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Give me examples of what an IM doc can do that an NP can NOT do

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MacGyver

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Surely there are a few procedures out there that are restricted to docs only.

But NPs have full script rights with NO doc oversight/supervision. They can literally prescribe any drug than an IM doc can prescribe.

NPs can also open up their own clinics, with no doctor oversight.

They can admit and discharge patients in many hospitals, and can run the full course of diagnostic studies and lab tests.
 

papilloma

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An IM doc also have full script right to take care of a patient with CHF with no cardiology oversight/supervision. Chances are, if the IM doc cares, he will recognize his knowledge base limitations and refer to cardiologist when he sees a CHF. I'm guessing the same goes for NPs.

Originally posted by MacGyver
Surely there are a few procedures out there that are restricted to docs only.

But NPs have full script rights with NO doc oversight/supervision. They can literally prescribe any drug than an IM doc can prescribe.

NPs can also open up their own clinics, with no doctor oversight.

They can admit and discharge patients in many hospitals, and can run the full course of diagnostic studies and lab tests.
 

MacGyver

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You assume too much for NPs... most of them feel they can handle everything on their own with no referrals.
 

papilloma

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Then they might end up getting sued (losing money and license) to malpractice, just like an IM doc would if he/she didnt make proper referrals.

Originally posted by MacGyver
You assume too much for NPs... most of them feel they can handle everything on their own with no referrals.
 

Kalel

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NP's refer way too often, which causes an overutilization of specialists that ends up costing the insurance companies money. That's why some won't let NP's make referrals. When they don't refer, they oftentimes end up missing diagnoses or mismanaging patients. IM requires a lot of knowledge that you learned in med school; if anything, I'd say that NP's have a bigger shot at taking over something like derm which doesn't require as much knowledge from your med school years or CRNA's and anesthesiology or some specialty where patients don't get to know their providers. Anyways, as I stated in your "FP is a dying profession" thread, I don't think that any one specialty is invulnerable to these turf wars. Every specialty has allied health providers that want a bigger piece of their pie.
 

MacGyver

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Originally posted by Kalel
Every specialty has allied health providers that want a bigger piece of their pie.


Turf wars between MDs is ENTIRELY different than turf wars between midlevels and MDs.

With MDs, doctors control scope of practice.

with nurses, MDs have NO SAY in scope of practice.

I'm still trying to figure out what the hell MDs were doing when the NPs were changing all the regulations to expand their scope left and right.

I think many of you dont understand how much power they have. Their scope is dictated SOLELY by whatever the state nursing boards say. If the state nursing boards decide that their NPs shold be able to do surgeries, then with a stroke of a pen its done. Now, they are a little more shrewd than that so they are not going for the grand slam home run all at once.

Piece, by piece, procedure by procedure, they have expanded their scope over time.

NPs competing with MDs directly is a bad thing because the MDs will lose everytime due to money issues. MDs cost at least double the salary of an NP. Once the NP scope is expanded, the genie is out of the bottle and there is no going back.

Of course, FP and IM are on the front lines. As I said, many hospitals have made it so that NPs and IM docs are IDENTICAL such that NPs can do anything and everything that an IM doc can do, with no oversight or supervision. Wage suppression will be th end result. So far, no IM docs have been pushed out of their jobs, but their salaries WILL fall as a result.

Its time for IM docs and FP docs to take notice as to what the NPs are trying to do. NPs have a very effective lobby. MDs have been asleep at the wheel for far too long.
 

edik

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Speaking from personal exprience... I had to have a TB skin test done. Then NP insisted that I was positive since the redness was over 5cm in diameter, and strongly suggested that I take antibiotics for 6-9 months. I was unable to convince her that she should measure the elevation, not the redness.
If I didn't know any better, I would be killing my liver for nothing for 6 months.
Depth of knowledge is the difference in my opinion.
 

beyond all hope

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IM docs have way more training. That can make all the difference sometimes. Just like the last poster stated, depth of knowledge can make all of the difference, and when you're talking about your health.

What's the difference between high-output heart failure and low-output heart failure? Don't ask an NP because they're clinically identical, but the treatment can be very different. What's the difference between systolic and diastolic heart failure...same point.

90% of medidine is repetition. NPs can do that very well. It's the 10% of the time that serious insight is required that you want an MD. And those 10% cases are usually the most important.
 

MacGyver

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Originally posted by beyond all hope
IM docs have way more training. That can make all the difference sometimes. Just like the last poster stated, depth of knowledge can make all of the difference, and when you're talking about your health.

What's the difference between high-output heart failure and low-output heart failure? Don't ask an NP because they're clinically identical, but the treatment can be very different. What's the difference between systolic and diastolic heart failure...same point.

90% of medidine is repetition. NPs can do that very well. It's the 10% of the time that serious insight is required that you want an MD. And those 10% cases are usually the most important.

So I guess you dont have a problem with NPs running their own clinics, will full script rights, with full hospital privileges, with no doctor oversight?
 

avendesora

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Originally posted by beyond all hope

90% of medidine is repetition. NPs can do that very well. It's the 10% of the time that serious insight is required that you want an MD. And those 10% cases are usually the most important.

This is pretty much what it comes down to. I have worked with NP's and have received my healthcare from an NP at my sh**y student health center. From their training, NP's just approach a problem a different way. Hard to describe, but more of a "automatic" way of dealing with things. I hesitate to say "unthinking" because some of them are very smart, but that's what it kind of felt like last time I saw the NP.

Also, to the issue of NP's performing surgery, I go news for you -- at least in CT surgery at my institution, "physician extenders" are already doing much of the case, with the CT surgeon just coming in just to do the critical parts.

The ideal use of a physician extender would be in an MD's office, under the supervision of an MD, seeing the so-called "normals". It's too bad that we are moving away from that. NP's serve a useful purpose, but given the choice, I would not see one or send my loved ones to one in a solo situation.

Also -- to the dude with the PPD -- I sincerely hope it was not 5cm indurated ;)
 

MacGyver

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Originally posted by avendesora
Also, to the issue of NP's performing surgery, I go news for you -- at least in CT surgery at my institution, "physician extenders" are already doing much of the case, with the CT surgeon just coming in just to do the critical parts.

There is no state in the country that allows a PA or NP or anyone besides an MD/DO to run a surgery without MD supervision.

PAs are allowed to do a lot of the work, but its still against regs to run it themselves. I'm sure the PAs are working to change that right now.

At any rate, I dont think you understand how powerful the state nursing boards are in some states. In 25 states, the board of nursing is the SOLE DECISION MAKER on scope of practice of NPs. If they wanted to, they could write an addendum to their scope to include surgery immediately. There is nothing the MDs could do about it either besides raise a ruckus and protest.

PAs are a different animal, because they are controlled by state medical boards. The only way PAs can expand their scope is if the state medical board (composed of MD/DOs) allows them to.

The state medical board in 25 states has NO SAY in what scope of practice NPs have.
 

augmel

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Macgyver, the problem with your theory is that mid-levels don't want to take on all the responsibility of an MD for less money. They want the SAME money. Do you think that a NP or PA wants to take q4 call and admit patients in the middle of the night for the rest of their career for 50k per year? Hell no. They want the money too, therefore, where is the economic incentive to utilize them more?
 

MacGyver

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Originally posted by augmel
Macgyver, the problem with your theory is that mid-levels don't want to take on all the responsibility of an MD for less money. They want the SAME money. Do you think that a NP or PA wants to take q4 call and admit patients in the middle of the night for the rest of their career for 50k per year? Hell no. They want the money too, therefore, where is the economic incentive to utilize them more?

NPs generally make 75-80k, not 50k. RNs make 50k. Its all about choices. NPs would love to make as much as MDs, but they are PERFECTLY SATISIFIED WITH THE 75k salary. Your theory that they wont practice as NPs unless they make EXACTLY as much money as an FP MD is wrong.

75k is a lot less than most FP MDs make. This will only drive down FP MD salaries and reimbursement.
 

papilloma

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You are all speaking as though patients have no choice in this. Take yourselves or your parents as examples. If they feel palpitations from their hearts, or severe back pains, or coughing up blood, are they going to make an appointment to see the doc or the np, especially if the appointment can be in weeks? Does your family choose to have "your personal family doctor" or "your family nurse practitioner" monitoring your health, especially those with more severe cases. If one has cancer, are you going to let a nurse p follow up on you, or a doc, or better yet, an oncologist.

Despite what the law says, the patient is going to make choices. For me, I'd rather pay more bucks to make sure I'm getting 100% of right answers when it comes to my health than anything less. If I think I have anything wrong with me, I going to see my doc.
 

juddson

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I have always found this issue interesting.

One of two things are going on:

On the one hand, perhaps NP's are not taking on (cannot take on in the future) additional responsibilities because they simply lack the training to do it well. This would mean that in the aggregate solo NP's and NP's who work beyond thier traditional scope of practice would experience higher morbidity and mortality rates. This would drive up insurance costs and work, in general, to depress their wages and responsibilities - thereby keeping them at a practice level which you obviously think is more appropriate. Hence, if their relative lack of training would AUTOMATICALLY prevent them from practicing beyond thier scope and render them non-threatening to IM's.

On the other hand, perhaps NP's do NOT experience higher morbidity and mortality rates when they practice beyond thier traditional scope. In that case, MD's have little basis upon which to complain about the situation. They will have been overqualified and (therefore) unjustly overcompensated.

If an NP really CAN do everything an MD can do, a normal person would be driven to question the value all that extra medical training brings, and the compensation that comes with it. The barrier to MD level practice is either genuine (it reallty does take that much training) or it is not (MD's are no better care providers than NP's are). In the first case, you have nothing to worry about. In the second case, you have no basis to complain.

Judd
 

papilloma

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People, look. In the courtroom, the accused can self-defend without a JD, or can hire a chain-store lawyer to defend the case, or get some Yale attorney/Johnny Cochran to beef it up. It is the exact same in medicine. If you have chest pains, you can self diagnose at webMD.com, go see an accupuncturist, a np, or MD. Whom the patients consult will not be based on the law, but the patients. In the end, the chain-store lawyer will always be that, and Johnny Cochran will always be the famous guy who can save anybody if you can pay him the big bucks.
 

papilloma

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Not to mention, if I am having a heart attack, I demand a cardiologist revive me. And if they do not consent and give me some np, my family is going to sue the damn hospital, no matter what the law says. Tell me your family wouldnt do the exact same.
 

papilloma

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And during that heart attack, I'd rather sell my house to pay cardiology than pay $100 to np and end up dead.
 

red-rat

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One of my past teachers is a NP. She recived an email from the board that accredits nursing programs that said they plan to move the requirements to become an NP from a masters to a doctorate deegre by 2015. Like the doctorate some physical thearapist get.

Hello doctor nurse. :eek: :eek:

What the F**K!
 

peptidoglycan

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I noticed this year that at the local school that trains PTs, they are giving the PhD where they used to give the masters, with the same amount of education. So you go to school for a couple of years and instead of walking out with a masters, you get a PhD. Does anyone know anymore about this practice? Is what I'm hearing just a bad rumor?
 

uxbridge

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Haha If that is the case, it just looks like they're after the title "Dr" which would end up confusing many patients.
 

uxbridge

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red-rat said:
One of my past teachers is a NP. She recived an email from the board that accredits nursing programs that said they plan to move the requirements to become an NP from a masters to a doctorate deegre by 2015. Like the doctorate some physical thearapist get.

Hello doctor nurse. :eek: :eek:

What the F**K!


Same goes with this issue - if the training for the PhD equates to the training with a Masters, looks like they just want the title "Dr" which will definitely confuse patients/ give the false impression to patients that they're being treated by an MD instead of an NP. tsk tsk.
 

casturba md

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Wow! All that hard work and $140k in med school loans to boot and this is what I get, competition from back door competitors.
 

trauma_junky

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No offense, but you can't even begin to compare the basic science understandings and clinical training. Clinical understanding is great, but in order to extrapolate realy requires a solid understanding of hard basic sciences. IE Biochemistry.
 

trauma_junky

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edik said:
Speaking from personal exprience... I had to have a TB skin test done. Then NP insisted that I was positive since the redness was over 5cm in diameter, and strongly suggested that I take antibiotics for 6-9 months. I was unable to convince her that she should measure the elevation, not the redness.
If I didn't know any better, I would be killing my liver for nothing for 6 months.
Depth of knowledge is the difference in my opinion.

uhh a positive ppd, the next step is a two view chest. I wouldn't want to jump to INR with a positive skin rxn. It is entirely possible you were stuck in that same region in the past and the langerhan cells in that area have processed the antigen and know to respond to it humorally rather than a cell mediated process.
 

Furrball

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peptidoglycan said:
I noticed this year that at the local school that trains PTs, they are giving the PhD where they used to give the masters, with the same amount of education. So you go to school for a couple of years and instead of walking out with a masters, you get a PhD. Does anyone know anymore about this practice? Is what I'm hearing just a bad rumor?

I do not know about PT's, but to earn a PhD one normally must write a thesis based on original research whether one is in the humanities or sciences. Most programs also require the student to pass a series of exams to pass to candidacy and then the candidiate must publicly defend their thesis to be awarded their doctor of philosophy degree. Why would a PT have a doctor of philosophy? Normally the thesis must inlcude three chapters worthy of publication in peer reviewed journals plus an introduction and conclusion. The process normally can not be completed in less than three years and take upwards of seven or a little longer depending on the research.
 

june015b

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MacGyver said:
NPs generally make 75-80k, not 50k. RNs make 50k. Its all about choices. NPs would love to make as much as MDs, but they are PERFECTLY SATISIFIED WITH THE 75k salary. Your theory that they wont practice as NPs unless they make EXACTLY as much money as an FP MD is wrong.

75k is a lot less than most FP MDs make. This will only drive down FP MD salaries and reimbursement.


I know several NP making around 150K in New York area. In general NP get paid around 75K-80K for beginner. When I was in NYC, we had many NP's working for M.D. and N.P. had to report their work to M.D. hospitalists on daily basis. Regarding N.P. having an independent practice...it's very possible where M.D. are scarce (like Alaska, Wyoming, Alabama, etc.) , but it's almost impossible to have one in most of cities in west coast/east coast areas/major other cities.
 

retroviridae

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What can't a NP do that an IM doc can? Apply for Fellowship! :laugh:

Given the economics of the situation, I really do envision a time where all out-patient non-specialist medicine is handled by "trained" paramedical staff. MDs will be relegated to supervising these people and handling in-patient medicine. At least for now, the specialities are safe ... although so many NP/PA work in specialities in academia now, that that might change.

I know an ER doc from Poland, who said that after WWII, Poland graduated people early from med school because of a shortage of doctors. In the last 10 years, they have started making those people complete their med school programs in order to keep working. He found it ironic that as Poland moved away from its stop-gap measure (because of the losses of war), the US was moving in that direction due to money. I can't argue against the fact that the US cannot afford our healthcare system. Something has got to give. Lower MD salaries, lower drug costs, lower hospital bills, lower malpractice, etc.
 

casturba md

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what about just increasing the enrollment in medical schools in the US? There are plenty of worthy, ambitious MD candidates that have to go down south or not go anywhere at all.
 

CJMPre-Med

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retroviridae said:
I can't argue against the fact that the US cannot afford our healthcare system. Something has got to give. Lower MD salaries, lower drug costs, lower hospital bills, lower malpractice, etc.

Or, we can raise wages in the US to where they should be across the board and mandate that people pay out of pocket for a certain percentage of their medical costs each year based on income bracket. The only reason that "costs" are out of control is because of the role of third parties play in the payment process (i.e., insurance companies and government via medicare/caid). When a doctor or hospital can't recoup costs from insurance co's, and hence can't make any profit at all, then billing levels go up and uninsured, cash-paying patients get reamed. Unfortunately, no one will ever attempt to remove such proxies from the medical process.
 

red-rat

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uxbridge said:
Same goes with this issue - if the training for the PhD equates to the training with a Masters, looks like they just want the title "Dr" which will definitely confuse patients/ give the false impression to patients that they're being treated by an MD instead of an NP. tsk tsk.

For exaple a person with a BS or BA degree can get their Doctor of Physical Therapy in like 33 months of graduate school. They do much less research than a PHD. THeir degree is a DPT not a PHD. THeir are already over 80 programs in the USA. See link for info:

http://www.apta.org/Education/dpt/dpt_faq#BM1

THIS IS SIMILAR TO WHAT THE NURSE PRACTIOTIONERS EDUCATION ACCREDITING BODY IS GOING TO START DOING! :eek: NP would then be able to be called doctor (not physician). Thus doctor nurse.One less diffrence between a mid level practitioner and MD/DO.

What do you think?
 

Furrball

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Well if you add up the months for an MD

1st year approx: 9
2nd year approx: 10
3rd year approx: 12
4th year we pay for 12 but it's only about 9:

Total = 40 months or so, 33 isn't that much less or about what it takes for a JD? An MD with a completed residency program is very roughly equivalent to a PhD. It's at that point both degree holders are qualified to have positions as post doctoral fellows. The PhD post-doc and the MD/DO fellow are different but have roughly equivalent positions in their spheres of influence.

I think what separates us from DPTs or DNPs -- ND is a naturopath -- is the fact that MDs and DOs are required to complete residency training. Besides does it really matter if someone's lab coat has DNP embroidered on it as opposed to NP? Now if they start trying to compete with us for residency positions then I say take em down.

The PAs and the NPs I've known fill different roles than MD/DOs. They go home at 5 or 6 it is the residents and attendings who stay the night and come up with the treatment plans. Primary care is different, but even there the NPs I've encountered know when to go to the FP or IM physician to ask for help.
 

Easydoesit

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People,

Why respond to such forum trolls? :mad:


In medicine, there will always be people practicing as:

1) Board certified, fully accredited, licensed physicians in their area of expertise and practicing within their scope and fund of knowledge (i.e. a cardiologist, a Cardiothoracic surgeon) :love:

2) Those physicians who are licensed, (and perhaps board certified in something), but not necessarily practicing within their scope of expertise or knowledge. An example is a general practitioner who is doing liposuction. Most people would go to a board certified plastic surgeon--someone who is well trained in anatomy and physiology, and one who knows the vascular plains and risks associated with even the most routine procedures (i.e. pneumothorax for lipo), and how to deal with them should the worse happen.

3) Without a medical license (illegal, but unfortunately it happens)

or

4) So called mid-levels and/or non physicians. Included are dentists, NPs, PA's, CRNAs, chiropracters, PTs, OTs, and everyone else that can be called "doctors," etc. Many can practice independently, depending on the state and more importantly the hospital/clinic. Most, however, have physicians who are either "overlooking" what they do, or have to answer in some way to a physician. True, in a rural setting, FP's and NP's probably have the same job description. True, perhaps in some health clinics and even some community hospitals, NPs have more autonomy. But the vast majority of university hospitals and academic centers have physicians running the show. Period. Despite local law. Hospitals can hire/fire and set policies as they see fit. Most hospitals (due to legal implications) require physicians be the ultimate ones responsible for pt well being. Otherwise, NPs mostly practice in office-based settings and smaller, private community hospitals, or ERs that have a fast track type system.


Take home message:

I believe that NPs and all non-physicians in health care are integral. They should ideally work as a team, to utilize resources and labor appropriately. Not be in competition. It is up to the primary care provider to refer appropriately--to specialists or other. Ultimately, it is up to the patient to seek out and find someone they trust as their PCP, whether it is a RN or MD, or friend's mom across the street. I know many competent PAs and NPs who do a great job caring for patients. That being said, they will never replace physicians, and nor will physician salaries fall dramatically. They all serve a purpose in our twisted health care system. Why worry or respond to trolls who post messages intended to start a silly flame war? :oops: (for the record, I am just posting to alleviate this problem in the future). No worries!!!! :laugh:
 

brendang

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uxbridge said:
Haha If that is the case, it just looks like they're after the title "Dr" which would end up confusing many patients.

tell me about it... check out the ophtho forum. optometrists freely call themselves "eye doctors" and confuse the $hit out of patients all the time... it has gotten to the point that they have fooled themselves into thinking that they went to medical school and now want surgical rights!!!
 

Furrball

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Easydoesit said:
People,
Why respond to such forum trolls?
I believe that NPs and all non-physicians in health care are integral. They should ideally work as a team, to utilize resources and labor appropriately. Not be in competition. It is up to the primary care provider to refer appropriately--to specialists or other. Ultimately, it is up to the patient to seek out and find someone they trust as their PCP, whether it is a RN or MD, or friend's mom across the street. I know many competent PAs and NPs who do a great job caring for patients. That being said, they will never replace physicians, and nor will physician salaries fall dramatically. They all serve a purpose in our twisted health care system. Why worry or respond to trolls who post messages intended to start a silly flame war? :oops: (for the record, I am just posting to alleviate this problem in the future). No worries!!!! :laugh:

Very well said! :clap:
 

red-rat

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Many dont know about the plan to make all or almost all graduate prepared nurses recive a doctorate degree. Whether you think it is bad or not is up to you.

This is a press release

"Currently, advanced practice nurses (APNs), including Nurse Practitioners, Clinical Nurse Specialists, Nurse Mid-Wives, and Nurse Anesthetists, are prepared in master's degree programs that often carry a credit load equivalent to doctoral degrees in the other health professions. AACN's newly adopted Position Statement on the Practice Doctorate in Nursing calls for educating APNs and other nurses seeking top clinical roles in Doctor of Nursing Practice (DNP) programs."

Reference:
http://www.aacn.nche.edu/Media/NewsReleases/DNPRelease.htm

The fact is midlevels scope of practice (in some states) and nuber of practioners is increasing.The title of doctor is now something that NPs will gain. This could be confusing and misleading to patients.

So you think im a troll for talking about this. I guess internet discussion boards are not for communication. :rolleyes:
 

Easydoesit

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red-rat said:
So you think im a troll for talking about this. I guess internet discussion boards are not for communication. :rolleyes:


No, you are not a troll for bringing this up for discussion. :scared:

This topic (and many similar topics ) have been talked about many times already. Here, in this forum, and elsewhere. Nothing new. Like beating a dead horse. In fact, there are already "doctor nurses." I know a few who have their RN and PhD. Instead, they will have their nursing doctorate in something clinically based. Dont change much. So they can do a few more things. Good! Less work and scut for physicians. They are still nurses. There are, and will be, many professionals clamoring to be called doctor. Whatever. There are countless forum trolls that post naive/ignorant & inflammatory posts just to rile up the likes of young med studs or residents. Like CRNAs claiming they can do anything an anesthesiologist can do. Like optometrists claiming they can do anything "real" eye docs can do. Etc. Etc. Etcetera!

There are only 2 groups who are indeed physicians. MDs and DOs. They exist for a reason. No one, not optometrists, not psychologists, not chiropracters, not nurses--will ever (or at least any time soon) be legally called physicians. I heard in some states chiropracters want that title. So far, access denied! Realistically, state legislatures and the informed public will never let that happen. It is true that in general, physicians need to do a better job at lobbying against certain policies requested by larger and more vocal lobbyists (i.e. psychologists wanting to prescribe meds). Physicians need to inform the public and yes, even the US/state senators about the differnces between physicians and the MANY doctors. But these types of groups have and will continue to exist, and they will always fight for more autonomy and power (heck, can I blame them? If I were in their shoes, I probably would do the same).

However, bottom line is physicians have been around since biblical times. They will always have a job, and a place in our health care system. And in general, they will always be considered as the ultimate in health care "expertise." Maybe there will be a doctor nurse who will become the national leading expert on post-MI dietary guidelines. Big Whoop. If anyone wants to do that, be my guest (including physicians, who would be just as capable should they choose to be).


AGAIN NO WORRIES!!!!!!!!!!!!!!!!!! :laugh:
 

Jeff05

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1. understand the scope and practice of EBM

2. further the field of medicine through research design and implementation
 
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deleted6669

" further the field of medicine through research design and implementation"

have to disagree with you on this one....anyone can do basic medical research and have it published. the study that convinced everyone not to patch all corneal abrasions was done by a pa in the masters in em residency in west virginia.....
 

ERMudPhud

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red-rat said:
One of my past teachers is a NP. ...
Who goes and digs up a >1 year old thread from Macgyver's "The sky is falling midlevels secret plan to take over the world" days.

trauma_junky said:
uhh a positive ppd, the next step is a two view chest. I wouldn't want to jump to INR with a positive skin rxn. It is entirely possible you were stuck in that same region in the past and the langerhan cells in that area have processed the antigen and know to respond to it humorally rather than a cell mediated process.

The original PPD post was about the difference between measuring the induration vs erythema in assessing a PPD. I've known MDs and RNs who didn't appreciate the difference so I don't think the importance of measuring the induration is a secret taught only in med school.

The CDC recommendation for a positive PPD in a health care worker is for a CXR to distinguish active disease from exposure. If your CXR is negative but your PPD induration is positive than you will more than likely need INH for 6-9 months. If your CXR is positive you will need sputum testing, AFB cultures, and longer treatment with possibly more drugs.

As for the Langerhans cell hypothesis. Langerhans cells are skin dendritic cells (although back in the day we thought they were skin resident macrophages). In any event, they are primarily antigen presenting cells and are not responsible for immunologic memory. Even if they have seen PPD before they should not respond appreciably to a further PPD. Perhaps Trauma Junky is thinking of the boost effect where someone with an old TB infection has their T cell responses "boosted" by an initial negative appearing PPD resulting in a second PPD being positive.
 

MacGyver

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As usual, greater than 1 year since I started this thread I see many people who like to play pretend that this stuff with midlevels and NPs isnt really happening. Have fun playing in your dream world. :rolleyes:

I'm shocked and apalled that I'm the only person who bothers to keep informed on whats going on in the outside world regarding midlevels. Do you guys really think this doesnt apply to you? You wont feel that way when you find out that your new "attending physician" is an NP instead of a real doctor.

There is a battle waging here people. Psychologists now have script rights in 3 states. CRNAs have virtual independence in half of all states. NDs (naturopaths) have FULL SCRIPT RIGHTS INCLUDING SCHEDULE II NARCOTICS in 2 states, and 3 other states are considering it too. Optometrists have surgical privileges in Oklahoma, and 5 other states are considering it. Chiropractors are pushing for script rights in 10 states currently. NPs are starting doctoral level clinical programs and are expected to require DNP degrees within 15 years.

Its up to us to put a stop to this bull****. Your fatcat attendings dont have the best interests of the profession at heart. Hell they are the ones who sold out the profession with their so-called "supervision" of midlevels. PAs are one thing. Their duties are controlled by the state medical board. The only way PAs can expand their independence/scope/authority is if the medical boards controlled by MDs allow them to do so. But NPs are a whole other enemy. Unlike PAs, the medical boards have ZERO CONTROL over NPs.

They fall under the state nursing board, which has the state-vested authority to define "nursing" as however they see fit. If the state nursing board wanted to, they could define surgery as "nursing" and then allow NPs to start doing it. Once these DNP programs are up and running, I have no doubt their next move will be to redefine all kinds of specialty areas of medicine as "nursing" and thus engage on a new wave of turf wars. You think its bad now, people, you aint seen nothing yet. These DNP programs represent the second greatest threat to doctors (only socialized medicine is worse)

DO NOT AGREE TO SUPERVISE NPs, EVEN IF MEDICARE/MEDICAID/INSURANCE REIMBURSES YOU FOR IT!! I cannot stress how important that is. If you get involved with all these cursory supervisory relationships with NPs, it only furthers their agenda.
 
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