NPR segment on DNP's - make your voices heard!

[Taurus]

I have a unique perspective on this. I am a physician (i.e. I actually went to medical school). I was also a nurse and took NP classes.

There is absolutely NO comparison between the two. ZERO. Most NP programs contain less actual "medical" classes than you get in one semester of real medical school. Mine was 15 credit hours. The rest is nursing theory, research, nurse political activism and such. It is so unbelievably different, you can't compare the two. The truly scary thing is that they don't how much they don't know.

NPs, DNPs have absolutely NO right to independent practice. I think there is a role for them such as running coumadin clinics, helping with post-op evals, vaccinations and other such limited practice.

They simply do not have a fraction of the knowledge that the worst FM physician has. Not even close.

Imagine this. Would you let a fourth year medical student open up a clinic and do primary care? H@(( no! And the fourth year medical student already has VAST more medical education than an NP or DNP.

If this does not bother you, it should. I've seen the inside politics of this debate. These people want your job. They hate, resent and envy you. They are cunning and very political active. If we don't stop them, it will negatively affect us all. And their pathway to "independence" will be littered with the dead bodies from their blissful ignorance and pride.

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[sirus_virus]

Physicians will loose this one like they do everything else. I have always said physicians are trained in medical school and residency to act like sheep, but the real world is full of wolves ready to devour. You ask an average physician what they think about unionizing and they will give you a laundry list of why it will not work for physicians, when really all they are trying to say is "I don't have the balls to unionize and fight for my rights, because you never know what might happen to my precious MD if I am too vocal". That is what physicians are thought in training; don't you ever say you like money, don't stand up against authority even when you are right, if it makes no sense just do it anyway if you are asked to, smile to your superiors when you are mad then take it out on your subordinates, one mistake and we will destroy your career/life. End product ===> Sheep.

The nurses have a strong union and they are playing hard ball with it, and rightfully so, what do you expect. They make it clear they want money and they actually prefer your money. You know that money you claimed you did not care about, they will like for you to hand it over. Now they want more than your money, they actually want your title too. Politicians have also sensed the weakness in the physician workforce and they are ready to hump. Let's not talk about lawyers or insurance companies. What are physicians going to do about it? They will do what they were trained to do, lay low and hope you make it to the next level.

So if you are a physician just remember your fate lies in the hands of nature which typically does not select for the weak. I am sure when things get bad enough physicians will grow some nutz and start fighting, but it will not be this breed of physicians and it will not be any time soon.

 

[maceo]

Physicians will loose this one like they do everything else. I have always said physicians are trained in medical school and residency to act like sheep, but the real world is full of wolves ready to devour. You ask an average physician what they think about unionizing and they will give you a laundry list of why it will not work for physicians, when really all they are trying to say is "I don't have the balls to unionize and fight for my rights, because you never know what might happen to my precious MD if I am too vocal". That is what physicians are thought in training; don’t you ever say you like money, don’t stand up against authority even when you are right, if it makes no sense just do it anyway if you are asked to, smile to your superiors when you are mad then take it out on your subordinates, one mistake and we will destroy your career/life. End product ===> Sheep.

The nurses have a strong union and they are playing hard ball with it, and rightfully so, what do you expect. They make it clear they want money and they actually prefer your money. You know that money you claimed you did not care about, they will like for you to hand it over. Now they want more than your money, they actually want your title too. Politicians have also sensed the weakness in the physician workforce and they are ready to hump. Let's not talk about lawyers or insurance companies. What are physicians going to do about it? They will do what they were trained to do, lay low and hope you make it to the next level.

So if you are a physician just remember your fate lies in the hands of nature which typically does not select for the weak. I am sure when things get bad enough physicians will grow some nutz and start fighting, but it will not be this breed of physicians and it will not be any time soon.

Ok whatever.. Your post is ignorant. You dont even know the facts. It is illegal for physicians to organize in this country.

 

[Miami_med]

I would say forget unionizing, and let's just form a political organization that actually represents physicians (something like the AMA supposedly does). History is funny. When physicians in the modern sense had no better outcomes than witch doctors in the majority of circumstances (think 1914), they were given sole rights to practice. Now that medicine is actually a largely scientific and partially evidence based endeavor that clearly requires a specific type of person to administer, that monopoly is in jeapordy. In a way, previous generations of physicians brought it upon themselves. This generation is largely the victim of those choices. That being said, a little bit of political saavy, and the current trend could be reversed.

The goal should NOT be to try and block nurses practice rights, because that makes them look like a victim. The goal should be a legitimate public education campaign about the differences followed by threats to walk if conditions don't improve. Nurses can have whatever legal right to practice they want. An educated public would interfere with credentialling to such a degree, that licensing would be irrelevant. It's sort of like how FPs don't perform colectomies. They have the licensing, but they don't have the credentialling, and an informed public would slaughter them AND any involved hospital in a court of law for any complication.

 

[sirus_virus]

Ok whatever.. Your post is ignorant. You dont even know the facts. It is illegal for physicians to organize in this country.

F&ck a whole lot of that ****. I have read the damn law left, right, up and down. Anyone can unionize if you want to. You might have restrictions on industrial actions and negotiations, but you can unionize if you want to. Those restrictions can be overcome if your union is made up of people with the balls to fight. That is what the other unions have done historically.

 

[sirus_virus]

I would say forget unionizing, and let's just form a political organization that actually represents physicians (something like the AMA supposedly does). History is funny. When physicians in the modern sense had no better outcomes than witch doctors in the majority of circumstances (think 1914), they were given sole rights to practice. Now that medicine is actually a largely scientific and partially evidence based endeavor that clearly requires a specific type of person to administer, that monopoly is in jeapordy. In a way, previous generations of physicians brought it upon themselves. This generation is largely the victim of those choices. That being said, a little bit of political saavy, and the current trend could be reversed.

The goal should NOT be to try and block nurses practice rights, because that makes them look like a victim. The goal should be a legitimate public education campaign about the differences followed by threats to walk if conditions don't improve. Nurses can have whatever legal right to practice they want. An educated public would interfere with credentialling to such a degree, that licensing would be irrelevant. It's sort of like how FPs don't perform colectomies. They have the licensing, but they don't have the credentialling, and an informed public would slaughter them AND any involved hospital in a court of law for any complication.

Excellent point, but who is going to fund that campaign if not a union or some gathering of physicians?

 

[McGillGrad]

The goal should NOT be to try and block nurses practice rights, because that makes them look like a victim. The goal should be a legitimate public education campaign about the differences followed by threats to walk if conditions don't improve. Nurses can have whatever legal right to practice they want. An educated public would interfere with credentialling to such a degree, that licensing would be irrelevant. It's sort of like how FPs don't perform colectomies. They have the licensing, but they don't have the credentialling, and an informed public would slaughter them AND any involved hospital in a court of law for any complication.

Those are valid arguments, but it is still playing a game where we could become the victim of our own strategy. Yes, we could use scare tactics to remind people of their lack of knowledge and diagnostic skills, but that is only helpful if there wasn't empirical evidence that proved-otherwise (especially since common people have common problems that are easily remedied with common therapeutic protocols).

Instead, it is pertinent to take advantage of the early stages of this new era of medicine where there are far more morbid patients than fully licensed MD/DO's in primary care. Pawn off the doc-in-a-box duties to the DNPs and other mid levels and legally codify true medicine with legal consequences for those mid-levels who cross the line.

If that is too complicated, then make sure any DNP/NP/CRNA who wants the responsibility to practice medicine to take full responsibility financially and legally for their actions (with full malpractice payments and being sued for mistakes). That'll thin out the *****s from the really amazing mid-levels. In the end, the patients, win too!

 

[mig26x]

If this does not bother you, it should. I've seen the inside politics of this debate. These people want your job. They hate, resent and envy you. They are cunning and very political active. If we don't stop them, it will negatively affect us all. And their pathway to "independence" will be littered with the dead bodies from their blissful ignorance and pride.

Absolutely right, if people want to know how much nurses really hate doctors (especially the old ones) please go to allnurses.com

Its unbelievable the way they express themselves about doctors.

Thankfully the new nurses, the young ones, are not so evil toward doctors. In fact my experience has been they are very happy bunch of people

 

[McGillGrad]

It is true that we can create "unions" but we cannot strike or take actions that place society in danger. That takes the bite out of it.

F&ck a whole lot of that ****. I have read the damn law left, right, up and down. Anyone can unionize if you want to. You might have restrictions on industrial actions and negotiations, but you can unionize if you want to. Those restrictions can be overcome if your union is made up of people with the balls to fight. That is what the other unions have done historically.

 

[sirus_virus]

It is true that we can create "unions" but we cannot strike or take actions that place society in danger. That takes the bite out of it.

Sure, but you start with what you can do which is form the union. Labor laws change everyday because unions fight to change them. Nurses can strike tomorrow if they want to, does that not put society in danger? There were laws preventing pilots from going on strike, but not only did they strike, they actually came out ahead. Society will not hand anyone anything for free, and if physicians continue with this passive attitude, it will be too late in a hurry.

 

[McGillGrad]

Ineffective Unions are the reason why American auto makers are a miserable failure. More money is used by unions to pay union bosses and useless union committes than on protecting the actual members.

Unions are not the answer, political clout that lobbies in our interests and against insurance interests would be more realistically useful.

Sure, but you start with what you can do which is form the union. Labor laws change everyday because unions fight to change them. Nurses can strike tomorrow if they want to, does that not put society in danger? There were laws preventing pilots from going on strike, but not only did they strike, they actually came out ahead. Society will not hand anyone anything for free, and if physicians continue with this passive attitude, it will be too late in a hurry.

 

[sirus_virus]

Ineffective Unions are the reason why American auto makers are a miserable failure. More money is used by unions to pay union bosses and useless union committes than on protecting the actual members.

Unions are not the answer, political clout that lobbies in our interests and against insurance interests would be more realistically useful.

You might be right, but remember this kind of lobbying already exists. The key to success is aggression. When physicians show they are both capable and willing to put up a fight, then the forces working against physicians (politicians, insurance, DNPs etc) will have to factor physician resistance into the equation before they pull some crap out their rears. That is not a factor right now, and the sense is that physicians are a weak workforce ripe for destruction by anyone who so pleases.

 

[Acherona]

Absolutely right, if people want to know how much nurses really hate doctors (especially the old ones) please go to allnurses.com

Its unbelievable the way they express themselves about doctors.

Thankfully the new nurses, the young ones, are not so evil toward doctors. In fact my experience has been they are very happy bunch of people

I don't see why nurses should hate doctors so much. It's a free country. If they want to go to med school, nobody's stopping them. But I don't see how they could expect the same responsibility/salary as someone who trained twice as long as them.

 

[maceo]

Ineffective Unions are the reason why American auto makers are a miserable failure. More money is used by unions to pay union bosses and useless union committes than on protecting the actual members.

Unions are not the answer, political clout that lobbies in our interests and against insurance interests would be more realistically useful.

Ineffective unions?? 75 bucks an hour to install tires on cars!! I wouldnt call that in effective. I would call that really effective

 

[lowbudget]

Sure, but you start with what you can do which is form the union. Labor laws change everyday because unions fight to change them. Nurses can strike tomorrow if they want to, does that not put society in danger? There were laws preventing pilots from going on strike, but not only did they strike, they actually came out ahead. Society will not hand anyone anything for free, and if physicians continue with this passive attitude, it will be too late in a hurry.

Most physicians aren't employed and function, instead, as independent contractors. "Unionizing" subjects you to collusion and antitrust with is triple damages if it's found to restrict competition.

We don't live in France. Unionizing and striking is not favorably viewed by the general public. Especially when it's among "highly paid" professions where you're easily viewed as whiners (think: professional athletes like baseball, basketball & hockey) and where public's health & welfare are endangered (think: air traffic controllers).

Professional sports strikes took many years to recover, and people have an unfavorable view them and, really, show very little sympathy for them. That's the opposite of what we're trying to do. And, air traffic controllers were simply fired by the President and replaced. In America, we love destroying our heroes for public consumption.

Listen, we live in a country that values competition. Because competition drives innovation which benefits everyone. And people are willing to pay up for things that are better. Rather than try to squash competition by putting up barriers, you should thrive in it by RAISING the LEVEL of your GAME, Doctor.

DNP's have trained and learned from us and they say they can do our job better than us. Why not learn from these DNP's and find out what their secret sauce is (if any) and do it better than them? What you will find out is when exposed to competition, there's no doubt who the winner will be.

Chiropractors won their anti-trust suit against AMA (allopathic physicians)... but their lack of science and, basically, greed has left their profession in shambles. DO's won their suit against the AMA (allopaths), but almost all DO's have since ABANDONED osteopathy.

Nurses & DNPs are trying to tell us that they can do our jobs just as well (while abandoning their own profession)... Find out what they are really trying to say, and start delivering that to our patients. Nancy Pelosi told American women to "Know Your Power" because "There Is No Secret Sauce." I think as doctors and DNP's alike, we all know this.

At the end of the day, the patients will make the ultimate decision. And I have faith that they'll side with the people who can best take care of them. This is why I like learning from RN's, PA's, NP's, PT's, OT's, RT's, MA's, clinical lab, AT-C's, CRNA's... you name it. And seeing what I've seen, I'm not worried.

 

[McGillGrad]

Ineffective unions?? 75 bucks an hour to install tires on cars!! I wouldnt call that in effective. I would call that really effective

How long will they be working when the industry folds? Not long, and that's why they are ineffective.

 

[Taurus]

Not surprisingly, the nurses are lying about the DNP exam in their propaganda and once again the ASA is taking the charge to respond:

Just as we feared, ABCC’s statement below equates the DNP exam to Step 3 of the United States Medical Licensing Examination (USMLE), which not only jeopardizes patient safety by misleading patients to believe that DNPs are equivalent to physicians, but it also minimizes the physician-patient relationship.

The ABCC exam was comparable in content, similar in format and measured the same set of competencies and applied similar performance standards as Step 3 of the United States Medical Licensing Examination, which is administered to physicians as one component of qualifying for licensure​

NBME assured the medical community that it would address any instance of misrepresentation to the public of equivalency and that NBME’s contract to supply such questions to ABCC would terminate due to misrepresentation. Moreover, NBME’s rationale for its involvement in the DNP certification as outlined in the white paper, “NBME Development of a Certifying Examination for Doctors of Nursing Practice” supports this commitment made to the medical community. Specifically,

The DNP certifying examination is not designed to replicate the USMLE assessment for medical licensure. It does not include the in-depth assessments of fundamental science, clinical diagnosis, and clinical skills that are provided through USMLE Step 1, Step 2 CK, and Step 2 CS. Similarly, the training leading to the DNP degree is substantially different from the educational experiences that result in the MD or DO degrees. The context and the scope of a DNP certifying examination is materially different from the context and scope of the USMLE.​

You can sample some of the DNP exam questions here. I installed the software and did the questions. It's not even close in difficulty with the USMLE steps.

 

[Taurus]

Why not learn from these DNP's and find out what their secret sauce is (if any) and do it better than them?

See my above post. Their secret sauce is 1) lying to the public and lawmakers about their training and capabilities 2) propaganda and lobbying to expand their scope 3) poorly organized physicians who don't challenge their every move.

Does it make sense to you why we allow NP's to proclaim that they are practicing "advanced nursing"? They practice medicine, but they won't say that because they are terrified of being regulated by the boards of medicine. They think that by using euphemisms that they can confuse and trick people into what they do.

Physicians can learn from nursing. We need to be better organized and do our own lobbying. We need to do studies to demonstrate the real differences in outcomes between physicians and NP's. We need to file lawsuits to challenge that NP's should be regulated by boards of medicine. We need to educate the public, lawmakers, lawyers, and insurance executives about the differences in training and capabilities of NP's and physicians. We, as physicians, can definitely do more than what we are doing now.

 

[xxyyzz]

Patients who have insurance plans are not stupid.

My practice has a good mix of HMO, PPO, private, FFS/indemnity plans. My HMO patients as you all know are assigned to me (or they choose me from the directory), and the rest are strictly by their choice. They all expect a medically licensed physician to take care of them.

In particular, those with the non-HMO plans listed above would want the best person to address their medical needs. And I will go as fas as to say that I believe the majority of them would want a residency-trained, board-certified, medically licensed physician. That's because they usually have the financial means to have the kind of plan with a higher co-pay, choice of going in or out of network, or affording the brand name drugs. They don't need a referral to see a specialist. They want a PHYSICIAN, not a nurse.

Now, I am sure there will be patients who may prefer the "doctor" that has advanced nursing training, but these "doctor nurses" still have to identify themselves legally as a "nurse", NOT a physician, right? And if after this is stated and the patient wants to have this "doctor nurse", then by all means they should have it. They are choosing a practitioner who is practicing a mixed hybrid of medicine and nursing. Yes, the medical training and certification exams are watered-down versions of medicine, but if this is the type of care the patient wants in exchange for the "nursing skills", then so be it.

And that's ok by me because I am confident that the majority of patients will want a physician, not a nurse. The title "doctor" is just a title. Some elementary school principals insist on being referred to as "doctor"! (but I just introduce myself as "xxyyzz" because I don't feel the need to stroke my ego...besides I really don't want to be giving out free medical advice). But the profession "physician" is important to distinguish from "nurse".

As far as the issue that DNPs will fill the void of primary care..so what? I have confidence in my training and profession that distinguishes me from nurses, and patients who carry premium insurance plans are a picky lot.

Now, DNPs could fill the role of working in community clinics or underserved areas. These patients may or may not care as much because they are at least getting some form of health care and they are just grateful for something.

DNPs can call themselves "doctor". And I will respect that level of training, as long as this "doctor nurse" also respects the training I have received to practice medicine as a physician.

Again, have faith in your patients in their choice of practitioners.

 

[UMED122]

I wish I had the same faith in the general public that you do. Most people I know decide who a good doctor is by their bedside manner, and I don't think physicians do much better than nurses in this regard. In a way, I can't really blame the patients...how are they supposed to know which practitioner knows their pathophysiology, etc. Basically, all they have to judge a doctor by is how much they like him/her as a person, with the expectation that if they made it through medical school, they must know what they're doing.

 

[xxyyzz]

I wish I had the same faith in the general public that you do. Most people I know decide who a good doctor is by their bedside manner, and I don't think physicians do much better than nurses in this regard. In a way, I can't really blame the patients...how are they supposed to know which practitioner knows their pathophysiology, etc. Basically, all they have to judge a doctor by is how much they like him/her as a person, with the expectation that if they made it through medical school, they must know what they're doing.

Well, that should inspire you to have a great bedside manner. The best source of marketing is word of mouth...listen, be your patient's advocate, and provide good "customer service". Despite the notion of doing this for the sake of altruism, it's also about providing a service that the patient (and their friends and family) want.

Believe me, when you start seeing patients with good insurance, they are very educated. After all, they want good quality care and get the best bang for their buck. And they will want you, the practitioner with the MD or DO after their name, not the "nursing doctor". And if your patient asks what the difference between your title and DNP is, then (without berating or belittling the DNP profession) educate them about the different licensing and education requirements. Then to finish, just ask let them know the choice is theirs what kind of practitioner they want.

I am confident that if you use that great bedside manner and take the time to educate, they will always choose the PHYSICIAN, YOU.

 

[UMED122]

Well, that should inspire you to have a great bedside manner. The best source of marketing is word of mouth...listen, be your patient's advocate, and provide good "customer service". Despite the notion of doing this for the sake of altruism, it's also about providing a service that the patient (and their friends and family) want.


I am confident that if you use that great bedside manner and take the time to educate, they will always choose the PHYSICIAN, YOU.

I'm confident in my own bedside manner. However, I think it would be vain of us to think that, because we are physicians, we have bedside manners that are that much better than nurses. We can claim more medical knowledge, but bedside manner is for anybody with some common sense and people skills, not just doctors or even nurses. And that's what the public judges their caregivers on, because they assume that the system (medical school, residency, etc.) has already selected for medical knowledge.

 

[McGillGrad]

As far as the issue that DNPs will fill the void of primary care..so what? I have confidence in my training and profession that distinguishes me from nurses, and patients who carry premium insurance plans are a picky lot.

Now, DNPs could fill the role of working in community clinics or underserved areas. These patients may or may not care as much because they are at least getting some form of health care and they are just grateful for something.

DNPs can call themselves "doctor". And I will respect that level of training, as long as this "doctor nurse" also respects the training I have received to practice medicine as a physician.

Again, have faith in your patients in their choice of practitioners.

Good point, because underserved areas are important to staff because their health (or disease) has a direct impact on society. People do not pay taxes for Medicaid out of the goodness of their hearts. They pay for Medicaid so the poor and dirty do not start TB epidemics (etc) and harm the rich people.

 

[xxyyzz]

I'm confident in my own bedside manner. However, I think it would be vain of us to think that, because we are physicians, we have bedside manners that are that much better than nurses. We can claim more medical knowledge, but bedside manner is for anybody with some common sense and people skills, not just doctors or even nurses. And that's what the public judges their caregivers on, because they assume that the system (medical school, residency, etc.) has already selected for medical knowledge.

I couldn't agree more. Bedside manner is more about your interpersonal skills than your medical knowledge. But why should they choose the DNP over you, the physician?

What can a DNP truly offer more than a physician? Bedside manner? If that's the only platform they are running on they will be in a world of hurt.

Day to day I treat my patients as "customers". My staff does call backs to them a few days later to see what we can do for them and how their visit was. Some receive random surveys in the mail about their visit experience. Just for them to receive a call and ask about how their visit was goes a really long way.

There are physicians that feel entitled so much that bedside manner is underutilized. And patients STILL go to them. Ask them why and they will usually say "because he/she diagnosed the right problem, sent me to the right specialist, saved my life, etc." Yes, there are exceptions.

Now, if these entitled physicians would just work on their bedside manner, their cross section of patients with premium insurance plans would increase tremendously.

 

[maceo]

Good point, because underserved areas are important to staff because their health (or disease) has a direct impact on society. People do not pay taxes for Medicaid out of the goodness of their hearts. They pay for Medicaid so the poor and dirty do not start TB epidemics (etc) and harm the rich people.

inadequate care is not better than no care

 

[mercaptovizadeh]

xxyyzz:

That's all well and good but many of these people identify themselves as "doctor" to the patient. My mother went to the ambulatory medicine clinic at UCSF, waited for hours, and was "seen" by a self-presented "doctor." Many would just accept the title at face value. She, however, was suspicious and asked him if he was really a doctor. He said yes. She asked if he had an MD. He said no but was qualified blablabla (he was not a medical student). She then told him that her insurance entitled her to care from an MD and that she would accept no less.

Many people out there don't know that there are frauds out there masquerading as doctors. They won't be able to pick up on subtle cues and won't probe further.

 

[McGillGrad]

It is obvious that you have never worked in a clinic in a developing nation or in the extremely rural areas where simple preventative care (and timely BASIC treatment) is the difference between full recovery & death/losing limbs/severe disabilities.

Get over yourself. Any monkey can provide basic care and prevent common ailments caused by lack of treatment.

inadequate care is not better than no care

 

[xxyyzz]

xxyyzz:

That's all well and good but many of these people identify themselves as "doctor" to the patient. My mother went to the ambulatory medicine clinic at UCSF, waited for hours, and was "seen" by a self-presented "doctor." Many would just accept the title at face value. She, however, was suspicious and asked him if he was really a doctor. He said yes. She asked if he had an MD. He said no but was qualified blablabla (he was not a medical student). She then told him that her insurance entitled her to care from an MD and that she would accept no less.

Many people out there don't know that there are frauds out there masquerading as doctors. They won't be able to pick up on subtle cues and won't probe further.

For your specific case, is this a DNP or someone who portrayed themselves as a "doctor" but really wasn't one (PA, FNP)? If the latter is the case, then your mother should report this to their licensing board and to the UCSF administration.

I am a physician. Am I insulted by the comparison of my education to a DNP? Certainly, just like many of you here on this message board. But, your patients if educated will be just as insulted as well.

Your mother just demonstrated my faith in patients. She would accept no less than a physician. Her insurance entitles her to care from a physician. She pays or her employment pays for her to have care from a physician who oversees her care.

My own patients, when I send them for a referral/consultation with a specialist, only see the physician. I educate them about asking who they are going to see when they make their appointment. I am not asking for an opinion from their trained PA. And my patients always tell me "thanks Dr. xxyyz, that's very helpful". They tell their friends, who tell their friends, etc.

 

[BlondeDocteur]

It is obvious that you have never worked in a clinic in a developing nation or in the extremely rural areas where simple preventative care (and timely BASIC treatment) is the difference between full recovery & death/losing limbs/severe disabilities.

Get over yourself. Any monkey can provide basic care and prevent common ailments caused by lack of treatment.

I was with you till the last sentence...

 

[McGillGrad]

I was with you till the last sentence...

Yeah, the last sentence was meant as more of a zinger than a valid point...

 

[peerie]

Never mind! I give up. Time to go for a walk and watch the daffodils come up.

 

[Taurus]

You are deluding yourself if you really think that's what NPs are limiting themselves to.

Agreed. It's extremely naive to think that NP/DNP's want to just do primary care. It's low earning with a lot of paperwork hassle and poor hours. They have their eyes set on the specialties like cards, GI, dermatology, etc.

 

[mercaptovizadeh]

Agreed. It's extremely naive to think that NP/DNP's want to just do primary care. It's low earning with a lot of paperwork hassle and poor hours. They have their eyes set on the specialties like cards, GI, dermatology, etc.

Derm is relatively low risk, but cards? Are they nuts? Next they'll want to be neurosurgeons...

 

[chimichanga]

I don't see why nurses should hate doctors so much. It's a free country. If they want to go to med school, nobody's stopping them. But I don't see how they could expect the same responsibility/salary as someone who trained twice as long as them.

RN=3-4 years of school

MD/DO=12-20 years of school...

fuzzy math you have...

that being said, I have been on the receiving end of nurse hate, based on titles only...there is a caste system in the health care (delivery) system...
so please don't opine on what you don't (yet) understand...

don't want your responsibility, just your respect for my place in the game (which you undoubtedly coach)

 

[Taurus]

Derm is relatively low risk, but cards? Are they nuts? Next they'll want to be neurosurgeons...

Yes, I've heard talk from NP's who work in cards that they would be interested in hanging their own shingle someday. It's amazing how much they don't know what they don't know. Be very careful what you teach an NP or CRNA. If you train them on the simplest of cases, they will begin to think that they can do any case independently. Until this issue with them is resolved, I will preferentially hire PA's and AA's. Otherwise, you're just training your future competitor, albeit an unqualified one who utilizes propaganda and lies to portray themselves as equivalent to you. Learn from the surgeons. They do not formally train NP's in surgery. Do you hear any NP's who say that they should be allowed to perform plastics, ENT, urology, ortho surgery independently? Same thing with radiology. Do you hear any NP's who say that they can read a chest CT as well as a radiologist?

 

[mig26x]

who here has sent an email to the ACP? NBME? FSMB? regarding this issue. I have, we have to put pressure on this people and let them know that we are against this DNP joke.

 

[McGillGrad]

I am not in the hospitals to see this dynamic, but how is it logistically possible for a DNP and NP to practice medicine via diagnosing, prescribing and billing as physician would?

 

[McGillGrad]

You give them independent practice rights, put a long white coat on them, and insist everyone refer to them as "Doctor".

What logistics do you think stand in their way?

Putting your silly attitude aside, how is that different from a physician? If there is no difference then, why do we go through all of this training?

As an aside, what you described is not legal. Want to try again with a non-fantasy answer?

 

[drfunktacular]

Putting your silly attitude aside, how is that different from a physician? If there is no difference then, why do we go through all of this training?

As an aside, what you described is not legal. Want to try again with a non-fantasy answer?

Putting your hostility aside, you are missing the point of this argument. The entire debate centers on making it legal for them to practice independently.

 

[McGillGrad]

Putting your hostility aside, you are missing the point of this argument. The entire debate centers on making it legal for them to practice independently.

Putting your inability to judge the tone of a sentence aside, it is impossible for it to become legal because they are not licensed physicians.

 

[PeepshowJohnny]

Putting your silly attitude aside, how is that different from a physician? If there is no difference then, why do we go through all of this training?

As an aside, what you described is not legal. Want to try again with a non-fantasy answer?

Because perception is everything. Tired's scenario is not far off, and hinges on DNP's getting independent practice rights.

Hell, I've seen the following scenario multiple times: I ask a patient who his primary doctor is because I need some info form their office. He replies "Dr. Humberts" and gives me the office #. I call the office and explain I have a patient of Dr. Humberts here...only to be corrected that the only Humberts there is Tina Humberts, APN.

The confusion happens even now when their is no intended deception! Patients think "White coat, seen in doctors office = doctor". Give them a doctor title and a whole other big segment of the population is going to be making this false assumption.

I could go on a big long rant about this issue, which I usually stay out of, but I think Taurus has already said it best: They don't know how much they don't know. And that's scary.

 

[ProRealDoc]

Because perception is everything. Tired's scenario is not far off, and hinges on DNP's getting independent practice rights.

Hell, I've seen the following scenario multiple times: I ask a patient who his primary doctor is because I need some info form their office. He replies "Dr. Humberts" and gives me the office #. I call the office and explain I have a patient of Dr. Humberts here...only to be corrected that the only Humberts there is Tina Humberts, APN.

The confusion happens even now when their is no intended deception! Patients think "White coat, seen in doctors office = doctor". Give them a doctor title and a whole other big segment of the population is going to be making this false assumption.

I could go on a big long rant about this issue, which I usually stay out of, but I think Taurus has already said it best: They don't know how much they don't know. And that's scary.

Make sure you tell that patient that his "doctor" is actually a nurse.

 

[core0]

Putting your inability to judge the tone of a sentence aside, it is impossible for it to become legal because they are not licensed physicians.

No they are nurses. They are licensed under the state board of nursing to diagnose, treat and prescribe as advanced practice nurses. In a number of states they need no physician involvement in their practice outside of a physician name for billing. They have managed to convince the public that since this is nursing its perfectly legal.

Not sure what you don't understand.

David Carpenter, PA-C

 

[McGillGrad]

No they are nurses. They are licensed under the state board of nursing to diagnose, treat and prescribe as advanced practice nurses. In a number of states they need no physician involvement in their practice outside of a physician name for billing. They have managed to convince the public that since this is nursing its perfectly legal.

Not sure what you don't understand.

David Carpenter, PA-C

What I don't understand is the difference between a physician and a DNP who has all the rights and responsibilities of a physician.

If DNP = MD is a "number of states," then have a state medical board who has no power over DNPs.

You really think that in a world where auto makers unions force non-unionized workers out of the factories, something as important as healthcare would allow non-MDs to do the same thing?

 

[core0]

What I don't understand is the difference between a physician and a DNP who has all the rights and responsibilities of a physician.

If DNP = MD is a "number of states," then have a state medical board who has no power over DNPs.

You really think that in a world where auto makers unions force non-unionized workers out of the factories, something as important as healthcare would allow non-MDs to do the same thing?

Medical boards have power over the practice of medicine. Nursing boards have power over the practice of nursing. So yes in most states medical boards have no power over any nurse much less DNPs. Boards only have power over members that practice that profession. For example the plumbing board has no power over dentists (to use an example). If a dentist held themselves out as a licensed plumber (and did not have a license) then the plumbing board could take action. Same with medical boards. Since diagnosis and treatment by advanced practice nurses is part of nursing the medical boards have nothing to do with it.

Unions are about labor laws and contract law not sure what this has to do with medical boards.

David Carpenter, PA-C

 

[McGillGrad]

Then what is the difference between a physician and a DNP and a PA if we all do the same thing?

Medical boards have power over the practice of medicine. Nursing boards have power over the practice of nursing. So yes in most states medical boards have no power over any nurse much less DNPs. Boards only have power over members that practice that profession. For example the plumbing board has no power over dentists (to use an example). If a dentist held themselves out as a licensed plumber (and did not have a license) then the plumbing board could take action. Same with medical boards. Since diagnosis and treatment by advanced practice nurses is part of nursing the medical boards have nothing to do with it.
Unions are about labor laws and contract law not sure what this has to do with medical boards.

David Carpenter, PA-C

 

[McGillGrad]

Ok, just had a discussion with one of the experienced attendings and he set me straight on this topic.

He confirmed that I have been ignorant of many trends that would be obvious to practicing physicians in medical centers all over the country. I seem to have been grossly mistaken on the scope of this situation and have been blatantly wrong in some of my assumptions about mid-levels and their motivations.

In short, even though the current system disallows NPs and DNPs from acting as sole providers of comprehensive medical treatment, they are fighting for legislative loopholes that will allow them equal footing in hospitals and in private practice.

This brings me back to my original idea of forcing DNPs to detail their scope of practice in order to regulate and beat back their advances into practicing medicine as physicians do.

Unfortunately, in America, you need to employ "public awareness" campaigns that will utilize non-sensationalized facts to educate the public about the benefits of physicians and the risks of using DNPs in CERTAIN circumstances. Scare tactics will not succeed and it is important to avoid them in order to prevent DNP from acting like the victim.

 

[maceo]

Medical boards have power over the practice of medicine. Nursing boards have power over the practice of nursing. So yes in most states medical boards have no power over any nurse much less DNPs. Boards only have power over members that practice that profession. For example the plumbing board has no power over dentists (to use an example). If a dentist held themselves out as a licensed plumber (and did not have a license) then the plumbing board could take action. Same with medical boards. Since diagnosis and treatment by advanced practice nurses is part of nursing the medical boards have nothing to do with it.

Unions are about labor laws and contract law not sure what this has to do with medical boards.

David Carpenter, PA-C

Look if I examine someone and his bp is elevated, I will diagnose him with HTN. IM practicing medicine.

If an advance nurse looks at a bp and its elevated she/ he will diagnose him with htn. She is practicing medicine..

WTF< its the same damn thing. diagnosing is practicing medicine i dont care who does it.

 

[mig26x]

People, we need to write to the ACP, FSMB, NBME, your board certified institution.

I already did, go ahead.

 

[sirus_virus]

The solution to these psuedo-doctors encroachment is simple. See, these DNPs, RNs and the other alphabet combos which I honestly can't keep up with are relying on disguise to achieve their goals. So what can physicians do?

1) Abandon the whole "we are a team" nonsense, while they try their best to undercut you.

2) Launch a massive public awareness campagn to enlighten patients about the difference between a doctor and these pseudo-doctors. Let pts know if they intend to see a doctor, they need to make sure they are not defrauded by someone else dressed in a white coat.

3) Make sure the students entering these programs understand that if their intention is to be a DNP, NP, etc then fine, but if they are looking for a round about way to pass themselves off as a physician, they will be exposed as a fraud.

4) If they must be independent, then they must also be legally independent. They must carry the total legal burden for malpractice. Lawyers need to be enlightened about the autonomy of these DNPs. Right now they try to maintain the luxury of calling themselves "helper nurses" when the the legal fireworks start flying, otherwise they want to be called physicians.

BTW, it is time to abandon the AMA and iit's metrosexual ways. All that toothless posturing the AMA has been practicing needs to be abandoned. The AMA is a failed organization; it has failed the patients, and physicians alike. It is time for physicians to look into forming a different organization with the intent of protecting physicans' interests.