full/324/7341/819


Mundinger, M.O., Kane, R.L., Lenz, E.R., Totten, A.M., Wei-Yann, T., Cleary, P.D.,et. al.(2000). Primary Care Outcomes in Patients treated by Nurse Practitioners or Physicians [Electronic version]. Journal of American Medical Association, 283, 59-68

THe Mundinger research was said to be an poor display of whether or not NPs provide excellent care because the follow-up was post 6 months. Thus, Mundinger conducted another followup after 2 years and found the same results. Search for this on Jama as well.


Hope this helps. As a Nurse Practitioner to be I love staying current on issues facing our healthcare provider community. NPs are here to stay so we really should learn to get along rather than trying to maintain an insecure ego. I respect the care that both MDs and NPs provide. Nurses have worked there butts off to gain respect by acquiring more education and braodening our skill levels, yet still we don't get any respect. What do some of the MDs want nurses to do--clean beds, give baths, or basically mother the patients. We did that and we didn't get any respect.
I am a strong believer in decreasing health disparities in the US and one way to do that is expanding the number of primary care health care providers. There just aren't enough MDs to do the job, so that's why NPs are here to help. Not supporting NPs is like saying you don't believe in promoting health and increasing quality of life for the people of your country.
 

delicatefade

ASA Member
15+ Year Member
Jun 13, 2004
846
2
41
Status
Attending Physician
NPtobe said:
Not supporting NPs is like saying you don't believe in promoting health and increasing quality of life for the people of your country.
Is it really??? Way to use a straw man...
 

JohnDO

MS III
7+ Year Member
15+ Year Member
Oct 14, 2003
655
0
Visit site
Status
There just aren't enough MDs to do the job, so that's why NPs are here to help. Not supporting NPs is like saying you don't believe in promoting health and increasing quality of life for the people of your country.
No, it's really not. No matter how much you argue about it, your training is not as academically or clinically as thorough as an MD or DO program.

One thing I don't think you understand is that this land of milk and honey medicine DNPs are exposed to will not last forever. As your autonomy increases, so will your worries. Once lawyers get wind of what's going on, and you guys start getting slapped with lawsuits left and right, we'll see what that does to the "affordable, quality" healthcare you provide. Of course physicians would like to stay with patients longer and order less tests, but lawyers and insurance companies regulate medicine. Don't think they won't regulate the practice of a DNP. It's only a matter of time.

I am a strong believer in decreasing health disparities in the US and one way to do that is expanding the number of primary care health care providers.
So we should just start handing them out to anyone who wants one?

I still haven't heard an acceptable answer: If you wanted to play doctor why didn't you go to medical school?
 

NPtobe

Junior Member
10+ Year Member
Feb 11, 2005
6
0
Status
If I was interested in specializing then I probably would have gone to med school, however primary care NPs are doing an excellent job and I can say I will be proud to be a NP. Besides I'm not trying to play doctor, I'm a nurse trying to expand my scope of practice by taking on more responsibilities. A proud nurse not a MD wanna be. If I wanted to be an MD then I would be. It's unfortunate this upsets you, however, there is nothing you can do about it. I will work for 3 years for someone else to help gain experience which will essentially be my residency and then open up my own independent practice with other MDs or NPs. If I am doing the work I'd like to see the compensation. My boyfriend is a 3rd year medical student and respects what I am doing. Not just any med student but an overachiever with a 4.0 and Step I scores in the 95th percentile and he has no ego and greatly respects nurses. We respect one another. I'm happy he'll be one of the MDs leading the pack and showing other MDs you can have a collegial relationship with NPs.
 

Sinnman

Senior Member
7+ Year Member
15+ Year Member
Mar 12, 2003
132
0
Visit site
Status
NPtobe, I have a few comments on your "respect" issues. Your posts demonstrate that you desire to be respected for something you are not. You want the respect, pay and autonomy of a physician, yet you have not undergone the same level of education and training, work and sacrifice.

I do respect nurses. I am a nurse. I have respect for all the different members of the healthcare team. People respect physicians for the education, work and sacrifice that they have undergone. Physicians don't go around flaunting this and demanding respect.

The problem with NPs is that they want all the same rights and privileges as physicians without the work. NPs are pretty vocal about this. This does not engender respect; it actually has the opposite effect.

I've said many times before. If you want to practice medicine, go to medical school. Try as you may to convince yourself and everybody else otherwise, there are no shortcuts.
 

JohnDO

MS III
7+ Year Member
15+ Year Member
Oct 14, 2003
655
0
Visit site
Status
Besides I'm not trying to play doctor, I'm a nurse trying to expand my scope of practice by taking on more responsibilities.
I will work for 3 years for someone else to help gain experience which will essentially be my residency and then open up my own independent practice with other MDs or NPs. If I am doing the work I'd like to see the compensation.
And what will differentiate your primary care practice from the practice of a primary care physician? I see you guys pointing to studies saying, "look, we are like physicians!" Again, I ask, if you wanted to act like a physician, why didn't you go to medical school?
 

diabeticfootdr

10+ Year Member
May 14, 2004
534
103
41
Los Angeles, CA
Status
Attending Physician
NPtobe said:
Here are a few research publications of NPs providing equal or if not better care than primary care MDs,

Horrocks, S., Anderson, E., Salisbury, C. (2002). Systemic review of
whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal. Retrieved January 30, 2005 from http://bmj.bmjjournals.com/cgi/content/full/324/7341/819


Mundinger, M.O., Kane, R.L., Lenz, E.R., Totten, A.M., Wei-Yann, T., Cleary, P.D.,et. al.(2000). Primary Care Outcomes in Patients treated by Nurse Practitioners or Physicians [Electronic version]. Journal of American Medical Association, 283, 59-68

THe Mundinger research was said to be an poor display of whether or not NPs provide excellent care because the follow-up was post 6 months. Thus, Mundinger conducted another followup after 2 years and found the same results. Search for this on Jama as well.

Nurses have worked there butts off to gain respect by acquiring more education and braodening our skill levels, yet still we don't get any respect. What do some of the MDs want nurses to do--clean beds, give baths, or basically mother the patients. We did that and we didn't get any respect.
.
It all comes down to supervision. Everyone is supervised in some capacity or another. Physicians supervise other physicians. Physicians supervise nurses. Physicians are the leader of the healthcare team. Why should an NP who has less training than an MD (no one can deny this - undergrad + graduate + post grad) be allowed to practice independently without physician supervision???

Every practitioner has a "referral threshold" as I like to call it. NP referral thresholds are lower than those with more training - namely FPs, or generalists. Midlevel practitioners were designed to fill the void of doctors in rural areas to provide "point of care" health services while being supervised by a physician.

From your posts in this thread, you sound like you want to be a generalist, treating anything and acting as the sole gatekeeper to the patient.

Why aren't NPs satisfied by fullfilling their original obligations? If they all become like MDs or specialize (many NPs want to) then where does that leave the void that was initially filled by NPs. Do we promote LPNs to RNs, RNs to NPs, and NPs to MDs without any further training? Where does it end?

NPs should manage minor health problems and refer to specialists if they suspect something more serious. This is how I would want my mother treated, if she was your patient, and I believe you would want your mother to see a specialist too.

Oh, and I don't believe any study that says NPs deliver better care than MDs. You can design a study to prove anything you want -- especially one with fluid outcomes like "better healthcare".

NPs make good salaries, provide necessary services, if they could only be HAPPY :confused:
 

Ponte-Claret

Junior Member
10+ Year Member
Feb 4, 2005
5
0
Status
NPtobe said:
I will work for 3 years for someone else to help gain experience which will essentially be my residency and then open up my own independent practice with other MDs or NPs. If I am doing the work I'd like to see the compensation. My boyfriend is a 3rd year medical student and respects what I am doing. Not just any med student but an overachiever with a 4.0 and Step I scores in the 95th percentile and he has no ego and greatly respects nurses. We respect one another. I'm happy he'll be one of the MDs leading the pack and showing other MDs you can have a collegial relationship with NPs.
I think your boyfriend is just telling you that to get you in the sack. Either that, or he is lacking in the 'sack' department himself.
 

CJMPre-Med

Senior Member
10+ Year Member
5+ Year Member
Jun 29, 2004
419
1
Status
JohnDO said:
I'm not sure I understand the purpose of all this. If people wanted to be physicians or function like physicians, why didn't they just go to medical school?
Because they want all the benefits with none of the drawbacks, risks, and sacrifices. Anyone who asserts otherwise-- such as by proffering that they're concerned about "access to care"-- is kidding themselves, exceptions to the rule notwithstanding (i.e., there are some who are genuinely concerned about access or patient care, but these are not the rule, considering that the situation is, in most instances, not dire).


The fact is that medical school is the most difficult of the professional schools; when you throw in the grueling 3-8 year residency, all the more so. Some dentists may quibble by saying that they take the same courses alongside med students, but the fact remains that the pressures are not the same-- they're not competing against the "creme de la creme", so to speak, nor is the same mastery of the material expected of them (since it would not have as severe repercussions as it would for a medical doctor in most cases). Also, keep in mind that when I say that the medical track is more difficult, I'm speaking of the whole shebang: undergrad, med school, residency, and the obligations of the profession in general. Med school candidates are held to a much higher standard in undergrad if they hope to gain acceptance to a US med school; they also have to jump through many more hoops (research, extracurriculars, higher GPA and supplementary courses etc.). Some dental or PA candidates may do all this, but, again, this is the exception rather than a matter of course.


And this is not to demean any of these other professionals, as if they're somehow less intelligent or valuable-- not at all. The rigors of the professions, in terms of responsibilities and standards, are simply vastly different, and there's no value judgment there-- that's just the way it is. And it's a hard road because of all this. Is a person who has a Master's degree necessarily any less intelligent than one who holds a Ph.D? Of course not.


In light of the stringent standards for pre-meds, medical students, and MD's in residency training programs, it's not surprising that many people are put off by the whole process, yet they may still have some of the same goals (noble goals, such as to help others etc.) that many doctors do. However, such idealism can become misplaced and can ultimately be of detriment to the patient, as is the case when ancillary professionals decide to attempt to operate outside their scope of expertise and training, and to circumvent traditional limitations on their practice by way of politico-legal challenges rather than equal (note: not "increased"-- "equal") standards.


In addition, this trend is indicative of a larger shift in American society, towards people who simply "do not know their place", and refuse to acknowledge the differences in expertise between various professions, and to suppose themselves capable of providing similar services just because their own (subjective) experience, in their respective training programs, was difficult (to them). This is pure subjectivism being exalted as keen insight. After all, when a PA or NP announces indignantly that they've "trained just as hard as a doctor", what decent person has a desire to belittle their training and expertise? No one of good sense, obviously, because that would be rude. Yet at some point, it becomes clear that we cannot allow such importunate voices to set policy by dint of their subjective, emotional appeals. The fact remains that if they want equal rights and responsibilities, then it is only proper that they undergo equal training (again: not "increased", not "some extra courses"-- equal). This strikes me (and most reasonable people) as eminently sensible. You never see a 2nd year law student agitate for the ability to try cases in court, and you never see a middle manager push for CEO-level scope of influence, yet we tolerate that very mentality in medicine. Why?


The drawbacks of undertaking a career in medicine:


- incredible time investment, both in terms of length of training as well as the reduction in "free time" incurred; this starts in undergrad and never ends, pretty much

- debt load

- litigation concerns and ultimate responsibility for a patient, which can be a daunting prospect

- the difficulty of completing the training

- being "on call" all the time in many instances; the strain on one's personal life

- the incredible continuing educational investment even after certification



The benefits of medicine:


- Being able to help others in the fullest sense (i.e., not limited to, say, the oral cavity)

- financial rewards (though even this is being eroded; PA's and CRNA's make more than pediatricians in many instances-- is this just?)

- intellectual stimulation and sense of accomplishment that is tied to the rigors of the training



Now, notice that all attempts to increase scope of practice are ultimately aimed at gaining some of the benefits of medical training without suffering any of the drawbacks. In fact, it's mostly financially motivated. Many midlevels are quick to paint physicians as "greedy" because they bristle at the notion of expanding the midlevel's scope of practice, yet these very same people exhibit protectionism which is just as fierce when it comes to their own professions and the encroachment of even LESSER trained people on their sphere of influence. So it's disingenuous in that sense. At least physicians-- if they are, in fact, being "greedy" (and I don't think that desiring commensurate compensation can rightly be termed "greedy")-- have undergone the most rigorous training; with that comes certain rights. One of these rights is not having midlevels telling you how to do your job, and another is (or should be) not having to worry about undertrained professionals muscling in on your territory without equivalent training. It's as if all the holders of master's degrees around the nation started petitioning their legislature to allow them to be granted tenure as professors at universities like their Ph.D counterparts-- it's ridiculous, quite frankly.


The number of logical fallacies employed by people like NPtobe are astounding; I'm not sure if she'd get through an introductory philosophy course with the quality of "reasoning" she's exhibited here. I mean, seriously, how can you say this:

NPtobe said:
If I was interested in specializing then I probably would have gone to med school...Besides I'm not trying to play doctor, I'm a nurse trying to expand my scope of practice by taking on more responsibilities. A proud nurse not a MD wanna be. If I wanted to be an MD then I would be.
...with a straight face and not see the glaring contradictions present? Really now...


This post was NOT an effort to demonize anyone's efforts or their professions (be it MD, NP, PA etc.). However, I firmly believe in standards, and since the standards for becoming a medical doctor have been fairly constant for decades, and since it has been common knowledge that certain things are only within the scope of practice of an MD, how can such attempts at encroachment upon these rights and responsibilities logically be defended unless it is accompanied by a call for equal training? That is, if one wants to do all these things, then they should go to medical school. Makes sense to me, and I'm not even a doctor. I'm at least glad that I have the good sense to realize that different professionals have different standards and, hence, different functions and responsibilities. Anyone who denies this much-- as is evidenced by agitating for increases in scope of practice-- is clearly both unsatisfied with themselves (i.e., they have some sort of inferiority complex; and this, despite the fact that being a doctor does not make one any more intelligent or a better person than anyone else-- all it means is that you have undergone certain rigorous training which confers certain rights and responsibilities), and does not possess the requisite intelligence, in terms of the functionality of their critical thinking apparatus, to provide medical care at the highest level, which is what they aspire to.


Like I alluded to earlier, this trend only mirrors a larger sociological trend-- it's simply one manifestation of the same societal illness. And make no mistake, behaving in the way that some midlevels (like NPtobe) do, by agitating for privileges typically afforded physicians, is not only indecorous, it is absurd. I can say with the utmost confidence that only those who either have a chip on their shoulder (i.e., an inferiority complex) or have an IQ below 100 engage in this sort of practice-- and those suffering from either of these conditions should not imagine themselves capable of providing "high quality medical care" in the first place. It's just utterly foolish. It endangers patients' lives and health solely for the sake of one's self-esteem; such arguments are eristic at best, dangerous at worst, and should not be tolerated by any sane individual.


continued in the next post...
 

CJMPre-Med

Senior Member
10+ Year Member
5+ Year Member
Jun 29, 2004
419
1
Status
con't:


The attempt to subvert long-standing policy and standards of training by appealing to emotional rhetoric, and the subsequent attempts to convince legislatures to codify such illogic in the form of greater autonomy, is the height of absurdity. I fail to see how anyone could think otherwise. Obviously, every health care professional deserves to be accorded respect, both for their training and for their altruism. But this...this is something else entirely-- and it always seems to be midlevels who instigate it (in the form of petitioning for increased scope of practice w/o equal training and also by constantly stating that doctors "disrespect them", which, I would imagine, is more indicative of their own mental state- i.e., latent inferiority complexes- than of anything going on in obejctive reality) rather than vice-versa, at least on these boards.


That's how I see it, and I'm sure it won't be a popular view given the forum it's in. Please realize that, to my (and most sane people's) mind, there is no disrespect towards midlevels contained in this entire post-- it certainly was not my intention, so if anyone's "reading that into" my remarks, I'd advise them to read it again, this time critically.
 

JohnDO

MS III
7+ Year Member
15+ Year Member
Oct 14, 2003
655
0
Visit site
Status
Indeed, very well said. I haven't seen a valid argument for increasing the scope of practice for mid-levels other than the assertion that their aren't enough physicians. And while this notion is certainly open to debate, especially when considering rural populations, it is certainly not a strong argument for expanding their scope of practice. If DNPs truely felt this was a just cause for increasing their scope of practice, then we should see a majority of DNPs going into rural and underserved practice.

The poster who presented that argument went on to say that she would likely open a practice with other MDs, indicating that the location she would practicing in would at least have some MDs. She also said, "If I am doing the work I'd like to see the compensation." She quoted studies that indicated NPs perform as well as physicians clinically, and that she would be working with MDs and have her own private practice. This is clearly a case of someone wanting to have the role of physician without attending medical school.
 

chicoborja

Clinical Audiologist
10+ Year Member
15+ Year Member
Nov 13, 2002
203
0
Visit site
Status
For starters, I do not necessarily support the DNP movement; however, I am not adamently opposed to it either. Many posters seem to be approaching this from the medical point of view or the bull**** nurding theory point of view. I, on the other hand, believe a business perspective most accurately describes the current scenario. From a business perspective, advancing advanced practice nursing to a doctoral level allows the profession to gain more pull when lobbying for greater insurance reimbursements or changes in state law. Additionally, it may elevate their status in the eyes of the consumer/patient regardless of how much actual improvement is created. Pharmacy, physical therapy, and audiology have also transitioned or are in the process of transitioning to doctoral education and they have not received the same opposition that nursing is or will receive. I understand why nuring receives more opposition and I imagine othere readers do to and I see no need to further elaborate on that. My second point is this, allied health in general has made it trendy to advance the entry-level professional requirements. Everybody's doin it. In addition to the previously mentioned transitions to doctoral education, let's not forget PA and OT who have recently changed from bachelor's to master's level. The main point I'm trying to make is that there seems to be advantages for nursing to advance to a doctoral level that are not outweighed by the disadvantages. Posters may say that they may confuse the general public or provide inferior care and those are both valid concerns. However, the public is already confused about healthcare in general. Most patients assume a podiatrist has gone to med school, a nurse is a nurse is a nurse, and chiropractors are the spine specialists. Who's to say a little more confusion will really make a difference :laugh: ? As far as inferior care, well, in general I believe little difference will be seen. Will DNP nurses miss more important symptoms that lead to misdiagnoses, yes I think its quite possible. Will this be significant? I think only time will tell on that one.
 

CJMPre-Med

Senior Member
10+ Year Member
5+ Year Member
Jun 29, 2004
419
1
Status
chicoborja said:
Will DNP nurses miss more important symptoms that lead to misdiagnoses, yes I think its quite possible. Will this be significant? I think only time will tell on that one.
That's a big risk to take, especially considering that it's being done for no other reason than to salve the bruised egos of certain midlevels (see: NPtobe). Realize that physician salaries are responsible for only 3% of health care costs in this country, so I don't think "cost containment" is an adequate reason for such a shift, especially given the possible deleterious consequences in terms of patient outcomes. You still haven't provided a rationale for increased scope of practice, btw. If there are two choices, one being the status quo with decent patient outcomes, and one being increased scope with even possibly worse patient outcomes (which only makes sense given the disparities in training), then why should we choose the latter? Especially when there is no other overarching concern which would cause us to do so-- the only thing at stake is the egos of midlevels and their own financial motivations. Period. Standards exist for a reason, and refusing to adhere to them is, as I mentioned, indicative of a larger social trend, one that we witness everywhere from medicine, to education, to business.


Allow me to ask: if that's the case (i.e., that there won't be any difference in outcomes), then why have the requirements for becoming a physician always been so strict? Why has their training always been so rigorous? I guess "standards" are just an antiquated ideal? They didn't REALLY have to be trained as well as they have been all these years? :laugh: And this type of rhetoric always comes from people who trumpet the fact that they're concerned about patients-- if that was the case, then they'd make sure that they met the MOST stringent standards (you know, like physicians do) in order to guarantee competence. The hypocrisy, logical fallacies, and doubletalk disturbs me, quite frankly.
 

chicoborja

Clinical Audiologist
10+ Year Member
15+ Year Member
Nov 13, 2002
203
0
Visit site
Status
CJMPre-Med said:
That's a big risk to take, especially considering that it's being done for no other reason than to salve the bruised egos of certain midlevels (see: NPtobe). Realize that physician salaries are responsible for only 3% of health care costs in this country, so I don't think "cost containment" is an adequate reason for such a shift, especially given the possible deleterious consequences in terms of patient outcomes. You still haven't provided a rationale for increased scope of practice, btw. If there are two choices, one being the status quo with decent patient outcomes, and one being increased scope with even possibly worse patient outcomes (which only makes sense given the disparities in training), then why should we choose the latter? Especially when there is no other overarching concern which would cause us to do so-- the only thing at stake is the egos of midlevels and their own financial motivations. Period. Standards exist for a reason, and refusing to adhere to them is, as I mentioned, indicative of a larger social trend, one that we witness everywhere from medicine, to education, to business.


Allow me to ask: if that's the case (i.e., that there won't be any difference in outcomes), then why have the requirements for becoming a physician always been so strict? Why has their training always been so rigorous? I guess "standards" are just an antiquated ideal? They didn't REALLY have to be trained as well as they have been all these years? :laugh: And this type of rhetoric always comes from people who trumpet the fact that they're concerned about patients-- if that was the case, then they'd make sure that they met the MOST stringent standards (you know, like physicians do) in order to guarantee competence. The hypocrisy, logical fallacies, and doubletalk disturbs me, quite frankly.

I'm not sure whether or not you realize that this issue isn't really about cost containment or healthcare for rural or underserved areas. This is about healthcare in a capitalist market where providers will compete for their share of the pie regardless of what is best for the patient. Chiros are a perfect example! How can there healthcare parasites thrive? Hehe...well it's not because there are so many subluxations that need to be corrected for the good of society. They've been somewhat savy by getting on insurance plans for reimbursement and creating a situation where the law gives them space to maneuver. Nurses never took the Hippocratic oath! If they succeed in their venture it is because of ambition, power, and foresight. Like most organizations, what they say is not always what actaully is.
 

bemused

duct, duct, goose
10+ Year Member
5+ Year Member
Oct 23, 2004
64
0
Status
NPtobe said:
I will work for 3 years for someone else to help gain experience which will essentially be my residency and then open up my own independent practice with other MDs or NPs.
Have you researched EXACTLY what a physician residency is like? It's full of rotations to multiple specialties, which you will not getting working in an office. It's seeing the patient, making the diagnosis & plan, then running it by the attending who will then see your patient and decide if you are right. Your chances of getting that level of education from your future employer is pretty slim at best.

No disrespect meant to NPs in general... but a few years of practice is NOT the equivalency to a residency, and does NOT make you the equivalent of a residency-trained physician.

The last FNP-S I spoke to was on his ob-gyn "rotation" where he had to do 25 Pap smears - that's it. He did it in 3 days. That's not adequate preparation for independent practice.

Great dreams, sweetie, but that crap they feed you in NP school is not how it works in the real world. I admire your aspirations but wonder how long they will last when you start working.
 
Status
Not open for further replies.