NPs can now do dermatology residencies

[Integrity]

Yeah, derm is nice and the average dermatologist treats alot of acne and warts, but they truly know alot. There are approx 2500 dermatological diagnoses, and while you may only see 20-30 in your office on a regular basis the derm boards don't care.

Hey, seriously Abducens. Who said there shouldn't be any physicians treating pemphigus vulgaris, lyell syndromes, cutaneous kikuchi, etc. They would be turfed to a less rurally located HOSPITAL, where you would find a skilled dermatologist, seeing these diseases more often, due to s.p.e.c.i.a.l.i.z.a.t.i.o.n.

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Members don't see this ad.

 

[Rabbit Hole]

exPCM: great post, it shows how costs could be cut drastically if nurses were allowed to do all the scoping.

In Germany, nurses do all the sonos of the carotids and vertebral arteries. In Scandinavian countries, nurses monitor anesthesia, after the anesthesiologist has intubated and initiated anesthesia.

This will only increase. I realize that you all hate this, and that you are willing to jump on those non-fossils that actually greet the move towards working according to ability and not status.

This actually proves that you don't need to know nothing about janus kinases and hormone receptors, or any other areas of intracellular or extracellular signaling, to practice in certain areas of medicine, and I sure as h3ll didn't need it. You don't even need undergrad to go into medicine, but you all want to keep it the way things are because 1) you are SNOBS and 2) you have economic interest in doing so.

Consider your colleagues dedicating their careers to research and obtaining grants. Their work ultimately results in "Evidence-based medicine".. which should be the foundation of your clinical practice.

You may not know or care about JAK-STAT or whatever, but those "cash money SNOBS" are at the helm of advancing our line of profession. Don't be so quick to marginalize the knowledge and interest they garnered in medical school basic sciences.

I don't know who exactly was knocking dermatology earlier.. but people with skin problems suffer a lot. Whether it's because of acne or wrinkles or rare disease. Those people suffer everyday because they can't hide those problems, it's one thing to have a belly full of tumors but if you have them all over your arms and legs.. that's devastating. Imagine dealing with a medical problem and you're put on display like a circus with people looking and pointing as you walk through the grocery store. When your disease manifests on the outside so everyone can see, it has a deep psychological impact.. it's not all about botox and vanity.

Lastly, I'm not down with all this Dr. Nurse stuff. I will have some free time in a few weeks and I want to find out about what we can do to be more proactive and get organized enough to put some pressure on whoever the hell is supposed to be representing physicians in the political arena. It may be more fruitful than just raging over the internet and then forgetting about it until somebody starts raging again (not that there's anything wrong with that).. but something different would be nice.

 

[tncekm]

All of you pissed off, indignant people need to do something. Whining on a forum isn't going to fix anything.

Toss the ego's, put some of your phucking earnings together into a big phucking bank account and start raising hell.

Until physicians can do this and quit being a bunch of selfish, apathetic a-s-s-holes, I have no respect for the whole lot of you. I don't give a schit if you've got a big, fancy education and you think you kick ass so long as a bunch of panzies can walk all over you like a pathetic, castrated ****old.

Seriously, most physicians could take a $10,000 hit in their yearly salary and not even feel it in their lifestyle. So, if every physician donated $10,000 into political action, we'd have damn near $10,000,000,000 (10 billion). That's absolutely ridiculous money, and it's absolutely achievable. (Note: I intentional picked really huge numbers to simply make a point).

 

[tncekm]

Lastly, I'm not down with all this Dr. Nurse stuff. I will have some free time in a few weeks and I want to find out about what we can do to be more proactive and get organized enough to put some pressure on whoever the hell is supposed to be representing physicians in the political arena.

Seriously, I'm with you 100%. It's time to raise hell. People need to be pissed off to be compelled to action. If we can get just a few students at every medical school involved, we can get organized and make a big difference.

Don't expect our predecessors to do jack schit. They're too comfortable, to complacent. It starts with us, or it ends with us.

 

[GasEmDee]

At the end of medical school, when I had already matched into the anesthesia program at my own school, I asked my anesthesia chairman what I could do to maintain my anesthesia skills during internship. Without missing a beat, he said flatly, "you don't have any skills".

At the end of my first (CA-1) year in anesthesia residency, I felt very confident with my skills and wondered why residency was a total of 4 years.

In my second (CA-2) year, I got exposed to all the subspecialties of anesthesia and started to realize just how grossly inadequate my skills and knowledge base was as a CA-1 resident.

In my final (CA-3) year of residency, I finally realized how much more there was to learn and how impossible it was ever to learn it all in my life, let alone during residency.

Of course you all know the point that I am driving at. It is when you know the least that you are at risk of thinking that you know the most. I think of knowledge as a circle. When the circle is smallest, the circumference is smallest, and you don't think there is that much more to know. As the circle gets larger, the circumference gets larger....i.e., the boundaries you perceive about your ignorance is MUCH larger.

I think this is the problem with mid-level practitioners claiming equivalence with fully trained physicians. Like many posters have said, you often really don't know what you don't know.


I had a recent example of this just a few days ago. I brought a patient out to the PACU (post-anesthesia care unit). The patient had just had a laparascopic procedure done. I put on the blood pressure cuff and the first BP is quite high. The nurse looks at the patient, and the patient looks tranquil. So the nurse then removes the blood pressure cuff and puts it somewhere else. Her reasoning is that the patient looks quite comfortable, so therefore the BP reading must be incorrect. In her mind, the only thing on the differential for HTN is pain. She didnt know that laparascopy itself causes some hypertension, the physiologic mechanism being an abdominal compartment syndrome intraoperatively, as well as activation of a neurohumoral response that lasts briefly into the post-operative period. When I explained that to her, I could see her eyes glaze over. Needless to say, the repeat BP on another location yielded the same result. Years of clinical experience do not replace a solid theoretic foundation of knowledge.

i like to give these folks the benefit of the doubt, but the reality is that they are nowhere in the universe of being able to practice independently. i often think that if we were to focus on just clinically relevant material that we could probably cut medical school down to 2-3 years and have similarly compentent physicians. i know several PAs that were very knowledgeable after their initially training and i think if we were to implement medical student standards we could really get it done without losing too much meaningful clinical knowledge (we don't really need to memorize amino acid structure or learn how iron interacts with bacteria, etc. to be good clincians).

with this said, though, even after a rigorous 4 years of medical school, medical school graduates are NOT ready for indepent practice. I'm sure if any of us residents reflects on this, we at some point believed we could do it, but as you progressed through residency, it is a humbling experience to realize how much you don't know or never learned in medical school. these NPs and other midlevels seeking independence are probably of a similar mindset because they are ignorant of just how many gaps in their knowledge exist. keeping in mind that most med students are usually much brighter individuals than most NP students (sorry, but it's true...) and that medical school curriculum is much more rigorous, I can't even begin to imagine how ignorant some of these individuals might be.

these NPs have the mindset of an overly confident medical student. and as absurd as it is to consider a recent medical school graduate running an indpendent practice, it's even more absurd to consider that an NP can do so.

as the saying goes, "he who doesn't know he doesn't know, is a fool."

 

[twostep376]

Years of clinical experience do not replace a solid theoretic foundation of knowledge.

 

[Laryngophed]

Years of clinical experience do not replace a solid theoretic foundation of knowledge.

Interestingly, it appears (from my extremely limited experience) that the inverse is true as well. A solid theoretical foundation of knowledge is no replacement for years of clinical experience. This is why physicians (IMO) are entrusted with the ultimate responsibility of the patients health and well-being. Not only have they spent years (literal years) with their noses in books and following around other docs trying to pick up the profession (it's a little more organized than that but you get the idea) but they then have serve as something less than a attending under the direct purview of attendings to ensure they are competent. A great nurse practioner is still just that, a nurse practioner. That's not a slam or meant to be divisive, it simply is a fact. If mid-levels want to be equivalent to physicians in all manners of patient care, then by George, go to medical school and complete the necessary post-graduate training to do so. Until then, masquerading as a physician is eventually going to needlessly harm someone and the mid-level will get sued into tomorrow for overstepping their bounds.

I don't think it is necessary or proper to expose patient to care provided by people who have less knowledge than most M3s. Again, not a slam but if a medical school graduate isn't trusted with an unrestricted license until a minimum of passing all 3 Steps and one year of post-grad training, why in the world would we want people who got their doctorate online treating us with one year .5 FTE worth of training to practice unsupervised?

 

[deleted128562]

2 years ago I went over to allnurses.com and proposed the creation of the EMT-practitioner to fill the primary care nursing shortage. You'd think that with all the nurses who support the NP role, they'd totally support the idea. You'd be wrong. In fact, their comments were exactly what you'd expect to see an MD say in arguing against NP autonomy. Here's the link if you're interested:

http://allnurses.com/general-nursing-discussion/emt-practitioner-305996.html

And the text of my original idea:

Nursing is without a doubt one of the most important jobs a person can undertake. I have personally been blessed by many wonderful nurses. Unfortunately there is a problem....

As we all know, there is a major nursing shortage which is expected to get much worse over the next several years. I have come up with an idea that will help alleviate this problem, especially benefitting underserved areas, particularly in primary care. I would love to collect your support and send a petition to congress and various medical organizations - please "sign" via your positive reply to my post.

My idea is the creation of the EMT-Practitioner program. Many of you are already aware that many EMTs function as Techs at Emergency Departments around the country. EMTs are already allowed to do many "nursing functions" including but not limited to: wound care, EKGs, IVs and lab draws, foley catheter insertions and removals, splinting, BLS, providing patient care and comfort, and so on. Techs are not allowed to administer medications, give shots, or do nursing assessments. They also do not have ACLS/PALS etc. However, I think with a little additional training, EMTs could do most of these things in 99.9999% of cases within the primary care setting.

Following is my proposed 1 semester, 15 credit hour program allowing EMT-Basics to become EMT-Practitioners and work essentially as "nurses" - with all nursing privileges - in any primary care setting. (NOTE: PRIMARY CARE SETTING ONLY!!!!)

EMT-Prac 100: Basics of Chemistry (2 credits)
EMT-Prac 102: Administering Meds as Ordered (2 credits)
EMT-Prac 103: Knowing if a Med Order Looks Wrong (1 credit)
EMT-Prac 105: Fundamentals of Nursing Assessment for Primary Care
(3 credits)
EMT-Prac 110: ACLS/PALS Certification (2 credits)
EMT-Prac 200: EMT-Practitioner Clinical (5 credits - 225 hours of experience in a primary care clinical setting)

Please show your support! This may be the answer we're looking for in terms of solving the primary care nursing shortage. I've worked with many, many good EMTs and I know they could probably do just as well as primary care nurses in 99.999% of cases with just a little bit of additional training. Plus they'll probably cost a couple bucks an hour less than an RN, saving money for practices and for patients! Everyone wins!!!!

Of course I'll eventually want to expand the EMT-practitioner role into the specialties, but sssshhhhhh... don't tell anyone!!

 

[Gfunk6]

I had a recent example of this just a few days ago. I brought a patient out to the PACU (post-anesthesia care unit). The patient had just had a laparascopic procedure done. I put on the blood pressure cuff and the first BP is quite high. The nurse looks at the patient, and the patient looks tranquil. So the nurse then removes the blood pressure cuff and puts it somewhere else. Her reasoning is that the patient looks quite comfortable, so therefore the BP reading must be incorrect. In her mind, the only thing on the differential for HTN is pain. She didnt know that laparascopy itself causes some hypertension, the physiologic mechanism being an abdominal compartment syndrome intraoperatively, as well as activation of a neurohumoral response that lasts briefly into the post-operative period. When I explained that to her, I could see her eyes glaze over. Needless to say, the repeat BP on another location yielded the same result. Years of clinical experience do not replace a solid theoretic foundation of knowledge.

Merely to play devil's advocate . . . though your clinical knowledge is clearly much larger it doesn't appear to have made a difference in clinical outcome for the case you cited.

I think people should go back in this thread and read SimulD's excellent post about making a metric to actually PROVE that our patients have better outcomes. Just becuase physicians have a larger knowledge base this does not prove that NPs are unsuited to practice primary care or any other sub-speciality independently.

For instance, you don't need a PhD in Aerospace Engineering just to do routine maintenance on aircraft. I think that this is how some in the pro-NP communities view physicians -- grossly overqualified for the job that they do. Certainly if the **** hits the fan or a VIP is involved everyone wants a REAL doctor but those cases constitute a small minority of our total clinical practice in many cases.

 

[tncekm]

2 years ago I went over to allnurses.com and proposed the creation of the EMT-practitioner to fill the primary care nursing shortage. You'd think that with all the nurses who support the NP role, they'd totally support the idea. You'd be wrong. In fact, their comments were exactly what you'd expect to see an MD say in arguing against NP autonomy. Here's the link if you're interested:

http://allnurses.com/general-nursing-discussion/emt-practitioner-305996.html

And the text of my original idea:



Of course I'll eventually want to expand the EMT-practitioner role into the specialties, but sssshhhhhh... don't tell anyone!!

Seriously, reading through those nurses responses made me want to scratch my eyeballs out. Please see below

The OP isn't trying to propose anything. He and his friend (check their post counts) are merely trolling for reactions by using a poorly constructed parable illustrating that EMT-B:RN :: DNP:MD.

They waited for a couple of clearly "That's absurd!" responses and then pointed out the supposed hypocrisy of our stance, as if protectionism of one's profession is somehow unjustifiable in this case.

 

[tncekm]

Merely to play devil's advocate . . . though your clinical knowledge is clearly much larger it doesn't appear to have made a difference in clinical outcome for the case you cited.

I think people should go back in this thread and read SimulD's excellent post about making a metric to actually PROVE that our patients have better outcomes. Just becuase physicians have a larger knowledge base this does not prove that NPs are unsuited to practice primary care or any other sub-speciality independently.

For instance, you don't need a PhD in Aerospace Engineering just to do routine maintenance on aircraft. I think that this is how some in the pro-NP communities view physicians -- grossly overqualified for the job that they do. Certainly if the **** hits the fan or a VIP is involved everyone wants a REAL doctor but those cases constitute a small minority of our total clinical practice in many cases.

Advocating a "meet the minimum" standard of care is pretty ridiculous IMHO. If that's the case, why should anybody go to school? We can train a monkey to do the jobs of almost everyone in the hospital.

 

[GasEmDee]

Interestingly, it appears (from my extremely limited experience) that the inverse is true as well. A solid theoretical foundation of knowledge is no replacement for years of clinical experience.

As a practicing physician, I couldn't agree with you more. Both are necessary. I only mentioned the one, because in their argument for equivalence, mid-level practitioners frequently cite their years of clinical experience as a suitable proxy for the differential in formal education.

 

[medsRus]

Any news from the Florida Medical Board on this issue?

 

[Slack3r]

For instance, you don't need a PhD in Aerospace Engineering just to do routine maintenance on aircraft. I think that this is how some in the pro-NP communities view physicians -- grossly overqualified for the job that they do. Certainly if the **** hits the fan or a VIP is involved everyone wants a REAL doctor but those cases constitute a small minority of our total clinical practice in many cases.

I think that kind of attitude is what allows this kind of nonsense in the first place. It's a race to the bottom of mediocrity. Yes, prescribing antiobiotics and monitoring blood pressure could be done by a high school student with a defined set of protocols. But the problem is, whenever something is actually wrong, the nurse's protocol is "consult the real doctor". I'm not sure that filling the so-called "shortage" of physicians with half-assed intermediaries solves any problems. Nor do I particularly want people practicing independently that have to refer anything outside of very basic diseases. Not to mention the day when a DNP misdiagnoses something serious as something basic because, get this, THEY'RE NOT DOCTORS.

 

[Laryngophed]

As a practicing physician, I couldn't agree with you more. Both are necessary. I only mentioned the one, because in their argument for equivalence, mid-level practitioners frequently cite their years of clinical experience as a suitable proxy for the differential in formal education.

Sorry, I didn't mean to imply that thought it was unnecessary. I was trying to point out how the two are separate but intimately entwined. Or at least I think they are, but I don't know crap as I'll only be an M1 in a few months.

 

[DoctwoB]

Advocating a "meet the minimum" standard of care is pretty ridiculous IMHO. If that's the case, why should anybody go to school? We can train a monkey to do the jobs of almost everyone in the hospital.

Agreed. I find the idea that because 95% of the time a physician is overqualified, we should have someone less qualified provide the care to be ridiculous. You could take a bum of the street, have him observe a couple hundred appendectomies, supervise him for a hundred more, and then turn him lose an 95% of the time he'd probably be ok. Of course, if something goes wrong, the patient is SOL. When dealing with people's lives, i'd rather have overqualified than underqualified.

And props to whoever posted the EMT-practitioner post. My favorite response was

"if you want to work essentially as a nurse, with all nursing privaleges, then by all means goto nursing school and pass nclex..."

Which of course, is identical to saying:

"If you want to work essentially as a physician, with all physician privaleges, then by all means go to medical school and pass USMLE

 

[Integrity]

I had a recent example of this just a few days ago. I brought a patient out to the PACU (post-anesthesia care unit). The patient had just had a laparascopic procedure done. I put on the blood pressure cuff and the first BP is quite high. The nurse looks at the patient, and the patient looks tranquil. So the nurse then removes the blood pressure cuff and puts it somewhere else. Her reasoning is that the patient looks quite comfortable, so therefore the BP reading must be incorrect. In her mind, the only thing on the differential for HTN is pain. She didnt know that laparascopy itself causes some hypertension, the physiologic mechanism being an abdominal compartment syndrome intraoperatively, as well as activation of a neurohumoral response that lasts briefly into the post-operative period. When I explained that to her, I could see her eyes glaze over. Needless to say, the repeat BP on another location yielded the same result. Years of clinical experience do not replace a solid theoretic foundation of knowledge.

If she had a lot of experience, she would have seen the numbers showing post-up blood pressure elevation in appies.

What she wouldn't have recognized, is the elevation of blood pressure in relation to experimental increases of intraabdominal pressure regulated by gas, unless those numbers were glued to the patient's chart post-operatively.

 

[GasEmDee]

Merely to play devil's advocate . . . though your clinical knowledge is clearly much larger it doesn't appear to have made a difference in clinical outcome for the case you cited.

This is anecdotal and was not intended to be an exhaustive proof of the superiority of physician training to nursing training.

But you are right, there was no difference. On the other hand, there have been circumstances where this hypertension was treated, with consequent hypotension has the effects of the laparascopy wore off.

Again, just anecdote. I did not do a prospective study on it.

 

[GasEmDee]

If she had a lot of experience, she would have seen the numbers showing post-up blood pressure elevation in appies.

What she wouldn't have recognized, is the elevation of blood pressure in relation to experimental increases of intraabdominal pressure regulated by gas, unless those numbers were glued to the patient's chart post-operatively.

Physiologic perturbations of all sorts (e.g., hypertension, hypotension, tachycardia, bradycardia, dysrhythmias) are seen post-operatively in many procedures. Even I would find it hard to extract meaningful patterns out of all this without an understanding of the procedure itself as well as an understanding of physiology.

 

[asmallchild]

I think that kind of attitude is what allows this kind of nonsense in the first place. It's a race to the bottom of mediocrity. Yes, prescribing antiobiotics and monitoring blood pressure could be done by a high school student with a defined set of protocols. But the problem is, whenever something is actually wrong, the nurse's protocol is "consult the real doctor". I'm not sure that filling the so-called "shortage" of physicians with half-assed intermediaries solves any problems. Nor do I particularly want people practicing independently that have to refer anything outside of very basic diseases. Not to mention the day when a DNP misdiagnoses something serious as something basic because, get this, THEY'RE NOT DOCTORS.

I think this is a sentiment that applies to even the most basic of examples (I'll use a derm one this time around, I'm afraid I'm not too familiar with the PACU setting ).

I've met a world-renowned dermatopathologist who had his pants sued off for missing a melanoma in what was a seemingly benign seborrheic keratosis under the microscope. I could only imagine the confusion on the clinical level.

Are cases like these rare? Fairly. But if this is the type of thing that can happen, I'm not sure I would want independent mid-level care for my loved ones. And if it's not good enough for my loved ones, wouldn't I be doing patients a disservice by OKing independent mid-level care for them?

 

[deleted89854]

I'm kind of confused as to how all the NPs and DNPs entering practice are able to obtain malpractice coverage for any kind of environment in which they are the sole provider. Are the premiums that much less? Miss a cancer diagnosis and you might as well just paint a giant bulls-eye on their forehead. If the threshold to prove liability is 50% probability ("more likely than not"), how can any of them hope to defend themselves when the standard of care dictates otherwise?

 

[deleted6669]

I'm kind of confused as to how all the NPs and DNPs entering practice are able to obtain malpractice coverage for any kind of environment in which they are the sole provider. Are the premiums that much less? Miss a cancer diagnosis and you might as well just paint a giant bulls-eye on their forehead. If the threshold to prove liability is 50% probability ("more likely than not"), how can any of them hope to defend themselves when the standard of care dictates otherwise?

there is an np association that sells malpractice policies to np's at lower rates than physician groups for similar coverage( it's the natl np organization so they put themselves "at risk" to some extent to get cheap policies out there to get more np's to buy them and go into independent practice).

 

[deleted87716]

All of you pissed off, indignant people need to do something. Whining on a forum isn't going to fix anything.

Toss the ego's, put some of your phucking earnings together into a big phucking bank account and start raising hell.

Better yet, support your state and/or national specialty association Political Action Committee(s). If you don't have one, at least support the AMA, regardless of whether or not you think they represent all of your interests to your satisfaction. If they don't, then who does?

 

[badasshairday]

It is important to talk to your fellow med students, residents, attendings. Some are oblivious. Let them know what is going on. When they ask what they can do, tell them to join the AMA and there state medical societies, general and speciality specific.

 

[dutchman]

All of you pissed off, indignant people need to do something. Whining on a forum isn't going to fix anything.

Toss the ego's, put some of your phucking earnings together into a big phucking bank account and start raising hell.

Until physicians can do this and quick being a bunch of selfish, apathetic a-s-s-holes, I have no respect for the whole lot of you. I don't give a schit if you've got a big, fancy education and you think you kick ass so long as a bunch of panzies can walk all over you like a pathetic, castrated ****old.

Seriously, most physicians could take a $10,000 hit in their yearly salary and not even feel it in their lifestyle. So, if every physician donated $10,000 into political action, we'd have damn near $10,000,000,000 (10 billion). That's absolutely ridiculous money, and it's absolutely achievable. (Note: I intentional picked really huge numbers to simply make a point).

Well said. For those that think running from primary care is the solution to all the BS facing physicians, these types of developments serve as warning. If you cant fight for your profession, you might loose your profession. BTW, NPs infest and proliferate faster than rodents. If derm does not handle it's business fast, things can go south real fast

 

[JaggerPlate]

So any new news on this today? AMA say anything new? AAD? FMB???

 

[deleted87716]

So any new news on this today? AMA say anything new? AAD? FMB???

It's definitely on the radar, and there's plenty of discussion going on. Don't necessarily expect any reactionary comments. That's not going to help any of us. This isn't a new issue.

Support your PACs. Get involved yourself, or support those willing to do so on your behalf. 'Nuff said.

 

[Integrity]

Any place you can bet on the outcome?

Scuse me for trolling, but I am seriously jaded in my perspectives. All I see is one interest organization fighting the other one, and this has very little to do with patient care. Some will benefit from more available care, others would benefit more from doctors with a higher theoretical background. Although I doubt that all colleagues are so proficient when it comes to pathophysiology, as my attending says- allergies are allergies.

Honestly, I don't care if any doctors of the ROAD specialties are dragged down financially. Even though I wouldn't want a glass spatula if you threw it after me. My ex gunned into derm, and may she burn in h3ll.

 

[Slack3r]

Any place you can bet on the outcome?

Scuse me for trolling, but I am seriously jaded in my perspectives. All I see is one interest organization fighting the other one, and this has very little to do with patient care. Some will benefit from more available care, others would benefit more from doctors with a higher theoretical background. Although I doubt that all colleagues are so proficient when it comes to pathophysiology, as my attending says- allergies are allergies.

Honestly, I don't care if any doctors of the ROAD specialties are dragged down financially. Even though I wouldn't want a glass spatula if you threw it after me. My ex gunned into derm, and may she burn in h3ll.

The in-fighting amongst different specialties is another reason things like this are allowed to happen. No one cared before because it's just PC fields (and they're not real doctors anyway, amiright!?). Now it's derm. What next? The silly high-school bickering and d!ck-measuring between specialties has really got to stop.

 

[deleted87716]

Any place you can bet on the outcome?

Yes, it's called "medical school."

 

[mig26x]

Any news from the Florida Medical Board on this issue?

Nope, they are working very hard to make the process of obtaining a florida medical license the hardest task ever made, like the one im going through righ now!!!

 

[DOCTORSAIB]

So any new news on this today? AMA say anything new? AAD? FMB???

So I emailed the AAD yesterday to bring to their attention the yahoo article and letting them know that this DNP movement into PC and various specialties (derm) is bad for all of us.

Here's what I got back from them:

Thank you for contacting the Academy Member Resource Center. The Academy does did not have anything to do with the article you are referring to. You may wish to express your concerns to the CA medical licensing board on this issue, since nurse practioners in any specialty would have to be licensed by the state. Thank you.

 

[medsRus]

So I emailed the AAD yesterday to bring to their attention the yahoo article and letting them know that this DNP movement into PC and various specialties (derm) is bad for all of us.

Here's what I got back from them:

Thank you for contacting the Academy Member Resource Center. The Academy does did not have anything to do with the article you are referring to. You may wish to express your concerns to the CA medical licensing board on this issue, since nurse practioners in any specialty would have to be licensed by the state. Thank you.

Oh, they will do something... But, also contact the medical boards as I mentioned in my very first message on this thread...

 

[JaggerPlate]

Does anyone think the LCME would do anything? I mean technically, they grant USF the ability to operate, so could they say "None of this DNP residency BS, or else??" Or just too extreme/unlikely/not their turf.

 

[Rabbit Hole]

Is this a fu*cking joke??? Honestly. What the hell is this? I don't even get how doctors can just bend over and take it up the ass in what feels like monthly intervals.

It's starting to be pretty clear that the role of a doctor with regard to clinical practice is over. The only hope is to manage people in what used to be a doctor's job. They stepped aside and let insurance companies, government, and mid-levels take it over, with very, very little fight.

I'm sitting here with an acceptance in hand, trying to physically convince myself to consider diving into this mess, and I really don't know if I even can. It's a joke.

Somehow the fu*cking nurses were able to lobby enough power to get absolutely everything they wanted, but there isn't a single organization that can muster up enough defense to stop this bull****?

The AMA can't stand up and represent docs for once? The LCME can't threaten to pull the accreditation of schools like USF that set up these - f*uck around in undergrad, become a DNP, skip the debt, get a derm residency, and make 300k a year programs???

This is a joke?

I'd like to thank everyone who made this possible ... I wonder how long before they are performing surgery???

Seriously, I'm with you 100%. It's time to raise hell. People need to be pissed off to be compelled to action. If we can get just a few students at every medical school involved, we can get organized and make a big difference.

Don't expect our predecessors to do jack schit. They're too comfortable, to complacent. It starts with us, or it ends with us.

Better yet, support your state and/or national specialty association Political Action Committee(s). If you don't have one, at least support the AMA, regardless of whether or not you think they represent all of your interests to your satisfaction. If they don't, then who does?

It's definitely on the radar, and there's plenty of discussion going on. Don't necessarily expect any reactionary comments. That's not going to help any of us. This isn't a new issue.

Support your PACs. Get involved yourself, or support those willing to do so on your behalf. 'Nuff said.

By golly we are on to something here. I want to use SDN to get organized and start gathering a pool of information to build a solid platform so the "suits in the boardroom" start paying attention to our collective concerns. I know the helpy-helpertons are amongst us and we could really use their skills to get the ball rolling. There are so many of us on SDN and if we care enough to log on and write these posts then we should care enough to be more proactive.. maybe get some pamphlets together or start petitions or whatever... I think this would be a great catalyst to nudge physicians out of their apathy. I've said this before and I'll say it again, we are like the "rain man" amongst other professions. It doesn't have to be that way anymore.

Think about how organized these nurse associations have become, seriously. They're blurring the boundaries of our profession while we are doing.. what? Complaining. The people/associations who are supposed to represent our interests - at least they are doing something - but it's not enough. The blame belongs to all of us who have been so complacent - and now we're pissed because nurses are pushing their agenda - they're protecting their interests.. that's what they're supposed to do.

It's not the golden age of physicians anymore - we're becoming increasingly marginalized and frankly it's a shame to the history of medicine. Whatever we do, and whatever ideas we have.. I insist that we do not stoop to the level of these "militant nurse organizations".

We are better than that. The respect and honor of our predecessors and future physicians can only be maintained with a cool head and open hands instead of clenched fists. If we want our boundaries to be respected, we must respect the boundaries of other health professionals as well. I really believe that using "attack tactics" will compromise our goals. We can learn a lot from how President Barack Obama utilized technology and brought like-minded people together during his campaign. I don't care about how you feel about his policies, this is not about that. I'm talking about how he encouraged individual people to be more proactive instead of just sitting back thinking their efforts & contributions don't count.

I'm still learning more about these issues just like all of you guys. Let's stay informed and be open minded.. and try not to get sidetracked by internet rage. Anyway, I'll have some free time in a few weeks and I will look into making good use of the "groups" function on SDN. It's a neglected resource on this forum but I think it's a good place to start. If anyone else wants to get that ball rolling, by all means - let's do it.

The end.

 

[JaggerPlate]

^^

For what it's worth, I was planning on emailing ...

1. AMA
2. AAD
3. AOA (American Osteopathic Association)
4. AOCD (American Osteopathic College of Dermatology)

before Monday. Anyone who wants to do the same, it's a good start. The AOA had a link to the story on their blog page under 'health news' but not a single comment about their stance on it. Lame.

 

[medsRus]

^^

For what it's worth, I was planning on emailing ...

1. AMA
2. AAD
3. AOA (American Osteopathic Association)
4. AOCD (American Osteopathic College of Dermatology)

before Monday. Anyone who wants to do the same, it's a good start. The AOA had a link to the story on their blog page under 'health news' but not a single comment about their stance on it. Lame.

Right on...

 

[exPCM]

So I emailed the AAD yesterday to bring to their attention the yahoo article and letting them know that this DNP movement into PC and various specialties (derm) is bad for all of us.

Here's what I got back from them:

Thank you for contacting the Academy Member Resource Center. The Academy does did not have anything to do with the article you are referring to. You may wish to express your concerns to the CA medical licensing board on this issue, since nurse practioners in any specialty would have to be licensed by the state. Thank you.

Amazing how clueless the AAD appears to be about this issue. They assumed USF was in California (it is actually UCSF which is in California), USF is the University of South Florida.

^^

For what it's worth, I was planning on emailing ...

1. AMA
2. AAD
3. AOA (American Osteopathic Association)
4. AOCD (American Osteopathic College of Dermatology)

before Monday. Anyone who wants to do the same, it's a good start. The AOA had a link to the story on their blog page under 'health news' but not a single comment about their stance on it. Lame.

Good plan. I will email these as well.

 

[Kubed]

The problem with getting the FL medical board involved is that they (like many other states) do not regulate NP/DNP's. Rather it's the state board of nursing that sets the scope of practice for them. That's what kills me when I read articles like the one posted about the ASU health clinic. NPs will cry foul about unequal reimbursement for providing the "same" service, but will in the same breath claim what they do is in no way "medicine" so they are not subject to the BOM's oversight.

 

[Zap Rowsdower]

There is not a more stable career than medicine right now. In my city, a major midwest city, law graduates (w/ high tuition) can't find jobs. Practicing lawyers have been laid off. The town levies are not passing, and teachers are being laid off. Engineering firms are not hiring, and a family friend (CEO of a regional bank) recently told me that the job market is putrid for MBA's.

I'm not trying to tell people not to care about the DNP movement. It's gotten me pissed off before, even recently. I'm just trying to add prospective. Medicine is, and will remain, a safe career choice for some time to come. Now is the best time to enter medicine, even in primary care (I'm talking about job guarantees, not salary and lifestyle).

Also, for what it's worth I'm a pretty hardcore libertarian. I wish we had a free market healthcare system. It would make it so much easier for physicians to stand out (cash only, catastrophic insurance, etc.) That way, physicians could put their money where their mouths are when competing with DNP's for patients (for better or worse results). If over time, DNP's (and PA's) can prove that they can offer a service cheaper than an MD and with the same outcome, how is this a bad thing? Of course, these studies would take many years. I just wanted to point out my political views, b/c I got the sense my post seemed very socialist for some reason.

Just my opinion, maybe it has something to due with being raised by a truck driver and a teacher (I always felt rich growing up). Negativity sucks (which is pretty hypocritical, considering I'm posting in the most negative thread ever)

 

[JaggerPlate]

Amazing how clueless the AAD appears to be about this issue. They assumed USF was in California (it is actually UCSF which is in California), USF is the University of South Florida.

HAHAHA ... God. I seriously couldn't figure out why they were talking about CA in the reply. Oh well, a few more emails should cause them to look into it.

I will email these as well.

Sounds good.

 

[FlowRate]

^^

For what it's worth, I was planning on emailing ...

1. AMA
2. AAD
3. AOA (American Osteopathic Association)
4. AOCD (American Osteopathic College of Dermatology)

before Monday. Anyone who wants to do the same, it's a good start. The AOA had a link to the story on their blog page under 'health news' but not a single comment about their stance on it. Lame.

This goes for any of ya'll who really care about this stuff:

If you posted easy links and pre-made forms to send/example statements, the number of people who ALSO contact these organizations would increase exponentially. Furthermore, if you used your medical contacts to forward these pre-made forms and AMA/AAD/AOA/AOCD pertinent emails to each other, you could really get something going.

I have none of these contacts and I'm not the greatest writer ever, but this seems to be the next logical step in any internet-based political movement I've seen/participated in.

 

[DermMatch]

I am completely sickened by this DNP dermatology residency -- but I find even more galling the AAD's cooperation in creating this farce.

I am a dermatology resident. I spend NO time doing Botox, fillers, or peels. I have NO intention of graduating into a cosmetics practice.

I spend a significant amount of time working with patients who have dermatological manifestations of rheumatological diseases, consulting with other services whose patients have developed puzzling skin findings, managing immunosuppressive biologics and other systemic therapies, screening for melanoma/SCCs/BCCs, helping patients with Kaposi's or CTCL, and generally working as a physician.

I have seen disasters where others have tried to freeze what turned out to be melanoma.

Let patients sue their nurse practitioners. I can't wait.

 

[DermMatch]

I just sent a complaint into the AAD. Please do the same if you oppose this development.

First it was the primary care docs, then the anesthesiologists, now the dermatologists, next it will be you.

 

[exPCM]

There is not a more stable career than medicine right now. In my city, a major midwest city, law graduates (w/ high tuition) can't find jobs. Practicing lawyers have been laid off. The town levies are not passing, and teachers are being laid off. Engineering firms are not hiring, and a family friend (CEO of a regional bank) recently told me that the job market is putrid for MBA's.

I'm not trying to tell people not to care about the DNP movement. It's gotten me pissed off before, even recently. I'm just trying to add prospective. Medicine is, and will remain, a safe career choice for some time to come. Now is the best time to enter medicine, even in primary care (I'm talking about job guarantees, not salary and lifestyle).

Also, for what it's worth I'm a pretty hardcore libertarian. I wish we had a free market healthcare system. It would make it so much easier for physicians to stand out (cash only, catastrophic insurance, etc.) That way, physicians could put their money where their mouths are when competing with DNP's for patients (for better or worse results). If over time, DNP's (and PA's) can prove that they can offer a service cheaper than an MD and with the same outcome, how is this a bad thing? Of course, these studies would take many years. I just wanted to point out my political views, b/c I got the sense my post seemed very socialist for some reason.

Just my opinion, maybe it has something to due with being raised by a truck driver and a teacher (I always felt rich growing up). Negativity sucks (which is pretty hypocritical, considering I'm posting in the most negative thread ever)

Why is the law job market bad? Big factor: Overproduction of grads.
At least 10 new law schools are on the drawing board around the country, in addition to the 200 already accredited by the ABA. At the same time, the demand for legal services has dropped during the economic recession, prompting hundreds of firms to lay off lawyers, cut salaries, and delay the start dates of new associates. As law schools continue to churn out graduates, the resulting bottleneck could make the competition for jobs even more fierce. And some legal experts predict that even when they do resume hiring, many big firms won't be able to continue paying new associates the salaries of $120,000 or more that students had counted on to whittle down their debt.
But that sobering news hasn't stopped students from flocking to law schools, which saw the number of applicants rise 4.3 percent for this fall, according to the ABA. ...
http://www.professorbainbridge.com/professorbainbridgecom/2009/07/is-law-a-mature-industry.html
Why is the MBA job market bad? Big factor: Overproduction of grads and outsourcing of corporate accounting and finance work overseas.
http://www.cfo.com/article.cfm/8134953?f=related
Why is the engineering job market bad? Outsourcing of a lot of work and insourcing of H1-B visa grads so as to not hire Americans.
Teaching companies to not hire Americans: http://www.youtube.com/watch?v=TCbFEgFajGU
http://www.financialexpress.com/news/ibm-fires-500-us-staff-across-the-board/586389/
Here is a snapshot of IBM's US headcount:
2005 133,789
2006 127,000
2007 121,000
2008 115,000
2009 105,000
2010 98,000 estimate
These are all good paying jobs that can support a family and pay taxes.
Today, 75% of the total headcount is overseas. The overseas revenue is 65%. The company reported record profits last year. IBM decided to stop reporting their US headcount this year.

If you don't think that the ramping up of DNP production does not have the potential to hurt physician employment prospects you are sadly mistaken.

Already nurses have taken a big hit:
http://www.realityrn.com/visitor-topics/new-grad-nurse-job-struggle/1350/

Physicians are seeing some effects too: http://www.ama-assn.org/amednews/2009/01/26/bisb0126.htm

 

[KWTRCSI]

Interesting, I wasn't aware that we had such a shortage of dermatological care. What is the DNP's excuse this time?

I'm sure a lot of medical students will be upset that their crown jewel is under attack.

I've always wondered though, what exactly do dermatologists do? A lot of it just doesn't seem that connected to medicine to be honest. Biopsy, antibiotics, steroids... seems like a waste for the best and brightest medical students to inject botox in clinic 4 days a week. I don't think it's a stretch to train a few pseudo-docs to spot melanoma or sell wrinkle creams.

The next step will be like this :

DO U WANT TO BE A SURGEON..NO PROBLEM

For tailors and barbers certified courses, be a general surgeon
For limberjacks certified courses, be an orthopedic surgeon
For beauticians certified cources, be a plastic surgeon
For teenagers/playstation gamers certified courses, be a laprascopic surgeon

Hurry up seats are limited !!!!!!!!!!!!!!

 

[glasshouse]

I am concerned that these DNPs are blatantly misrepresenting their training by referring to themselves as "doctors" who have completed a "residency". I think there should be some distinction to make it clear to patients that they have a less comprehensive training background. Any way this could be addressed as well?

 

[Rabbit Hole]

^^

For what it's worth, I was planning on emailing ...

1. AMA
2. AAD
3. AOA (American Osteopathic Association)
4. AOCD (American Osteopathic College of Dermatology)

before Monday. Anyone who wants to do the same, it's a good start. The AOA had a link to the story on their blog page under 'health news' but not a single comment about their stance on it. Lame.

This goes for any of ya'll who really care about this stuff:

If you posted easy links and pre-made forms to send/example statements, the number of people who ALSO contact these organizations would increase exponentially. Furthermore, if you used your medical contacts to forward these pre-made forms and AMA/AAD/AOA/AOCD pertinent emails to each other, you could really get something going.

I have none of these contacts and I'm not the greatest writer ever, but this seems to be the next logical step in any internet-based political movement I've seen/participated in.

If anyone has sample statements that we can use (for this specific issue) and the email addresses to those organizations - that would be really helpful. That way people can edit and personalize it quickly and email it to the right place.

 

[MOHS_01]

That's what biopsies are for. Your argument is a red herring. The fact that nobody can diagnose melanoma definitely by looking at it with their naked eye is not pertinent to the discussion. Do you think learning about sodium and potassium channels is going to improve the likelihood of finding melanoma? How about all of those COPD and CHF exacerbations admitted during internship? I'm sure a dermatologist or dermpathologist are more likely to be better at picking out melanoma but not because they trained in medical school or internship, they are better because they see more melanomas. I don't see why a nurse practioner who specializes in melanomas and sees enough cases won't be able to spot melanomas as well as a dermatologist. I am sorry, but derm is not brain surgery. The clinically relevant pathophysiology of a melanoma is not that complex. Stop kidding yourself.

Someone lacks insight into how much they do not know.

 

[Rabbit Hole]

I have created a new group on SDN - please join and spread the word!

pol.i.tick.ing