NPs can now do dermatology residencies

[Taurus]

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Watch the CNN video. NP talks about how nurses need expanded authority.

http://www.valuemd.com/ross-univers...-healthcare-civil-war-between-nurses-drs.html

 

[Dr Oops]

I received this email from the Florida board of medicine.

Thank you for your recent correspondence regarding the Doctor of Nursing
Practice (DNP) and the University of South Florida creation of a DNP
"residency" in dermatology. I am taking this opportunity to provide a
summary of this matter.

DOCTOR OF NURSING PRACTICE:

The Doctor of Nursing Practice is not new, although it is getting
attention lately. The first program, offering the Doctor of Nursing
(ND), was established at Case Western Reserve University in 1979 which
offered an entry-level nursing degree. Since then, several
practice-focused doctoral programs and degree titles have emerged. By
2004 eight clinical or practice doctoral nursing programs existed or
were in the approval stage.

These new practitioners were to be educated across all levels of health
care and help to design policy related to safe practice. The seven
essential areas of content include:
1. Scientific underpinnings for practice; 2. Advanced nursing practice;
3. Organization and system leadership/management, quality improvement
and system thinking; 4. Analytic methodologies related to the evaluation
of practice and the application of evidence for practice; 5. Utilization
of technology and information for the improvement and transformation of
healthcare; 6. Health policy development, implementation and evaluation;
and 7. Interdisciplinary collaboration for improving patient and
population healthcare outcomes.

Today, there are more than 150 universities accepting students into the
Doctor of Nursing Practice program, eight of which are in the State of
Florida. The individual programs are structured very differently to
achieve the objectives as determined by their mission.

UNIVERSITY OF SOUTH FLORIDA (USF), COLLEGE OF NURSING, DNP RESIDENCY
PROGRAMS COMPARED TO MEDICAL RESIDENCY PROGRAMS:

A complete description of the DNP dermatology program, including an
overview of the program, program structure, admission requirements,
curriculum and content is available at the USF website:
http://health.usf.edu/nocms/nursing/

To my knowledge, there is no legal restriction on the use of the term
"residency" by USF to describe their dermatology program.

Postgraduate training programs for Medical Doctors (MD) are accredited
by The Accreditation Council for Graduate Medical Education (ACGME) who
is responsible for the accreditation of post-MD medical training
programs within the United States. Accreditation is accomplished through
a peer review process and is based upon established standards and
guidelines.

STANDARDS FOR PATIENT NOTIFICATION OF HEALTH CARE CREDENTIALS:

In considering how patients will know whether a practitioner offering
dermatology services is an MD with an ACGME Residency in dermatology or
a DNP with a residency in dermatology from USF, or another program,
please consider the following.

Florida Statutes, section 456.072 (1), provides the following grounds
for discipline to ensure a patient knows under what license a
practitioner is offering their services:

(t) Failing to identify through written notice, which may include the
wearing of a name tag, or orally to a patient the type of license under
which the practitioner is practicing. Any advertisement for health care
services naming the practitioner must identify the type of license the
practitioner holds. This paragraph does not apply to a practitioner
while the practitioner is providing services in a facility licensed
under chapter 394, chapter 395, chapter 400, or chapter 429. Each board,
or the department where there is no board, is authorized by rule to
determine how its practitioners may comply with this disclosure
requirement.
Thank you for taking the time to express your concerns on this issue.
The Board of Medicine does not have authority over nursing educational
programs; however, the Board is very interested in its mission to
promote, protect and improve the health of all people in Florida. A
copy of this letter will be provided to the Board.

Sincerely,



Larry McPherson
Executive Director
Florida Board of Medicine

Doesnt seem the like can/willing to do anything about it.

 

[dilated]

And people LIKE nurses and PAs - they don't have the same PR problem due to class envy that you do. They don't have the reputation of making a lot of money, so people think nurses/PAs are going into medicine for "the right reasons" -- that plays well to John Q Public.

This is your central problem, and it is why "they" are winning and you are losing - it's all about PR.

The public hates everyone who they perceive as successful. Lawyers, bankers, doctors, public sector workers, even teachers. Everybody makes too much money but them. This is never going to change.

The difference between the other groups and us is effective lobbying. End of story. Want to see hardball? Try not giving the teachers their yearly raise. Not a pay cut, just not a raise. Apocalypse.

 

[medicinesux]

I received this email from the Florida board of medicine.

"The Board of Medicine does not have authority over nursing educational
programs."

And therein lies the problem. The Florida medical board can drag it's own through the ringer but yet have ZERO jursidiction over all these infestive NP's. The powerless tone of this letter clearly illustrates this.

 

[Dr Oops]

"The Board of Medicine does not have authority over nursing educational
programs."

And therein lies the problem. The Florida medical board can drag it's own through the ringer but yet have ZERO jursidiction over all these infestive NP's. The powerless tone of this letter clearly illustrates this.

Yea I agree, but if you can drag our own through the ringer then lets do it to those who train NP/DNPs.

As well, as Law2Doc has said, we need to define the practice of medicine and make it illegal for nurses to practice it. This would seem to fall under the responsibility of the board of medicine.

 

[JaggerPlate]

I received this email from the Florida board of medicine.



Doesnt seem the like can/willing to do anything about it.

Wow ...

wouldn't it just have been easier to respond:

"Shrug? We're not gonna do anything."

-Florida.

It's good they are one of the states that requires proper identification, er whatever, but that email had a disheartening tone to it (to say the least).

 

[maceo]

Yea I agree, but if you can drag our own through the ringer then lets do it to those who train NP/DNPs.

As well, as Law2Doc has said, we need to define the practice of medicine and make it illegal for nurses to practice it. This would seem to fall under the responsibility of the board of medicine.

and drag through the ringer they do.. when you apply they send you a 75 page application with 300 yes/no questions and if they think you answered one of them not so truthfully doesnt matter why... they will deny you a license then send the report to the databank

 

[Slack3r]

and drag through the ringer they do.. when you apply they send you a 75 page application with 300 yes/no questions and if they think you answered one of them not so truthfully doesnt matter why... they will deny you a license then send the report to the databank

And yet nurses can establish residencies and a grueling 1000 hrs later, boom, DOCTOR!

 

[Rabbit Hole]

I received this email from the Florida board of medicine.



Doesnt seem the like can/willing to do anything about it.

Dr Oops,

Thanks for posting this email. I read over it carefully and I strongly feel that you should write back. He may not be able to do much, but don't let that stop you from raising awareness.

You may feel that your concerns are falling on deaf ears, but take a moment to consider the scenario that this person may casually bring it up in conversation to his friends or make a mention of it at board meetings - what if down the road your concerns fall on the ears of someone who can/will do something about it? Or how about the chance that this one person you reached out to goes to a hospital or clinic and encounters someone wearing a white coat introducing themselves as "Doctor All" but their name tag reads "Dr. Killam All, DNP, OMG, GTFO". Technically, they're not violating Florida Statutes right? Maybe then he will realize the ultimate outcomes of these phony programs with self-awarding titles based on incredibly ambiguously defined goals (read the 7 essential areas of content in his email) - so they can fake out patients into thinking they're phyisicians because they get off on being called 'doctor' and start demanding the same pay because they're practically the same, right?

badasshairday mentioned somewhere that he actively talks about this issue with his friends and classmates because they are utterly unaware of what is going on. If you think this is general knowledge amongst physicians, you're wrong. Look at this entire thread.. hell I didn't even know the depths of this situation until now. I think it is imperative that we examine the facts before formulating opinions - read up on it and be informed because the opposition's propaganda relations team is strong.

His email deserves a response. Since you have been in contact with him I think you should send it, but if you don't want to please let me know and I'll send it myself. Here is my response, edit as you wish:

To: Mr. Larry McPherson; Florida Board of Medicine

Thank you for responding to my concerns regarding the Doctorate of Nursing Practice (DNP) "residency" program in dermatology at the University of South Florida. I would like to make a few comments and also provide a brief explanation on the grounds of my concerns.

I was pleased to see your comment stating that the Florida Board of Medicine has an interest in promoting, protecting and improving the health of all people in Florida. My interest is the same for all people in the United States and that is why I have taken the time to bring this issue to your attention.

I understand that the Board of Medicine does not have authority over nursing educational programs. However, I think it is important to consider how these programs can cause confusion to patients about the health care credentials that these practitioners hold. I want to bring to your attention that the "Doctorate in Nursing Practice" is a prime example of degree inflation which is further being inflated by "residency" programs such as the DNP dermatology "residency" program at USF. A doctorate degree implies a higher level of education and training - a level that a DNP degree simply does not possess. The quality of patient care is my greatest concern in this matter - I do not see anything beneficial coming out of inflating credentials and blurring the roles of physicians and nurses.

The American Medical Association released a publication on the Scope of Practice of Nurse Practitioners in October 2009. I urge you to read pages 29-34 on the Doctorate in Nursing Practice degree. The publication can be found here:
http://npsearch.org/AANPCMS2/publicpages/08-0424 SOP Nurse Revised 10-09.pdf

The American Academy of Nurse Practitioners gave a response to this publication in December 2009. The response can be found here:
http://www.aanp.org/AANPCMS2/publicpages/AMANPModuleLtr120809.pdf

Finally, please be aware that for reasons unknown, the content of the USF DNP dermatology residency program was removed from the website in the last week of April. The content included a 17 page pdf powerpoint presentation describing the program and a short introductory video by the director of the DNP dermatology residency program, Debra Shelby. As you can see, the content has been completely removed:
http://health.usf.edu/nocms/nursing/AdmissionsPrograms/dnp_concentrations_derm.html

I suspect this is because a number of my colleagues and I sent emails to various medical organizations expressing our concern. The powerpoint presentation and a transcript of the video was saved from the website before the content was removed, if you would like a copy I am more than willing to send it to you.

I realize that the Board of Medicine may not be able to do anything regarding this issue. I only request that my concerns are kept in mind shall another issue comes up similar to this one. Thank you for taking the time to read this letter.

Sincerely,

 

[mig26x]

the board of nursing is taking it up to the ***** of the board of medicine w/o vaseline, they are owning the board of medicine and the BM is to afraid to do anything. They are getting own.

what a shame!!!

in 15 years nobody is going to want to go to med school, what the hell for? you can do it in a much easier way by going to nursing school and a lot cheaper too!!!

 

[Maybeknot]

the board of nursing is taking it up to the ***** of the board of medicine w/o vaseline, they are owning the board of medicine and the BM is to afraid to do anything. They are getting own.

what a shame!!!

in 15 years nobody is going to want to go to med school, what the hell for? you can do it in a much easier way by going to nursing school and a lot cheaper too!!!

Pardon my ignorance, but who comprises these boards of medicine? From my own limited understanding, I thought it was a state government body that primarily deals with licensure issues. Perhaps this is outside their, for lack of a better term, scope of interest?

Could we perhaps think of other avenues to pursue this? Hospital executive committees, insurance companies, etc?

 

[doctorperez]

Could we perhaps think of other avenues to pursue this? Hospital executive committees, insurance companies, etc?

Why don't you, instead, consider helping us target each state legislature so that we can prevent the encroachment of DNPs on our profession?

Please come see our thread here ---> http://forums.studentdoctor.net/showthread.php?p=9618392

and volunteer to help us lobby our state congressmen.

Thanks! 👍

 

[deleted87716]

Pardon my ignorance, but who comprises these boards of medicine? From my own limited understanding, I thought it was a state government body that primarily deals with licensure issues. Perhaps this is outside their, for lack of a better term, scope of interest?

Could we perhaps think of other avenues to pursue this? Hospital executive committees, insurance companies, etc?

State Boards of Medicine are comprised primarily of physicians. They're primarily a licensing and oversight body. Scope of practice issues are based on laws in each state. These laws are made by the state legislature.

Your time is best spent contacting your state specialty academies and AMA branches who lobby within the state, and sending money to your Political Action Committees (PACs).

 

[deltamed]

State Boards of Medicine are comprised primarily of physicians. They're primarily a licensing and oversight body. Scope of practice issues are based on laws in each state. These laws are made by the state legislature.

Your time is best spent contacting your state specialty academies and AMA branches who lobby within the state, and sending money to your Political Action Committees (PACs).

If anyone knows of independently practicing NPs who made major mistakes that harmed patients due to their lack of knowledge, we should send these examples to the media. That type of thing can make a big public impact as well.

 

[Dr Oops]

Dr Oops,

Thanks for posting this email. I read over it carefully and I strongly feel that you should write back. He may not be able to do much, but don't let that stop you from raising awareness.

You may feel that your concerns are falling on deaf ears, but take a moment to consider the scenario that this person may casually bring it up in conversation to his friends or make a mention of it at board meetings - what if down the road your concerns fall on the ears of someone who can/will do something about it? Or how about the chance that this one person you reached out to goes to a hospital or clinic and encounters someone wearing a white coat introducing themselves as "Doctor All" but their name tag reads "Dr. Killam All, DNP, OMG, GTFO". Technically, they're not violating Florida Statutes right? Maybe then he will realize the ultimate outcomes of these phony programs with self-awarding titles based on incredibly ambiguously defined goals (read the 7 essential areas of content in his email) - so they can fake out patients into thinking they're phyisicians because they get off on being called 'doctor' and start demanding the same pay because they're practically the same, right?

badasshairday mentioned somewhere that he actively talks about this issue with his friends and classmates because they are utterly unaware of what is going on. If you think this is general knowledge amongst physicians, you're wrong. Look at this entire thread.. hell I didn't even know the depths of this situation until now. I think it is imperative that we examine the facts before formulating opinions - read up on it and be informed because the opposition's propaganda relations team is strong.

His email deserves a response. Since you have been in contact with him I think you should send it, but if you don't want to please let me know and I'll send it myself. Here is my response, edit as you wish:

Hey Rabbit Hole,

I did respond to Mr. McPherson, Althought I wish I had seen your template first as I would have included some of those links.

I did a little background check on Mr. McPherson before I responded to him and it hadnt occurred to me that these people we are communicating with (at least at this initial stage) know very little about medicine. Mr. McPherson is a lawyer and from some of the info he responded to me with shows he basically just googled the nursing doctor program.

Heres the response I sent him, anybody can change this and use it if they like

Mr. McPherson,

I thank you for taking the time to reply to me. NPs are a very important part of our healthcare team, however their independent practice represents a danger to patients and a decrease in the quality of healthcare as these practitioners are aiming for parity of pay with lesser years/rigor of training. The Case Western program (ND) has long since switched over to the DNP curriculum.

Here is a link from an article in Forbes written by the creator of the DNP program:
http://www.forbes.com/2007/11/27/nurses-doctors-practice-oped-cx_mom_1128nurses.html

Here are a few troubling excerpts from the article:

"The doctor of nursing practice (DNP) is a new level of clinical practice that is attracting a rapidly growing number of nursing professionals. This doctoral degree enables advanced-practice nurses to gain the knowledge and skills necessary to practice independently in every clinical setting."

"These clinicians are peerless prevention specialists and coordinators of complex care. In other words, as a patient, you get the medical knowledge of a physician, with the added skills of a nursing professional."

"Along with a doctorate and the title of "doctor," the fact that a nurse practitioner has fulfilled this certification requirement will instill confidence in patients that DNPs have the expertise to serve as their health-care provider of choice."

"Nurse practitioners are reimbursed by Medicare and Medicaid in every state, but only variably by commercial insurance carriers. That is certain to change soon, as these DNP graduates prove they are the logical choice to become the new comprehensive-care clinicians."

They claim their new degree provides them with equivalent knowledge to someone who has gone through medical school and residency. Which simply is not true.

A quick google search pulls up the curriculum of one of these programs:

DNP Family Nurse Practitioner Schedule
A 2-year program for those who already have the FNP certification.

YEAR 1

FALL

NSG 911 Philosophy of Science 3(3-0)
BIOE 712 Principles of Epidemiology 3(3-0)
NSG 814 Biostatistics 3(3-0)

TOTAL 9(9-0)
SPRING

NSG 916 Concept & Theory Analysis 3(3-0)
HOPR 851 Leadership and Health Policy 3(3-0)
NAPS ____ Nursing Advanced Practice Selective 4(2-2)
or required specialty equivalent
TOTAL 10(8-2)

YEAR 2

FALL

HOPR 877 Health Care Economics 3(3-0)
NSG 819 Evaluation of Practice 4(4-0)
NAPS ____ Nursing Advanced Practice Selective 4(2-2)
or required specialty equivalent
TOTAL 11(9-2)
SPRING

NSG 926 Resident Practicum 6(0-6)
NSG 946 Residency Project 3(3-0)

TOTAL 9(3-6)


TOTAL NUMBER OF HOURS FOR THIS OPTION
39(29-10)


Theses courses have almost nothing to do with clinical practice and certainly do not prepare an individual for independent practice, nor do they provide anywhere near the level of education of a physician. Their claiming of equivalence to physicians is not only an insult but a serious danger to patients.

These nurses are interested independent practice of primary care only because it opens up to them the more lucrative specialties, such as dermatology, as you can see.

The differences in training between theses nurses and physicians is phenomenally large. MD/DOs spend 4 years in medical school (post college), then 3-7 years in residency and then can do a fellowship for an additional 1-3 years in which they work 80 hours per week. Where as the DNP can be done in 2 years and almost completely online (the exception being 1000 clinical hours-the nurse equivalent of residency). To even matriculate into medical school students must be near the top of their classes in college and still only approx 10% of applicants are accepted. A nurse however can get their BSN in college, then go straight to a DNP in a few years.

Most medical students have more clinical hours than DNPs by the time they graduate but still must do a minimum of 12,000 more hours in residency before they can practice.

We currently use three tests (the USMLEs) + residency as the metric for competency to practice medicine independently. The DNPs were given an easier, watered-down version of the USMLE step 3 test (which most physicians take without studying during their residency). 50% of these nurses from the program at Columbia university studied for this easier version and failed.

I understand there is little that the Florida BOM can do to control the Board of Nursing, but perhaps we can prevent physicians from being part of the training of these dangerous practitioners. In addition there are movements to restrict the use of the title "doctor" in the clinical setting to MD, DO, DPT, and DPMs, in order to help alleviate patient confusion. The Florida BOM must also fight any legislation to allow independent practice of these NP/DNPs and restrict their prescribing rights, as they do not receive the training about the physiology or biochemistry of how these drugs work.

Thank you.

I know that people hardly know anything about this. Ive been telling my friends. My friends who are in charge of one of the clubs at my school wanna put together a panel or have a speaker come in to tell people about the whole DNP issue. Just not sure where to start. Its kinda appalling how little medical students know about the whole healthcare reform and issues like these. So I try to tell my friends and pretty much anyone who will listen whenever I can.

 

[Maybeknot]

State Boards of Medicine are comprised primarily of physicians. They're primarily a licensing and oversight body. Scope of practice issues are based on laws in each state. These laws are made by the state legislature.

Your time is best spent contacting your state specialty academies and AMA branches who lobby within the state, and sending money to your Political Action Committees (PACs).

That's what I figured; there really isn't much to be gained by lobbying the state medical board, since they don't have any power to do anything about it.

Thanks for the info. I will send letters to my state legislators.

 

[concernedms4]

Here's an idea:

Maybe we should petition, but i dont know if it will help to send things to congress. This nurse doctor thing seems to be a state issue. We could find someone that could write it up really nicely and in a convincing manner.

Congress petition:

http://petition2congress.com/2/create/?gclid=CIKppPKYraECFUtX2god7nRoAQ

Generalized petition:

http://www.ipetitions.com/start-petition?q=GoogleSearch

I guess all individual hospitals need to start taking action on this, that may be the most powerful method.

We shouldn't wait for the AMA or any association to take action. Individuals in power can make a difference too.

I think this is a great idea! I'm currently writing a petition using Scrub421's template and incorporating WingedScapula's feedback. I hope to post it tomorrow and I ask that everyone take a few minutes to read it and offer feedback. I hope to be able to submit the petition by next weekend and hope that you might send the petition to all of your family, friends, associates, acquaintances, etc.

 

[Charles_Carmichael]

Hey Rabbit Hole,

I did respond to Mr. McPherson, Althought I wish I had seen your template first as I would have included some of those links.

I did a little background check on Mr. McPherson before I responded to him and it hadnt occurred to me that these people we are communicating with (at least at this initial stage) know very little about medicine. Mr. McPherson is a lawyer and from some of the info he responded to me with shows he basically just googled the nursing doctor program.

Heres the response I sent him, anybody can change this and use it if they like



I know that people hardly know anything about this. Ive been telling my friends. My friends who are in charge of one of the clubs at my school wanna put together a panel or have a speaker come in to tell people about the whole DNP issue. Just not sure where to start. Its kinda appalling how little medical students know about the whole healthcare reform and issues like these. So I try to tell my friends and pretty much anyone who will listen whenever I can.

Good post that you sent to him. I just recently emailed Daniel Blaney-Koen (the lawyer who responded to racerx in the other thread) my NP/DNP curricula vs. MD/DO curricula comparison. Hopefully, he'll be able to use that information to help educate others about the vast differences in training. I think I'll email Mr. McPherson the same thing as well.

Edit: Quick question, but could somebody who emailed Larry McPherson post his email address on here or PM me please? For some reason, I'm having a hard time finding his email address on the Florida BoM website. Thanks in advance!

 

[starbuckscoffee]

i thought this was interesting since I've never seen PA and NP training compared side-by-side. Seems to me that PAs are better trained to function in the doctor role than NPs are.

http://www.wapa.org/pdfs/np-pa_chart.pdf

 

[Dr Oops]

Good post that you sent to him. I just recently emailed Daniel Blaney-Koen (the lawyer who responded to racerx in the other thread) my NP/DNP curricula vs. MD/DO curricula comparison. Hopefully, he'll be able to use that information to help educate others about the vast differences in training. I think I'll email Mr. McPherson the same thing as well.

Edit: Quick question, but could somebody who emailed Larry McPherson post his email address on here or PM me please? For some reason, I'm having a hard time finding his email address on the Florida BoM website. Thanks in advance!

Hey Kaushik,

I just emailed him through the form on their website.

[email protected]

thats the email his responses have been coming from though.

 

[Maybeknot]

I posted about this before, but I got a very tepid response. I've been working on a website that's intended to inform a general audience about the DNP issue.

It's still a work in progress; I was hoping to have it more complete before announcing it, but I can't really do this myself and I am hoping that putting the URL of this still-incomplete site might stir some more interest.

The website is www.no-shortcuts.org

If you're so inclined, please visit and let me know what you think.

 

[deltamed]

I posted about this before, but I got a very tepid response. I've been working on a website that's intended to inform a general audience about the DNP issue.

It's still a work in progress; I was hoping to have it more complete before announcing it, but I can't really do this myself and I am hoping that putting the URL of this still-incomplete site might stir some more interest.

The website is www.no-shortcuts.org

If you're so inclined, please visit and let me know what you think.

Great work- I like the website alot.

In the comparison chart you may wish to emphasize that many many physicians have more than 3 years of residency (ie put 3-8 depending on specialty) while DNPs almost never have more than the DNP degree offers.

Keep it going! Then we need to get word that it is out there.

 

[Dr Oops]

I posted about this before, but I got a very tepid response. I've been working on a website that's intended to inform a general audience about the DNP issue.

It's still a work in progress; I was hoping to have it more complete before announcing it, but I can't really do this myself and I am hoping that putting the URL of this still-incomplete site might stir some more interest.

The website is www.no-shortcuts.org

If you're so inclined, please visit and let me know what you think.

The site looks great, very good job. i'll be posting the link in my sig when its done.

 

[JaggerPlate]

I posted about this before, but I got a very tepid response. I've been working on a website that's intended to inform a general audience about the DNP issue.

It's still a work in progress; I was hoping to have it more complete before announcing it, but I can't really do this myself and I am hoping that putting the URL of this still-incomplete site might stir some more interest.

The website is www.no-shortcuts.org

If you're so inclined, please visit and let me know what you think.

Awesome. Well done.

 

[Maybeknot]

Thanks guys... I appreciate the comments. I really do need a lot of help in finishing and maintaining is (especially seeing as I'm starting PGY-1 surgery in less than 2 months ). If you could take a little time to edit, critique, or write a page, I think we could get this out in very soon.

Let me know if you would like to help; email me at [email protected]

JaggerPlate, I tried to PM you a few days ago about permission to post your letter template, but your inbox was full.

 

[concernedms4]

So I took the time to modify Scrubs421's initial petition and tried to incorporate wingedscapula's feedback with the hopes of starting a congressional petition:

http://petition2congress.com/2/create/?gclid=CIKppPKYraECFUtX2god7nRoAQ

I am posting what I have written below and I ask that you please take a few minutes to read it and provide thoughtful insight. With your feedback, I hope to post this petition by the end of the week so that we can start collecting signatures.

2. Give your petition a title
Defining the scope of medical practice

3. Add a 1 sentence description
This bill wants to ensure that when a patient sees a physician, he/she is seeing a medical doctor (MD/DO) who is board certified in that field

We are concerned about the growing efforts of Doctors of Nurse Practitioning (DNP) and other nurse practitioners (NP) to expand their scope of practice to include the same practice rights and reimbursement rates as physicians while demonstrating lower levels of education, training, and medical liability. Currently, they are petitioning in 28 states for the right to practice medicine independently, without physician (MD/DO) oversight. Unfortunately, this is not the role NP’s are designed to fill, and this is reflected in their significantly less clinical training. NP’s are “physician extenders,” their role is to assess patients and present the pertinent findings to a licensed physician so he/she can more efficiently treat the patient, thus optimizing the number of patients they can care for each day. They are not trained to practice as independent physicians.
We oppose expanding the rights of NP’s because the length and depth of their training is not equivalent to physicians. To qualify as a board-certified physician, one must complete 4 years of undergraduate training, 4 years of medical school (MD or DO), and 3-7 years of residency. To sub-specialize, physicians must train an additional 1-3 years. In comparison to the 11-18 years of higher education that physicians must complete, DNP’s require only 8-10 years. DNP’s must spend 2-4 years to receive a nursing degree , 2 years to receive a Masters of Science in Nursing, and a variable number of years, usually 2-4, to receive a DPN, a degree which can be completed entirely online without ever attending a class in person (i.e. Ball State University). However, where the difference in training is most obvious is in the huge discrepancy between number of clinical hours required for certification as a DNP compared to a board-certified physician. In the instance of family medicine, certification for an NP to practice family medicine requires a minimum of 500 hours with a nationwide mean requirement of 686 clinical hours (Bray, CO, Olson KK. Family Nurse Practitioner Clinical Requirements: Is the Best Recommendation 500 Hours? J. Amer. Acad. Nurse Prac. 2009;21: 135-139). An MD/DO family medicine residency requires 9,555 clinical hours* If an NP student were to work 65 hours a week, like the average MD/DO resident does, it would take only 8-11 weeks to complete their training, while it takes a physician 3 years. The disparity in clinical knowledge suggested by the 14 fold greater amount of clinical training that physicians receive is demonstrated by the 50% failure rate of DNPs who took a modified version of the United States Medical Licensing Exam (USMLE) Step 3.
Within the last two years, an entirely optional, DNP certification exam based off of the USMLE Step 3 exam was created in an attempt to prove the equivalence of DNPs to physicians. Since 1916, the National Board of Medical Education (NBME) has assessed the abilities of physicians-in training to demonstrate an appropriate level of medical competency. The current standard is the USMLE, a series of 3 exams, known as “steps,” that all physicians are required to “pass,” as part of the stringent process for licensure to practice medicine unsupervised in the United States (Dillion, GF, Boulet, JR, Hawkins, RE, Swanson, DB. Simulations in the United States Medical Licensing Examination (USMLE). Qual Saf Health Care 2004;13:i41-i45 doi: 10.1136/qshc.2004.010025). Step 3 is the final step in the medical licensing sequence of examinations. It is designed to assess whether the physician-in training not only possesses, but can appropriately apply the medical knowledge and understanding of clinical science considered essential for the unsupervised practice of medicine (Andriole, DA, Jeffe, DB, Hageman, HL, Whelan, AJ. “What Predicts USMLE Step 3 Performance?” Acad Med. 2005 Oct;80(10 Suppl):S21-4). 94% of all physicians “pass” Step 3 on their first attempt. However, 50% of DNPs who chose to take a modified version of Step 3 that required a lower percentage of correct answers to “pass” in addition to being stripped of any questions designed to assess competency in fundamental science, clinical diagnosis, or clinical skills, failed (http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm). The goals and standards that an individual must meet to be licensed to practice medicine unsupervised has already been established: a 4 year undergraduate degree, successful completion of a 4 year LCME or AOA accredited medical school, successful completion of USMLE Step 1, 2, and 3, and at minimum, completion of 1 year of an ACGME accredited residency. There is no logical rationale for why anyone with demonstrably substandard education, training, and skills should be allowed to circumvent this time-tested path to practice medicine unsupervised.
The signers of this petition understand that while NPs and other physician extenders play an important role in healthcare delivery, they are not equivalent to physicians, and as such should not be allowed to practice without supervision or be reimbursed at the same rate as physicians. If this is allowed to happen, the quality of medical care available to the public will noticeably suffer as the likelihood that a serious condition that would be noticed by a physician will be missed by DNPs, who only have 7% of the clinical hours possessed by the physicians that they wish to emulate. As a result, grave conditions that would be caught by physicians at an earlier, more treatable stage will go unnoticed by the less trained DNP and will be allowed to progress. DNPs are seeking false credentials that will confuse the public into thinking that they are physicians. The path to becoming a physician is already established and we, the signers of this petition, do not support the establishment of a short-cut path so that less qualified and less knowledgeable individuals can reap the financial and social benefits of being a “physician” at the expense of the public’s wellbeing.


* assuming an average of 65hr/wk x 49wk/yr x 3yr. 65 hr average was calculated by myself but looking at the avg number of hours worked by FM residents in FL, CT, and CA.

 

[doctorperez]

Concernedms4


Great job with that letter.

Could you allow me to use it to contact our state congressmen?

I believe the appropriate place to exert political pressure isn't in Washington but at the state level, which is where laws that regulate the practice of medicine are made.

In fact, DNP and NP lobbying, looking for expanded practice rights, takes place at the state level.

Please see the link on my signature to discuss it further...

http://forums.studentdoctor.net/show....php?p=9618392


P.S. Do let me know if I may use your sample letter, thanks

 

[xFutureMDx]

Thanks guys... I appreciate the comments. I really do need a lot of help in finishing and maintaining is (especially seeing as I'm starting PGY-1 surgery in less than 2 months ). If you could take a little time to edit, critique, or write a page, I think we could get this out in very soon.

Let me know if you would like to help; email me at [email protected]

JaggerPlate, I tried to PM you a few days ago about permission to post your letter template, but your inbox was full.

I whipped up a post that explains things a little more for laypeople. Use/modify it if you wish to post up on non medical boards and make the masses aware.


Here it is...


I recently found out about this on the internet and thought that it needed to be shared.

Nurses can now call themselves doctor. Yes you heard me right, there is a degree called the DNP (doctorate of nursing practice). This wonderful new degree apparently lets the holder be a NP (nurse practitioner) and that in turn allows them to see patients independently of an MD, write scrips, introduce themselves as doctor and even become so called "specialists" of a given field. I have read of nurses with the DNP going through 1000 hours of "residency" and then being turned loose to treat the masses.

The reason for my bringing all of this up is that it sounds dangerous to me after I got the facts. To get into a DNP program (of which there are more every day , not competitive at all) all you need is an RN license and in some cases a B.S. degree. Some of these programs can be done almost entirely online, less a few hospital hours here and there. Compare that with the 4+4 years of hellish (so I hear) medical school to be an MD/DO, add another 3 for internal medicine residency and another 2-5 of specialty fellowship (80 hr weeks in the residency and fellowship mind you) and you can easily see the problem. Grossly under-trained primary providers calling themselves doctor and having free reign to practice medicine (more or less).

At the same time understand that I am not hating on nurses. We need them too (and I'm sure many people on this site know a few of them). Nurses are very important, but having them do a few online courses, a few more clinical hours then allow them to practice independently and write scrips is just scary.

Don't allow these under-trained providers to have the last word on your health! When you go to the doctor's office, ER, wherever, make sure your your primary provider (the one that calls the shots and writes your care orders) is a truly qualified medical professional. Don't just think anymore because they introduce themselves as "Dr." that its all good. Look for those all important letters MD/DO or PA. These individuals worked there asses off and were put through the ringer by their respective schools to learn and practice MEDICINE.

You may be thinking that this isn't possible but I assure you it is. I read up on it. Nurse's "scope of practice" is determined by the BON (board of nursing) and is separate from the BOM (board of medicine). Further, there is nothing that gives power of governance of the BON to the BOM. That in essence means that the BON can "expand" their scope of practice as they see fit (conflict of interest) to include things that are usually reserved for the practice of medicine and yet they call it "advanced nursing practice".

I know everyone keeps saying that the physician shortage is very serious and all but this is not the answer. Cranking out barely qualified professionals to practice medicine is only going to cause more problems than it solves.

I have a link in my sig that has some great information, take a look. Take your pick, MD/DO/PA or a nurse who took a few extra online courses, who do you want to see you? Food for thought.

Educate yourself, you've been warned. Be safe!

 

[NotAProgDirector]

I hate to say this, but any plan to limit NP practice via legislation is IMHO doomed to failure for several reasons.

1. NP's already have full practice rights in several states. Federal legislation preventing this would create havoc in those states that have already allowed it. "Grandfathering" states that have done so is a messy solution.

2. This will come across as physicians protecting their turf. No amount of trying to hide behind "patient safety" or "quality of care" is going to deceive anyone.

3. The argument that there will not be enough PCP's for all the new insured patients, whether true or not, will make legislatures allow NP's to practice independently.

However, this does not mean that there is nothing to do:

1. Instead, define what the "practice of medicine" is. Then simply declare that licensing those that practice medicine falls under the umbrella of the BOM, regardless of the person's prior training. This would allow a BOM to define a minimum amount of practice experience before an NP could practice independently, or otherwise set rules.

2. Require "truth in advertising" -- that people need to declare clearly what their training is. This might include limiting the title "Doctor" in the clinical setting to those with MD/DO/MBBS etc degrees who have completed an ACGME / AOA residency.

Trying to pust to actually prevent practice rights for NP's is likely to fail, might as well focus on what you can realistically achieve.

 

[JaggerPlate]

Thanks guys... I appreciate the comments. I really do need a lot of help in finishing and maintaining is (especially seeing as I'm starting PGY-1 surgery in less than 2 months ). If you could take a little time to edit, critique, or write a page, I think we could get this out in very soon.

Let me know if you would like to help; email me at [email protected]

JaggerPlate, I tried to PM you a few days ago about permission to post your letter template, but your inbox was full.

Hey, sorry about that. I didn't realize it was full, and I think I actually missed out on a few PMs regarding this issue.

Feel free to post that template. You should probably post the full and condensed one, etc. Bottom line ... feel free, and let me know if there is anything else I can do.

 

[doctorperez]

I hate to say this, but any plan to limit NP practice via legislation is IMHO doomed to failure for several reasons.

1. NP's already have full practice rights in several states. Federal legislation preventing this would create havoc in those states that have already allowed it. "Grandfathering" states that have done so is a messy solution.

2. This will come across as physicians protecting their turf. No amount of trying to hide behind "patient safety" or "quality of care" is going to deceive anyone.

3. The argument that there will not be enough PCP's for all the new insured patients, whether true or not, will make legislatures allow NP's to practice independently.

However, this does not mean that there is nothing to do:

1. Instead, define what the "practice of medicine" is. Then simply declare that licensing those that practice medicine falls under the umbrella of the BOM, regardless of the person's prior training. This would allow a BOM to define a minimum amount of practice experience before an NP could practice independently, or otherwise set rules.

2. Require "truth in advertising" -- that people need to declare clearly what their training is. This might include limiting the title "Doctor" in the clinical setting to those with MD/DO/MBBS etc degrees who have completed an ACGME / AOA residency.

Trying to pust to actually prevent practice rights for NP's is likely to fail, might as well focus on what you can realistically achieve.

I completely agree with you, any attempts to block their [DNP, NP] practice rights will not prosper.

This is the reason why my call is to prohibit the use of the "doctor" title in the clinical setting to MD/DO/MBBS with the respective post graduate training.

I also agree with bringing the practice of medicine of any practitioner under the board of medicine.

 

[NYRN]

Let me just put this out there, as far as I know, NP's of any degree are not allowed to open up an independant practice in a specialty area outside of primary care. I can't see how these derm trained NP's could be on thier own.

I am an NP student now, I am looking into a fellowship, and I have no intention of starting my own practice. I didn't even consider that as a thought. I wanted the fellowship to learn more about the specialty I want, so when I'm done I can work with the physician group that I work with now. They seem to be all for it. Specifically, there is no way I could have started my own group in this specialty anyway because doing the procedures would be way out of my scope of practice.

Isn't it possible that some or most of these NP's want the fellowship just to gain more experience in a particular area and not looking to go off on their own??

 

[dilated]

Isn't it possible that some or most of these NP's want the fellowship just to gain more experience in a particular area and not looking to go off on their own??

Highly unlikely. NPs and PAs have traditionally had little problem breaking into specialties in their current role via on the job training. Given the DNP establishment's claim that they are producing "doctors" and that "independent practice needs to be the national standard", the only point to such a "residency" is that they need some sort of educational fig-leaf to justify expanding independent practice into specialties.

Being able to muddy the water via claiming that they're "residency trained" (by redefining what a residency is) represents a perfect way. If it wasn't supposed to confuse people into thinking it was like an actual residency they would have called it something else.

 

[NYRN]

Highly unlikely. NPs and PAs have traditionally had little problem breaking into specialties in their current role via on the job training. Given the DNP establishment's claim that they are producing "doctors" and that "independent practice needs to be the national standard", the only point to such a "residency" is that they need some sort of educational fig-leaf to justify expanding independent practice into specialties.

Being able to muddy the water via claiming that they're "residency trained" (by redefining what a residency is) represents a perfect way. If it wasn't supposed to confuse people into thinking it was like an actual residency they would have called it something else.

I don't disagree with you that some NP's or DNP's may want independant practice, but personally, I don't know ANY (or have ever met) any NP who plan on working totally independant without physician collaboration. I am in a class with 50+ students and nobody plans on doing that either. If you ask all of them what thier plans are, we all want to work in a doctors office somewhere or work in a hospital setting.

I just don't see these residencies really changing the scope of practice that much. I highly doubt that people who finish a DNP degree are going to be allowed to just go off and practice in any specialty they want. I have not read about the derm residency, but the residency I am looking at is for NP's to gain more experience this particular field. They train identically to the 1st year fellows with the exception of some procedures. It is in no way intended to be a replacement for an MD fellowship or claim to be equivelant.

I always say, I don't need to be the boss, I personally like working with experienced physicians. I learn a lot from them, and they are able to act as preceptors for us in our program. When I was in nursing school, my professors who all hold doctorate degrees NEVER addressed themselves as doctor to our patients. I very often see PA's let the patients call them doctor and NOT correct them. I always correct the patients if they think I'm the doctor. I think EVERYONE who is talking to the patient should introduce themself and identify thier title.

I don't think patients will be under the impression that nurses attend "residency" the same way that doctors do. There is a graduate nurse "residency" around here that is for new graduate nurses to be precepted by experienced nurses during thier first year. I don't think anyone would think these nurses had any sort of additional training equal to that of a doctor.

 

[doctorperez]

I don't disagree with you that some NP's or DNP's may want independant practice,

It's more than SOME given that there are currently 28 bills in 28 states requesting independent practice for DNP/NP.

 

[NYRN]

It's more than SOME given that there are currently 28 bills in 28 states requesting independent practice for DNP/NP.

The people doing this do not represent the majority of NP's. I have no intention of seeking equal scope of practice with doctors, nor does anyone else I know. I do think that there are some NP's who are more clinically competent than some doctors and vice versa. A practitioner can be a ***** no matter what degree they have. NP's can be wonderful practitioners and provide excellent care, but they are not and will never be 100% equal to a physicians training. I will always stand by that no matter what degree I have. I personally don't see what the NP's are so angry about, who cares if you need to have an MD sign your charts once every 4 months? It's not like they are sitting over your shoulder for every patient you are seeing.

 

[doctorperez]

The people doing this do not represent the majority of NP's. I have no intention of seeking equal scope of practice with doctors, nor does anyone else I know.

Would you be willing to sign a letter to your state legislators opposing the people doing this?

I do think that there are some NP's who are more clinically competent than some doctors and vice versa.

Would you care to elaborate?

 

[NYRN]

Would you be willing to sign a letter to your state legislators opposing the people doing this?





Would you care to elaborate?

I tell you this, I do not support legislation that is going to push for NP's gain 100% independant practice. If some day years down the road, the DNP training was standardized AND equal to med school/residency training, then I would have a different opinion.

I think any of us who are experienced health care providers come across doctors/nurses/np's/pa's who you wouldn't let them touch you with a ten foot pole and others who are excellent and you would trust them with your life. Some people just don't have common sense despite the degree behind thier name.
I'll give you one example. Pt has parkinsons is on a cardiac monitor. Pt is awake, alert and verbalizing, and is has hand tremors that are causing artifact that looks like v-tach. Intern wants to defibrillate, and I held the patients hands still which stopped the artifact and the monitor was back into NSR. Repeat 3x to show intern that this was artifact and not in fact an arrhythmia. Intern still wanted to shock the patient next time it happened. I don't care what degree he had behind his name, common sense should have kicked in. I'm just saying that not ALL or most MD's are incompetent providers either, but thank god, the vast majority of them are excellent. Come on, haven't you ever given sign out to someone and wondered where they got their medical degree from??

 

[doctalaughs]

The people doing this do not represent the majority of NP's. I have no intention of seeking equal scope of practice with doctors, nor does anyone else I know. I do think that there are some NP's who are more clinically competent than some doctors and vice versa. A practitioner can be a ***** no matter what degree they have. NP's can be wonderful practitioners and provide excellent care, but they are not and will never be 100% equal to a physicians training. I will always stand by that no matter what degree I have. I personally don't see what the NP's are so angry about, who cares if you need to have an MD sign your charts once every 4 months? It's not like they are sitting over your shoulder for every patient you are seeing.

Majority or minority- they represent the face of your profession to us now due to their outspoken political agenda. If you and the majority of other NPs dont agree then you need to let it be known- to the public and to the media.

You can see why physicians would be angry. Instead of calling it residency or fellowship you should call it what it is - a COURSE, studying to learn more about a specific area. I or any physician would have no problem with this.

Let me ask you, if medical assistants created a course and called it "nursing school" but it required 1/10th of the time of real nursing school (like 2 months instead of 2 years)... and then a good portion of them started advocating this "nursing school" allowed them to work as RNs at all hospitals across the country with full access to all the rights afforded by that licence, would you be pissed? Would you think that is good for patients?

By the way, what specialty area are you interested in? I don't know any area where an NP could function and train at the same level as a fellow who completed a residency. (I'm really curious, Im not trying to be inflammatory)

 

[group_theory]

I don't disagree with you that some NP's or DNP's may want independant practice, but personally, I don't know ANY (or have ever met) any NP who plan on working totally independant without physician collaboration. I am in a class with 50+ students and nobody plans on doing that either. If you ask all of them what thier plans are, we all want to work in a doctors office somewhere or work in a hospital setting.

I just don't see these residencies really changing the scope of practice that much. I highly doubt that people who finish a DNP degree are going to be allowed to just go off and practice in any specialty they want. I have not read about the derm residency, but the residency I am looking at is for NP's to gain more experience this particular field. They train identically to the 1st year fellows with the exception of some procedures. It is in no way intended to be a replacement for an MD fellowship or claim to be equivelant.

I always say, I don't need to be the boss, I personally like working with experienced physicians. I learn a lot from them, and they are able to act as preceptors for us in our program. When I was in nursing school, my professors who all hold doctorate degrees NEVER addressed themselves as doctor to our patients. I very often see PA's let the patients call them doctor and NOT correct them. I always correct the patients if they think I'm the doctor. I think EVERYONE who is talking to the patient should introduce themself and identify thier title.

I don't think patients will be under the impression that nurses attend "residency" the same way that doctors do. There is a graduate nurse "residency" around here that is for new graduate nurses to be precepted by experienced nurses during thier first year. I don't think anyone would think these nurses had any sort of additional training equal to that of a doctor.

I doubt that your fellowship will "train identically to a 1st year fellow" except some procedures. You do realize that fellowship training occurs AFTER residency training, right? And if you ask around, some fellows will say that the first year of fellowship is harder than the first year of internship.

 

[NYRN]

I doubt that your fellowship will "train identically to a 1st year fellow" except some procedures. You do realize that fellowship training occurs AFTER residency training, right? And if you ask around, some fellows will say that the first year of fellowship is harder than the first year of internship.

I am aware of what the fellows do, I work with plenty of them and I work closely with the program director who is well respected in his field. He looked over the curriculum for the NP program and feels that I would be a good match for it. I attend his lectures, he gives me case studies and questions that he gives the 1st year fellows. Does he expect me to know everything or even most of what they know? Of course not, but the fact that he feels I am capable of this level of understanding and is trying to prepare me is nice. The program description says that the training of the 1st year fellow and NP is nearly identical. There are no procedures in the 1st year. There is nothing in the program description that even gives the idea that the overall fellowship of the NP to the MD is the same. All it says is that the NP will train with the 1st year fellows. The fellows of course go on for another 2-3 years and complete the fellowship. The goal of the NP fellowship is to prepare them to work with a physician group, in no way does it say that it prepares the NP to start their own practice.

 

[NYRN]

Majority or minority- they represent the face of your profession to us now due to their outspoken political agenda. If you and the majority of other NPs dont agree then you need to let it be known- to the public and to the media.

You can see why physicians would be angry. Instead of calling it residency or fellowship you should call it what it is - a COURSE, studying to learn more about a specific area. I or any physician would have no problem with this.

Let me ask you, if medical assistants created a course and called it "nursing school" but it required 1/10th of the time of real nursing school (like 2 months instead of 2 years)... and then a good portion of them started advocating this "nursing school" allowed them to work as RNs at all hospitals across the country with full access to all the rights afforded by that licence, would you be pissed? Would you think that is good for patients?

By the way, what specialty area are you interested in? I don't know any area where an NP could function and train at the same level as a fellow who completed a residency. (I'm really curious, Im not trying to be inflammatory)

I would be totally against any medical assistant or unlicensed people calling themselves nurses. This is in fact illegal in all states. This is not simply a nursing issue though, this has been brought up in the past with doctors calling themselves "cosmetic surgeons" who were in fact dentists and the like and not plastics trained. People don't know the difference between a board certified plastics MD and a dentist who calls themself a cosmetic surgeon.

I think the term residency just means additional training. I think as long as the NP made it crystal clear to the patient and public that the fellowship/residency is a special training for nurses and not the same as a physician fellowship, I don't see what the big deal is.

I am just guessing, but I think maybe one reason these NP groups are fighting so hard is because they are under the impression that MD's are trying to eliminate the NP or midlevel providers alltogether. I think if the MD and NP groups could come to some sort of agreement on the level of practice, these groups would stop pushing to be 100% on their own.

 

[doctorperez]

I tell you this, I do not support legislation that is going to push for NP's gain 100% independant practice. If some day years down the road, the DNP training was standardized AND equal to med school/residency training, then I would have a different opinion.

You didn't answer my question...

Would you then join us in contacting state legislators to oppose the DNP minority, as you put it, that wants to obtain independent practice rights?

I think any of us who are experienced health care providers come across doctors/nurses/np's/pa's who you wouldn't let them touch you with a ten foot pole and others who are excellent and you would trust them with your life. Some people just don't have common sense despite the degree behind thier name.
I'll give you one example. Pt has parkinsons is on a cardiac monitor. Pt is awake, alert and verbalizing, and is has hand tremors that are causing artifact that looks like v-tach. Intern wants to defibrillate,

You're obviously comparing apples to oranges...

An experienced nurse practitioner on the floor vs. an intern who probably just got there month of June...

I just don't see how a full fledged nurse practitioner, despite all his/her experience can be more clinically competent than a full fledged attending.

 

[NYRN]

You didn't answer my question...

Would you then join us in contacting state legislators to oppose the DNP minority, as you put it, that wants to obtain independent practice rights?







You're obviously comparing apples to oranges...

An experienced nurse practitioner on the floor vs. an intern who probably just got there month of June...

I just don't see how a full fledged nurse practitioner, despite all his/her experience can be more clinically competent than a full fledged attending.

There are attendings out there that are careless or don't give a rat's ass and you wonder how they are still licensed. That happens and we all know it. If we are talking about competent and experienced NP's vs. attendings, than no, I don't think the NP has more knowledge or competence if they are both treating the same types of patients. I don't think its fair that ALL nurses are categorized together either. Depending on where we work and what our experiences are, that is comparing apples to oranges. All nurses do not work on the floor, and all do not blindly follow protocols.

Would I contact legislators and tell them I am against DNP's gaining independant practice in the current state? Sure, as long as I can be assured that the MD's are not trying to eliminate NP's all together. Like I said before, unless there is some way some how in the future that the training is fully equivelant, I would be against it.

 

[doctorperez]

Sure, as long as I can be assured that the MD's are not trying to eliminate NP's all together.

There isn't a single legislation bill, where anyone in the entire U.S., asks for the NP profession to be eliminated.

 

[NYRN]

There isn't a single legislation bill, where anyone in the entire U.S., asks for the NP profession to be eliminated.

If that is truly the case and the MD's are not going to try to get rid of NP's all together, than I have no problem supporting the MD's with thier position to keep midlevels at midlevel. I have years of experience, and even when I complete my program, I am under no illusion that my training is the same as an MD's. I wasn't even aware that people thought it was until I read all the postings on here about it.

 

[Maybeknot]

If that is truly the case and the MD's are not going to try to get rid of NP's all together, than I have no problem supporting the MD's with thier position to keep midlevels at midlevel. I have years of experience, and even when I complete my program, I am under no illusion that my training is the same as an MD's. I wasn't even aware that people thought it was until I read all the postings on here about it.

NYRN, if you have a chance, can you take a look at the website I'm working on to inform the general public about the DNP issue? I want to make it completely factual and fair, but obviously, I don't know much about the details of nursing education and training.

www.no-shortcuts.org

 

[concernedms4]

Yes, please by all means, everyone should feel free to use this letter.

Concernedms4


Great job with that letter.

Could you allow me to use it to contact our state congressmen?

I believe the appropriate place to exert political pressure isn't in Washington but at the state level, which is where laws that regulate the practice of medicine are made.

In fact, DNP and NP lobbying, looking for expanded practice rights, takes place at the state level.

Please see the link on my signature to discuss it further...

http://forums.studentdoctor.net/show....php?p=9618392


P.S. Do let me know if I may use your sample letter, thanks

 

[NYRN]

AndEE,

I looked at your website, and I will comment on each section. Keep in mind that I am going over this as if I was a layperson reading this. It doesn't really matter what nurses or MD's think, its what the patients do.

Overview: although I see your point, it does come across as anti-nursing. Argue against the NP group that is pushing for NP independance, not ALL NP's. Do say that NP's have a role in healthcare, but not at the level these groups are lobbying for. Clinical hours required are relevant, but you need to explain further what the MD residency hours entail that years of nursing experience of an NP don't. Remember, we are talking to the general public. They may say, oh well this doctor only had 3 years of training buy my DNP was a nurse for 15 years before getting her degree. I also wouldn't say that ALL NP's are pushing to be called doctor because I don't think that is accurate either. Your main focus should be not anti nursing, but WHY the patient should choose an MD provider or a mixed NP/MD group rather than a DNP only provider group.

Comparison: The minimum required years of practice is inaccurate. A nurse cannot apply to a DNP program without a bachelors degree at the very least. I just did a quick search online that shows an online program such as u of minn can be completed in 3 years after a bach degree, but NYU requires a masters at least before enrolling, and then its 5 semesters to completion. You can use the point that DNP programs are not standardized like med schools are, adn that even though one DNP may have years of training and a degree from an ivy league school, another could be from a crackpot internet school and as a member of the public, you don't know what you are going to get. Also, there is a certification that NP's must pass, the NCLEX would be for RN's only.

Myths:
Lose the part about primary care MD"s not making money. The general public will think oh boo hoo the rich doctor won't be able to buy his yacht. Not that I think PMD's shouldnt have higher reimbursement, but using this argument with the general public who are paying high premiums are not going to be sympathetic. Instead, try the angle of how important primary care is to people in order to keep thier health costs down and keep up quality of life and that appropriate reimbursements are needed to keep PMD's in practice. Try putting up there some example of what PMD's get reimbursed for example $7 for an office visit

The part about the doctor title: again, people come into contact with many people who use the title doctor who are not in fact physicians such as pharmacists, phys therapists, etc. I would say instead that "you" as a member of the public, should be aware that the person caring for you who calls themselves doctor, may not be a physician at all. The nurses used this angle years ago when hospitals tried to replace RN's with unlicensed staff. The patients should know if they are seeing a physician instead of a midlevel, or an RN instead of a medical assistant.

positions: I would keep the part of the importance midlevel providers play in medicine, but that because of the lack of training/edu that MD's have, mid level providers cannot replace the MD

 

[FutureDoc4]

AndEE,

I looked at your website, and I will comment on each section. Keep in mind that I am going over this as if I was a layperson reading this. It doesn't really matter what nurses or MD's think, its what the patients do.

Overview: although I see your point, it does come across as anti-nursing. Argue against the NP group that is pushing for NP independance, not ALL NP's. Do say that NP's have a role in healthcare, but not at the level these groups are lobbying for. Clinical hours required are relevant, but you need to explain further what the MD residency hours entail that years of nursing experience of an NP don't. Remember, we are talking to the general public. They may say, oh well this doctor only had 3 years of training buy my DNP was a nurse for 15 years before getting her degree. I also wouldn't say that ALL NP's are pushing to be called doctor because I don't think that is accurate either. Your main focus should be not anti nursing, but WHY the patient should choose an MD provider or a mixed NP/MD group rather than a DNP only provider group.

Comparison: The minimum required years of practice is inaccurate. A nurse cannot apply to a DNP program without a bachelors degree at the very least. I just did a quick search online that shows an online program such as u of minn can be completed in 3 years after a bach degree, but NYU requires a masters at least before enrolling, and then its 5 semesters to completion. You can use the point that DNP programs are not standardized like med schools are, adn that even though one DNP may have years of training and a degree from an ivy league school, another could be from a crackpot internet school and as a member of the public, you don't know what you are going to get. Also, there is a certification that NP's must pass, the NCLEX would be for RN's only.

Myths:
Lose the part about primary care MD"s not making money. The general public will think oh boo hoo the rich doctor won't be able to buy his yacht. Not that I think PMD's shouldnt have higher reimbursement, but using this argument with the general public who are paying high premiums are not going to be sympathetic. Instead, try the angle of how important primary care is to people in order to keep thier health costs down and keep up quality of life and that appropriate reimbursements are needed to keep PMD's in practice. Try putting up there some example of what PMD's get reimbursed for example $7 for an office visit

The part about the doctor title: again, people come into contact with many people who use the title doctor who are not in fact physicians such as pharmacists, phys therapists, etc. I would say instead that "you" as a member of the public, should be aware that the person caring for you who calls themselves doctor, may not be a physician at all. The nurses used this angle years ago when hospitals tried to replace RN's with unlicensed staff. The patients should know if they are seeing a physician instead of a midlevel, or an RN instead of a medical assistant.

positions: I would keep the part of the importance midlevel providers play in medicine, but that because of the lack of training/edu that MD's have, mid level providers cannot replace the MD

I commend your honesty and your beliefs in this matter. We all have a role in healthcare and I think you have started to restore some of my faith in DNPs.

If you don't mind, how did you find this thread/issue? can you get other like minded DNP/DNP students (who are NOT for independent practice rights), to come to SDN so they can get involved? (hopefully with the website and beginings of a petition)

Thanks for your input. Again, I think we can all agree, that we are not anti-nursing or anti-DNP. We are just against the notion of DNPs as unsupervised providers.

I think getting other DNPs (especially students), involved in this could be extremely powerful.