The President's Bill NP=MD

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exPCM

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Although you may hear President Obama really helps out primary care specialties, you may change your mind after reading this. Some of you who used to think you are in a specialty, by virtue of your years of additional residency training beyond medical school, will soon be disabused of that quaint notion after you read this.

p461--"Authority to allow Nurse Practitioners and Physician assistants (consistent with state law) to be in charge of a patient centered medical home.'

This is a pilot program which establishes a new care model for "high need" beneficiaries. Meaning, the sickest of the sick. p462-4 describe responsibilities which could fall to NP and PA under this.

You'll like this next one.

p463

"The term 'primary care' means health care that is provided by a physician or nurse practitioner who practices in the field of family medicine, general internal medicine, geriatric medicine, or pediatric medicine."

Gee, I thought doctors practiced medicine, and nurses practiced nursing. Silly me!

Having relegated you docs in these specialties to the status of a nurse practitioner, the government creates a new specialty to take care of patients with chronic illnesses that need a doctor.

p463-4

"The term 'principal care' means integrated, accessible care that is provided by a physician who is a medical subspecialist that addresses the majority of the personal health care needs of patients with chronic conditions requiring the subspecialist's expertise, and for whom the subspecialist assumes care management. "

Who's this mean? Well, apparently not you primary care NP's, whoops, I mean primary care doctors in pediatrics, geriatrics, etc.

Having leveled the playing field between the practice of nursing and medicine, you might ask "Well then, why can't Nurse Practitioners supervise Physician Assistants?" Obama has an answer!

p480

"(3) Primary care practitioner defined--In this subsection the term primary care practitioner A) Means a physician or other health care practitioner (including a nurse practitioner) who specializes in family medicine, general internal medicine, geriatrics, or obstetrics and gynecology and...B) includes a physician's assistant who is under the supervision of a practitioner described under subparagraph A."

Lest you think state licensing laws will prevent this, think again. All the government has to do is require states to be compliant with Obamacare regulations to get federal money.

For you OB-GYNS who have labored under the delusion that your specialty isn't really, here's Obama putting your money where his mouth is.

p483

"Section 1304 Increased Reimburesement rate for Certified Nurse Midwives--Section 1833...of the Social Security act...is amended by striking "(but in no event" and all that follows through "performed by a physician")".

I'll leave it to the CNM-(MD-DO's) who subspecialize in nurse midwifery to look that up, but I think it means that you additional years of training in Obstetrics and Gynecology don't deserve a pay differential with CNMs.

I guess ya'll have to change the name of your organization from ACOG to ACOGCNM's.


Let me close this with the proverbial 'money shot'


p778 "SUBTITLE C--ACCESS--Section 1721 Payments to Primary Care Practitioners.

OK, you'll have to read this yourself...it is next to incomprehensible, which means that they are trying to cover up what it appears to mean. Parity reimbursement for Nurse Practioners who would become, by the stroke of a pen, promoted to the practice of medicine in the above discussed medical soon to be non specialties. Got that?


Oh, there's more in here, but this should give you an idea. I would urge you to read for yourself, cut, past, post, and widely disseminate this information to your colleagues, especially in "primary care" medicine.

http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf

Members don't see this ad.
 
wow!!! Im speechless!!!

so now med school is not the way to go to practice medicine but instead is nursing school????

wow!!
 
This is what happened when a non-health care party trying to fix health care system. The cost may as well be lowered drastically if they only hire technicians or construction workers or any layman to practice medicine. There is no need to train any Nps, PAs, or MDs..etc cuz these will be wasting lots of taxpayers money.
 
That's why I believe that if NP's want to practice, let them practice by themselves with no physician involvement at all. We should have hospitals that are only staffed by NP's. Then let the lawyers loose. After being litigated to death, then NP's will beg to be tied to physicians. The best solution to NP's is the marketplace and not legislatively.
 
i'm sure physicians are salivating at the thought of becoming a professional witness in a med-mal case against NP and PA....
 
I've seen NP's range from being as good (or nearly as good) as a physician, to being terrible. There is no quality control that I see. Go ahead, but it's going to be the wild west.

The exception is in areas with poor provider penetration. Then some care is worse than no care, in my opinion.
 
what's worse... waiting 3 months to see your family practitioner getting sicker and sicker, or waiting 2 weeks to see a NP who has 15 years of experience in a FP outpatient setting?
 
what's worse... waiting 3 months to see your family practitioner getting sicker and sicker, or waiting 2 weeks to see a NP who has 15 years of experience in a FP outpatient setting?

you are not doing primary care, right?
 
what's worse... waiting 3 months to see your family practitioner getting sicker and sicker, or waiting 2 weeks to see a NP who has 15 years of experience in a FP outpatient setting?

Bad analogy. More likely it's an issue of seeing someone with a few years experience in either case. So it becomes a question of whether your diagnostician has done med school and residency or not. It is folly to suggest that most NPs are experienced veterans-- it's a relatively new credential. So the question is really whether you are willing to wait longer for someone who obtained a doctorate and did residency training or not. For many its worth the wait.
 
You guys are all drama queens :rolleyes:

I'm going into primary care (Med-Peds) and I really could care less if legislation is passed that "loosely" puts NPs and PAs on the same playing field as me. Fact of the matter is, we desperately need more practitioners to take care of the general population. And if more of us were deciding to pursue primary care (rather than Derm, Rads, or Ortho), then this wouldn't be an issue in the first place.

Do we need specialists too? Of course! But at the current rate of attrition from the field for primary care, why would I blame the government for attempting to blunt this dangerous trend?

If you think you're so high and mighty that a lowly NP shouldn't even be able to walk in your shadow, then go ahead and cry hissy fits while you see the nation's state of health deteriorate to that of developing countries.
 
The government set the stage for this problem in the first place with the attrition of primary care. They are not the ones who will solve it.

A Comprehensive physician will have accrued at least 17,000 hours of direct patient clinical experience upon completion of a three year residency and medical school. A DNP will not exceed 1000 hours. A third year medical student has more formal medical training than a DNP.

If you serioulsy advocate that we need more bodies to simply get the job done, you must not stop there. Let pharmacists prescribe too. Permit PAs autonomous practice. Remove restrictions on drugs so you no longer need an Rx. If you believe a DNP is as competent as a physician then you may as well permit people to self medicate.
 
You guys are all drama queens :rolleyes:

I'm going into primary care (Med-Peds) and I really could care less if legislation is passed that "loosely" puts NPs and PAs on the same playing field as me. Fact of the matter is, we desperately need more practitioners to take care of the general population. And if more of us were deciding to pursue primary care (rather than Derm, Rads, or Ortho), then this wouldn't be an issue in the first place.

Do we need specialists too? Of course! But at the current rate of attrition from the field for primary care, why would I blame the government for attempting to blunt this dangerous trend?

If you think you're so high and mighty that a lowly NP shouldn't even be able to walk in your shadow, then go ahead and cry hissy fits while you see the nation's state of health deteriorate to that of developing countries.

you probably have not seen what a mess those non-Mds made in real life. We should definitely blame the government because they are the ones to allow non-mds to practice medicine independently in this country and this jeopardize public health. The issue of inadequate primary care practioners should not be mixed or be an excuse in allowing non-mds to practice medicine independently. It just wrong.
 
You guys are all drama queens :rolleyes:

I'm going into primary care (Med-Peds) and I really could care less if legislation is passed that "loosely" puts NPs and PAs on the same playing field as me. Fact of the matter is, we desperately need more practitioners to take care of the general population. And if more of us were deciding to pursue primary care (rather than Derm, Rads, or Ortho), then this wouldn't be an issue in the first place.

Do we need specialists too? Of course! But at the current rate of attrition from the field for primary care, why would I blame the government for attempting to blunt this dangerous trend?

If you think you're so high and mighty that a lowly NP shouldn't even be able to walk in your shadow, then go ahead and cry hissy fits while you see the nation's state of health deteriorate to that of developing countries.

oh medical students, we were so cute/inexperience at that stage. Come and tell us the same thing in 5 years when you are done with med school and med/peds residency and you are looking for a job and they are taking the 60-70K per year salary NP/DNP over you in alot of places.

Although I agree with you that we need more primary care docs (Im IM 3rd year deciding between hospitalist vs primary care) the correct answer is not to give NP's 100% control over patient. Remember they went to nursing school to be nurses and we wnt to med school to be physicians, this is not a "power-trip" or high egos, is the same as lawyers going to law school to practice law and architects going to their school to practice their profession. Is as simple as that.

There are many ways to get people into primary: 1- increase salaries 2- get more loan repayment programs into primary care 3- reduce the paperwork ( you havent seen nothing as a med student).
 
Chairman Mao, the real one, would love this bill.

After all, he created "barefoot doctors" to work in the rural areas.

http://en.wikipedia.org/wiki/Barefoot_doctor


Yeah, Chairman Maobama takes another page out of the commie handbook.

Why haven't these models prevailed in other socialized medical systems? (NP/PA/CNM independent)

America is on a road far worse than NHS in Britain or Canada's healthcare, I'm afraid.

http://www.npr.org/templates/story/story.php?storyId=4990242

NPR story from 2005 praising Chairman Mao's solution as our answer for rural healthcare.

Are you kidding me!?!!?
 
Chairman Mao, the real one, would love this bill.

After all, he created "barefoot doctors" to work in the rural areas.

http://en.wikipedia.org/wiki/Barefoot_doctor


Yeah, Chairman Maobama takes another page out of the commie handbook.

Why haven't these models prevailed in other socialized medical systems? (NP/PA/CNM independent)

America is on a road far worse than NHS in Britain or Canada's healthcare, I'm afraid.

http://www.npr.org/templates/story/story.php?storyId=4990242

NPR story from 2005 praising Chairman Mao's solution as our answer for rural healthcare.

Are you kidding me!?!!?

You brought it on yourself. Medicals student picking the field that paid the most instead of going into primary care and being a real doctor. You priced yourself out of the market. For what? An extra 100K a year. CRNA's in gas are a perfect example of the financial hubris of physicians. NP, RN's, Techs are all getting more practice rights because physicians don't want to do the work. Socialized medicine has been successful in other countries precisely because they focus on the primary care model. Down with specialty care, its destroying America. 'Maobama' for the victory!
 
You brought it on yourself. Medicals student picking the field that paid the most instead of going into primary care and being a real doctor. You priced yourself out of the market. For what? An extra 100K a year. CRNA's in gas are a perfect example of the financial hubris of physicians. NP, RN's, Techs are all getting more practice rights because physicians don't want to do the work. Socialized medicine has been successful in other countries precisely because they focus on the primary care model. Down with specialty care, its destroying America. 'Maobama' for the victory!

:laugh::laugh::laugh::laugh:
 
There are many ways to get people into primary: 1- increase salaries 2- get more loan repayment programs into primary care 3- reduce the paperwork ( you havent seen nothing as a med student).


4) and reduce the hours.
 
That's why I believe that if NP's want to practice, let them practice by themselves with no physician involvement at all. We should have hospitals that are only staffed by NP's. Then let the lawyers loose. After being litigated to death, then NP's will beg to be tied to physicians. The best solution to NP's is the marketplace and not legislatively.


:thumbup:
 
legislators gave us our MD/DO monopoly and legislators can take it away; public opinion is the only thing that will save us
 
legislators gave us our MD/DO monopoly and legislators can take it away; public opinion is the only thing that will save us

:sleep:

Troll.

Our education and credentials are not a monopoly, anyone can get into medical school if they are up to snuff.

Now the legislators want to give the wannabe's and have-nots the keys to the patient's candy store.

Bad idea.
 
If NPs and PAs have the same practicing rights as physicians, shouldn't they have to take the same licensing exams?
 
I don't get people are blaming medical students for not going into primary care. There are many FMG/IMGs willing to do family medicine/internal medicine and are denied a spot in a residency program. The training of primary care physicians has simply not kept up. I'd rather have FMG and IMG handling primary care needs than nurses. I guess this won't happen as it's cheaper to train and pay nurses.
 
I stopped listening when Obama said that doctors make treatment decisions based on the amount of money it would make them.
 
Is there a place where I can stream this speech? I'm guessing it was showing today and I must have missed it.

Thanks.
 
I stopped listening when Obama said that doctors make treatment decisions based on the amount of money it would make them.

Um, yeah. That is actually true to a certain extent. The problem arises when doctors lack business/finance experience and try to increase revenue via reimbursements instead of creating a business plan that creates revenue streams that are independent of treatment plan.

In other words, the physician will not order a few extra tests (that are ethically acceptable but not absolutely required for a comprehensive work-up). Instead, alternate revenue streams allow a physician the freedom to choose less reimbursement-heavy options (that are often forced in order to balance the books and literally pay the rent).
 
I stopped listening when Obama said that doctors make treatment decisions based on the amount of money it would make them.

This happens all the time.

My schedule needs to be full. If I have openings next week, I'm likely to rebook patients to be seen more quickly. If your BP is elevated and I start HCTZ and then want to recheck, if I have a bunch of openings I'm likely to bring you back next week to recheck. if my schedule is full for the next 2-3 months, I might simply have you email your results to me.

If I'm a cardiologist, my cath schedule needs to be full. The more open slots there are, the lower the threshold to cath you gets.
 
This happens all the time.

My schedule needs to be full. If I have openings next week, I'm likely to rebook patients to be seen more quickly. If your BP is elevated and I start HCTZ and then want to recheck, if I have a bunch of openings I'm likely to bring you back next week to recheck. if my schedule is full for the next 2-3 months, I might simply have you email your results to me.

If I'm a cardiologist, my cath schedule needs to be full. The more open slots there are, the lower the threshold to cath you gets.

This is true, to a point. Most people get the care they need, regardless of the schedule or financial incentives. There is a significant minority that do not however. It's not right to say doctors make ALL their decisions based on that. But it would be wrong to say it's not an issue, either. The truth probably lies somewhere inbetween.
 
So, wait...how is this much different from how PAs and NPs currently practice?

As of right now, they are able to take call, rotate with general medicine and subspeciality teams, and see patients in clinic, which is a blessing. They take the heavy burden that many hospitalists have been plagued with overnight and help distribute admissions and they write H&Ps, Discharge summeries and progress notes. Nobody wants to do 50 diabetes or hypertension rechecks everyday, and yet, that appears to be their entire practice. Plus, they triage clinic patients if necessary. They are constantly assisting with any given surgery within any given surgerical speciality or subspeciality.

If the only true difference is that they'll be capable of doing this themselves without an MD writing "agree with NP or PAs assessment" in a note and then making no other decisions, then that's fine with me. In case all of you haven't noticed, the majority of them practice safe medicine, which means that if they don't know the answer, they will either look it up or go ask a physician. I can't say the same for many currently practicing docs.

Regardless of what any given law says, PAs and NPs will continue to get hip fractures, pneumonias, and gastroenteritis, but they will never be capable of handling the difficult ICU/CCU decisions, because that truly does take training within a residency program.

I'm going into General Internal Medicine and with the way things are going, I'm going to welcome their help. Hubris and jealousy in medicine doesn't help anyone anymore. We need all the help we can get, which is why the best medical systems in the country have more than just an M.D. making the decisions.
 
This happens all the time.

My schedule needs to be full. If I have openings next week, I'm likely to rebook patients to be seen more quickly. If your BP is elevated and I start HCTZ and then want to recheck, if I have a bunch of openings I'm likely to bring you back next week to recheck. if my schedule is full for the next 2-3 months, I might simply have you email your results to me.

If I'm a cardiologist, my cath schedule needs to be full. The more open slots there are, the lower the threshold to cath you gets.

Really, neither of these are treatment decisions. Both are examples of matching available resources (open appointments) to need. That is, if you always had open appointments, all your patients would come back for BP follow up (and rightly so). When cath appointments are in short supply, the higher risk candidates get them. As such, it's a better argument against single payer health care and the rationing that's sure to follow than anything else.

Unless its your contention that cards is taking people with normal clinical exams, normal labs, normal stress tests, and no risk factors to the cath lab on slow days to keep the dollars flowing?

Because that's sure what Obama's implication was when he said that a pediatrician would perform a tonsillectomy (despite the fact that general pediatricians don't perform tonsillectomies) instead of write for abx because the reimbursements were better...
 
1. I agree with the person that has stated that even if we americans don't decide to do such, there are FMGs, IMGs who would gladly do such and go through the same residency training that we would go through if we were doing these fields and who would even move to these smaller places where we are not willing to move.

2. if people want more people to go ito primary care there haso be bigger incentive in terms of increased pay with the increasing debt from medical education.

3. Part of the problem is not a sole matter of lack of PC physicians in the country but their distribution in the areas that need it most. This is true of a lot of countries. The people who need it the most are often the poor and the places where people don't want to practice is often in those poor areas or rural areas.

4. Yes doctors have a right to be angry over NPs and PAs want to take the rights of a physician without the training cuz they have neither the same breadth of knowledge as a doctor nor the years of training as a doctor and it makes them feel like why should one even go through all these years of training and accumulate such amounts of debt if they are going to start equating a nurse or PA with a doctor.

I know I personally have had bad experiences with NPs when I went to derm offices over acne issues and had the option of seeing one at my OB/Gyn's office and chose the OB/Gyn doctor rather then the NP. I don't regret it. My experiences in health have always been better when i've had a doctor rather then an NP. I think for minor things that an NP is fine but there are going to be cases where a doctor is still needed and this is why they have NPs and PAs under doctors in the first place. We need to work on making incentives better for PC potentials if you want them to go in those fields.

Better hours, better money, better loan repayment as someone suggested.

People go into derm, rads, etc. for the reasons stated in the above line. Better hours, better money, better loan repayment.

I had just the opposite experience personally (very anecdotal). Went to a derm office. barely anybody there, the NP took tons of time with me. The dermatologist came in there, and basically had one foot out the door while talking to me. I mean, I think you could spare more than 30 seconds talking to me. Poor patient care.
 
Unless its your contention that cards is taking people with normal clinical exams, normal labs, normal stress tests, and no risk factors to the cath lab on slow days to keep the dollars flowing?

It is my contention that when resources are plentiful, patients do not have to pay directly, and physicians have a powerful financial incentive to do procedures --> the threshold for doing a procedure goes down.

An example: A patient is admitted to the hospital for a GI bleed. They have been using lots of NSAIDs for OA. They get an EGD, and are found to have a clean based ulcer. They get discharged, with appropriate followup. When they see a doc in a month, do they get a repeat EGD to see if the ulcer is healed?

It's a complex decision without a clearly correct answer. They probably don't need it. If the EGD schedule is really full, or if GI docs didn't get paid a bunch of $$ to scope people, the patient probably wouldn't get one. I bet that there are very few docs who would think "This guy totally doesn't need an EGD, but it would be easy money to do one.". However, I bet there are a bunch of docs who think "This guy probably is fine. However, it's possible that the ulcer didn't heal. How do I know unless I take a look? And I have an opening next week. Won't cost him anything, because his insurance will cover it. Might as well." If the EGD schedule was totally full, they'd probably simply tell him that he was fine.

A personal example: I am salaried, so my income is fixed no matter what I do. We do have a type of incentive bonus, but it's so complicated and unreachable it might as well not exist. However, I am held to an RVU target. I have started to try to bill as many RVU's as I can now. Everytime I see a patient, I ask myself "Hey, is this a level 4 instead of a 3?" Let's be clear -- I'm not committing fraud, I'm just trying to "buff my notes" so that they meet the higher level if it's legal. I get "teaching sessions" from the biller/coders all the time how to do this better. "The patient won't be billed any more" they tell me. "This is completely legal", which it is. But, all I'm doing is increasing costs in the system.

A resident example: Many VA hospitals do not have MRI scanners. When working there, the residents have to either "live without" an MRI, or they have to ship the patient in an ambulance to another institution. Occassionally, this causes a huge inconvenience to everyone when the patient gets shipped. Most of the time, the patient who would have gotten an MR doesn't, and it's not clear that outcomes where MR is not immediately available is any worse.

The story in the New Yorker by Atul Gawande shows how bad it can get. This is not driven by bad people, trying to steal / commit fraud. It's driven by the system we have.

Although it's hard to measure exactly, in general increasing the availablility of medical resources tends to lead to increased utilization without increases in healthcare quality (at least, so says the Dartmouth Atlas project). There is some floor -- if you restrict resources enough, bad things start to happen. But that floor is much lower than we think it is. The ease of getting invasive / expensive / complex testing without any brakes on the system -- financial, resource limitations, etc -- is the engine driving the problem in healthcare.
 
It is my contention that when resources are plentiful, patients do not have to pay directly, and physicians have a powerful financial incentive to do procedures --> the threshold for doing a procedure goes down.

An example: A patient is admitted to the hospital for a GI bleed. They have been using lots of NSAIDs for OA. They get an EGD, and are found to have a clean based ulcer. They get discharged, with appropriate followup. When they see a doc in a month, do they get a repeat EGD to see if the ulcer is healed?

It's a complex decision without a clearly correct answer. They probably don't need it. If the EGD schedule is really full, or if GI docs didn't get paid a bunch of $$ to scope people, the patient probably wouldn't get one. I bet that there are very few docs who would think "This guy totally doesn't need an EGD, but it would be easy money to do one.". However, I bet there are a bunch of docs who think "This guy probably is fine. However, it's possible that the ulcer didn't heal. How do I know unless I take a look? And I have an opening next week. Won't cost him anything, because his insurance will cover it. Might as well." If the EGD schedule was totally full, they'd probably simply tell him that he was fine.

A personal example: I am salaried, so my income is fixed no matter what I do. We do have a type of incentive bonus, but it's so complicated and unreachable it might as well not exist. However, I am held to an RVU target. I have started to try to bill as many RVU's as I can now. Everytime I see a patient, I ask myself "Hey, is this a level 4 instead of a 3?" Let's be clear -- I'm not committing fraud, I'm just trying to "buff my notes" so that they meet the higher level if it's legal. I get "teaching sessions" from the biller/coders all the time how to do this better. "The patient won't be billed any more" they tell me. "This is completely legal", which it is. But, all I'm doing is increasing costs in the system.

A resident example: Many VA hospitals do not have MRI scanners. When working there, the residents have to either "live without" an MRI, or they have to ship the patient in an ambulance to another institution. Occassionally, this causes a huge inconvenience to everyone when the patient gets shipped. Most of the time, the patient who would have gotten an MR doesn't, and it's not clear that outcomes where MR is not immediately available is any worse.

The story in the New Yorker by Atul Gawande shows how bad it can get. This is not driven by bad people, trying to steal / commit fraud. It's driven by the system we have.

Although it's hard to measure exactly, in general increasing the availablility of medical resources tends to lead to increased utilization without increases in healthcare quality (at least, so says the Dartmouth Atlas project). There is some floor -- if you restrict resources enough, bad things start to happen. But that floor is much lower than we think it is. The ease of getting invasive / expensive / complex testing without any brakes on the system -- financial, resource limitations, etc -- is the engine driving the problem in healthcare.

+1 in a big way. Couldn't agree more.
 
A DNP after 4 years of experience is every bit as qualified as an MD or DO so once we get a residency established watch out because here we come! DNPs are the underdogs now like DOs were a few short years ago. Society will adjust.
 
A DNP after 4 years of experience is every bit as qualified as an MD or DO so once we get a residency established watch out because here we come! DNPs are the underdogs now like DOs were a few short years ago. Society will adjust.

Define for me what a nurse is? Why go to nursing school to be a doctor? Just plain silly.
 
A DNP after 4 years of experience is every bit as qualified as an MD or DO so once we get a residency established watch out because here we come! DNPs are the underdogs now like DOs were a few short years ago. Society will adjust.

what are you smoking!! have you seen the curriculum of this programs?, which by the way can vary greatly from program to program.

the DNP curriculum is a joke because it has no clinical exposure and the funny thing is that it was created to make nurses more independent clinically!! LOL.

enjoy this joke!!: Even my MPH of epidemiology at UF had more clinical hours than this!!!

DNP curriculum at Purdue Univ.

AGEC 596C Healthcare Economics and Finance 3

CIC 963 Information Technology 3

NUR 62500 History, Ethics, and Innovations of Healthcare Delivery Systems 3

NUR 63200 Health Policy: Local to Global 3

NUR 67300 Health Policy Residency 2


Evidence Based Practice Core - 9 credit hours
HK 44500 Principles of Epidemiology 3

NUR 61800 Biostatistics 3

NUR 61600 Evidenced Based Practice 3


Sample Cognates - 6 credit hours
Direct Practice/ Systems Mangement Focus (select 2)
Child Development 3

Pharmacology 3

Gerontology 3

Management 3

Genetics 3

Oncology 3

Systems Engineering 3

- OR -
Public Health/Homeland Security Focus (select 2)
Organizational Behavioral or Organizational Theory 3

Homeland Security 3

NUR XX6 Population-based Healthcare Delivery Systems 3

NUR XX9 Public Health Systems Risk Management 3


Evidence Based Nursing Research Project - 6 credit hours
NUR 68700 DNP Practice Inquiry Project I (192 residency hours) 3

NUR 68900 DNP Practice Inquiry Project II (192 residency hours) 3


Residency - 6 credit hours
Direct Practice/ Systems Mangement Focus
NUR 68000 DNP Residency: Direct Practice/Systems Management I (192 residency hours) 3

NUR 68100 DNP Residency: Direct Practice/Systems Management II (192 residency hours) 3

- OR -
Public Health/Homeland Security Focus
NUR 68300 DNP Residency: Public Health/Homeland Security Practice I (192 residency hours) 3

NUR 68500 DNP Residency: Public Health/Homeland Security Practice II (192 residency hours)
 
Another thing that I saw in that curriculum is the 192 hours of residency!! WOW, I do that in 3 weeks of my residency IM training!!!
 
Define for me what a nurse is? Why go to nursing school to be a doctor? Just plain silly.

If obama plan's goes foward nursing school is going to be the easy way to be a doctor!! Nurse Smith cant get into med school? Dont worry there are going to be hundreds of DNP's programs eager to take you to prepare you for doctor duty!!!

This is a joke. I only feel sad for the patients.
 
Did you go to med school or drama school? Is the sky falling too? Can I get one of your foil hats...lol



If obama plan's goes foward nursing school is going to be the easy way to be a doctor!! Nurse Smith cant get into med school? Dont worry there are going to be hundreds of DNP's programs eager to take you to prepare you for doctor duty!!!

This is a joke. I only feel sad for the patients.
 
Did you go to med school or drama school? Is the sky falling too? Can I get one of your foil hats...lol

I hope you are not going to primary care medicine because according to Obamas healthcare plan we have the following:

1- Authority to allow Nurse Practitioners and Physician assistants (consistent with state law) to be in charge of a patient centered medical home.

2-"The term 'primary care' means health care that is provided by a physician or nurse practitioner who practices in the field of family medicine, general internal medicine, geriatric medicine, or pediatric medicine."

3-Primary care practitioner defined--In this subsection the term primary care practitioner A) Means a physician or other health care practitioner (including a nurse practitioner) who specializes in family medicine, general internal medicine, geriatrics, or obstetrics and gynecology and...B) includes a physician's assistant who is under the supervision of a practitioner described under subparagraph A.


Is not that the sky is falling is that Obama is pushing down on physicians!!! You are a medical student, you are going to feel this at its worst when you come out of residency in 4-5 years and this plan has been running for awhile now.

But keeping believing that this is not going to affect doctors. I voted for obama but im very dissapointed by all the powers he wants to give nurses.
 
If you haven't noticed, I am Canadian and we have universal healthcare. We also have 50% taxes that I gladly pay to have universal healthcare for my fellow citizens. I also wish to remind you that Quebec has the highest taxes in N. America and the lowest paid physicians and primary care docs make an average of about $160,000US+. In other provinces primary care average ~195,000US.

If you are worried about becoming "socialist" like Canada, then you should have your head checked because you should hope to run such a tight ship (relatively speaking since there is a ARSELOAD of room for improvement).



I hope you are not going to primary care medicine because according to Obamas healthcare plan we have the following:

1- Authority to allow Nurse Practitioners and Physician assistants (consistent with state law) to be in charge of a patient centered medical home.

2-"The term 'primary care' means health care that is provided by a physician or nurse practitioner who practices in the field of family medicine, general internal medicine, geriatric medicine, or pediatric medicine."

3-Primary care practitioner defined--In this subsection the term primary care practitioner A) Means a physician or other health care practitioner (including a nurse practitioner) who specializes in family medicine, general internal medicine, geriatrics, or obstetrics and gynecology and...B) includes a physician's assistant who is under the supervision of a practitioner described under subparagraph A.


Is not that the sky is falling is that Obama is pushing down on physicians!!! You are a medical student, you are going to feel this at its worst when you come out of residency in 4-5 years and this plan has been running for awhile now.

But keeping believing that this is not going to affect doctors. I voted for obama but im very dissapointed by all the powers he wants to give nurses.
 
As a side note, ALL OF THIS WAS SAID WHEN DOs WERE TRYING TO DO THE SAME THING...

...the difference is that DOs are actually qualified, DNPs are not.
 
Define for me what a nurse is? Why go to nursing school to be a doctor? Just plain silly.
You are silly. Every degree has the potential for a doctorate. Nursing is no different. The fact is that DNPs are just as clinically competant as MDs. So no matter what YOU think society is voting for nurse practitioners; we listen beter which leads to better care.
 
As a side note, ALL OF THIS WAS SAID WHEN DOs WERE TRYING TO DO THE SAME THING...

...the difference is that DOs are actually qualified, DNPs are not.
DNPs are just as qualified as DOs, I know, I've been in both programs. The comlex was a joke. After two years of DO school I passed the comlex with flying colors and still had no idea what I was doing. I switched to DNP because I wanted to UNDERSTAND how to care for a patient.
 
Medical doctors gain their clinical training in residency. How does a DNP gain his/her clinical competence?
 
DNPs are just as qualified as DOs, I know, I've been in both programs. The comlex was a joke. After two years of DO school I passed the comlex with flying colors and still had no idea what I was doing. I switched to DNP because I wanted to UNDERSTAND how to care for a patient.

I think you have the two mixed up. You switch to DO to understand...

and I have a hard time believing you dropped out of med school after two years to become a nurse...
 
You brought it on yourself. Medicals student picking the field that paid the most instead of going into primary care and being a real doctor. You priced yourself out of the market. For what? An extra 100K a year. CRNA's in gas are a perfect example of the financial hubris of physicians. NP, RN's, Techs are all getting more practice rights because physicians don't want to do the work. Socialized medicine has been successful in other countries precisely because they focus on the primary care model. Down with specialty care, its destroying America. 'Maobama' for the victory!


Correct me if I am wrong, but weren't you interested in Anesthesia Spyyder? :slap:
 
it would seem that working towards protecting our turf (much like the nursing/PA people have done to claim theirs) should be the focus of our efforts.

this said, where do we go to do this? the nurses have unions that have hired PR firms to get the american people to believe they have credibility. where is our organization?

seriously, someone tell me who's doing anything about this so i can join up and get every resident, medical student and pre-med within a 100 mile radius to join too.
 
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