for the DNP haters

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BlondeDocteur

BlondeDocteur

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I thought you might enjoy this. Every Columbia affiliate just received a laudatory email from the president of the University re: Mary Mundinger's retirement. Here are some excerpts.

Most notably, Dr. Mundinger led the School of Nursing to the forefront of education advances in nursing with the development of a Doctor of Nursing Practice (DNP) degree. Helping to fill the nationwide shortage of primary care clinicians, the program educates nurses in sophisticated diagnostic and treatment competencies needed to care for patients in a variety of settings, from hospital to ambulatory care. Established in 2004, the DNP program was the first of its kind in the world. Since then, more than 200 schools have established similar clinical doctorate programs or have plans to institute such a program.

Dr. Mundinger is founder of Columbia Advanced Practice Nurse Associates (CAPNA), the first independent primary care faculty practice in which nurse practitioners hold commercial managed care contracts and are compensated at the same rate as primary care physicians. The School was also the first in which faculty gained admitting privileges at an academic health center hospital. Dr. Mundinger was named the Centennial Professor in Health Policy at the School of Nursing in 1995, the first chair of health policy in a nursing school nationwide. Her contributions to the advancement of nursing have been acknowledged with elected membership to the Institute of Medicine of the National Academy of Sciences, the American Academy of Nursing, and the New York Academy of Medicine. She holds a BS degree cum laude from the University of Michigan and a doctorate in public health from Columbia's Mailman School of Public Health.
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Did anyone else know the business about admitting privileges?
 
It is interesting to hear, but I suspect the higher numbers at med schools will equalize this DNP threat because person who are 200,000$ in debt will take any residency spot available.
 
BlondeDocteur said:
I thought you might enjoy this. Every Columbia affiliate just received a laudatory email from the president of the University re: Mary Mundinger's retirement. Here are some excerpts.

Did anyone else know the business about admitting privileges?
Click to expand...

No, but I just choked on my dinner while reading that letter-- what the heck, did Mundinger write that piece of crap herself?
 
I am clearly late to this conversation, but I had a couple questions. What are the requirements for a DNP both for admission and afterwards? Is it simply a BSN? Or do they need x number of yrs of experience? (Its a 3 yr program, right?) And what about after? Do they need to complete a residency or other apprentice-type training? It sounds like they are allowed autonomous care without any supervision???? (Which I believe is different from NP's?)

Hans - will more primary care docs chase DNP's out ofthe field? Or will more DNP's lower reimbursement for primary care docs??? I guess we will have to wait and see.

One tangential question: has the addition of CRNA's saved any money? I dont know how many CRNA's each MD can supervise, but if its only a few, we are paying more people and at some point paying one person a little bit more is not that different from paying one person less plus a fraction of one person who is paid a lot more. (I know - if CRNA's had their way, MD's would be available for backup and liability. But last I checked, CRNAs and MD's both get paid pretty well thus 1.25 or 1.3 salaries rather than 1.)

Also, you gotta love that all training is getting longer and longer. NP --> DNP. MPT --> DPT's now. I am sure they are going to push for higher salaries because of more training and educational debt. But will the extra year or so of training make them more qualified to provide better care for pts? Next thing you know, after 2 yrs of college you will get a Doctorate in the degree of Bachelor of Arts or something. Our educational system keeps getting dumbed down farther and farther until at some point a degree is totally worthless.
 
abbaroodle said:
I am clearly late to this conversation, but I had a couple questions. What are the requirements for a DNP both for admission and afterwards? Is it simply a BSN? Or do they need x number of yrs of experience? (Its a 3 yr program, right?) And what about after? Do they need to complete a residency or other apprentice-type training? It sounds like they are allowed autonomous care without any supervision???? (Which I believe is different from NP's?)

Hans - will more primary care docs chase DNP's out ofthe field? Or will more DNP's lower reimbursement for primary care docs??? I guess we will have to wait and see.

One tangential question: has the addition of CRNA's saved any money? I dont know how many CRNA's each MD can supervise, but if its only a few, we are paying more people and at some point paying one person a little bit more is not that different from paying one person less plus a fraction of one person who is paid a lot more. (I know - if CRNA's had their way, MD's would be available for backup and liability. But last I checked, CRNAs and MD's both get paid pretty well thus 1.25 or 1.3 salaries rather than 1.)

Also, you gotta love that all training is getting longer and longer. NP --> DNP. MPT --> DPT's now. I am sure they are going to push for higher salaries because of more training and educational debt. But will the extra year or so of training make them more qualified to provide better care for pts? Next thing you know, after 2 yrs of college you will get a Doctorate in the degree of Bachelor of Arts or something. Our educational system keeps getting dumbed down farther and farther until at some point a degree is totally worthless.
Click to expand...

So to answer your question... there isn't really a good answer. They didn't really come up with a standard DNP education-- some of the DNP programs are online, some of them are part time, some of them are full-time, some of them require a certain amount of clinical experience after receiving your BSN, others are direct-entry. The curriculum between the programs also seems to differ, but most of them seem to consist of fluff courses like "nursing leadership," "advanced nursing theory," etc. I think I would need a course just to understand what the heck these courses are about.

It sounds like they're changing the name, claiming that they're improving their education to the equal that of physicians so that they CAN gain complete autonomy. Some states allow NP's (It think 23 states-- go to allnurses.com; trust me these girls have those numbers memorized) to practice without physician supervision, but as far as I know, most hospitals do not allow NP's independent admitting priviliges.
 
silas2642 said:
So to answer your question... there isn't really a good answer. They didn't really come up with a standard DNP education-- some of the DNP programs are online, some of them are part time, some of them are full-time, some of them require a certain amount of clinical experience after receiving your BSN, others are direct-entry. The curriculum between the programs also seems to differ, but most of them seem to consist of fluff courses like "nursing leadership," "advanced nursing theory," etc. I think I would need a course just to understand what the heck these courses are about.

It sounds like they're changing the name, claiming that they're improving their education to the equal that of physicians so that they CAN gain complete autonomy. Some states allow NP's (It think 23 states-- go to allnurses.com; trust me these girls have those numbers memorized) to practice without physician supervision, but as far as I know, most hospitals do not allow NP's independent admitting priviliges.
Click to expand...

the dnp education is a joke. they talk kabout preparing nurses for unsupervised clinical practice and there' are programs without even clinical classes in their "online" curriculum. Its a freaking joke, I feel bad/sorry for the patients in this country, that they health is been treated by a online educational program
 
i've actually started a movement to use mundinger as an expletive. Kinda like Capt. Kirk shouting Kahn!!!!! MUNDINGER!!! (waving fist in the air)
 
futIDdoc said:
i've actually started a movement to use mundinger as an expletive. Kinda like Capt. Kirk shouting Kahn!!!!! MUNDINGER!!! (waving fist in the air)
Click to expand...
How about making it a euphemism for someone trying to do something well beyond their capabilities. As in:

"Today in clinic the attending asked me if I could hear the patient's murmur, but I couldn't even tell the two heart sounds apart; I felt like such a Mundinger."
 
Soooo...
To be honest and not a total d*ck, but...

What have YOU done about it...

Yes, I'm speaking to you who are reading this...

Complain, complain, complain, but have any of you written your medical boards, your senator or congressman?

I've been on these boards ~8years now and everyone b*tches and moans, but very few DO anything about it.

Take the time that you would respond to these threads and email or even better, snail mail, your reps, med boards, and COLLEAGUES.

(yes, I have done all the above) 🙂

talk the talk, and walk the walk
 
Dr. Mundinger is founder of Columbia Advanced Practice Nurse Associates (CAPNA), the first independent primary care faculty practice in which nurse practitioners hold commercial managed care contracts and are compensated at the same rate as primary care physicians. The School was also the first in which faculty gained admitting privileges at an academic health center hospital.​

Thank you for the email. It confirms what I have been saying. This is the vision that Mundinger has for the DNP. She wants it so DNP = MD = DO in every way possible. That includes reimbursements, admitting privileges, and rank in department.

It is our job as future physicians to make the facts known about this degree. I wouldn't have a problem if the training was equivalent to MD/DO, but the differences are too great to ignore. We need to educate the public, physicians, insurance execs, and lawyers about the differences.
 
abbaroodle said:
Also, you gotta love that all training is getting longer and longer. NP --> DNP. MPT --> DPT's now. I am sure they are going to push for higher salaries because of more training and educational debt.
Click to expand...

Salary won't change since the market hasn't changed, only the number of years of schooling has changed.

The DNP is worrisome because I feel it's a backdoor to an MD, but without the depth of knowledge or extensive training of one. However, I am willing to concede that if DNPs can find a marketplace, then they have the right to stay. If people are willing to pay to see a DNP and perceive no change in patient care, then maybe it's a signal that MDs are overtraining their primary care doctors. But if DNPs result in higher mortality, then the medical establishment are justified in their fears and resulting lawsuits will end the DNP idea. Only time will tell.
 
TysonCook said:
Soooo...
To be honest and not a total d*ck, but...

What have YOU done about it...

Yes, I'm speaking to you who are reading this...

Complain, complain, complain, but have any of you written your medical boards, your senator or congressman?

I've been on these boards ~8years now and everyone b*tches and moans, but very few DO anything about it.

Take the time that you would respond to these threads and email or even better, snail mail, your reps, med boards, and COLLEAGUES.

(yes, I have done all the above) 🙂

talk the talk, and walk the walk
Click to expand...

I also have done all the above but never have received a freaking response. I'll continue to try.
 
I've gotten responses, but the onus is on us to contact our reps etc. Nobody cares for MD's except us, and it takes just as much time to click a link above as it does to post here 🙂
Sweet!
Nova- Great links!
 
Does anyone know of any well worded "cut-and-paste" letters or such (written perhaps by a professional organization) that we can use to send to our legislatures? ACEP had an easy to use drop-down form that generated an automatic letter to your representative of choice regarding an issue that they were backing. Does anyone know of anything similar in regards to the mid-level issue?
 
Reading just that frustrates the heck out of me. I guess I'll just plan on specializing (as if there's a choice). Starting med school next fall and I already feel compelled to excel beyond means so that I don't end up competing against this insane "movement" as a PCP.
 
Primary care is not done. (D)NPs will only make a two tiered system on another variable.

1) Tiered upon wealth. Government care vs. private care
2) (D)NPs vs. Physicians. Guess who will practice private care and government care?

There is no need to fear going into primary care. Your training, and skills will set you apart. You should fear the government taking over medicine, and you should fear having to take insurance for a living. A primary care physician can charge cash. Do you think specialists can really charge cash only for their procedures or consultations? The 'better' choice isn't to specialize.

Drug companies are being demonized. They will no longer be dependable for advancements in our country or in the future. We are stripping them of their profits. Most of our country wants More for nothing. They don't want to spend money on healthcare and there is a push for socialization. Doing so will be far worse for specialists as their salaries are reduced to incentivize primary care. As people realize their they are paid the pennies of DNP and patients realize how much they loathe the new system, there will be an exodus.

Physicians and patients finding each other in the traditional doctor patient relationship with the goal of treating neither like a cog in a machine. Respect, freedom, income, improved patient outcomes, increased patient satisfaction will all be met. Welcome to the new glory of primary care. It is coming.
 
Good Solutions said:
Primary care is not done. (D)NPs will only make a two tiered system on another variable.

1) Tiered upon wealth. Government care vs. private care
2) (D)NPs vs. Physicians. Guess who will practice private care and government care?

There is no need to fear going into primary care. Your training, and skills will set you apart. You should fear the government taking over medicine, and you should fear having to take insurance for a living. A primary care physician can charge cash. Do you think specialists can really charge cash only for their procedures or consultations? The 'better' choice isn't to specialize.

Drug companies are being demonized. They will no longer be dependable for advancements in our country or in the future. We are stripping them of their profits. Most of our country wants More for nothing. They don't want to spend money on healthcare and there is a push for socialization. Doing so will be far worse for specialists as their salaries are reduced to incentivize primary care. As people realize their they are paid the pennies of DNP and patients realize how much they loathe the new system, there will be an exodus.

Physicians and patients finding each other in the traditional doctor patient relationship with the goal of treating neither like a cog in a machine. Respect, freedom, income, improved patient outcomes, increased patient satisfaction will all be met. Welcome to the new glory of primary care. It is coming.
Click to expand...


you really believe patients are going to pay you money to see them? you are kidding yourself. If they can get the janiitor to see them for free on a miniscule chance that the janitor may make them feel better, they will see the janitor. WHy give you money? You are a money sucking scum. (according to everyone, not me). Patients are pissed off when they have to pay 30 bucks co pay. Your idea is nice but you are dreaming. and guess what, government has already taken over medicine the govt is responsible for 60 percent of healthcare spending. so guess what? ThEY get to tell you what to do.

I feel bad for the people who are just starting to study medicine, boy are they in for it.
 
I seriously don't understand how some of you can not be banned for speaking suck vile things about fellow professionals. Mary Mundinger is brilliant.
name calling and outright bashing ought to ban a person from further posting. being new to this site i have seen several people get their accounts banned for speaking their mind, yet not others.

Is this not what free speach is all about.

I do not think it is fair that you do not let the dissenters speak--yet you can bash and name call and talk trash and its all public for the world to see

I think you should be ashamed for bashing mundinger in this fashion
 
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