KEVINMD blog post on NP. (even neonatologist is fooled)

[GoSpursGo]

The thread has basically gotten to NP vs. MD, which is a topic discussed ad nauseum in this forum. I'll move it to Topics in Healthcare, since it seems like several users who are not medical students are part of the discussion.

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[Mr.S]

That's because you are biased and think that everyone who says anything critical is against you. In reality, I have no bone in the NP vs MD argument. I think it's silly and based fully in ego on both sides. My experience with both found little differences in their knowledgebase on their specific jobs (family doctor, pediatrics, etc.) and I know a few NPs who teach and train med students just like I know MDs who teach and train NPs. I know NPs who are leading research into treating and caring for HIV patients. I know doctors who are leading research into various things. These are typically very experienced people, PhD/MDs, or DNPs. TBH, I really don't care. In my explanations above, I made it clear that all my knowledge is based on me researching the two (talking to people, looking into programs, salary, etc.) to choose one for myself.

My only bone in this whole conversation has always been about the use of the term doctor. MDs do not own that term and have not officially earned that title so to try to take ownership is absurd. If they have earned the title and are recognized as doctors then they can use the title. Anything argument otherwise has no merit unless you can definitively prove that their research was not up to par with expected research out of a professional doctoral student. If you truly want to complain, at least go do original research and an earn an actual doctorate degree.

So, my goal isn't to sound preachy. It's to hopefully point out the bias I see here and silliness of complaining about the title 'doctor' being used by anyone given the honor of using it whether it is honorary or earned.

******* Keep in mind I'm not referring to completely honorary degrees like the actors or people who get honorary degrees for being popular. MD isn't an honorary degree. Only the title doctor is honorary. The degree is terminal professional degree and is well earned.

I know your agenda. It is likely what organized healthcares agenda is.
A dnp is NOT equivalent to a physician.
In ANY respect.
There is NO requirement for General Chemistry with a lab or Organic Chemistry in undergrad.
I cannot even get past this fact to even make an argument. That IS my argument.

 

[jbax42]

I know your agenda. It is likely what organized healthcares agenda is.
A dnp is NOT equivalent to a physician.
In ANY respect.
There is NO requirement for General Chemistry with a lab or Organic Chemistry in undergrad.
I cannot even get past this fact to even make an argument. That IS my argument.

I apologize for the late reply, I didn't know that this topic was still being discussed. I honestly don't know why you are attempting to use Organic Chemistry as some kind of argument when it isn't even remotely important to the practice of an MD. As for chemistry, all of the programs I looked into after your post require general chemistry with a lab. That said, most of the MDs I know do not even remember the basics of OChem. I knew more than them when I started and still do. Not because I'm smarter than them but because I use it more often. You seem to be conflating these things. From what I gathered when I read through the NP documentation, it was created by a group of doctors and nurses to provide the same or better level of care as an MD in a particularly chosen field without the unnecessary information. That's why their rotations are so short because they only do a rotation in one specialty while MDs do it in all specialties. This was seen as unnecessary since most MDs never leave their particular specialty. It also removed requirements for courses that MDs never used while keeping the important courses. So attempting to use the fact that you took classes that you won't even use (unless you go into research) is a bit silly, don't you think?

I can give you an engineering example. I was an electrical engineer before going into bioengineering and before, now, going into Med school. German engineers often are in school for 2-3 years while most US engineers are in school for 4-5 years. Why? Do we know more then them? Generally, yes. But, when expanded on and thought about critically, no. The reason for this is because they choose a very specialized field and focus on that. When they come out they go into that field and, the engineers that I worked with were just as competent as us. In some situations they were more competent. We received a lot more knowledge but we didn't necessarily use that knowledge once we chose our specific focus so it didn't make us more competent in that job. That said, we were able to identify some things outside of our job that they couldn't but they were just as efficient by simply transferring that work over to the department which would take care of it anyways. It really came down to a matter of ego. There were some engineers who were bothered by their short study program and made fun of them even though they were achieving better results than some of those engineers. No different than the Ivy league engineers I worked with who couldn't perform a basic critical analysis problem yet they made fun of non-ivy league engineers when they first started. Over time, that way of thinking went away and after a few years on the job, most of those engineers stopped.

If they decide to change their specialties, they have to go back to school and obtain that new knowledge. That said, to say you will make a better family or adult acute care practitioner just because you learned more information (be it true or not) is a fallacy. The only thing that matters is the information necessary for the job. If you aren't using the knowledge then it does not help.

 

[DPTinthemaking15]

I apologize for the late reply, I didn't know that this topic was still being discussed. I honestly don't know why you are attempting to use Organic Chemistry as some kind of argument when it isn't even remotely important to the practice of an MD. As for chemistry, all of the programs I looked into after your post require general chemistry with a lab. That said, most of the MDs I know do not even remember the basics of OChem. I knew more than them when I started and still do. Not because I'm smarter than them but because I use it more often. You seem to be conflating these things. From what I gathered when I read through the NP documentation, it was created by a group of doctors and nurses to provide the same or better level of care as an MD in a particularly chosen field without the unnecessary information. That's why their rotations are so short because they only do a rotation in one specialty while MDs do it in all specialties. This was seen as unnecessary since most MDs never leave their particular specialty. It also removed requirements for courses that MDs never used while keeping the important courses. So attempting to use the fact that you took classes that you won't even use (unless you go into research) is a bit silly, don't you think?

I can give you an engineering example. I was an electrical engineer before going into bioengineering and before, now, going into Med school. German engineers often are in school for 2-3 years while most US engineers are in school for 4-5 years. Why? Do we know more then them? Generally, yes. But, when expanded on and thought about critically, no. The reason for this is because they choose a very specialized field and focus on that. When they come out they go into that field and, the engineers that I worked with were just as competent as us. In some situations they were more competent. We received a lot more knowledge but we didn't necessarily use that knowledge once we chose our specific focus so it didn't make us more competent in that job. That said, we were able to identify some things outside of our job that they couldn't but they were just as efficient by simply transferring that work over to the department which would take care of it anyways. It really came down to a matter of ego. There were some engineers who were bothered by their short study program and made fun of them even though they were achieving better results than some of those engineers. No different than the Ivy league engineers I worked with who couldn't perform a basic critical analysis problem yet they made fun of non-ivy league engineers when they first started. Over time, that way of thinking went away and after a few years on the job, most of those engineers stopped.

If they decide to change their specialties, they have to go back to school and obtain that new knowledge. That said, to say you will make a better family or adult acute care practitioner just because you learned more information (be it true or not) is a fallacy. The only thing that matters is the information necessary for the job. If you aren't using the knowledge then it does not help.

I’m curious, why are you choosing the medical school route if you read that NP’s have the same/better care? From your statements, it sounds like you would enjoy becoming an NP.

Edit: I’m not being sarcastic. I’m genuinely curious.

 

[KeikoTanaka]

I’m curious, why are you choosing the medical school route if you read that NP’s have the same/better care? From your statements, it sounds like you would enjoy becoming an NP.

Edit: I’m not being sarcastic. I’m genuinely curious.

He said it was because of the money.
I'll be interested to see how his knowledge base diverges in 7 years from his wife, who is an NP, and see what he thinks when he realizes he's much more capable at a more broad number of applications in medicine. Maybe he'll realize Engineering is NOT like medicine because in Engineering if your machine "dies", you build a new one, in medicine, you don't have that option at all. Once he can identify things that "just aren't important to his specialty" maybe he'll realize how important that is. I can't tell you how many Orthopedic problems we ended up having to refer back to someone else (and properly so) because, unlike PTs or Chiropractors who just learn musculoskeletal stuff, the Orthopedic can identify more subtle medical conditions still.

 

[deleted480308]

I have to say that Qualifying Exams do sound like they are probably more stressful than anything we do as medical students... Spend 2+ years in your PhD program, then go take all-day written tests and get orally grilled by leaders of your field, and then if your program doesn't have enough funding maybe 1/3 of your cohort fails out and basically just wasted 2 years of their lives. At least as a US MD student if you bomb the boards exams you still get to become a doctor, just maybe not a neurosurgeon.

Not if bomb means failure

 

[NicMouse64]

To respond do your message by point.

1. Medical schools are far less selective than a good PhD program. That said, it is more selective than other PhD programs so I won't argue this point since it is a fallacia non causae ut causae.

2. To pretend as though MD coursework cant be learned online is a bit nearsighted. I happen to know for a fact that there are already programs looking into this. Any coursework can be translated to an online equivalent (some may require conditions). It is a problem of systems and processes, not necessity. Medical school programs (a system) are older and rigid and will take time to adapt to this new way of learning. As an example, mechanical and electrical engineering for example (one of my undergrad degrees was in EE). While newer programs are able to build around new technologies and systems (I am using system in a broad sense here so not just technological). So this point is rather null. There have been many studies done on this point and have found that online programs offer no disadvantage in regards to learning if done properly. NP programs, to my knowledge, require you to be on campus when necessary but the classes that are capable of being done online are online without diminished returns. An example is the Advanced Pathophysiology in most programs I looked into while comparing the two focuses which requires in person lectures periodically and exams. There seems to be some differences in the requirements for admittance though although most seem to require at least 2 years experience a nurse, a BSN and at least a GPA of 3.0 from previous studies with the GPA being competitive after that point which is pretty standard for most post graduate degrees. I agree with you that the rigor varies greatly but that is said of every school in existence. I have been told not to apply to certain Med schools for this very reason.

3. I'm not sure what your point is here? Maybe I need you to elaborate a bit further? On the job training is just that... on the job training. You can get it in school or you can get it...on the job... This is just a matter of organization. Correct me if I am wrong but, as an MD student, you get experience in a wide variety of jobs during your rotations. A NPs experience during their rotations are very specific. You do clerkships in, Internal medicine, Obstetrics-gynecology, General surgery, Pediatrics, Psychiatry, Family medicine and/or neurology. So... I don't understand your argument. If you were to take out and only do one of those clerkships then your hours would be similar to theirs. This makes an MD more well rounded in their experience and capable of performing more jobs but keep in mind that those are all different jobs. When performing a single job (like almost all MDs do), the actual on the job experience is similar. This is simply a matter of mathematics and looking at the situation objectively. The fact that the program takes so long is because you have to study multiple jobs instead of just one. That said, the MDs I have talked to have all said that most of that knowledge goes over time except the job you decide to do. You have to relearn the rest again but that's how all knowledge works. This all said, I am not seeing the advantage you are speaking of when the math is said and done. I simply see a difference in organization of the programs but when performing the exact same job, studies have consistently shown the knowledgebase and patient outcome was similar with MDs being slightly greater in some studies and NP being slightly greater in others. I chose MD over NP only because of the money.

4. I would need to know what information you are referencing to discuss this point. I didn't find this anywhere in my researching the two or talking with people and colleagues from both. I don't think your statistic is objective or accurate because it sounds extremely unlikely that anyone who studied any graduate program would have a failure rate that high of a licensing exam. That program would have been restructured. Sounds like BS to be honest.

Do you want me to start spreading the link on the internet? fine.....I just wanna hear you say one more time that it didn't happen and it's BS...

 

[NicMouse64]

 

[762513]

View attachment 248425

Come on bro, these are n=19 student exams taken by who knows who and who knows where. You guys can’t laugh away NP studies you say aren’t valid and then post stuff like this as your evidence. This means absolutely nothing.

 

[NicMouse64]

Come on bro, these are n=19 student exams taken by who knows who and who knows where. You guys can’t laugh away NP studies you say aren’t valid and then post stuff like this as your evidence. This means absolutely nothing.

These were taken at the prestigious stanford university, and were watered down versions of STEP 3 specifically designed for APRNs. The point is that NPs can't effectively practice medicine. That is not an attack at NPs, just that equivalency can't be proven because the easiest board exam can't be passed by a majority of the top NP students.

 

[deleted480308]

These were taken at the prestigious stanford university, and were watered down versions of STEP 3 specifically designed for APRNs. The point is that NPs can't effectively practice medicine. That is not an attack at NPs, just that equivalency can't be proven because the easiest board exam can't be passed by a majority of the top NP students.

Notice the nps haven’t been lobbying to take our boards

 

[762513]

These were taken at the prestigious stanford university, and were watered down versions of STEP 3 specifically designed for APRNs. The point is that NPs can't effectively practice medicine. That is not an attack at NPs, just that equivalency can't be proven because the easiest board exam can't be passed by a majority of the top NP students.

These are NP students, between 19 and 45 of them, from 8-10 years ago, who had a 50-70 percent pass rate on an exam that had no bearing on their future, as compared to physicians who are actively practicing medicine. This doesn’t prove anything beyond those 19-45 people didn’t do well on that untested exam. You guys can’t mock NP studies and then post nonsense stuff like this and call it fact with a straight face.

 

[Mr.S]

This argument is soooo ridiculous. NPs cannot take Step 3 because they are not eligible. To be eligible, you have to have pre requisites. And those are at the very least successful passing of Step 1 and 2. having a Medical degree.


DNP is NOT a medical degree.

 

[Gurby]

Do you want me to start spreading the link on the internet? fine.....I just wanna hear you say one more time that it didn't happen and it's BS...

Please do spread the link. The link you gave above does not work.

 

[NicMouse64]

Please do spread the link. The link you gave above does not work.

The links are not functional anymore because they scrubbed it. I posted screenshots.

 

[Goro]

Notice the nps haven’t been lobbying to take our boards

 

[jbax42]

This argument is soooo ridiculous. NPs cannot take Step 3 because they are not eligible. To be eligible, you have to have pre requisites. And those are at the very least successful passing of Step 1 and 2. having a Medical degree.


DNP is NOT a medical degree.

Actually, quite frankly, I don't see it as having anything to do with that at all. The simple fact is experience. Step 3 is taken after a medical student has graduated AND typically after starting on the job training (residency). Additionally, the exam is prepared for before taking it. They don't just wake up one day and take it as part of a study. NP is more equivalent to MD than a DNP is. The DNP aspect is primarily related to research (critical analysis) more than practice and from what I noticed, most DNP typically focus their research on patient focused care (edit) and not disease centered care (edit) which appears to be the primary focus of STEP. So that doesn't necessarily make them more capable of passing the test. They would still need the experience that MDs get during their last year and during residency. To summarize, MDs spend their last 2 years of their degree focusing on 'on the job' experience while an DNP spends it on research often into patient.

Personally (if I really cared about this), I would be more interested with a study looking into an NP (doesn't have to be DNP) with a couple of years of experience and time to prepare taking the test than a NP or DNP student taking a test meant for graduates with experience. I hope you can see the difference there. And for full disclosure (like I always do), I am looking at this from an outside perspective with no direct experience in either program. This is strictly analytical comparison which seems to be uncalibrated already. Until that is addressed, a deeper analysis can not be performed in regards to capacity to pass that test. I do know that numerous studies have shown NPs to be just as proficient in every specific field studied. None that I know have said the opposite. Those studies don't test overall knowledge though, it tests ability to do the job so you may very well be correct that even when taking one specific field into account MDs are more knowledgeable but, as of right now, there is no basis of comparison for that so there is no point in making frivolous claims based on anecdotal experience or third hand hearsay.

 

[NicMouse64]

Actually, quite frankly, I don't see it as having anything to do with that at all. The simple fact is experience. Step 3 is taken after a medical student has graduated AND typically after starting on the job training (residency). Additionally, the exam is prepared for before taking it. They don't just wake up one day and take it as part of a study. NP is more equivalent to MD than a DNP is. The DNP aspect is primarily related to research (critical analysis) more than practice and from what I noticed, most DNP typically focus their research on patient care and not patient treatment which appears to be the primary focus of STEP. So that doesn't necessarily make them more capable of passing the test. They would still need the experience that MDs get during their last year and during residency. To summarize, MDs spend their last 2 years of their degree focusing on 'on the job' experience while an DNP spends it on research often into patient.

Personally (if I really cared about this), I would be more interested with a study looking into an NP (doesn't have to be DNP) with a couple of years of experience and time to prepare taking the test than a NP or DNP student taking a test meant for graduates with experience. I hope you can see the difference there. And for full disclosure (like I always do), I am looking at this from an outside perspective with no direct experience in either program. This is strictly analytical comparison which seems to be uncalibrated already. Until that is addressed, a deeper analysis can not be performed in regards to capacity to pass that test. I do know that numerous studies have shown NPs to be just as proficient in every specific field studied. None that I know have said the opposite. Those studies don't test overall knowledge though, it tests ability to do the job so you may very well be correct that even when taking one specific field into account MDs are more knowledgeable but, as of right now, there is no basis of comparison for that so there is no point in making frivolous claims based on anecdotal experience or third hand hearsay.

Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial not ethical to conduct the study. Also ya physicians don't treat patients? ok. If you actually believe this you guys should be lobbying to get rid of medical school. What a waste of time all of this sh** is then. It would take away a competitor during job searches.

 

[deleted480308]

Actually, quite frankly, I don't see it as having anything to do with that at all. The simple fact is experience. Step 3 is taken after a medical student has graduated AND typically after starting on the job training (residency). Additionally, the exam is prepared for before taking it. They don't just wake up one day and take it as part of a study. NP is more equivalent to MD than a DNP is. The DNP aspect is primarily related to research (critical analysis) more than practice and from what I noticed, most DNP typically focus their research on patient care and not patient treatment which appears to be the primary focus of STEP. So that doesn't necessarily make them more capable of passing the test. They would still need the experience that MDs get during their last year and during residency. To summarize, MDs spend their last 2 years of their degree focusing on 'on the job' experience while an DNP spends it on research often into patient.

Personally (if I really cared about this), I would be more interested with a study looking into an NP (doesn't have to be DNP) with a couple of years of experience and time to prepare taking the test than a NP or DNP student taking a test meant for graduates with experience. I hope you can see the difference there. And for full disclosure (like I always do), I am looking at this from an outside perspective with no direct experience in either program. This is strictly analytical comparison which seems to be uncalibrated already. Until that is addressed, a deeper analysis can not be performed in regards to capacity to pass that test. I do know that numerous studies have shown NPs to be just as proficient in every specific field studied. None that I know have said the opposite. Those studies don't test overall knowledge though, it tests ability to do the job so you may very well be correct that even when taking one specific field into account MDs are more knowledgeable but, as of right now, there is no basis of comparison for that so there is no point in making frivolous claims based on anecdotal experience or third hand hearsay.

No, the studies don’t show equivalence

 

[NicMouse64]

No, the studies don’t show equivalence

If they knew what a P-value was, maybe they would understand that. But because they don't get to the threshold of significance they assume "equivalence". It's like the most basic understanding of a P-value, they can't represent these studies accurately. A P-value>.05 just means the null hypothesis can't be rejected, and significance isn't due to random error most likely.

*sigh*

 

[762513]

Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial not ethical to conduct the study. Also ya physicians don't treat patients? ok. If you actually believe this you guys should be lobbying to get rid of medical school. What a waste of time all of this sh** is then. It would take away a competitor during job searches.

You guys keep saying that’s, it’s just not true. Comparing a federally funded NP only clinic with a physician only clinic is feasable. I just don’t think anyone wants to actually put the time in to do it. Certainly no one on these boards.

 

[jbax42]

Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial not ethical to conduct the study. Also ya physicians don't treat patients? ok. If you actually believe this you guys should be lobbying to get rid of medical school. What a waste of time all of this sh** is then. It would take away a competitor during job searches.

I never said physicians don't treat patients. I said the exact opposite. I'm not sure what you read. That said, In my opinion, with the introduction of NP, I feel that physicians would be better to focus on specialization and integrated medicine disciplines. When you go into a specialization, you require a significant understanding of the subsystem as well as a cursory understanding of the system. With any system level focus, you don't necessarily need to understand the subsystems as much to perform high quality system level work. That's why, in engineering as an example, we have systems engineers and electrical/bio/mechanical engineers. System engineers know enough to diagnose the system, manage the system, and make recommendations to go to a specific subsystem (specialization) or provide first level solution. In medicine, you have general practitioners and specialized practitioners. It's been discovered that general practitioners can provide the same level of care with less in depth experience into every specialization. That's OK. It's called progress. We are leveraging years of experience to make this discovery and that's called progress. The goal is always to make things more efficient.

MDs would also make more sense in a helping manage a private practice which requires that integration. That said, I personally believe that every practice should have two managers: a physician and nurse practitioner. I have personally noticed a difference in the level of patient focused care an NP provides vs a doctor. It is significantly higher and has an impact on patient outcome. There is a difference in patient focused care and disease focused care. Studies have noted this difference as well. I think that physicians should leverage NPs patient focused care and NPs should leverage physicians wide scope. I don't think they should be paid differently unless the physician is specialized though because they both bring significant business value and value to patient outcome.

All this said, I am more partial to research being done by MDs or DNPs and not necessarily just NPs. Imho, It's a smaller gap between MD with experience and MD/PhD than between NP with experience and DNP in regards performing quality research (this is not the same as practicing) and that has to do with research skills learned. But that's in general. Those skills can be learned.

 

[jbax42]

If they knew what a P-value was, maybe they would understand that. But because they don't get to the threshold of significance they assume "equivalence". It's like the most basic understanding of a P-value, they can't represent these studies accurately. A P-value>.05 just means the null hypothesis can't be rejected, and significance isn't due to random error most likely.

*sigh*

Lol, I read, dissect (for others, including med students), and prepare studies/papers all the time. It's literally my job (Other than doing the actual research). Unless you can show me a study supporting your point, it's kind of a null point. Also, considering DNPs have more research experience than an MD on average, wouldn't the statement you made be against yourself?

 

[NicMouse64]

I never said physicians don't treat patients. I said the exact opposite. I'm not sure what you read. That said, In my opinion, with the introduction of NP, I feel that physicians would be better to focus on specialization and integrated medicine disciplines. When you go into a specialization, you require a significant understanding of the subsystem as well as a cursory understanding of the system. With any system level focus, you don't necessarily need to understand the subsystems as much to perform high quality system level work. That's why, in engineering as an example, we have systems engineers and electrical/bio/mechanical engineers. System engineers know enough to diagnose the system, manage the system, and make recommendations to go to a specific subsystem (specialization) or provide first level solution. In medicine, you have general practitioners and specialized practitioners. It's been discovered that general practitioners can provide the same level of care with less in depth experience into every specialization. That's OK. It's called progress. We are leveraging years of experience to make this discovery and that's called progress. The goal is always to make things more efficient.

MDs would also make more sense in a helping manage a private practice which requires that integration. That said, I personally believe that every practice should have two managers: a physician and nurse practitioner. I have personally noticed a difference in the level of patient focused care an NP provides vs a doctor. It is significantly higher and has an impact on patient outcome. There is a difference in patient focused care and disease focused care. Studies have noted this difference as well. I think that physicians should leverage NPs patient focused care and NPs should leverage physicians wide scope. I don't think they should be paid differently unless the physician is specialized though because they both bring significant business value and value to patient outcome.

All this said, I am more partial to research being done by MDs or DNPs and not necessarily just NPs. Imho, It's a smaller gap between MD with experience and MD/PhD than between NP with experience and DNP in regards performing quality research (this is not the same as practicing) and that has to do with research skills learned. But that's in general. Those skills can be learned.

Lol, I read, dissect (for others, including med students), and prepare studies/papers all the time. It's literally my job (Other than doing the actual research). Unless you can show me a study supporting your point, it's kind of a null point. Also, considering DNPs have more research experience than an MD on average, wouldn't the statement you made be against yourself?

Lol, NOT THIS TIME. These responses are hilarious. Yeah "outside of the issue". You really seem to be outside the issue. BTW if you are so good at research can you tell me what a P-value of .74 means when comparing two groups? Say physicians and NPs?

 

[NicMouse64]

You guys keep saying that’s, it’s just not true. Comparing a federally funded NP only clinic with a physician only clinic is feasable. I just don’t think anyone wants to actually put the time in to do it. Certainly no one on these boards.

Comparing two clinics is not a good RCT. Factors must be controlled. I have already told you how I would conduct the study in another thread. It is unethical and would never get through an IRB as it wouldn't allow patients to receive any physician care whatsoever. The study would have to measure mortality long-term.

 

[Mr.S]

Lol, I read, dissect (for others, including med students), and prepare studies/papers all the time. It's literally my job (Other than doing the actual research). Unless you can show me a study supporting your point, it's kind of a null point. Also, considering DNPs have more research experience than an MD on average, wouldn't the statement you made be against yourself?

I think you are a nurse. You are thinking about this WAYYYYY too much.
THe fact is, most NPs ( I BET) dont want to put in the work to gain entrance to medical school. And that is not a diss. SO they find a way to backdoor and legislate their way into practice.
If this were REALLY about access, all you hav to do is triple or quadruple the size of PA schools and increase the amount of PAs.

 

[deleted480308]

I never said physicians don't treat patients. I said the exact opposite. I'm not sure what you read. That said, In my opinion, with the introduction of NP, I feel that physicians would be better to focus on specialization and integrated medicine disciplines. When you go into a specialization, you require a significant understanding of the subsystem as well as a cursory understanding of the system. With any system level focus, you don't necessarily need to understand the subsystems as much to perform high quality system level work. That's why, in engineering as an example, we have systems engineers and electrical/bio/mechanical engineers. System engineers know enough to diagnose the system, manage the system, and make recommendations to go to a specific subsystem (specialization) or provide first level solution. In medicine, you have general practitioners and specialized practitioners. It's been discovered that general practitioners can provide the same level of care with less in depth experience into every specialization. That's OK. It's called progress. We are leveraging years of experience to make this discovery and that's called progress. The goal is always to make things more efficient.

MDs would also make more sense in a helping manage a private practice which requires that integration. That said, I personally believe that every practice should have two managers: a physician and nurse practitioner. I have personally noticed a difference in the level of patient focused care an NP provides vs a doctor. It is significantly higher and has an impact on patient outcome. There is a difference in patient focused care and disease focused care. Studies have noted this difference as well. I think that physicians should leverage NPs patient focused care and NPs should leverage physicians wide scope. I don't think they should be paid differently unless the physician is specialized though because they both bring significant business value and value to patient outcome.

All this said, I am more partial to research being done by MDs or DNPs and not necessarily just NPs. Imho, It's a smaller gap between MD with experience and MD/PhD than between NP with experience and DNP in regards performing quality research (this is not the same as practicing) and that has to do with research skills learned. But that's in general. Those skills can be learned.

Post the study

 

[762513]

Comparing two clinics is not a good RCT. Factors must be controlled. I have already told you how I would conduct the study in another thread. It is unethical and would never get through an IRB as it wouldn't allow patients to receive any physician care whatsoever. The study would have to measure mortality long-term.

It’s not unethical if using federally funded NP only clinics.Those patients already are receiving NP only care. It’s doable. No one wants to do it though.

 

[jbax42]

I think you are a nurse. You are thinking about this WAYYYYY too much.
THe fact is, most NPs ( I BET) dont want to put in the work to gain entrance to medical school. And that is not a diss. SO they find a way to backdoor and legislate their way into practice.
If this were REALLY about access, all you hav to do is triple or quadruple the size of PA schools and increase the amount of PAs.

That's because your argument is full of fallacies. I have tried (unsuccessfully) to get this conversation back to its original topic several times now. You seem quite adamant on discussing this NP vs MD topic. I would be negligent if I didn't address your argument. The framework for your argument is flawed. You have not identified your bias and therefore cannot understand any other viewpoint. Bringing such single minded and unyielding thinking into your practice or any type of research would be troubling to say the least.

In regards to me being a nurse, I don't think a nurse would make anywhere near as many engineering references as me lol. That said, you should focus less on attacking the person debating and more on your argument. That was you can understand where your bias is and address it. Btw, it's OK to have bias, we all have it. The key is understanding so that you can remove it from your argument or minimizing it and focus on the facts regardless where they lead you. Even if it's not in your favor. That is the only reason I have invested my time in continuing this conversation.

 

[KeikoTanaka]

Just my two cents. I had a recent change of heart on the whole NP ordeal that these forums have. I *think* at the end of day NPs know MD/DOs obviously learn more, and are therefore more adept at medicine than them. And for this reason, they willingly work to assist the healthcare infrastructure we have within their capabilities to lighten the burden and to help patients. When physicians (mostly seeming like students) attack NPs, they obviously are going to attack back/defend themselves, with the same intensity as the attack against them. These people come into work 40+ hours a week and believe/ARE doing good to help people. MDs are not going to lose their jobs to them because at the end of the day (back to my initial point) they know we are more qualified. With that being said, if we worked together, NPs would naturally fall into their place at physicians side helping them out. When you pit the two against each other, NPs are obviously going to try to figure out how they can increase their competency/abilities by backdooring MDs/DOs. If MDs/DOs had worked better with NPs by setting up a better infrastructure, maybe they wouldn't have tried to get "independence" from the get-go? I'm not sure. At the end of the day, I've only actually known 2 NPs who were both very level headed people who understood the medical hierarchy and respected their physician colleagues and therefore were very well respected by the physicians.

Maybe I'm wrong, maybe the NP overlords really do have it out for us... but at the end of the day, if you're walking a dog on a leash and you walk level and comfortably, the dog will follow. Yank too hard, and the dog will bite at the collar and try to rip it off them. And I'm sorry this is a terrible analogy because it makes it seem like i'm comparing NPs to dogs, but that's not my intent. I'm alluding more to the "independence vs supervision" aspects of the career.

Obviously standards and things need to be worked on to make our healthcare system more efficient, but arguing about this non-stop on forums will not solve anything, it will just make more people bitter on both sides of the token. We need to come up with true solutions and figure out how to make the existence of PAs/NPs/DOs/MDs all work and create defined scopes for each.

 

[deleted480308]

Just my two cents. I had a recent change of heart on the whole NP ordeal that these forums have. I *think* at the end of day NPs know MD/DOs obviously learn more, and are therefore more adept at medicine than them. And for this reason, they willingly work to assist the healthcare infrastructure we have within their capabilities to lighten the burden and to help patients. When physicians (mostly seeming like students) attack NPs, they obviously are going to attack back/defend themselves, with the same intensity as the attack against them. These people come into work 40+ hours a week and believe/ARE doing good to help people. MDs are not going to lose their jobs to them because at the end of the day (back to my initial point) they know we are more qualified. With that being said, if we worked together, NPs would naturally fall into their place at physicians side helping them out. When you pit the two against each other, NPs are obviously going to try to figure out how they can increase their competency/abilities by backdooring MDs/DOs. If MDs/DOs had worked better with NPs by setting up a better infrastructure, maybe they wouldn't have tried to get "independence" from the get-go? I'm not sure. At the end of the day, I've only actually known 2 NPs who were both very level headed people who understood the medical hierarchy and respected their physician colleagues and therefore were very well respected by the physicians.

Maybe I'm wrong, maybe the NP overlords really do have it out for us... but at the end of the day, if you're walking a dog on a leash and you walk level and comfortably, the dog will follow. Yank too hard, and the dog will bite at the collar and try to rip it off them. And I'm sorry this is a terrible analogy because it makes it seem like i'm comparing NPs to dogs, but that's not my intent. I'm alluding more to the "independence vs supervision" aspects of the career.

Obviously standards and things need to be worked on to make our healthcare system more efficient, but arguing about this non-stop on forums will not solve anything, it will just make more people bitter on both sides of the token. We need to come up with true solutions and figure out how to make the existence of PAs/NPs/DOs/MDs all work and create defined scopes for each.

the solution is supervision, which they don't want....

 

[Mr.S]

they don't want supervision, they dont want to be called midlevels or nurses, they want the title doctor, they want a long white coat
they want complete independence and independent decision making. The only think they don't want is to go to medical school.

 

[NicMouse64]

It’s not unethical if using federally funded NP only clinics.Those patients already are receiving NP only care. It’s doable. No one wants to do it though.

I don't get why you don't understand that this isn't a RCT, but based on the definition, it's not. So you are skirting my point.

 

[NicMouse64]

That's because your argument is full of fallacies. I have tried (unsuccessfully) to get this conversation back to its original topic several times now. You seem quite adamant on discussing this NP vs MD topic. I would be negligent if I didn't address your argument. The framework for your argument is flawed. You have not identified your bias and therefore cannot understand any other viewpoint. Bringing such single minded and unyielding thinking into your practice or any type of research would be troubling to say the least.

In regards to me being a nurse, I don't think a nurse would make anywhere near as many engineering references as me lol. That said, you should focus less on attacking the person debating and more on your argument. That was you can understand where your bias is and address it. Btw, it's OK to have bias, we all have it. The key is understanding so that you can remove it from your argument or minimizing it and focus on the facts regardless where they lead you. Even if it's not in your favor. That is the only reason I have invested my time in continuing this conversation.

you did not address my question about the P-Value.

 

[NicMouse64]

Just my two cents. I had a recent change of heart on the whole NP ordeal that these forums have. I *think* at the end of day NPs know MD/DOs obviously learn more, and are therefore more adept at medicine than them. And for this reason, they willingly work to assist the healthcare infrastructure we have within their capabilities to lighten the burden and to help patients. When physicians (mostly seeming like students) attack NPs, they obviously are going to attack back/defend themselves, with the same intensity as the attack against them. These people come into work 40+ hours a week and believe/ARE doing good to help people. MDs are not going to lose their jobs to them because at the end of the day (back to my initial point) they know we are more qualified. With that being said, if we worked together, NPs would naturally fall into their place at physicians side helping them out. When you pit the two against each other, NPs are obviously going to try to figure out how they can increase their competency/abilities by backdooring MDs/DOs. If MDs/DOs had worked better with NPs by setting up a better infrastructure, maybe they wouldn't have tried to get "independence" from the get-go? I'm not sure. At the end of the day, I've only actually known 2 NPs who were both very level headed people who understood the medical hierarchy and respected their physician colleagues and therefore were very well respected by the physicians.

Maybe I'm wrong, maybe the NP overlords really do have it out for us... but at the end of the day, if you're walking a dog on a leash and you walk level and comfortably, the dog will follow. Yank too hard, and the dog will bite at the collar and try to rip it off them. And I'm sorry this is a terrible analogy because it makes it seem like i'm comparing NPs to dogs, but that's not my intent. I'm alluding more to the "independence vs supervision" aspects of the career.

Obviously standards and things need to be worked on to make our healthcare system more efficient, but arguing about this non-stop on forums will not solve anything, it will just make more people bitter on both sides of the token. We need to come up with true solutions and figure out how to make the existence of PAs/NPs/DOs/MDs all work and create defined scopes for each.

Don't pass state laws saying NPs don't need supervision then. Your argument is based on butterflies and lies. The fact is MDs have to be defensive because NPs/PAs saw a weak spot and have attacked the profession. It is time to fight back.

 

[762513]

Don't pass state laws saying NPs don't need supervision then. Your argument is based on butterflies and lies. The fact is MDs have to be defensive because NPs/PAs saw a weak spot and have attacked the profession. It is time to fight back.

How are NP’s/PA’s attacking medicine? Does allowing an NP to see patients remove your medical liscense?

 

[NicMouse64]

How are NP’s/PA’s attacking medicine? Does allowing an NP to see patients remove your medical liscense?

I'm not including PA's in that statement intentionally. NPs practice the same SOP as MDs with independent practice, with less regulation, while lying to consumer about credentials such as using "board certification" or "doctor" so and so. They do not have to be regulated under the BOM. PAs are less guilty of these things but moving in the wrong direction.

 

[jbax42]

TBH, I think the matter is one of pride and self absorption.

I'm not including PA's in that statement intentionally. NPs practice the same SOP as MDs with independent practice, with less regulation, while lying to consumer about credentials such as using "board certification" or "doctor" so and so. They do not have to be regulated under the BOM. PAs are less guilty of these things but moving in the wrong direction.

1. We've established that the title doctor is not only accurate but appropriate for a DNP. It is their proper title that they earned and anything less is disrespectful unless they have a difference preference. It would be no different than referring to a PhD as Mr if you have knowledge that they earned their PhD.

2. BOM is a regulatory board just like the BON. It's for accountability. It's not rocket science. The rules are pretty much a copy and paste. I could be wrong since I only went over them a moment ago. Noticed that the main difference was in how the NP was perceived. BON seems a lot more NP friendly while BOM seems to want to limit NP. The actual regulations for practicing outside of that didn't really change. Besides it was created by physicians AND nurses. So physicians are involved. I think they can properly regulate it.

3. A PA and NP seems to have two completely different goals in regards to the learning objective. NP goal seems to be heavily geared towards independent practice unlike PA.

My only concern is experience in regards to independent practice. I believe that there should be an experience requirement for NP of at least 2 or 3 years (dependent on what research shows) under an independently practicing physician or NP before an NP can practice independently themselves. An MD has approx 15000 hours of experience before independence (approx 6000 from last 2 years and 9000-10000 from 3 year residency). That said, their focus isn't as broad so they shouldn't need that much since the 6000 from MD clinical years is split across 6-7 disciplines. That can be cut since NP is focused on 1. They have to go back to school for others. They currently do approx 1500 hours. With 3 years on top, it would add approx. 7000-10000 (depending on hours worked) which is more than enough for a single discipline practice.

Even as an engineer, post degree experience (2.5 years minimum) is necessary if you open a practice where human life is a concern.

That said, I have no doubt that they can do the job independently, it's already been heavily researched and proven.

I think a lot of this has to do with pride more than anything. For example, That's the only reason I could think of by not calling someone their earned title. Of course I don't approve of MS NPs using the title since they weren't given a waiver by the government like MDs but DNPs earned their title. Show respect like people show you respect for your hard work.

 

[NicMouse64]

TBH, I think the matter is one of pride and self absorption.


1. We've established that the title doctor is not only accurate but appropriate for a DNP. It is their proper title that they earned and anything less is disrespectful unless they have a difference preference. It would be no different than referring to a PhD as Mr if you have knowledge that they earned their PhD.

2. BOM is a regulatory board just like the BON. It's for accountability. It's not rocket science. The rules are pretty much a copy and paste. I could be wrong since I only went over them a moment ago. Noticed that the main difference was in how the NP was perceived. BON seems a lot more NP friendly while BOM seems to want to limit NP. The actual regulations for practicing outside of that didn't really change. Besides it was created by physicians AND nurses. So physicians are involved. I think they can properly regulate it.

3. A PA and NP seems to have two completely different goals in regards to the learning objective. NP goal seems to be heavily geared towards independent practice unlike PA.

My only concern is experience in regards to independent practice. I believe that there should be an experience requirement for NP of at least 2 or 3 years (dependent on what research shows) under an independently practicing physician or NP before an NP can practice independently themselves. An MD has approx 15000 hours of experience before independence (approx 6000 from last 2 years and 9000-10000 from 3 year residency). That said, their focus isn't as broad so they shouldn't need that much since the 6000 from MD clinical years is split across 6-7 disciplines. That can be cut since NP is focused on 1. They have to go back to school for others. They currently do approx 1500 hours. With 3 years on top, it would add approx. 7000-10000 (depending on hours worked) which is more than enough for a single discipline practice.

Even as an engineer, post degree experience (2.5 years minimum) is necessary if you open a practice where human life is a concern.

That said, I have no doubt that they can do the job independently, it's already been heavily researched and proven.

I think a lot of this has to do with pride more than anything. For example, That's the only reason I could think of by not calling someone their earned title. Of course I don't approve of MS NPs using the title since they weren't given a waiver by the government like MDs but DNPs earned their title. Show respect like people show you respect for your hard work.

you still haven't answered my question about a p-value of .74....once you answer then I will acknowledge a number of other things you are discussing. Once you prove all the things you say with actual knowledge and research accumen then we can talk.

 

[jbax42]

you still haven't answered my question about a p-value of .74....once you answer then I will acknowledge a number of other things you are discussing. Once you prove all the things you say with actual knowledge and research accumen then we can talk.

I haven't addressed it because you have not referenced anything as of yet. Provide me with something to address and I will do just that. I have seen confidence intervals of 95 and p values less than 0.001 in different studies. I have not found any at .74. You will have to cite your reference.

 

[NicMouse64]

I haven't addressed it because you have not referenced anything as of yet. Provide me with something to address and I will do just that. I have seen confidence intervals of 95 and p values less than 0.001 in different studies. I have not found any at .74. You will have to cite your reference.

I am not asking specifics. I am asking, generally, what a P-value of .74 means? how can it be used when comparing two things. Let's say--mortality between physician led care and NP, theoretically, what would a P-value of .74 mean if the two groups were compared?

 

[deleted480308]

TBH, I think the matter is one of pride and self absorption.


1. We've established that the title doctor is not only accurate but appropriate for a DNP. It is their proper title that they earned and anything less is disrespectful unless they have a difference preference. It would be no different than referring to a PhD as Mr if you have knowledge that they earned their PhD.

2. BOM is a regulatory board just like the BON. It's for accountability. It's not rocket science. The rules are pretty much a copy and paste. I could be wrong since I only went over them a moment ago. Noticed that the main difference was in how the NP was perceived. BON seems a lot more NP friendly while BOM seems to want to limit NP. The actual regulations for practicing outside of that didn't really change. Besides it was created by physicians AND nurses. So physicians are involved. I think they can properly regulate it.

3. A PA and NP seems to have two completely different goals in regards to the learning objective. NP goal seems to be heavily geared towards independent practice unlike PA.

My only concern is experience in regards to independent practice. I believe that there should be an experience requirement for NP of at least 2 or 3 years (dependent on what research shows) under an independently practicing physician or NP before an NP can practice independently themselves. An MD has approx 15000 hours of experience before independence (approx 6000 from last 2 years and 9000-10000 from 3 year residency). That said, their focus isn't as broad so they shouldn't need that much since the 6000 from MD clinical years is split across 6-7 disciplines. That can be cut since NP is focused on 1. They have to go back to school for others. They currently do approx 1500 hours. With 3 years on top, it would add approx. 7000-10000 (depending on hours worked) which is more than enough for a single discipline practice.

Even as an engineer, post degree experience (2.5 years minimum) is necessary if you open a practice where human life is a concern.

That said, I have no doubt that they can do the job independently, it's already been heavily researched and proven.

I think a lot of this has to do with pride more than anything. For example, That's the only reason I could think of by not calling someone their earned title. Of course I don't approve of MS NPs using the title since they weren't given a waiver by the government like MDs but DNPs earned their title. Show respect like people show you respect for your hard work.

And the nurses don’t even want that much supervision....so the answer is no

 

[Mr.S]

I apologize for the late reply, I didn't know that this topic was still being discussed. I honestly don't know why you are attempting to use Organic Chemistry as some kind of argument when it isn't even remotely important to the practice of an MD. As for chemistry, all of the programs I looked into after your post require general chemistry with a lab. That said, most of the MDs I know do not even remember the basics of OChem. I knew more than them when I started and still do. Not because I'm smarter than them but because I use it more often. You seem to be conflating these things. From what I gathered when I read through the NP documentation, it was created by a group of doctors and nurses to provide the same or better level of care as an MD in a particularly chosen field without the unnecessary information. That's why their rotations are so short because they only do a rotation in one specialty while MDs do it in all specialties. This was seen as unnecessary since most MDs never leave their particular specialty. It also removed requirements for courses that MDs never used while keeping the important courses. So attempting to use the fact that you took classes that you won't even use (unless you go into research) is a bit silly, don't you think?

I can give you an engineering example. I was an electrical engineer before going into bioengineering and before, now, going into Med school. German engineers often are in school for 2-3 years while most US engineers are in school for 4-5 years. Why? Do we know more then them? Generally, yes. But, when expanded on and thought about critically, no. The reason for this is because they choose a very specialized field and focus on that. When they come out they go into that field and, the engineers that I worked with were just as competent as us. In some situations they were more competent. We received a lot more knowledge but we didn't necessarily use that knowledge once we chose our specific focus so it didn't make us more competent in that job. That said, we were able to identify some things outside of our job that they couldn't but they were just as efficient by simply transferring that work over to the department which would take care of it anyways. It really came down to a matter of ego. There were some engineers who were bothered by their short study program and made fun of them even though they were achieving better results than some of those engineers. No different than the Ivy league engineers I worked with who couldn't perform a basic critical analysis problem yet they made fun of non-ivy league engineers when they first started. Over time, that way of thinking went away and after a few years on the job, most of those engineers stopped.

If they decide to change their specialties, they have to go back to school and obtain that new knowledge. That said, to say you will make a better family or adult acute care practitioner just because you learned more information (be it true or not) is a fallacy. The only thing that matters is the information necessary for the job. If you aren't using the knowledge then it does not help.

IS Bio-Chemistry important for the practice of medicine. If you say yes it is, then Organic is a prereq to Bio -Chem.
Show me a syllabus where REAL GEN CHEM is a requirement for nursing school. Im talking the one where youre in a class with pharmacy majors and premeds and predents. The one with the Five hour lab once a week.

 

[Mr.S]

TBH, I think the matter is one of pride and self absorption.


1. We've established that the title doctor is not only accurate but appropriate for a DNP. It is their proper title that they earned and anything less is disrespectful unless they have a difference preference. It would be no different than referring to a PhD as Mr if you have knowledge that they earned their PhD.

2. BOM is a regulatory board just like the BON. It's for accountability. It's not rocket science. The rules are pretty much a copy and paste. I could be wrong since I only went over them a moment ago. Noticed that the main difference was in how the NP was perceived. BON seems a lot more NP friendly while BOM seems to want to limit NP. The actual regulations for practicing outside of that didn't really change. Besides it was created by physicians AND nurses. So physicians are involved. I think they can properly regulate it.

3. A PA and NP seems to have two completely different goals in regards to the learning objective. NP goal seems to be heavily geared towards independent practice unlike PA.

My only concern is experience in regards to independent practice. I believe that there should be an experience requirement for NP of at least 2 or 3 years (dependent on what research shows) under an independently practicing physician or NP before an NP can practice independently themselves. An MD has approx 15000 hours of experience before independence (approx 6000 from last 2 years and 9000-10000 from 3 year residency). That said, their focus isn't as broad so they shouldn't need that much since the 6000 from MD clinical years is split across 6-7 disciplines. That can be cut since NP is focused on 1. They have to go back to school for others. They currently do approx 1500 hours. With 3 years on top, it would add approx. 7000-10000 (depending on hours worked) which is more than enough for a single discipline practice.

Even as an engineer, post degree experience (2.5 years minimum) is necessary if you open a practice where human life is a concern.

That said, I have no doubt that they can do the job independently, it's already been heavily researched and proven.

I think a lot of this has to do with pride more than anything. For example, That's the only reason I could think of by not calling someone their earned title. Of course I don't approve of MS NPs using the title since they weren't given a waiver by the government like MDs but DNPs earned their title. Show respect like people show you respect for your hard work.

If everyone is called Doctor, (which I dont even care) you can call me grand master flash if you like, how do you differentate the physicians from the nurses and the pharmacists and the physical therapists?

 

[KeikoTanaka]

If everyone is called Doctor, (which I dont even care) you can call me grand master flash if you like, how do you differentate the physicians from the nurses and the pharmacists and the physical therapists?

I think it goes back to basic introductory skills you learned as a kid.
"Hello, I'm Doctor Lee, Doctor of Nurse Practitioner"
"Hello, I'm Jackie Lee, Nurse Practitioner"
"Hello, I'm Doctor Lee, Emergency Physician"
"Hello, I'm Nurse Lee, Registered Nurse"

That way, you can get your title but still set up appropriate expectations based on your degree? Notice I only inserted Doctor into the person who is an actual physician and the person who published research and got a doctorate, is that fair or no?

Although, "Hello, I'm Nurse Lee, Doctor of Nurse Practitioner" sounds better no? It's a bit less redundant

 

[deleted480308]

I think it goes back to basic introductory skills you learned as a kid.
"Hello, I'm Doctor Lee, Doctor of Nurse Practitioner"
"Hello, I'm Jackie Lee, Nurse Practitioner"
"Hello, I'm Doctor Lee, Emergency Physician"
"Hello, I'm Nurse Lee, Registered Nurse"

That way, you can get your title but still set up appropriate expectations based on your degree? Notice I only inserted Doctor into the person who is an actual physician and the person who published research and got a doctorate, is that fair or no?

Although, "Hello, I'm Nurse Lee, Doctor of Nurse Practitioner" sounds better no? It's a bit less redundant

In appropriate in a patient care setting

 

[KeikoTanaka]

In appropriate in a patient care setting

Wait, are you being facetious? lol

 

[deleted480308]

Wait, are you being facetious? lol

Serious. No nurse practitioner should be introducing themself as doctor in a patient care setting

 

[KeikoTanaka]

Serious. No nurse practitioner should be introducing themself as doctor in a patient care setting

So, I know this would never happen, but let's pretend a Ph.D. in Neuroscience came in with a Neurosurgeon for whatever reason to do a consult. The Doctor would introduce themselves as "Dr. Such and Such, Neurosurgeon", and he could be like "This is my colleague, Dr. Ventricle, PhD in Neuroscience" like he's still Dr...... he's just not a medical doctor, so as long as that distinction is made by correctly introducing yourself, isn't that appropriate? Is there a law that forbids this? Obviously there's a law against impersonating healthcare professionals of any kind, but calling yourself Doctor and further clarifying your credentials doesn't seem to be a problem, unless of course you read your patient and come to understand they are very uneducated so you don't say anything at all and just try to help? Idk. On a whole I agree that only physicians should be called Doctors in a patient care setting, but I'm not sure how to go about maintaining that level of respect for people who worked hard for their credentials. I feel like theres gotta be a middle ground between title calling and full disclosure of credentials and capabilities. But I agree, Doctor does give off a very specific connotation of their skills and abilities and a person with less knowledge about medicine calling themselves Doctor can set a patient up for disappointment.

Sorry, I agree with you, I don't really know what I'm getting at.

 

[NicMouse64]

Serious. No nurse practitioner should be introducing themself as doctor in a patient care setting

They keep moving the ball. They now think it is appropriate. They will be coming for the physician title next.