Hi, I have seen this DNP thing or whatever it's called. And on the nurse website, someone posted about there being so much success with Nurse Practioners and CRNAs that they should start pushing towards Nurses moving into other specialties of medicine that Doctors usually do. The post that I was reading was accused of being a troll from this very site but he spoke of nurses being allowed to perform surgery in some places and that others should be able to do so also after completing some further training. I think there is a position called an RFNA or something along those lines that works in the OR as an assistant if i'm not mistaken and he was suggesting that those people would not need to learn much in order to challenge surgeons in their skills. My question to you guys is how far you think nurses will go in what they are legally allowed to do. Also, do you think that this is right or wrong because Doctors are usually the ones doing these things. I am not a doctor but will be one someday and it seems that if someone wants to do what a doctor does they should go to school for that, not try to get in through the backdoor. What are your opinions?
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Why is that?My opinion is that you made a mistake posting on SDN
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deleted50478
Obviously doctors know that doctors should practice medicine and nurses should practice nursing.
Your 'mistake' is acting as if there is a sensible discussion that is possible on this issue. Of course doctors should practice medicine. Of course architects or nurses who want to practice medicine should go to medical school. We get lots of nurses who post here. They want to redefine nursing, gain the right to practice medicine through lobbying/legislation, or create "doctoral" nursing degrees that don't provide a doctoral level of education in anything but name rather than gaining the right to practice medicine through education in medical school.
You can't argue with these people because they pretend nursing education is medical education and they measure education as a length of time rather than as a depth of knowledge. Education isn't a unit of time! A year of kindergarden < DNP program < a year of high-school < a year of nursing school <<< a year of medical school. Not only is the amount of education occuring in a year dramatically different, but the purpose/focus is different too. Even if the amount learned was equal, which it isn't, what is learned is different, even if the course title sounds the same.
This discussion has taken place countless times on SDN and there is little more to add. I just gave you my 2 cents because I don't mind repeating myself and I don't think you're a troll. You can find this stuff discussed ad nauseum on past threads.
Points well taken, but I still would like to know how far people think this will go. If someone is considering a certain career and there is a chance of that career being threatened by another group of people, then that should be taken into account.
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Not very far. There is a vast difference between the skill level of a physician and a nurse. There is also a vast difference between the cognitive ability of a physician versus a nurse. Anybody who gets very deep into medicine and begins to understand its inherent complexities will understand that. You're not going to see a nurse handling a complex situation, medical or surgical. Trust me -there are much greater problems in the field of medicine right now than competition with nurses. Most of us are more worried about how the hell we're going to make a living when the government starts artificially deflating our reimbursement.
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How far what will go the DNP? Many careers are threatened by others so what? I dont agree with the DNP and think its another ill-thought out plan. In addition to the Ph.D., nursing has had a doctorate of nursing science (D.N.Sc) and a nursing doctorate of nursing (N.D.). I guess they fell off the map somewhere.
I think mid-levels should be mid-levels and a masters is enough for that. PAs and NPs will be around forever; I just hate that the plan is to require a DNP for nurses in a few years.
Cognitive ability? I thought everyone had equal cognitive ability unless they were learning disabled.
Blanket statement. Ive handled a few complex cases in my time mainly because one doc didnt want to come and tried to sluff off on another unwilling soul all the while my patient is crashing. Yep, I was forced to practice medicine.
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"Cognitive ability?" I thought everyone had equal cognitive ability unless they were learning disabled.
Blanket statement. I've handled a few complex cases in my time…mainly because one doc didn't want to come and tried to sluff off on another unwilling soul…all the while my patient is crashing. Yep, I was forced to practice medicine.
I get so tired of hearing this nonsense. No offense to nurses, but the standards of admission at nursing schools are lower than medical schools. Period. End of story. Getting through nursing school is easier than getting through medical school and residency. Period. End of story. Anybody who believes any differently is in Wonderland with Alice. Same thing for anybody who thinks a nurse can handle a patient like a physician can. The extra education and rigor we endure is not useless, you know? It serves a purpose. Nurses are a very important part of the healthcare team, but they are not a replacement for physicians any more than a technician is a replacement for a pharmacist.
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All the above is true, however, (possibly due to your fatigued brain being able to soak of only a fraction of what is presented to you in medical school), you did not understand that your statement, "There is also a vast difference between the cognitive ability of a physician versus a nurse" is not true. My cognitive ability (since neither of us seems to be cognitively impaired) is equal to yours no matter what our job descriptions are. You however, have more knowledge in a certain area than I do. Let's reword your statement to say, "There is a vast difference in the knowledge base of a physician versus a nurse."
I don't care to practice medicine but as I said before, I have been "forced to keep a patient alive." Luckily, all physicians have written orders to cover my butt... and theirs. One even called me at home...and woke me up...to thank me. That was ok, I guess since nurses are always waking up docs.
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deleted50478
All the above is true, however, (possibly due to your fatigued brain being able to soak of only a fraction of what is presented to you in medical school), you did not understand that your statement, "There is also a vast difference between the cognitive ability of a physician versus a nurse" is not true. My cognitive ability (since neither of us seems to be cognitively impaired) is equal to yours no matter what our job descriptions are. You however, have more knowledge in a certain area than I do. Let's reword your statement to say, "There is a vast difference in the knowledge base of a physician versus a nurse."
I don't care to practice medicine but as I said before, I have been "forced to keep a patient alive." Luckily, all physicians have written orders to cover my butt... and theirs. One even called me at home...and woke me up...to thank me. That was ok, I guess since nurses are always waking up docs.
I think that what he is saying is that it is fair to assume that the average doctor's IQ is higher than the average nurse's IQ. There are very bright nurses who could practice medicine if they went to medical school, but most nurses could never get into medical school in the first place. Most nurses think that the difference between doctors and nurses is just the school, but there is an underlying difference in cognitive ability, IQ, or whatever you want to call it in addition to the difference in knowledge base from different levels of education. Sure there is overlap, but the basic pattern is still there. If nursing school became extremely competitive, then maybe they'd be equal or better than doctors, but that just isn't the case.
I don't want to argue about this. I'm not comparing individuals, just the overall groups. You keep pretending not to understand what he is saying, but you must know it to be true.
It's like you are saying there's no difference in athletic ability between high school basketball players and NBA players. Of course there is a difference because even though high school teams are selective for athletic ability, NBA teams are far more selective. There are some high school basketball players who could, and will, play in the NBA, but most couldn't. Lots of the players who think they are good enough for the NBA aren't.
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What was meant by the bolded text?
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I am referring to all the antagonistic forces that exist toward docs today. Mid-levels want expanded practice rights and, in many cases, outright independent practice rights. Insurance companies and the government want to decrease physician reimbursement rates and squeeze every penny out of the doc's pocket that they can, so they can put it back in their own pocket - not that it's going to save the patient any money. Increasingly, it seems like even the public harbors views of docs as greedy, arrogant, and deserving of getting kicked off the hill a bit. Just the other day I had someone tell me that his view of docs is that "they're all scumbags." And, this was an educated, reasonable person (although he seemed a bit jealous). I just don't understand why our co-workers, patients, and the public at large can't respect us a bit more. We work hard, we assume a lot of risk, and we deserve what we get in return (or used to get). We are not as easily replaceable as some on these forums would suggest. And, if the quality of medical talent decreases due to government changes being proposed right now, we will all be worse off to have lower quality docs. Bright students will go where the money is. If it isn't in medicine, they'll go elsewhere. Basic human nature.
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I won't belabor the point...for too long...but there is an important point to be made here. When RGMSU said, There is a vast difference between the skill level of a physician and a nurse. There is also a vast difference between the cognitive ability of a physician versus a nurse, he was correct in the first sentence and incorrect in the 2nd sentence.
Now you're saying that the average doctor's IQ is higher than the average nurse, and that most nurses could never get into medical school in the first place. Do you see a problem with your comment? My teacher wife, an expert in brain-based learning, does.
No, I'm mostly having fun but did expect more "knowledge" from those professed to be way up there in cognitive ability.
Sorry, OP. Now back on track.
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I honestly don't know why everybody argues about this so much. Let people see whatever provider they want to. If a patient wants to see a nurse instead of a doc, and they're happy with the results they get - great. What the hell does that have to do with an MD? Let the patients who want to see an MD come and see one. My guess is the waiting line will be longer than at the DNP's door.
If I may interject as a physician. It is critical for the successful physician, no matter in what type of practice environment, to be respectful of nurses and their abilities. If you are antagonistic, you will be killed career-wise. I have seen this occur. be careful.
Nurses know when a patient is sick. And when they get concerned, as a doc, you better listen and apply some attention to that patient. Nurses often based on educational emphasis do not have a firm foundation in pathophysiology and even anatomy at times, and so there is a more in depth level of understanding that a physician SHOULD apply in patient care, but that doesn't always occur.
The issue here is largely standards of training at schools. Medical school standards at the school level tend to be more even, while nursing schools are a bit all over the map.
But a good nurse is worth their weight in gold and then some. Remember I said this.
One last thing - when I used to round on the weekends- the first place I would go would be to the nurses station - and my first question was " Who is sick?"
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deleted50478
If it is a choice, then sure. If people are forced to see a lesser 'provider' than they might because of cost, then you are undermining the medical profession and it becomes a race to the bottom. There is no obvious lower limit of education that would not produce a cheaper 'provider'. For most people getting routine care, it wouldn't make any difference if they went to a FP, NP, PA, or auto mechanic because they have something self-limited anyway. At some point and for some patients, that will be detrimental or deadly.
The general population isn't knowledgable enough to weigh the risks and benefits of seeing doctors vs less well educated people. I'd be happy to send my parents to a nurse practitioner or PA who knows when he's in over his head and gets a consult. There is wide variability in how aware people are of what they don't know though.
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I don't disagree with any of that. Nowhere in my posts did I say anything antagonistic toward nurses. I just get tired of hearing NPs and PAs get on these forums say they can replace physicians. They can't. They can try to, but the public won't buy it anyway. And, no, it isn't just about school standards. Nursing schools would have to increase their standards about 500% to match the level of rigor of an average American medical school. As a physician, if you remember medical school, you should definitely know that.
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You know as well as I do this is precisely what is about to happen. There aren't enough physicians to see everyone about to be enrolled on Uncle Sam's new programs. And, if you think physicians are going to treat everybody for free like Uncle Sam says, you're gonna get a big shock, cuz they won't.
Have to disagree with you here completely. You grossly oversimplify general medicine with this statement. We just had a genetics panel yesterday with the mother of a 1 yr old infant that died. Took the girl to a pediatrician on a Friday afternoon. Case presented like a relatively routine illness (vomiting and whatnot). Pediatrician debated whether to hospitalize. Really didn't have a clue what was going on. Chose not to hospitalize. By 4am the next morning, one year old girl was dead. Rare genetic disorder. If the MD couldn't stop this from happening, I seriously doubt an auto mechanic could. And, I wouldn't take my car to an MD either. Those of us who are physicians/future physicians need to learn to stick together across specialty lines. There's way too much disrespecting of family medicine that goes on within the ranks of physicians. We should all have the foresight to see that if any physician specialty is weakened, it hurts all physicians ultimately. And, frankly, from the looks of it, it appears that family medicine may fair better than many specialties out of the new healthcare proposals. And mid-level encroachment is in no way limited to general medicine. NPs and PAs are already discovering that they can make more money in other fields, and they're going where the money is.
Oh, yes they are. If you give people the choice of seeing an MD over anyone else, they will choose the MD about 99.9999% of the time because of the recognizable status of the degree.
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deleted50478
That's an argument to expand medical school. Not to expand midlevel training.
You aren't disagreeing with me. I said, "For most people getting routine care, it wouldn't make any difference if they went to a FP, NP, PA, or auto mechanic because they have something self-limited anyway. At some point and for some patients, that will be detrimental or deadly."
You have just pointed out one of the 'some patients' that physicians could make a difference for (though unfortunately one didn't in that case). I'm not arguing against primary physicians. I'm arguing in their favor. If you study outcomes, there will be little difference between providers because most people in a primary care clinic aren't all that sick or have straightforward problems. The overkill in having a physician see all these patients is worthwhile because he will be more likely to help the occasional patient who is decompensating or with an unusual diagnosis. The value of primary care physicians is not in routine management of chronic disease, but in keeping contact with patients so that serious problems get picked up early.
If you give them a financial incentive to see someone less trained than an MD, they will do that a significant % of the time. If you put a clinic in Walmart, people will see whoever staffs it. If you let someone see an NP tomorrow vs an MD in 2 weeks, many will see the NP. Most of these people will be just fine with lesser trained providers. The problem is that the patients don't know when they need to see a doctor and the mid-levels can't always be counted on to realize they need to send some patients up the ladder.
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deleted50478
No question that nurses are a vital part of medical care when practicing nursing.
'Advanced practice nursing' aka practice of medicine with less education is another matter entirely. Which isn't to say that they aren't valuable too, but there seems to be a trend toward less training and worse care. If we aren't going to maintain our standards for the practice of medicine, we might as well just let doctors take apprentices and train them in the office. If doctors are more selective than nursing school, then they'll wind up better trained than APNs and they'll be even cheaper to produce, which is apparently more important than quality.
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I hate to sound crude, but not the smart people with good jobs who have the money to pay me. Those are the ones I would prefer to see anyway, no? You will see a division develop based on economic lines in medicine, which is really already the case anyway. Rich people will continue to see MDs, and MDs will work out a way to get paid more for it. Poor people will see anybody who's available, and the mid-levels will inevitably get paid less. That's the way it's always been, and one guy who comes along and lands in the White House won't change the activities of millions of people ad infinitum. If he thinks he will succeed in duping thousands of smart docs into working for free just because he and Pelosi say so, he'll get a big surprise, cuz we ain't going for it. I'd love to see him replace all of us with the snap of his fingers.
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"If you let someone see an NP tomorrow vs an MD in 2 weeks, many will see the NP."
What if they get so see an MD tomorrow and pay twice or three times as much in cash up-front for it? It's called boutique family practice, and it happens every day.
What if they get so see an MD tomorrow and pay twice or three times as much in cash up-front for it? It's called boutique family practice, and it happens every day.
Things change, well nothing is permanent but change. Now a days certain professions needs to improve other things that are beyond their previous knowledge can't give out an opinion about this for now for I'm still confused if it is for good or for bad.
