Interesting AMA Legislation

[jonwill]

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AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES Resolution: 303 (A-08)

Introduced by: Illinois Delegation

Subject: Protection of the Titles “Doctor,” “Resident” and “Residency”

Referred to: Reference Committee C (David M. Lichtman, MD, Chair)

Whereas, Certain specialty societies recognize that many allied health care professions have improved their educational standards and incorporated doctorate designations in their training programs; and

Whereas, Many nursing schools have re-titled their training program as a Residency and their students as Residents, despite the traditional attribution of these titles to medical doctors and their training programs; and

Whereas, The growing trend of this title encroachment is of concern because patients will be confused when the titles of Doctor, Resident and Residency are applied to non-physicians who hold non-medical doctorates or to non-physicians in training; therefore be it

RESOLVED, That our American Medical Association adopt that the title “Doctor,” in a medical setting, apply only to physicians licensed to practice medicine in all its branches, dentists and podiatrists (New HOD Policy); and be it further

RESOLVED, That our AMA adopt policy that the title “Resident” apply only to individuals enrolled in physician, dentist or podiatrist training programs (New HOD Policy); and be it further

RESOLVED, That our AMA adopt policy that the title “Residency” apply only to physician, dentist or podiatrist training programs (New HOD Policy); and be it further

RESOLVED, That our AMA serve to protect, through legislation, the titles “Doctor,” “Resident” and “Residency.” (Directive to Take Action)
Fiscal Note: Staff cost estimated at less than $500 to implement.

 

[WADO]

Certainly makes sense. I wonder what the AMA outlook is for other fields like optometry and pharmacy, which could conceivably be in a hospital setting as well.

 

[darazon]

So the AMA is finally saying, "yes podiatrists are real doctors", or am I reading this thing wrong??

 

[MaseratiGT]

Certainly makes sense. I wonder what the AMA outlook is for other fields like optometry and pharmacy, which could conceivably be in a hospital setting as well.

So the AMA is finally saying, "yes podiatrists are real doctors", or am I reading this thing wrong??

If you read other forums, especially regarding DNP's using the title "Doctor" in a patients room, it seems like the AMA selected those who can use the title very carefully.

A lot of it stems from DNP going into patient's room in the hospital and saying, "Hello, I'm Dr. X," instead of "Hello, I'm the NP." I think it's more of a fight against them than the lot of them at the ready to jump on podiatry's bandwagon.

I'm not sure how I feel about the situation. USF now has an NP derm "residency" and plan to follow with these extremely watered down versions of post graduate training. I definitely think that NPs have a place within medicine. But how long will it be until the NPs want a piece of the podiatry pie?

 

[215353]

I'm not sure how I feel about the situation. USF now has an NP derm "residency" and plan to follow with these extremely watered down versions of post graduate training. I definitely think that NPs have a place within medicine. But how long will it be until the NPs want a piece of the podiatry pie?

MaseratiGT,

You took the words right out of my mouth. I too have been reading that same thread and was going to comment on this as well. If DNPs are getting a watered-down post grad training in Derm and are able to do a lot of the things that MD or DO derms can do then I would not put it past the major organization for nursing (don't know the name of it) to start trying to push its way into podiatry or other specialties as well.

Think about it...there are areas in the US where there are little to no Pods. Whose to stop DNPs from forming another watered down post-grad fellowship program in chip and clip? Maybe even training in preventing diabetes related foot ulceration!

The purpose of having DNPs was because it was another answer to the shortage of primary care physicians. Now they are fighting to move into other specialties where there might not be enough specialty physicians to take on new patients.

I am not saying that DNPs are not needed because they are. Someone has to pick up the slack for the lack of primary care providers. It's just scary because the head nursing organization is a pretty powerful force.

Nurses are a legitimate force in anesthesiology with the number of CRNAs (who make a ridiculous amount of money btw) being pumped out every year as well. And they are not done in that area of medicine either. From what I have read they are fighting to be able to administer anesthesia on their own and not be observed by an MDA or DOA. If that is ever officially allowed that will probably doom the MDA and DOA profession. Although CRNAs make serious bank they still make less then the typical MDA or DOA. Hospitals would certainly want to hire more of them to cut costs. They are always actively wanting and fighting for things they think they deserve. It's commendable and scary at the same time.

 

[WADO]

I'm not sure how I feel about the situation. USF now has an NP derm "residency" and plan to follow with these extremely watered down versions of post graduate training. I definitely think that NPs have a place within medicine. But how long will it be until the NPs want a piece of the podiatry pie?

It seems like every profession tries to push the boundaries of their scope of practice without having to step foot into medical school. This will probably deter a lot of students from going into medical school since they would be able to circumvent medical school and become a "doctor" with less formal education.

 

[Feli]

The NP issue is interesting. I think I almost agree with #18 here:
http://forums.studentdoctor.net/showthread.php?p=9536576#post9536576

They simply can't have their cake (near physician level care/services) and eat it too (lack of physician malpractice liability). Hiding behind the "supervising physician" might work for a few low level cares, but if they want to increase scope, then they will have to take accountability for their failure to diagnose/treat, procedure complications, etc also. I don't view them as any real threat to podiatry; our training is incredible, and there's just no way they could provide anywhere near a comparable level of care and overall F&A services with a "crash course" type of education.

It seems NPs have a valuable service and help many people, and it's great they're upping their level of education. Still, trying to misrepresent themself as a residency trained physician is misleading, and this AMA proposal is a good idea for the good of the public. The part about the NP telling her patients she's just like a doctor except for the pay was pretty laughable; she casually failed to mention lack of a 3+yr hospital residency, physician board certs, possible fellowship, etc... just minor details.

 

[MaseratiGT]

I don't view them as any real threat to podiatry; our training is incredible, and there's just no way they could provide anywhere near a comparable level of care and overall F&A services with a "crash course" type of education.

A couple of years ago, I'm sure the dermatologists, cardiologists, orthos, peds, and psychiatrists all said the same thing...these are all "residencies" available to DNPs. The cardiology residency @ USF is Interventional Cardiology.

http://health.usf.edu/nocms/nursing/AdmissionsPrograms/DNP_Residency_Fall2008.pdf

I wouldn't discount the lobbying effects of the nurses. It seems they are getting whatever specialties they want. IC for MDs and DOs is 13 to 14 years of training!!!

I just think we're in a "lucky" time period right now. We don't have mid-levels trying to come and move out our business. But our specialty is just as vulnerable as cardio was. Even dentists are fighting the good fight in some states against hygienists performing simple fillings. I definitely think we're not immune to this. Especially when we, as 11 year trained doctors, are not on equal footing in some states as our MD and DO colleagues.

Don't look @ me in 10 years when Dr. Nurse BlahBlah DNP RN LPN CNA LOL MBA, Board Certified Foot Specialist, opens shop right across from Dr. X, FACFAS! 😆

 

[Feli]

...I wouldn't discount the lobbying effects of the nurses. It seems they are getting whatever specialties they want. IC for MDs and DOs is 13 to 14 years of training!!!

I just think we're in a "lucky" time period right now. We don't have mid-levels trying to come and move out our business. But our specialty is just as vulnerable as cardio was...

Don't look @ me in 10 years when Dr. Nurse BlahBlah DNP RN LPN CNA LOL MBA, Board Certified Foot Specialist, opens shop right across from Dr. X, FACFAS! 😆

You fail to grasp how good our training is... and how much brighter and harder working the average MD/DO/DPM/DDS is than the average nurse. They can pass their classes, their boards, their clinicals, their residencies, etc. The vast majority of them would never pass ours. Not only is our education longer chronologically, it's also much higher quality. You will come to realize that when you reach the clinicals, residency, CME, etc.

I invite any competition for my services in any form... pedorthists, chiros, other DPMs, other MD/DO specialists, etc. So long as they represent themselves and their training for what they are... and will face the same legal, financial, and professional liability I do on the services we provide. When you're good, you're good. Other providers offering inferior quality on the same or similar services only stands to make your high end skills be in even more demand. The public will realize that in a highly skilled trade such as medicine, you often get what you pay for...
http://forums.studentdoctor.net/showpost.php?p=9586751&postcount=49

What we do is not easy; that's why even many who undergo the rigorous training are still not great at it. It's a highly skilled trade. Mistakes are made, but less training and less intelligent students (ie medical school + residency vs NP school + "residency") will mean more mistakes...
http://forums.studentdoctor.net/showpost.php?p=9589622&postcount=55

 

[dyk343]

Obviously a doctoral program is going to be more challenging than a nursing program academically wise. But once in the hospital, at least from what I have seen, nurses work very hard. Whenever I visited a doctors office I spend most of my time with the nurse rather than the actual doctor. To say nurses dont work very hard seems to be a harsh statement.

Although the pods I shadowed didnt rely very much on a nurse.

 

[janV88]

So the AMA is finally saying, "yes podiatrists are real doctors", or am I reading this thing wrong??

I don't recall the AMA ever saying that Podiatrists aren't real doctors. I could be wrong tho...

EDIT:
Regarding the DNP issue. Mid levels are here to stay...no use in fighting that issue. I think the issue is when mid levels keep fighting for increased scope and independence, exactly what the nurses are doing. I have an "attack plan" that might work well for the AMA, APMA, AOA, etc. We should support the PA's. As far as I know, PA's seem very content with their role as physician extenders (I could be wrong though). I don't recall any PA school that advertises themselves as independent practioners. Why not back them up so they create competition for DNP's/NP's. By backing up the PA's and calling on all Doctors to hire PA's instead of NP's, NP's will become a dying profession. PA's will become the "gold standard" of mid levels. Demand for PA's will increase, more PA schools will open to fill this demand, and students will see that PA is the best track to becoming a mid level. This would "solve" the need for mid levels and effectively shut the argument that nurses make for the need of DNP's/NP's (to fill physician shortages) while keeping the role of independent practitioners out of the hands of "residency trained" nurses. What do you guys think?

 

[MaseratiGT]

You fail to grasp how good our training is... and how much brighter and harder working the average MD/DO/DPM/DDS is than the average nurse. They can pass their classes, their boards, their clinicals, their residencies, etc. The vast majority of them would never pass ours. Not only is our education longer chronologically, it's also much higher quality. You will come to realize that when you reach the clinicals, residency, CME, etc.

I invite any competition for my services in any form... pedorthists, chiros, other DPMs, other MD/DO specialists, etc. So long as they represent themselves and their training for what they are... and will face the same legal, financial, and professional liability I do on the services we provide. When you're good, you're good. Other providers offering inferior quality on the same or similar services only stands to make your high end skills be in even more demand. The public will realize that in a highly skilled trade such as medicine, you often get what you pay for...
http://forums.studentdoctor.net/showpost.php?p=9586751&postcount=49

What we do is not easy; that's why even many who undergo the rigorous training are still not great at it. It's a highly skilled trade. Mistakes are made, but less training and less intelligent students (ie medical school + residency vs NP school + "residency") will mean more mistakes...
http://forums.studentdoctor.net/showpost.php?p=9589622&postcount=55

Medical boards have nothing to do with nurses. DNPs don't practice medicine under any medical association. They practice under the auspices of nursing practice. I'm not arguing against MDs/DOs/DPMs having superior training or isn't longer. Of course I know that it is. So I don't really understand your 1st counterpoint. You're using my original point/argument. That's exactly what I've been saying...so I haven't really failed to grasp anything. I don't need any rotation to know that much. That's the entire argument against DNPs - that their training is inferior?!

I disagree with your second point. The public often doesn't recognize the difference between initials behind the last name of a clinician. If a DNP can learn to perform the services a board certified dermatologist can, what makes us any different? If DNPs did start to enter the podiatry arena, and became certified thru nursing boards, the public may not even know the difference. And some of them are not representing their level of education. That's the entire purpose of the AMA's new guidelines. They are playing on our court with their rules. So no they won't all be saying, "Hi, I'm Dr. Nurse X. I'm a nurse practitioner. However there is a MD/DO/DPM down the street you can see, if that makes you more comfortable."

Counterpoint to your #3 - There are studies that show that DNPs can handle simple cases with the same outcomes as physicians, with the same likelihood of errors. If DNPs broke into podiatry, they could use their legislative leverage to push for broader scopes, which is happening right now to MD/DOs. ME Burman, AM Hart, SM McCabe - American Journal of Critical Care, 2005 - AACN. They argue that because they can handle simpler cases, they can handle more specialized cases. AND THAT ARGUMENT IS OBVIOUSLY WORKING! From recent lobbying movement, I don't think it will be long before DNPs are pushing to perform surgical procedures. Minor at first, but that will be the St. Peter's Gate for DNPs.


All you need to do is look at what's happening in the MD/DO world. It doesn't matter that medical students spend more time and effort. We all know they do. It doesn't matter that a majority of DNP students can't pass part I. They have no need to. But the nurses still push for more rights. It certainly isn't beyond conceivability that this could happen to us. It's happening to them, even the procedural specialties, as we speak. What is so special and unique about podiatry, that differs from one of the residencies that I posted before, that will keep us immune from the ever-growing DNP speciality scope? Many of those are much more specialized than we are. Our profession is lucrative with the majority of competition from other DPMs. Of course they could start to compete with us with less rigorous credentials! It's like Malibu real estate. We shouldn't stick our heads in the sand and hope it goes away.

 

[MaseratiGT]

Obviously a doctoral program is going to be more challenging than a nursing program academically wise. But once in the hospital, at least from what I have seen, nurses work very hard. Whenever I visited a doctors office I spend most of my time with the nurse rather than the actual doctor. To say nurses dont work very hard seems to be a harsh statement.

Although the pods I shadowed didnt rely very much on a nurse.

I don't disagree with you that nurses work hard. However, DNPs want the same privileges as physicians with a fraction of the clinical hours that medical students/residents get.

I keep using interventional cardiology as an example because it's so striking. The IC DNP "residency" is a mere 1000 clinical hours.

 

[Feli]

... nurses work very hard...

...To say nurses dont work very hard seems to be a harsh statement...

I didn't say they don't work hard. I just said that, on average, docs work harder and are also more intelligent people going into the program. That is why the medical students had higher SAT, ACT, GRE, MCAT, etc scores going in... and why it takes more hours of studying in school, more working hours in residency, etc for completion of the medical training model vs the nursing model.

Again, read the post. I never said that nurses weren't smart or hardworking... I just said that docs are even moreso on average. When you combo that with more didactic training and many many more clinical training hours, there certainly will be an appreciable competency difference for the average practitioner that's produced from each model. I think most would agree.

 

[dyk343]

I didn't say they don't work hard. I just said that, on average, docs work harder and are also more intelligent people going into the program. That is why the medical students had higher SAT, ACT, GRE, MCAT, etc scores going in... and why it takes more hours of studying in school, more working hours in residency, etc for completion of the medical training model vs the nursing model.

Again, read the post. I never said that nurses weren't smart or hardworking... I just said that docs are even moreso on average. When you combo that with more didactic training and many many more clinical training hours, there certainly will be an appreciable competency difference for the average practitioner that's produced from each model. I think most would agree.

Fair enough, I agree with you.

 

[MaseratiGT]

Regarding the DNP issue. Mid levels are here to stay...no use in fighting that issue. I think the issue is when mid levels keep fighting for increased scope and independence, exactly what the nurses are doing. I have an "attack plan" that might work well for the AMA, APMA, AOA, etc. We should support the PA's. As far as I know, PA's seem very content with their role as physician extenders (I could be wrong though). I don't recall any PA school that advertises themselves as independent practioners. Why not back them up so they create competition for DNP's/NP's. By backing up the PA's and calling on all Doctors to hire PA's instead of NP's, NP's will become a dying profession. PA's will become the "gold standard" of mid levels. Demand for PA's will increase, more PA schools will open to fill this demand, and students will see that PA is the best track to becoming a mid level. This would "solve" the need for mid levels and effectively shut the argument that nurses make for the need of DNP's/NP's (to fill physician shortages) while keeping the role of independent practitioners out of the hands of "residency trained" nurses. What do you guys think?

I agree 100% 👍

 

[WADO]

I don't recall the AMA ever saying that Podiatrists aren't real doctors. I could be wrong tho...

EDIT:
Regarding the DNP issue. Mid levels are here to stay...no use in fighting that issue. I think the issue is when mid levels keep fighting for increased scope and independence, exactly what the nurses are doing. I have an "attack plan" that might work well for the AMA, APMA, AOA, etc. We should support the PA's. As far as I know, PA's seem very content with their role as physician extenders (I could be wrong though). I don't recall any PA school that advertises themselves as independent practioners. Why not back them up so they create competition for DNP's/NP's. By backing up the PA's and calling on all Doctors to hire PA's instead of NP's, NP's will become a dying profession. PA's will become the "gold standard" of mid levels. Demand for PA's will increase, more PA schools will open to fill this demand, and students will see that PA is the best track to becoming a mid level. This would "solve" the need for mid levels and effectively shut the argument that nurses make for the need of DNP's/NP's (to fill physician shortages) while keeping the role of independent practitioners out of the hands of "residency trained" nurses. What do you guys think?

This is a tough call because how do you gauge the level of contentment within a profession (mid-level)? It seems to me that all health professions now try to push for an increased scope of practice similar to those of physicians and this also applies to PAs which is evident through threads found on SDN and on the internet. If you do a google search I'm certain you will find PAs that want to push for independent practice rights and a change of their title is a way to get that ball rolling. I sound like a broken record but it seems like there are many mid-levels that want to be a physician but want to achieve that goal without going to medical school.

 

[janV88]

This is a tough call because how do you gauge the level of contentment within a profession (mid-level)? It seems to me that all health professions now try to push for an increased scope of practice similar to those of physicians and this also applies to PAs which is evident through threads found on SDN and on the internet. If you do a google search I'm certain you will find PAs that want to push for independent practice rights and a change of their title is a way to get that ball rolling. I sound like a broken record but it seems like there are many mid-levels that want to be a physician but want to achieve that goal without going to medical school.

Well by doing this you form a "partnership" between Doctors and PA's. Sort of a I scratch your back you scratch mine. Doctors support PA's, demand for PA's increase, Heads of PA organizations continue to sell PA's as physician extenders to keep "partnership" with Doctors healthy. Seems logical but of course, it's human nature to be greedy. It is very possible that PA's will still push for increased scope.

I guess what I'm saying is maybe Doctors should embrace this new trend to atleast have a hand in shaping its future.

 

[dtrack22]

I don't think you can stop it...PT to DPT, NP to DNP, pretty soon we'll have DPA's. All have been debated (even within their own professions) but all became or are becoming the new standard. And I agree that the general public is rather uneducated when it comes to who has what degree/training. If the yellow book and/or tv says DNP Suzie can give me some meds for half the price (or my insurance agrees to cover it) then I go to DNP Suzie.

It's really just a waiting game...either nurses continue to be nurses or they get more privileges, screw up royally, get put out of business after Mr. Greenberg sues the living Bejesus out of a few of them, and go back to being nurses. I guess in the end they will always be nurses which is works for Dr.'s and patients alike.

 

[WADO]

I don't think you can stop it...PT to DPT, NP to DNP, pretty soon we'll have DPA's. All have been debated (even within their own professions) but all became or are becoming the new standard. And I agree that the general public is rather uneducated when it comes to who has what degree/training. If the yellow book and/or tv says DNP Suzie can give me some meds for half the price (or my insurance agrees to cover it) then I go to DNP Suzie.

It's really just a waiting game...either nurses continue to be nurses or they get more privileges, screw up royally, get put out of business after Mr. Greenberg sues the living Bejesus out of a few of them, and go back to being nurses. I guess in the end they will always be nurses which is works for Dr.'s and patients alike.

DPA - what an oxymoron that would be...a doctor that is a doctor's assistant. Funny stuff but unfortunately that is reality and have been in discussion.

 

[MaseratiGT]

I posted yesterday that I didn't think it would be long until DNPs would be in the surgery pot... lo and behold! It's here already!

http://www.medscape.com/viewarticle/500552_3

"As an RNFA student, I have had clinical experience in both vascular and general surgery cases. The specific surgeries include hernia repairs, cyst removal, breast biopsies, abdominal procedures, abdominal aortic aneurysms -- open and endovascular repair, lower extremity bypass, carotid endarterectomies, and amputations. Each procedure requires expertise in basic skills, such as maintaining a sterile environment. I practiced gowning and gloving prior to beginning my clinic rotation. My next step was to learn positioning, prepping, and draping for a procedure. Initially, I merely observed with some minor assisting and retracting. As I gained more experience, I gradually participated more in the cases, eventually able to anticipate the next step, tying knots, and assisting in closure. Even though I have completed the course requirements, I am eager to learn much more of the intricacies of general and vascular surgery."

This poster is also a NP. I'm definitely not saying that RNFAs (Registered Nurse First Assist) aren't valuable because I don't know. However, it seems like the perfect vehicle to start performing minor surgeries. (Notice the specific examples to the lower extremity though.)

 

[MaseratiGT]

This is a tough call because how do you gauge the level of contentment within a profession (mid-level)? It seems to me that all health professions now try to push for an increased scope of practice similar to those of physicians and this also applies to PAs which is evident through threads found on SDN and on the internet. If you do a google search I'm certain you will find PAs that want to push for independent practice rights and a change of their title is a way to get that ball rolling. I sound like a broken record but it seems like there are many mid-levels that want to be a physician but want to achieve that goal without going to medical school.

I think it's safer to stick with PAs. PAs are governed by the medical board of their respective states. Personally, I feel like there are clearer definitions of scope for PAs V. DNPs.

As for nurses staying nurses...we are WELL past that point.

"I am a doctorally prepared nurse," says doctor nurse Ray Scarpa. A doctor, he says, "is a doctorally prepared physician."

Scarpa works in the department of surgery at University Hospital in New Jersey. "I am not here to practice medicine, I am here to practice nursing," he says. "And I practice it at an advanced level, and I have earned the right to be called doctor."

http://www.npr.org/templates/story/story.php?storyId=100921215