DrNP and ND programs

[50960]

People stop trying to compare yourself to MDs; it is useless and makes no real sense. MDs, despite what they may tell you are not the product of the most stringent training, acceptance guidelines anywhere that I have known! They are well trained, but not really well educated. In my part of the world it is much harder to get accepted to nursing school than medical school. PhD scientists have much much more rigorous training, and much more stringent acceptance guidelines than med students, and they provide the foundation for all that future MDs will be putting in to practice without really understanding. Get some perspective...

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[JohnDO]

MDs, despite what they may tell you are not the product of the most stringent training, acceptance guidelines anywhere that I have known! They are well trained, but not really well educated.

Yea, we spend our first two years learning our right hand from our left hand. MD's have one of the most rigorous training programs out there, and you haven't demonstrated otherwise. Look at a typical courseload for a medical student and tell me with a straight face they're not "well educated".

In my part of the world it is much harder to get accepted to nursing school than medical school.

In your part of the world, which would be California? I'm sure some people would contest that, but I'm not in that position.

PhD scientists have much much more rigorous training, and much more stringent acceptance guidelines than med students, and they provide the foundation for all that future MDs will be putting in to practice without really understanding.

First, PhD programs don't have more stringent acceptance guidelines on the whole. Some, of course, only take top candidates, but I think you'll find most people who want a PhD can get one. Second, their training is rigorous, but very focused and rigorous in a different way. Third, MD's are extremely involved in medical research (pick up a copy of JAMA, check the authors). Fourth, you don't think we understand the research PhD's do? Give me a break. MD's spend their lives interpreting and applying research PhD's do.

 

[CJMPre-Med]

In my part of the world it is much harder to get accepted to nursing school than medical school.

Undoubtedly a nation with socialized health care; this makes sense, because the process of becoming a physician, as well as the responsibilities the job entails, is incredibly rigorous. Relatively few people want to undergo such intense training, and bear so much repsonsibility and stress, for $65-70K USD per year (average physician salary in socialized nations). However, nurses, though being well-trained for what they do, go through a far less demanding educational process (we're talking undergrad, med school, and post-grad in residency), and make about the same money in socialized nations (~55-$60K USD); hence why nurse programs are more difficult to get into: more people want to fill those seats than to fill med school seats, because the pay is comparable yet it's a much easier journey by anyone's account (note to nurses: nobody is saying that what you do is easy, only "easier"). This is why all socialized nations save for a couple are experiencing physician shortages. Nothing more to it than that.


Trying to pass off such a phenomenon as evidence of the difficulty of their respective curricula or clinical training is incredibly disingenuous-- then again, that's to be expected, since there's already so much of that sort of conduct and thought permeating the thread.


It's also amusing that you deride MD's as "uneducated", yet hold nurses up as their superiors. If you had said Ph.D scientists, then, though I still wouldn't agree necessarily, I would take much less issue. Again, it's interesting to note that it's a nurse or other midlevel attempting to demean physicians and not vice versa.

 

[JohnDO]

Location: Ca

I guess that's Canada, not California.

 

[CJMPre-Med]

I guess that's Canada, not California.

It would make sense, as Canada is suffering a severe shortage of physicians for the very reasons elaborated upon above. Sure, Canada (to their credit), happens to have the most adequate compensation for physicians of all the socialized nations, but, regardless, $85-90K USD for physicians and $155K USD for a neuro-freaking-surgeon is just a tad paltry. Especially with the unique demands placed on them in the Canadian system.


I just think it's funny how she tried to pass it off as nursing programs being more "difficult". Hell, even if she comes out and says that she's living in the US, it wouldn't surprise me, as physicians are woefully underpaid even here. Hmm, let's see...I can break my ass for 8 years in med school and residency (not to mention undergrad) and become a pediatrician and make $130K (and always be on call, with all the continuing education demands, conferences etc.), or I can just get my 2-year MBA and make $185K/year like my cousin does at age 29, home at 6 PM every day, always vacationing, and no outside obligations at all beyond his family. Cost-benefit analyses are the way of the world, unfortunately. Nursing is a big field right now because the need for them is great, the training manageable, and the pay is good (just like most midlevel providers' programs, which is why PA etc. programs are so hard to get into). Conversely, applications to med school have fallen 30% since the mid-90's. Wonder why...

 

[truthseeker]

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.

I am a PT and agree with the entire essay that you posted. Increasing scope of practice requires documented training in an area that is more rigorous than other professions. PT is not really trying to expand their scope of practice, but simply becoming more independent in the area where we are already more "expert" than other health care providers. We don't want to do surgery, we don't want to prescribe pills, we don't necessarily want imaging credentials (although it has been a successful experiment in the military for years where a recent comparison study found when comparing orthopedists, FPs, and PTs in the miliary the PTs and the orthos order imaging appropriately more than do FPs)

I think there is a difference between increasing the scope of practice and increasing independence within the scope of practice.

Comments?

 

[50960]

Wow, what a rorschach experience this has been!! I am not a she, do not live in Canada, am not a nurse, and never said nursing training is more rigorous...that is just stupid. I am also not a midlevel, have nothing against MD's, and am NOT many of the other things recent members have assumed. MD/DO training is the most rigorous in medicine (aside from DVM maybe)...not a doubt. However this does not make a person a scientist or make them by default able to do the jobs of other healthcare providers. My jab was at midlevels who constantly measure themselves and their training against an MD; this is just counterproductive. As far as my education point goes, I simply meant that medical training does not necessarily equal intellectual; this is not a bad thing. I would much rather have a practicing MD in the ER after a car wreck that a college professor...that was my point.

relax..

 

[deleted6669]

"I think there is a difference between increasing the scope of practice and increasing independence within the scope of practice.

Comments?"

there is a big difference between knowing how to do something and having it be a good idea. as a pa for years I probably could do the following becausee I have 1st assisted at all of these:
a c-section
a tubal ligation
a thoractomy for trauma
a carpal tunnel reduction procedure
draining peritonsilar abscesses

that doesn't make it a good idea......

at this point if I wanted to do all of these things by myself I would go to med school

 

[CJMPre-Med]

"I think there is a difference between increasing the scope of practice and increasing independence within the scope of practice.

Comments?"

there is a big difference between knowing how to do something and having it be a good idea. as a pa for years I probably could do the following becausee I have 1st assisted at all of these:
a c-section
a tubal ligation
a thoractomy for trauma
a carpal tunnel reduction procedure
draining peritonsilar abscesses

that doesn't make it a good idea......

at this point if I wanted to do all of these things by myself I would go to med school

See, here we have a sensible person.


Psisci, I'll get to you a bit later.

 

[chicoborja]

I am a PT and agree with the entire essay that you posted. Increasing scope of practice requires documented training in an area that is more rigorous than other professions. PT is not really trying to expand their scope of practice, but simply becoming more independent in the area where we are already more "expert" than other health care providers. We don't want to do surgery, we don't want to prescribe pills, we don't necessarily want imaging credentials (although it has been a successful experiment in the military for years where a recent comparison study found when comparing orthopedists, FPs, and PTs in the miliary the PTs and the orthos order imaging appropriately more than do FPs)

I think there is a difference between increasing the scope of practice and increasing independence within the scope of practice.

Comments?

Although I am not familiar with the entire scope of practice for a PT, I don't see the distinction you're trying to make about increasing actual scope vs. increasing independence of scope. When you referred to being more independent in the beginning of your post, I imagined you were referring to autonomy direct access. I would agree attaining both would increase the independence within the scope; however, is ordering imaging within the PT's current scope? Since you mentioned a military experiment I'm assuming ordering of imaging is not currently done by PTs in regular practice be it because of law, scope, reimbursement I am not familar with this enough to say. I wanted to clarify that if it is reimbursement issues that prevent PTs from regularly ordering imaging then this would be an example of an issue where one could attempt to increase independence of scope of practice. However, if the issue is that its not in your scope currently but you certain factions believe that you are well capable of pursuing this venture (e.g. successful military experiment) then this would indeed be an attempt to expand scope of practice. If it was currentl within your scope as a profession but law prohibited PTs ordering imaging, I think this area is a bit more gray and could be argued either way

 

[truthseeker]

Although I am not familiar with the entire scope of practice for a PT, I don't see the distinction you're trying to make about increasing actual scope vs. increasing independence of scope. When you referred to being more independent in the beginning of your post, I imagined you were referring to autonomy direct access. I would agree attaining both would increase the independence within the scope; however, is ordering imaging within the PT's current scope? Since you mentioned a military experiment I'm assuming ordering of imaging is not currently done by PTs in regular practice be it because of law, scope, reimbursement I am not familar with this enough to say. I wanted to clarify that if it is reimbursement issues that prevent PTs from regularly ordering imaging then this would be an example of an issue where one could attempt to increase independence of scope of practice. However, if the issue is that its not in your scope currently but you certain factions believe that you are well capable of pursuing this venture (e.g. successful military experiment) then this would indeed be an attempt to expand scope of practice. If it was currentl within your scope as a profession but law prohibited PTs ordering imaging, I think this area is a bit more gray and could be argued either way

I'm not exactly sure how the distinction is made but in the military, for quite some time, PTs have been allowed to order radiographs, CT, MRI, Nuclear studies autonomously for those cases in which they are the primary contacts of the soldiers. I wonder if it is something like a standing order such as with a PA or NP i.e. priviledges allowed by the military medical heirarchy. It is not in my scope of practice and there is no move that I am aware of to make it so. There was just an interesting article in the Journal of Physical Therapy that compared the appropriateness of imaging between orthos, PTs, and FPs. PTs did as well (statistically insignificant diference) as orthos.
I am probably just suffering from inferiority complex and wanted to illustrate that PT is not trying to get more, just, as you said, become more independent through direct access.

To my knowledge, nowhere can a civilian PT by law order imaging. we can suggest it to our MD/DO/PA/NP/DC colleagues but can't do it ourselves.

 

[PACtoDOC]

I'm not exactly sure how the distinction is made but in the military, for quite some time, PTs have been allowed to order radiographs, CT, MRI, Nuclear studies autonomously for those cases in which they are the primary contacts of the soldiers. I wonder if it is something like a standing order such as with a PA or NP i.e. priviledges allowed by the military medical heirarchy. It is not in my scope of practice and there is no move that I am aware of to make it so. There was just an interesting article in the Journal of Physical Therapy that compared the appropriateness of imaging between orthos, PTs, and FPs. PTs did as well (statistically insignificant diference) as orthos.
I am probably just suffering from inferiority complex and wanted to illustrate that PT is not trying to get more, just, as you said, become more independent through direct access.

To my knowledge, nowhere can a civilian PT by law order imaging. we can suggest it to our MD/DO/PA/NP/DC colleagues but can't do it ourselves.

Once again, I think the point is less about who knows how to order something, but more about who knows how to interpret the study. I don't know what a PT's X-ray reading instruction involves, but I know that they cannot possibly know as much as an ortho doc. You can teach any monkey when to order certain studies. It is routine in ED's and urgent care centers to give nurses and techs the ability to send a patient to X-ray based on certain clinical findings prior to the doctor ever seeing the patient.

 

[nev]

so wont this DNP program affect the demand for PAs in the future?

 

[CJMPre-Med]

Wow, what a rorschach experience this has been!! I am not a she, do not live in Canada, am not a nurse, and never said nursing training is more rigorous...that is just stupid. I am also not a midlevel, have nothing against MD's, and am NOT many of the other things recent members have assumed. MD/DO training is the most rigorous in medicine (aside from DVM maybe)...not a doubt. However this does not make a person a scientist or make them by default able to do the jobs of other healthcare providers. My jab was at midlevels who constantly measure themselves and their training against an MD; this is just counterproductive. As far as my education point goes, I simply meant that medical training does not necessarily equal intellectual; this is not a bad thing. I would much rather have a practicing MD in the ER after a car wreck that a college professor...that was my point.

relax..

Okay, psisci, at the risk of sounding immodest, let me break this down for you. I usually wouldn't do this (and never have), but your attempts at doublespeak and obfuscation annoy me, quite frankly.


I scored an 800 on the verbal portion of the SAT (1993, prior to the re-norm); I regularly score 14's and even a few 15's on practice MCAT verbal sections; I have a verbal IQ four standard deviations above the norm. Here's the relevant point: I can read. What's more, I can comprehend the written word. You wrote above that you've "never said that nursing training was more rigorous" (i.e., "more difficult" as it has been implicitly defined in this topic), and yet here is the relevant portion of your original post, with the sentence in question bolded:

MDs, despite what they may tell you are not the product of the most stringent training, acceptance guidelines anywhere that I have known! They are well trained, but not really well educated. In my part of the world it is much harder to get accepted to nursing school than medical school. PhD scientists have much much more rigorous training, and much more stringent acceptance guidelines than med students, and they provide the foundation for all that future MDs will be putting in to practice without really understanding.

Now, based on that single sentence, perhaps a case can be made that you were not implicitly asserting that nursing school is more difficult than medical school. However, based on the surrounding context, it's clear that the message any astute reader will take away is that you believe nursing school to be "harder" (i.e., more difficult; rigorous) than medical school, which is patently false by any objective standard you'd care to measure it by. The vehemence with which you uttered your first sentence, as evidence by the exclamation point, as well as the generally disparaging tone of the surrounding sentences (e.g., physicians are "not really well educated"; they're "not subject to stringent training and acceptance standards"; Ph.D scientists have "much more" rigorous training etc.), virtually ensures that this will be the way your sentence is interpreted-- not in the manner you explained it in your latest post above.


So if you're going to attempt to make it seem as though others are "misrepresenting you", or are "reading too much into your words", perhaps you should A) learn how to write; specifically, how to put your remarks in a context conducive to proper interpretation; and B) stop making asinine and indefensible remarks in the first place. In particular, your comment about MD's not being able to "understand" the work of Ph.Ds is farcical, quite frankly. Does that mean that I believe physicians are more intelligent than Ph.Ds, or vice versa? Of course not. Just try to think a bit about what you're saying before you type it out next time, mmkay?


Thank you for your time.

 

[50960]

Prescribe yourself a valium, and understand that no IQ test has a 4th SD. The tail past the 3rd on both sides is infinite. Anyhow if your IQ is in the 4th it could well be below 20. Take a peek at the standard curve sometime..you sortof proved my point for me.....

 

[CJMPre-Med]

Prescribe yourself a valium, and understand that no IQ test has a 4th SD. The tail past the 3rd on both sides is infinite. Anyhow if your IQ is in the 4th it could well be below 20. Take a peek at the standard curve sometime..you sortof proved my point for me.....

Err, as far as I understand it (admittedly being ignorant of statistics; I don't take it until this coming fall semester), the standard deviation on most IQ tests is roughly 15 points. Is that untrue? I have a 162 verbal IQ, and the average IQ is 100. Do the math. Regardless, this wasn't intended as braggadocio, and was only mentioned because you seem to think that others are "misreading" what you've stated when in fact that is anything but what's happening; I'm merely reading what you wrote as it appears on the screen. But it's interesting to note that you cannot refute any of the points I've raised regarding your manner of expression.

 

[deleted6669]

so wont this DNP program affect the demand for PAs in the future?

YES-it should increase the demand for pa's!
conversation inside doc's head:
hmm np and pa applying for the same job......pa has a masters and np has a "doctorate"...hmmm probably thinks she's as good as me...might even try some of that "independence" nonsense....better hire the pa......

 

[jwk]

YES-it should increase the demand for pa's!
conversation inside doc's head:
hmm np and pa applying for the same job......pa has a masters and np has a "doctorate"...hmmm probably thinks she's as good as me...might even try some of that "independence" nonsense....better hire the pa......

Agreed!

 

[hospPA]

YES-it should increase the demand for pa's!
conversation inside doc's head:
hmm np and pa applying for the same job......pa has a masters and np has a "doctorate"...hmmm probably thinks she's as good as me...might even try some of that "independence" nonsense....better hire the pa......

I was thinking more like, "Doctor? YEAH RIGHT! Who the h$ll do they think they are? 4 years of part-time fluff and they call themselves doctor."

Pat

 

[group_theory]

If I am doing the work I'd like to see the compensation.

so wont this DNP program affect the demand for PAs in the future?

NPs and PAs are attractive to physician groups because they are cheaper than getting another physician to join the group. If NPs with greater debt load from nursing school (for their doctorates) start demanding physician salaries, then what would be the financial advantage of hiring an NP instead of another MD/DO. Or worse, if a physician group wants to hire a midlevel, the PA would cost less than the NP.

 

[JohnDO]

what would be the financial advantage of hiring an NP instead of another MD/DO. Or worse, if a physician group wants to hire a midlevel, the PA would cost less than the NP.

Indeed. There will be no incentive to hire an NP whatsoever, especially when you can get another MD/DO for the same 'price'. They will also lose their ability to compete with PA's, and will thus be stuck somewhere in the middle. Physicians seeking help will look to other physicians or PAs.

 

[hospPA]

Indeed. There will be no incentive to hire an NP whatsoever, especially when you can get another MD/DO for the same 'price'. They will also lose their ability to compete with PA's, and will thus be stuck somewhere in the middle. Physicians seeking help will look to other physicians or PAs.

One of the gripes a lot of PA's have is that NP's seem like they will work for a piss poor salary. PA's demand more, and get it. NP's, because of the number of schools they have and number of grads they are producing, are making themselves a "dime a dozen". This is not a jab at the quality of graduates, it is a jab at the system for overdoing the quantity of graduates. They need to cut down the number of programs out there. There are 130 PA programs (too many IMHO) and 500+ NP programs in this country.
Unfortunately, a lot of docs hire the NP purely because they will work for cheaper, regardless of the quality of the applicant. So, I doubt with so many of them around, that NP salaries will ever go up as you suggest, regardless of "Pseudo" doctorates.

Pat

 

[DRGIGGLES]

this is a really interesting thread...

since i don't know much about this new program, and the original idea was to garner physicians' opinions about it, i decided to educate myself for two seconds. (sorry, i'd love to do more but i feel pathetic enough sitting here typing on a saturday night when i should either be partying, sleeping or reading the stack of journals i keep ignoring. plus, in all honesty, i really don't give that much of a damn.) anyway, here's some information that might prove valuable to those still formulating an opinion...

from the u of tenn website (ok, not columbia but certainly not a slouch school):

[Doctor of Nursing Practice

The Doctor of Nursing Practice (DNP) is a program of fulltime doctoral study for the nurse seeking specialty preparation in advanced levels of nursing practice.

The DNP Program educates clinicians for leadership roles in a specialized area of advanced practice with an emphasis on:

1. Philosophical, ethical, and scientific principles that provide the foundation for leadership in professional nursing care;
2. Continued acquisition of knowledge and clinical skills in an area of advanced practice specialization;
3. Analysis and examination of practice including completion of the Residency Project during the clinical residency year.

The DNP curriculum is Web-mediated including opportunities for synchronous and asynchronous learning. Students are only required to be on campus 4 times a year (July, December, January, & April) for 5 to 7 days each session. With faculty approval, clinical courses can be completed in the student's state of residence. ]

i added the bold. so if i'm reading this correctly you can do this program by being on campus 4 times per year and doing the rest of it over the web.

the columbia program, which i won't post all the details of, is basically 40 hours on top of a master's. there are a few prerequisite courses as well. here are a few tidbits from their FAQs:

[Is a master's degree in nursing required for admission?
No. The program is designed with two entry points. Students may be admitted with either a baccalaureate or masters in nursing. The post master's program will be offered first, beginning in 2005.

Is full-time study required?
Yes, The DrNP program is only available for full-time students. In 2005, DrNP students will enter in the fall for full-time study. The first year will include thirty credits of course work and field experiences offered over the fall and spring semesters. The courses will require attendance 2-3 days/week. The second year will consist of a full-time Residency and seminar.]

here's what i've gotten from my two second research: at one program, i can get the DNP essentially over the web and at another "full-time" program, i will have to go 2-3 times per week for one year followed by my one year residency. if you look further in the website, you will find that the residency is 28-40 hours per week.

after carefully analyzing the above data and taking another sip of my cool frosty friend here, all i can say is wow, what rigor. did any of you other docs see the 28 hour per week residency when you were filing for the match? (ok, maybe you pm&r guys soaked up those spots...sorry, i couldn't resist a little dig here.) anyway, need i say more?

sure i do. i usually try to keep an even keel here on SD but this time i have to say, this effort by the nursing profession is astoundingly naive at best and pathetically laughable at worst. in light of the above, i COMPLETELY agree with the sentiment of many of the other posters. this is simply an attempt to grab a little power, a little more money and little more respect. i'm afraid it's going to backfire, as theorized by some of the posters.

in fact, for me it already has. i wish i didn't do my two second research. usually this sort of thing makes no difference to me but now i'm afraid the first time i see a long coat with DNP on it, it's going to be really hard to stifle my giggle. i'm just going to think about that 28 hour/week residency and feel like peeing my pants. damn it all! this is hard enough for me already. oh well...i picked the name for a reason i guess.

-drgiggles

 

[windsurfr]

I asked several administrators at my hospital about the "Dr." issue. A smaller hospital in town is already spearheading a policy that no one other than an MD / DO can address themselves to patients as "Doctor". Not a PhD, PsyD, PharmD, LRD, DNP, etc. This is to protect the patient from false information and prevent confusion. Our institiution (quite large) is considering a similar policy. Any thoughts?

 

[zenman]

I asked several administrators at my hospital about the "Dr." issue. A smaller hospital in town is already spearheading a policy that no one other than an MD / DO can address themselves to patients as "Doctor". Not a PhD, PsyD, PharmD, LRD, DNP, etc. This is to protect the patient from false information and prevent confusion. Our institiution (quite large) is considering a similar policy. Any thoughts?

Well, since holders of the Ph.D. are the only real doctors, they should also retain the title. It's easy to tell the patients who you are.

 

[windsurfr]

Correct. However in the healthcare settting "Doctor"=Physician. Patients do not know the difference between all the letters behind the name, and therefore the hospital is making an attempt to clear the confusion.

 

[50960]

Patient's know the difference, and even if they did not that is really their problem, and it is an easy ignorance to correct. This is about egos and the increasing amount of health providers who are doctors of something other than medicine. No damage will result in a patient thinking a PhD is the same as am MD because it is the doctor's responsibility to practice within their own expertise, not the patient's.

 

[windsurfr]

Good point....

 

[PACtoDOC]

Patient's know the difference, and even if they did not that is really their problem, and it is an easy ignorance to correct. This is about egos and the increasing amount of health providers who are doctors of something other than medicine. No damage will result in a patient thinking a PhD is the same as am MD because it is the doctor's responsibility to practice within their own expertise, not the patient's.

Oh okay, its the patient's problem!! That sounds like something you might here in the former communist USSR. Perhaps thats where we should send all these new DNP's to work!!!

 

[50960]

Perhaps.

 

[punjabiMD]

Patient's know the difference, and even if they did not that is really their problem, and it is an easy ignorance to correct.

no, they don't. They regularly see hospital staff wearing long white coats come into their rooms to speak about a variety of issues- the patient sees a person standing next to their bed with a litany of capitalized initials after the name embroidered on the white coat (MD, FNP, PA-C, RN, LPN, RT, PT, OT, MT, RDMS, CRNA, RD, CRTT, and so on.. I think you get the point).

You could argue (justly) that it is the healthcare providers job to clarify their role in the patient's care when they introduce themselves... but you know what? As a medical student, I wear a SHORT white coat (w/o any embroidered name or degrees) and at least 10-15% of my patients think that I'm an attending physician or resident (despite repeatedly telling them otherwise).

No damage will result in a patient thinking a PhD is the same as am MD because it is the doctor's responsibility to practice within their own expertise, not the patient's.

Please, don't say that this confusion would not lead to any problems! We ALL know that this not true (unless you have not worked in an actual large-hospital setting, where confusion and red tape run rampant).

 

[50960]

It is not really worth arguing about. I can guarantee you if a hospital tries to tell people with a legitimate doctorate they cannot refer to themselves professionally as "doctor", there will be a lawsuit.

 

[PACtoDOC]

It is not really worth arguing about. I can guarantee you if a hospital tries to tell people with a legitimate doctorate they cannot refer to themselves professionally as "doctor", there will be a lawsuit.

Wrong again. Hospitals can and do enforce various standards of professional conduct and they can in fact dictate whatever type of policy they see fit to protect their patients. The "doctor" can always choose to practice elsewhere, or the hospital can choose not to credential the "doctor" (and they don't need a reason to do this).

 

[NotChoCheez!]

[Sarcasm on]

No it's not about ego. As you can clearly see from my signature, I have a PhD in phrenology and will soon be a Doctor of Reflexology. After graduating, I plan to put my skills to use as a dental assistant in my uncle's dental practice. It will be a cold day in Hades indeed when I let a patient get away with not addressing me as "doctor."

[Sarcasm off]

 

[rn29306]

Sorry guys, have to side with the mds on this one:
(boy am i gonna get flamed for this one)

1. anyone besides a medical student or physician wearing a white coat in a hospital should be shot on sight. our crna program requires us to wear the white coat and i personally hate it. EVERYONE assumes i am a dr and it does get old after a while. citizens at large assume (incorrectly, but still) that white coat = physician.

2. anyone calling themselves a doctor in a medical institution who is not a physician should be hung by their toenails, then shot. the public at large and most medical people assume (and rightly so in this case) that doctor = physician.

Anyone calling themselves a doctor or introducing themselves as such when he / she is not a physician should be guilty of fraud.

rn29306

 

[50960]

I meant it is an ego fight for the MDs, not the others.
I am a psychologist, with a legit doctorate, working in a large hospital where I have been privileged by the medical staff; I am even on the privileging committee. YES a hospital can do what they want, but so can individuals, unions etc.. I guarantee you such a policy would spark a suit. As for the nursing comment that is just ignorant..get a doctorate and then speak about the issue. I did not wish to be called Dr. when I had an AA degree either.
Why do surgeons in the UK revert to Mr, Ms after they become surgeons? Think about it....

 

[50960]

PS. I am not a proponent of the Dnp thing. However I know NP s with a PhD in a clinical field (psych etc) who are called Dr, and deserve to be. When a doctor of education wants to referred to as doctor in a medical setting that is unethical. An MD in no more a doctor that a PhD etc....actually less by the definition.

Cheeze...you are a dork..lol

 

[rn29306]

As for the nursing comment that is just ignorant..get a doctorate and then speak about the issue.

That is exactly the problem that some have with the doctorate of nursing and no it is not an ignorant statement.

 

[beastmaster]

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".

As silly as some of your arguments are, you do make one valid point, albeit by accident.

If a DNP wishes, by 2015 (who knows what the healthcare climate will be), to be independent and compete with primary care physicians, by all means they should have that right. MD/DOs may not want to hear this, but the ensuing competition will lead to decreased healthcare costs because a chunk of the population may be more inclined to a visit an inexpensive DNP. Fat-cat PCPs will have to prove their worth for the buck, rather than enjoy the monopoly they currently have on primary care. The marketplace (as crippled as it is) can sort the rest out by pushing more physicians into subspecialties.

 

[PACtoDOC]

As silly as some of your arguments are, you do make one valid point, albeit by accident.

If a DNP wishes, by 2015 (who knows what the healthcare climate will be), to be independent and compete with primary care physicians, by all means they should have that right. MD/DOs may not want to hear this, but the ensuing competition will lead to decreased healthcare costs because a chunk of the population may be more inclined to a visit an inexpensive DNP. Fat-cat PCPs will have to prove their worth for the buck, rather than enjoy the monopoly they currently have on primary care. The marketplace (as crippled as it is) can sort the rest out by pushing more physicians into subspecialties.

What do you think the healthcare costs will be when the less educated NP has no clue and misses the diagnosis of a very treatable disease pathology, when it was still in the cheap-to-treat stage? And how much do you think it will cost the insurance companies when the NP's triple the number of current referrals to specialists because they are not trained to a level capable of caring for common disease entities? It won't take long for big medicine to realize that these people need to go back to the ward and put on their tight white skirts and paper hats with the red cross on them!! Or maybe that was one of those movies that my Dad used to keep in his underwear drawer!!!

 

[50960]

LOL.... I sense maybe you were cath'd by a mean nurse somewhere along the line!!

 

[Docgeorge]

Why do surgeons in the UK revert to Mr, Ms after they become surgeons? Think about it....

Actually why dont you read about it. Surgeons are calle Mr. or Ms. because of holdbacks to day when surgeons were not physicians, but rather barbers. As science and the practice of surgery evolved, having a barber cut on you seemed to be not such a bright idea, and surgery became a branch of medicine who were infact fully qualified physicians. The Brits have this facination with what used to be. As a result of traditions, and to stand appart from their more traditional brethern (much as PT boat officers dipped their brass in sea water to stand out form the big ship officers)who practicied Medicine they started refering to themsleves as Mr. But make no mistake that they are Physicians, and are not cofused as anything else, because in england...at least in the hospital I've seen only Physicians wear long coats.

 

[50960]

Ya I know... I was educated in London. I was not suggesting they are not physicians.

 

[beastmaster]

What do you think the healthcare costs will be when the less educated NP has no clue and misses the diagnosis of a very treatable disease pathology, when it was still in the cheap-to-treat stage? And how much do you think it will cost the insurance companies when the NP's triple the number of current referrals to specialists because they are not trained to a level capable of caring for common disease entities? It won't take long for big medicine to realize that these people need to go back to the ward and put on their tight white skirts and paper hats with the red cross on them!! Or maybe that was one of those movies that my Dad used to keep in his underwear drawer!!!

If your scenario occurs, the DrNP will be revealed as failure, strengthening the position of MDs and justify their cost.

But hey, you're telling me that with upto 10 years of post-undergrad schooling (assuming a curriculum is specially designed) that a DrNP would be incapable of reasonable diagnostic and treatment strategy is a tough argument to make dude. With 0.1% higher error rate in diagnosis, it would still be an economically viable alternative to a more expensive MD.

With a powerful legal lobby, society could have to face the fact that medical care cannot be perfect. And if they want pay 60% less for care that is 0.1% less perfect, let them see how they like it. But, realistically I don't see this happening any time soon.

 

[deleted6669]

[
QUOTE=beastmaster]If your scenario occurs, the DrNP will be revealed as failure, strengthening the position of MDs and justify their cost.

But hey, you're telling me that with upto 10 years of post-undergrad schooling (assuming a curriculum is specially designed) that a DrNP would be incapable of reasonable diagnostic and treatment strategy is a tough argument to make dude. With 0.1% higher error rate in diagnosis, it would still be an economically viable alternative to a more expensive MD.

With a powerful legal lobby, society could have to face the fact that medical care cannot be perfect. And if they want pay 60% less for care that is 0.1% less perfect, let them see how they like it. But, realistically I don't see this happening any time soon.[/QUOTE]

where do you get 10 years?
bsn 4 years
ms np 2 years( maybe less...a lot of np programs are 20 months or so-part time no less)
dnp 2 years(also part time)
8 years total, 4 of them part time

I have an ms as a pa and have 9 years.....
bs 4 yrs
paramedic program 1 yr
pa program 3 years( bs #2)
masters emergency medicine fellowship 1 year

 

[beastmaster]

where do you get 10 years?
bsn 4 years
ms np 2 years( maybe less...a lot of np programs are 20 months or so-part time no less)
dnp 2 years(also part time)
8 years total, 4 of them part time

I have an ms as a pa and have 9 years.....
bs 4 yrs
paramedic program 1 yr
pa program 3 years( bs #2)
masters emergency medicine fellowship 1 year

I said upto 10 years, we have to wait and see how the program is structured. But then again, I'm just thinking out loud. The day will come, sooner or later, that an MD/DO will not be the first line of defense in primary care. How that will happen, I do not know.

 

[group_theory]

Just curious,

for the non-physician doctorates out there in clinical setting,

when you approach a patient and the patient ask you "are you a doctor?"

Would you answer

"Yes I have a doctorate, but I'm a ...insert name of profession ..." (Pharmacy, DPT, PhD, PsyD, etc)

"Yes" (nothing else)

"No"

"No, I'm not a medical doctor, but I do have a doctorate in "

or another response


Why am I asking this? Like it or not, the general public will equate doctor = physician (hence the yelling "someone get a doctor!!" instead of "someone get a physician"). I was wondering how people w/ DNP or clinical doctorates will respond or should respond when patients ask "are you a doctor?".

 

[deleted6669]

if I had a phd or dhsc( I don't at the present time) I would still say:
hi my name is "emedpa", one of the em pa's in the dept.
my cv and name tag would say: PA-C, DHSc, EMT-P but I would not introduce myself as"dr" or expect to be called "dr" unless it was outside of a clinical setting, for instance if I was lecturing at a pa program or credited in a journal manuscript. in that setting anyone with a brain can figure out that "emedpa, phd" is not an md.

 

[PACtoDOC]

I said upto 10 years, we have to wait and see how the program is structured. But then again, I'm just thinking out loud. The day will come, sooner or later, that an MD/DO will not be the first line of defense in primary care. How that will happen, I do not know.

It will only take one 20/20 propaganda story showing how some NP missed something like nephrotic syndrome and instead sent the poor patient home with a thiazide diuretic to "take care of their fluid retention". Minimal change disease is very common in young adults, and can be easily cured with steroids, not diuretics. I guarantee if you lined up 300 NP's, not a damn one of them could explain the pathophysiology of the epithelial podocyte foot processes and how they get jacked up in this disorder. As a PA, I had never even heard of such a diagnosis. As an almost doctor now, I have already seen it 3 times in 9 months.

Now go ahead NP's run to your little cookbook of medical algorithms and come back knowing all about Lipoid Nephrosis, as I expect you will. But bottom line is that even EMED will hopefully fess up and show that even someone with decades of medical knowledge well superior to an NP, is still not a doctor. Its okay to admit that you don't know what a physician knows. Just don't expect the world to sacrifice their first borns to save a buck. FP will always be dominated by physicians and until I die, I will gladly intend to testify at any state's legislative session about the need to keep physicians as the in-charge. Don't underestimate the damage a former midlevel turned physician can do to a bunch of wannabe NP's trying to get more power. I can happily testify for hours about simple diagnoses I once knew nothing about as a midlevel provider, but now am comfortable treating.

NO NP PCP's on this doc's watch!!!!!

 

[windsurfr]

Docgeorge:
Think about it.... pick up a medical economics journal or talk to someone who actually knows about medical finace. What percentage of the US health care dollar is spent on MD's. You figure this out... then figure out what 60% of that is. This is what the public would "save" for seeing an NP or PA. (I'll give you a hint: the cost is way below 10%)

So your final cost saved is somewhere in the ballpark of 1.5% On a 150 dollar visit this is about 2-3 bucks. Now lets think about what the costs are for an NP or PA to order even one more MRI a week than an MD. (Hint: Way more than a grand).

You do the math. Now envision when NP's and PA's (with their new independence) finally get slammed with a 3 million dollar lawsuit and the floodgates open. What will happen to their MRI/CT/Cardiolyte/etc ordering practice. Trust me, the powers that be will be watching very closely. NP's and PA's are valuable members of the health-care team, but they are not physicians. Unfortunately medicine is a buisness and people will be scrutinizing these things very closely. As always I am looking foreward to arguements and other points of view... in the end hopefully we all learn from the mess that we are getting into.