Possible threat to FP

[exPCM]

As the shortage of primary-care physicians mounts, the nursing profession is offering a possible solution: the "doctor nurse."

More than 200 nursing schools have established or plan to launch doctorate of nursing practice programs to equip graduates with skills the schools say are equivalent to primary-care physicians. The two-year programs, including a one-year residency, create a "hybrid practitioner" with more skills, knowledge and training than a nurse practitioner with a master's degree, says Mary Mundinger, dean of New York's Columbia University School of Nursing. She says DNPs are being trained to have more focus than doctors on coordinating care among many specialists and health-care settings.
To establish a national standard for doctors of nursing practice, the non-profit Council for the Advancement of Comprehensive Care plans to announce Wednesday that the National Board of Medical Examiners has agreed to develop a voluntary DNP certification exam based on the same test physicians take to qualify for a medical license. The board will begin administering the exam this fall. By 2015, the American Association of Colleges of Nursing aims to make the doctoral degree the standard for all new advanced practice nurses, including nurse practitioners.

But some physician groups warn that blurring the line between doctors and nurses will confuse patients and jeopardize care. Nurses with doctorates use DrNP after their name, and can also use the designation Dr. as a title.
http://online.wsj.com/public/article_print/SB120710036831882059.html

 

[deleted87716]

That article was from April of last year, dude.

There have only been roughly a zillion thread in various forums on SDN about this subject already.

Where have you been, under a rock?

 

[mx_599]

That article was from April of last year, dude.

There have only been roughly a zillion thread in various forums on SDN about this subject already.

Where have you been, under a rock?

do you think this will have much an impact on fam med docs? decrease salary at all?

 

[deleted87716]

do you think this will have much an impact on fam med docs? decrease salary at all?

No.

Read the forum. It's all there.

 

[secretwave101]

Moving to Clinicians forum. Recommend to OP to search threads prior to posting on news over a year old. LOTS of threads and digits spent on this topic.
😳

 

[zenman]

Moving to Clinicians forum. Recommend to OP to search threads prior to posting on news over a year old. LOTS of threads and digits spent on this topic.
😳

👍...even Mundinger is hiding under a rock these days...

 

[tony montana]

👍...even Mundinger is hiding under a rock these days...

Why would she be hiding under a rock?

 

[zenman]

Haven't heard anything from or about her lately.

 

[RGMSU]

Mundinger's ideas may not have been as popular as she hoped. No threat to FP.

 

[DNPDoctor]

Not this again... It's old news.

Most NP don't support the DNP = equivalent to physician talk

FYI, for the new folks out there, Mundinger has resigned.

 

[deleted87716]

Mundinger's ideas may not have been as popular as she hoped. No threat to FP.

When you consider that the entire DNP "movement" arose out of her own inferiority complex, that's not too surprising.

Mary Mundinger, dean of the Columbia University School of Nursing, was just a young nurse when she learned a lesson in medical hierarchy. She was working in an intensive care unit when a patient seemed to take a turn for the worse in the wee hours. "He didn't look right to me," recalls Mundinger, 61. "So I called his physician." Instead of advice she got a dressing down. The doctor, irate because he thought he had been needlessly awakened, contemptuously dismissed her observations. Mundinger called another doctor who confirmed her fears and treated the patient. But the disillusionment lingered. "It was," she says, "a humiliating experience."

Over the years, Mundinger channeled her outrage into a quest to win greater respect for nurses.

Source: http://www.people.com/people/archive/article/0,,20126345,00.html

 

[fab4fan]

👍...even Mundinger is hiding under a rock these days...

Probably the same one bin Laden is hiding under.

 

[deleted6669]

Probably the same one bin Laden is hiding under.

I've heard they are actually the same person....if you can't destroy america with bombs,try direct entry dnp's.....🙂

 

[fab4fan]

I've heard they are actually the same person....if you can't destroy america with bombs,try direct entry dnp's.....🙂

Nah. Bin Laden has better looking legs.

 

[core0]

Nah. Bin Laden has better looking legs.

And didn't sell out to United Healthcare.

 

[julie walker]

sighs.....what a bag of ignorance!

 

[fab4fan]

sighs.....what a bag of ignorance!

Don't talk about yourself that way. It's not nice.

 

[julie walker]

Here she goes again...Stop! I will report you this time..

 

[deleted87716]

Here she goes again...Stop! I will report you this time..

 

[Siggy]

here she goes again...stop! hammer time!

ftfy

 

[Simann]

Good read!

However, I do not know how this will pan out as the current "more viable" option between RN and MD is the P.A.

 

[LobotomyPlzThx]

What annoys me most about most doctors (M.D.s/D.O.s, aka "real doctors") is that they can be so arrogant and insecure. What is the percentage of med students/residents that plan on going into primary care in rural settings? It's not a double digit number. Medical Doctors have long been hailed as the only people with the status to get the job done. The only problem is that inner-city and rural environments aren't being served by medical doctors who have their yacht owner's club dues coming up. Traditional doctors aren't getting the job done everywhere, so why do you have a problem with letting the mid-levels who actually care about learning medicine and helping people have a crack at it?

 

[Paseo Del Norte]

Oh boy, here we go again...

 

[Starpower]

What annoys me most about most doctors (M.D.s/D.O.s, aka "real doctors") is that they can be so arrogant and insecure. What is the percentage of med students/residents that plan on going into primary care in rural settings? It's not a double digit number. Medical Doctors have long been hailed as the only people with the status to get the job done. The only problem is that inner-city and rural environments aren't being served by medical doctors who have their yacht owner's club dues coming up. Traditional doctors aren't getting the job done everywhere, so why do you have a problem with letting the mid-levels who actually care about learning medicine and helping people have a crack at it?

Unfortunately, more and more PAs are heading into specialty practice as well ... that's where the money is. I'll be starting my Peds rotation this coming Monday and am really excited about it ... I've always loved working with kids. So I thought, 'hmmm, I wonder', and looked up the salary. It's the lowest.

I'm sure that many Doctors and PAs WANT to work in family practice. But the real-life situation is that just as many have massive loans to pay off, I know I do. I'll be close to 200K in debt when I graduate. It will take me so much longer to pay that off making 64K (ack, that's reportedly Peds), then it would at 100K or higher (if I'm in an ER or other specialty). Even tho many PA programs try and direct towards rural and underserved practice, it happens a lot less than you would think (unless the NHSC scholarship is involved).

Not to say that I don't think your point is completely invalid. NPs, from what I know, are usually directed towards family practice and peds, but I also know that many aren't receiving the salary or respect that they deserve. I see a NP as my primary care practitioner, she's worked in this office for 12 years. A young resident was working with her and had the nerve to say to someone on the phone with her in earshot, "yea, I'm flying solo today". She also makes less than 80K, which is simply ridiculous considering the work she does and the length of time she has done it. I urged her to find another place of employment.

Where is the answer? Hopefully the new government bill will help. I know they're planning on increasing funding for inner city primary care centers. Hopefully they'll increase the salaries for the people who are going to have to work in them.

And just for the record, I know a great many Doctors who I've seen as a patient and worked with, who are anything but arrogant and insecure. The other kind are out there, but I don't think they're the majority. Maybe the younger grads. I have to ask tho ... why did you post these thoughts of yours in this post? Was there a problem with something someone said? It seemed to be a conversation about the DNP, not about MD vs NP or working in rural areas. Unless you're approaching it from a DNP=more primary care providers standpoint?

 

[secretwave101]

Why do you have a problem with letting the mid-levels who actually care about learning medicine and helping people have a crack at it?

They (we) don't. Mid-levels were supposed to help solve the primary care crisis.

For some reason, they are streaming for the exits...just like the docs started to a decade ago.

Crack all you want. Nobody's stopping you.

 

[Paseo Del Norte]

80K huh? Seems kinda overpaid to me.

Meh, I can pull an easy 80k by pimping my self out as a traveler to the highest bidder with a scant three years of education under my belt.

 

[Starpower]

80K huh? Seems kinda overpaid to me when you think about the fact that the resident was more educated (4 years undergrad + 4 years med school + residency), worked more hours on average, and is more productive.

I think you must have misread, she's seen patients there for 12 years ... doing the same work that a Doctor does (it's a primary care clinic). I would hardly call a resident "more productive" in such a situation (I've seen some residents make some pretty gnarly mistakes). In fact, I had to see a resident the time before last (my NP was unavailable), who noticed that my blood pressure reading was high. I found that odd, as I had been taking mine on my own in the ER where I had rotated and it had been fine. He still switched my BP meds to a higher dose, based on the readings. This last time, I noted my concern to my NP, which is when she noticed that they had been using a normal sized cuff on me ... I have large arms. She changed the cuff, my BP was quite good, and she adjusted my medication back down. Just one of the many ways that experience can help greatly. And no, she works there full time, very full time.

When it comes to 12 years of practice, she knows what she's doing. Which is the reason why I've continued to see her. $87K was actually the 2007 national average for a NP of her standing... she needs to find another job.

 

[Paseo Del Norte]

Just to keep perspective, I work with Intermediate EMT's who have 200 hours of total training that make 40k with benefits, so complaining about nurses specifically seems rather irrelevant as it seems many "less educated" people make more than resident physicians. Sound more like a resident physician problem than a nurse practitioner problem.

Why not advocate for change within your own profession?

 

[LobotomyPlzThx]

80K huh? Seems kinda overpaid to me when you think about the fact that the resident was more educated (4 years undergrad + 4 years med school + residency), worked more hours on average, and is more productive.

@Starpower: This is exactly the kind of ignorance that made me post what I did. This guy doesn't even get it. This thread (and many others I've seen) are all about "OMG NPs want to be called Dr.! They didn't go to Med school like I did! They didn't have to put in 80 hour weeks like I did! I sacrificed my prime years to a low-paying residency and debt-incurring med school, therefore, I should be the only one to be called 'doctor'!"

DNP is a doctoral degree. They have to write a thesis or dissertation. They did their hours, ergo, they deserve to be called "Doctor" just as a Ph.D. in clinical psychology deserves to be called "doctor."

Any experience PA's lack is made up for in the fact that they have physicians' help. Also, PA's do have the opportunity to pursue residency, in which case, little or no distinction is made between them and their M.D. counterparts.

What frustrates me most is the nerve of some of these M.D. graduates that only see dollar signs and power. It's like they get their jollies solely from saying, "I am more educated than everyone else." I was always led to believe that the point of being a clinician is not a matter of who's better, but rather healing patients. That doesn't seem to be the focus of these kinds of threads.

 

[deleted87716]

PA's do have the opportunity to pursue residency, in which case, little or no distinction is made between them and their M.D. counterparts.

Um...no.

 

[Starpower]

The NPs in our department do H + P and round on inpatients, something a MS4 does and well below the responsibility of a typical resident.

I can see where there this could apply, it all seems dependent on the situation. My resident preceptor on my surgical rotation was amazing, he was a complete and utter genius. He had the attendings coming at him from every angle during his presentations, he was so on the ball. But that's specialty based. He was ready to be a surgeon, something a NP will never do. I was speaking more of primary care/family practice. Tho I do imagine there are NPs in other rad onc places who do more than just H&Ps and rounding. I don't doubt you tho, because I know of NPs who only do similar duties in surgery.

I think that your viewpoint comes from your being a resident and from what you've seen as standard on your rad onc floors. If that's how NPs are utilized there where you are, then I can understand why you said what you did.

I still am rather surprised that you would consider $80K a high salary for a family practice NP of 12 years. It shows that you have a ways to go towards a better understanding of medical practice, no offense. And to be clear, THAT'S OKAY. It actually makes sense. I'm learning too, even tho I've worked in health care for years before starting PA school. It comes with life experience, seeing different environments and systems and how they work. One system or constitution isn't automatically going to be the same as another, it's one of the biggest lessons I'm continuing to learn. But let's not forget that NPs have the license to practice primary care independently, should they desire to.

 

[chimichanga]

Just to keep perspective, I work with Intermediate EMT's who have 200 hours of total training that make 40k with benefits, so complaining about nurses specifically seems rather irrelevant as it seems many "less educated" people make more than resident physicians. Sound more like a resident physician problem than a nurse practitioner problem.

Why not advocate for change within your own profession?

Exactly

 

[Paseo Del Norte]

@Starpower: This is exactly the kind of ignorance that made me post what I did. This guy doesn't even get it. This thread (and many others I've seen) are all about "OMG NPs want to be called Dr.!
It's slightly more complicated than that.



They didn't go to Med school like I did! They didn't have to put in 80 hour weeks like I did! I sacrificed my prime years to a low-paying residency and debt-incurring med school, therefore, I should be the only one to be called 'doctor'!"
In the clinical environment to prevent patient confusion, yes.


DNP is a doctoral degree. They have to write a thesis or dissertation. They did their hours, ergo, they deserve to be called "Doctor" just as a Ph.D. in clinical psychology deserves to be called "doctor."

Yes; however, DNP does not = MD.


Any experience PA's lack is made up for in the fact that they have physicians' help. Also, PA's do have the opportunity to pursue residency, in which case, little or no distinction is made between them and their M.D. counterparts.
I have to keep telling myself, "one face palm comment every 24 hours."


What frustrates me most is the nerve of some of these M.D. graduates that only see dollar signs and power. It's like they get their jollies solely from saying, "I am more educated than everyone else." I was always led to believe that the point of being a clinician is not a matter of who's better, but rather healing patients. That doesn't seem to be the focus of these kinds of threads.

It's not necessarily the focus of some of the DNP arguments. You think some of these nurses are interested in playing nice in the sand box?

 

[LobotomyPlzThx]

Um...no.

Ummmm... a simple google search could have saved you from looking like a pompous know-it-all.

Association of Postgraduate Physician Assistant Programs

Johns Hopkins P.A. residency.

Johns Hopkins Emergency Medicine P.A. Residency.

St. Joseph Mercy Cardiothoracic surgery Residency for PA's.

University of Iowa PA Residency programs.

Duke University Cardiothoracic surgery residency for PA's.

Just a couple of sites. I bet you're going to say you've never heard of Johns Hopkins or Duke, aren't you? Is it that necessary that nobody but DOCTORS get residency training? What do you care if other programs are out there to help care for your workload?

 

[deleted87716]

Ummmm... a simple google search could have saved you from looking like a pompous know-it-all.

Well, it certainly hasn't stopped you. 🙄

Despite the nomenclature, PA "residency" is nothing like MD residency, and it certainly doesn't make them indistinguishable from physicians, as you stated.

 

[deleted87716]

I have to keep telling myself, "one face palm comment every 24 hours."

I'll do it for you, then. 😉

 

[Starpower]

@Starpower: This is exactly the kind of ignorance that made me post what I did. This guy doesn't even get it. This thread (and many others I've seen) are all about "OMG NPs want to be called Dr.! They didn't go to Med school like I did! They didn't have to put in 80 hour weeks like I did! I sacrificed my prime years to a low-paying residency and debt-incurring med school, therefore, I should be the only one to be called 'doctor'!"

DNP is a doctoral degree. They have to write a thesis or dissertation. They did their hours, ergo, they deserve to be called "Doctor" just as a Ph.D. in clinical psychology deserves to be called "doctor."

I should tell you that I am not for the DNP. I would be if it were better constructed and better mandated, but it's not. Letting oneself be called "Doctor" in a clinical setting where people are interpreting the title to mean MEDICAL Doctor is misleading and dishonest, not to mention inaccurate.

Any experience PA's lack is made up for in the fact that they have physicians' help. Also, PA's do have the opportunity to pursue residency, in which case, little or no distinction is made between them and their M.D. counterparts.

Yea, no, not necessarily. If you're speaking of someone who worked as an ER tech for 10 years before going to PA school, and then did a post-PA program residency, I might be more inclined to agree with you. But I think "distinction" is probably what makes your sentence incorrect. To be fair, experience can play a huge key. Heck, just collaboration can play a huge part in patient care.

For example, on my ER rotation, I diagnosed a patient with pneumonia, based on my clinical assessment and the X-rays (sorry, 'radiographic films') ... my exact words, "but he has perihilar infiltrate". Both my supervising PA and MD said 'nope, simple viral flu'. The report came in the next morning, "XXXDISCREPANCY FOUND: PERIHILAR INFILTRATEXXX", I kid you not. Still, it could have just as easily been them on the other side of the situation ... it's so good to bounce things off of others sometimes.

It happened again another time, we had a patient who had eaten a tuna sandwich hours earlier, had immediately started vomiting (11 times), had had diarrhea, and a fever which had spiked to 101F but was now down to normal (the vomiting and diarrhea had subsided as well). I told him he had a simple case of food poisoning, that we'd start him on fluids for his dehydration, and send him home since any of the bugs we'd need to seriously worry about would still be causing him symptoms. AGAIN both the supervising PA and MD told me that ' no way does food poisoning ever present with fever'. So I went back and grabbed one of the large Emed references I brought in every day and showed them both, that indeed, depending on the organism, it can. I think I've gone totally off-topic now lol. Let's see, where were we.

Anyhow, it's all relative. Maybe the one MD during the food poisoning incident had a good excuse, because she was young. But the PA had worked there for 7 years, she really surprised me. As for the pneumonia, again, it could have just as easily been me who missed it. I'm sure I'll miss things in the future, that others (MD/PA/NP/nurse/tech) will help catch me on. That's what makes a team. Granted, I'll probably be less likely to make those sort of mistakes with the more education and experience I have. That's life. We all want to know it all, but we can't and don't and won't. But we can make sure that we know a hell of a lot, as much as we possibly can to do our jobs to care for others in the best way we can.

What frustrates me most is the nerve of some of these M.D. graduates that only see dollar signs and power.

You know tho, you'll find that everywhere in life. It usually has to do with the type of person the individual is more than anything.

It's like they get their jollies solely from saying, "I am more educated than everyone else."

Well, largely, they are. Don't ever forget that, because Doctors are one of your greatest assets. I can't be thankful enough for the Doctors who grabbed me and said, 'here, I want you to watch this' or 'here, I want you to do this' or even just gave me the answer to the patient who was post-cesarean pre-eclamptic with a BP thru the roof and a pulse lower than hell ... "hydralazine" (although I think there is newer recommended constitution now, whatever, it still works). Again, how someone handles themselves in life is probably their personality. I know some PAs who have only worked a couple of years who think they're God's gift to the Universe.

I was always led to believe that the point of being a clinician is not a matter of who's better, but rather healing patients.

You are 100% RIGHT. But does the DNP make a Medical Doctor? I thnk that was the point of the OP posting the article.

That doesn't seem to be the focus of these kinds of threads.

Eh, don't forget that this is a student-interactive forum. There are a lot of students on the PA forum who aren't so full of wisdom yet either.

 

[Starpower]

Ummmm... a simple google search could have saved you from looking like a pompous know-it-all.

Association of Postgraduate Physician Assistant Programs

Johns Hopkins P.A. residency.

Johns Hopkins Emergency Medicine P.A. Residency.

St. Joseph Mercy Cardiothoracic surgery Residency for PA's.

University of Iowa PA Residency programs.

Duke University Cardiothoracic surgery residency for PA's.

Just a couple of sites. I bet you're going to say you've never heard of Johns Hopkins or Duke, aren't you? Is it that necessary that nobody but DOCTORS get residency training? What do you care if other programs are out there to help care for your workload?

You're out of line. PA residency is nowhere the same as MD residency. It may be closer to in some cases, but it's still not there. For example, a PA surgical residency will basically ready the PA to First Assist. IN TIME, the surgeon will probably leave more cases to the PA to handle autonomously, but when a surgical resident graduates, they are a surgeon right away.

 

[LobotomyPlzThx]

Well, it certainly hasn't stopped you. 🙄

Despite the nomenclature, PA "residency" is nothing like MD residency, and it certainly doesn't make them indistinguishable from physicians, as you stated.

Really? Have you taken a Physician Assistant residency? I know several PA residents that went through rounds together with their M.D. Resident peers.

I never said that residency makes PA's "indistinguishable from physicians." PA's, although they have their own medical licenses, cannot practice medicine independently from physicians.

"Being indistinguishable from physicians" is a term you say a lot. It must be your biggest fear. If you're really afraid of not being "special" anymore, why don't you let the PA's and NP's be and go and pursue some fancy cardiothoracic surgery fellowship for the next seven years. You and the PA assisting you in surgery will both know that you're the boss. You did the time and you get all the credit in the world. That PA will be the one that has to swallow his pride and be satisfied with the knowledge that he isn't in it for the glory and still is a qualified practitioner according to state law. That PA will let you have your glory and status and still be ok with his or her work at the end of the day like a well-balanced individual that doesn't have an inferiority complex that needs to be compensated for with the title of "doctor."

 

[Starpower]

Are you really just a PA posing as a student, who has a sh*tty job somewhere?

 

[deleted87716]

"Being indistinguishable from physicians" is a term you say a lot.

Prove it. I don't even think I've said it twice.

 

[LobotomyPlzThx]

Are you really just a PA posing as a student, who has a sh*tty job somewhere?

No. Why would I do that? That makes absolutely no sense. But even if I was, I could be the greatest clinician in the world and snobby young doctors fresh out of medschool will think they're God's gift to humankind because they had a short two more years of college. Clinical experience and intelligence are what make a good practitioner. You only get so much of the former in med school as opposed to PA school, and the latter--talent and aptitude--are not taught anywhere. Even if I saved more lives than that PGY1 prick, nobody will ever look at me with any of the respect that he gets handed to him. And why? I chose a pre-PA path over a pre-med path because of the arrogance of a lot of doctors. Glory wasn't my concern--learning about medicine was. Now because apparently when I graduate I'll be lucky if I am given the opportunity to clean a supervising doctor's shoes with my toothbrush, I'm considering switching from a pre-PA path to a pre-McDonalds burger-flipping path. At least in that path everyone will look down on me and I won't have spent a hard six years and $125,000 studying to be a Physician assistant and be treated just as bad.

 

[LobotomyPlzThx]

Prove it. I don't even think I've said it twice.

You said, "it certainly doesn't make them indistinguishable from physicians, as you stated." Before I go scouring this forum for instances where you and your peers said those words verbatim or implied them, prove that I said it or implied it once. Or don't. I don't really care. Now you're just arguing for the sake of arguing, which is a waste of time.

 

[Paseo Del Norte]

Thanks for having my back Blue Dog, I am a strong willed dude, but I'm only human.

Lobotomy, you would not happen to go by the name of Tammy? Recently finished a lovely conversation on a similar thread with a TammyDNP.

 

[LobotomyPlzThx]

Thanks for having my back Blue Dog, I am a strong willed dude, but I'm only human.

Lobotomy, you would not happen to go by the name of Tammy? Recently finished a lovely conversation on a similar thread with a TammyDNP.

No, I go by the name of Ryan. I might seem like "TammyDNP" because you probably treated her like she was an undeserving fool too. Us wannabes tend to have a similar reaction when we're told by people like you that we're inferior human beings.

 

[Starpower]

I'm considering switching from a pre-PA path to a pre-McDonalds burger-flipping path.

Well, my very first job was at a Carl's Jr. (west coast chain, rules), and I had a great time. 🙂

 

[deleted87716]

I'm considering switching from a pre-PA path to a pre-McDonalds burger-flipping path.

I think that's a great idea.

 

[Paseo Del Norte]

No, I go by the name of Ryan. I might seem like "TammyDNP" because you probably treated her like she was an undeserving fool too. Us wannabes tend to have a similar reaction when we're told by people like you that we're inferior human beings.

Cool beans, I had to ask because the conversation was so similar. Don't worry about being treated like an inferior fool by old Ruckus Del Norte, I am about as inferior as RN's come. In fact, I'm one of those associate degree nurses. Truly an inferior provider.

So, now that we have that well established, I suspect we can continue to have a nice discussion based upon mutual respect.

 

[prairiedog]

You may choose to disagree but to me it's a joke that NP's get paid double what a resident does when a resident on the average is far better. the majority of attendings would pick a resident over an NP unless that NP works with the same physician for long periods which a resident cant do.

Did something change? I thought "we" pay residents salary via tax dollars? What the insitution pays NPs is secondary to ? productivity? The actual costs of a resident are more than just salary, at least as how I understand the process.

 

[WasntTrolling]

Cool beans, I had to ask because the conversation was so similar. Don't worry about being treated like an inferior fool by old Ruckus Del Norte, I am about as inferior as RN's come. In fact, I'm one of those associate degree nurses. Truly an inferior provider.

So, now that we have that well established, I suspect we can continue to have a nice discussion based upon mutual respect.

Apparently we can't do that because someone banned me for expressing my opinion. No profanity or harrassment on my part, no warning on the moderator's part. You all can have your petty arguments all to yourself. No one here treats midlevels with any kind of respect at all. No, we're "a threat" to you. Whatever. Ban this account too. Nobody here will care. I know I won't lose sleep over being banned by a community with a charter of paranoia and censorship.