More on DNP= MD/DO

[ProRealDoc]

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

Audio: http://www.npr.org/templates/player...n=1&t=1&islist=false&id=100921215&m=100986726

Listen to this Doctor Murse Ray Scarpa "I am a doctorally prepared nurse and he is a doctorally prepared doctor" WTF? Listen to the patient's wife at the end of the audio file and you'll see they are calling the nurse doctor. The nursing organizations can claim otherwise but we know it is not true.

 

[Planktonmd]

Any one knows what on earth the "American Board of Comprehensive Care" is ???
What is comprehensive care?
😕

 

[Planktonmd]

After some research I found that "Comprehensive care" is care that "comprehends" the patient as opposed to the noncomprehensive type of care all these greedy physicians provide.
It's a more compassionate care that the American public will have the unique privilege to obtain while the rest of the world will continue to receive that terrible noncomprehensive type of care by people who went to medical school.
Once again medicine in the U.S. is showing the rest of the world how it is done.
Go Comprehensive 👍

 

[Taurus]

Any one knows what on earth the "American Board of Comprehensive Care" is ???
What is comprehensive care?
😕

American Board of Comprehensive Care is the vehicle that Mundinger et al created to promote the DNP degree.

"Comprehensive care" is the nursing description for primary care because they don't want to call it medicine. Otherwise, it would be subject to BOM regulation. It's like how NP's say that they're practicing "advanced nursing" and not medicine when in reality they do.

 

[bigpharmD]

As a pharmacist I would like to see the average GPAs and SATs of people who get into nursing school and then compare that to MD school. I know several people who flunked out of my pharmacy class and went into nursing with no problem. They said it was a joke compared to pharm school. Now they are NPs going around writing for the wrong stuff all day. Does this make any sense?

 

[ProRealDoc]

duplicate

 

[Taurus]

Now they are NPs going around writing for the wrong stuff all day. Does this make any sense?

Not to mention ordering unnecessary labs and tests. Studies have proven that NP's do order more unnecessary labwork.

If Obama wants to reduce health care costs, then he needs to de-incentivize doing procedures and reward outcomes. Furthermore, he needs to make sure that only necessary labs and tests are ordered. Physicians, with their extensive training, are the best ones to judge which labs and tests should be ordered.

 

[leaverus]

Sickening...I can't believe the guy actually has the nerve to say that he "earned the right to be called doctor." On a similar note, they give out long white coats to everybody these days - the F***in utilization management people at my hospital wear longs white coats!!

 

[DO4lifer]

After some research I found that "Comprehensive care" is care that "comprehends" the patient as opposed to the noncomprehensive type of care all these greedy physicians provide.
It's a more compassionate care that the American public will have the unique privilege to obtain while the rest of the world will continue to receive that terrible noncomprehensive type of care by people who went to medical school.
Once again medicine in the U.S. is showing the rest of the world how it is done.
Go Comprehensive 👍

I am a DO. Comprehensive care is what we do!! 😍

 

[Taurus]

Sickening...I can't believe the guy actually has the nerve to say that he "earned the right to be called doctor." On a similar note, they give out long white coats to everybody these days - the F***in utilization management people at my hospital wear longs white coats!!

You know what's funny? Nurses have no problem at all arguing that they should be able to wear the long white coat. Yet, at my institution, they won't let anyone but RN's wear the all white nurse uniform. The LPN's have to wear a different color. They don't want to confuse the patient about who's a nurse! Talk about hypocrisy!!!

 

[periopdoc]

I may just go back to wearing slacks and a tie when out of the OR, even though I generally think ties in the hospital are pretty gross. I have yet to see a nurse wearing slacks and tie anywhere in the hospital but admin.

- pod

 

[maceo]

Not to mention ordering unnecessary labs and tests. Studies have proven that NP's do order more unnecessary labwork.

If Obama wants to reduce health care costs, then he needs to de-incentivize doing procedures and reward outcomes. Furthermore, he needs to make sure that only necessary labs and tests are ordered. Physicians, with their extensive training, are the best ones to judge which labs and tests should be ordered.

that is absolutely true. I see so much shotgun ordering. its unbelievable. I see patients who are healthy going in for same day procedure getting ekg and chest xray ordered by the nurse reviewing the chart because its on her checklist. CMON. what are we in 1979, when that was rampant?

 

[maceo]

You know what's funny? Nurses have no problem at all arguing that they should be able to wear the long white coat. Yet, at my institution, they won't let anyone but RN's wear the all white nurse uniform. The LPN's have to wear a different color. They don't want to confuse the patient about who's a nurse! Talk about hypocrisy!!!

I hate wearing lab coats. in fact i dont own one

 

[core0]

You know what's funny? Nurses have no problem at all arguing that they should be able to wear the long white coat. Yet, at my institution, they won't let anyone but RN's wear the all white nurse uniform. The LPN's have to wear a different color. They don't want to confuse the patient about who's a nurse! Talk about hypocrisy!!!

Actually the really funny part is watching them blow up about anyone but an RN (and maybe an LPN) uses the term nurse. They are happy to use the Wikipedia definition of Doctor to "prove" that physicians usurped the title and it really belongs to everyone that has any kind of doctorate regardless of qualifications. On the other hand the fact that nursing was a generic title that was in use long before organized nursing was around does not sway them from denouncing anyone that dares use the title that is not an RN. They also conveniently ignore the fact that in many states nurse is not a protected title and Registered nurse is the protected title.

 

[bigpharmD]

Sickening...I can't believe the guy actually has the nerve to say that he "earned the right to be called doctor." On a similar note, they give out long white coats to everybody these days - the F***in utilization management people at my hospital wear longs white coats!!

are we sure its a guy? what a tool.

 

[scotchnwater]

Not to threadjack too much, but does anybody know off the top what sorts of rules there are about DNPs presenting themselves as "doctor"? I know it's been discussed on here before...

I was in our Trauma Center working a shift last night when a woman walked in wearing a long white coat bearing the badge "Dr. Nursey McNurserson". She was coming to check up on a nursing student who had been working in our department all day long. The only reason I figured that out is that she had the same institution name on her coat as he did on his scrubs (and it's not a place that has anything to do with physician training - something I'm sure your everyday common patient may not be aware of).

I asked a couple of the attendings about her and they knew she was a PhD from the nursing school. When I asked about the title on her badge their reply was "well, I guess she has a PhD and the right to be called 'doctor'." (This answer just invoked the memory of Ross from "Friends").

Does anybody else find it to be more than a little misleading to walk around in a busy county trauma center in a long white coat with a badge bearing the title "Dr." on it? Aren't there rules against this?

I'm all for proper acknowledgement of the work she put in to get her degree, but "Nursey McNurserson, PhD" would adequately convey her level of training without misrepresenting herself in a place that is already a chaotic and acutely changing patient-care environment.

I mean, hell, my own badge says "Scotch N. Water, MD" on it, not "Dr. Scotch N. Water". It also denotes that I'm a resident, so as not to confuse me with an attending.

 

[Gern Blansten]

Not to threadjack too much, but does anybody know off the top what sorts of rules there are about DNPs presenting themselves as "doctor"? I know it's been discussed on here before...

I was in our Trauma Center working a shift last night when a woman walked in wearing a long white coat bearing the badge "Dr. Nursey McNurserson". She was coming to check up on a nursing student who had been working in our department all day long. The only reason I figured that out is that she had the same institution name on her coat as he did on his scrubs (and it's not a place that has anything to do with physician training - something I'm sure your everyday common patient may not be aware of).

I asked a couple of the attendings about her and they knew she was a PhD from the nursing school. When I asked about the title on her badge their reply was "well, I guess she has a PhD and the right to be called 'doctor'." (This answer just invoked the memory of Ross from "Friends").

Does anybody else find it to be more than a little misleading to walk around in a busy county trauma center in a long white coat with a badge bearing the title "Dr." on it? Aren't there rules against this?

I'm all for proper acknowledgement of the work she put in to get her degree, but "Nursey McNurserson, PhD" would adequately convey her level of training without misrepresenting herself in a place that is already a chaotic and acutely changing patient-care environment.

I mean, hell, my own badge says "Scotch N. Water, MD" on it, not "Dr. Scotch N. Water". It also denotes that I'm a resident, so as not to confuse me with an attending.

It is a damned shame that it has come to this. Leaders in medicine have been asleep at the switch for far too long. I hope it is not too late to salvage things.

 

[Planktonmd]

It is a damned shame that it has come to this. Leaders in medicine have been asleep at the switch for far too long. I hope it is not too late to salvage things.

I am afraid it's already too late to salvage anything.
Medicine in this country is going to be increasingly driven by the desire of politicians to provide the cheapest care to as many people as possible. Physicians are not the cheapest solution so get ready to see more and more cheaper doctor alternatives.

 

[niranjan162]

I am afraid it's already too late to salvage anything.
Medicine in this country is going to be increasingly driven by the desire of politicians to provide the cheapest care to as many people as possible. Physicians are not the cheapest solution so get ready to see more and more cheaper doctor alternatives.

luckily for them they'll never have to get any care from the system the create

 

[Taurus]

Not to threadjack too much, but does anybody know off the top what sorts of rules there are about DNPs presenting themselves as "doctor"?

Read the Pearson report (also linked in my signature), it's the bible of NP political agenda.

eight states—Arkansas, Connecticut, Georgia, Maine, Mississippi, Ohio, Oklahoma, and Oregon—that have statutory restrictions against doctorally-educated NPs being addressed appropriately as "Doctor NP."​

 

[firefly333]

I just read this Pearson report:
In it, NPs post adverse outcomes/ legislative action ratios of NP and DO and MD. However, if I recall: when there is a lawsuit, all names are taken out of the chart that were engaged in patient care (including resident physicians, attendings, multiple services - anesthesia and surgery). Therefore, is it really 1:139 for NPs and 1:4 for MDs? If so, could that be due to bias for the practitioner with the "deeper pockets"? This report seems pretty compelling that NPs indeed are involved in less adverse outcomes and are sued less. Just wondering if these results can be biased or are erroneous.

 

[firefly333]

Task Force on Doctoral Education for Nurse Anesthetists Begins Work
AANA President Brian Thorson, CRNA, MA, has appointed a Task Force on Doctoral Education of Nurse Anesthetists. The Task Force is an outgrowth of an invitational AANA Summit on doctoral education held in June 2005. Current interest in doctoral education is the result of an initiative by the American Association of Colleges of Nursing to move advanced practice nursing education to the Doctor of Nursing Practice (DNP) degree by 2015.

 

[Neogenesis]

I saw this license plate today that made me think of this whole debate. I guess this is their ultimate goal.

http://forums.studentdoctor.net/attachment.php?attachmentid=13571&stc=1&d=1253202856

 

[Matty44]

.

 

[alphaholic06]

WTF is a doctorally prepared physician?

 

[fakin' the funk]

Drs have 12 years of schooling.
Nurses have 4 years of schooling and perhaps an online NP degree
stretched out to 3 yrs to make it a PhD.

Not so equal sounding when you look at it that way.

I personally disagree with calling residency "schooling." It's on-the-job training. The difference between residency and "nursing work experience" is that residency is still TRAINING with mandated educational aspects and mandated supervision. But schooling...nah.

 

[goodcalling]

An MD is one who treats the disease who happens to be within a person, a nurse is one who treats the person who happens to have a disease, it is good to have specialist and it is good to have generalists, we each have our place in health care, some of us will treat chronic disease, some will treat catastrophic injuries, if you think nursing classes are so easy than why done you take a few and pass judgment then, I know plenty of nurses who had 4.0 GPA's before starting nursing course work and struggled the rest of the way through, and undergrad nursing programs are one of the hardest undergrad degree programs to enter into based on the selection criteria and high level of competition for a seat, nurses combine medical knowledge and technical skill with acute sensitivity to patient needs, the building blocks to critical thinking in nursing care are vast.

If everyone stops kvetching we might actually realize that as colleagues of the health disciplines we are more effective together than we are sailing our own ships with our noses in the air, yes things will change in medicine and health care, you can be a part of the change or you can fight for the old dried out fear based ways of thinking and doing, what each one of us says and does makes an impact on ourselves and in turn the lives of others, are you a force of growth and vitality or are you a force of anger and fear?

 

[G-Man82]

Very eloquently put and you touch on an interesting point. "...nursing programs are one of the hardest undergrad degree programs ..." But isn't that just it? An undergrad degree? The debate isn't that nurses are not required within healthcare. No, nurses are absolutely VITAL to the overall care of the patient. A nurse's work not only helps the patient, but it helps us physicians focus more on the patient's medical issues so that together we can resuscitate the patient well enough to leave the hospital. The debate here is that nursing school IS NOT medical school, and we are appalled that there are nurses out there that through legislation and the creation of a degree that seems to teach more administration than clinical science want to pass themselves off as medical doctors. The only route to having the same voice on patient care as current medical doctors is to GO TO MEDICAL SCHOOL like I am currently doing (and finishing). Nurses who want that final authority on patient care should do so, as some already have.

 

[devilpup]

Reporter asks obvious question- "how can patients tell their caregivers apart if they have the same title?"

Mundinger replies:

"For starters you would say 'I'm Doctor Mundinger and I'm your nurse"


what a load of bull. One of my class buddies has a PhD in Neuroscience, so technically if he wants to be a tool he could introduce himself to patients during his rotations as "i'm doctor X, a med student" ...the Attending would rip him apart.

 

[EMTB2MD]

What if the AMA or another organization purchased the rights to use 'Doctor' in the health care setting. Physicians would pay a little extra per year to be part of AMA or whatever organization that purchased the trademark rights. The requirements to call yourself a 'doctor' in a health care setting would require a DO or MD designation and membership to an organization to be able to use the title. If someone wanted to call themselves a doctor that wasn't a DO or MD they could be sued.

There are a lot of fields outside of medicine that have designations that are registered trademarks. Certified Financial Planner (CFP) is an example of one. I used to work in a financial planning capacity but could not call myself a financial planner since CFP is a registered trademark and I didn't belong to their organization.

 

[Neogenesis]

Found this today.

http://arkansasmatters.com/content/fulltext/news?cid=200521

Is Your "Nurse" Licensed?

Also at the Capitol today, a bill passed that would regulate just who is giving you or your kids their shots-and they might be unlicensed.

Without medical assistants, The Little Rock Children’s Clinic probably wouldn't be open.

“I know that without medical assistants it would be hard especially in the outpatient setting like our clinic,” said Pediatrician Dr. Steve Thompson.

Medical assistants, or MA’s, at doctor's offices around the state already perform simple procedures from taking temperature, keeping records or giving shots.

“It's a practice that's been going on in physician’s offices ever since the beginning of medical practice but for the first time, now we're going to have rules and regulations by the licensing board,” said David Wroten with the Arkansas Medical Society. They backed the bill.

Friday, the House passed Senate Bill 239 after some discussion-and the vote was tight.

The bill says doctors can train and then delegate tasks to unlicensed people in their offices but the state Medical Board will first set rules and regulations on who can do what and with how much training. Doctors themselves must supervise.

Some of the tasks these MA’s can perform include giving immunizations, medications and other injections though they are specifically forbidden under the bill to give anesthesia.

Some doctors say a nursing shortage in the state, as well as a tough economy, make good arguments for this bill.

"RNs have a different pay scale, LPN's and medical assistants so it makes it more affordable to run the clinic with medical assistants," said Dr. Thompson.

But some nurses say that isn't enough to justify a lack of education.

"What we are concerned about is public protection. Because there's nothing in the bill that requires formal education as is required of nurses. It could be on the job training is what we expect it will be," said Faith Fields, head of the Arkansas State Nursing Board.

MA’s, on the other hand, say on the job training is enough-and say when it comes to care, patients can't tell the difference.

“They have no idea which one is which, here we are on the same playing field. In a hospital it is different because we don't do IVs here. But as far as the injections, any of our assitants could set in next to an RN and do just as good a job,”

The state Medical Board will be setting rules and regulations for these MA’s and there will be a period for public comment.

The bill also specifically refers to podiatrists to be monitored by their licensing board as well.






Interesting if you replace "Nurse" with "MD/DO" and "MA" with "DNP". 😕

I guess one group has got to fill in the void when another group moves up the ladder😉

NEO

 

[CVRN]

I can understand the anger towards nurses wanting to use the title doctor, I agree that it would be confusing and ridiculous. Its also obvious to anyone that will put aside their biases that medical doctors have a far deeper scientific understanding of the human body, disease processes, etc than a DNP prepared nurse would. So I agree nurses are no subsitute for MD/DOs. But I am wondering what are your opinions of the more moderate advanced practice nurses? I am a new CVICU nurse who's early on in my education (working on RN-BSN) and plan to continue on to CRNA. So for me to see all this anger directed at the profession as a whole it doesn't suprise me that the two sides are so polarized. I'm not someone who thinks CRNA's should be performing open heart anesthesia independently or opening up a pain management clinic but I am wondering if there is anyone out there that actually gives the profession the respect it deserves? I just think such intense rhetoric from either side is going to eliminate the moderates of each profession who are the ones that could actually create a sustainable situation for two professions to coexist. Thanks for any thoughts.

 

[dhb]

Most people on both sides are moderates. However the AANA (which represents >90% of CRNA's) is certainly not in the moderate camp.
What you see here is people reacting to numerous trolls who have regurgitated AANA propaganda ad nauseum while proving their clinical incompetence.
The moderate and competent midlevels are very much respected on this board.

Best of luck.

 

[ozzie20]

An MD is one who treats the disease who happens to be within a person, a nurse is one who treats the person who happens to have a disease, it is good to have specialist and it is good to have generalists, we each have our place in health care, some of us will treat chronic disease, some will treat catastrophic injuries, if you think nursing classes are so easy than why done you take a few and pass judgment then, I know plenty of nurses who had 4.0 GPA's before starting nursing course work and struggled the rest of the way through, and undergrad nursing programs are one of the hardest undergrad degree programs to enter into based on the selection criteria and high level of competition for a seat, nurses combine medical knowledge and technical skill with acute sensitivity to patient needs, the building blocks to critical thinking in nursing care are vast.

If everyone stops kvetching we might actually realize that as colleagues of the health disciplines we are more effective together than we are sailing our own ships with our noses in the air, yes things will change in medicine and health care, you can be a part of the change or you can fight for the old dried out fear based ways of thinking and doing, what each one of us says and does makes an impact on ourselves and in turn the lives of others, are you a force of growth and vitality or are you a force of anger and fear?

I'm a D.O., and one of the first BS things that the professors taught us was "DO's treat the whole patient, not just the disease, unlike our MD counterparts." Being naive and clueless (still am, though just starting to realize it) I took it at face value. MDs treat the whole patient just as much as DOs do. Likewise the statement above comes off as ignorant at best, insulting at worst. Doctors treat the whole patient, including the disease. Likewise, everything you said about the undergraduate training of nurses applies to physicians as well.

Yes, things ARE changing in healthcare. Things have changed in healthcare for the past 100 years, and will continue to change. Things have changed so drastically that nursing staff have taken on a belligerent attitude towards not only residents, but ALL physicians, automatically assuming we're idiots who know nothing about medicine, and don't really care about the patients as a whole.

Quite frankly, I don't mind if nursing wants more authority, I don't mind if they would like independent practice, given 2 caveats:
1. Treat physicians with respect, not as superiors who are coming down on you, but as people, who have families, friends, and lets not forget the 80+hours a week they work in exchange for little to nothing.

2. If nursing and midlevel providers want independent practice, thats fine with me too, just take on the full level of liability that physicians take on. This is not a nursing fault, but a fault of the legal system we are in, lawyers want to eat the fish with the most meat on it.

 

[coprolalia]

Likewise the statement above comes off as ignorant at best, insulting at worst. Doctors treat the whole patient, including the disease.

Apparently when I signed up to become an M.D., I also signed up to be martyr. Maybe I should change my name to Jesus H. Christ.

People - all manner from other physicians to nurses to administrators to patients to members of healthcare oversight boards - feel they can insult me, talk down to me, ridicule me, question my otherwise sound decisions, decide which part of the treatment plan they want to institute and which they want to ignore, yell at me, belittle me, and do whatever else to basically insult my intelligence.

God forbid - GOD FORBID - I actually give them back a little dose of their own medicine.

For that, I could be written-up, have a report submitted to the state medical board - without any due-process - noting that I am a "disruptive physician", spend time in the nursing office, spend time in HR, spend time in front of a jury...

Yes, I never realized that by going into medicine that I would be expected to just sit there and take the insults occasionally hurled at me simply because I'm "the doctor"... that being treated disrespectfully comes with the territory. I never realized that I would be expected to be routinely nailed to the cross.

Now, people out there want to claim that they have the same authority as I do without the same scope and depth of training?

MORE POWER TO THEM! Let 'em have it, provided that they have to endure the same bullsh*t that I have to routinely endure just to do what I consider to be a good job. Let 'em pay the malpractice. Let 'em have their decisions questioned. Let 'em be subject to all manner of arbitrary reporting if someone doesn't like something they do. Let 'em sit in court and defend their actions in front of a jury.

I say, let 'em treat the whole patient... and suffer all the co-requisite responsibility that comes along with that.... because apparently there's a lot of people out there who seem to believe that we're *****s who're incapable of doing that.

-copro

 

[Consigliere]

I printed that post and framed it, sir.