DNPs will eventually have unlimited SOP

[sozme]

I believe the so-called Doctors of Nurse Practice or Practitioners are going to eventually get an unlimited scope of practice. In fact, I believe they will probably be doing surgery within a decade or so, just as soon as the AANP can develop residency programs to facilitate this and recruit turn-coat surgeons to "train" the first generation of NPs who will in turn teach the next. Of course this will be after they fully cement unlimited practice rights in all areas they are in right now (which by they way, they've been pretty successful at).

Why I do I believe this will happen? Answer - because the government will not have any other way to provide "health care" to the millions of people they've promised it to.

I'm sure there were many M.D.s who once said that podiatrists would never be allowed to do surgery, optometrists would never be allowed to do anything more than fit people for glasses, and chiropractors would never be widely seen as legitimate and receive Medicare compensation. Well, they were all wrong.

I'm sure at one point NPs had to be watched very closely (supervised, not "collaborated" with), and I remember a time in my state when they couldn't write for controlled substances (or anything for that matter, the doctors signature had to be on every prescription they wrote).

Nowadays, they "collaborate" with physicians. Collaborate? What does that even mean? Correct me because I could be wrong but so far as I know, "collaboration" = no supervision and no liability for the price of some random chart "reviews" by a physician who could be a 100 miles away from where the NP is practicing.

Without getting into a discussion about the Patient "Affordability" and "Protection" Act, please let me know:

- Do you agree NPs (DNPs, whatever they are calling themselves) will achieve full practice rights in all specialties (no physician supervision/collaboration/whatever required), restricted only by what their national organization and state boards of nursing allow?

- If yes, do you think this will be good or bad for the country's health and well-being?

^ Some would say yes, because more will be treated. In fact, according to the media reports I've looked at on this issue, most people seem eager to have NPs gain full autonomy.

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[notbobtrustme]

Primary care has been a dying field for doctors anyways. The economics of it haven't been working for some time now and I don't think that's going to change even with the PPACA.

 

[cbrons]

I agree with the comment some random person made on a CNN report celebrating the woman who helped found the NP movement:

"The truth is the US is broke and can no longer afford to pay for physicians to be on the front lines in health care. NPs came about to serve very rural areas where there is no physician. Now as a part of Health Care Reform we will see a big PR campaign to distract from the fact that NPs have less than half the training of physicians and most could not get in to med school if they tried. There will be misdiagnoses, delays for treatment, etc. You get what you pay for."
​

 

[ArcGurren]

I believe the so-called Doctors of Nurse Practice or Practitioners are going to eventually get an unlimited scope of practice. In fact, I believe they will probably be doing surgery within a decade or so, just as soon as the AANP can develop residency programs to facilitate this and recruit turn-coat surgeons to "train" the first generation of NPs who will in turn teach the next. Of course this will be after they fully cement unlimited practice rights in all areas they are in right now (which by they way, they've been pretty successful at).

Why I do I believe this will happen? Answer - because the government will not have any other way to provide "health care" to the millions of people they've promised it to.

I'm sure there were many M.D.s who once said that podiatrists would never be allowed to do surgery, optometrists would never be allowed to do anything more than fit people for glasses, and chiropractors would never be widely seen as legitimate and receive Medicare compensation. Well, they were all wrong.

I'm sure at one point NPs had to be watched very closely (supervised, not "collaborated" with), and I remember a time in my state when they couldn't write for controlled substances (or anything for that matter, the doctors signature had to be on every prescription they wrote).

Nowadays, they "collaborate" with physicians. Collaborate? What does that even mean? Correct me because I could be wrong but so far as I know, "collaboration" = no supervision and no liability for the price of some random chart "reviews" by a physician who could be a 100 miles away from where the NP is practicing.

Without getting into a discussion about the Patient "Affordability" and "Protection" Act, please let me know:

- Do you agree NPs (DNPs, whatever they are calling themselves) will achieve full practice rights in all specialties (no physician supervision/collaboration/whatever required), restricted only by what their national organization and state boards of nursing allow?

- If yes, do you think this will be good or bad for the country's health and well-being?

^ Some would say yes, because more will be treated. In fact, according to the media reports I've looked at on this issue, most people seem eager to have NPs gain full autonomy.

tl;dr bro

 

[yoyostring]

AMA support for Obamacare was purchased.

Guarantee they will be rethinking their support when they are powerless to protect the docs they represent from encroachment on their scope of practice.

 

[Michael Corleon]

Us wants cheap and not good health care. Recognize.

 

[notbobtrustme]

AMA support for Obamacare was purchased.

Guarantee they will be rethinking their support when they are powerless to protect the docs they represent from encroachment on their scope of practice.

not really, doctors are just going to move to fields where their skills are irreplaceable. People may not feel like they need a board-certified primary care practitioner, but I doubt you'll find many people willing to see a NP or PA for cancer, surgery, heart conditions, GI, etc etc. It's one thing to get on blood pressure medications and 6 month physicals. People don't see the logic and reasoning behind everything a physician does and so they don't value that kind of service when compared to NPs/PAs. However, people do recognize that some things a doctor does cannot be replicated.

 

[cbrons]

not really, doctors are just going to move to fields where their skills are irreplaceable. People may not feel like they need a board-certified primary care practitioner, but I doubt you'll find many people willing to see a NP or PA for cancer, surgery, heart conditions, GI, etc etc. It's one thing to get on blood pressure medications and 6 month physicals. People don't see the logic and reasoning behind everything a physician does and so they don't value that kind of service when compared to NPs/PAs. However, people do recognize that some things a doctor does cannot be replicated.

You sure about that? I'd bet a lot of money most people will buy the propaganda put out by the AANP.

 

[Dysgenics]

Well listen up guys, there are three very simple reasons behind all of this.

1) The population of the United States is increasing.
2) The medical school (M.D.) spots have not been increased for almost 30 years except for very recently.
3) The residency spots for (M.D.s) are not being increased in number.

Perfect example: There are more ophthalmologists retiring than are being produced. Solution? Optometry gains numerous scope of practice victories in every state for the past 40 years.

Lesson?: The human universe balances itself out. Entropy may be increasing but it may not apply to humans as much as the natural world.

 

[SpecterGT260]

Well listen up guys, there are three very simple reasons behind all of this.

1) The population of the United States is increasing.
2) The medical school (M.D.) spots have not been increased for almost 30 years except for very recently.
3) The residency spots for (M.D.s) are not being increased in number.

Perfect example: There are more ophthalmologists retiring than are being produced. Solution? Optometry gains numerous scope of practice victories in every state for the past 40 years.

Lesson?: The human universe balances itself out. Entropy may be increasing but it may not apply to humans as much as the natural world.

Shnurek? Did you make a new account since your other one is on hold?

 

[calvnandhobbs68]

Shnurek? Did you make a new account since your other one is on hold?

He's so sneaky

 

[link2swim06]

Well listen up guys, there are three very simple reasons behind all of this.

1) The population of the United States is increasing.
2) The medical school (M.D.) spots have not been increased for almost 30 years except for very recently.
3) The residency spots for (M.D.s) are not being increased in number.

Perfect example: There are more ophthalmologists retiring than are being produced. Solution? Optometry gains numerous scope of practice victories in every state for the past 40 years.

Lesson?: The human universe balances itself out. Entropy may be increasing but it may not apply to humans as much as the natural world.

Actually residency spots are increasing, just very slow compared to the rapid increase med school spots.

Also its not the routine population increase which really the issue. Its that a huge part of our population is about to be senior citizens.


At the end of the day who cares? Doctors will always be on the forefront of medicine and will always have a niche. Medicine is becoming more complex everyday. Look back at medicine, things once known by doctors are now commonly know by nurses. For every inch lost by doctors, its regained with new/more advanced procedures or more complex patients.

 

[cbrons]

New Acute Care Nurse Practicioner "Fellowship" program --> http://www.mc.vanderbilt.edu/reporter/index.html?ID=12364

Now even fellowship trained CC/Pulm docs can be replaced by NPs.

 

[link2swim06]

New Acute Care Nurse Practicioner "Fellowship" program --> http://www.mc.vanderbilt.edu/reporter/index.html?ID=12364

Now even fellowship trained CC/Pulm docs can be replaced by NPs.

Thats terrifying.

 

[Bacchus]

Primary care has been a dying field for doctors anyways. The economics of it haven't been working for some time now and I don't think that's going to change even with the PPACA.

It's not really the best way to make money, I agree, especially when compared to a group of your peers with the same base education.

What I don't get, is the "doomsday" scenarios though. Primary care is a poor choice if you're going to be opening your own office, but its still a legitimate career as is psych and peds if you're going to be working in a hospital-owned office.

I know some PCPs in my area that still do quite well with this option and have a great amount of autonomy. Of course, they've been at this awhile. I think it all comes down to your first few years practicing as a resident and attending and how you allocate funds to the repayment process.

 

[swamprat]

New Acute Care Nurse Practicioner "Fellowship" program --> http://www.mc.vanderbilt.edu/reporter/index.html?ID=12364

Now even fellowship trained CC/Pulm docs can be replaced by NPs.

Its put together by MDs..we do it to ourselves.

 

[PrideNeverDie]

easy solution

we should be welcoming the midlevels and transforming ourselves into their managers
have our lobbyists make it so all midlevels have to have a doctor supervise them to get full insurance reimbursement

we become more valuable
DNPs do all the dirty work
we work less hours
spend more time with our family
make more money

brb lifelong residents in my private practice

 

[SpecterGT260]

easy solution

we should be welcoming the midlevels and transforming ourselves into their managers
have our lobbyists make it so all midlevels have to have a doctor supervise them to get full insurance reimbursement

we become more valuable
DNPs do all the dirty work
we work less hours
spend more time with our family
make more money

brb lifelong residents in my private practice

That's kinda how things were

 

[PrideNeverDie]

That's kinda how things were

and it can still be that way

all it takes is the fear of losing malpractice suits because the public believes they deserve a doctor to be responsible for their care instead of a DNP

 

[pkwraith]

Government has no other way to provide healthcare? Uh, that's pretty incorrect. They can increase residency funding, they just are choosing not to. To say that is no other options is pretty simplistic.

Also, stop with the douchey quotation marks you're throwing in everywhere. Seriously? Patient "Affordability" and "Protection" Act?

 

[Bacchus]

Government has no other way to provide healthcare? Uh, that's pretty incorrect. They can increase residency funding, they just are choosing not to. To say that is no other options is pretty simplistic.

Also, stop with the douchey quotation marks you're throwing in everywhere. Seriously? Patient "Affordability" and "Protection" Act?

You can't just create residency funding. CMS won't be solvent in 15 years, so it's kind of hard to make the argument, "even though you're going broke spend some more money."

 

[SpecterGT260]

and it can still be that way

all it takes is the fear of losing malpractice suits because the public believes they deserve a doctor to be responsible for their care instead of a DNP

I agree here.

 

[notbobtrustme]

Medicare funding could be solved for 20 years if Congress removed the cap on Medicare taxes. Currently, only the first 110,000 dollars earned are taxable for SS/Medicare, meaning Warren Buffet and someone who makes 110,000 dollars a year pay the same amount of SS/Medicare tax. Remove that cap and SS/Medicare are easily solvent for 20 years.

 

[smq123]

I believe the so-called Doctors of Nurse Practice or Practitioners are going to eventually get an unlimited scope of practice. In fact, I believe they will probably be doing surgery within a decade or so, just as soon as the AANP can develop residency programs to facilitate this and recruit turn-coat surgeons to "train" the first generation of NPs who will in turn teach the next. Of course this will be after they fully cement unlimited practice rights in all areas they are in right now (which by they way, they've been pretty successful at).

Out of curiosity....why does it matter so much? Why does it bother you?

I work with a couple of NPs. They do their own thing, only asking me for help if they're not sure about something. I'd say they're at the level of a good 3rd year resident, forever...once things get more complicated or far away from a textbook, they get a little spooked. I don't agree with the NP's treatment plans all the time, and sometimes I think that they miss more complex stuff, but that's to be expected.

And I don't agree when DNPs say that they're "equivalent" or "just as good" as an MD/DO.

But a DNP seeing patients on their own? Why does that bother you?

I'm so inundated with difficult complicated patients that I feel like I'm always drowning. These are tough tough patients, and there are never enough MDs or NPs....the clinic schedule is always packed to bursting. So there are plenty of patients to go around for everyone....

 

[cbrons]

Government has no other way to provide healthcare? Uh, that's pretty incorrect. They can increase residency funding, they just are choosing not to. To say that is no other options is pretty simplistic.

Also, stop with the douchey quotation marks you're throwing in everywhere. Seriously? Patient "Affordability" and "Protection" Act?

You're just begging the question "they can increase residency funding, they are just choosing not to." Well why do you think that is? Residency programs = cost a lot. DNP residency = non-existent (so far as I can tell it is all on the job training). So yes, it is pretty simplistic.

I work with a couple of NPs. They do their own thing, only asking me for help if they're not sure about something. I'd say they're at the level of a good 3rd year resident,

With respect, I would just like to clarify, do you really believe they are just as competent, knowledgeable and reliable as someone who went through 4 years of medical school, board exams, and 3 years of residency? I assume that's what you mean by "at the level of a good 3rd year resident."

 

[cbrons]

Its put together by MDs..we do it to ourselves.

It's nice when the older, seasoned members of the profession throw the whole trade under the bus for the younger generation.

I wonder why I don't see lawyers training paralegals to replace them... after all, it would be cheaper to be represented by a paralegal, and when they screw up its unlikely that someone might die. This sort of thing of course happens all the time in the medical profession.

Instead of moving forward like we have through history, where credentialing becomes even more rigorous and time-consuming, as the knowledge of the trade continues to grow, we're actually moving backwards.

 

[Frazier]

It's nice when the older, seasoned members of the profession throw the whole trade under the bus for the younger generation.

I wonder why I don't see lawyers training paralegals to replace them... after all, it would be cheaper to be represented by a paralegal, and when they screw up its unlikely that someone might die. This sort of thing of course happens all the time in the medical profession.

Instead of moving forward like we have through history, where credentialing becomes even more rigorous and time-consuming, as the knowledge of the trade continues to grow, we're actually moving backwards.

No need...the new law grads are willing to work for cheaper rates than paralegals. I'm only half-joking.

$12/hr doc review FTW

 

[duckie99]

You sure about that? I'd bet a lot of money most people will buy the propaganda put out by the AANP.

I am sure about it. People don't want to see the nurse. They want to see the doctor. Everybody knows that.

Is a MD/DO always necessary? no. Do people know that? no. They definitely aren't necessary for regular physical but I predict healthy physicals for adults will not be happening in 10 years as studies have shown them to be unnecessary.

But a MD will always be involved in the care of patients who have medical conditions. It is will always be true for ANY surgery or specialty medicine. NPs can fill roles however in under-served areas and it places of basic screening care like your local pharmacy clinic. They cannot replace the training a physician undergoes.

The role of the NP/PA is essentially to be the intern - see easy patients alone/ sick ones with the physician, dictate notes, put in orders, etc. It allows the physician to see more patients in the same amount of time. A good NP can function as a 2nd or 3rd year resident, not necessarily in comprehensive knowledge but in ability to perform specific tasks. Most probably function as an intern.

 

[smq123]

With respect, I would just like to clarify, do you really believe they are just as competent, knowledgeable and reliable as someone who went through 4 years of medical school, board exams, and 3 years of residency? I assume that's what you mean by "at the level of a good 3rd year resident."

Well, keep in mind that the average age of the NPs I work with has been in the mid-late 40s.

Reliable? YES. Absolutely. Many of them are experienced NPs and were experienced nurses before that. They know how to take care of patients, they show up on time, they're respectful. They're even respectful of me, as a physician, despite the fact that I'm young enough to be their grandkid. They don't complain much, which is more than I can say for the average PGY-3....or hell, even the average intern.

Competent? Yeah. They take reasonable care of the patients that they see. The things that they do are within the standard of practice, although I think that they are more eager to refer patients out than I am. But, again, referring to a specialist is not a deviation from the standard of practice.

Knowledgeable? I'll compromise and say no. They have enough knowledge to take care of the average patient that walks in. Do they have enough knowledge to take care of the zebras? No, not necessarily. Nor do I think that they have enough knowledge to recognize the zebras. And I have found that their training is much more focused - if they're trained to be hospital NPs, they have a hard time switching to outpatient, and vice versa. I think that MD/DO residency training DOES give you more flexibility in that regard.

Thinking it over, I might amend my statement to a mid-year PGY-2. That being said, many mid-year PGY-2s moonlight independently, despite not having completed a residency and despite being just a year and a half away from med school.

 

[cbrons]

I am sure about it. People don't want to see the nurse. They want to see the doctor. Everybody knows that.

Is a MD/DO always necessary? no. Do people know that? no. They definitely aren't necessary for regular physical but I predict healthy physicals for adults will not be happening in 10 years as studies have shown them to be unnecessary.

But a MD will always be involved in the care of patients who have medical conditions. It is will always be true for ANY surgery or specialty medicine. NPs can fill roles however in under-served areas and it places of basic screening care like your local pharmacy clinic. They cannot replace the training a physician undergoes.

The role of the NP/PAs is essentially to be the intern - see easy patients alone/ sick ones with the physician, dictate notes, put in orders, etc. It allows the physician to see more patients in the same amount of time. A good NP can function as a 2nd or 3rd year resident, not necessarily in comprehensive knowledge but in ability to perform specific tasks. Most probably function as an intern.

That's all well and good, but I don't think you understand that they accepted that role initially only as a means to gradually gain greater and greater autonomy.

Ask yourself if this NP in this interview will accept the role you laid out for her (see easy patients alone/ sick ones with the physician, dictate notes, put in orders, etc.):

[YOUTUBE]ai0PSXcd6dw[/YOUTUBE]

(its 4 minutes)

 

[calvnandhobbs68]

It's nice when the older, seasoned members of the profession throw the whole trade under the bus for the younger generation.

I wonder why I don't see lawyers training paralegals to replace them... after all, it would be cheaper to be represented by a paralegal, and when they screw up its unlikely that someone might die. This sort of thing of course happens all the time in the medical profession.

Instead of moving forward like we have through history, where credentialing becomes even more rigorous and time-consuming, as the knowledge of the trade continues to grow, we're actually moving backwards.

Haha because you can get a lawyer to do work for you at the cost of a paralegal...lawyers have the exact opposite problem. Too many lawyers, not enough clients. You can get a lawyer to do a no fault divorce for 150 bucks. Go check out the yellow pages and you'll find pages of lawyers whose offices you can just walk into. It's also hard to compare the two because lawyers have a much lower demand from the general public. I've never had to consult a lawyer for anything so far, but I've probably been to a doctor's office 20+ times over the course of my life (just think about all the well-baby checkups, peds checkups, immunizations, etc.).

I have never seen a medical office in any specialty that wasn't at least somewhat busy. Never. I'm sure you've had the same experience. Even in the lowest volume family practice I've seen (which is my own family doc) I can't get an appointment for a few days. Like smq123 said there usually isn't enough time in the day to see all the patients.

 

[calvnandhobbs68]

No need...the new law grads are willing to work for cheaper rates than paralegals. I'm only half-joking.

$12/hr doc review FTW

lol beat me to it.

 

[calvnandhobbs68]

Medicare funding could be solved for 20 years if Congress removed the cap on Medicare taxes. Currently, only the first 110,000 dollars earned are taxable for SS/Medicare, meaning Warren Buffet and someone who makes 110,000 dollars a year pay the same amount of SS/Medicare tax. Remove that cap and SS/Medicare are easily solvent for 20 years.

The ACA tries to address some of this with a 3.8% Medicare tax on capital gains...and yes I know this may affect some of us but I take solace in the fact that it will hopefully affect the people making millions from capital gains or selling real estate for a $500,000 capital gain as well.

http://health.burgess.house.gov/uploadedfiles/one_page_on_unearned_medicare_tax.pdf

 

[Perrotfish]

Instead of moving forward like we have through history, where credentialing becomes even more rigorous and time-consuming, as the knowledge of the trade continues to grow, we're actually moving backwards.

The credentialing hasn't gotten more rigerous and time consuming because the training has gotten more advanced. It's gotten more rigerous and time consuming because we allow medicine to function as a trust. The people who get to use us as better than free labor for the duration of our training are also allowed to vote on the length of our training, and unlike every other profession in America if you go outside their system its actually a felony. They get to charge patients as though they saw a board certified physician, but Medicaid reimburses the program for the physician's salary twice over, so they get at least part of the income from being a doctor without training to be one. There is nothing selfless going on when surgery decides that yet another year is the bare minimum to finish a gen surg residency, all for the privlidge of chucking 90% of that knowledge in the garbage and beginning three years of fellowship training.

Whether the field of medicine is actually harder than it was two generations ago is an interesting question. We certainly have a wider range of diagnoses and therapies, but we also have more algorithems, do fewer of our own procedures, and perhaps most importantly we focus on a drastically smaller portion of the field of Medicine as a whole. At the start of WWII a country physician, with four years medical school and an Intern year, could in an average week deliver a child, close reduce one fracture, ampute a limb, treat (and advise his town on) an outbreak of a diabling/fatal pediatric infecious disease like HiB, counsel the depressed, triage and turf the mildly ill, all while running his own labs and reading his own films. Does a modern Intensivist or Neonatologist really match that level of complexity when they have a dozen subspecialists supporting them? Does our version of General practice even come close? I'm not sure the NPs are wrong, I think they aer perfectly qualified to do at least a large subset of what we do. More importantly I think it should be their right to sell their product to whoever is willing to buy.

 

[xenotype]

If you are drowning in patients now, wait until the 400+ DNP programs have put out substantially more DNPs than there are MDs. They will always be able to undercut you in salary because they don't have nearly the educational expense.

 

[smq123]

If you are drowning in patients now, wait until the 400+ DNP programs have put out substantially more DNPs than there are MDs. They will always be able to undercut you in salary because they don't have nearly the educational expense.

Exactly how many DNPs are being produced each year?

And how many DNPs are strictly 100% clinical, and not teaching, becoming faculty, becoming nurse managers, or doing other administrative work?

And how many DNPs are paid that much less than MDs? And by how much?

How much of your post is based on fact or on fear mongering? I mean it.

I'm not saying that DNP = MD. Of course not. Absolutely not, and my (limited) experience with NPs does not bear that out. But...how much of the fear of OMG EXPANDING SCOPE OF PRACTICE is based on genuine threat and how much of it is based on just fear?

 

[munchymanRX]

Exactly how many DNPs are being produced each year?

And how many DNPs are strictly 100% clinical, and not teaching, becoming faculty, becoming nurse managers, or doing other administrative work?

And how many DNPs are paid that much less than MDs? And by how much?

How much of your post is based on fact or on fear mongering? I mean it.

I'm not saying that DNP = MD. Of course not. Absolutely not, and my (limited) experience with NPs does not bear that out. But...how much of the fear of OMG EXPANDING SCOPE OF PRACTICE is based on genuine threat and how much of it is based on just fear?

FWIW, it's certainly one of the factors behind my desire to enter a non-primary care field, or at least one that's more procedure-based. I don't like the idea that someone with half the training or less can (on paper, and averaged over the whole population) do my job and have roughly the same outcomes. A policymaker isn't going to care about this or that physician's anecdotal experience with a smattering of NPs. They're going to look at papers like this one: http://www.ncbi.nlm.nih.gov/pubmed/10632281 and make their decisions.

For us, it's not a matter of fear. It's going to happen, and there's not a damn thing we can do about it. Healthcare is expensive and politicians are looking for ways to keep the cost down. This is an obvious way to accomplish that. All we can do is try to protect ourselves as best we can.

And schools wonder why less and less graduates are opting for primary care.

 

[Lokhtar]

Why wouldn't they? They are producing papers showing equivalence - if you want to show that physicians produce superior outcomes - it has to be proven.

 

[munchymanRX]

Why wouldn't they? They are producing papers showing equivalence - if you want to show that physicians produce superior outcomes - it has to be proven.

That's my point exactly. According to the data, the outcomes are the same. Rather than hemming and hawing about horses vs. zebras and who signs who's paychecks at the end of the day, it'd be better if us medical students adapted to the situation (one we can do little about-we are both outmanned and outgunned in terms of lobbying power) and tried to find a niche where we can distinguish ourselves from NPs. Hence my interest in procedure-heavy specialties.

 

[xenotype]

That's my point exactly. According to the data, the outcomes are the same. Rather than hemming and hawing about horses vs. zebras and who signs who's paychecks at the end of the day, it'd be better if us medical students adapted to the situation (one we can do little about-we are both outmanned and outgunned in terms of lobbying power) and tried to find a niche where we can distinguish ourselves from NPs. Hence my interest in procedure-heavy specialties.

PAs and CRNAs are doing almost all of the procedures in procedure heavy fields like IR, pain, anesthesia, critical care. Not sure that plan will save you. In fact its probably much easier to do the procedural aspects of rads/ccm than it is to do the thinking parts.

 

[SpecterGT260]

Why wouldn't they? They are producing papers showing equivalence - if you want to show that physicians produce superior outcomes - it has to be proven.

The studies are inappropriate.

 

[Lokhtar]

The studies are inappropriate.

So do ones that are appropriate. Until then, it's data that people can take to their legislatures vs. no data.

You won't win any battles like that.

 

[surftheiop]

Who really cares? If the DNPs start harming patients then their use will be curtailed just like happens to any new procedure/drug/medical model/etc. that is not as safe as expected.

Medstudents always trot out the "patient safety" stuff which is important, but you know 99% of the time thats not their actual motivation, they are scared of their paycheck/prestige taking a hit. I think the reality is our paychecks arent going to be getting any bigger regardless of what happens with DNPs, so why lose so much sleep over someone else getting called doctor?

 

[SpecterGT260]

So do ones that are appropriate. Until then, it's data that people can take to their legislatures vs. no data.

You won't win any battles like that.

Trust me I would love to. There are obstacles to putting those together and the organizations using the inappropriate study designs have interests in particular outcomes and are willing to put in the resources to put the papers together

 

[Lokhtar]

Trust me I would love to. There are obstacles to putting those together and the organizations using the inappropriate study designs have interests in particular outcomes and are willing to put in the resources to put the papers together

All of that may be true, but the fact still remains that you will never win a battle in the statehouse or congress if the other side is offering a more cost effective solution and has data to back it up. You just won't. So whatever excuses there are for not doing those studies, they need to get over them, or accept the fact that it's going to happen and deal with it.

 

[xenotype]

Who really cares? If the DNPs start harming patients then their use will be curtailed just like happens to any new procedure/drug/medical model/etc. that is not as safe as expected.

Medstudents always trot out the "patient safety" stuff which is important, but you know 99% of the time thats not their actual motivation, they are scared of their paycheck/prestige taking a hit. I think the reality is our paychecks arent going to be getting any bigger regardless of what happens with DNPs, so why lose so much sleep over someone else getting called doctor?

Paycheck matters when you have to pay back a half a million dollars in loans at seven percent interest. Some physicians in some specialties are likely replaceable by DNPs, and will have trouble finding work or will be forced to work at a small fraction of their current salaries. I have heard that the VA is preferentially hiring NPs over MDs due to cost savings. These things are a big deal.

 

[sozme]

So I guess the consensus generally is: who cares?

Why waste time and money on medical school, just get a nursing degree, get the "clinical experience" that comes with being a nurse, take a grad program where a lot of it is sociology and not clinical, and some of it delivered online (or all of it insome cases), and learn most of your actual trade on-the-job (but not in residency).

If the doctors and med students on SDN don't care, then I guess it doesn't matter.

 

[Rendar5]

With respect, I would just like to clarify, do you really believe they are just as competent, knowledgeable and reliable as someone who went through 4 years of medical school, board exams, and 3 years of residency? I assume that's what you mean by "at the level of a good 3rd year resident."

I'd rather have a midlevel than an intern honestly. For basic patient cases, yes, I would say that is accurate. For complex patient cases, senior residents start showing superiority.

 

[cbrons]

"The curricula for both degrees also vary. Just as an example, medical students learn anatomy, biochemistry, physiology, pharmacology, psychology, microbiology, and pathology, among numerous other courses focusing on treatment and prevention of a wide array of diseases.​

Some of the courses offered by various DNP programs (determined by each educational institution) include Evidence-Based Practice and Nursing Systems, Health Policy Development & Implementation, Ethics and Public Policy in Healthcare Delivery, and Global Health & Social Justice."


from - http://studentdoctor.net/2011/04/sdn-reports-the-dnp-degree/

​

 

[cbrons]

FWIW, it's certainly one of the factors behind my desire to enter a non-primary care field

Based on what has been said here by many attendings, residents, and upper-class medical students, why in the world would anyone ever do primary care? Perhaps we should close all primary care residencies and leave more money for specialization, because the DNPs provide equivalent care at a fraction of the cost. Seems pretty unethical for medical schools to try to push someone with 500k in debt into a job that a much cheaper DNP can do.