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What part of that shows evidence that Nurse Practitioners refer patients more frequently than PA's or other Family Practice Docs?
What part of that shows evidence that Nurse Practitioners refer patients more frequently than PA's or other Family Practice Docs?
What part of that shows evidence that Nurse Practitioners refer patients more frequently than PA's or other Family Practice Docs?
See my last post. You will have less knowledge than a family practice MD. Therefore, you will see more patients with problems of which you have no working knowledge and are unable to treat. One of two things will happen: you will not recognize these problems and release the patient or you will recognize them and refer the patient to more knowledgeable people (real doctors). Giving NP's the benefit of the doubt by assuming that you will actually be able to recognize when you are in over your head, you will generate more referrals than an FP. If you aren't generating more referrals, then you are missing stuff, which wouldn't surprise me.
Again, just conjecture, how about some facts to support this claim.
Again, just conjecture, how about some facts to support this claim.
The fact is you will be less knowledgeable than a family practice MD. You don't need a study to show that.
I actually envy the position you are in...being one of the trailblazers into a new field that was born out of a small kabal of nurses who wanted more respect, status and power than they currently feel they receive who generated an entirely new field with a "doctorate" without much of a curriculum, research, publication, time investment or an idea about. But they were smart, I'll give them that. They made sure that they were not under state medical boards, even though it is obvious that they are practicing medicine, because they knew that their idea is a joke.
No, there is no data or evidence to prove anything about DNPs, good or bad. None. Because every study done was no good. Pure, unadulterated, biased crap. Sure, that Mundingle study in 2000 made it to JAMA, where it was dissected and seen for what it was by numerous people, and then the subsequent paper based on the same experiences a few years later was published in a no name journal that no one reads.
So, no, there is no evidence to refute your position. Yet. We can only hope that someday there will be. So, go forth and "practice". Hopefully you aren't too beaten down by what I'm sure you think was very difficult training. QAnd if anyone gives you flak, you just pull out the, "Show me the evidence" nonsense and then smile because there is none. That must be a very satisfying feeling.
While it is a fact that I don't have the same training as a FP Doc, I have never seen the need to refer a patient to another FP provider. Not that I haven't made a call to a physician a time or two and run a treatment plan past them but I have never sent a patient for a second visit unless they needed a specialist.
I was only asking for something more that "cuz I said so" to show that NPs / PAs generate more "unnecessary" referrals than doctors.
There are a number of studies for the UK that show that NPs there use more resources and preform more tests. However, as usual the problem is with the definition of the NP in the UK which is substantially different than it is here.Again, just conjecture, how about some facts to support this claim.
So, in your opinion, what would be the equivalent degree to a doctorate in nursing practice ?
This is an older post but I'll reply to it anyway....
There is already a doctorate in nursing. It is called the PhD.
There is also already a doctorate in nursing clinical practice. It is called the MD.
Many nurses enter med school every year. They are often better equipped for the rigors of medical education, especially in third year. They fight their way to an MD degree even though MD schools, unlike DO schools, still favor the traditional biology major over nurses (which is a big mistake, in my opinion).
What I don't understand is why some people think it's okay to piss all over the achievements of their nursing colleagues while seeking a shortcut.
A sensible option that most people here would get behind is some sort of midlevel-to-MD bridge program, or even making DNP programs follow a similar curriculum as MD schools, just like the DO programs before them.
Instead, many people wish there to be an "easy mode" path to independent medical practice. No yucky MCATs, no tough nights away from home on call, no icky USMLEs/COMLEXs, and watered-down hard science classes since hard science makes their heads hurt.
This obviously makes real doctors and real med students such as yours truly a little pissy. But hey, maybe we're all just being territorial and elitist, trying to reserve the cool independent medical jobs to people with unfair advantages such as "good work ethic" or "high IQ."
But never mind all that. What is probably more important is trying to explain to your patients why you chose to take the easy route to independent practice. Why you felt that you did not need to spend all those tough years learning real medicine, and instead spent time on such demanding courses as "Nursing Leadership in Medicine" and "Theory and Practice of Nursing." Why you did not feel any particular need to learn all you could learn before putting yourself in charge of the health of your patients.
The patients. Remember them?
Is medicine becoming less complex?"
Your question is appropriate if you believe that residencies were extended because medicine has become more complex. Personally, I don't, and I have heard excellent lectures from Medical Historians that cite the GI Bill and hospitals' desire for cheap labor as the primary reason residencies became (and continue to become) longer.
If dealing with nurses can be a pain now because they think that they know medicine when they don't, can people imagine what it will be like when these nurses start to proclaim, "Well, I'm a doctor too and I'll do as I please". There will be constant bickering from these DNP's because they no doubt want to run the show too. This is a very good reason why more states need to restrict the use of the title "doctor" in a clinical setting. There should be no confusion as to who is in charge of patient care.
As for FP, not according to this:
http://www.aafpfoundation.org/PreBuilt/foundation_dennisresearch.pdf
By the way, I'm not a primary care physician.
Not sure I see the relevance. Looks like the FP residency started in 1969-70 and was originally designed to be 3y. Nothing in there about extending the length of residency training based on an increasing complexity of medicine.
I was specifically referring to the post-WWII era, when residencies really got swinging. I have been told (sorry, no citation) this was a result of the VA choosing to designate post-graduate medical/surgical residencies as "educational" and therefore eligible for reimbursement from the government.
Now a little subset of med school rejects comes along and gets everyone riled up by saying that they should be making the decisions. The sad thing is that now we have all these excellent nurses starting to believe that if you're not the one making the decisions, you're not important.
Now a little subset of med school rejects comes along and gets everyone riled up by saying that they should be making the decisions. The sad thing is that now we have all these excellent nurses starting to believe that if you're not the one making the decisions, you're not important.
A prime example would be caring for a cardiac patient in the ICU. If a 85 year old presents with A fib and is on a heparin gtt, I'm a happy camper and it's gonna be an easy night. The pt is probably going to be a "flip and feed" and make sure her PTT's are okay on her heparin. But what if she develops tachycardia or a 1st degree heart block. Should I be worried, should I call the cardiologist at 3am to tell him she's now in a 1st degree, should I stop her Digoxin? Or what if she develops a junctional rhythm and has a stable blood pressure? But the zinger is, what if she starts having bradycardia, has difficulty breathing, complains of chest pain and possibly complains of a headache?!? Will I be smart enough to know that she may have thrown a clot either to her brain or to her lungs? So, having some advanced knowledge is not a bad thing, it's in how you use that knowledge.
The eye cannot see what the mind does not know.
I'm not surprised that you haven't. If you don't know what to look for, how do you know when you should seek someone with more training?
your job is recognize the change in clinical status and make the call.
Their are many programs that aren't focused at primary care. Acute care NP, Emergency NP, Neonatal NP, Psych / Mental Health NP, Nurse Midwife.Given the emphasis of primary care in most NP programs...
You guys can't have it both ways.
Their are many programs that aren't focused at primary care. Acute care NP, Emergency NP, Neonatal NP, Psych / Mental Health NP, Nurse Midwife.
Nurses are doing research all the time ..and publishing it.
You guys can't have it both ways.
Their are many programs that aren't focused at primary care. Acute care NP, Emergency NP, Neonatal NP, Psych / Mental Health NP, Nurse Midwife.
. Just to clear things up, I"m an RN with 20 years of experience. I WAS accepted to medical school, because my family gave me a hard time about going to nursing school and said I did it due to the fact that I couldn't get accepted into med school. So, I got accepted and STILL DIDN'T GO, because it's not what I want to do.
I am now in an Adult health NP program, MAINLY because it was a program at the local Unversity, where I could attend for "instate" tuition rates and finish my MSN part time so that I could teach nursing school. As I realize now, going the NP route was a great choice because I really feel that I am learning about pathology, pathophysiology and medical treatments to care for patients. I really don't care if I ever have Rx rights and can dispense scripts for ABX or write an order for a CXR. What I DO care about is being able to better care for patients and teach other nurses to do the same.
DNP (which makes sense as I would be teaching nursing students to perform clinical skills.) I really don't give a crap about ordering labs, xrays or rx's, but IMHO, having a nurse that has a CLUE about the pathophysiology of a disease process and understanding the normal and abnormal signs and symptoms related to that prosess would be a HUGE help for an MD.
I agree, patient care is a TEAM approach, Every team wins with power and strategy. Knowledge is power, communication is strategy. So why are we all arguing over knowledge that will provide our patients with better care AND outcomes.
I"m an RN with 20 years of experience. I WAS accepted to medical school, because my family gave me a hard time about going to nursing school and said I did it due to the fact that I couldn't get accepted into med school. So, I got accepted and STILL DIDN'T GO, because it's not what I want to do.
Then why did you apply to med school if you knew you didnt want to go?
Sounds pretty sus to me.
it's kind of funny how many people "apply and get in to med school but chose not to go"
I usually ask what schools they applied to and keep the conversation going. You can usually catch them in the lie
not saying everyone wants to go to med school but it's funny how many people use that line solely for an ego boost
I do not think its an ego boost as much of a way to VALIDATE what they say as true.
Really there are many holes in this argument.
For Some reason that I cannot understand many people in America want a Shortcut into practicing medicine.
I understand why people want the shortcut. It's a great career. Good job security and compensation. I don't understand why we as physicians or the American people as patients would ever allow it.
and then you have threads like this where nurses are absolutely convinced the training is equivalenthttp://allnurses.com/forums/f34/do-you-think-np-s-midlevels-314439-3.html
remember "a doctoral degree is a doctoral degree is a doctoral degree"......riiiiiiiight
I also wonder what would happen if a CNA had a PhD in underwater basketweaving oir whatever and referred to their themselves as "Dr so and so and I basically do all the stuff nurses do anyways".....the nurses would probably go ape-crap over that
We are not physicians, we do not have the same scope of practice. I like the idea of being the best of both worlds, since we can consult someone if need be. What irks me is the idea that "only" an MD can provide full-spectrum care... if so, why do they refer to specialists?
For my own care I don't have a preference. I love NPs but that isn't an option here--if I ever get certified and licensed I will be the only one in the area providing primary care. There are some MDs that I would flat-out refuse to be seen by. Choice is a good thing. NPs will be their own best advertisements.
As for the time it takes to do the programs... a DNP and MD *ARE* the same amount of time (a doctoral degree is a doctoral degree is a doctoral degree), without residency factored in which can account for 1-4 additional years. My stating this is ABSOLUTELY NOT opening the door to arguing for or against the DNP degree. I am not discussing the DNP here... I just wanted to comment on the length of time it does take and clarify that the timeframe for most doctoral degrees, regardless of DNP vs MD vs PhD vs PharmD, is all the same.
Oh, and as far as residencies-First not required for the MD degree-its actually for board certification after licensing, so you are comparing one thing against something totally different,
and then you have threads like this where nurses are absolutely convinced the training is equivalenthttp://allnurses.com/forums/f34/do-you-think-np-s-midlevels-314439-3.html
remember "a doctoral degree is a doctoral degree is a doctoral degree"......riiiiiiiight
What how do you get that from this?As for FP, not according to this:
http://www.aafpfoundation.org/PreBuilt/foundation_dennisresearch.pdf
By the way, I'm not a primary care physician.
1959 released the Report of the Committee on
Preparation for General Practice.
􀂄 Recommended several 2 year graduate pilot
programs to teach General Practice.
􀂄 This eventually grew to 165 programs offering 783
positions, however within 10 years most of the
general practice programs closed.
􀂄 The 2 year pilot programs had focused mainly on
Internal Medicine and Pediatrics, however several
GPs were also practicing minor surgical procedures.
This led to 8 resolutions at the 1960 AMA meeting
which led to including Surgery and Obstetrics
1969 15 pilot programs in Family Practice were
approved and the AMA approved Family Practice as
the newest medical specialty.
􀂄 Spring 1970 1st administration of the certification
exam: 6 hour written exam, exams on charts,
diagnostic data, and patient management.
􀂄 In order to qualify to take the exam, the ABFP
required 3 years of residency with re-certification
every 6 years.
􀂄 American Board of Family Practice was the first
specialty to require periodic re-certification.
􀂄 Re-certification process made up of: mandatory
cognitive written exam, office record review,
mandatory CME of 300 hrs. per 6 year cycle, and a
valid and unrestricted license to practice
I also wonder what would happen if a CNA had a PhD in underwater basketweaving oir whatever and referred to their themselves as "Dr so and so and I basically do all the stuff nurses do anyways".....the nurses would probably go ape-crap over that
To practice medicine in most states also requires an intern year which in our institution is 70.4 hours x 48 weeks or another 3379 hours. What most people miss is there is an average of 12.7 hours of formal didactic instruction per week in internship. So this adds up to another 597 didactic hours and 2800 hours of clinical work. Total minimum to practice medicine in most states (for a US grad) 2412 didactic hours and 6815 clinical hours.
To say that both the DNP and the MD are four year degrees after undergraduate school is technically true. To imply that the DNP and the MD are equivalent in either didactic or clinical training is simply false.
I don't really have a hard time supporting physicians in this, I do have a hard time supporting you. Nursing will now have to make up a new term when horizontal violence is practiced by a former nurse now practicing medicine. I precept medical students, PA students and NPs. I understand the difference in educational models and how to respect people.
I thought he said to post it on another thread to continue. Did you get a pm from the Admin?
BTW: I enjoyed reading this thread. I was told that DNPs had a similar education as a regular doc and can practice in private. However, I had always wondered how it is possible to have the same practice rights with less education and training. This thread certainly cleared up alot of the myth.
thanks!
I did not think we could do clinicals under a PA?
The long answer is that you will occassionally run into attendings who, for whatever reason, wish to maintain their position as "Clinical Faculty" but have no desire to actually do teaching.
The short answer is that of course they can't precept medical students.
The long answer is that you will occassionally run into attendings who, for whatever reason, wish to maintain their position as "Clinical Faculty" but have no desire to actually do teaching. In such instances, they may pawn off their students on to NPs and PAs. In such instances, I'm sure the NP/PA is under the impression that they are "precepting".
Of course, if the school actually knew what was going on, the situation likely wouldn't occur very long.
I have been clinical faculty at 2 fp residencies over the yrs. I was the preceptor of record. the residents see pts in the e.d., present pts to me, we formulate a plan, I see the pts and I sign their charts and write their evals. only my name and signature is on the eval. I also precept medstudents rotating through the dept.
I have been clinical faculty at 2 fp residencies over the yrs. I was the preceptor of record. the residents see pts in the e.d., present pts to me, we formulate a plan, I see the pts and I sign their charts and write their evals. only my name and signature is on the eval. I also precept medstudents rotating through the dept.
Let me get this straight,
A PA is Co signing a CHart for a Doctor ( a resident) ? How is this legal?