NBME to develop licensing exam for DNPs

[MacGyver]

http://online.wsj.com/article/SB120710036831882059.html?mod=todays_us_personal_journal

At first I thought this was your regular, run of hte mill, routine "My doctor is a nurse practitioner op-ed". That is, until I saw this:

To establish a national standard for doctors of nursing practice, the non-profit Council for the Advancement of Comprehensive Care plans to announce Wednesday that the National Board of Medical Examiners has agreed to develop a voluntary DNP certification exam based on the same test physicians take to qualify for a medical license. The board will begin administering the exam this fall.

A spokeswoman for the medical licensing board, which provides examinations used by licensing authorities for several health professions, says the planned DNP exam will be narrower in scope than the three-step exam that doctors take, including tests on organ systems and a range of medical disciplines. A number of physicians have supported the efforts to advance nursing to the doctorate level through the Council for the Advancement of Comprehensive Care.

All nurses currently are licensed by the state in which they practice and are certified by specialty groups. The planned certification exam won't be a requirement for licensing of DNPs, and it is too early to say whether it will catch on broadly as a desirable credential for practice. Jeanette Lancaster, president of the American Association of Colleges of Nursing says "we are keeping an open mind as to whether it will add another level of validation of competency."

This is unfreaking believable. I knew there were a lot of sellout doctors whoring out their practices to NPs. I foolishly thought that the treachery was limited mostly to private practice and to a lesser extent academic medical centers.

But this is huge. Now the the licensing people are selling us out to the nurses.

I'm absolutely shocked and appalled.

I want the names of the NBME bastards who took their 30 pieces of silver and betrayed us like Judas!

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[Faebinder]

I wonder if they will start competing for residency as well. They will be like DOs back in the days? First their own residency then start competing for allopathic residency?

Anyway, I dont think this is negative... It's when they start claiming they can go into residency that I start saying... we got problems.

 

[Faebinder]

Whoa.. I didn't see this part... this is not good. Internal and Family Medicine should have a fit with that.

In addition to training in diagnostic and treatment skills, doctors of nursing practice can have hospital admitting privileges, coordinate care among specialists, help patients with preventive care, evaluate their social and family situations, and manage complex illnesses such as diabetes and heart disease, says Dr. Mundinger, who has been leading the effort behind the National Board of Medical Examiners' planned certification exam.

 

[MacGyver]

They've had admitting privileges for awhile, thats not new.

What really pisses me off is that the NBME guys would agree to work wtih that bitch Mary Mundinger (I refuse to give her the "doctor" title). She wrote the article below about how NPs are better "doctors" than MDs are:

http://www.forbes.com/opinions/2007/11/27/nurses-doctors-practice-oped-cx_mom_1128nurses.html

 

[MacGyver]

I wonder if they will start competing for residency as well. They will be like DOs back in the days? First their own residency then start competing for allopathic residency?

Anyway, I dont think this is negative... It's when they start claiming they can go into residency that I start saying... we got problems.

Havent you heard? The new DNP programs include a 1 year "residency"

Just a matter of time before they start pushing for specialist residencies too.

Again, I expected the nursing organizations to push hard for this.

But for the NBME to essentially validate all their propaganda? Not only that, but to GET ON BOARD WITH A LICENSING EXAM THATS SUPPOSED TO BE "SIMILAR" TO PHYSICIAN LICENSING EXAMS??????

I thought it would be another 30 years before NPs take over primary care completely. But with the NBME speeding this thing along, I may have to adjust my time schedule.

 

[E Dubble]

AMA!! Where are you?!?

 

[kirurg]

In the article that MacGyver posted, Mundinger said:
DNPs are the ideal candidates to fill the primary-care void and deliver a new, more comprehensive brand of care that starts with but goes well beyond conventional medical practice. In addition to expert diagnosis and treatment, DNP training places an emphasis on preventive care, risk reduction and promoting good health practices. These clinicians are peerless prevention specialists and coordinators of complex care. In other words, as a patient, you get the medical knowledge of a physician, with the added skills of a nursing professional.

While I find it hard to believe that NPs have the medical knowledge of a physician, they probably can manage simple health maintenence, HTN and DM if a real doctor reviews all of the cases. It may be good for doctors... MDs can focus on the complex cases and NPs can schedule colonoscopies and increase insulin doses. It may also be good for patients who have to wait months to get an appointment. I feel that the patients should personally be seen by an MD once per year and for anything acute.

I'm still a student, and not going into primary care, so before you crucify me, please remember that these are just my opinions. I'd like to hear from people who disagree with me and let me know if I'm way off base.

 

[MacGyver]

In the article that MacGyver posted, Mundinger said:
DNPs are the ideal candidates to fill the primary-care void and deliver a new, more comprehensive brand of care that starts with but goes well beyond conventional medical practice. In addition to expert diagnosis and treatment, DNP training places an emphasis on preventive care, risk reduction and promoting good health practices. These clinicians are peerless prevention specialists and coordinators of complex care. In other words, as a patient, you get the medical knowledge of a physician, with the added skills of a nursing professional.

While I find it hard to believe that NPs have the medical knowledge of a physician, they probably can manage simple health maintenence, HTN and DM if a real doctor reviews all of the cases. It may be good for doctors... MDs can focus on the complex cases and NPs can schedule colonoscopies and increase insulin doses. It may also be good for patients who have to wait months to get an appointment. I feel that the patients should personally be seen by an MD once per year and for anything acute.

I'm still a student, and not going into primary care, so before you crucify me, please remember that these are just my opinions. I'd like to hear from people who disagree with me and let me know if I'm way off base.

If you read the rest of hte article you find out that Mundinger isnt talking about a collaborative practice. She's talking about NPs running teh shop solo with no doctor collaboration or oversight whatsoever.

 

[kirurg]

Yeah, I read the article and I am 100% opposed to NPs flying solo. My only point was that I don't have any serious problems with NPs taking care of the simplest tasks if a physician is keeping tabs. I wouldn't want a family member to be treated by an NP for anything acute, so I would not support Mundinger's plan entirely. I guess you run into the problem of 'if you give them a foot, they'll take a yard.'

 

[Coastie]

This is one of the horsemen.

They call one of the DNP's a "primary care physician" in the article.

Now the NBME does this?

I think the high enrollment and new medical schools will somewhat help stem the tide, not to mention reimbursement issues, but adding this many people to the medicare pie will inevitably cause reimbursements to PLUMMET.

http://online.wsj.com/article/SB120710036831882059.html?mod=todays_us_personal_journal

At first I thought this was your regular, run of hte mill, routine "My doctor is a nurse practitioner op-ed". That is, until I saw this:





This is unfreaking believable. I knew there were a lot of sellout doctors whoring out their practices to NPs. I foolishly thought that the treachery was limited mostly to private practice and to a lesser extent academic medical centers.

But this is huge. Now the the licensing people are selling us out to the nurses.

I'm absolutely shocked and appalled.

I want the names of the NBME bastards who took their 30 pieces of silver
and betrayed us like Judas!

 

[Coastie]

Dude, it'll be just around the corner. You can see the chess Mudslinger is playing.

I wonder if they will start competing for residency as well. They will be like DOs back in the days? First their own residency then start competing for allopathic residency?

Anyway, I dont think this is negative... It's when they start claiming they can go into residency that I start saying... we got problems.

 

[Tired]

Same old, same old.

The physicians of today are selling out the physicians of tomorrow. After all, what does the guy with the established practice care about new NPs coming in the market? It's just like gas with their CRNAs --> they'll make you a lot of money now that you have a thriving solo practice, and screw the young guys trying to get going fresh out of residency.

If the surgeons had any balls at all (including my own group) they would only take consults from licensed physicians, and refuse to do cases unless an Anesthesiologist was in the room.

 

[Coastie]

Note that the two specialties leading the fight in that article are AAFP and ASA (Anesthesiologists).

We have both been on the front lines against these sort of incursions. Now it will open up to all of medicine.

We docs have to unite for our patients and for our livelihood before it's too late. We are rounding the corner, folks..

 

[Coastie]

Same old, same old.

The physicians of today are selling out the physicians of tomorrow. After all, what does the guy with the established practice care about new NPs coming in the market? It's just like gas with their CRNAs --> they'll make you a lot of money now that you have a thriving solo practice, and screw the young guys trying to get going fresh out of residency.

If the surgeons had any balls at all (including my own group) they would only take consults from licensed physicians, and refuse to do cases unless an Anesthesiologist was in the room.

CRNA's within an ACT model (under an Anesthesiologist) is acceptable. At this time (and probably, forever) solo MD Anesthesiology isn't possible without shutting down most of the US hospitals, as only 35% of anesthesia is delivered solely by an MD, but 90% of all anesthetics delivered in the US are either by an MD solo or a CRNA working closely under a MD supervising in the ACT model.

But yeah, dude. We are in big time trouble. I'd say the three fronts are family practice, anesthesiology, and military medicine. We're losing on each.

 

[Coastie]

Two words:

Trial lawyers.

 

[Tired]

CRNA's within an ACT model (under an Anesthesiologist) is acceptable. At this time (and probably, forever) solo MD Anesthesiology isn't possible without shutting down most of the US hospitals, as only 35% of anesthesia is delivered solely by an MD, but 90% of all anesthetics delivered in the US are either by an MD solo or a CRNA working closely under a MD supervising in the ACT model.

I can't help but wonder if the expansion of CRNA practice rights comes from a desire of groups that employ them to not have to supervise them so closely, and possibly lessen their own liability for their errors.

But yeah, dude. We are in big time trouble. I'd say the three fronts are family practice, anesthesiology, and military medicine. We're losing on each.

You (anes) already lost milmed. Forget about it.

It's pretty clear that wherever MDs have expanded the use of mid-levels to make a quick buck, indepedent practice has followed shortly thereafter. Minimal incursions in Orthopaedics so far from what I have seen/heard, but I know General Surgery already uses them to do "minor" procedures solo.

I can only hope I get a practice set up before they overwhelm us.

 

[Coastie]

I can't help but wonder if the expansion of CRNA practice rights comes from a desire of groups that employ them to not have to supervise them so closely, and possibly lessen their own liability for their errors..

Interesting theory. Out of my pay grade. Maybe some of the attendings can weigh in?

You (anes) already lost milmed. Forget about it.

That's what I hear. They are still trying to heavily recruit us, despite having General CRNA's boss around junior officer MD's. With few bright exceptions, as you know, milmed is really doing our boys a disfavour.

It's pretty clear that wherever MDs have expanded the use of mid-levels to make a quick buck, indepedent practice has followed shortly thereafter. Minimal incursions in Orthopaedics so far from what I have seen/heard, but I know General Surgery already uses them to do "minor" procedures solo. I can only hope I get a practice set up before they overwhelm us.

Well, at the end of the day, you're a physician, and you can market yourself as such. The future of medicine is a big unknown, so beyond that, and fighting on the political level, not much you or anyone can do. We physicians HAVE to view this as a war, though. It cannot be anything else. Why bring a knife to a gun fight? You and I both know if the paralegals ever tried to practice law, well...There would be some bigtime smackdown.

 

[blotto geltaco]

They've had admitting privileges for awhile, thats not new.

What really pisses me off is that the NBME guys would agree to work wtih that bitch Mary Mundinger (I refuse to give her the "doctor" title). She wrote the article below about how NPs are better "doctors" than MDs are:

http://www.forbes.com/opinions/2007/11/27/nurses-doctors-practice-oped-cx_mom_1128nurses.html

I agree, that woman is a bitch.

 

[Gas]

I am floored by the NBME. We all know these DNP exams are going to be a joke, compared to what physicians take, but it looks like the plan is moving forward. If the exams were really that similar, why even make a new one? Make these nurses take the USMLE - not one will pass.

I think once a few of these DNP's start practicing, they are bound to make big-time mistakes, and hopefully the trial lawyers will weed them out. If not, I really don't know what our options are. I wish the AAFP/AMA/ASA would have done more to prevent this from even getting here.

 

[Hurricane]

If they are going to bill themselves as having "the medical knowledge of a physician" then they should back it up by passing the same three-step USMLE.

 

[Coastie]

I am floored by the NBME. We all know these DNP exams are going to be a joke, compared to what physicians take, but it looks like the plan is moving forward. If the exams were really that similar, why even make a new one? Make these nurses take the USMLE - not one will pass.

I think once a few of these DNP's start practicing, they are bound to make big-time mistakes, and hopefully the trial lawyers will weed them out. If not, I really don't know what our options are. I wish the AAFP/AMA/ASA would have done more to prevent this from even getting here.

Merely passing the USMLE's isn't hard. A lot of FMG's study for step 1 for 3 years, finally pass, step 2 for 3 years, pass, etc. Kaplan and lots and lots and lots of time can get you to PASS the USMLE.

Become a physician? Something else. That something else, which requires a lot, requires to also make great grades in organic chem, undergrad, 4 years of med school, and the steps along the way, but the mere passing of a standardized test isn't it.

 

[zinjanthropus]

If they are going to bill themselves as having "the medical knowledge of a physician" then they should back it up by passing the same three-step USMLE.

I understand what you are implying but I don't think anyone should have the right to sit for the exam unless you are a PHYSICIAN/medical student.

I could potentially pass the state bar if I studied hard for a few months but no one but law school grads have the ability to take it (99% of the time anyway).

There is a culture associated with being a physician and that can not be replicated or invoked by clinicians trained in a different model. There are things that make us unique beyond multiple choice clinical knowledge and it's those things (insight, reasoning, decision making, management, etc) that make the profession worth protecting.

 

[Taurus]

I also posted this on the allo forum.

NBME sells out the medical profession to the nurses

 

[Taurus]

It will be just a matter of time when the DNP's start to say that they truly are equivalent to physicians because they passed the "same" test.

 

[core0]

I also posted this on the allo forum.

NBME sells out the medical profession to the nurses

I will point out that part of the NBME mission is to provide testing services for other health care organizations as seen here:
http://www.nbme.org/programs-services/health-professionals/index.html

Organizations that they consult with include echocardiography, physical therapy, medical assistants and veterinary medicine among others. Also it is one thing to have a staff member say that they will work to develop the test and another to figure out how to pay for it and who will be responsible for the credential.

David Carpenter, PA-C

 

[Taurus]

I will point out that part of the NBME mission is to provide testing services for other health care organizations as seen here:
http://www.nbme.org/programs-services/health-professionals/index.html

Organizations that they consult with include echocardiography, physical therapy, medical assistants and veterinary medicine among others. Also it is one thing to have a staff member say that they will work to develop the test and another to figure out how to pay for it and who will be responsible for the credential.

David Carpenter, PA-C

That may be true, but don't you think that the nurses have an ulterior motive to go through the NBME? Oh, maybe like because they want to make people think that physicians and DNP's take the same test because they go through the same testing organization and that this so-called new test is a subset of the USMLE? Nursing has the organization and manpower to develop their own test if they so wish.

 

[Dr. Wexler]

Two words:

Trial lawyers.

Won't happen unless the DNPs have big bucks to go after. Trial lawyers don't sue people who can't pay.

 

[Faebinder]

Ya but they would be easier to sue cause it's easy to get expert witnesses higher than them...

 

[kraphtymac]

Feel free to e-mail old Mary Mundinger... [email protected]

 

[Coastie]

Won't happen unless the DNPs have big bucks to go after. Trial lawyers don't sue people who can't pay.

True, but we have to fight fire with fire.

Not to mention, you think that if they ever reach parity in the public's eyes, they will pay LESS malpractice?

Actually, by that time, things will be completely socialized, and doctors will be on the streets ala fantasy of pandabear. What a website: http://www.pandabearmd.com

I love the quote about nephrologists bumming dirty syringes to test each other's blood chemistry by the open barrel fire.

 

[yaah]

Somehow I doubt the "residency" that they are referring to here is a similarly rigorous residency that physicians have to go through. It's probably just a regular 9-5 job with a little bit of extra reading and less pay. No way in heck that non-physicians are going to give away their overtime pay for anything more than the 40 hour week. So I think the "threat" of DNPs competing for residency spots is laughable.

 

[Dr. Wexler]

Not to mention, you think that if they ever reach parity in the public's eyes, they will pay LESS malpractice?

Quite possibly. Malpractice premiums are based on cost to insure. Cost to insure is closely related to probability of getting sued. I propose that probability of getting sued is based in part how how much money (ie malpractice coverage) you have.

 

[AwesomO]

True, but we have to fight fire with fire.

Not to mention, you think that if they ever reach parity in the public's eyes, they will pay LESS malpractice?

Actually, by that time, things will be completely socialized, and doctors will be on the streets ala fantasy of pandabear. What a website: http://www.pandabearmd.com

I love the quote about nephrologists bumming dirty syringes to test each other's blood chemistry by the open barrel fire.

Apparently panda got quite the load of hate mail after he wrote that "a brand new intern is more competent than a brand new mid level." He even wrote a response post to all the commotion.

 

[THP]

Apparently Mundinger is on the Board of Directors of United Health Care. Hmmm. . . . http://www.unitedhealthgroup.com/about/103007_board.pdf

by 2007 she had received (per the company's 2007 proxy) rights to acquire 345,930 shares of UnitedHealth, and in 2006 was paid $73,750 in cash and stock options valued at $412,575. That level of compensation might inspire some loyalty.


http://hcrenewal.blogspot.com/2008/04/what-influences-advocacy-for-doctor.html

 

[Miami_med]

Apparently Mundinger is on the Board of Directors of United Health Care. Hmmm. . . . http://www.unitedhealthgroup.com/about/103007_board.pdf

by 2007 she had received (per the company's 2007 proxy) rights to acquire 345,930 shares of UnitedHealth, and in 2006 was paid $73,750 in cash and stock options valued at $412,575. That level of compensation might inspire some loyalty.


http://hcrenewal.blogspot.com/2008/04/what-influences-advocacy-for-doctor.html

You know, you guys are complaining a lot. In the hands of the right PR guy, the fact above alone coupled with painting her as the face of the DNP movement could set it back for years.

If you want to destroy something in America, paint it as being part of corporate america while it doesn't yet have the political stability to withstand the associated attack. Right or wrong, that works. Painting this as a scheme to make the big evil insurance company rich by providing substandard care to its patients would go over well. It might even destroy the stereotype that the nurses are some sort of angelic force saving the world from the evil money grubbing physicians.

 

[Coastie]

Pays well to come up with superfluous degrees and get published in WSJ and Forbes.

MDs should take note. If we don't stand together...whew.

Apparently Mundinger is on the Board of Directors of United Health Care. Hmmm. . . . http://www.unitedhealthgroup.com/about/103007_board.pdf

by 2007 she had received (per the company's 2007 proxy) rights to acquire 345,930 shares of UnitedHealth, and in 2006 was paid $73,750 in cash and stock options valued at $412,575. That level of compensation might inspire some loyalty.


http://hcrenewal.blogspot.com/2008/04/what-influences-advocacy-for-doctor.html

 

[spudbunny]

For those of you who advocate that the nurses should be made to take the USMLE steps 1-3 - it will only take the publicization of handful of nurses passing those steps to totally destoy your argument that pre-med, and 4 years of med school are necessary to enter residency. Once a few pass those, the floodgates are open to nurses competing with you for residencies. The PA's will then insist that they be allowed to take the exams too, and prospective med students like myself will start asking themselves "Why not take the 2 year CC rn, self-study like crazy and take the steps at one's leisure, bypassing MCATs, 4 years of med school instead of online classes at one's convenience. Believe me, if this were possible there would be a lot of pre-meds questioning the wisdom of the med school path, if another one that allows entry to residency is available.

 

[orientedtoself]

if dr. np's are going to go into independent practice, then they should know what you need to know to go into independent practice, which is supposed to be what step 1-2-3 test for. i wouldn't care if a dnp passed step 1-2-3. i would think it's great that they have the same knowledge base. but we all know for most np's that's not the case, as they have different training than we do.

 

[core0]

Quite possibly. Malpractice premiums are based on cost to insure. Cost to insure is closely related to probability of getting sued. I propose that probability of getting sued is based in part how how much money (ie malpractice coverage) you have.

In a normal world yes. However, most NPs are insured through ANA. ANA also insures RNs. So even though RNs pay very little, the incredibly small rate that they get sued helps subsidize the NP rates. Nice little gig.

David Carpenter, PA-C

 

[core0]

That may be true, but don't you think that the nurses have an ulterior motive to go through the NBME? Oh, maybe like because they want to make people think that physicians and DNP's take the same test because they go through the same testing organization and that this so-called new test is a subset of the USMLE? Nursing has the organization and manpower to develop their own test if they so wish.

I definitely agree that this is another attempt to equate themselves with physicians. Its also very self serving. The NBME is happy to develop the test which is what the staffer stated. However, the NBME is not cheap. You can look at the cost of the Step tests for example. I have also seen the cost for test development that the NCCPA is charged and its not cheap. Either the cost is going to be subsidized by someone or its going to be >$10k at a guess. When that happens of course they will say "we wanted to do this but the doctors made it too expensive".

just my cynics view.

David Carpenter, PA-C

 

[mig26x]

And this is why we have to specialize (fellowships), Primary care days are numbered for Physicians with clinics opening in Walmart, CVS etc etc, all this places are more than happy to pay less for a RN and/or NP instead of a physician and people are going to attend this clinics.

keyword is FELLOWSHIP!!

 

[Coastie]

10k is nothing.

I believe it is very dangerous for some of the above posters to boil down the nurse vs doctor divide on 4 days of testing alone..Step 1, 2, 3. As it has been posted, studying solely for these exams, and passing, isn't beyond the reach of a non-physician.

I definitely agree that this is another attempt to equate themselves with physicians. Its also very self serving. The NBME is happy to develop the test which is what the staffer stated. However, the NBME is not cheap. You can look at the cost of the Step tests for example. I have also seen the cost for test development that the NCCPA is charged and its not cheap. Either the cost is going to be subsidized by someone or its going to be >$10k at a guess. When that happens of course they will say "we wanted to do this but the doctors made it too expensive".

just my cynics view.

David Carpenter, PA-C

 

[orientedtoself]

sure, and i didn't think they were that hard (granted i haven't gotten my step 3 score back yet). but let's face it people, np's essentially have our same scope of practice. dnp's want to take a test. the steps are supposed to cover basic clinical knowledge/ competency needed for independent practice. why not let them take it?

10k is nothing.

I believe it is very dangerous for some of the above posters to boil down the nurse vs doctor divide on 4 days of testing alone..Step 1, 2, 3. As it has been posted, studying solely for these exams, and passing, isn't beyond the reach of a non-physician.

 

[orientedtoself]

well, i think primary care may be the first to be taken over by np/ pa's. but you know there are advanced practice np's that are subspecialists. what is to prevent them from becoming independent subspecialists if they can be independent generalists?

And this is why we have to specialize (fellowships), Primary care days are numbered for Physicians with clinics opening in Walmart, CVS etc etc, all this places are more than happy to pay less for a RN and/or NP instead of a physician and people are going to attend this clinics.

keyword is FELLOWSHIP!!

 

[HMSBeagle]

And this is why we have to specialize (fellowships), Primary care days are numbered for Physicians with clinics opening in Walmart, CVS etc etc, all this places are more than happy to pay less for a RN and/or NP instead of a physician and people are going to attend this clinics.

keyword is FELLOWSHIP!!

I see the lawsuits coming for missed diagnosis from NPs and DNPs in such settings. I'll just sit to hear from it in the media. But people won't care since doctors are disposable crap these days.

 

[group_theory]

remember that passing Step 1-3 is merely the minimum requirement for independance. A lot of states also require post-graduate work (aka residency).


The true test is the specialty board tests that residency-trained physicians must take. Want to work independantly and claim to be just as good as a primary care doc? Better be able to pass the pediatrics boards, or the internal medicine boards, or the family medicine boards.

If you want to work in a specialty field and claim you "have the knowledge of a physician" you better be able to pass that specialty board.

 

[Doowai]

But for the NBME to essentially validate all their propaganda? Not only that, but to GET ON BOARD WITH A LICENSING EXAM THATS SUPPOSED TO BE "SIMILAR" TO PHYSICIAN LICENSING EXAMS??????
.

I am sure its money. Step 2 CS use to only be for FMG/IMG's. Then I think NBME realized how much more money they could make by charging $1300 to all the AMG's too. Now I think they realize how much more money they could make charging $1300 to every nurse, PA, PT, etc too that wants a NBME "doctor" title.

 

[mocdoc]

I am sitting here in the library and all I see are nursing, PA, SRNA, NP, DRNP and PharmD (they want more turf also) students coming and going.

Basically the same way the democrats hate the rich, there is a push in the US to say that MD's do not deserve what we earn. You have to ask even the most unsophisticated patient, "How much is your life worth?"

I have seen mid level providers kill and maim innocent patients, I was easily able to detect their errors, even as an intern. Unfortunately, mid levels are mid levels at best. Most of all, it is their arrogance that kills, I have seen it first hand. They make assumptions that are right 85% of the time, and think that there can be no other way . . . the 15% that happen to look like they have a UTI but really are in DKA are just SOL, a casualty of war. It makes me sad. This patient I have in mind was missed because, "How can he have diabetes, he is not obese?" And, since he "obviously" had a UTI, why bother getting a chem 7, UA or urine culture, just treat empirically, right? There are countless others.

Becoming a physician is not just about organic chem and college, or mcats, or medical school. It is not about USMLEs or clinical rotations, or internship or residency and call, and it is not only about ownership of patient care decisions and complications. Simply passing a specialty written or oral board is not enough either. Being a physician is about all of these things together, and even in the best of circumstances, it is sometimes not enough.

The one thing that gives me hope . . . I know where the bodies are buried . . . and if medicine becomes way too unpleasant or unprofitable . . . law school is shorter than some fellowships and I will gladly go after the small $$ when the DRNP screws up.

 

[mocdoc]

I keep thinking, how would you like to fly in an airplane that was put together in a way "similar" to the instructions manual. Just we won't tell you where and how much we deviated from the actual proven plan.

 

[Taurus]

Just don't hire NP's or DNP's. PA's are the logical choice if you care about your profession.