N.P vs MD/DO ?

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J1515 said:
With all due respect, many (I hesitate to say most because I don't know for a fact) colleges have different chemistry classes for nurses vs. pre-meds. It's similar to science vs non-science major courses.
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Actually I'd have to look back at undergrad courses and I still might not be able to tell by looking at at the curriculum. But, no one expects nurses and other health providers to have the level required of physicians. In fact, courses geared to that provider might be a good thing. But overall, it's not on my radar of being important to me 😳
 
Why can'r we all get along. Everyone profession is important in one way or the other.
 
zenman said:
Let me put it another way. Instead of studying patients, or about patients, or patient's response(s) to what you do, are you studying the patient's experience?
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Are you suggesting that you can separate the patient from their experience...? 😕
 
zenman said:
Actually I'd have to look back at undergrad courses and I still might not be able to tell by looking at at the curriculum. But, no one expects nurses and other health providers to have the level required of physicians. In fact, courses geared to that provider might be a good thing. But overall, it's not on my radar of being important to me 😳
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Actually I think 95% of organic chemistry in college was useless when it came to med school. I was just responding to Dr. DNPDoctor who was telling everyone how rigorous the basic science education of an RN is.
 
zenman said:
Let me put it another way. Instead of studying patients, or about patients, or patient's response(s) to what you do, are you studying the patient's experience?
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I'm sorry but "studying the patients experience" is total BS in my very humble opinion. In so many cases, there is no way we could possibly completely understand what is going on in a pt or the depths of their suffering, and it is insensitive in many cases to say, "I understand what you're going through," when you don't-- it's insulting to the patient.

The best physicians, the best healers that I know aren't the zen-like people who sit around "studying patient's experiences," which they can't really fully understand unless they've been there, but the ones who are human beings around their pts and approach people with a sense of compassion and empathy. They're the ones who hold their pts hands, joke with them, ask them what's cooking at home, what turns them on, and when appropriate, cries with them. That's what a good doctor does in addition to all the science, books, and medical journals.
 
silas2642 said:
I'm sorry but "studying the patients experience" is total BS in my very humble opinion. In so many cases, there is no way we could possibly completely understand what is going on in a pt or the depths of their suffering, and it is insensitive in many cases to say, "I understand what you're going through," when you don't-- it's insulting to the patient.

The best physicians, the best healers that I know aren't the zen-like people who sit around "studying patient's experiences," which they can't really fully understand unless they've been there, but the ones who are human beings around their pts and approach people with a sense of compassion and empathy. They're the ones who hold their pts hands, joke with them, ask them what's cooking at home, what turns them on, and when appropriate, cries with them. That's what a good doctor does in addition to all the science, books, and medical journals.
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Hot damn, you got it!!! Except very few docs get to do so in today's healthcare environment. Yes, you can never understand unless you've been there but you can certainly hear their story.
 
atkinsje said:
I don't think so. I'm enjoying it. This is of course my opinion and I am sure there are many docs who are great who were miserable through medical school. But I would think if you truly want to be a doc then med school should be interesting and fun. Does that mean it isn't hard? Of course not.

And because someone is likely to bring up the fact that I'm only an M1 I look at it like this. Everyone told me M1 would be miserable and I would hate it. I don't. As I said its the opposite. Now people tell me the same about M2, but after talking with friends who have been through (especially the ones who came from very similar back ground as me) they actually enjoyed M2 more, and then enjoyed M3-4 even more. So even though I haven't experienced it, I suspect (given the fact that I actually enjoy working 100+ hours a week) that I too will enjoy M2, M3 and M4 just as much or more than I am digging M1 right now.
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You'll enjoy it. I'm an M4 and I enjoy the heck out of it still; I was the same way you are as a underclassman. It gets better every year.

Don't let those negative-nellies get you, my theory is that they're just bitter because they're not as passionate or happy about their choice as you are, and probably don't appreciate their life, opportunity, and good fortune as much as you. Having said that, try not to judge them for it, because you really are the fortunate one, and I bet they envy your ability to enjoy your struggle. We all get a taste of "not enjoying our struggle" where we can't bring ourselves to study, or aren't enjoying a rotation, or are sick of patients or rounding or something from time to time, so that serves as a reminder of what some of these prematurely jaded individuals experience. We're lucky. Just try to surround yourself with people who feel the same way about med school as you do. They're around, they just aren't as vocal as the complainers.
 
Here's my stance on the issue...

There are some cases that end up being fairly straight-forward. You see the symptoms, you run some tests, you get confirmation of a condition, you start treatment, and the patient gets better. An independent NP could probably handle these types of cases on their own with no problem. BUT, a lot of the time, even problems that seem obvious on the surface end up having lots of complicated hidden layers....hidden layers that take a deep understanding of the nitty gritty science to discover and diagnose. These cases are definitely best off with MDs/DOs. The danger is that sometimes there's no way of knowing right off the bat which cases are going to be the weird ones.

So lets say that a patient has a complex and difficult to diagnose condition, but the most obvious symptoms that manifest are non-distinct and common. Who do you think would be more likely to find the real problem faster, a primary care doctor with advanced medical and scientific knowledge or a primary care NP who has received only a fraction of the education? I'd bet my money on the doctor. The NP could refer the patient out to an MD, true...but if an NP is "confident" enough to branch out on their own and play doctor, I have a hard time believing that they'd be willing to swallow their pride and own up to their relative lack of knowledge.

I don't have anything at all against nurses or NPs. I've been helped by many great nurses and PAs and I respect them fully. I just think that independent practice is a really bad idea. For the good of the patient, having doctors on hand for consults is a must.
 
I've read much on this site about the DNP replacing the family doctor. Nothing could be further from the truth. We as, DNP's, ARE the family doctor.
 
silas2642 said:
The best physicians, the best healers that I know aren't the zen-like people who sit around "studying patient's experiences," which they can't really fully understand unless they've been there, but the ones who are human beings around their pts and approach people with a sense of compassion and empathy.
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zenman said:
Except very few docs get to do so in today's healthcare environment. Yes, you can never understand unless you've been there but you can certainly hear their story.
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It's not "getting" to do so. If you want to, you do it. If you don't want to, you don't make the emotional effort. It's simple.

<shrug> I've met doctors who can make an emotional connection with a patient in 5 minutes (heck, I've done it, and I'm only an intern!) and nurses/NPs who can't make an emotional connection despite being in the patient's room for an hour. It's all based on your personal interaction skills, not what the healthcare environment dictates.
 
DrNPc Tammy said:
I've read much on this site about the DNP replacing the family doctor. Nothing could be further from the truth. We as, DNP's, ARE the family doctor.
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DoubleFacePalm.jpg
 
rosebud1 said:
Who do you think would be more likely to find the real problem faster, a primary care doctor with advanced medical and scientific knowledge or a primary care NP who has received only a fraction of the education?
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When you say advanced medical and scientific knowledge, do you mean chemistry, biochemistry, physics, embryology, immunology and neuroanatomy--you know the stuff physicians use every day with every patient encounter to glean an accurate diagnosis?

rosebud1 said:
I'd bet my money on the doctor.
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I too would put my money on the doctor of nursing practice.

rosebud1 said:
The NP could refer the patient out to an MD, true...but if an NP is "confident" enough to branch out on their own and play doctor, I have a hard time believing that they'd be willing to swallow their pride and own up to their relative lack of knowledge.
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First, DNP's aren't playing "doctor"--they are doctors. Second, are you saying that physicians don't refer out when its always needed? If so, check your local cemetery--its filled with people with which physicians have either missed an obvious diagnosis or failed to refer out when needed. As NP's we are trained to always error on the side of safety--not profits. This means, when in doubt, send to a specialty DNP, or if there are none available, then a specialist physician can be used.


rosebud1 said:
I don't have anything at all against nurses or NPs.
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Outstanding! We'll add you to the list of advocates for advancing DNP practice. We sure can use a few in the medical-model based community who don't generalize, are not into ego at the expense of patient-choice, and don't go out of their way to bend literature for turf protection via an AMA-based anti nursing agenda which does nothing but decrease patient access to affordable care.

rosebud1 said:
I just think that independent practice is a really bad idea. For the good of the patient, having doctors on hand for consults is a must.
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It's a good thing this is not the consensus as indepentent NP practice will evident in the vast majority of states shortly after the DNP mandate of 2015. It's OK though--there is much room in the losing debate of quashing DNP indpendence. There was once a time when a dying minority of people thought it a bad idea for women to vote, for women to be physicians and generally for all people to be treated equally in the US.

As independent DNP practice grows and expands to all corners of the country, though, I do support your endevors, as well as the idealogs of the Birthers and Flat Earth Society. It takes courage to stand on principle--as flawed and far from reality as it might be, and take a firm stand on the loosing side of rhetoric.
 
DrNPc Tammy said:
...I do support your endevors...and take a firm stand on the loosing side of rhetoric.
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It's endeavors, and losing...

Anyway, this person is on the fringe...

"Specialty DNP" 😱

please God help us...

Tell me there are no DNP endocrinologists, neurologists, etc...
 
Last edited:
DNPs are not specialty trained, unless it is straight from a BSN. Then it is just acute care, family, pediatrics, neonatal, women's health, psych...

The post-masters DNP curriculum simply contains classes on statistics, theory, leadership, health policy, research, teaching, etc...

One particular DNP program states the objectives are:

  • translate and implement nursing research into evidence based practice to provide the best possible outcomes for your population of interest.
  • develop the leadership and organizational expertise to effectively enact the policies and procedures necessary to meet the dynamic state of healthcare delivery.
  • identify approaches for quality management and performance improvements in health care organizations.
DNP graduates must have at least 1,000 clinical hours post BSN, so most DNP programs contain around 400-500 clinical hours, but from the looks of a lot of curriculum, majority of those hours come from indirect care, not direct.
 
Maybe this "Doctor" Tammy is just Taurus in disguise...I could see Taurus creating an (online) persona whose profile he thinks so many AP nurses would fit...
 
chimichanga said:
Maybe this "Doctor" Tammy is just Taurus in disguise...I could see Taurus creating an (online) persona whose profile he thinks so many AP nurses would fit...
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:laugh: wouldn't be surprised...

however, it is a shame that a few rotten eggs really do ruin the image of all APNs...
 
chimichanga said:
It's losing...

Anyway, this person is on the fringe...

"Specialty DNP" 😱

please God help us...

Tell me there are no DNP endocrinologists, cardiothorasics, etc... .
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Thanks for finding problems with my spelling rather than with my points. Since you probably have already figured it out from your edit, the correct spelling for cardiothorasics is "cardiothoracics" No worries, though, I'm here to help educate rather than give spelling lessons.

BTW, I didn't know you were in the need of a good NP endocrinologist. Sometimes those hormones can cause problems with our ability to reason properly. Here are a few. Let me know if I can help find one in your area.

https://www.healthline.com/doctors/endocrinologist/carolyn-williams/5438162

https://www.healthline.com/doctors/endocrinologist/kathryn-ziembo/14402660

http://www.sjhmg.com/physicians/phys-info.php/699/Emalee-Picou/
 
Tammy,

The first two appear to work in a hospital setting...Collaborative, alongside and overseen by actual doctors...

The third works for a "Medical group"
Do that math yourself...

Diabetic educators that have an AP degree...

Likely more like a clinical nurse specialist...

And none of the three are DNPs...

I have nothing against NPs doing paps, sore throats, and physicals, as long as they work in a collaborative model alongside an actual doctor (MD/DO)

chimi,
RN
 
chimichanga said:
Too funny, but my sentiments exactly...

99.99% of all NURSES feel this way about the doctor nurse thing...

Really we do Taurus...
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Yeah, I know. It's funny when you look at nursing and note chaos in the educational environment, and poor and dare I say dangerous working conditions. (Patients and healthcare providers.) Honestly, I felt safer rolling through the streets of Kabul in a 1980's Toyota van during morning rush hour than I ever did on any given day during my days of ER nursing.

Nursing has so many problems and challenges to face at a rudimentary level.
 
Too bad she was banned...I was looking forward to more silly posts from her...
 
Paseo Del Norte said:
Yeah, I know. It's funny when you look at nursing and note chaos in the educational environment, and poor and dare I say dangerous working conditions. (Patients and healthcare providers.) Honestly, I felt safer rolling through the streets of Kabul in a 1980's Toyota van during morning rush hour than I ever did on any given day during my days of ER nursing.

Nursing has so many problems and challenges to face at a rudimentary level.
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You just described my day today to a "T." I hope a semi takes me out so I can call in dead tomorrow.
 
Thank you for that img, Paseo; I saved it. I know I'll be needing it...shortly.
 
chimichanga said:
Maybe this "Doctor" Tammy is just Taurus in disguise...I could see Taurus creating an (online) persona whose profile he thinks so many AP nurses would fit...
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No, I think that she may be the real deal as far as extremist nurse practitioners are concerned. I think there is a "Tammy" nurse practitioner student on allnurses.com who is working on her MSN online; I kind of get a kick out of her posts but at the same time get really concerned for her future patients-- she just doesn't know how much she doesn't know. I'm half way through my third year and if there is one thing I know, it's that I don't know enough to do anything by myself.
 
silas2642 said:
No, I think that she may be the real deal as far as extremist nurse practitioners are concerned...
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That's my point...

I believe she is the exception, not the rule...

I've been an RN for 14+ years,worked in many, many settings...NEVER have I met or heard about anyone like her (other than Mundinger), who (in the immortal words of Barney Fife) is " a nut!"...

Taurus' passion and dedication are to be commended...However, I know the numbers of ANP extremists are more few and far between than he would care to admit...

Relax... most of us would rather all "midlevels" be supervised (ANP, CRNA, PA, AA, et (freakin' alphabet soup) cetera)

Oh, BTW, never once have I participated in, or heard of a conversation involving the AANA, Mundinger, or any other (rogue) nursing movement...

I was too busy taking care of patients...
 
chimichanga said:
That's my point...

I believe she is the exception, not the rule...

I've been an RN for 14+ years,worked in many, many settings...NEVER have I met or heard about anyone like her (other than Mundinger), who (in the immortal words of Barney Fife) is " a nut!"...

Taurus' passion and dedication are to be commended...However, I know the numbers of ANP extremists are more few and far between than he would care to admit...

Relax... most of us would rather all "midlevels" be supervised (ANP, CRNA, PA, AA, et (freakin' alphabet soup) cetera)

Oh, BTW, never once have I participated in, or heard of a conversation involving the AANA, Mundinger, or any other (rogue) nursing movement...

I was too busy taking care of patients...
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Neither have I. The only time I ran into a rogue NP I wound up hating him because he was a total tool who tried to "pass" for an MD. Pissed me off when I figured out he was a nurse. I wanted to stick my foot out and trip him as he went striding by in his long white coat...but that might have been perceived as "workplace hostility."
 
DrNPc Tammy said:
First, DNP's aren't playing "doctor"--they are doctors.
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:laugh: Now THAT'S funny. Just goes to show you how WRONG the whole DNP thing is going to be interpreted ... a Doctor of Nursing Practice? Sure. A Doctor of Medicine, err, no, you actually need to goto something that's called MEDICAL SCHOOL.
 
DrNPc Tammy said:
First, DNP's aren't playing "doctor"--they are doctors.
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The so-called "Doctoral" program offered to DNP's is not medical. Which of the following classes make a DNP an acceptably educated alternative to an MD?:

From the University of Arizona's Online DNP Program
NURS 630 Statistics for Health Sciences (3 credits) <-- crap
NURS 631 Advanced Statistics for Health Sciences (3 credits) <-- crap
NURS 642 Health Policy and Economics (3 credits) <-- that'll help save lives :roll eyes:
NURS 644 Molecular & Clinical Genetics / Genomics (3 credits) <-- minimally useful
NURS 646 Health Care Information Systems (3 credits) <-- crap
NURS 650 Theories of Leadership & Organizational Management (3 credits) <-- crap
NURS 652 Methods for Scholarly Inquiry (3 credits) <-- crap
NURS 695a The Science and Practice of Nursing (1 credit) <-- crap
NURS 705 Philosophy of Nursing Science (3 credits) <-- crap
NURS 706 Theory Development and Evaluation (3 credits) <-- crap
NURS 738 Translational Research (3 credits) <-- crap
NURS 752 Evaluation Methodologies for Safety & Quality Improvement (3 credits) <-- crap
NURS 753 Emerging Diseases and Population Health (3 credits) <-- crap
NURS 922 Practice Inquiry (9 credits) <-- not sure what this is

Second, are you saying that physicians don't refer out when its always needed? If so, check your local cemetery--its filled with people with which physicians have either missed an obvious diagnosis or failed to refer out when needed. As NP's we are trained to always error [sic] on the side of safety--not profits. This means, when in doubt, send to a specialty DNP, or if there are none available, then a specialist physician can be used.
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Of course physicians refer out, just not needlessly. The point is needless referals due to inadequate education/understanding is costly! And, if you are making the ridiculously silly implication that MD's would put more people in the cemetery because they are money-grubbing a-holes detached from humanity, well... that just proves how far removed you are from reality.
 
Starpower said:
:laugh: Now THAT'S funny. Just goes to show you how WRONG the whole DNP thing is going to be interpreted ... a Doctor of Nursing Practice? Sure. A Doctor of Medicine, err, no, you actually need to goto something that's called MEDICAL SCHOOL.
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I am sure Tammy and Tarus are the same person, clearly dx with a personality disorder with the primary goal to stir things up for the unsuspecting.
 
prairiedog said:
I am sure Tammy and Tarus are the same person, clearly dx with a personality disorder with the primary goal to stir things up for the unsuspecting.
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I don't think so. There's a Tammy, FNP/GNP on allnurses who spouts a ton of pro-NP/DNP agenda without much thinking. She even referred (on allnurses) to the post DrNPc Tammy made here on SDN. I'm thinking DrNPc Tammy and Tammy, FNP/GNP are the same person.

I doubt that Taurus would care enough or that he has enough time (he's a resident now I think) to make a separate account to troll on SDN.
 
Recently I had a physical examination done in preparation for my first year of med school and it was done by a NP. I asked him his views on the DNP movement and he was very skeptical.

Someone posted a link a while ago detailing a DNP program that you can complete in 1 yr and online no less. I was shocked...with the recent economic recession and the public's misconception of healthcare job security, I feel these programs are a way for institutions to make quick money.

How do you guys feel?
 
I've got a question regarding NPs/DNPs and being regulated by the BON:

Couldn't state medical boards take it to the courts that NPs/DNPs are practicing medicine without a license? Wouldn't it be difficult for advanced practice nurses to say they're practicing nursing when they do very similar things as physicians do? And, in this manner, couldn't medical boards easily bring APNs under the BOM and regulate NPs/DNPs very tightly? I find it hard to believe that APNs would be able to successfully argue that they're not practicing medicine and that they should be regulated by the BON rather than medical boards.

Or is there something I'm missing? Thanks.
 
Kaushik said:
I've got a question regarding NPs/DNPs and being regulated by the BON:

Couldn't state medical boards take it to the courts that NPs/DNPs are practicing medicine without a license? Wouldn't it be difficult for advanced practice nurses to say they're practicing nursing when they do very similar things as physicians do? And, in this manner, couldn't medical boards easily bring APNs under the BOM and regulate NPs/DNPs very tightly? I find it hard to believe that APNs would be able to successfully argue that they're not practicing medicine and that they should be regulated by the BON rather than medical boards.

Or is there something I'm missing? Thanks.
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Every state has a medical practice act. It defines what the practice of medicine is. It also defines who can legally practice medicine. Every state also has a nursing practice act. It defines what the practice of nursing is. It can say whatever the politicians want. For example a state could define the practice of medicine as the diagnosis and treatment of humans and animals and open the practice of medicine up to all medical and veterinary school graduates. In this model a vet could limit his practice to dogs, cats and children under eight for example (real example of something that was almost passed into law in the early 70's).

Usually the different practice acts are set up in such a way that diagnosis and treatment for example is the domain of medicine when practiced by physicians (and PAs) and the domain of nursing when practiced by advanced practice nurses. Sometimes poorly written practice acts put up barriers. For example despite attempts in California, prescribing is solely the domain of medicine. There is a work around in that NPs and PAs can "furnish" medications through something remarkably similar to a prescription. This is largely a product of infighting between the medical society and nursing association.

This is also why any profession has to be careful when you open the practice act to amendment. Lets say you wanted to open the medical practice act to allow a particular business model. You might find unfriendly amendments to the act that would prohibit physician ownership of ASCs for example (courtesy of your local hospital). Bottom line is that any time a medical society tries to amend a practice act they have money in the bank and high powered lobbyists on speed dial.

David Carpenter, PA-C
 
Kaushik said:
I've got a question regarding NPs/DNPs and being regulated by the BON:

Couldn't state medical boards take it to the courts that NPs/DNPs are practicing medicine without a license? Wouldn't it be difficult for advanced practice nurses to say they're practicing nursing when they do very similar things as physicians do? And, in this manner, couldn't medical boards easily bring APNs under the BOM and regulate NPs/DNPs very tightly? I find it hard to believe that APNs would be able to successfully argue that they're not practicing medicine and that they should be regulated by the BON rather than medical boards.

Or is there something I'm missing? Thanks.
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Could the reverse also work? Nursing boards taking medical boards to court? MDs practicing nursing when they do very similar things as nurses do? Where do you draw the line? The $$$ is with the MDs , the ### of votes are with the nurses. Last report I read on most trusted professionals had nurses #1.
 
prairiedog said:
Could the reverse also work? Nursing boards taking medical boards to court? MDs practicing nursing when they do very similar things as nurses do? Where do you draw the line? The $$$ is with the MDs , the ### of votes are with the nurses. Last report I read on most trusted professionals had nurses #1.
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To be honest, I couldn't care less if a doc does something that is technically a nursing task. I mean, whatever makes the day flow more smoothly. I couldn't care less about "my turf." There's more than enough work to go around.
 
chudat said:
what's an example of a task that only nurses can do and doctors cannot?
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I think that was the point. There are really no specific tasks save for checking the little boxes in the nursing care plan or performing the nursing assessment that are nursing specific. Even then, I do not really know as I have never had a doctor offer to do my care plan or nursing assessment. Not that I would ever complain if the offer was extended.
 
chudat said:
what's an example of a task that only nurses can do and doctors cannot?
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Running a busy ED (from a throughput, i.e. directing "traffic" standpoint) :laugh:

Seriously...Stick to taking care of patients...Please don't room them, or direct ambo flow......It usually gets ugly...


His point is that we both should have plenty of our own stuff to occupy our time...Teamwork is key...
 
Paseo Del Norte said:
I think that was the point. There are really no specific tasks save for checking the little boxes in the nursing care plan or performing the nursing assessment that are nursing specific. Even then, I do not really know as I have never had a doctor offer to do my care plan or nursing assessment. Not that I would ever complain if the offer was extended.
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Yes, you would. I worked with an RN turned MD. Unfortunately, he couldn't turn loose of the nurse role and he just got in the way and slowed things down. This was in ER.
 
zenman said:
Yes, you would. I worked with an RN turned MD. Unfortunately, he couldn't turn loose of the nurse role and he just got in the way and slowed things down. This was in ER.
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Maybe; however, I frequently let PA students draw blood, place peripheral IV's, insert NG tubes, and even mix, hang, and titrate medications. While I was more efficient at these tasks because I did them all the time, I had absolutely no problem letting these guys do stuff that I normally did. I even gave pointers here and there. I actually enjoyed working with the students and there was allot of mutual learning that occurred. Perhaps our enthusiasm for students helped these guys out?

The real funny thing is one of those students took an ER PA position at a small facility near a base I fly out of, and now I take report from him when I fly patients out of that facility. So, you never know how things role in this field.
 
Paseo Del Norte said:
Maybe; however, I frequently let PA students draw blood, place peripheral IV's, insert NG tubes, and even mix, hang, and titrate medications. While I was more efficient at these tasks because I did them all the time, I had absolutely no problem letting these guys do stuff that I normally did. I even gave pointers here and there. I actually enjoyed working with the students and there was allot of mutual learning that occurred. Perhaps our enthusiasm for students helped these guys out?
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Students are another matter; I actually enjoyed teaching. But the guy I was talking about was not a student, just confused about his role.
 
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