Comparison Studies - NP, Physician, and PA

[blindedmewithscience]

Ok, in retrospect, I probably should not have included a comment on NP independence to practice in my last post. I ask that people stay on topic and refrain from personal attacks. The point of this thread is to comment on the studies listed in the first post and suggest possible improvements. This thread is not to discuss politics on this issue. Why should you stay on topic? Because whether you are trying to prove that NPs or PAs lack the knowledge to be independent providers or that NPs or PAs should practice independently because of their backgrounds and other healthcare issues, you should be trying to support your points with scientific evidence. If you find the current studies are lacking in depth or quality, you should be striving to create standards, so that a study can be performed hopefully proving your point. Your thoughts on what those standards should be, should be a part of your reply to this thread (the more specific you can get, the better). This is not a place to state anecdotal evidence, make assumptions, or reply with irrelevant information, and I ask that those people please use the search bar to find the large number of threads that have those responses (if that is your goal). I have added some of these statements to the first post. Now one of the posters earlier made a comment about journal quality, so here are links to the review processes/guidelines:

JAMA - http://jama.jamanetwork.com/article.aspx?articleid=202118#EditorialReviewandPublication
Human Resources for Health - https://human-resources-health.biomedcentral.com/submission-guidelines/peer-review-process
BMJ Open - http://bmjopen.bmj.com/site/about/guidelines.xhtml
CHEST (2 articles) - http://journal.publications.chestnet.org/ss/forauthors.aspx
Research in Gerontological Nursing - http://www.healio.com/nursing/journals/rgn/submit-an-article
International Journal for Nursing Studies - https://www.elsevier.com/journals/i...f-nursing-studies/0020-7489/guide-for-authors
BMC Health Services Research - http://bmchealthservres.biomedcentral.com/submission-guidelines/peer-review-process
Cochrane Database of Systematic Reviews - http://community.cochrane.org/editorial-and-publishing-policy-resource-new
Primary Care Respiratory Journal - http://www.nature.com/authors/peer_review/index.html

Some of the replies have stayed on topic and provided good suggestions, like better sample sizes, longer studies, standardized patient populations or patients are given to a provider without any preference, better data reporting, and NPs (or PAs depending on the study) that practice independently of the physician for some of the studies. The more specific you can get, again, the better. Also, your suggestions on standards should produce study goals that are achievable. Meaning, for example, a 60 year old study on primary care following patients would seem unreasonable, if statistically the majority of patients switch primary care providers in that time frame.

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[VA Hopeful Dr]

1. Really?

https://www.aamc.org/newsroom/newsreleases/385506/07172014.html?version=meter+at+0&module=meter-
Links&pgtype=article&contentId=&mediaId=&referrer=http%3A%2F%2Fthehealthcareblog.com%2Fblog%2F2014%2F07%2F21%2Fthe-answer-to-the-doctor-shortage-isnt-more-doctors%2F&priority=true&action=click&contentCollection=meter-links-click

https://www.aamc.org/data/workforce/reports/439206/physicianshortageandprojections.html

http://ushealthpolicygateway.com/vi.../impact-on-access-to-care/physician-shortage/

https://www.aamc.org/newsroom/newsreleases/426166/20150303.html
"The doctor shortage is real – it’s significant – and it’s particularly serious for the kind of medical care that our aging population is going to need,” said AAMC President and CEO Darrell G. Kirch, MD."

Now show me why you say there is not a physician shortage. I'm not being confrontational; why do all these reputable associations and organizations say one exists when you say one does not.

3. NP and PA should be compensated the same in all places, not "many places."

Gee, the association of medical colleges thinks we need more med schools. Color me shocked. It's like the teacher's union saying we need to pay teachers more.

I don't know of anywhere that reimburses PAs differently from NPs.

 

[762513]

Gee, the association of medical colleges thinks we need more med schools. Color me shocked. It's like the teacher's union saying we need to pay teachers more.

I don't know of anywhere that reimburses PAs differently from NPs.

That doesn't show me evidence of why you are correct and they are wrong.

 

[VA Hopeful Dr]

That doesn't show me evidence of why you are correct and they are wrong.

http://www.americanactionforum.org/weekly-checkup/doc-shortage-or-maldistribution/

2.6 PCPs per 3500 patients is more than enough as many PCPs carry that many patients individually.

Edit: this took me literally 15 seconds on Google. Do your homework.

 

[Makati2008]

That doesn't show me evidence of why you are correct and they are wrong.

Give it a rest. You are just trying to further your agenda to gain independent practice it seems. Also I can tell you if anything nurse practitioners historically have attempted to keep PAs out of certain states in the past....Mississippi comes to mind immediately. Most hostile state I worked in as a PA. I would assume Ohio is right up there as well.


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[762513]

Give it a rest. You are just trying to further your agenda to gain independent practice it seems. Also I can tell you if anything nurse practitioners historically have attempted to keep PAs out of certain states in the past....Mississippi comes to mind immediately. Most hostile state I worked in as a PA. I would assume Ohio is right up there as well.


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I very respectfully asked a point to be proven. I notice you didn't tell anyone else to "give it a rest" until they were 40 posts into trolling me on the previous thread. I most likely am never going to practice independently ever in my career so I don't know what agenda you are describing. Thanks for the moderation.

 

[Makati2008]

I very respectfully asked a point to be proven. I notice you didn't tell anyone else to "give it a rest" until they were 40 posts into trolling me on the previous thread. I most likely am never going to practice independently ever in my career so I don't know what agenda you are describing. Thanks for the moderation.

Not moderating you. Your free to say whatever you want as long as it doesn't violate any rules (which you haven't). I was saying that more so as personals opinion.


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[blindedmewithscience]

I ask people to read my reply at the top of page two. I am curious about hearing more comments about the studies and improvements to the studies, regardless of your backgrounds. I will try to add some more details from each study about provider background, but all that information should be available with the links on page one. Also, in the reply above, I provided links to the journal review processes.

 

[hamstergang]

I ask people to read my reply at the top of page two. I am curious about hearing more comments about the studies and improvements to the studies, regardless of your backgrounds. I will try to add some more details from each study about provider background, but all that information should be available with the links on page one. Also, in the reply above, I provided links to the journal review processes.

I asked for your background. It's hard to explain the problems without knowing where you're coming from. This isn't something so simple that it can be well understood without training.

 

[blindedmewithscience]

I asked for your background. It's hard to explain the problems without knowing where you're coming from. This isn't something so simple that it can be well understood without training.

There are a couple of reasons I will not state my background: 1) it welcomes unwanted replies that are not relevant to the main point of the thread, 2) if I do not understand one of your points, I can always respond by asking questions, 3) because, I am not the only one reading your response(s) and many members have listed their medical backgrounds that could be relevant, and 4) because if you want to give feedback on those articles, having a restricted conversation would limit the type of feedback these articles can get. There are a few other reasons that I did not mention. Here's what I want to see, if you were to have a discussion with those authors, what feedback would you give them, so that they can create a study that is a valid comparison?

 

[Makati2008]

There are a couple of reasons I will not state my background: 1) it welcomes unwanted replies that are not relevant to the main point of the thread, 2) if I do not understand one of your points, I can always respond by asking questions, 3) because, I am not the only one reading your response(s) and many members have listed their medical backgrounds that could be relevant, and 4) because if you want to give feedback on those articles, having a restricted conversation would limit the type of feedback these articles can get. There are a few other reasons that I did not mention. Here's what I want to see, if you were to have a discussion with those authors, what feedback would you give them, so that they can create a study that is a valid comparison?

Sounds like you are a NP(or Rn) with an agenda to push......


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[VA Hopeful Dr]

I ask people to read my reply at the top of page two. I am curious about hearing more comments about the studies and improvements to the studies, regardless of your backgrounds. I will try to add some more details from each study about provider background, but all that information should be available with the links on page one. Also, in the reply above, I provided links to the journal review processes.

To what end? If one of us could design a great study, so what? No one in academia cares about a) what anyone on SDN things and b) what anyone not in academia thinks c) what medical students/residents think.

 

[VA Hopeful Dr]

There are a couple of reasons I will not state my background: 1) it welcomes unwanted replies that are not relevant to the main point of the thread, 2) if I do not understand one of your points, I can always respond by asking questions, 3) because, I am not the only one reading your response(s) and many members have listed their medical backgrounds that could be relevant, and 4) because if you want to give feedback on those articles, having a restricted conversation would limit the type of feedback these articles can get. There are a few other reasons that I did not mention. Here's what I want to see, if you were to have a discussion with those authors, what feedback would you give them, so that they can create a study that is a valid comparison?

Your background matters because very often you won't even know the correct questions to ask. Plus, it can help us tailor our responses when we know your educational background.

 

[blindedmewithscience]

To what end? If one of us could design a great study, so what? No one in academia cares about a) what anyone on SDN things and b) what anyone not in academia thinks c) what medical students/residents think.

I asked people to provide feedback on those studies, so that there can be improvements, NOT to design a new study. First, I think this would lead to more productive conversations on this forum, rather than generalizations and unsupported assertions. I think at the very least it would give someone a point of reference for topics on those providers (PAs and NPs). Although that line of thinking could be true, by the same token, it might not be and I think if we truly cared about this topic, but did not want to contact the authors (wanting to stay anonymous, for example) or help conduct a study, we would be trying to do our part by publicizing our suggestions, if the amount of effort is reasonable (and not just having conversations among our colleagues or classmates). Think about it this way, at worst, no one cares and this thread goes dormant for many future years (a neutral result) and at best, it gives this forum a scientific conversation about these types of studies and might give the authors something to improve upon. But, I think to constantly state that those studies are not valid comparisons is unreasonable, if you don't suggest specific standards that should be met (because then those studies will never be up to expectations, even if they follow drug trial protocols). My last point is, I really do not want comments tailored to anyone's background, because that probably will introduce unproductive conversations and a huge amount of bias. Rather than arguing about my background, I ask that people list feedback on any or all of those studies, if they have any, as a better use of their time. Remember that I am not the only person reading this thread or forum.

 

[deleted480308]

I asked people to provide feedback on those studies, so that there can be improvements, NOT to design a new study. First, I think this would lead to more productive conversations on this forum, rather than generalizations and unsupported assertions. I think at the very least it would give someone a point of reference for topics on those providers (PAs and NPs). Although that line of thinking could be true, by the same token, it might not be and I think if we truly cared about this topic, but did not want to contact the authors (wanting to stay anonymous, for example) or help conduct a study, we would be trying to do our part by publicizing our suggestions, if the amount of effort is reasonable (and not just having conversations among our colleagues or classmates). Think about it this way, at worst, no one cares and this thread goes dormant for many future years (a neutral result) and at best, it gives this forum a scientific conversation about these types of studies and might give the authors something to improve upon. But, I think to constantly state that those studies are not valid comparisons is unreasonable, if you don't suggest specific standards that should be met (because then those studies will never be up to expectations, even if they follow drug trial protocols). My last point is, I really do not want comments tailored to anyone's background, because that probably will introduce unproductive conversations and a huge amount of bias. Rather than arguing about my background, I ask that people list feedback on any or all of those studies, if they have any, as a better use of their time. Remember that I am not the only person reading this thread or forum.

you propose this thread didn't start with a bias?

 

[GimpGenius]

Um... Feedback was already given. Background absolutely matters since you're n=1'ing opinions on an online forum. As improvements are concerned, the suggestions as I understand it were to design a better, more controlled study; poor data gives you poor results, irrespective of how you look at them.

Just as you think prior posts have been unreasonable, I'd opine that you're being just as unreasonable by arguing provider parity when clear methodological issues have been raised.

So... Flawed studies; you don't want to design a better one, nor do you want to discuss some legitimate concerns about conducting studies like these. Allnurses may be a better forum for this discussion now, because the physicians clearly aren't going to agree with you.

 

[Makati2008]

Um... Feedback was already given. Background absolutely matters since you're n=1'ing opinions on an online forum. As improvements are concerned, the suggestions as I understand it were to design a better, more controlled study; poor data gives you poor results, irrespective of how you look at them.

Just as you think prior posts have been unreasonable, I'd opine that you're being just as unreasonable by arguing provider parity when clear methodological issues have been raised.

So... Flawed studies; you don't want to design a better one, nor do you want to discuss some legitimate concerns about conducting studies like these. Allnurses may be a better forum for this discussion now, because the physicians clearly aren't going to agree with you.

Agreed. The Op wants to ask us questions but then refuses to answer basic ones that we ask. Maybe another place would be more appropriate for the answers he/she is looking.


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[762513]

Um... Feedback was already given. Background absolutely matters since you're n=1'ing opinions on an online forum. As improvements are concerned, the suggestions as I understand it were to design a better, more controlled study; poor data gives you poor results, irrespective of how you look at them.

Just as you think prior posts have been unreasonable, I'd opine that you're being just as unreasonable by arguing provider parity when clear methodological issues have been raised.

So... Flawed studies; you don't want to design a better one, nor do you want to discuss some legitimate concerns about conducting studies like these. Allnurses may be a better forum for this discussion now, because the physicians clearly aren't going to agree with you.

There is only one physician posting on this forum, the rest are midlevels and med students. I would like to know everyone's current schools and education so that I know who I don't really need to listen to. Demanding someone else's credentials with the history of how this forum has behaved is basically the same request.

These studies are low levels of evidence. There is zero evidence they are flawed. What we have been comparing all along is low level evidence versus opinion. So level 6 or expert opinion, which btw its debatably if anyone here is an expert in health study research, versus level 5, qualitative research findings.

 

[blindedmewithscience]

If you look at the first post of this thread, I did not state any opinions. I performed a search on this topic, before posting, and found that very little of the responses posted were based on any substantial evidence. Instead, what I saw was clinical anecdote or opinionated statements. So no, the first post was presented without any bias, hence, why I copied and pasted the results/conclusions of each study, without stating any opinions. The two opinions I did state later on were to instigate discussions on how implementation could be possible, with selectivity in examining a huge patient populations (cost of examining patients with the same disorder) or examining many different variables (ability to diagnose and to resolve/mitigate a disorder versus cost of treatment plus ability to diagnose and to resolve/mitigate a disorder). My thought is if you are suggesting an improved design, limiting factors should be included in that discussion. That does not mean that I do not want discussions on better design or legitimate study concerns. But it should be a balanced conversation that promotes more productive (specific) responses.

Again, I never argued for provider parity ever in this thread. I presented studies that have compared the different professionals and then responded with comments about implementation and relevance (for example, anecdotes are not relevant). In fact, one of the reasons I posted this thread was to get feedback on the study methods. I ask people to not make assertions that go against what I have stated in this forum and are not true. If you want a productive conversation on this topic that could be resourceful to better the study designs, then implementation should be apart of that conversation. This does not mean I am refuting your arguments, but instead opening up a discussion for you to be more specific on how to analyze a specific patient population where, for example, nurse practitioners have independent practice rights within a specific specialty (i.e. primary care). I'll try to do another post that includes all the study-specific comments to keep track of them. Also, since this forum has many members, I'd like to hear from more people about their comments on the studies.

 

[Makati2008]

There is only one physician posting on this forum, the rest are midlevels and med students. I would like to know everyone's current schools and education so that I know who I don't really need to listen to. Demanding someone else's credentials with the history of how this forum has behaved is basically the same request.

These studies are low levels of evidence. There is zero evidence they are flawed. What we have been comparing all along is low level evidence versus opinion. So level 6 or expert opinion, which btw its debatably if anyone here is an expert in health study research, versus level 5, qualitative research findings.

I'm a Physician/PA. Your turn?


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[762513]

I'm a Physician/PA. Your turn?


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You're a Physician or a PA, or are those two things the same thing in your opinion?

 

[Makati2008]

You're a Physician or a PA, or are those two things the same thing in your opinion?

Went to PA school, finished. Practiced for a while and went to medical school. What are your credentials?


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[762513]

Went to PA school, finished. Practiced for a while and went to medical school. What are your credentials?


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Are you currently licensed as a PA? If you are not, then you are not a PA. I believe you're a physician, and are an expert in diagnosing and treating disease. Are you also an expert in healthcare study research and methodology?

 

[blindedmewithscience]

There is only one physician posting on this forum, the rest are midlevels and med students. I would like to know everyone's current schools and education so that I know who I don't really need to listen to. Demanding someone else's credentials with the history of how this forum has behaved is basically the same request.

These studies are low levels of evidence. There is zero evidence they are flawed. What we have been comparing all along is low level evidence versus opinion. So level 6 or expert opinion, which btw its debatably if anyone here is an expert in health study research, versus level 5, qualitative research findings.

There is also almost always going to be some limiting factor depending on your background. For example, if you are a primary care physician, people might question whether you can respond to anesthesiology or ICU studies (not stating whether this is correct or not). If you are an anesthesiologist, people might question whether you can comment on primary care studies. If you are a nurse practitioner or physician , people might question whether you can comment without any bias. Even if you are an MD/PhD or a DNP/PhD, people might comment on whether you can understand "the other side" of this conversation. The point is when you start tailoring your discussion to a specific group rather than just stating your entire opinion, you risk excluding important information. No one will have a background that cannot be subjected to criticism.

And it should not be that way, this thread should have discussions from all backgrounds to hopefully add to the conversation. I also wanted to ask if it goes against rule #1 about members soliciting information from other members. If you have feedback, please give it or if you have, please respond to my points about selectivity or try to be more specific in other ways.

 

[deleted480308]

There is also almost always going to be some limiting factor depending on your background. For example, if you are a primary care physician, people might question whether you can respond to anesthesiology or ICU studies (not stating whether this is correct or not). If you are an anesthesiologist, people might question whether you can comment on primary care studies. If you are a nurse practitioner or physician , people might question whether you can comment without any bias. Even if you are an MD/PhD or a DNP/PhD, people might comment on whether you can understand "the other side" of this conversation. The point is when you start tailoring your discussion to a specific group rather than just stating your entire opinion, you risk excluding important information. No one will have a background that cannot be subjected to criticism.

And it should not be that way, this thread should have discussions from all backgrounds to hopefully add to the conversation. I also wanted to ask if it goes against rule #1 about members soliciting information from other members. If you have feedback, please give it or if you have, please respond to my points about selectivity or try to be more specific in other ways.

called it...I knew you would still duck the question

 

[762513]

called it...I knew you would still duck the question

What you are doing this very moment is an attempt at gaining the knowledge you need to conduct an Argumentum ad hominem. What you have done since you began posting in this forum is attempt to conduct an Argument from silence.

It doesn't matter if he's a short order cook, he is using evidence to debate a point and you are not.

 

[deleted480308]

What you are doing this very moment is an attempt at gaining the knowledge you need to conduct an Argumentum ad hominem. What you have done since you began posting in this forum is attempt to conduct an Argument from silence.

It doesn't matter if he's a short order cook, he is using evidence to debate a point and you are not.

the evidence isn't evidence if it's no good

 

[762513]

the evidence isn't evidence if it's no good

Are you qualified to judge if evidence has met the bar?

 

[deleted480308]

Are you qualified to judge if evidence has met the bar?

feel free to articulate how my critiques have been unfounded..

 

[762513]

feel free to articulate how my critiques have been unfounded..

You are very good at debate and I have actually learned a lot from you and valued many of your contributions, however, you are not qualified to state a qualitative research methodology is so poor that is has less bearing than an opinion that uses no research at all.

 

[deleted480308]

You are very good at debate and I have actually learned a lot from you and valued many of your contributions, however, you are not qualified to state a qualitative research methodology is so poor that is has less bearing than an opinion that uses no research at all.

res ipsa loquitur...My point is quite literally so clear that "the thing proves itself". Physicians are the gold standard of medical decision making and as such anything not physician is less. When you propose changing the entire structure of the medical profession in a nation for decades it is on you to provide solid proof. If your proof can't handle the questions of a handful of people on the internet it's not proof.

 

[762513]

res ipsa loquitur...My point is quite literally so clear that "the thing proves itself". Physicians are the gold standard of medical decision making and as such anything not physician is less. When you propose changing the entire structure of the medical profession in a nation for decades it is on you to provide solid proof. If your proof can't handle the questions of a handful of people on the internet it's not proof.

Careful, that's an argument from stone, argument from repetition, begging the question, assuming the conclusion, fallacy of composition, fallacy of authority, appeal to tradition, fallacy of the single cause, and probably most accurately in this particular case a fallacy of personal incredulity.

As stated earlier you and I are not qualified to gauge whether this evidence is superior than opinion.

More studies need to be done. All we can conclude is that we don't yet know the answer.

 

[Makati2008]

Careful, that's an argument from stone, argument from repetition, begging the question, assuming the conclusion, fallacy of composition, fallacy of authority, appeal to tradition, fallacy of the single cause, and probably most accurately in this particular case a fallacy of personal incredulity.

As stated earlier you and I are not qualified to gauge whether this evidence is superior than opinion.

More studies need to be done. All we can conclude is that we don't yet know the answer.

I'm still waiting on my answer. What are your credentials?


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[blindedmewithscience]

the evidence isn't evidence if it's no good

Although some of the data might not be sufficient, some of the studies might show association with the quality of care. That still makes it evidence, even if it does not prove or disprove provider parity.

I'm still waiting on my answer. What are your credentials?


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Not to be that person, but could you please tell me if asking this question violated this rule?

Protect anonymity. Remember, students, doctors, schools and professional organizations follow the SDN Forums. Please keep your identity protected – don’t post or use your real name on the forums. Additionally, members are not permitted to solicit personally identifiable information from other members (such as through research surveys, etc.) without written permission from SDN or disclose another member’s identity without their written permission.

 

[deleted480308]

Careful, that's an argument from stone, argument from repetition, begging the question, assuming the conclusion, fallacy of composition, fallacy of authority, appeal to tradition, fallacy of the single cause, and probably most accurately in this particular case a fallacy of personal incredulity.

As stated earlier you and I are not qualified to gauge whether this evidence is superior than opinion.

More studies need to be done. All we can conclude is that we don't yet know the answer.

I'm an intelligent human being who is more than capable of noticing some blatant weaknesses in research procedure...if anything, me noticing these flaws only shows how large they are

 

[deleted480308]

Although some of the data might not be sufficient, some of the studies might show association with the quality of care. That still makes it evidence, even if it does not prove or disprove provider parity.



Not to be that person, but could you please tell me if asking this question violated this rule?

Protect anonymity. Remember, students, doctors, schools and professional organizations follow the SDN Forums. Please keep your identity protected – don’t post or use your real name on the forums. Additionally, members are not permitted to solicit personally identifiable information from other members (such as through research surveys, etc.) without written permission from SDN or disclose another member’s identity without their written permission.

there are more than 200k NPs in the country, you find that personally identifiable?

 

[blindedmewithscience]

there are more than 200k NPs in the country, you find that personally identifiable?

Asking someone's occupation and other credentials would seem like it would violate that rule. Regardless, if people are adamant about my background, why don't you restrict your responses to people with certain credentials? For example, if you feel that only a physician can understand the complexities of this issue, state that in your response, that gives more detailed responses for study improvements (poor data collection is not that specific) or to address the two opinions/remarks. If you want, you can even disregard my (two) opinions stated later in the thread and address some ways to overcome implementation issues (that should not effect the point that you need my background to address the opinions I stated).

 

[VA Hopeful Dr]

What you are doing this very moment is an attempt at gaining the knowledge you need to conduct an Argumentum ad hominem. What you have done since you began posting in this forum is attempt to conduct an Argument from silence.

It doesn't matter if he's a short order cook, he is using evidence to debate a point and you are not.

Sb is about the least likely to go ad hominem on you of any poster I have ever seen.

 

[VA Hopeful Dr]

Are you currently licensed as a PA? If you are not, then you are not a PA. I believe you're a physician, and are an expert in diagnosing and treating disease. Are you also an expert in healthcare study research and methodology?

Incorrect . If I stop practicing tomorrow I will still be a physician and that will not change

 

[blindedmewithscience]

Please read my last (few) post(s). I ask that we stay on topic. I do appreciate the study feedback that's given so far.

 

[Makati2008]

Asking someone's occupation and other credentials would seem like it would violate that rule. Regardless, if people are adamant about my background, why don't you restrict your responses to people with certain credentials? For example, if you feel that only a physician can understand the complexities of this issue, state that in your response, that gives more detailed responses for study improvements (poor data collection is not that specific) or to address the two opinions/remarks. If you want, you can even disregard my (two) opinions stated later in the thread and address some ways to overcome implementation issues (that should not effect the point that you need my background to address the opinions I stated).

That's definitely NOT a violation of the TOS. Asking you to tell us what your profession is NOT unless I'm asking you truly identifiable information. It's funny you asked me in a roundabout way what my profession was and still won't answer the question when I ask for yours. Personally I wish this thread would just die lol.


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[blindedmewithscience]

That's definitely NOT a violation of the TOS. Asking you to tell us what your profession is NOT unless I'm asking you truly identifiable information. It's funny you asked me in a roundabout way what my profession was and still won't answer the question when I ask for yours. Personally I wish this thread would just die lol.


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Ok, good to know. Because, she/he might not want to give out that information. People have been fired, faced board/institutional actions, or received some other punishment, as a result of posting something on the internet. Maybe stating one's occupation alone would not identify them, but in conjunction with some other information they posted, it definitely could. And apart from the few verification types that are done on this forum (assuming you provided an email AND a license number), there is no way to verify I am who I say I am or you are, who you say you are. And it should not be relevant. It certainly wasn't relevant when you and other members were giving feedback initially on the studies. Somehow, I understood the comments then. But, now since I provided two opinions on implementing those improved study designs to make the feedback a little better, I now need to state my credentials.

 

[GimpGenius]

Good gravy. You basically want to turn the thread into an NP love fest. Note the second word in this website. You've been given feedback, yet you still insist on pushing whatever agenda you have (and honestly, I don't even know what you're "on topic" point is). You're either being willfully obtuse or are so entrenched in your ideas that your low levels of evidence are dangerous.

Physicians can't have a legitimate conversation with you, very few mid levels are weighing in, and you can't or won't engage in an honest debate; obfuscation does not a good discussion make. Either have an open discussion with your colleagues or spend your time figuring out how to make a better study.

This thread reeks of troll.

 

[762513]

Good gravy. You basically want to turn the thread into an NP love fest. Note the second word in this website. You've been given feedback, yet you still insist on pushing whatever agenda you have (and honestly, I don't even know what you're "on topic" point is). You're either being willfully obtuse or are so entrenched in your ideas that your low levels of evidence are dangerous.

Physicians can't have a legitimate conversation with you, very few mid levels are weighing in, and you can't or won't engage in an honest debate; obfuscation does not a good discussion make. Either have an open discussion with your colleagues or spend your time figuring out how to make a better study.

This thread reeks of troll.

There will never be an "NP love fest." Even when a thread is asking only current DNP students to discuss their graduate school experiences we still had PA's and med students giving their two cents and being offensive. Here, let me help you, NP's are horrible people and don't care about anyone but themselves. There, it's done, we talked badly about NP's, hope you feel better.

Calling someone a troll for refusing to answer a question they feel uncomfortable answering is not a mature move. Out of an abundance of caution, for whatever reason, real or imaginary, he does not wish to disclose his profession. Either move on with the discussion, or ignore the thread.

 

[hamstergang]

It certainly wasn't relevant when you and other members were giving feedback initially on the studies. Somehow, I understood the comments then. But, now since I provided two opinions on implementing those improved study designs to make the feedback a little better, I now need to state my credentials.

I asked about your background because your comments made it sound like you had no formal training in evaluating or designing studies. You said things like "drug trial formatting (double-blind...)," which is just weird. Yes, drug companies will do doubled blinded studies to test their drugs, but that's not unique to drug trials, and certainly all drug trials aren't double blinded. You didn't think that the journal a study was published in or the authors were relevant in evaluating how valid a study is. Your response to how an ideal study on NP/PA/MD/DO equivalence should be set up also seemed untrained -- you stated that we would need to use the exact same patient to really test the variables.

So in several areas, feedback was given on the studies already done and the dream study on this issue, and your responses tell me that we're jumping the gun. If you really don't get why the journal matters, if you really think we need to use the exact same patients, then we need to start with the basics. We're having this discussion at 2 different levels which will prevent progress from being possible. Or maybe you do understand these issues but have a more advanced reason for discounting them -- then, we would need to start the discussion there. If you actually want to understand the answers to the questions you ask, then you would benefit from answering my simple question on background. It won't identify you. But it can help.

 

[GimpGenius]

There will never be an "NP love fest." Even when a thread is asking only current DNP students to discuss their graduate school experiences we still had PA's and med students giving their two cents and being offensive. Here, let me help you, NP's are horrible people and don't care about anyone but themselves. There, it's done, we talked badly about NP's, hope you feel better.

Calling someone a troll for refusing to answer a question they feel uncomfortable answering is not a mature move. Out of an abundance of caution, for whatever reason, real or imaginary, he does not wish to disclose his profession. Either move on with the discussion, or ignore the thread.

Again, Student Doctor Network. It's an Internet forum for the neurotic and zealous. If you're not ready to deal with that, there are plenty of other places to go.

It would also be worthwhile to address issues regarding the studies themselves. Previous posters have done this, and you've either been ignorant to the basic premises or unwilling to engage. In the former case, knowing where you are from an educational standpoint helps. In the latter, again, there are other places to post.

As far as the troll suggestion goes, either engage or deal with accusations of incredulity. Thus far you haven't provided any substantial argument toward your points. Assuming you're an NP (and let's not kid ourselves, you either are or are in support of them), then the onus of proof is on you. Previous posts have outlined issues involved in all of the studies you've cited. You haven't addressed any of them in a meaningful way. "Stay on topic" is, frankly, a poor way of avoiding an actual discussion with your peers. If you can't make an argument with the intellectual rigor required of the group you're trying to make a point toward (i.e. physicians), perhaps you should rethink your argument.

So... yeah, sure, I'm "not mature." I like to think of it as calling you out on intellectual cowardice in a forum where anonymity reigns supreme. Limiting discussion to "only current DNP students" seems a bit restrictive, doesn't it? Oh, and it wasn't your initial argument.

So there's that.

Feel free to ignore; I'd be happy to oblige.

 

[762513]

..

Again, Student Doctor Network. It's an Internet forum for the neurotic and zealous. If you're not ready to deal with that, there are plenty of other places to go.

It would also be worthwhile to address issues regarding the studies themselves. Previous posters have done this, and you've either been ignorant to the basic premises or unwilling to engage. In the former case, knowing where you are from an educational standpoint helps. In the latter, again, there are other places to post.

As far as the troll suggestion goes, either engage or deal with accusations of incredulity. Thus far you haven't provided any substantial argument toward your points. Assuming you're an NP (and let's not kid ourselves, you either are or are in support of them), then the onus of proof is on you. Previous posts have outlined issues involved in all of the studies you've cited. You haven't addressed any of them in a meaningful way. "Stay on topic" is, frankly, a poor way of avoiding an actual discussion with your peers. If you can't make an argument with the intellectual rigor required of the group you're trying to make a point toward (i.e. physicians), perhaps you should rethink your argument.

So... yeah, sure, I'm "not mature." I like to think of it as calling you out on intellectual cowardice in a forum where anonymity reigns supreme. Limiting discussion to "only current DNP students" seems a bit restrictive, doesn't it? Oh, and it wasn't your initial argument.

So there's that.

Feel free to ignore; I'd be happy to oblige. .

I'm a DNP student and a student doctor as well. I'm not allowed a forum, however, even though psychologists, optometrists, and chiropractors are. Hmm. Interesting.

Attacking someone for feeling unsafe providing their credentials is also intellectually dishonest. Again, he could be a a paper boy, but if his arguments have merit, that is what actually matters.

 

[Makati2008]

I'm a DNP student and a student doctor as well. I'm not allowed a forum, however, even though psychologists, optometrists, and chiropractors are. Hmm. Interesting.

Attacking someone for feeling unsafe providing their credentials is also intellectually dishonest. Again, he could be a a paper boy, but if his arguments have merit, that is what actually matters. ...

You are allowed a forum, it's this one. DNP=PA. Just because you have doctor in your title it does not change your scope of practice.


Sent from my iPhone using SDN mobile app

 

[deleted480308]

Careful, that's an argument from stone, argument from repetition, begging the question, assuming the conclusion, fallacy of composition, fallacy of authority, appeal to tradition, fallacy of the single cause, and probably most accurately in this particular case a fallacy of personal incredulity.

As stated earlier you and I are not qualified to gauge whether this evidence is superior than opinion.

More studies need to be done. All we can conclude is that we don't yet know the answer.

I'm a DNP student and a student doctor as well. I'm not allowed a forum, however, even though psychologists, optometrists, and chiropractors are. Hmm. Interesting.

Attacking someone for feeling unsafe providing their credentials is also intellectually dishonest. Again, he could be a a paper boy, but if his arguments have merit, that is what actually matters. ...

Do you see the inconsistency here?

 

[VA Hopeful Dr]

I'm a DNP student and a student doctor as well. I'm not allowed a forum, however, even though psychologists, optometrists, and chiropractors are. Hmm. Interesting.

Attacking someone for feeling unsafe providing their credentials is also intellectually dishonest. Again, he could be a a paper boy, but if his arguments have merit, that is what actually matters. ...

This forum is for NP/PA/whatever, its why its the "Clinicians" part, its for all providers who don't have their own section. However, since this is the student doctor network, you're going to get more folks on the MD/DO pathway than anything else and that will show in how things are responded to.

The credentials thing was never about arguments not having merit, its about not even knowing how to phrase the arguments in ways that make sense. Its like when I take my car to the mechanic - I sometimes can't even put the problem into words that make sense to him.