DNPs will eventually have unlimited SOP

[iCY]

I absolutely think that I was. Good thing too, because the guy who got a 4.0 in something silly and then didn't have the chops to handle the MCAT or didn't have the drive to do other ECs is currently not in medical school

This is very disturbing. This kind of cut throat competitiveness is unnecessary. Again, you rationalize all your hard work by saying that it proves you're better than everyone who couldn't jump the hoops, & i'm arguing that it is UNNECESSARY to jump the hoops. Sure you can make a requirement of writing a ****ing thesis & say anyone who can't write a thesis is not worthy of medical education, but does that mean it is necessary? NO.

Let everyone who wants to become a doctor become a doctor. If they truly can't handle medical school then they will get poor step 1 scores & be delegated to primary care.

Again, you can rationalize your hard work all you want, but in the end america decides what you can or cannot do. What are you going to do when DNPs get an unlimited SOP, the same as yours? Are you gonna sit on your high throne & continue spitting out comments like "well they can do everything that I can, but I've worked harder, therefore I'm better than them" ?? They will be laughing all the way to the bank with their small loans & 6 figure + salaries, & you will left just stroking your ego.

Don't forget that you are not the one who decides the rules, if you can't convince lawmakers that your extra hard work is necessary for practicing medicine, they are going to make that decision for you. All that will be left of an entire decade of hard work is just your personal satisfaction, or rather rationalization for your work. Also keep in mind that you are going to be working UNDER doctors from other countries who didn't do all the cutthroat bull**** that you describe. American made MDs are only a small part of the medical puzzle, noone is going to treat you differently from carribean or UK doctors once you are out in practice.

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[SpecterGT260]

The way I see it, all doctors should specialize, now that NPs have started taking over the primary care field. If its true that they can miss the rare diagnosis, then let them refer patients to specialists. Anyone here would be stupid to go into a primary care field, you just might become obsolete in the near future, esp when an NP can do the same work that you do (i.e., treat easy stuff & refer the difficult cases) for less $$. The only way I am personally justifying my 8 years of hard work is by going into a specialty, perhaps radiology/IR which will require knowledge of physics, or cardiology/electrophysiology, maybe nuclear medicine? who knows, but pick something where you can't be replaced in the future.

That is 1 way to do it. IMO that is a bandaid and akin to just bending over and taking it.

IMO primary care should be made much more attractive to grads. Restructure the billing code such that primary care referrals are needed again before seeing a specialist and increase PCP reimbursement. For the record, I want simply nothing to do with primary care, but I think this would be good for public health as a whole. If we want to take certian things and make them available to DNP practice fine. I don't really want to see the sniffles every day anyways. That said, I don't trust DNPs to repeatedly identify the sniffles vs something serious correctly and I attribute it to their pattern recognition method as opposed to the physician's method of building clinical knowledge on and around basic sciences. Sure, some pre-clinical courses have more utility than others, depending on what it is you want to do later on. I could see valid arguments for making more courses elective... maybe... but I honestly don't think it matters that much. I personally believe that abandoning primary care to the midlevels is bad for public health. They are less able to handle complex prescription regiments, correctly identify complex cases (meaning knowing when it is above their heads), and correctly diagnose complex cases.

The point is, the bar has to be set somewhere. On what basis would you admit HS grads to a 6 year program? On what basis would you deny thousands of HS grads entry? because that will still happen. We could nerf our system like they have it in other countries where being a doctor is no longer as attractive as it is, then when apps fall we wont have this issue anymore, but these other countries you cite do not have the same demand that we do. How do you determine who does or does not get in based on HS achievements?

 

[peteB]

On what basis would you admit HS grads to a 6 year program? On what basis would you deny thousands of HS grads entry? because that will still happen. We could nerf our system like they have it in other countries where being a doctor is no longer as attractive as it is, then when apps fall we wont have this issue anymore, but these other countries you cite do not have the same demand that we do. How do you determine who does or does not get in based on HS achievements?

We could use something similar to the UKCAT - http://en.wikipedia.org/wiki/UK_Clinical_Aptitude_Test

Doesn't matter how high the demand is, you simply pick enough people to fill the seats and that's it. I'm not sure 4 years of UG reveals anything much about a person's academic ability that wasn't there in high school.

 

[SpecterGT260]

This is very disturbing. This kind of cut throat competitiveness is unnecessary. Again, you rationalize all your hard work by saying that it proves you're better than everyone who couldn't jump the hoops, & i'm arguing that it is UNNECESSARY to jump the hoops. Sure you can make a requirement of writing a ****ing thesis & say anyone who can't write a thesis is not worthy of medical education, but does that mean it is necessary? NO.

Let everyone who wants to become a doctor become a doctor. If they truly can't handle medical school then they will get poor step 1 scores & be delegated to primary care.

Again, you can rationalize your hard work all you want, but in the end america decides what you can or cannot do. What are you going to do when DNPs get an unlimited SOP, the same as yours? Are you gonna sit on your high throne & continue spitting out comments like "well they can do everything that I can, but I've worked harder, therefore I'm better than them" ?? They will be laughing all the way to the bank with their small loans & 6 figure + salaries, & you will left just stroking your ego.

Don't forget that you are not the one who decides the rules, if you can't convince lawmakers that your extra hard work is necessary for practicing medicine, they are going to make that decision for you.

1) I think shoving the trash to primary care is a mistake. Increasing the quality of physicians in primary care will streamline the entire system, bring down costs, and generally benefit everyone involved (except the pocketbooks of the specialists... which I intend to be some day, but honestly I believe this is what is best for public health)

2)You assume that everyone who isn't qualified will fail step1 or perform poorly. Yes, many will. But there are many people who will make terrible physicians who can study and pass a test. The weeding out will not be at tests, it will be in poor outcomes for patients. The reason the system makes you prove it up front is because nobody wants to produce half-assed doctors who have to kill someone before we realize they don't have what it takes. This isn't really all that outrageous.

3) I think IF the DNPs get the same scope of practice as a physician that the poor outcomes and lower quality of clinical reasoning will become apparent and the DNPs will be well described by what I said in point 2. Right now their lack of expertise is covered by a safety net of physicians who watch what they do. Flying solo for a few years will demonstrate (In my opinion) that they aren't capable of similar scope, and it will simultaneously show the folly in reducing education requirements or "hoops". Your point of view here hinges upon equally good performance of DNPs. The problem is that their current research on this doesn't show that to any real degree.

I wouldn;t be surprised if they got expanded scope in some states temporarily some time during my career. I expect whole heartedly that it will get pulled relatively quickly once they start killing people. As it stands right now their mistakes are hidden within the systems and it is too difficult demonstrate by numbers how ineffective they are.

 

[peteB]

2)You assume that everyone who isn't qualified will fail step1 or perform poorly. Yes, many will. But there are many people who will make terrible physicians who can study and pass a test. .

The same is true for any test in UG or the MCAT.

 

[jmadden]

Most DNPs cant pass step 1 as a study showed of a sample of them

 

[iCY]

That is 1 way to do it. IMO that is a bandaid and akin to just bending over and taking it.

IMO primary care should be made much more attractive to grads. Restructure the billing code such that primary care referrals are needed again before seeing a specialist and increase PCP reimbursement. For the record, I want simply nothing to do with primary care, but I think this would be good for public health as a whole. If we want to take certian things and make them available to DNP practice fine. I don't really want to see the sniffles every day anyways. That said, I don't trust DNPs to repeatedly identify the sniffles vs something serious correctly and I attribute it to their pattern recognition method as opposed to the physician's method of building clinical knowledge on and around basic sciences. Sure, some pre-clinical courses have more utility than others, depending on what it is you want to do later on. I could see valid arguments for making more courses elective... maybe... but I honestly don't think it matters that much. I personally believe that abandoning primary care to the midlevels is bad for public health. They are less able to handle complex prescription regiments, correctly identify complex cases (meaning knowing when it is above their heads), and correctly diagnose complex cases.

The point is, the bar has to be set somewhere. On what basis would you admit HS grads to a 6 year program? On what basis would you deny thousands of HS grads entry? because that will still happen. We could nerf our system like they have it in other countries where being a doctor is no longer as attractive as it is, then when apps fall we wont have this issue anymore, but these other countries you cite do not have the same demand that we do. How do you determine who does or does not get in based on HS achievements?

When you go to clinicals, you're going to realize practicing medicine is much different than what you remember. Most docs work based on pattern recognition. You identify a symptom, you make a differential diagnosis, you work through the differential based on how they PRESENT, then you follow the appropriate diagnostic tests to confirm your suspicions. Biochemistry, microbiology, & whatever else molecular science you can think of do NOT come into play when treating patients.

You will be surprised on your medicine clerkship, then the PA student rotating through is able to diagnose patients just as well as you can. The only difference between us so far is that we have the law in our favor, saying that can't prescribe medicine, so they can't work on their own.

Education is not something you should have to compete for. A medical education should be made available to everyone. Open up more schools, allow anyone who thinks they can make it to enter. Sure you're right there has to be a screening process because the schools are investing in their students. But does the screening process need to be 4 years of tough sciences + however many hours of pre-clinicals? I think its safe to say that if you can score over a 30 on an MCAT, you know how to understand & intrepret/apply science.

 

[SpecterGT260]

We could use something similar to the UKCAT - http://en.wikipedia.org/wiki/UK_Clinical_Aptitude_Test

Doesn't matter how high the demand is, you simply pick enough people to fill the seats and that's it. I'm not sure 4 years of UG reveals anything much about a person's academic ability that wasn't there in high school.

I think it is silly to expect 18 year olds to have aptitude in anything. IMO the best applicants are those who know a little bit about how the real world works. The UK and europe have a number of other issues and differences from the USA that make such a system impractical here. i.e. I think it is an error to treat medicine so uni-dimensionally and claim that everything one does along the way needs to be directly utilized in practice.

Again, why not just stick some toddlers into a medical tract? They know only slightly less about what medicine is than the average HS grad who are largely impacted by societal views of medicine (i.e. prestige, money, whatever) and not clinical medicine.

 

[PrideNeverDie]

I'd like to see you guys propose another system. If you are hinting at direct clinical training out of UG or something more similar to DNP training... you guys need to stop sniffing glue. We have already had a number of practicing physicians come in here and describe the (low) level of ability that DNPs have in the clinic. Do you think its just because that is who they are and that you would be able to do better with the same training? Doubt it. This preoccupation with the face value retention of details completely misses the point in medical education.

i'm not against the system
i was just explaining why doctors and residents might be biased when asked to evaluate their med school/residency experiences

i might be telling my kids to be DNPs and optometrists instead of MDs someday LOL

 

[peteB]

Most DNPs cant pass step 1 as a study showed of a sample of them

When did DNPs become eligible for Step 1?

 

[peteB]

i'm not against the system
i was just explaining why doctors and residents might be biased when asked to evaluate their med school/residency experiences

i might be telling my kids to be DNPs and optometrists instead of MDs someday LOL

I think the best advice to your kids may be to avoid medicine all together. It is going downhill fast. It might be all right during our time, but it's not looking very good for the next generation at all.

Btw I hope Shnurek sees your post, he will have an orgasm.

 

[SpecterGT260]

When you go to clinicals, you're going to realize practicing medicine is much different than what you remember. Most docs work based on pattern recognition. You identify a symptom, you make a differential diagnosis, you work through the differential based on how they PRESENT, then you follow the appropriate diagnostic tests to confirm your suspicions. Biochemistry, microbiology, & whatever else molecular science you can think of do NOT come into play when treating patients.

I am already very well aware of this. The difference that I have noticed is that doctors tend to be more aware when something doesn't fit, and again, I attribute this to the basic science groundwork that clinical practice is built on. Maybe I am wrong, but I haven't seen anything, nor have I heard anything from the vast majority of M3-4s that I know which would indicate otherwise. PAs and DNPs that I have worked with and been seen by do not have this by comparison. I'm not arguing about the bread and butter cases here, yes they can handle that just fine. So the question is: how valuable is the life of that 1 patient who doesn't fit the mould? Do we just shove them through the best treatment protocol and hope it fits? That is what a DNP will do more often than a physician.

 

[Evil_Abed]

Most DNPs cant pass step 1 as a study showed of a sample of them

50% of DNPs from one of the best DNP schools in the nation failed a watered-down version of Step 3, supposedly the easiest of the Step exams. No DNP has taken Step 1.

 

[iCY]

1) I think shoving the trash to primary care is a mistake. Increasing the quality of physicians in primary care will streamline the entire system, bring down costs, and generally benefit everyone involved (except the pocketbooks of the specialists... which I intend to be some day, but honestly I believe this is what is best for public health)

2)You assume that everyone who isn't qualified will fail step1 or perform poorly. Yes, many will. But there are many people who will make terrible physicians who can study and pass a test. The weeding out will not be at tests, it will be in poor outcomes for patients. The reason the system makes you prove it up front is because nobody wants to produce half-assed doctors who have to kill someone before we realize they don't have what it takes. This isn't really all that outrageous.

3) I think IF the DNPs get the same scope of practice as a physician that the poor outcomes and lower quality of clinical reasoning will become apparent and the DNPs will be well described by what I said in point 2. Right now their lack of expertise is covered by a safety net of physicians who watch what they do. Flying solo for a few years will demonstrate (In my opinion) that they aren't capable of similar scope, and it will simultaneously show the folly in reducing education requirements or "hoops". Your point of view here hinges upon equally good performance of DNPs. The problem is that their current research on this doesn't show that to any real degree.

I wouldn;t be surprised if they got expanded scope in some states temporarily some time during my career. I expect whole heartedly that it will get pulled relatively quickly once they start killing people. As it stands right now their mistakes are hidden within the systems and it is too difficult demonstrate by numbers how ineffective they are.

my god man, do you not have any real world experience before making these opinions? You are really misguided.

1) agreed, can't argue with that one
2) Theres always a solution to every answer. the solution to this answer is if people pass step 1 but are ****ty clinicians, don't graduate them from their residency programs. Extend their residency programs until they become competent. You are mistakenly thinking that only the brilliant people who can complete tough science courses & make it through preclinicals in 2 years can become physicians. If it takes someone an extra year or 2 to learn clinical medicine in the field, then so be it. Your "high performance" is only going to get you to the end result faster, it doesn't mean you're the only one who can get to it.

3) AGAIN, its obvious you have no real world experience. The NPs that I work with are NOT SUPERVISED BY PHYSICIANS. They are flying solo already. NO DOCTOR is going to waste his time supervising someone else. They have a prescription pad that is already cosigned, & they do whatever the f they want. THIS IS ALREADY HAPPENING, just accept it.

 

[PrideNeverDie]

I think the best advice to your kids may be to avoid medicine all together. It is going downhill fast. It might be all right during our time, but it's not looking very good for the next generation at all.

Btw I hope Shnurek sees your post, he will have an orgasm.

ur probably right on the "avoid medicine" part

the optotroll part was meant specifically for Shnurek
he makes optometry sound like the greatest thing since sliced bread

 

[peteB]

I don't really get what you're arguing for.. Do you want to get rid of MDs and have DNPs run the entire show?

my god man, do you not have any real world experience before making these opinions? You are really misguided.

1) agreed, can't argue with that one
2) Theres always a solution to every answer. the solution to this answer is if people pass step 1 but are ****ty clinicians, don't graduate them from their residency programs. Extend their residency programs until they become competent. You are mistakenly thinking that only the brilliant people who can complete tough science courses & make it through preclinicals in 2 years can become physicians. If it takes someone an extra year or 2 to learn clinical medicine in the field, then so be it. Your "high performance" is only going to get you to the end result faster, it doesn't mean you're the only one who can get to it.

3) AGAIN, its obvious you have no real world experience. The NPs that I work with are NOT SUPERVISED BY PHYSICIANS. They are flying solo already. NO DOCTOR is going to waste his time supervising someone else. They have a prescription pad that is already cosigned, & they do whatever the f they want. THIS IS ALREADY HAPPENING, just accept it.

 

[iCY]

I am already very well aware of this. The difference that I have noticed is that doctors tend to be more aware when something doesn't fit, and again, I attribute this to the basic science groundwork that clinical practice is built on. Maybe I am wrong, but I haven't seen anything, nor have I heard anything from the vast majority of M3-4s that I know which would indicate otherwise. PAs and DNPs that I have worked with and been seen by do not have this by comparison. I'm not arguing about the bread and butter cases here, yes they can handle that just fine. So the question is: how valuable is the life of that 1 patient who doesn't fit the mould? Do we just shove them through the best treatment protocol and hope it fits? That is what a DNP will do more often than a physician.

One can also argue that the reason for this is that we have limited their education. What if they spend another year or so learning more about the complex cases & gained the ability to diagnose rare diseases (isn't that what a DNP degree is for??)

I'm with the poster above, I would NOT recommend anyone in the future becoming a doctor. If they really want to do it, either get into a 7 year program so you don't have to jump hoops, go to another country, or becoming a DNP.

 

[Evil_Abed]

iCY, so basically, your issue is that you're pissed off that you've had to work so hard and jump through all these hoops while nursing midlevels are using the law to bypass and short-cut their way into practicing medicine?

I agree that sucks, but that doesn't mean they have equivalent knowledge-base or ability to diagnose and treat as an attending does. There is no evidence for this at all. Seriously, search the literature. You won't find any adequately powered studies comparing NPs to attendings.

 

[iCY]

I don't really get what you're arguing for.. Do you want to get rid of MDs and have DNPs run the entire show?

what I want, & what is happening are 2 different things.

What I want is more physicians with more time spent studying things that matter & less time jumping through hoops just to advance to the next level. Open up more MD schools & make admission easier. It makes for less angry medical students who want to do nothing but electrophysiointerventionalnuclearderm medicine because its the only way to justify their hard work.

I think that primary care should be taken over by NPs or DNPs, but with MORE TRAINING so that they can handle both easy complaints, & know who to refer to for complex complaints. They should be taking more responsibility (including the insurance costs) for their practice. Don't forget that medicine was a gold mine before people realized we were being overpaid & then salaries started being cut. The same thing is going to happen with the nursing field, they're going to start out with ridiculous salaries (as evident by the 100k+ NPs in primary care, derm, anesthesiology, CC), they're going to cash in, before eventually things start getting cut, decades down the road. I can justify my potential 200k+ salary by saying I spent 12 years working for it with 250k in loans, but how do you justify a 150k salary with 6 years of training & less than half in loans?

Esp considering the future reimbursement cuts, I think it would be an easier pill to swallow if we didn't have to kill ourselves to get to where we are.

 

[iCY]

iCY, so basically, your issue is that you're pissed off that you've had to work so hard and jump through all these hoops while nursing midlevels are using the law to bypass and short-cut their way into practicing medicine?

I agree that sucks, but that doesn't mean they have equivalent knowledge-base or ability to diagnose and treat as an attending does. There is no evidence for this at all. Seriously, search the literature. You won't find any adequately powered studies comparing NPs to attendings.

Yup thats exactly it. I was told that jumping through hoops was a necssary part of becoming a doctor & practicing medicine. But turns out all you need to practice medicine is a law allowing you to prescribe.

. But most primary care docs can't diagnose **** as it is. They rely on advanced imaging techniques/radiologists to tell them what is happening. They rely on biopsies/pathologists to tell them what is happening. They rely on specialists to handle any complex cases.

I completely agree that NPs do NOT compare to doctors, but I think they can take over the role of the "medical gate keeper" while we use our extensive training to do something more complicated, instead of treating sore throats & giving pain meds to addicts.

 

[PrideNeverDie]

iCY, so basically, your issue is that you're pissed off that you've had to work so hard and jump through all these hoops while nursing midlevels are using the law to bypass and short-cut their way into practicing medicine?

I agree that sucks, but that doesn't mean they have equivalent knowledge-base or ability to diagnose and treat as an attending does. There is no evidence for this at all. Seriously, search the literature. You won't find any adequately powered studies comparing NPs to attendings.

after graduating high school:
it takes 12 years to be an attending
it takes 6 years to become a NP?

i'll take 6 extra years of real world experience getting paid at NP wages instead of resident wages
i wonder if the extra 6 years of working would allow me to become as good as an attending

OFF-TOPIC: had no idea that very few Caribs actually practice in the US. aware me please. Caribs must be the new art students (paying 30+k tuition with no guaranteed job prospects LOL)

 

[peteB]

after graduating high school:
it takes 12 years to be an attending
it takes 6 years to become a NP?

i'll take 6 extra years of real world experience getting paid at NP wages instead of resident wages
i wonder if the extra 6 years of working would allow me to become as good as an attending

It takes more than 6 years out of high school to become a DNP. I'm pretty sure you need to do your BSN, and MSN before you can go on to DNP. Some programs also require you to work as a nurse beforehand too.

As for NPs who only have a masters degree, they are going to stop allowing that in a couple of years. New NPs will be required to go all the way to DNP.

The biggest problem with the DNP curriculum right now is that it's not standardized. You never really know what you're getting from a DNP, but you will always know what you're getting from an MD. It'll be a while before everyone gets comfortable with DNPs. Even after all these years, I still know people who have no clue what a DO is.

 

[iCY]

after graduating high school:
it takes 12 years to be an attending
it takes 6 years to become a NP?

i'll take 6 extra years of real world experience getting paid at NP wages instead of resident wages
i wonder if the extra 6 years of working would allow me to become as good as an attending

OFF-TOPIC: had no idea that very few Caribs actually practice in the US. aware me please. Caribs must be the new art students (paying 30+k tuition with no guaranteed job prospects LOL)

OK I may have inflated the #s a bit. Here is the document from the AAFP. Its 5.5 years to become a NP minimum, & 7.5 to become a DNP minimum. So far i've been referring to NPs, but if the poster above is true, NPs could eventually have to become DNPs? Also don't forget the NPs who are grandfathered into their degrees, & don't need to deal with that.

again don't forget that the years spent training for NP are LESS RIGOROUS so you get to spend more time with your family & friends during your training. which is a huge plus. Can you justify spending days studying for difficult pre-med exams for courses that no longer matter when you could have been chillin @ home with your friends?

also here is the link for the SGU match list. It looks like they aren't having any problems finding a job.
https://apps.sgu.edu/ERD/2012/ResidPost.nsf/BYPGY?OpenView&RestrictToCategory=PGY1&Count=-1

 

[peteB]

OK I may have inflated the #s a bit. Here is the document from the AAFP. Its 5.5 years to become a NP minimum, & 7.5 to become a DNP minimum. So far i've been referring to NPs, but if the poster above is true, NPs could eventually have to become DNPs? Also don't forget the NPs who are grandfathered into their degrees, & don't need to deal with that.

again don't forget that the years spent training for NP are LESS RIGOROUS so you get to spend more time with your family & friends during your training. which is a huge plus

What year of med school are you? You might still be able to switch into an NP program and come out ahead since you get to skip the rest of medical school and residency...

 

[PrideNeverDie]

OK I may have inflated the #s a bit. Here is the document from the AAFP. Its 5.5 years to become a NP minimum, & 7.5 to become a DNP minimum. So far i've been referring to NPs, but if the poster above is true, NPs could eventually have to become DNPs? Also don't forget the NPs who are grandfathered into their degrees, & don't need to deal with that.

again don't forget that the years spent training for NP are LESS RIGOROUS so you get to spend more time with your family & friends during your training. which is a huge plus

also here is the link for the SGU match list. It looks like they aren't having any problems finding a job.
https://apps.sgu.edu/ERD/2012/ResidPost.nsf/BYPGY?OpenView&RestrictToCategory=PGY1&Count=-1

okay that makes it much closer

so either 4 years of residency or 4 years of DNP wages and better work/life balance

i'll take the DNP wages and better work/life balance. this is of course hypothetically assuming that DNPs have the same access and autonomy to all the specializations of MD (which is not reality and may never be)

 

[iCY]

What year of med school are you? You might still be able to switch into an NP program and come out ahead since you get to skip the rest of medical school and residency...

MSIII. Interesting idea but I would be throwing away years of hard work + 200k in loans to switch to primary care. Also I don't care for primary care, so its not feasible.

 

[Evil_Abed]

after graduating high school:
it takes 12 years to be an attending
it takes 6 years to become a NP?

i'll take 6 extra years of real world experience getting paid at NP wages instead of resident wages
i wonder if the extra 6 years of working would allow me to become as good as an attending

Those extra 6 years of working will not allow you to become as good as an attending. You do realize that, during residency, you're getting "real world experience" as a practicing clinician right?

okay that makes it much closer

so either 4 years of residency or 4 years of DNP wages and better work/life balance

Number of years of training is a very poor measure of comparing midlevels with physicians. A better number to look at is hours of clinical training. DNPs get only a fraction of the clinical training that physicians get.

Also, I don't know how old that figure you're quoting is. You can get a BSN-DNP in about 2-2.5 years total. It doesn't take 1.5-5 years of training after a BSN to get a DNP, unless you're doing it part-time or something. Keep in mind also that you can do this entirely online if you wanted to and continue to work as a nurse during this training. That's how "rigorous" these programs are. I think, if a med student tried to go through the entire DNP curriculum and worked as hard as they do in med school, they could probably get it done in a semester.

 

[SpecterGT260]

it.

3) AGAIN, its obvious you have no real world experience. The NPs that I work with are NOT SUPERVISED BY PHYSICIANS. They are flying solo already. NO DOCTOR is going to waste his time supervising someone else. They have a prescription pad that is already cosigned, & they do whatever the f they want. THIS IS ALREADY HAPPENING, just accept it.

That is state by state Mr real world experience

Its also clinic by clinic. Yes, many doctors WILL "waste" the time looking over the charts they are about to become liable for. You have been in the clinic for all of 6 or 7 months at this point. That real world experience isn't as valuable for this discussion as you make it out to be

Sent from my DROID RAZR using SDN Mobile

 

[peteB]

MSIII. Interesting idea but I would be throwing away years of hard work + 200k in loans to switch to primary care. Also I don't care for primary care, so its not feasible.

Well if you don't want to do primary care, then DNPs are not an issue for you at all.

 

[SpecterGT260]

One can also argue that the reason for this is that we have limited their education. What if they spend another year or so learning more about the complex cases & gained the ability to diagnose rare diseases (isn't that what a DNP degree is for??)

I'm with the poster above, I would NOT recommend anyone in the future becoming a doctor. If they really want to do it, either get into a 7 year program so you don't have to jump hoops, go to another country, or becoming a DNP.

We have limited their education? They set their own education! Even more so in nursing. What are you talking about? we have not limited their education. And weren't you the one just arguing for reducing physician education? Now your counterpoint to how that works out for DNPs is to increase their education????? Yeah.... seems legit
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[SpecterGT260]

Well if you don't want to do primary care, then DNPs are not an issue for you at all.

Until he is fielding unnecessary referrals from them or cleaning up after them when they screw up.

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[peteB]

Crazy how long this DNP thread has been going on... wow

I think we've exhausted this discussion - we should be focusing our attention on other, more significant developments in the news - for example, Justin Bieber and Selena Gomez have broken up!

 

[peteB]

Until he is fielding unnecessary referrals from them or cleaning up after them when they screw up.

Sent from my DROID RAZR using SDN Mobile

That sounds good. More paid work for him

 

[SpecterGT260]

That sounds good. More paid work for him

I suppose. But in the real world which I apparently know nothing about doctors tend to dislike cleaning up after other people's mistakes.

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[Evil_Abed]

One can also argue that the reason for this is that we have limited their education. What if they spend another year or so learning more about the complex cases & gained the ability to diagnose rare diseases (isn't that what a DNP degree is for??)

I'm with the poster above, I would NOT recommend anyone in the future becoming a doctor. If they really want to do it, either get into a 7 year program so you don't have to jump hoops, go to another country, or becoming a DNP.

Missed this post earlier. We have no control at all over what NP and DNP schools teach. They consider it "advanced practice nursing," so medicine cannot regulate any of it. So, I don't know what you mean that we're "limiting their education." Also, no, the DNP is NOT designed to learn about "complex cases & gained the ability to diagnose rare diseases." Have you ever actually looked at a DNP curriculum? It's designed to give practitioners more training in the business and policy side of practicing, not to increase their knowledge of pathophysiology or how to diagnose rare diseases. Even the DNPs themselves will tell you that the DNP is not a clinical doctorate (ie. its emphasis is not on improving the clinical acumen of NPs) and this is obvious when you look at the DNP curriculum and see that it's basically an MPH curriculum. I've had it explained as a "practice" doctorate in that it trains NPs on how to better run their practices and how to become involved in health policy.

 

[PrideNeverDie]

Those extra 6 years of working will not allow you to become as good as an attending. You do realize that, during residency, you're getting "real world experience" as a practicing clinician right?



Number of years of training is a very poor measure of comparing midlevels with physicians. A better number to look at is hours of clinical training. DNPs get only a fraction of the clinical training that physicians get.

Also, I don't know how old that figure you're quoting is. You can get a BSN-DNP in about 2-2.5 years total. It doesn't take 1.5-5 years of training after a BSN to get a DNP, unless you're doing it part-time or something. Keep in mind also that you can do this entirely online if you wanted to and continue to work as a nurse during this training. That's how "rigorous" these programs are. I think, if a med student tried to go through the entire DNP curriculum and worked as hard as they do in med school, they could probably get it done in a semester.

i was wrong ... you only get 4 extra years as a DNP
working 40 hrs/week, that gives u about 2k clinical hours/year

the difference between an attending and a DNP would be 7-9k clinical hours

give up 7-9k clinical hours for better wages and 7-9k family hours
i wonder at what point do clinical hours hit diminishing returns
DNPs would have hit the Malcolm Gladwell 10k hour mastery mark just barely

 

[SpecterGT260]

i was wrong ... you only get 4 extra years as a DNP
working 40 hrs/week, that gives u about 2k clinical hours/year

the difference between an attending and a DNP would be 7-9k clinical hours

give up 7-9k clinical hours for better wages and 7-9k family hours

I may be wrong but you seem to be counting post grad clinic work time as "clinical hours" when comparing. Totally not the same thing though. Residents are actively trained as opposed to DNPs who just "practice". Once formal training for DNPs ends any advancement in skills is largely on them. If I were to just head into the clinic and start doing my thing today I couldn't claim that time in comparing to someone straight out of residency.

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[PrideNeverDie]

I may be wrong but you seem to be counting post grad clinic work time as "clinical hours" when comparing. Totally not the same thing though. Residents are actively trained as opposed to DNPs who just "practice". Once formal training for DNPs ends any advancement in skills is largely on them. If I were to just head into the clinic and start doing my thing today I couldn't claim that time in comparing to someone straight out of residency.

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no, you are very correct and that is one of the many reasons MDs > DNPs

i'm making a ton of assumptions with my comparisons

i guess i'm just conceited enough to think that i could do a DNP's curriculum and inferior clinical training and still turn out to be a kickass attending
dat "grass is greener on the other side" mentality

 

[peteB]

I suppose. But in the real world which I apparently know nothing about doctors tend to dislike cleaning up after other people's mistakes.

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Well a doctors job is usually to clean up patient s mistakes

 

[SpecterGT260]

no, you are very correct and that is one of the many reasons MDs > DNPs

i'm making a ton of assumptions with my comparisons

i guess i'm just conceited enough to think that i could do a DNP's curriculum and inferior clinical training and still turn out to be a kickass attending
dat "grass is greener on the other side" mentality

Im not intending to
knock you at all when I say: I think that is a lot or what is happening here. I mentioned it earlier in a post. I don't have any insight into how much of how doctors turn out is the curriculum selection and educational hurdles vs just who they are as people. But as I said earlier I see two systems producing two types of providers and the argument seems to be pushing for their system as if it won't affect the kind of provider produced. Maybe YOU would have turned out the same. But on the whole? When he is pushing for decreases in the selection process and in the training itself. Whether it is the training or the person is a moot point because those in the less rigorous program will just choose medicine as it becomes more similar. Quality of care suffers no matter how you cut it

Well a doctors job is usually to clean up patient s mistakes

Right so why tack on the burden of someone with minimal training making it worse?


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[peteB]

Right so why tack on the burden of someone with minimal training making it worse?


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I agree that we shouldn't, but I think the answer to that is because there's a shortage of doctors and they're very expensive.

 

[iCY]

That is state by state Mr real world experience

Its also clinic by clinic. Yes, many doctors WILL "waste" the time looking over the charts they are about to become liable for. You have been in the clinic for all of 6 or 7 months at this point. That real world experience isn't as valuable for this discussion as you make it out to be

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How can an MSII be so misguided? where are you getting this info from? 7 months in the field is still better than 0 so

Again, all of you keep making statements that you're better, that you can offer better quality, that all the **** you've gone through is necessary for what you're doing. But it really isn't

@ no point did I say that NPs should become the doctors the way that they are now. I said give them more training & then let them take over primary care, WITH MORE TRAINING. This is the future so get used to it. All that background in biochem gives you is just an appreciation for the disease process. Thats it, just an appreciation, like appreciating art. It doesn't actually offer you any usefulness when you are deciding on a treatment for a patient.

its quite sad really. You hold yourself in such high regard, & you continue to justify your hard work. This is exactly the type of mentality that MD schools are breeding. They make you pour an unnecessary portion of your time & life, & so you feel compelled to defend it & rationalize that its an important & necessary evil (while doctors are being created all around the world without this bull****, so obviously its not necessary). Because if it wasn't necessary, you would be admitting to wasting your life.

As the NP/DNP curriculum continues to grow, they're going to get more SOP & are going to take greater & greater roles in primary care. Making really vague statements like "this is going to diminish quality of care. they are going to make mistakes & kill people" aren't gonna really hold up anymore when people aren't spontaneously dropping dead after walking out of DNP offices. & why aren't they dropping dead? because they're just going to refer to specialties whenever they don't know something! just the same way a primary care MD would do!

The only thing we MDs have on our side right now is the law. Law prohibiting patients from obtaining prescription drugs directly from a pharmacy, thereby making us necessary. Law prohibiting other fields from encroaching on our practicies, giving us things to do & bill for. But that is slowly going away as other fields take procedures away from MDs. Hey, it turns out, you don't really need to be a neurologist to understand how to administer a botox injection! But wait....botox is a neurotoxin....it works on the nervous system.....obviously you need years of training on how the nervous system works before you inject a muscle with a neurotoxin right? maybe even a phD?

Remember that in the end, it doesn't matter how highly esteemed you think you are, or how big your ego is. All that matters is what lawmakers think. Sure you can be an elitist in the future, justifing that you're smarter & better than DNPs. But when they're doing the same job you're doing, getting the same gratitude & the same prestige, & making the same $$$$ with better job satisfaction,what are you going to do then?

jump ship while you can! or become a neurointerventionalelectrophysiologist so you that your job actually requires the **** you've studied.

 

[SpecterGT260]

You cray brah

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[peteB]

jump ship while you can! or become a neurointerventionalelectrophysiologist so you that your job actually requires the **** you've studied.

So why (again) aren't you jumping ship?

 

[SpecterGT260]

So why (again) aren't you jumping ship?

Because he's an oober gunner who is looking to deter people so his matching options get better

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[peteB]

Because he's an oober gunner who is looking to deter people so his matching options get better

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I heard that DNPs are forming their own "residencies" now.

Another thing- Do you really believe that DNPs will win the fight to get equal pay? I mean, isn't the whole point that they are cheaper? If insurance has to pay the same, then what's the benefit of having DNPs in the first place?

 

[SpecterGT260]

I heard that DNPs are forming their own "residencies" now.

Another thing- Do you really believe that DNPs will win the fight to get equal pay? I mean, isn't the whole point that they are cheaper? If insurance has to pay the same, then what's the benefit of having DNPs in the first place?

They have some "residencies". I think the fight is an example of extreme short sightedness. Yes, they are cheaper. That is because they don't do as much as we do (will). It starts with wanting more scope because they are the cheaper option. Then they will want more money because they have greater scope (the reason to expand scope is money after all). The question will be if anyone who matters sees it and calls shenanigans.

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[iCY]

I heard that DNPs are forming their own "residencies" now.

Another thing- Do you really believe that DNPs will win the fight to get equal pay? I mean, isn't the whole point that they are cheaper? If insurance has to pay the same, then what's the benefit of having DNPs in the first place?

Yup the only limitation to DNP is that they don't have proper training/residency, but looks like that is going to change...

I certainly think they are going to win the fight for equal pay. They can manage a patient's asthma just as well as you can, so why shouldn't they get paid the same? Again the only justification for your high fees is that you've spent 12 years training for it. People don't get paid based on how much work they have done to get to where they are. They get paid based on how much skill it requires to do what they are doing. If a DNP can do the same thing you do in less time, then why pay them less? Either their salaries go up, or yours go down.

If you gave someone a flu shot, would you charge more than a nurse would charge for giving flu shots? Demanding more money is a sure fire way of throwing away your future career. "why go to my doctor who charges me x amount of dolloars just to refil my meds, when I can go to a DNP for a cheaper price & refill my meds"

 

[peteB]

People don't get paid based on how much work they have done to get to where they are. They get paid based on how much skill it requires to do what they are doing. If a DNP can do the same thing you do in less time, then why pay them less?

This is generally not true. People who are equally qualified to do the same task do not always get paid the same.

For example, a famous lawyer with decades of experience can charge many times as much as a lawyer fresh out of school to do even the simplest of legal tasks, even though both are equally qualified. It's possible that their work could be exactly the same, but one gets paid way more than the other due to experience.

 

[SpecterGT260]

Yup the only limitation to DNP is that they don't have proper training/residency, but looks like that is going to change...

I certainly think they are going to win the fight for equal pay. They can manage a patient's asthma just as well as you can, so why shouldn't they get paid the same? Again the only justification for your high fees is that you've spent 12 years training for it. People don't get paid based on how much work they have done to get to where they are. They get paid based on how much skill it requires to do what they are doing. If a DNP can do the same thing you do in less time, then why pay them less? Either their salaries go up, or yours go down.

If you gave someone a flu shot, would you charge more than a nurse would charge for giving flu shots? Demanding more money is a sure fire way of throwing away your future career. "why go to my doctor who charges me x amount of dolloars just to refil my meds, when I can go to a DNP for a cheaper price & refill my meds"

They also tie their shoes as well as a doctor can. You are oversimplifying the issue.

Currently a doctor can bill out higher for some things but not all things. In many cases reimbursement is set and providers are legally restricted. On the states where they are allowed to they may cut lower deals with insurance companies for reimbursement as a form of business practice but in many clinics a checkup is a checkup regardless of who gices it as far as the patient is concerned. My clinic copay doesn't change when a nurse sees me vs the doctor, yet you are indicating that they charge more to refill meds.... sure the clinic or hospital may pay more per hour but that isn't what you said.


I.e. no I don't think a physician will charge more than a nurse to give a vaccine. At the hospital Im at the vaccines cost what they cost or what the insurance agreed to depending on the patient. Most docs don't give them themselves and have a nurse do it but that is irrelevant.
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