DNPs will eventually have unlimited SOP

[SpecterGT260]

peteB, whether you're right or wrong, you're such a godawful know-it-all last-word-grabbing literal thinker, that I just want to hit you repeatedly until forget every last bit of fancy-shmancy debate club logic.

Ouch

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[Rendar5]

Ouch

I don't want to be mean to him or anything, but wow, that degree of argumentativeness is kinda tiresome, and I think the dead horse has been beaten quite a bit.

 

[peteB]

peteB, whether you're right or wrong, you're such a godawful know-it-all last-word-grabbing literal thinker, that I just want to hit you repeatedly until you forget every last bit of fancy-shmancy debate club logic.

Wow. You are pretty wound up. You need to relax man, it was just a spirited discussion!

 

[evilbooyaa]

PeteB wins troll of the year award ITT.

Just ignore his triple and quadruple posting and it'll all end.

Now to get back on topic: DNPs should have to pass USMLE Steps 1-3 and pass residency boards. If they do all that, I don't see why they can't practice independently if they do that. Of course without the background in basic sciences all but the most astute and intelligent of DNPs will obviously fail at some point (like 50% of the Columbia DNPs failing a weak step 3)

I'd consider maybe giving them just Step 2 and Step 3 to see if they can diagnose and manage diseases appropriately, and letting them skip Step 1. Thoughts on that last sentence of mine?

 

[xenotype]

PeteB wins troll of the year award ITT.

Just ignore his triple and quadruple posting and it'll all end.

Now to get back on topic: DNPs should have to pass USMLE Steps 1-3 and pass residency boards. If they do all that, I don't see why they can't practice independently if they do that. Of course without the background in basic sciences all but the most astute and intelligent of DNPs will obviously fail at some point (like 50% of the Columbia DNPs failing a weak step 3)

I'd consider maybe giving them just Step 2 and Step 3 to see if they can diagnose and manage diseases appropriately, and letting them skip Step 1. Thoughts on that last sentence of mine?

Step 1, 2, and 3. No shortcuts.

 

[cbrons]

PeteB wins troll of the year award ITT.

Just ignore his triple and quadruple posting and it'll all end.

Now to get back on topic: DNPs should have to pass USMLE Steps 1-3 and pass residency boards. If they do all that, I don't see why they can't practice independently if they do that. Of course without the background in basic sciences all but the most astute and intelligent of DNPs will obviously fail at some point (like 50% of the Columbia DNPs failing a weak step 3)

I'd consider maybe giving them just Step 2 and Step 3 to see if they can diagnose and manage diseases appropriately, and letting them skip Step 1. Thoughts on that last sentence of mine?

If step 1 isnt important, why do i have to take it?

 

[hrandani]

Listen, this is crazy.

If they want to get paid throughout their training and then do some online degree, all the while living in the location of their choice, why the hell do I have to move all over the country several times during my career, PAY for the PRIVILEGE of a year of grueling 80 hour work weeks and then limit myself to one field of medicine for the rest of my life?

If NPs want to shoehorn their way into independent clinical practice so badly through this ruse of rural care, mandate five year NP residencies in the middle of nowhere for 40k a year.

Also, you were an OB nurse for ten years? Congratulations, OB Noctor. That's it for you. No dermatology procedures. I don't give a rat's ass about how many buckets of empathy you have for your patients, that's not a license to kill.

This is all after they pass their steps of course. We wouldn't want the poor to be underserved by incompetent noctors. That's abusive.

You put this into effect, all this BS would disappear overnight.

 

[greatnt249]

Anyway.... To get back to the actual topic of the thread...

My point was that it is not unreasonable to think that if compensated well enough, there would be surgeons willing to train DNPs. There are enough people out there who would put personal gain ahead of protecting their profession. If you don't believe that's true, then I have a bridge to sell you. Just take a look at radiologists who participate in outsourcing.

I actually do know a surgical resident who has agreed to do it, but of course I can't prove that without giving away my anonymity.

Paying surgeons to train nurses how to perform surgery kind of defeats the idea of midlevels being present to provide "more affordable" care. You're going on about how you know people who would be willing to train nurses to do surgery; where exactly do you see that money coming from? What advantage does having a nurse perform surgery even provide?

 

[peteB]

Paying surgeons to train nurses how to perform surgery kind of defeats the idea of midlevels being present to provide "more affordable" care. You're going on about how you know people who would be willing to train nurses to do surgery; where exactly do you see that money coming from? What advantage does having a nurse perform surgery even provide?

The upfront costs are high, but the long term costs are lower.

The advantage is the same as for primary care. Nurses are cheaper than MDs.

 

[Dharma]

To paraphrase Blue Dog, an attending over in the FM forums, if you think you could be replaced by a midlevel, then maybe you should be. Quality physicians have very little to worry about.

Are things changing? Of course. Let your own skills (and those to be) speak for themselves. All it takes is a missed zebra by an autonomous midlevel for patients to realize that they are safer overall in the hands of competent physicians. Say the numbers of DNPs practicing autonomously skyrocket. Odds are misdiagnoses will also be on the increase and these statistics will find their way into studies, media, etc. Folks will run for the hills to find physicians.

All of this said, the average DNP does not see her/himself as being the equivalent of a MD/DO and only wishes to serve his/her role on a healthcare team, which IS the future of the practice of medicine. Those wishing to fly-solo, well they have their work cut out for them. Just wait until it starts raining lawsuits and Noctor Smith finds herself chin deep in malpractice insurance. Lawyers will have a field day with this $hit and I'm sure those in the know, standing on the sidelines, are just licking their chops waiting to pounce on easy prey.

Tl;dr version: nothing to fear. Control what you have control over- becoming a kick ass physician.

 

[SpecterGT260]

To paraphrase Blue Dog, an attending over in the FM forums, if you think you could be replaced by a midlevel, then maybe you should be. Quality physicians have very little to worry about.

Are things changing? Of course. Let your own skills (and those to be) speak for themselves. All it takes is a missed zebra by an autonomous midlevel for patients to realize that they are safer overall in the hands of competent physicians. Say the numbers of DNPs practicing autonomously skyrocket. Odds are misdiagnoses will also be on the increase and these statistics will find their way into studies, media, etc. Folks will run for the hills to find physicians.

All of this said, the average DNP does not see her/himself as being the equivalent of a MD/DO and only wishes to serve his/her role on a healthcare team, which IS the future of the practice of medicine. Those wishing to fly-solo, well they have their work cut out for them. Just wait until it starts raining lawsuits and Noctor Smith finds herself chin deep in malpractice insurance. Lawyers will have a field day with this $hit and I'm sure those in the know, standing on the sidelines, are just licking their chops waiting to pounce on easy prey.

Tl;dr version: nothing to fear. Control what you have control over- becoming a kick ass physician.

I really do hope it works that way.... but patient preference, propaganda, relative health of PCP patients, and patient ignorance are variables which cannot really be predicted. We have already talked about a number of ways in which DNPs can dress themselves up in the data to look like quality physicians even when they are not.

 

[Dharma]

I really do hope it works that way.... but patient preference, propaganda, relative health of PCP patients, and patient ignorance are variables which cannot really be predicted. We have already talked about a number of ways in which DNPs can dress themselves up in the data to look like quality physicians even when they are not.

I hear ya. The truth will speak for itself eventually... hopefully, assuming proper outcome studies are performed without finagling results to create skewed interpretations. Gotta love the statistical game of twister people play to bend results in their favor.

I haven't read the whole thread, but physicians need to start teaming up a bit politically-speaking and have their voices heard as a collective whole, without coming off as bunch of pompous self-fellating a-holes. It's bad enough a good chunk of the population thinks most doctors are money hungry egomaniacs living the lifestyle of Christian Troy.

 

[SpecterGT260]

I hear ya. The truth will speak for itself eventually... hopefully, assuming proper outcome studies are performed without finagling results to create skewed interpretations. Gotta love the statistical game of twister people play to bend results in their favor.

I haven't read the whole thread, but physicians need to start teaming up a bit politically-speaking and have their voices heard as a collective whole, without coming off as bunch of pompous self-fellating a-holes. It's bad enough a good chunk of the population thinks most doctors are money hungry egomaniacs living the lifestyle of Christian Troy.

we will see how things play out over the next 15 years or so. I could easily see myself getting involved in policy and doing such studies later on in practice. I have a pretty healthy (Unhealthy? ) interest in these issues and once I don't feel like competing in academic research it may be a nice change of pace. But by then some bastardization of the healthcare team model may be in place and it could be too late. I doubt it, but maybe...

 

[calvnandhobbs68]

The upfront costs are high, but the long term costs are lower.

The advantage is the same as for primary care. Nurses are cheaper than MDs.

Really? You think nurses would let insurance pay them THAT much less for surgery? Doubt it. They'll use the same arguments surgeons use (surgery is dangerous, high malpractice, high risk) to justify their pay. Already we keep seeing NPs push for higher reimbrsements in primary care.

I think those are valid arguments btw which is why we require such thorough surgery training.

 

[SpecterGT260]

Really? You think nurses would let insurance pay them THAT much less for surgery? Doubt it. They'll use the same arguments surgeons use (surgery is dangerous, high malpractice, high risk) to justify their pay. Already we keep seeing NPs push for higher reimbrsements in primary care.

I think those are valid arguments btw which is why we require such thorough surgery training.

Right. Nurses are cheaper BECAUSE they don't do these things. Once they are indistinguishable from doctors (assuming that ever happens) they will demand the same pay. This cannot end with equal practice at lower cost.

 

[calvnandhobbs68]

Listen, this is crazy.

If they want to get paid throughout their training and then do some online degree, all the while living in the location of their choice, why the hell do I have to move all over the country several times during my career, PAY for the PRIVILEGE of a year of grueling 80 hour work weeks and then limit myself to one field of medicine for the rest of my life?

If NPs want to shoehorn their way into independent clinical practice so badly through this ruse of rural care, mandate five year NP residencies in the middle of nowhere for 40k a year.

Also, you were an OB nurse for ten years? Congratulations, OB Noctor. That's it for you. No dermatology procedures. I don't give a rat's ass about how many buckets of empathy you have for your patients, that's not a license to kill.

This is all after they pass their steps of course. We wouldn't want the poor to be underserved by incompetent noctors. That's abusive.

You put this into effect, all this BS would disappear overnight.

Exactly. Don't go to med school, whatever, but you still have to pass all the exams and postgraduate training we have to do at least. I'd love to see that data...then we'd finally have hard data on head to head comparisons between medical students and NPs on steps. I think I can guess who'd have the better averages.

 

[SpecterGT260]

Exactly. Don't go to med school, whatever, but you still have to pass all the exams and postgraduate training we have to do at least. I'd love to see that data...then we'd finally have hard data on head to head comparisons between medical students and NPs on steps. I think I can guess who'd have the better averages.

I thought they had that.... with like a 50% pass rate. At the very least it says that their training cannot consistently produce solo practitioners.

 

[calvnandhobbs68]

I thought they had that.... with like a 50% pass rate. At the very least it says that their training cannot consistently produce solo practitioners.

Haha yeah but that was that lame version of step 3. I want to see full on step 1-3 data with no watering down. Let's see how the cards fall then.

Yeah people might say step 1 isnt useful but whatever we have to take it to get a license. If its so not useful then we shouldnt take it either (never gonna happen).

 

[SpecterGT260]

Haha yeah but that was that lame version of step 3. I want to see full on step 1-3 data with no watering down. Let's see how the cards fall then.

Id be surprised at double digit step1 pass rates.

 

[music2doc]

I thought they had that.... with like a 50% pass rate. At the very least it says that their training cannot consistently produce solo practitioners.

Even we assume Step 3 is like Step 1 in terms of difficulty (and I've always heard it's easier but please correct me if that is inaccurate), passing it would only require being above about the 2nd SD to the left. The fact that 50% failed indicates their understanding of the material is, on average, 2 Standard Deviations below the median MD's. That's a pretty huge gap! Their 50th percentile is our 2nd!

 

[hrandani]

In my experience, without any interference, when patients realize they're spending the same amount of money for an inferior product they tend to snap and demand to see "a real doctor."

That may change if the training of NPs improves. Watched a NP miss a case of IUFD by dopplering the abdominal aorta the other day. Whoooo boy.

 

[cbrons]

In my experience, without any interference, when patients realize they're spending the same amount of money for an inferior product they tend to snap and demand to see "a real doctor."

That may change if the training of NPs improves. Watched a NP miss a case of IUFD by dopplering the abdominal aorta the other day. Whoooo boy.

lol

 

[Rendar5]

In my experience, without any interference, when patients realize they're spending the same amount of money for an inferior product they tend to snap and demand to see "a real doctor."

That may change if the training of NPs improves. Watched a NP miss a case of IUFD by dopplering the abdominal aorta the other day. Whoooo boy.

U/s doppler or just a portable doppler device? Because if it was just a regular doppler, that's embarassing because even my RN's and sometimes med techs can differentiate between mom's and baby's heart tones, let alone any midlevels. Out of curiousity, why was an NP doing such an exam? It's usually done by midwives if it's in their clinics, or a regular old RN if it's in the ED, the L&D floor, or the Ob's office.

 

[45408]

U/s doppler or just a portable doppler device?

What are you trying to differentiate here? Are you referring to B-mode versus Doppler?

 

[Rendar5]

What are you trying to differentiate here? Are you referring to B-mode versus Doppler?

I mean ultrasound duplex/M-mode vs. a more simplified fetal doppler device (similar to the ones used by vascular for listening). Wasn't sure which he was referring to since he was saying there was fetal demise (an u/s diagnosis nowadays) and then saying heart rate was obtained off the aorta (which is a little strange using an u/s).

Either way, the NP was dumber than her RN colleagues.

 

[greatnt249]

The upfront costs are high, but the long term costs are lower.

The advantage is the same as for primary care. Nurses are cheaper than MDs.

Really? For someone who's been demanding evidence, you're just going to give my question a flip response like that?

How, in the long run, is training a nurse to do surgery a cheaper option? Not only that, where is the money coming from to provide incentive to surgeons to even train those outside their profession?

 

[greatnt249]

Watched a NP miss a case of IUFD by dopplering the abdominal aorta the other day. Whoooo boy.

NP shouldn't have been reassured by hearing the abdominal aorta regardless; rate is much too low for a normal fetal heart rate. What made them go back and reassess only to find an IUFD?

 

[modsar]

Last year, I had a NP misdiagnose a simple UTI and ultimately I ended up in the ER. I refuse to see a NP or midwife anymore.

 

[crazychadtu]

Yeah people might say step 1 isnt useful but whatever we have to take it to get a license. If its so not useful then we shouldnt take it either (never gonna happen).

I don't remember where I read it, but there was a recommendation by a USMLE reform committee to get rid of Step 1 in favor of a USMLE step 1/step 2 hybrid taken in the third year. It was ultimately turned down, but I think it helps to know that even the test makers recognize that step 1 scores do not correlate well with the schools producing 'good doctors'.

 

[hrandani]

I had already established a fairly antagonistic relationship with that particular healthcare provider (she told me that I am no longer allowed to speak to any of her (?) patients when she is on duty) so I may or may not have ducked out to anonymously page the attending to come by and take a look after the NP left for lunch.

But that's just one example out of, let's say a hundred, that I've seen over the last year.

Stuff like that really puts me in a bad position as a student that has zero rights or legal protection of any kind. I feel morally, legally and ethically obligated to do something, but practically speaking if I had said something I'm pretty sure the NP would have found a way to fail me, seeing as how she is the attending's wife.

But after some heavy reflection I don't think I could live with myself if I had to cover for someone's blatant incompetence like that. My life would be a lot easier if I could just walk out of uncomfortable situations and let somebody else handle the mess while I do uworld questions.

Yet I still vaguely remember that I didn't go into this screwball career to sit and watch people get thrown under the bus by a midlevel just because they're on medicaid.

Her final words before leaving the room were,"oh what a pretty heartbeat. Your baby is fine."

When I stop and think about the perfectly decent people I know who dropped out / failed out of carib schools I feel physically ill.

 

[calvnandhobbs68]

I don't remember where I read it, but there was a recommendation by a USMLE reform committee to get rid of Step 1 in favor of a USMLE step 1/step 2 hybrid taken in the third year. It was ultimately turned down, but I think it helps to know that even the test makers recognize that step 1 scores do not correlate well with the schools producing 'good doctors'.

Yeah well not many lawyers use what they learn for the bar exam for the rest of their careers (or so I've heard) but you still have to pass the bar to be a lawyer. My point is that they should have to take the exact same series of tests we have to if they want to be able to practice independently. I don't really care if the test makes you a "better doctor" or not.

 

[SpecterGT260]

Yeah well not many lawyers use what they learn for the bar exam for the rest of their careers (or so I've heard) but you still have to pass the bar to be a lawyer. My point is that they should have to take the exact same series of tests we have to if they want to be able to practice independently. I don't really care if the test makes you a "better doctor" or not.

I also think we need to avoid the idea that we need to only learn that which is directly involved in our practice.

That IS what NPs do.... they don't spend the time on the basics and a good many of the complaints we hear are concerned with poor grasps of the basic sciences and how that translates into practice down the road. I may not need to know what enzymes in metabolism use thiamine, but having studied it will at least allow me to recognize trends and pull meaning from what I see. Or I could just follow the protocol and prescribe treatment x because he has symptom y

 

[Rendar5]

I had already established a fairly antagonistic relationship with that particular healthcare provider (she told me that I am no longer allowed to speak to any of her (?) patients when she is on duty) so I may or may not have ducked out to anonymously page the attending to come by and take a look after the NP left for lunch.

But after some heavy reflection I don't think I could live with myself if I had to cover for someone's blatant incompetence like that. My life would be a lot easier if I could just walk out of uncomfortable situations and let somebody else handle the mess while I do uworld questions.

Yet I still vaguely remember that I didn't go into this screwball career to sit and watch people get thrown under the bus by a midlevel just because they're on medicaid.

Her final words before leaving the room were,"oh what a pretty heartbeat. Your baby is fine."

Most stories with NP's doing stupid stuff are believable mistakes. But I'm actually having problems believing this story, and it may be because I'm very confused. I'm trying to give you the benefit of the doubt.

What's an NP doing with an Obstetric patient in the first place. What device is she using to assess the heartbeat. Why is the patient waiting around after the NP saw her and went to lunch, and is around in time for the attending to come by and re-assess the patient. And how was it determined this was an IUFD.

Honestly, in the ED's I work in, and the L&D floors I worked in as a resident, this scenario would've been impossible, even with an NP dumber than an inexperienced RN.

 

[SpecterGT260]

Most stories with NP's doing stupid stuff are believable mistakes. But I'm actually having problems believing this story, and it may be because I'm very confused. I'm trying to give you the benefit of the doubt.

What's an NP doing with an Obstetric patient in the first place. What device is she using to assess the heartbeat. Why is the patient waiting around after the NP saw her and went to lunch, and is around in time for the attending to come by and re-assess the patient. And how was it determined this was an IUFD.

Honestly, in the ED's I work in, and the L&D floors I worked in as a resident, this scenario would've been impossible, even with an NP dumber than an inexperienced RN.

I feel like I have heard of NPs working in obstetrics. I believe that is actually one of the areas they are looking for autonomy.

 

[hrandani]

Most stories with NP's doing stupid stuff are believable mistakes. But I'm actually having problems believing this story, and it may be because I'm very confused. I'm trying to give you the benefit of the doubt.

What's an NP doing with an Obstetric patient in the first place. What device is she using to assess the heartbeat. Why is the patient waiting around after the NP saw her and went to lunch, and is around in time for the attending to come by and re-assess the patient. And how was it determined this was an IUFD.

Honestly, in the ED's I work in, and the L&D floors I worked in as a resident, this scenario would've been impossible, even with an NP dumber than an inexperienced RN.

It was an outpatient setting, although this particular office is across the road from the hospital. The practice has several offices that are all staffed by NPs / PAs.

I don't know what it is formally referred to as, it is just a handheld wand and doesn't have any markings on it.

The patient was waiting in the back of the clinic for the lab tech to come back from lunch. Generally, patients spend at least 2 hours in the clinic waiting for this or that.

I wasn't sure it was an IUFD until I read the chart a few days later, I was just concerned something was off enough to see if I could get an MD to walk across the street from the maternity wing to check it out. I don't pretend to know what is going on most of the time, but being unable to find a fetal heartbeat after five minutes is an event where it's pretty difficult to hide the awkwardness. I may not be an OB but I know where the abdominal aorta is, and it sounded very different than a normal fetal heartbeat.

I agree that this situation should never happen. There were no upsides to this.

 

[Instatewaiter]

Now to get back on topic: DNPs should have to pass USMLE Steps 1-3 and pass residency boards. If they do all that, I don't see why they can't practice independently if they do that. Of course without the background in basic sciences all but the most astute and intelligent of DNPs will obviously fail at some point (like 50% of the Columbia DNPs failing a weak step 3)

The steps are necessary but not sufficient. You need the clinical experience that goes with medical school and residency training.

This is one reason why some FMGs have monster step 1 and 2 scores yet are clinically incompetent. Just because you can sit in a room and study a book to pass an exam does not mean you are capable of being a doctor.

 

[Rendar5]

It was an outpatient setting, although this particular office is across the road from the hospital. The practice has several offices that are all staffed by NPs / PAs.

I don't know what it is formally referred to as, it is just a handheld wand and doesn't have any markings on it.

The patient was waiting in the back of the clinic for the lab tech to come back from lunch. Generally, patients spend at least 2 hours in the clinic waiting for this or that.

I wasn't sure it was an IUFD until I read the chart a few days later, I was just concerned something was off enough to see if I could get an MD to walk across the street from the maternity wing to check it out. I don't pretend to know what is going on most of the time, but being unable to find a fetal heartbeat after five minutes is an event where it's pretty difficult to hide the awkwardness. I may not be an OB but I know where the abdominal aorta is, and it sounded very different than a normal fetal heartbeat.

I agree that this situation should never happen. There were no upsides to this.

That makes a little more sense to me, but I still find it rather strange that an Ob practice uses NP's as midlevels when it would make more sense to hire a midwife (a more specialized midlevel than an NP). That device is usually called a fetal doppler. At many places, it's done by whoever's trained to get the vital signs (usually an RN), and occasionally repeated by the provider. I agree that there are many limitations in the ability of midlevels to function independently at higher levels, but do realize that if this is representative of the midlevels at your place, they are among the worst I have ever heard of and would be fired from most places.

 

[45408]

I don't know what it is formally referred to as, it is just a handheld wand and doesn't have any markings on it.

Doppler = noise

B-mode = image

Duplex = both (can show a picture and then show color to demonstrate flow)


You're talking about a handheld doppler, and there's nothing special about a fetal one versus any other one, but it's usually pretty small.

 

[Rendar5]

Doppler = noise

B-mode = image

Duplex = both (can show a picture and then show color to demonstrate flow)


You're talking about a handheld doppler, and there's nothing special about a fetal one versus any other one, but it's usually pretty small.

I guess I could've been a bit more explicit and say I meant handheld doppler vs. ultrasound machine, but the words were escaping me.


There is also a non-doppler mode available on a full ultrasound machine that can be used to find the FHR and has much lower energy transmission to the fetus. M(movement)-mode is a continuous graph of a 1-d image over time, using a single line from B(basic?)-mode (2-d image). You can see the movement of the heart as a waving line (one of the mobile parts of the heart such as the anterior wall or a valve leaflet) and measure the frequency to obtain the FHR. M-mode is also used in echocardiography a lot to measure valve opening and wall motion abnormalities and such.

I had intially asked this because with M-mode, if you don't see where the line you're using lies anatomically, it's hard to tell what you're measuring. So it'd be possible to confuse the FHR with a couple fetal breaths or some other rmovement.

 

[PikminOC]

Haha well we can enjoy that for now but eventually DNP will meld into the popular definition of a doctor, the nursing associations will see to it that that happens.

yep. nurses have strong associations, not fractured ones like docs.

 

[PikminOC]

The steps are necessary but not sufficient. You need the clinical experience that goes with medical school and residency training.

This is one reason why some FMGs have monster step 1 and 2 scores yet are clinically incompetent. Just because you can sit in a room and study a book to pass an exam does not mean you are capable of being a doctor.

Do you think the new Obamacare cares if you are a nurse or doc? Nurses are much cheaper. Churn em out and feed them to the masses.

On a side note, FMG's also take years to study for the steps while 2nd years only get about 8-12 weeks. I noticed the big difference with FMG communication and skills during my psychiatry oral board test.

 

[Smooth Operator]

Do you think the new Obamacare cares if you are a nurse or doc?

Yes. Nurses are cheaper, therefore they will become the preferred provider.

 

[SpecterGT260]

Yes. Nurses are cheaper, therefore they will become the preferred provider.

Until their scope meets that of current pcps. At which time they will want equal compensation

 

[valkener]

Money drives business first, then quality.

That's why we import all our stuff from China.

It's not #1 quality but it's #1 price.

Don't close your eyes to what is going on, doctors need to fight for their turf, not hand it over!

 

[DoctwoB]

Even if you could train dnp's to be competent surgeons (which I doubt will happen, remember surgery is more then cutting, it pre-post op care, knowing when not to operate, etc.), there is much less of an incentive to do so because a surgeon's salary is relatively insignificant compared to the costs of surgery.

That 10-20k knee replacement probably pays the orthopod $500-1000. Even if you find someone willing to do it for half the price, you barely made a dent in the overall cost. For primary care, the direct cost is much more dependent on the provider's salary.

 

[PikminOC]

Until their scope meets that of current pcps. At which time they will want equal compensation

But they will never want equal liability. "collaboration:"

 

[SpecterGT260]

But they will never want equal liability. "collaboration:"

I dont think they can have their cake and eat it too. Nobody is going to assume their liability without being compensated for it.

 

[PikminOC]

I guess we will see..if obamacare is like socialized med in other countries with tort reform...if...

 

[SpecterGT260]

I guess we will see..if obamacare is like socialized med in other countries with tort reform...if...

Other countries don't have DNPs.... or that was my understanding anyways. The USA seems to be the only place where every degree gets to be a doctorate. Smells an awful lot like those little leagues that give trophies to everyone regardless of anything

I just think from a job market standpoint. What doctor is going to go into a collaborative practice when the deal is "you're the fall guy if (when) I kill someone but you don't make any more than me because I have the same scope of practice as you". Aside from that, I think there are obstacles in terms of reimbursements and the like that will keep them below docs for a while to come. We will see though.


If tort reform makes malpractice insurance a non issue I'll eat my hat.

 

[PikminOC]

In psychiatry due to lack of access, the APNPs have been churned out.

I worked with one I refused to collaborate with, and I could not even cover for her bc I was so uncomfortable with the number and type of refills without reevaluating the pt. Some pts hadnt physically seen her in 8 or more months!