NPs can now do dermatology residencies

[deleted87716]

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Members don't see this ad.

As Elle Woods in Legally Blonde said, "Wait, am I on glue?"

Shouldn't it be incumbent on the challengers to prove that they are as competent as physicians and can provide an equal service at a lower cost? Shouldn't they have to be the ones to make their own way and distinguish themselves? Haven't physicians already set the standard for others to meet? When did we go down some rabbit hole here where white is black and black is white?

Exactly. For those here who may (God willing) actually do more than just whine on SDN, this is a key point to bring to your legislators.

 

[turquoiseblue]

I don't see why the DNP's still went ahead and created the derm residency program, even though it isn't approved by the Florida State Medical Board (FSMB). What are they going to be able to do once the NPs finish the program if it is not approved? They won't be able to practice until the FSMB approves, right? and they may not even be able to get approval at all. it seems to be only a pilot program at this point

 

[exPCM]

I don't see why the DNP's still went ahead and created the derm residency program, even though it isn't approved by the Florida State Medical Board (FSMB). What are they going to be able to do once the NPs finish the program if it is not approved? They won't be able to practice until the FSMB approves, right? and they may not even be able to get approval at all. it seems to be only a pilot program at this point

NPs are not regulated by the FSMB. They are regulated by the Board of Nursing. The BON is fully behind their NP brethren.

 

[deleted87716]

Again, these "residencies" are just about more letters after their name and more revenue for the school. It has nothing to do with NPs' practice rights.

Currently, only two states (including Florida) prohibit NPs from prescribing controlled substances. IMO, the bill would probably be getting more traction if it didn't include optometrists.

http://www.enpnetwork.com/groups/82...ng-bill-log-jamed-will-not-progress-this-year

I say let 'em overreach. It's easier to defeat them that way.

 

[Coastie]

I'm an anesthesiology resident and I called the american academy of dermatology's Washington office at 202-842-3555.

We have to stick together. NOW.

 

[JaggerPlate]

These bogus certifications are not unlike the non-ABMS certifications that some physicians complete. They aren't worth the paper they're printed on, and doctors and employers, for the most part, recognize this.

Doctors and employers maybe ... but not patients. I think the guys in Beverly Hills making 7 figures through their board certification in "cosmetic surgery" through the American Academy of Cosmetic Surgery will attest to that.

If a DNP can still obtain independent state practice rights and set up a private practice with Dr. Noctor, Board Certified Dermatologist on the door ... then it's still a huge problem for all involved.

 

[JaggerPlate]

The only solution (albeit temporary) is to specialize. As much as possible. I've got my eye on EP right now. By the time the nurses start to infiltrate that field I'll be halfway through my career with my loans paid off.

I don't understand why people keep falling back on these arguments ...


What makes EM safe??? Assuming you can find a field that safe is a. untrue in my opinion. I guarantee there were derms sitting around 3 years ago saying how bad the mid level is in FM, but it's okay because they are fine. Don't assume a field is safe. b. This just propels the problem. If every doc runs for a safe field, shuns the problem, then it's only going to get worse. So what if you think Neurosurgery is safe ... don't just ignore the guys in FM, derm, etc who are affected by it. They are docs too. We should show a TAD of unity and realize this problem affects everyone who has put in the time to go though any medical school/residency program.

 

[Speculatrix]

I don't understand why people keep falling back on these arguments ...


What makes EM safe??? Assuming you can find a field that safe is a. untrue in my opinion. I guarantee there were derms sitting around 3 years ago saying how bad the mid level is in FM, but it's okay because they are fine. Don't assume a field is safe. b. This just propels the problem. If every doc runs for a safe field, shuns the problem, then it's only going to get worse. So what if you think Neurosurgery is safe ... don't just ignore the guys in FM, derm, etc who are affected by it. They are docs too. We should show a TAD of unity and realize this problem affects everyone who has put in the time to go though any medical school/residency program.

I believe s/he was talking about cardiac electrophysiology, rather than emergency medicine; I don't ever see a nurse practitioner ablating accessory pathways. I admire your tenacity, despite not having even started medical school yet!

 

[cyclohexanol]

The only solution (albeit temporary) is to specialize. As much as possible. I've got my eye on EP right now. By the time the nurses start to infiltrate that field I'll be halfway through my career with my loans paid off.

I don't understand why people keep falling back on these arguments ...


What makes EM safe??? Assuming you can find a field that safe is a. untrue in my opinion. I guarantee there were derms sitting around 3 years ago saying how bad the mid level is in FM, but it's okay because they are fine. Don't assume a field is safe. b. This just propels the problem. If every doc runs for a safe field, shuns the problem, then it's only going to get worse. So what if you think Neurosurgery is safe ... don't just ignore the guys in FM, derm, etc who are affected by it. They are docs too. We should show a TAD of unity and realize this problem affects everyone who has put in the time to go though any medical school/residency program.

EP as a specialty = electrophysiology, a cardiology subspecialty.

As far as assuming nothing is safe, I agree. Physicians need to stop being such ******* and unite against this bull****.

 

[deleted87716]

The problem with becoming a super-sub-specialist, as I've said previously, is that there are comparatively few job opportunities to choose from, and you will likely find yourself with far less leverage with employers and payers. After all, what else are you going to do?

You may feel less threatened by mid-levels, but you won't be "safe" from an employment or reimbursement standpoint.

 

[deleted87716]

If a DNP can still obtain independent state practice rights and set up a private practice with Dr. Noctor, Board Certified Dermatologist on the door ... then it's still a huge problem for all involved.

That goes back to the "patient safety" argument.

 

[JaggerPlate]

That goes back to the "patient safety" argument.

Why can't it be a problem for both physician's and patients? The two are not mutually exclusive??? I don't understand why it's so disgraceful for doctors to show any interest in the wellbeing of their profession and ability to provide for their families??

If I'm misinterpreting your statement, then I apologize.

 

[JaggerPlate]

I believe s/he was talking about cardiac electrophysiology, rather than emergency medicine; I don't ever see a nurse practitioner ablating accessory pathways. I admire your tenacity, despite not having even started medical school yet!

EP as a specialty = electrophysiology, a cardiology subspecialty.

As far as assuming nothing is safe, I agree. Physicians need to stop being such ******* and unite against this bull****.

DOH!!

How noob of me ... I mistook EP for Emergency Practice (which I thought was odd initially - EP not EM??? but w/e)

Regardless ... the sentiment remains the same - we shouldn't assume anything is safe and there is no reason not to show a little unity as docs, in my very, very limited opinion.

 

[ShyRem]

And stories like this are just convincing patients that they're a good idea in general.

 

[JaggerPlate]

Okay, so several things:

1. I finished my general email/template, and I'm going to post it here. I'd really love some feedback from students, residents, attendings, etc, before I send it off to: AMA, AOA, AAD, AOCD, and maybe some state boards (any suggestions on the list will help too). I'd really love to get this email perfect, so that people can just take the template, tweak a few things, and send it off. I feel like volume and frequency will get attention here

2. In going over the email, I was obviously researching the issue and looking over some of the specific stuff for the derm residency at USF ... and Jesus Christ, this has to stop. It's no joke, and it's serious. Even if you don't believe it's a powerful movement, even if you don't believe it will affect your field of practice, please just look at the precedent. Look at how the residency advertises rotations in MOHS surgery, excision, podiatry, ETC. Look at Dr Shelby, DNP, introduce herself as the 'program directory of the dermatology residency at USF,' ET freaking C. It's no joke.

3. Here is the email ... please feel free to help me edit, change, add, delete, etc. I say we make one really good one, post it all over, and make it super easy for people to copy, paste, put their name in it, and send it all over:





To Whom It May Concern,

My name is _____________, and I am a medical student at __________________ (Class of ________). As a new student and an individual dedicated to the medical profession, I strive to stay current in relevant health care news, and recently discovered a disheartening, shocking situation - expanding rights and privileges for nurse practitioners.

According to recent reports, by 2015, nearly all new nurse practitioners will participate in Doctorate programs and achieve their Doctorate in Nursing Practice, or "DNP." These newly minted practitioners intend to promote themselves as "doctors" in a clinical setting, and justify this act by stating chiropractors, dentists, and veterinarians follow the same practice without patient confusion or misrepresentation. Clearly, this justification is illogical, and represents the aggressive, renegade behavior embraced by this expansion movement. However, nurse practitioners referring to themselves as doctors in hospitals, outpatient facilities, and private practices is far from the most pressing issue associated with nurse practitioner expansion.

Twenty-eight states are now considering an expansion of nurse practitioner rights and privileges. Nurse practitioners desire independent practice, prescription rights, and even Medicare reimbursement at physician rates. Initially, nurse practitioners used the shortage of primary care physicians as justification for their rapid evolution. With a disproportionate amount of physicians entering primary care and an ever expanding patient base, nursing interest groups built momentum and achieved (and continue achieving) greater clout in crucial primary care fields. However, recent events indicate that nurse practitioners have no intention of practicing strictly within the realm of primary care, nor do they offer justification for the new Doctor of Nursing Practice residency in dermatology at the University of South Florida (USF).

According to Dr. Debra Shelby, a DNP who introduces herself as the program directory of the dermatology residency at USF, the program trains Advanced Practice Nurses in both general and surgical dermatology. The 1,000 hour residency program is supported by both the Dermatology Nursing Association (DNA) and the American Association of Nursing Dermatology (AAND), and encourages its graduates to advertise their credentials in dermatology. The "residency" includes training in dermatopathology, podiatry, cutaneous surgery, MOHS procedures, advanced excision and closure, laser surgery, and cosmetic dermatology. Furthermore, Dr. Shelby ensures prospective candidates that this program is the first of many to come, but does not explain how this training fills a health service void, or how a nurse practitioner with the ability to advertise themselves as a doctor with advanced training in dermatology is advantageous to patient care.

http://health.usf.edu/nocms/nursing/AdmissionsPrograms/dnp_concentrations_derm.html

http://health.usf.edu/nocms/nursing/AdmissionsPrograms/DNA_Dermatology_Residency_Presentation.pdf

This new residency program represents a threat to medical students, residents, attending physicians, and, most importantly, unsuspecting patients. Personally, I believe this expansion will continue into various medical fields, and as a powerful, physician interest group, I urge you to help protect physician rights, patient safety, and the practice of ethical medicine. The time of disapproval and speculation is over, and I know that with unity and resolve, these issues can be eliminated. Thank you for your time. Please do not hesitate to contact me with any questions, concerns, or desires. I'd love to do my part.

Sincerely,
__________

 

[DrMom]

And stories like this are just convincing patients that they're a good idea in general.

I especially like this part:

"We're constantly having to prove ourselves," said Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she's just like a doctor "except for the pay."

🙄

 

[J1515]

According to Dr. Debra Shelby, a DNP who introduces herself as the program directory of the dermatology residency at USF,[/I]

"Program director." Otherwise looks good.

 

[Saga1]

As a med student hearing that a nurse might be equivalent to a doctor is incorrect.

 

[Rabbit Hole]

Okay, so several things:

1. I finished my general email/template, and I'm going to post it here. I'd really love some feedback from students, residents, attendings, etc, before I send it off to: AMA, AOA, AAD, AOCD, and maybe some state boards (any suggestions on the list will help too). I'd really love to get this email perfect, so that people can just take the template, tweak a few things, and send it off. I feel like volume and frequency will get attention here

2. In going over the email, I was obviously researching the issue and looking over some of the specific stuff for the derm residency at USF ... and Jesus Christ, this has to stop. It's no joke, and it's serious. Even if you don't believe it's a powerful movement, even if you don't believe it will affect your field of practice, please just look at the precedent. Look at how the residency advertises rotations in MOHS surgery, excision, podiatry, ETC. Look at Dr Shelby, DNP, introduce herself as the 'program directory of the dermatology residency at USF,' ET freaking C. It's no joke.

3. Here is the email ... please feel free to help me edit, change, add, delete, etc. I say we make one really good one, post it all over, and make it super easy for people to copy, paste, put their name in it, and send it all over:

I put your email template for download (MSword) in this SDN group: pol.i.tick.ing

For those of you interested in joining, please do. I've also gathered all the websites and contact pages for the organizations that we can send emails to.

"Program director." Otherwise looks good.

Fixed it in MSword.

 

[starbuckscoffee]

I'm an anesthesiology resident and I called the american academy of dermatology's Washington office at 202-842-3555.

We have to stick together. NOW.

I just called and left a message too. Rather than complaining on this forum, let's take Coastie's lead and contact the people who can either stop these programs or work toward rules regulating what they can and cannot do.

 

[deleted87716]

Why can't it be a problem for both physician's and patients? The two are not mutually exclusive??? I don't understand why it's so disgraceful for doctors to show any interest in the wellbeing of their profession and ability to provide for their families??

If I'm misinterpreting your statement, then I apologize.

Nobody cares about doctors' well-being. Really and truly, they don't. If you try to argue from the "poor me" platform, you don't have a chance. It can't be about us. Let the nurses continue to make ridiculous statements like "I'm just like a doctor except for the pay." It will ultimately bite them in the ass.

We need action, but not reaction.

 

[scrubs421]

Here is what I am hoping. I have created a petition letter (below) around this debate. I am hoping someone will edit it (it probably needs editing) and create it into a petition form (there are website out there to do this but I am unsure of how to do it). This way we can sign it online and send it around to everyone (medical students, attendings). I wrote this the best I could; please feel free to edit and change it around. This is as far as I can go with it but I feel it is a good start:


Dear Colleagues and Friends,

First, I want to say thank you for taking the time to read this letter and apologize for its length. I have written this letter for medical students, physicians, premedical students, patients, and their families. I hope you have the chance to read through it all and sign this petition.
The problem I am speaking to you about today is Doctors of Nurse Practitioning (DNP) and other nurse practitioners that are asking for medical equivalence in almost twenty-eight states around the United States. These practitioners serve a vital role in our healthcare system; however, the notion that these practitioners should be left to practice medicine alone and unsupervised throughout the country is scary to say the least. I will try to debunk some of the counterarguments and myths associated with this issue. There is a large amount of propaganda associated with this issue put out by various lobbying organizations that have a strong political agenda.
Myth 1: "DNPs have equal to better outcomes than FP and other physicians". There have been very limited studies comparing the outcomes of DNPs and DO/MDs, most have significantly lacked power and have various endpoints. What should we measure as endpoints for patients in these studies---heart attacks? Strokes? High blood pressure control? Diabetes outcomes? This is an issue not easily solved, however, the fact that many organizations use that argument is both backhanded and incorrect.
Myth 2: "The training of the DNP is equivalent to MD/DO". The average MD/DO goes through 4 years of undergraduate training, 4 years of medical school, 3-4 years of residency, and 1-2 years of fellowship. The DNP schooling requirements are not universal (aka they vary from institution to institution). Many of these programs can be completed completely online (never having to attend classes in person, one of many examples is the program at Ball State University). The path to be a DNP includes 4 years of undergraduate, 2 years for a Masters in Nursing, and the DNP program anywhere from 2-4 years (often part time). Comparing the number of years of training is 13-15 for MD/Dos, while the DNPs 8-11 years.
Myth 3: "Many DNPs, advertise that they are ‘board certified'" MDs must complete 3 sets of boards Steps 1-3, and then complete an individual exam for each specialty (e.g. a specialty exam for Dermatology or Rheumatology). Steps 1-3 consist of exams that are 8 hours in length and cover much of medical school in its entirety. The specialty specific exams are extremely intense and thorough and prepare practitioners to be leaders in their respective fields. DNPs recently undertook an exam to try and proof equivalence to MD/DOs. Essentially, it was a water-downed version of the medical boards Step 3 exam. (They have no equivalent examination to cover Steps 1-2). Only 50% of those that took the exam had a passing score (http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm).
Myth 4: "Physicians are over trained for their job" I have heard this argument often, and I feel the only way to dispel it is to give an example outside the realm of healthcare. I will give an example of my good friend John. John had always thought about law school but decided that it was too much time and energy. He worked as a paralegal for a patent law firm for 25 years and has gotten to know the business inside and out. He drafted documents, was involved even in negotiations and all aspects of the business. Now, should I ask John to be my patent attorney? Of course I shouldn't. He has much of the practical knowledge of the business (probably as good as an attorney in his office) but lacks a theoretical knowledge of the law. Therefore, his ability to adapt to new scenarios and difficulties will be severely limited. The axiom we must each understand is that that early in our training (in almost any career) "we don't know how much we do not understand." Without that health understanding of our limited knowledge base we may be dangerous (in any career).
Myth 5: "DNPs are only trying to fill the primary care void" This is the argument I hear most often. However, the training new DNPs doesn't guarantee the appropriate distribution (that's right it's a distribution of resources problem we have in healthcare) of healthcare resources. We need more primary care in rural and underserved areas and DNPs are just as likely not to practice in these areas as MD/DOs. The solution to this problem is increased debt forgiveness and payment for physicians (MD/DOs) to practice in areas that are underserved.
Myth 6: "DNPs are only in primary care this will not effect me as specialized physician" Many physicians are unfortunately terse and apathetic to one another. These are just some of the comments I have heard in my short medical career "Family practice is easy, we don't need MD/DOs doing that. Mid-level practitioners are fine" or "Anesthesiology requires hours of sleeping with moments of panic, any nurse can handle that (in reference to CRNAs)." I think each of us (because of our limited exposure to each field) "do not understanding how much we don't know" in terms of what it really requires to be a Family Physician or an Anesthesiologist. We must respect the knowledge and expertise of other physicians. But, to think that this will not/could not happen to your field is ignorant. Recently, DNPs tried creating "Residency Programs" that span 3-4 months (compared to the 3-4 years of Residency for MD/DOs) for Dermatology (http://health.usf.edu/nocms/nursing/AdmissionsPrograms/dnp_concentrations_derm.html). Clearly, the training in this program is no where near as rigorous as a MD/DO residency, and I hope you look at these programs in horror as these DNPs advertise themselves as "Dermatologists"
Final Thought: "What would you do for your family members?" I hope that I gave you some insight into some of the myths around this debate. Bottom line is that I like to live by one axiom in terms of medical treatment "Would this care/intervention be good enough for my family member? (mother, father etc)" If the answer is "no" than this is not something I can support. I cannot support these DNPs asking for independent practice and credentials that "fake" the public into believing their training is on equal par with physicians (MD/DOs). Please sign the below petition and we will be forwarding the petition to various news organizations. We are hoping to collect greater than five thousand signatures. Thank you for your support.

Sincerely,
Your Concerned Future/Current Physicians.



P.S. I wrote this in hopefully an easy to understand way (aka not for physicians), so the general public could read it and understand what we were saying

 

[fab4fan]

Nobody cares about doctors' well-being. Really and truly, they don't. If you try to argue from the "poor me" platform, you don't have a chance. It can't be about us. Let the nurses continue to make ridiculous statements like "I'm just like a doctor except for the pay." It will ultimately bite them in the ass.

We need action, but not reaction.

I realize I'm the lone voice as a nurse here, but I still think this is a minority of nurses who truly believe they are equal to physicians. Why they haven't been stomped down before things got to this level, I just don't understand.

I also fail to understand where these practitioners are getting patients. I guess I live on some sort of parallel universe, but in my mind, patients still want to see physicians, not noctors.

The whole DNP crap was the major reason I stopped the nurse-practitioner path I was on. That, and realizing I didn't want that level of responsibility with what I felt was not enough education. My job is difficult enough as it is, thanks all the same.

 

[mig26x]

i can just imagine the day 10-15 yrs later where future IM residents or FM residents have to present DNP at the outpt setting clinic on their pts.

you might as will kill me now if one i have to do that!

Im just finishing my residency right now, but if that happened to me I will say NO.

 

[Dr Oops]

Hey guys,

a couple of my friends are on the e-board of our family practice club and I showed them the article and told them should have a meeting or speaker come in, and educate students about this, they thought it was a great idea. Any of you guys have any ideas about who we should call about getting a speaker or any ideas about what we should do?

 

[badasshairday]

I realize I'm the lone voice as a nurse here, but I still think this is a minority of nurses who truly believe they are equal to physicians. Why they haven't been stomped down before things got to this level, I just don't understand.

I also fail to understand where these practitioners are getting patients. I guess I live on some sort of parallel universe, but in my mind, patients still want to see physicians, not noctors.

The whole DNP crap was the major reason I stopped the nurse-practitioner path I was on. That, and realizing I didn't want that level of responsibility with what I felt was not enough education. My job is difficult enough as it is, thanks all the same.

Respect to the real nurses out there. 👍

 

[stn2006]

there was a recent article on the NPs want to be call "doctor" because they do have Ph.D but will patients understand the difference?

 

[JaggerPlate]

"Program director." Otherwise looks good.

Oh whoops! Thanks for catching that. I had like nine windows pulled up while I was typing, lol.

 

[JaggerPlate]

Nobody cares about doctors' well-being. Really and truly, they don't. If you try to argue from the "poor me" platform, you don't have a chance. It can't be about us. Let the nurses continue to make ridiculous statements like "I'm just like a doctor except for the pay." It will ultimately bite them in the ass.

We need action, but not reaction.

I'm not advocating the poor me stance ... I think that groups that represent physician interest should argue physician interest and I think the general public should know that they could be seeing a nurse who introduces themselves as a doctor, and that their training is no where near docs, so ... be aware and if you aren't happy about this, let's do something.

Plus, what do you recommend Blue??? You seem to be shooting everything down, and kind of taking the 'this will bite them in the ass/let em try it/it's just a small minority' stance. This hasn't worked in the past, and it seems like the norm that gets physicians into the muck in the first place.

What do you recommend???

 

[Winged Scapula]

Below are my thoughts...

Dear Colleagues and Friends,

First, I want to say thank you for taking the time to read this letter and apologize for its length.

Do not use the phrase "First" unless there is a "Second". Do not apologize especially right off the bat; there is no need - the reader has done nothing for you yet (thank them at the end, if you feel the need).

I have written this letter for medical students, physicians, premedical students, patients, and their families. I hope you have the chance to read through it all and sign this petition.

The order should be patients and their families, pre-medical and medical students and physicians.

The last sentence sounds awkward. I'd reword it, "I ask you to read through it in its entirety and sign the petition which follows."

The problem I am speaking to you about today is Doctors of Nurse Practitioning (DNP) and other nurse practitioners that are asking for medical equivalence in almost twenty-eight states around the United States.

You are not "speaking to" us. The degree is a Doctorate of Nursing Practice (DNP). If you are truly writing this to patients and their families, the term medical equivalence will be vague to them. You need to clearly state that these practitioners are asking for equivalent practice rights and pay without equivalent education, training, or liability. Do not hedge - it is not "almost" 28 states - it IS 28 states.

These practitioners serve a vital role in our healthcare system; however, the notion that these practitioners should be left to practice medicine alone and unsupervised throughout the country is scary to say the least.

Inflammatory and colloquial language. Yes, we may find it scary, but use of this term only serves to demean NPs and fails to recognize that NPs already ARE practicing independently around the country. You need to address what is being proposed in addition to the current status and that you have "concerns" not that you are scared.

I will try to debunk some of the counterarguments and myths associated with this issue. There is a large amount of propaganda associated with this issue put out by various lobbying organizations that have a strong political agenda.
Myth 1: "DNPs have equal to better outcomes than FP and other physicians". There have been very limited studies comparing the outcomes of DNPs and DO/MDs, most have significantly lacked power and have various endpoints. What should we measure as endpoints for patients in these studies---heart attacks? Strokes? High blood pressure control? Diabetes outcomes? This is an issue not easily solved, however, the fact that many organizations use that argument is both backhanded and incorrect.

Again the average laypublic will not know what an "endpoint" is. In addition, the problem is not only that these studies are poorly designed but that they have been funded by nursing organizations, fail to take into account that complex medical management and physiological pertubations are not well managed by most NPs (ie, they only used simple algorithmic medical problems which likely don't even require an NP to resolve) and the public's inability to determine what good care is. Being nice, a good conversationalist, spend time with patients and give them what they want (ie, ABX for a viral illness) and all of a sudden you're Albert Schweitzer.

Myth 2: "The training of the DNP is equivalent to MD/DO". The average MD/DO goes through 4 years of undergraduate training, 4 years of medical school, 3-4 years of residency, and 1-2 years of fellowship.

Although I get your point here, the "average" MD/DO spends a minimum of 3 years of residency, most do not do a fellowship. Several residencies are a minimum of 5 years as well. Besides, again, the average layperson doesn't know what residency or fellowship is - better to say that physicians spend anywhere from 3-10 additional years training in their specialty after medical school.

The DNP schooling requirements are not universal (aka they vary from institution to institution). Many of these programs can be completed completely online (never having to attend classes in person, one of many examples is the program at Ball State University). The path to be a DNP includes 4 years of undergraduate, 2 years for a Masters in Nursing, and the DNP program anywhere from 2-4 years (often part time). Comparing the number of years of training is 13-15 for MD/Dos, while the DNPs 8-11 years.

Again, your numbers are off here. The number of years of education for MD/DO may be as little as 11 (4+4+3), or as many as 18 (4+4+7+3). I think it more relevant to talk about what's involved in that training - you've highlighted the online aspect of the DNP programs but you should also focus on the fact that it is almost an entirely administrative not clinical degree and compare the hours involved in training. Frankly, it means nothing real that DNPs take 2-4 years to complete if the total number of hours involved in getting that doctorate is 1000 hours beyond the Masters. Even assuming the 80 hour work-week, residents will complete 1000 hours in about 3 months. THAT is what people need to know, not just the years involved but that all of those residency and fellowship years require MUCH more hours directly involved in clinical work.

Myth 3: "Many DNPs, advertise that they are ‘board certified'" MDs must complete 3 sets of boards Steps 1-3, and then complete an individual exam for each specialty (e.g. a specialty exam for Dermatology or Rheumatology).

Steps 1-3 are NOT board examinations. They are licensing examinations. To be Board Certified, you must be licensed (which includes passing Steps 1-3 of course), complete residency training (or at least a minimum number of years in some specialties that allow the exams to be taken during residency), and then take a written and oral examination for the specialty, as well as Maintenance of Certification, with continuous CMEs to remain licensed.

Steps 1-3 consist of exams that are 8 hours in length and cover much of medical school in its entirety. The specialty specific exams are extremely intense and thorough and prepare practitioners to be leaders in their respective fields.

Leaders? A bit of hyperbole there?

DNPs recently undertook an exam to try and proof equivalence to MD/DOs. Essentially, it was a water-downed version of the medical boards Step 3 exam. (They have no equivalent examination to cover Steps 1-2). Only 50% of those that took the exam had a passing score (http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm).

Yes, this is true, but the phrase "watered-down" (which is the correct phrase, not "water-downed") sounds like sour grapes. You need to clarify that the examination was based on the USMLE Step 3, an examination that over 94% of US physicians pass on the first try, but that was simplified for NPs, yet less than 50% were able to pass this simplified version. You may wish to discuss the history of BC and how it was designed to protect the public yet the DNPs are attempting to foist a substandard level of education, training, and skills as being equivalent onto the unsuspecting public.

Myth 4: "Physicians are over trained for their job" I have heard this argument often, and I feel the only way to dispel it is to give an example outside the realm of healthcare. I will give an example of my good friend John. John had always thought about law school but decided that it was too much time and energy. He worked as a paralegal for a patent law firm for 25 years and has gotten to know the business inside and out. He drafted documents, was involved even in negotiations and all aspects of the business. Now, should I ask John to be my patent attorney? Of course I shouldn't. He has much of the practical knowledge of the business (probably as good as an attorney in his office) but lacks a theoretical knowledge of the law. Therefore, his ability to adapt to new scenarios and difficulties will be severely limited. The axiom we must each understand is that that early in our training (in almost any career) "we don't know how much we do not understand." Without that health understanding of our limited knowledge base we may be dangerous (in any career).
Myth 5: "DNPs are only trying to fill the primary care void" This is the argument I hear most often. However, the training new DNPs doesn't guarantee the appropriate distribution (that's right it's a distribution of resources problem we have in healthcare) of healthcare resources. We need more primary care in rural and underserved areas and DNPs are just as likely not to practice in these areas as MD/DOs. The solution to this problem is increased debt forgiveness and payment for physicians (MD/DOs) to practice in areas that are underserved.

The latter ignores the fact that these DNP programs have "residencies" in fields like Cardiology and Dermatology - hardly primary care fields. In addition, with the uptick in the number of medical school graduates, there will be (regardless of current number of residency positions), more physicians practicing in the future.

Myth 6: "DNPs are only in primary care this will not effect me as specialized physician" Many physicians are unfortunately terse and apathetic to one another.

Don't admit to weakness. Its one thing for us to recognize it but as soon as we let the general public know that we don't support each other, we've lost ghe battle.

These are just some of the comments I have heard in my short medical career

With all due respect, as a pre-med, you don't have a "medical career."

"Family practice is easy, we don't need MD/DOs doing that. Mid-level practitioners are fine" or "Anesthesiology requires hours of sleeping with moments of panic, any nurse can handle that (in reference to CRNAs)." I think each of us (because of our limited exposure to each field) "do not understanding how much we don't know" in terms of what it really requires to be a Family Physician or an Anesthesiologist. We must respect the knowledge and expertise of other physicians. But, to think that this will not/could not happen to your field is ignorant.

Again, I would leave this out - in essence everything above are Myths the general public has, not physicians. You don't need to focus on infighting within the medical community. We all see it, my partner and I argued about it when she wanted to hire an NP for the practice. She ended up hiring a PA which is better but there are still shades of "I know more than half the physicians in this town" (an actual quote from her - less than 6 months after her graduation from PA school 😱 ).

Recently, DNPs tried creating "Residency Programs" that span 3-4 months (compared to the 3-4 years of Residency for MD/DOs) for Dermatology (http://health.usf.edu/nocms/nursing/AdmissionsPrograms/dnp_concentrations_derm.html). Clearly, the training in this program is no where near as rigorous as a MD/DO residency, and I hope you look at these programs in horror as these DNPs advertise themselves as "Dermatologists"

Clear to whom? Certainly not to patients, family members and probably most pre-meds and early med students. Dermatologists were at the top of their medical school class; they didn't just do more time, they worked harder than most of us. Good point to mention the differences in training but don't presume the general public has any idea about how "rigorous" the training is. My family is John Q Public and had NO idea until they saw me go through it, and even then, they weren't living with me and didn't see the toll the training took on a day to day basis.

Final Thought: "What would you do for your family members?" I hope that I gave you some insight into some of the myths around this debate. Bottom line is that I like to live by one axiom in terms of medical treatment "Would this care/intervention be good enough for my family member? (mother, father etc)" If the answer is "no" than this is not something I can support. I cannot support these DNPs asking for independent practice and credentials that "fake" the public into believing their training is on equal par with physicians (MD/DOs). Please sign the below petition and we will be forwarding the petition to various news organizations. We are hoping to collect greater than five thousand signatures. Thank you for your support.

Sincerely,
Your Concerned Future/Current Physicians.

Again use of the word "fake" is inflammatory. While I am furious over these programs and their claims (did you see the DNP on CNN yesterday who claimed the only difference was that he practiced "holistically" as opposed to physicians?) , we will not win by looking arrogant or belittling nurses. You must present the facts without emotion.

 

[jack shepherd]

At the risk of being flamed.
I have done a 4-week derm rotation in medical school and have a cousin in derm so I feel like I am somewhat educated to speak on this issue. 80% of cases that the regular dermatologist (medical) sees is something that anybody with an high school education can treat honestly.
Basically, its like this. If it is a rash, scrape it for fungus. If scrape positive, treat with anti-fungals. If scrape negative, treat with steroids. The exceptions to such cases, might be a scabies case, but they have a much different pattern than most other rashes and can be scraped and added to mineral oil or something like that and put under a microscope.
You might see an occasional acne, but acne has clear protocols for treatment.
To be honest, I could not believe that such a field was attracting “the brightest” medical students. What a waste 99% of medical school was for such doctors.
There is no reason that NP can’t treat such cases. Anybody with half a brain could treat such cases. They are not life threatening and very simple. It would save the patient time and the healthcare system money (assuming that NP’s get billed less than MD’s which should definitely be the case).
Doing skin biopsies is such a joke that they even had us medical students doing them at the end of our 4 weeks.

The other ~20% of cases (changing moles, skin cancers, unusual rashes), they should refer out to the MD dermatologists. I am sure this would also make the dermatology cases much more interesting by removing all of the boring garbage.
And don’t bring the melanoma argument. Melanoma is very small, small piece of the pie. And they should refer such a case to the MD anyway.

You guys should start being altruistic (isnt that the reason we came to medical school in the first place) and caring about patient care and access to medical care instead of yourselves.

Resneck JS Jr, Lipton S, Pletcher MJ. Short wait times for patients seeking cosmetic botulinum toxin appointments with dermatologists. J Am Acad Dermatol. 2007 Dec;57(6):985-9. Epub 2007 Aug 27.

Resneck JS Jr, Isenstein A, Kimball AB. Few Medicaid and uninsured patients are accessing dermatologists. J Am Acad Dermatol. 2006 Dec;55(6):1084-8. Epub 2006 Sep 6.

Tsang MW, Resneck JS Jr. Even patients with changing moles face long dermatology appointment wait-times: a study of simulated patient calls to dermatologists. J Am Acad Dermatol. 2006 Jul;55(1):54-8. Epub 2006 May 6.

Resneck J Jr, Pletcher MJ, Lozano N. Medicare, Medicaid, and access to dermatologists: the effect of patient insurance on appointment access and wait times. J Am Acad Dermatol. 2004 Jan;50(1):85-92.

 

[FutureDoc4]

At the risk of being flamed.
I have done a 4-week derm rotation in medical school and have a cousin in derm so I feel like I am somewhat educated to speak on this issue. 80% of cases that the regular dermatologist (medical) sees is something that anybody with an high school education can treat honestly.
Basically, its like this. If it is a rash, scrape it for fungus. If scrape positive, treat with anti-fungals. If scrape negative, treat with steroids. The exceptions to such cases, might be a scabies case, but they have a much different pattern than most other rashes and can be scraped and added to mineral oil or something like that and put under a microscope.
You might see an occasional acne, but acne has clear protocols for treatment.
To be honest, I could not believe that such a field was attracting "the brightest" medical students. What a waste 99% of medical school was for such doctors.
There is no reason that NP can't treat such cases. Anybody with half a brain could treat such cases. They are not life threatening and very simple. It would save the patient time and the healthcare system money (assuming that NP's get billed less than MD's which should definitely be the case).
Doing skin biopsies is such a joke that they even had us medical students doing them at the end of our 4 weeks.

The other ~20% of cases (changing moles, skin cancers, unusual rashes), they should refer out to the MD dermatologists. I am sure this would also make the dermatology cases much more interesting by removing all of the boring garbage.
And don't bring the melanoma argument. Melanoma is very small, small piece of the pie. And they should refer such a case to the MD anyway.

You guys should start being altruistic (isnt that the reason we came to medical school in the first place) and caring about patient care and access to medical care instead of yourselves.

Resneck JS Jr, Lipton S, Pletcher MJ. Short wait times for patients seeking cosmetic botulinum toxin appointments with dermatologists. J Am Acad Dermatol. 2007 Dec;57(6):985-9. Epub 2007 Aug 27.

Resneck JS Jr, Isenstein A, Kimball AB. Few Medicaid and uninsured patients are accessing dermatologists. J Am Acad Dermatol. 2006 Dec;55(6):1084-8. Epub 2006 Sep 6.

Tsang MW, Resneck JS Jr. Even patients with changing moles face long dermatology appointment wait-times: a study of simulated patient calls to dermatologists. J Am Acad Dermatol. 2006 Jul;55(1):54-8. Epub 2006 May 6.

Resneck J Jr, Pletcher MJ, Lozano N. Medicare, Medicaid, and access to dermatologists: the effect of patient insurance on appointment access and wait times. J Am Acad Dermatol. 2004 Jan;50(1):85-92.

I want to thank you. I was really on the fence about this, but I now realize for sure that with colleagues like you out there we have already lost this battle. (This has NOTHING to do with patient care, this has all to do with people (DNP) trying to get "their piece of the pie" and not even doing the work everyone else does to get it)

So, I have two options, leave medicine or play the system and take advantage of you and all my other "altruistic" colleagues that want to work for 50K a year and drive a 20 year old car, while paying off 200K loans. But, I am glad to see you reaffirmed my belief that medicine is bringing in people dumber than ever to fill in the void of medical school seats.

 

[Doctor Bob]

Some posts on here are written in a complex and confusing manner. So I wanted to provide a translation.

At the risk of being flamed.

I am about to make statements which I know will be inflammatory but I want to see what sort of rise I can get out of people... It's why I created the account.

I have done a 4-week derm rotation in medical school and have a cousin in derm so I feel like I am somewhat educated to speak on this issue.

At this point in my life I no longer have anything else to learn about dermatology.

80% of cases that the regular dermatologist (medical) sees is something that anybody with an high school education can treat honestly.

I have a very low opinion of the intelligence of dermatologists... including my cousin. He gave me lots of wedgies when we were younger.

Basically, its like this. If it is a rash, scrape it for fungus. If scrape positive, treat with anti-fungals. If scrape negative, treat with steroids.

I think I read this on a t-shirt.

The exceptions to such cases, might be a scabies case, but they have a much different pattern than most other rashes and can be scraped and added to mineral oil or something like that and put under a microscope.

Dermatology textbooks are very short because they only need 4 pages. Page 1 is fungal rashes, page 2 is non-fungal rashes, and page 3 is scabies. The fourth page had the name of the liquid you add to your scrapings but my copy of the book was missing that page.

You might see an occasional acne, but acne has clear protocols for treatment.

Fortunately there is only one way to treat these skin problems and only one option for each kind of medication. All patients respond the same way to that one medication.

To be honest, I could not believe that such a field was attracting "the brightest" medical students. What a waste 99% of medical school was for such doctors.

I on the other hand absorbed 100% of the information in school and will use it all on a daily basis. As evidenced by my deep understanding of derm.

There is no reason that NP can't treat such cases. Anybody with half a brain could treat such cases.

Do you see my subtle backhanded compliment here?

They are not life threatening and very simple. It would save the patient time and the healthcare system money (assuming that NP's get billed less than MD's which should definitely be the case).

Nobody ever died from a problem that originated in the skin.

Doing skin biopsies is such a joke that they even had us medical students doing them at the end of our 4 weeks.

I fully understand the risks of doing these procedures and I know that there are no possible complications from them.

You guys should start being altruistic (isnt that the reason we came to medical school in the first place) and caring about patient care and access to medical care instead of yourselves.

Unlike you suckers, I plan on providing my services for free after I graduate. Because that's what really matters.

Resneck JS Jr, Lipton S, Pletcher MJ. Short wait times for patients seeking cosmetic botulinum toxin appointments with dermatologists. J Am Acad Dermatol. 2007 Dec;57(6):985-9. Epub 2007 Aug 27.

Resneck JS Jr, Isenstein A, Kimball AB. Few Medicaid and uninsured patients are accessing dermatologists. J Am Acad Dermatol. 2006 Dec;55(6):1084-8. Epub 2006 Sep 6.

Tsang MW, Resneck JS Jr. Even patients with changing moles face long dermatology appointment wait-times: a study of simulated patient calls to dermatologists. J Am Acad Dermatol. 2006 Jul;55(1):54-8. Epub 2006 May 6.

Resneck J Jr, Pletcher MJ, Lozano N. Medicare, Medicaid, and access to dermatologists: the effect of patient insurance on appointment access and wait times. J Am Acad Dermatol. 2004 Jan;50(1):85-92.

I did a literature search for articles by my hero Dr. Resneck. I have a poster of him on the wall in my room, next to my bed. He's so dreamy.

 

[bluealiendoctor]

I just had to comment on your editing of the letter written. WingedScapula...you are a beautiful person. Fantastic job and I hope the author takes your advice as I thought it was beyond brilliant. Ummmm, any chance of YOU writing a letter?

 

[doc20]

Does anyone see how this DNP's will add to the already strained medical system. What happens when a guy gets a mole, obvisously cannot get a dermatologist appointment , so runs to the local DNP office around the corner that might well be sitting at the local walmart near the produce aisle, gets looked by DNP who charges 100$ to medicaid/medicare/insurance and then refers back to dermatologist since its out of their scope of practice.
We as doctors need to forget our egos and worry about patients and the overall health of our already broken medical system. adding another layers of midlevels who will eat up extra medical dollars is not helping anyone if they can only provide half services we doctors are trained to provide.
someone should do the study at much its going to end up costing to nation if there are this more mid level providers opening up their doors at every corner only to refer them back to actual doctors.

 

[FutureDoc4]

Agreed about wingedscapula writing the letter.

 

[Rabbit Hole]

I just had to comment on your editing of the letter written. WingedScapula...you are a beautiful person. Fantastic job and I hope the author takes your advice as I thought it was beyond brilliant. Ummmm, any chance of YOU writing a letter?

Any chance of anyone editing it with WS's suggestions? I'll post up the unedited version with WS's comments for now.. I'll replace it with a new version once somebody works on it.

Oh, and bluealiendoctor sooooo want's to make out with WS

 

[Winged Scapula]

At the risk of being flamed.
I have done a 4-week derm rotation in medical school and have a cousin in derm so I feel like I am somewhat educated to speak on this issue. 80% of cases that the regular dermatologist (medical) sees is something that anybody with an high school education can treat honestly.
Basically, its like this. If it is a rash, scrape it for fungus. If scrape positive, treat with anti-fungals. If scrape negative, treat with steroids. The exceptions to such cases, might be a scabies case, but they have a much different pattern than most other rashes and can be scraped and added to mineral oil or something like that and put under a microscope.
You might see an occasional acne, but acne has clear protocols for treatment.
To be honest, I could not believe that such a field was attracting "the brightest" medical students. What a waste 99% of medical school was for such doctors.
There is no reason that NP can't treat such cases. Anybody with half a brain could treat such cases. They are not life threatening and very simple. It would save the patient time and the healthcare system money (assuming that NP's get billed less than MD's which should definitely be the case).
Doing skin biopsies is such a joke that they even had us medical students doing them at the end of our 4 weeks.

The other ~20% of cases (changing moles, skin cancers, unusual rashes), they should refer out to the MD dermatologists. I am sure this would also make the dermatology cases much more interesting by removing all of the boring garbage.
And don't bring the melanoma argument. Melanoma is very small, small piece of the pie. And they should refer such a case to the MD anyway.

You guys should start being altruistic (isnt that the reason we came to medical school in the first place) and caring about patient care and access to medical care instead of yourselves.

Resneck JS Jr, Lipton S, Pletcher MJ. Short wait times for patients seeking cosmetic botulinum toxin appointments with dermatologists. J Am Acad Dermatol. 2007 Dec;57(6):985-9. Epub 2007 Aug 27.

Resneck JS Jr, Isenstein A, Kimball AB. Few Medicaid and uninsured patients are accessing dermatologists. J Am Acad Dermatol. 2006 Dec;55(6):1084-8. Epub 2006 Sep 6.

Tsang MW, Resneck JS Jr. Even patients with changing moles face long dermatology appointment wait-times: a study of simulated patient calls to dermatologists. J Am Acad Dermatol. 2006 Jul;55(1):54-8. Epub 2006 May 6.

Resneck J Jr, Pletcher MJ, Lozano N. Medicare, Medicaid, and access to dermatologists: the effect of patient insurance on appointment access and wait times. J Am Acad Dermatol. 2004 Jan;50(1):85-92.

What you're failing to recognize is the nuance, breadth and depth of skill that medical school and residency provide.

Many tasks in medicine are protocol driven and can be done at some basic level by anyone with enough training and experience. My medical assistant and the radiology techs at the hospital have seen enough cancers that they can recognize it on a mammogram or sonogram; does that mean they should start diagnosing and treating them? Does it mean that they are always right? Hell, I can read breast imaging but that doesn't make me anywhere near qualified to be a radiologist; I know what a malignancy looks like under the microscope but I would be a very poor pathologist. That recognition of mine is *one* reason why I get a little miffed when a patient comes with a radiology report or personal communication with a radiologist recommending operation "X". I don't try and step outside my scope of practice, nor should anyone else.

The "fact" that 80% of derm/FM/insert specialty X can be done (at some level) by someone without a medical degree doesn't meant that it should. Until you work closer with a few of these APNs, you will fail to see that not only do they NOT refer patients when they should, but they give patients false information and treatments, some which may impact survival. Just talk to my patient with an SCC of the chest who was treated for months by her NP with hydrocortisone cream for her "eczema". We've all got these stories. Things get complex and all of sudden that expensive medical degree and crappy residency start to look pretty good. I can't wait for the day when these DNPs start paying a 6 figure number for malpractice (because they'll start being sued just like physicians) and start whining about it. Currently in Arizona, I pay 60 times what NPs pay for malpractice per year. If they start doing my job (and let's not forget that there are non-surgeons doing surgery and scopes elsewhere), then they better man up to the legal responsibility.

Finally, you may have told that age old lie that you "wanted to help people" to get into medical school but most of us had other motives. For me, it was a second career, something I found intellectually interesting and challenging, a chance to do something that few people can and do. I sacrified my youth, my health, and my relationships in pursuit of this career and if they want to be a doctor then they need to do the same. In the words of the 20 year old in my office this week when I inquired as to why she didn't go to medical school to be an anesthesiologist instead of her stated goal to be a CRNA, "oh, I don't want to spend that much time in school or learn 'all that stuff'. I can make a lot of money and not work as hard as a doctor but still do the same things." 🙄 I'm happy that my healthcare practitioners worked their asses off and didn't have the same attitude.

 

[jp104]

Some posts on here are written in a complex and confusing manner. So I wanted to provide a translation.


I am about to make statements which I know will be inflammatory but I want to see what sort of rise I can get out of people... It's why I created the account.


At this point in my life I no longer have anything else to learn about dermatology.


I have a very low opinion of the intelligence of dermatologists... including my cousin. He gave me lots of wedgies when we were younger.


I think I read this on a t-shirt.


Dermatology textbooks are very short because they only need 4 pages. Page 1 is fungal rashes, page 2 is non-fungal rashes, and page 3 is scabies. The fourth page had the name of the liquid you add to your scrapings but my copy of the book was missing that page.


Fortunately there is only one way to treat these skin problems and only one option for each kind of medication. All patients respond the same way to that one medication.


I on the other hand absorbed 100% of the information in school and will use it all on a daily basis. As evidenced by my deep understanding of derm.


Do you see my subtle backhanded compliment here?


Nobody ever died from a problem that originated in the skin.


I fully understand the risks of doing these procedures and I know that there are no possible complications from them.


Unlike you suckers, I plan on providing my services for free after I graduate. Because that's what really matters.


I did a literature search for articles by my hero Dr. Resneck. I have a poster of him on the wall in my room, next to my bed. He's so dreamy.

Loved the subtitles!

 

[Winged Scapula]

Oh and BTW, "jack shepherd", it is a violation of the SDN TOS you signed when you registered to create a duplicate account.

Since your primary account appears to be applying to Derm and/or PRS, I'll be sure to alert the authorities of your lack of respect for your future field and that you're ok with DNPs taking over. I'm sure they'll be pleased. 🙄

 

[medicinesux]

I hereby declare that we are officially under attack by NP's. I would equate that disturbing video detailing the start of a "Derm Residency Program" to the storming of the Bastille or the Attack on Pearl Harbor. There are now nearly 300 NP programs open or in the planning stages (versus 125 med schools). Furthermore, NP's have been pushing their realm of practice into fields that would have been inconceivable just five years ago. Physicians once and for all need to come together and assert themselves against this hijacking of our profession that we all worked so hard for! Call and write your legislators. Email your state health dept and medical societies. Send a link to this thread to all your classmates and coresidents. Tweet, blog, make a video, start a Facebook group....be proactive and get the word out. I, too, fully endorse drafting a letter and would strongly recommend making it a sticky since this issue has struck such a nerve among so many of us here on SDN this week. We can look at this letter as our "Declaration of Independence" from any further encroachment and decay in the medical field.

 

[Winged Scapula]

Oh, and bluealiendoctor sooooo want's to make out with WS

😛

Obviously you haven't been privy to some of the disagreements bluealien and I have had in the past.

 

[Rabbit Hole]

I realize I'm the lone voice as a nurse here, but I still think this is a minority of nurses who truly believe they are equal to physicians. Why they haven't been stomped down before things got to this level, I just don't understand.

I also fail to understand where these practitioners are getting patients. I guess I live on some sort of parallel universe, but in my mind, patients still want to see physicians, not noctors.

The whole DNP crap was the major reason I stopped the nurse-practitioner path I was on. That, and realizing I didn't want that level of responsibility with what I felt was not enough education. My job is difficult enough as it is, thanks all the same.

They are getting patients by convincing them that they are experts equal to physicians - using the media to propagate this idea. See my post #182 on the previous page.

(BTW, I really liked your previous avatar!)

 

[Rabbit Hole]

😛

Obviously you haven't been privy to some of the disagreements bluealien and I have had in the past.

I wasn't aware.. makes it even funnier!

 

[deleted87716]

I'm not advocating the poor me stance ... I think that groups that represent physician interest should argue physician interest

Again, it can't be about us. It has to be about patients.

I think the general public should know that they could be seeing a nurse who introduces themselves as a doctor, and that their training is no where near docs, so ... be aware and if you aren't happy about this, let's do something.

That's fine. That concerns what's best for patients, not what's best for doctors.

Plus, what do you recommend Blue??? You seem to be shooting everything down, and kind of taking the 'this will bite them in the ass/let em try it/it's just a small minority' stance. This hasn't worked in the past, and it seems like the norm that gets physicians into the muck in the first place.

What do you recommend???

The fact that I'm not wetting myself like some of you doesn't mean that I'm not doing anything. You'll just have to take my word for it. 😉

 

[mig26x]

this derm program is of major concern, this is only the tip of the iceberg. The start of the video is scary. If you listen to the start of the video you think you are listening to the PD of the derm residency program FOR PHYSICIANS of that hospital.

FReaking scary stuff.

 

[Winged Scapula]

Today I wrote to AAD and USF's PD for the MEDICAL residency in Dermatology about this issue - Dr. Neil Fenske.

Tomorrow my goal is the AMA and the State of Florida BOM. Is there a society for Derm residents? They should be all over this.

Further investigation also reveals that the dermatologist next door is faculty for a local AOCD derm residency. I might have to have a chat with him about this.

 

[Zap Rowsdower]

I want to thank you. I was really on the fence about this, but I now realize for sure that with colleagues like you out there we have already lost this battle. (This has NOTHING to do with patient care, this has all to do with people (DNP) trying to get "their piece of the pie" and not even doing the work everyone else does to get it)

So, I have two options, leave medicine or play the system and take advantage of you and all my other "altruistic" colleagues that want to work for 50K a year and drive a 20 year old car, while paying off 200K loans. But, I am glad to see you reaffirmed my belief that medicine is bringing in people dumber than ever to fill in the void of medical school seats.

You are not entitled to jack ****. If someone with less training comes along and is able to provide the same service with the same outcomes (or better) as you, then the patients should make the choice who they want to see. Once again, the incentives for patients would be to see a provider who offers an excellent service at a lower price. This is called competition and free market principles, by God it works (*Note, I'm not saying DNP's = physicians, it would take many years for academic studies to determine proper outcomes). It would be ideal if our healthcare industry operated in a free market. Not sure why DNP's want equal medicare reimbursements, kinda defeats the purpose of bringing costs down (albeit minimally).

FutureDoc: No one forced you into medicine. No one forced you to dish out 200k in loans. Medicine has always rapidly changed, and there should be no guarantees. There are no guarantees for law graduates, who have debt just as high, if not higher than medical students. There are no guarantees a teacher will find a job (one that starts at what, 30k?) after being 60k in debt following undergrad. These people took a risk, and so did you. There should be no guarantees in life. The notion of being entitled to anything is what drove this country to shambles. You talk about "playing the system." Again, no one is forcing you to play the system and make 50k. Do your residency and go cash only. If you're services prove to be that much better than DNP's, patients will flock to your practice and you will ultimately make more money than you would have under the safety net of Big Brother.

 

[FutureDoc4]

I don't feel entitled for jack ****. And I don't feel like anyone should be. Clearly, you are intelligent enough to understand that medicine is unfortunately not a free market (though, I agree with you that it should be). It is unfortunate because I will have to adapt to a model (to get the outcome I want) that likely involves me doing more paperwork and pencil pushing (managing multiple practices, increased patient loads, working with multiple mid-levels, decreased patient time etc), to maintain the income I desire (to payback loans etc) because my colleagues have set the bar low (again, not a free market). Again, this sucks but I will deal with it and I will do my best to help as many people I can in the process. However, your initial argument is very flawed... it is under the assumption that these providers can provide the SAME service when we all know there are not good studies showing +/- and unfortunately, people may get hurt in the process in determining those outcomes.

Comparing us to law graduates and others is a little ridic. Anyone with half a brain going into that field realizes its over saturated and unless you go to a T5-10 you will have problems finding a job. This is a NEW development in the healthcare world (when I happen to be in school). Again, in teaching you realize that starting right now is 30-40K (going in), and it is often difficult to find a job (lets be real though, the teachers have unions to protect their interests and have to undergo much less schooling than physicians in terms of compensation comparison). The real point is that these changes in healthcare and medicine education happened to occur pretty unforseeably (yes, you can argue we could see things coming about DNP but hindsight is always 20/20).

P.S. Your argument of "you are not entitled to jack ****" is just a knee jerk reaction to when **** goes bad and when people complain. How about analyzing the situation and saying.... well, you made a smart investment... **** happens... and you deal with it. Sorry, its just your attitude that pisses me off.

 

[Zap Rowsdower]

As Elle Woods in Legally Blonde said, "Wait, am I on glue?"

Shouldn't it be incumbent on the challengers to prove that they are as competent as physicians and can provide an equal service at a lower cost? Shouldn't they have to be the ones to make their own way and distinguish themselves? Haven't physicians already set the standard for others to meet? When did we go down some rabbit hole here where white is black and black is white?

I'm sorry if my post was not clear enough. I'm not equating DNP's=physicians. There needs to be lengthy academic studies to determine if DNP's can offer services with the same (or even better) outcomes as physicians in whatever the specialty is. If DNP's are able to PROVE THEMSELVES EQUAL TO PHYSICIANS, then I don't see why they can't compete with physicians.

I don't know, maybe I'm too idealistic. I just love free markets and competition. I think the problem everyone has is government determining that DNP's can do some of what a physician can do. In a free market, all physicians should feel confident and even arrogant that DNP's would challenge their craft. Instead, everyone is scared (and I have been too). I also think the big thing no one really wants to admit is money. Physicians have always looked to medical societies and congress to determine their salaries. AMA, working with congress to determine residency spots and reimbursement, thus maintaining physician incomes. Again I'm not saying physicians are overpaid, but who knows maybe in a free market system physicians would make more, or less than what the politicians and bean counters determine their worth.

**This could earn it's own thread, but student loans are a huge problem too. The fact that government backs all of our loans gives the schools no incentives to lower tuition, only to increase. Sure if student loans were abolished, only rich kids would be able to attend med school for a while. But the schools would eventually be forced to lower tuition, and that would be great for us. It would release some of the financial stress that students feel the moment they start school. Peter Schiff (spelling?) wrote a great article on this. He's the guy who predicted the housing bubble and the economic meltdown years in advance, and all the talking heads on CNBC and Fox Business laughed at him.