DNPs will eventually have unlimited SOP

[SpecterGT260]

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.

I feel like we are in violent agreement here..... Yes... they need to put out some of these studies to refute the crap being put out by the AANP. A few of them have commentaries which discuss the inappropriateness of the stats, which is good. However there needs to be positive data which shows a danger to patients.

Zebras were brought up. A particular CRNA paper I saw intentionally left out complicated or high risk cases. So I would say a paper along side that which assesses the CRNA ability to judge the complexity of a case would be pretty big. Things of that order.

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[evilbooyaa]

Anyone who goes into primary care as a MD within the next 5-10 years is going to be SoL when DNPs get all of the same rights as MDs.

Hell, if you're planning to go into primary care now and are not yet in medical school, f that **** and go through nursing to become a DNP. Then you'll be "equal" todoctors.

Loved it when a DNP didn't know what G6PD deficiency was and I had to explain it to her. Then I had to explain to her what G6PD was and why it was important. Luckily someone in the office knew and told her what it was (Attending was seeing a patient) before she prescribed bactrim for a patient's UTI...

 

[Michael Corleon]

I blame it on inefficient medical education. In america we take 8 years to get a surgical resident To day 1 of residency. 13 years to train a surgeon. All the while he will study all kinds of things he will forget and never use. Mid levels walk into school and train right away for clinic.

Not all doctors need researcher teaching them.

 

[Michael Corleon]

We all will be working. Just the fields with nurses will earn 20-30% less.

 

[SpecterGT260]

Anyone who goes into primary care as a MD within the next 5-10 years is going to be SoL when DNPs get all of the same rights as MDs.

Hell, if you're planning to go into primary care now and are not yet in medical school, f that **** and go through nursing to become a DNP. Then you'll be "equal" todoctors.

Loved it when a DNP didn't know what G6PD deficiency was and I had to explain it to her. Then I had to explain to her what G6PD was and why it was important. Luckily someone in the office knew and told her what it was (Attending was seeing a patient) before she prescribed bactrim for a patient's UTI...

The thing is... unfortunately the ONLY way to prove that there is harm in letting these people play doctor is to allow it to happen. That will happen once they have their own clinics.

 

[cbrons]

Anyone who goes into primary care as a MD within the next 5-10 years is going to be SoL when DNPs get all of the same rights as MDs.

Hell, if you're planning to go into primary care now and are not yet in medical school, f that **** and go through nursing to become a DNP. Then you'll be "equal" todoctors.

Loved it when a DNP didn't know what G6PD deficiency was and I had to explain it to her. Then I had to explain to her what G6PD was and why it was important. Luckily someone in the office knew and told her what it was (Attending was seeing a patient) before she prescribed bactrim for a patient's UTI...

Pesky things like M1 biochemistry shouldn't take precedence over the more important, clinically relevant material taught in classes like "Ethics and Public Policy in Healthcare Delivery" or "Global Health & Social Justice." True without such knowledge the patient might get a nice little drug induced hemolysis but at least the DNP was fully prepared to treat him in a more compassionate and socially justified manner.

 

[Michael Corleon]

I feel like we are in violent agreement here..... Yes... they need to put out some of these studies to refute the crap being put out by the AANP. A few of them have commentaries which discuss the inappropriateness of the stats, which is good. However there needs to be positive data which shows a danger to patients.

Zebras were brought up. A particular CRNA paper I saw intentionally left out complicated or high risk cases. So I would say a paper along side that which assesses the CRNA ability to judge the complexity of a case would be pretty big. Things of that order.

Haha. Academic people dont understand business. They don't make decisions based upon finding good quality research. They make a decision and THEN look for research to support what they want.

The quality of the studies means nothing. Its not about that. Its economics. Its profit.

If MDs want to show people why they are valuable they need to persuade them that they cost less or offer a unique service that no nurse can provide. A double blind randomized study will sit on the sidelines.

 

[evilbooyaa]

The thing is... unfortunately the ONLY way to prove that there is harm in letting these people play doctor is to allow it to happen. That will happen once they have their own clinics.

Maybe at the end of the day, maybe we should let DNPs run their own PCP offices? Let the competent/lucky ones who dodge zebras and incompetency rake in the bucks while the incompetent/unlucky ones get sued for malpractice (without MDs having to take the fall, hooray!) Of course, maybe the nurses will be so good at smoothing things over socially that the patients won't feel a need to sue since their dead relative was being taken care of by such a social savant.

The thing I hate from that Fox News segment is the retrospective chart review. Does that mean that IF the almighty DNP makes a mistake (like MDs do all the time), the DNP will be liable? Or since she is being supervised by a MD who is across state and technically letting her practice independently, the MD will still be liable even though he wouldn't have been able to stop the malpractice from happening in the first place?

All I know is, that I am not going into outpatient (as I imagine independent DNPs will be 99% focused on outpatient PCP work) PCP work anytime in my life. If I go IM, hospitalist might be a career choice, but noooooooooooooo way I'm doing clinic work.

 

[xenotype]

Maybe at the end of the day, maybe we should let DNPs run their own PCP offices? Let the competent/lucky ones who dodge zebras and incompetency rake in the bucks while the incompetent/unlucky ones get sued for malpractice (without MDs having to take the fall, hooray!) Of course, maybe the nurses will be so good at smoothing things over socially that the patients won't feel a need to sue since their dead relative was being taken care of by such a social savant.

The thing I hate from that Fox News segment is the retrospective chart review. Does that mean that IF the almighty DNP makes a mistake (like MDs do all the time), the DNP will be liable? Or since she is being supervised by a MD who is across state and technically letting her practice independently, the MD will still be liable even though he wouldn't have been able to stop the malpractice from happening in the first place?

All I know is, that I am not going into outpatient (as I imagine independent DNPs will be 99% focused on outpatient PCP work) PCP work anytime in my life. If I go IM, hospitalist might be a career choice, but noooooooooooooo way I'm doing clinic work.

What makes you think they would be happy to stick with primary care? There is a CCM fellowship at Vandy to make NP "intensivists".

 

[grt398]

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.

Just out of curiousity, exactly how could you do an appropriate study when I'm guessing you won't find a single IRB at any reputable institution allowing randomization of patients into a DNP vs. MD study where the DNPs are given no physician oversight and are forbidden from consulting physicians if they encounter complications with their patients. And how are you supposed to compare outcomes when the DNP's always have physician backup if something goes wrong? Even putting the IRB aside, I'd argue there are serious ethical issues with it.

 

[evilbooyaa]

What makes you think they would be happy to stick with primary care? There is a CCM fellowship at Vandy to make NP "intensivists".

I read that thread as well. Forgot about it until just now. While I am skeptical about the study that was posted, I will be amazingly surprised if a FAIR trial comparing self-sufficient NP intensivists to PCCM docs will show no significant differences between patient outcomes.

I have the PCP trial open right now, but CBA to read it just yet. Once I do I'll pick out all its flaws that I notice and post em here for all of us to gloat about.

 

[smq123]

Loved it when a DNP didn't know what G6PD deficiency was and I had to explain it to her. Then I had to explain to her what G6PD was and why it was important. Luckily someone in the office knew and told her what it was (Attending was seeing a patient) before she prescribed bactrim for a patient's UTI...

Meh.

I had a patient who had a DOCUMENTED SULFA ALLERGY who was given Bactrim by an EM physician. And then, when he had the inevitable allergic reaction, the explanation that he was given was, "Oh, that particular brand of Bactrim has traces of sulfa in it."

Heard another story of an IM resident who tried to self-treat her UTI with clinda....for 2 weeks straight.

Dumb people exist in all fields.

So I guess the consensus generally is: who cares?

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

No, you're not answering my question.

Where is the PROOF that the doom-and-gloom will happen? That DNPs will be pumped out at such a rate that they will completely overtake MDs? That there will be a definite job shortage for all physicians (because mid levels exist in ALL fields - I have worked with PAs on urology and transplant surgery, even!) because of NPs?

Proof, people, proof. Not fear mongering, not "I heard such-and-such will happen," but proof.

My boyfriend is a rad onc resident. Every month a new bunch of med students rotate through the radiation oncology department, and inevitably one of them will pipe up with, "I heard that radiation oncology is a dying field because chemotherapy will be SO GOOD and SO TARGETED that we won't need radiation anymore." Yeah....no. But we can toss rumors back and forth all day long - doesn't make them true without proof.

I have heard that the VA is preferentially hiring NPs over MDs due to cost savings. These things are a big deal.

It's also the VA. In case you haven't heard, physicians aren't exactly falling over themselves to work at the VA. VAs often have a tough time recruiting.

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.

So you think it's just primary care?

- Nurse-midwives deliver babies unsupervised and unchaperoned. In some states, midwives even do c-sections.

- CRNAs are doing more and more interventional pain procedures. They intubate, place central lines, a-lines, epidurals, etc.

- At the hospital where I did my residency, PAs literally ran the ER. They did their own sutures, their own central lines, and casted their own fractures. Same for the PAs in the ICU.

- One of the cardiology groups was training an NP how to put in defibrillators.

- On my surgery rotation as an intern, the PAs were often in the OR, so that junior residents would be free to do consults and take care of patients on the floor.

- Many dermatology procedures are being usurped by primary care and NPs. NPs can give Botox, as can anyone with a weekend course.

So, which fields does that leave you?

 

[smq123]

All I know is, that I am not going into outpatient (as I imagine independent DNPs will be 99% focused on outpatient PCP work) PCP work anytime in my life. If I go IM, hospitalist might be a career choice, but noooooooooooooo way I'm doing clinic work.

Actually, some hospitalist services utilize NPs to do admissions for them.

I've seen PAs on inpatient surgery services as well.

 

[SpecterGT260]

Haha. Academic people dont understand business. They don't make decisions based upon finding good quality research. They make a decision and THEN look for research to support what they want.

The quality of the studies means nothing. Its not about that. Its economics. Its profit.

If MDs want to show people why they are valuable they need to persuade them that they cost less or offer a unique service that no nurse can provide. A double blind randomized study will sit on the sidelines.

yes, but if you find data that says that a DNP, statistically, will kill Granny 9x more often than a physician.... guess which way the public outcry will sway policy? People stop caring about money so much when you put a face on it. You are right that it is about business, and part of a good business is keeping your clientele from thinking you are more lethal than the other guy

 

[xenotype]

Meh.
Where is the PROOF that the doom-and-gloom will happen? That DNPs will be pumped out at such a rate that they will completely overtake MDs? That there will be a definite job shortage for all physicians (because mid levels exist in ALL fields - I have worked with PAs on urology and transplant surgery, even!) because of NPs?

^DNP programs as per AACN.

You think the fact that midlevels can 'literally run the ER' doesn't pose a threat to physician jobs? If they really can, why do we need EM physicians? If I was a hospital administrator, why would I pay more for the same labor?

 

[cbrons]

You think the fact that midlevels can 'literally run the ER' doesn't pose a threat to physician jobs? If they really can, why do we need EM physicians? If I was a hospital administrator, why would I pay more for the same labor?

Exactly. It looks like smq and the rest of us wasted or are wasting our time in worthless medical school, we're wasting a lot of years learning some low-yield stuff.

 

[SpecterGT260]

Actually, some hospitalist services utilize NPs to do admissions for them.

I've seen PAs on inpatient surgery services as well.

but you havent seen them doing surgery.

You have seen mid levels midleveling. Major difference from the expansion of SoP that we are talking about here. The "I have seen them, and they exist" argument is really out of place.

 

[evilbooyaa]

Actually, some hospitalist services utilize NPs to do admissions for them.

I've seen PAs on inpatient surgery services as well.

Okay, sure, but are NPs that work on hospitalist services making a push to not be unsupervised in the hospital? Where all the sick and dying people come? Where if you mess up a treatment or miss a diagnosis, a patient goes to the ICU or dies?

And yes, I've seen PAs on surgery as well. However, I have never seen a PA be allowed to be the lead person in a surgery.

My response to your post is, "Are all those other examples making significant pushes to be INDEPENDENT of physicians"?

If they do more and more procedures, I will agree that they are on the path to where DNPs are. However, at the end of the day, do all of those fields know when it is and is not appropriate to do such procedures without a physician consult? That's the point we have reached with DNPs. They want to consult patients about their medical decisions without having to discuss anything with a physician. I cannot imagine a cardiology group consisting of a bunch of DNPs/RNs without at least one or two physicians present. If the group existed, who would refer patients to them anyways? Maybe the DNP PCP practices would selectively refer to the DNP cardiology practice. Then we'd have an official two-tiered system of medicine.

As for your anecdotes - There is nothing I can say to them except those physicians are incompetent. I especially don't like the first example for the EM physician to 'play-off' his mistake like it was nothing, especially to another physician. If he plays it off to the patient so he doesn't get his ass litigated, I have some more sympathy. As for the second example.... I have no words for that. First off, clinda for a UTI in the first place? Where did she learn that?

I don't like incompetency that affects patient care regardless of the letters after someone's name. What I will say however, is that the physicians SHOULD have the knowledge to not make those errors. The DNP may have just never learned about G6PD deficiency and it's significance in clinical practice (not sure of this, so any nurses on these forums can clarify if I'm incorrect), and thus I can't fault her for not knowing it if she was never taught.

 

[evilbooyaa]

but you havent seen them doing surgery.

You have seen mid levels midleveling. Major difference from the expansion of SoP that we are talking about here. The "I have seen them, and they exist" argument is really out of place.

Took my post and condensed it into one sentence. Well played.

 

[xenotype]

Okay, sure, but are NPs that work on hospitalist services making a push to not be unsupervised in the hospital? Where all the sick and dying people come? Where if you mess up a treatment or miss a diagnosis, a patient goes to the ICU or dies?

And yes, I've seen PAs on surgery as well. However, I have never seen a PA be allowed to be the lead person in a surgery.

My response to your post is, "Are all those other examples making significant pushes to be INDEPENDENT of physicians"?

The only thing standing in the way of them becoming independent hospitalists in many states is the medicare requirement of a physician of record upon hospital admission. This requires a physician signature to bill medicare for the patient care. There are some god awful hospitals out there that stay in business because nobody knows when they screw up, so bad outcomes can be swept under the rug in the name of corporate profits. Believe me, a good 25-40% of NPs want independence everywhere and the same goes for PAs. The current CMS administrator is a nurse who can make that requirement disappear at the drop of her hat.

 

[SpecterGT260]

Took my post and condensed it into one sentence. Well played.

I'm due for one of those every once in awhile. It is usually me writing the novel while someone comes in with a catch phrase that says everything i wanted to

 

[dr zaius]

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?

Because I jumped through the hoops. I worked my ass off in undergrad, grad school, and now in medical school. Someone now wants to bunny hop over those efforts and do the same job with the same title with an online degree. That just rubs me the wrong way. Some will say good for them. It's great that they found that loop hole and are turning the gears to make things work in their favor. I say **** that, man. What's going to happen when they can all practice autonomously? Who will pay their malpractice? Won't costs even out then? Every single DNP student I see on rotations wants to go into derm or GI. Yea, that's helping the primary care shortage. Don't piss in my face and tell me it's raining.

 

[SpecterGT260]

Because I jumped through the hoops. I worked my ass off in undergrad, grad school, and now in medical school. Someone now wants to bunny hop over those efforts and do the same job with the same title with an online degree. That just rubs me the wrong way. Some will say good for them. It's great that they found that loop hole and are turning the gears to make things work in their favor. I say **** that, man. What's going to happen when they can all practice autonomously? Who will pay their malpractice? Won't costs even out then? Every single DNP student I see on rotations wants to go into derm or GI. Yea, that's helping the primary care shortage. Don't piss in my face and tell me it's raining.

I agree with the first part of what you said here. Its BS

However, THEY will pay their malpractice. I think that will be the kiss of death for this. Do you think that because they make less the suits will be for less? No...... so let them have that

 

[xenotype]

And for those counting on surgery to be safe:

Your Surgeon May Not Be A Doctor

 

[SpecterGT260]

And for those counting on surgery to be safe:

Your Surgeon May Not Be A Doctor

that article isnt really accurate. They do very superficial procedures under direct supervision in the OR. They are doing things that medical students do like closing. The other thing I have heard of them doing in the OR is harvesting the saphenous for bypasses. The headline suggests a surgeon will not be involved... the reality is, instead, that not everyone with their hands on you in the OR will be a surgeon. Major difference.

 

[cbrons]

And for those counting on surgery to be safe:

Your Surgeon May Not Be A Doctor

"As the country ages and more than 30 million new patients enter the health care system under the Affordable Care Act, experts predict that soon, there won't be enough doctors for everyone who wants to see one -- a shortage of 90,000 doctors by 2020, according to the Association of American Medical Colleges. To meet the demand, a surging class of almost-but-not-quite-doctors known as physician assistants, are stepping up to fill the M.D.'s shoes."

Some patients are understandably wary about receiving care from nondoctors. But just because physician assistants didn't go to medical school doesn't mean they can't take care of you: Educators say the training programs mirror medical school in many ways, and studies have shown that physician assistants provide the same level of care as doctors, with no additional liability or malpractice risk. Many patients don't even realize that their "doctor" isn't actually a doctor, but a physician assistant. "Care receivers think everybody is their doc," says Anthony Brenneman, president of the Physician Assistant Education Association.

from - http://www.smartmoney.com/plan/health-care/your-surgeon-may-not-be-a-doctor-1346970593986/

​

Are you kidding me?

 

[Michael Corleon]

And for those counting on surgery to be safe:

Your Surgeon May Not Be A Doctor

Gain multiple skills. Doctors are no longer the only show in town. Bankrupt medicare means they will change laws to make it affordAble. Nurses will be doing our job soon. We need to show why we are better and not by showing we hit diagnoses 4.796% more often. It has to be value, what tangible skills we have to differentiate. And if nurses can run things like ERs or anesthesia then why the hell are we using 11 or 12 years to train them? Because its always been that way? Because schools earn more? Seriously, doctors training is VERY long and time consuming but also very inefficient. How much do we learn to memorize then forget? How much so we do meaningless work on wards?

Physicians have had the market cornered and therefore training could be slow and crappy. The slower the more demand for docs. Well that strategy bit us all in the ass. 12 years to become an anesthesiologist? No wonder nurses are taking over that field. Designing curriculum based upon what you need to do the job from day 1 rather than surveying all of medical science.

 

[calvnandhobbs68]

Are you kidding me?

Haha wow not only is that a ridiculous statement but I don't think many PAs would be cool with that sentence. That's the kind of thing that makes people pissed off...instead of acknowledging their job for what it is and the importance of it you make it seem like they're some doctor knock-off.

 

[xenotype]

Gain multiple skills. Doctors are no longer the only show in town. Bankrupt medicare means they will change laws to make it affordAble. Nurses will be doing our job soon. We need to show why we are better and not by showing we hit diagnoses 4.796% more often. It has to be value, what tangible skills we have to differentiate. And if nurses can run things like ERs or anesthesia then why the hell are we using 11 or 12 years to train them? Because its always been that way? Because schools earn more? Seriously, doctors training is VERY long and time consuming but also very inefficient. How much do we learn to memorize then forget? How much so we do meaningless work on wards?

Physicians have had the market cornered and therefore training could be slow and crappy. The slower the more demand for docs. Well that strategy bit us all in the ass. 12 years to become an anesthesiologist? No wonder nurses are taking over that field. Designing curriculum based upon what you need to do the job from day 1 rather than surveying all of medical science.

Considering 50% of Columbia DNP grads can't pass a watered down version of step 3, I'd say med school counts for something important. How many CRNAs could pass the anesthesiology boards? There is a difference, it is just not being emphasized politically and not being properly studied.

 

[SpecterGT260]

Gain multiple skills. Doctors are no longer the only show in town. Bankrupt medicare means they will change laws to make it affordAble. Nurses will be doing our job soon. We need to show why we are better and not by showing we hit diagnoses 4.796% more often. It has to be value, what tangible skills we have to differentiate. And if nurses can run things like ERs or anesthesia then why the hell are we using 11 or 12 years to train them? Because its always been that way? Because schools earn more? Seriously, doctors training is VERY long and time consuming but also very inefficient. How much do we learn to memorize then forget? How much so we do meaningless work on wards?

Physicians have had the market cornered and therefore training could be slow and crappy. The slower the more demand for docs. Well that strategy bit us all in the ass. 12 years to become an anesthesiologist? No wonder nurses are taking over that field. Designing curriculum based upon what you need to do the job from day 1 rather than surveying all of medical science.

I am starting to think you are a well camouflaged troll.....

 

[evilbooyaa]

And for those counting on surgery to be safe:

Your Surgeon May Not Be A Doctor

"Duke University, which runs the oldest and highest-ranked physician assistant program in the country, according to U.S. News & World Report, had more than 1,200 applicants for the 84-seat class that entered the program last month, an admissions rate of less than 7% -- that's almost as competitive as many medical schools."

Is the article serious? Are they comparing the competitiveness of PA schools to that of medical school (MD or DO)? C'mon now. This is BS reporting and word manipulation at it's finest.

 

[Postictal Raiden]

First of all, I'm only a pre-med, so my knowledge and exposure is limited, but I will offer my input on the topic.

For those of you who oppose the expansion of midlevels, don't you think it's far better to allow NP's to practice independently than opening more residency spots or recruiting foreign physicians, flooding the market with doctors?

I think threats to the medical profession are often posed by physicians "borrowing" patients and procedures from each other. Look at what happened to fields like CT surgery, and compare that to the situation in anesthesiology. Despite of decades of midlevels' involvement in gas, anesthesiologist remain to be one of the highest paid doctors. CT surgeons on the other hand were nearly driven out of the profession when cardiologists began stenting.

As a future physician, I don't see midlevels as a threat to the medical profession, because when given the choice, people will chose doctors over nurses any day any time, given that everything else is the same (ie. cost).

 

[peteB]

As a future physician, I don't see midlevels as a threat to the medical profession, because when given the choice, people will chose doctors over nurses any day any time, given that everything else is the same (ie. cost).

That's assuming they know the person is a nurse. The DNPs have the title of "Doctor" in front of their name, so it's not immediately obvious that they are nurses.

Also, the distinction between an MD and a DNP is already something nebulous to the general public, and with the right marketing from the nurses, they can convince people pretty easily that they are one and the same.

 

[Michael Corleon]

I am starting to think you are a well camouflaged troll.....

Of course you think that. I have a different opinion than you.

I'd love to keep my pay higher but the reality is Medicare is running out of money. Either the program dies or nurses do more. Nurses doing more has obvious consequences to our field.

 

[SpecterGT260]

"Duke University, which runs the oldest and highest-ranked physician assistant program in the country, according to U.S. News & World Report, had more than 1,200 applicants for the 84-seat class that entered the program last month, an admissions rate of less than 7% -- that's almost as competitive as many medical schools."

Is the article serious? Are they comparing the competitiveness of PA schools to that of medical school (MD or DO)? C'mon now. This is BS reporting and word manipulation at it's finest.

competitiveness =/= selectiveness

I have seen MANY people make this mistake. The average medical matriculant, by stats, would walk into any PA school in the country. The resumes are simply more impressive. This is still a numbers game at a certain level.

 

[SpecterGT260]

Of course you think that. I have a different opinion than you.

I'd love to keep my pay higher but the reality is Medicare is running out of money. Either the program dies or nurses do more. Nurses doing more has obvious consequences to our field.

no... that isnt why. Where do we have a difference of opinion? Or do you just assume that we do because I think you're trolling?

 

[Lokhtar]

Just out of curiousity, exactly how could you do an appropriate study when I'm guessing you won't find a single IRB at any reputable institution allowing randomization of patients into a DNP vs. MD study where the DNPs are given no physician oversight and are forbidden from consulting physicians if they encounter complications with their patients. And how are you supposed to compare outcomes when the DNP's always have physician backup if something goes wrong? Even putting the IRB aside, I'd argue there are serious ethical issues with it.

Why would they be forbidden? You could track things like consultations if you wanted (and compare those as well, since they factor into the cost).

In any case, if it is indeed impossible, then the games over. Can't be won. So someone better figure out a way to make it possible. Whether you agree with it or not, no one is going to (least of all elected officials - the ones who've given physicians a monopoly on certain types of procedures and scope of practice) just trust your word when the other side is coming up with data and potential solutions to the ever tightening budget problems.

 

[loveoforganic2]

I agree with the first part of what you said here. Its BS

However, THEY will pay their malpractice. I think that will be the kiss of death for this. Do you think that because they make less the suits will be for less? No...... so let them have that

I agree. Malpractice actuaries aren't going to have any NP bias - they should eventually arrive at a value for DNP insurance that should be a measure of NP safety. Of course they could all refer to a physician anyone w/any risk and keep their safety high. But obviously insurance companies won't dig that!

I'm not sure how long it will take, but I think these two things should eventually determine the efficacy, safety, and viability of NP independent practice. If it works out so that they're both safe and efficacious, so be it - good for the patients. Regardless, I think I would have taken the safer route of trying to knock out some of the inefficiencies in medical training rather than build another independent practitioner from the ground up.

 

[Lokhtar]

I agree with the first part of what you said here. Its BS

However, THEY will pay their malpractice. I think that will be the kiss of death for this. Do you think that because they make less the suits will be for less? No...... so let them have that

Yup, they will be.

If someone gets hit by a car from an average guy, vs. Bill Gates - you bet the lawsuit is going to be a lot different. This is why in any suit, the lawyers try to name the entity with the deepest possible pockets. E.g if they can name the hospital in addition to the doctor...or a national chain instead of a local store, etc. How much a person is able to pay has a big effect on how much the lawyers seek. There is little point in taking on a long and expensive lawsuit where your upside is extremely low in terms of recovery.

 

[xenotype]

First of all, I'm only a pre-med, so my knowledge and exposure is limited, but I will offer my input on the topic.

For those of you who oppose the expansion of midlevels, don't you think it's far better to allow NP's to practice independently than opening more residency spots or recruiting foreign physicians, flooding the market with doctors?

I think threats to the medical profession are often posed by physicians "borrowing" patients and procedures from each other. Look at what happened to fields like CT surgery, and compare that to the situation in anesthesiology. Despite of decades of midlevels' involvement in gas, anesthesiologist remain to be one of the highest paid doctors. CT surgeons on the other hand were nearly driven out of the profession when cardiologists began stenting.

As a future physician, I don't see midlevels as a threat to the medical profession, because when given the choice, people will chose doctors over nurses any day any time, given that everything else is the same (ie. cost).

They call themselves doctors, so the public is easily confused. You will never be able to compete with them on price, because you will have a large student loan debt to pay off and years of lost income in comparison. They will always be willing to work for less money than you. Anesthesiologists cannot get jobs in most desirable urban markets because of CRNAs. This is a fact. As more CRNAs are produced, it will become harder for them to get a job anywhere. The fact that a CRNA with a two year degree can do their job makes them an even juicier target for heavy medicare cuts. Expect anesthesio income to drop by 40% or more in the next decade. CT surgeons were not instantly replaced, they were gradually replaced as stenting tech began to proliferate in the 90s. When we take foreign physicians for residency, we take the best ones from their countries. We also get to discard them if they suck in the residency they have to repeat

 

[peteB]

I'm not really concerned about competition from DNPs. We as medical students have faced lots of competition in our lives and thrived. If we truly believe that we are better trained and more capable than the DNPs, we should be able to demonstrate that through our work. If we can't do that, then maybe our extra training is meaningless.

People who excel at their job will always have a job, regardless of how many people there are competing for it. If you are confident in your skills and can compete, then any number of additional Mid-levels shouldn't be a concern to you any more than any number of additional MDs are.

Expensive sushi restaurants haven't shut down even though Walmart now sells discount sushi...

 

[SpecterGT260]

Yup, they will be.

If someone gets hit by a car from an average guy, vs. Bill Gates - you bet the lawsuit is going to be a lot different. This is why in any suit, the lawyers try to name the entity with the deepest possible pockets. E.g if they can name the hospital in addition to the doctor...or a national chain instead of a local store, etc. How much a person is able to pay has a big effect on how much the lawyers seek. There is little point in taking on a long and expensive lawsuit where your upside is extremely low in terms of recovery.

No, they won't be. At least not substantially.

True, the suits name the biggest figure they think they can get away with. We arent talking about the personal sallaries of the practitioners here, but the value of the practices they work in. If they have autonomous practice, they will be as responsible as any physician for the suit brought against THE HOSPITAL. Who has the biggest pockets here, the physician or the DNP? Answer: the hospital. The great equalizer here. Malpractice dollars will be very comparable and therefore malpractice insurance will be.

 

[Postictal Raiden]

They call themselves doctors, so the public is easily confused. You will never be able to compete with them on price, because you will have a large student loan debt to pay off and years of lost income in comparison. They will always be willing to work for less money than you. Anesthesiologists cannot get jobs in most desirable urban markets because of CRNAs. This is a fact. As more CRNAs are produced, it will become harder for them to get a job anywhere. The fact that a CRNA with a two year degree can do their job makes them an even juicier target for heavy medicare cuts. Expect anesthesio income to drop by 40% or more in the next decade. CT surgeons were not instantly replaced, they were gradually replaced as stenting tech began to proliferate in the 90s. When we take foreign physicians for residency, we take the best ones from their countries. We also get to discard them if they suck in the residency they have to repeat

I don't know where you're getting your data from. Gas salaries have been going up since the 90's, and any potential income reduction will be a direct result of medicare cuts, not CRNA.

Physician to population ratio in the US is one of the lowest among developed nations. There's a real shortage. There are only two solutions for this problem: One, is to increase residency spots, allowing FMG's to work in the US. Two, giving midlevels more autonomy to ease the shortage. I personally, think the latter option is economically the best for physicians. If you flood the market with doctors, salaries will go down for sure. Physicians will be competing with others sharing same grounds. However, NP's and PA's can never win a fight against doctors.

 

[Postictal Raiden]

I'm not really concerned about competition from DNPs. We as medical students have faced lots of competition in our lives and thrived. If we truly believe that we are better trained and more capable than the DNPs, we should be able to demonstrate that through our work. If we can't do that, then maybe our extra training is meaningless.

People who excel at their job will always have a job, regardless of how many people there are competing for it. If you are confident in your skills and can compete, then any number of additional Mid-levels shouldn't be a concern to you any more than any number of additional MDs are.

Expensive sushi restaurants haven't shut down even though Walmart now sells discount sushi...

Exactly.

Therefore, as future physicians we must do our best to maintain this leverage. We must stay on top of our game and keep evolving to adapt to the market's need.

The fact is physicians will never enjoy the absolute autonomy and untouchable status they once had decades ago. Medicine is a delicious pie, and everyone wants a piece.

 

[Crim1]

I'm a current medical student rotating through a solo primary care (internal medicine) practice once per week. I can confidently say a DNP is not qualified to provide care to a good fraction of the patients we see (the medicare patients in particular).

Most patients actually want to know what is wrong with them and they also want it explained to them in common terms, along with their treatment options. This requires a level of understanding beyond recognize and prescribe. Many patients are also dealing with a complex web of chronic illnesses, new symptoms and drug risks requiring a level of understanding that DNPs are not trained and educated for (again, old people in particular).

Honestly, I'm not worried. If DNPs want to see patients for common illness that's fine. If they gain a broad scope of practice that's fine. Patients will quickly find out who knows what is going on and who doesn't. If they have a serious problem they will come to us. Let the nurse handle the seasonal allergies, flu shots and weight counseling.

 

[Michael Corleon]

I'm not really concerned about competition from DNPs. We as medical students have faced lots of competition in our lives and thrived. If we truly believe that we are better trained and more capable than the DNPs, we should be able to demonstrate that through our work. If we can't do that, then maybe our extra training is meaningless.

People who excel at their job will always have a job, regardless of how many people there are competing for it. If you are confident in your skills and can compete, then any number of additional Mid-levels shouldn't be a concern to you any more than any number of additional MDs are.

Expensive sushi restaurants haven't shut down even though Walmart now sells discount sushi...

I agree IF we can work together. Physician need to form a real united group. The ama blows and each specialty association is great but not enough. We need a real national group that has our back.

 

[peteB]

The fact is physicians will never enjoy the absolute autonomy and untouchable status they once had decades ago. Medicine is a delicious pie, and everyone wants a piece.

This is absolutely right. Physicians are going to lose more power, prestige, and money.

At one time the title of 'doctor' carried a lot of prestige with it. Very soon everyone will be some sort of 'doctor', i'm sure. That sucks, but it's the way it's going to be. Engineers have the same problem. Even people who pick up trash nowadays are called "Sanitation Engineers". The department in our hospital where the guys who fix the plumbing and change lightbulbs work is called "Engineering". Is changing a lightbulb the same as designing an airplane or a car?

The titles will probably become meaningless, but the quality of the work won't. That's what will differentiate us.

 

[xenotype]

I don't know where you're getting your data from. Gas salaries have been going up since the 90's, and any potential income reduction will be a direct result of medicare cuts, not CRNA.

Read the gas forums on here for thirty seconds.

I'm a current medical student rotating through a solo primary care (internal medicine) practice once per week. I can confidently say a DNP is not qualified to provide care to a good fraction of the patients we see (the medicare patients in particular).

It is my understanding that in many practices they are simply given a panel of patients just like a new physician hire, with little difference in how sick the patients are other than a smaller panel at first. I'd love to be proven wrong. I have been told by a general IM attending nearing retirement that primary care is "not that hard" and "can easily be done by PAs and NPs". I don't agree with that statement but if the government is willing to pay for ****ty primary care, what is stopping them?

 

[cbrons]

I agree IF we can work together. Physician need to form a real united group. The ama blows and each specialty association is great but not enough. We need a real national group that has our back.

Oh please, give me a freaking break. A national group? Just take a look at what some people post on threads like these. Most here couldn't give a damn less what happens to the guy in peds, FM, IM, etc. In fact, many on these forums make jokes about the guy or girl who wants to go into any of those specialties. The fact that so many are willing to throw the "generalist" under the bus speaks volumes about the character and pride left in the profession.

"Real united group" ROFL

 

[peteB]

Oh please, give me a freaking break. A national group? Just take a look at what some people post on threads like these. Most here couldn't give a damn less what happens to the guy in peds, FM, IM, etc. In fact, many on these forums make jokes about the guy or girl who wants to go into any of those specialties. The fact that so many are willing to throw the "generalist" under the bus speaks volumes about the character and pride left in the profession.

"Real united group" ROFL

I agree, physicians aren't going to be united anytime soon. They are always fighting amongst themselves.

If we really wanted to fight this all physicians could stand together and say we are not going to hire or work with any PAs or DNPs. But that's never going to happen. There will always be some physicians who see that as an opportunity to make more money and ruin the entire movement.