NMBE sells out the medical profession to the nurses

[Taurus]

soonereng is strongly biased. His wife is an NP.

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[soonereng]

Yeah, after taking our Evidenced Based Medicine class in med school, I tend to trust all published papers much less.

I agree. I can probably rip to shreds almost every paper I see, but the point is that the NPs have done the work to at least provide some evidence that their treatment is equivalent for primary care.

Again, simply saying one's training isn't the same is no valid argument.

 

[soonereng]

soonereng is strongly biased. His wife is an NP.

Oh and everyone else isn't strongly biased because we're going to be doctors?

 

[soonereng]

1. Patient outcomes were measured only for pre-diagnosed conditions. No comparison was made of the abilities of NP's and MD's to actually diagnose. In other words, even if there weren't methodological problems with the study, it would not prove that care in general is equivalent, rather that management of pre-diagnosed conditions is equivalent.

I think that almost everyone would concede that it doesn't take an MD to diagnose HTN or diabetes.

 

[cpants]

I think that almost everyone would concede that it doesn't take an MD to diagnose HTN or diabetes.

No it doesn't, but I think almost everyone would concede that a primary care practice involves a lot more than just catching HT and DM. There are thousands of possible diagnoses that involve a lot more than just reading one number off the chart.

 

[soonereng]

No it doesn't, but I think almost everyone would concede that a primary care practice involves a lot more than just catching HT and DM. There are thousands of possible diagnoses that involve a lot more than just reading one number off the chart.

True. I was simply referring to what the paper was studying. One can argue diagnostic capabilities, I just don't know of any published research on this when comparing midlevels to physicians. Does anyone know of such studies?

 

[tantrum]

DNP's should why MD's are being territorial about our profession. IT'S FREAKING HARD TO BECOME A DOCTOR. The bar is so high that on academics alone, you need high MCAT (30 plus), High GPA, numerous volunteering hours, absorb HIGH LEVEL Basic science courses in med school, Pass Steps 1,2,3 and finish residency.
If all midlevels can do that then there is no problem. But if they insist, we might as well tell all MD applicants to go home, don't bother and take the Nursing route.

 

[Its_MurDAH]

True. I was simply referring to what the paper was studying. One can argue diagnostic capabilities, I just don't know of any published research on this when comparing midlevels to physicians. Does anyone know of such studies?

Look, they are called MID-levels for a reason okay? To compare the diagnostic capabilities of a NP to a MD is just plain laughable because there really is NO COMPARISON.

Even a 13-year old who keeps seeing patients coming in with ascites, lower extremity edema, increased JVP, and pleural effusions can eventually learn to recognize the signs and symptoms and say with a certain amount of certainty that the next patient with the same symptoms probably has right heart failure. That DOES NOT mean that he has the same diagnostic capability as a physician. It just means that he has the capacity to learn from experience - even chimpanzees can do that. What happens when a patient comes in with chagas disease or some other exotic illness that the NP's Philosophy of Pathology class didn't cover?

 

[cpants]

True. I was simply referring to what the paper was studying. One can argue diagnostic capabilities, I just don't know of any published research on this when comparing midlevels to physicians. Does anyone know of such studies?

DIAGNOSIS is everything. Any monkey can follow treatment protocols and monitor lab numbers after a diagnosis is made.

 

[soonereng]

DIAGNOSIS is everything. Any monkey can follow treatment protocols and monitor lab numbers after a diagnosis is made.

Well, following this logic along with Murdah's supposition that all PCPs should be able to diagnose all diseases, then subspecialists are really overpaid for their work when they are referred a pt with a known diagnosis for treatment.

 

[Coastie]

Bingo.

This is why DNP's will go for specialties next.

It's a chess game, folks. If CRNA's = Anesthesiologists in the OR, and CRNA's agree with the MD presupposition that the OR = extension of the ICU, then they will demand for ICU privileges once the reimbursement is higher than OR. Additionally, they will say "Well, we can do ICU, which is the top of the pyramid, why not derm/rads/ortho/cards"? This is all the more apparent when you see CRNA's lobbying for pain in LA, as well as use of fluoro in OK, both of which are huge stepping stones into lucrative interventional fields.

You combine the above (which is happening, or has happened) with the DNP + NBME, and the takeover of primary care? That's medicine. You take the non-acute, and the acute, and you claim equivalency, it's just a matter of taking out the broad middle.

How anyone cannot see this is beyond me, and how anyone thinks that this is safe, legitimate, acceptable...Well...You're either on the payroll of these guys or you are just completely blinded to the realities of medicine.

Well, following this logic along with Murdah's supposition that all PCPs should be able to diagnose all diseases, then subspecialists are really overpaid for their work when they are referred a pt with a known diagnosis for treatment.

 

[aged2]

That's right it is all a plot to destroy the medical establishment disenfranchise physicians and drive them into hiding BWHA-HA-HA. Mediation may do some good.
Please CRNA's doing rads, cardio. Hmmmm, perhaps I will just strike out to do general surgery while I am at it. ROFL

 

[Miami_med]

Well, following this logic along with Murdah's supposition that all PCPs should be able to diagnose all diseases, then subspecialists are really overpaid for their work when they are referred a pt with a known diagnosis for treatment.

I actually think that this is often true. Many referrals to specialists are the result of the current reimbursement scheme and have nothing do with the inability of PCPs to treat or look up the "recommended treatment" for a particular disorder. Midlevels have many possible uses, but there ability to compete against physicians in certain fields of medicine is due to the fact that the current reimbursement system promotes a substandard apporach to medical care.

Both politically and economically, physicians are idiots. There is really no other explanation. The current crop of doctors does NOTHING to educate the public on the differences in training between groups, assert authority over medical decision making or practice, or protect themselves financially. At my hospital, the nurses already run the show. Yes, doctors work more and are paid more (the attendings that is), but I've seen nurses engage in all sorts of behavior that would get an attending physician fired. If you question a physician's skills, treatment, or just ignore his orders, it's always in the best interest of the patient, but If I question yours, I'm a tyrant who needs to be put in his place with a complaint to someone. I'm sorry that don't understand why a CT w/o contrast is okay in the CKD patient, but it is, and please just send the patient without anymore 2 am phone call to our ragged intern.

Who is going to pay for all of this training? I'm going to guess the government. In the face of a growing nursing shortage, only the government could come up with a system in which we remove more nurses and use them to do a job that they aren't qualified to do with government loans and grants. There is NOTHING free market about what's happening in medicine. Everyone I know who's had surgery, across all walks of life, likes to talk about how the surgeon they found is one of the best because XYZ. It's the same with the PCP. People will see DNPs because they A)don't understand the difference between a DNP/MD or B) Are forced to by their insurance company or government payer. The system that makes this happen is highly REGULATED, the money comes from the GOVERNMENT. It is NOT a free market.

 

[Taurus]

Council for the Advancement of Comprehensive Care and National Board of Medical Examiners Announce New Certification Examination for Doctors of Nursing Practice
NEW YORK--(BUSINESS WIRE)--The Council for the Advancement of Comprehensive Care (CACC) and the National Board of Medical Examiners (NBME) today announced that they have reached an agreement to develop and administer a Certification Examination for Doctors of Nursing Practice (DNP). This competency-based examination, which will be administered to DNP graduates for the first time in November 2008, will assess the knowledge and skills necessary to support advanced clinical practice. It will be comparable in content, similar in format and will measure the same set of competencies and apply similar performance standards as Step 3 of the United States Medical Licensing Examination (USMLE), which is administered to physicians as one component of qualifying for licensure.

The Doctor of Nursing Practice degree was developed in 1999 to respond to a national need for increased access to comprehensive patient care. More than 200 schools have or plan to establish a DNP program. This degree builds on nursing licensure as an advanced practice nurse by adding expanded knowledge and skill in nursing and medical aspects of care for complex illness. The growing burden of chronic illness in the United States will require an even greater focus on collaborative and team-based care.

DNP certification is a three-part process. Candidates must attain licensure as advanced practice nurses, graduate from a DNP program, and successfully complete the CACC Doctor of Nursing Practice Certification Examination. In addition to completion of the DNP educational program, a passing score on the DNP Examination is intended to provide further evidence to the public that DNP certificants are qualified to provide comprehensive patient care. CACC will also focus its efforts on working within the nursing communities to define standards of care as well as develop and implement policies and procedures for monitoring the performance of individuals certified as DNPs, including their patients’ outcomes.

The Council for the Advancement of Comprehensive Care (CACC) was established in 2000 to further the development of standard clinical competencies for graduates of Doctor of Nursing Practice (DNP) programs. The Council determined that a national certification process would provide the public with a reliable way to identify advanced nurse clinicians with the DNP degree who can provide comprehensive care. Council membership is comprised of nurses, physicians, health care organization representatives and health and public policy experts.

The NBME is an independent, not-for-profit organization that provides high-quality examinations for the health professions. Protection of the health of the public through state of the art assessment of health professionals is the mission of the NBME, along with a major commitment to research and development in evaluation and measurement. The NBME was founded in 1915 because of the need for a voluntary, nationwide examination that medical licensing authorities could accept as the standard by which to judge candidates for medical licensure. Since that time, it has continued without interruption to provide high-quality examinations for this purpose and has become a model and a resource of international stature in testing methodologies and evaluation in health professions.

 

[Taurus]

DNP Exam Information

Content Description
The exam is comprised of 336 multiple choice questions

Purpose
The purpose of this exam is to test DNP graduates' medical knowledge and understanding of clinical science considered essential for the sophisticated practice of comprehensive care, with emphasis on patient management in ambulatory care settings. This provides evidence of the competence necessary to assume independent responsibility for providing comprehensive care to patients. DNP competencies developed by CACC (2003 and 2006) and published by the American Association of Colleges of Nursing (2006) are covered in this exam.

* The exam emphasizes selected tasks, namely, evaluating severity of patient problems and managing therapy. Assessment of clinical judgement will be prominent.

* Clinical problems involve mainstream, high-impact diseases. Provision is made for less common but important clinical problems as well.

* Test items and cases are patient centered, starting with a description of a clinical encounter (vignette). The multiple-choice items pose action-related challenges that require clinical decisions or judgment.

* Emphasis is on ambulatory patient encounters; however, inpatient encounters of significant complexity and reflecting contemporary trends also are represented.

* Provision is made for incorporating applied basic science concepts, especially as they relate to justification for prognosis or management.

 

[Its_MurDAH]

Well, following this logic along with Murdah's supposition that all PCPs should be able to diagnose all diseases, then subspecialists are really overpaid for their work when they are referred a pt with a known diagnosis for treatment.

Let me guess: You are a first year medical student?

It is not about diagnosing every disease the patient has or even getting it right it is about the ability TO diagnose. If you have never heard of a disease before how are you going to diagnose it in a patient? The ability to create a differential is what 2nd and 3rd year of medical school is all about. Seeing the same patients over and over again and learning what symptoms goes with what disease isn't diagnosis, it is learning through repetition.

Also, your knowledge of referrals is flawed. Anytime a patient comes in with something that is not standard primary care fare it doesn't mean that the PCP immediately throws his or her hands up in the air and writes a referral to a random specialist. How would one even know WHO to refer the patient to? If a person comes in with acanthosis nigricans of the axilla, the PCP will know that this is a possible phenotypic marker for stomach cancer. Will the NP know that? I highly doubt it. It is the vast difference in the knowledge that we acquire throughout medical school compared to the NPs that makes us diagnosticians and NPs MID-LEVELS.

Medical school is 4 years long for a reason - there is a ridiculous amount of sh1t to learn.

 

[soonereng]

Let me guess: You are a first year medical student?

I am a first year although I really don't see how that has anything to do with the current discussion.

As far as the rest of your post, I think you must have misread what I wrote or something because you are responding to something totally different than what I wrote.

And who cares how you learn it: through many patient repetitions or rote memorization in 2nd year. Learning the symptoms is learning the symptoms. Plus people have different learning styles. Some people learn better with a concrete object such as a patient to reinforce the material.

 

[soonereng]

It will be comparable in content, similar in format and will measure the same set of competencies and apply similar performance standards as Step 3 of the United States Medical Licensing Examination (USMLE), which is administered to physicians as one component of qualifying for licensure.

If the test material and performance standards are truly equivalent (which I'm not saying they will be), I really don't see what the big deal is other than that one could no longer claim that there was inferior care being provided. Would it just piss you off that a different education model could give the same result without all the unnecessary garbage and hoopjumping that is physician education?

I say let the NPs and the PAs who want to take Step 3 (screw steps 1 and 2) and if they can pass, then the joke really is on all of us medical students.

 

[nonesuchgirl]

If the test material and performance standards are truly equivalent (which I'm not saying they will be), I really don't see what the big deal is other than that one could no longer claim that there was inferior care being provided. Would it just piss you off that a different education model could give the same result without all the unnecessary garbage and hoopjumping that is physician education?

I say let the NPs and the PAs who want to take Step 3 (screw steps 1 and 2) and if they can pass, then the joke really is on all of us medical students.

I have to say that I highly doubt that NP's will equal out to MD/DO.

PA's still work in the "team" model with the MD/DO as the head. Someone has to be the one with whom the buck stops- ultimately it is the MD/DO's responsibility, because they are in charge.

NPs/DNPs are not going to want to be completely in charge. They're like the 4yo's at the neighborhood playground, going just far enough away from Mommy that they're "independent" but not "responsible" for whatever happens.

Also, the USMLE tests specifically for a specific way of thinking. You can fake it for an exam- anyone who's ever gone in on SAT/ACT/MCAT/whatever without a Kaplan/etc has done the same thing.

There is- or should be- something in physician education that creates in physicians the ability to think beyond the test. To be able to take scattered bits of information and allow them to coalesce into a dx, a tx, a whatever. "Theory of Path" doesn't allow that. Passing a step doesn't prove that you can do that. It proves that you can pass a test. Woot, woot.

 

[oldManDO2009]

.....Just as I wouldn't go to a law clerk instead of a lawyer, I would not go to an NP or PA in a life or death situation. I would go to a doctor - a doctor with many years under his/her belt. I would however, go to an NP or PA when I have the flu or an ear infection when I can get an appointment the next day instead of waiting weeks or months for an appointment with a doctor......

I am a nurse that went to medical school and there is no comparison. The classes are not the same and educational objectives are not the same.

A nurse must have a basic understanding of path/physio so that s/he can function in a medical environment. A nurse is not required to diagnose a disease which is why a physician has a deeper more complete understanding. I did not just take anatomy/physio , I also took physiology and pathology for every system (e.g. cardio, renal, neuro).

This idea that you can go to the "Doctor Nurse" for the flu is a bad idea - just think what will be missed. Patients will demand to see a physician once the media gets a hold of the kind of incompetence that they will attempt to passed off as advanced care. I reviewed the courses required to get a DNP and it is a complete joke. There were no science courses or "advanced" path/physio/pharm courses - just concepts in nursing. I guess they assume the inadequate education NP's receive should cover the deal. Their whopping year of "advanced" path/pharm is all that is needed???

The battle is already lost, CRNA have made huge inroad into medicine! That diatribe they spout about not practicing medicine and diagnosing patients using nursing concepts and diagnosis to treat patients as an NP is BS. There is no nursing Dx for the flu unless "ineffective airway clearance" all of the sudden covers the flu and every other URI. So the goal of DNP's is to push more physicians into specialties so they can continue to take over primary care and like the CRNA's they will continue to try and increase their scope of practice.

Do not despair, the war is not over!!!! We must educate the public and let them know that their "doctor" might be a nurse and who do you want taking care of grandpa? a nurse with a Bull$hit degree in "advance nursing concepts" or a physician trained to treat the most complex illnesses? I hate unions but physicians should form a union and fight back against insurance co fee and govt Medicare cuts, outrageous malpractice insurance premiums with tort reform, and laws that limit the scope of practice of mid-levels that want to play doctor. The AMA is asleep at the wheel and we are in for some rough times unless we act. Just look at how anesthesiologist shot themselves in the foot with CRNA's, to at first make more money, they are probably regretting that move today. We are next with NP/DNP's desire to play doctor with ever increasing scope of practice creep.


rant done!!!

 

[oldManDO2009]

That's right it is all a plot to destroy the medical establishment disenfranchise physicians and drive them into hiding BWHA-HA-HA. Mediation may do some good.
Please CRNA's doing rads, cardio. Hmmmm, perhaps I will just strike out to do general surgery while I am at it. ROFL

keep laughing... CRNA's had to be sued to stop practicing pain management and they are trying to get licensed to use fluoroscopy to "insert peripheral lines" or state they are qualified to use fluoro and could also do injections such as maybe spinal???

This move by DNP's has been well tested by CRNA's and it works!

 

[soonereng]

NPs/DNPs are not going to want to be completely in charge. They're like the 4yo's at the neighborhood playground, going just far enough away from Mommy that they're "independent" but not "responsible" for whatever happens.

Why would you say this? In my state NPs practice under their own license not that of a physician and are responsible for the patient care they provide, complete with the requisite malpractice insurance.

 

[nonesuchgirl]

...This idea that you can go to the "Doctor Nurse" for the flu is a bad idea - just think what will be missed. Patients will demand to see a physician once the media gets a hold of the kind of incompetence that they will attempt to passed off as advanced care. I reviewed the courses required to get a DNP and it is a complete joke. There were no science courses or "advanced" path/physio/pharm courses - just concepts in nursing. I guess they assume the inadequate education NP's receive should cover the deal. Their whopping year of "advanced" path/pharm is all that is needed???...

*applauds* Just because you think it's the flu doesn't mean it is. Concepts in nursing isn't going to allow you to say, hey wait a minute something's not right here...

keep laughing... CRNA's had to be sued to stop practicing pain management and they are trying to get licensed to use fluoroscopy to "insert peripheral lines" or state they are qualified to use fluoro and could also do injections such as maybe spinal???

This move by DNP's has been well tested by CRNA's and it works!

No mf'ing CRNA is coming anywhere near me, my family, my friends, or my patients with a peripheral or a spinal or anything other than "pressing the go button when the anesthesiologist says so". The end.

 

[nonesuchgirl]

Why would you say this? In my state NPs practice under their own license not that of a physician and are responsible for the patient care they provide, complete with the requisite malpractice insurance.

Are they allowed to do everything all by their onesies? They shouldn't be, they don't have the training.

To whom do they go running when they f*ck up? They're nurses, for the love of god, and I never ever thought I'd say this, but it's about f*cking time to put midlevels- NP, PA, CRNA, whatever- back in the middle.

While we're at it, get rid of all this MA, CNA, NA, Certified office assistant BS too. You need a competent office coordinator for the paperwork and and in practice, a PA to do what you tell her to- if she's trained, I have no problem letting a PA do wound check. An RTC visit. But practising on her own, hell no. Liability is one thing, being an idiot is another.

 

[soonereng]

Are they allowed to do everything all by their onesies? They shouldn't be, they don't have the training.

Everything that is in their scope of practice, they are allowed to practice on their onesies as you put it.

Editing to add that they run to the same people as physicians run to when they screw up: their lawyer.

 

[nonesuchgirl]

Everything that is in their scope of practice, they are allowed to practice on their onesies as you put it.

Yeah, IDK where the onesies came from. Blame psuedo-Britishness and being broody.

But everything is not in their scope of practice. Won't be/ can't be/ shouldn't be, yes? Or are the NP's planning, once they've taken over primary, gunning for the specialties?

I'm starting to forget the point here, but... if a MD/DO can spec out on their own after residency, what's to keep the nurses from doing the same? And thus MD/DO go the way of the dodo?

 

[oldManDO2009]

I for one vote to have all NA's CNA's and anybody else in a white coat take a test similar to the NCLEX and immediately start practicing as a nurse. There is a nursing shortage and we need to have every ill-prepared under-educated person stomp in someone else's turf.

I am sure a CNA has taken a temperature and changed a dressing - I say qualified based on the current practice of I am as good as X so I should get the same Y

 

[cpants]

If the test material and performance standards are truly equivalent (which I'm not saying they will be), I really don't see what the big deal is other than that one could no longer claim that there was inferior care being provided. Would it just piss you off that a different education model could give the same result without all the unnecessary garbage and hoopjumping that is physician education?

I say let the NPs and the PAs who want to take Step 3 (screw steps 1 and 2) and if they can pass, then the joke really is on all of us medical students.

Screw steps 1 and 2? At this point I can't take you seriously anymore. You are just trying to rile us up, right?

I for one vote to have all NA's CNA's and anybody else in a white coat take a test similar to the NCLEX and immediately start practicing as a nurse. There is a nursing shortage and we need to have every ill-prepared under-educated person stomp in someone else's turf.

I am sure a CNA has taken a temperature and changed a dressing - I say qualified based on the current practice of I am as good as X so I should get the same Y

Hilarious.

The AMA should get on this pronto. I would love to hear the nurses squeal when every CNA, EMT, and phlebotomist is trying to take the NCLEX to cure the nursing shortage. It is almost exactly what they are doing to us.

 

[Faebinder]

If the test material and performance standards are truly equivalent (which I'm not saying they will be), I really don't see what the big deal is other than that one could no longer claim that there was inferior care being provided. Would it just piss you off that a different education model could give the same result without all the unnecessary garbage and hoopjumping that is physician education?

I say let the NPs and the PAs who want to take Step 3 (screw steps 1 and 2) and if they can pass, then the joke really is on all of us medical students.

What the heck is a first or even second year who doesn't even know that a flu and stage I ALL will present similarly in a 40 year old doing tell everyone it doesnt matter not to know the basic science? I suppose you want your ALL diagnosed when it's stage IV instead of II right? You wanna wait till the cancer hits the lungs or the liver till you finally check it out right? Oh ya, the cancer patient is 1 of 1000 patients out there, so he/she doesnt matter and hardly affects the quality?

Quit denying that the minority of patients are not as important as the majorty and deserve a quick diagnosis and treatment followup.

 

[yaah]

6. We get out clinical skills during our education. Starting from semester 1, we (ALL nursing students, not just DNPs) are in the hospital working 8-12 hour shifts several days a week. We also have labs, and at my school a simulation lab which reinforces our clinical skills. So yes, we get our clinical skills. In fact, at this time, I am far for more competent clinically than my 2nd year med student boyfriend.

I think this is the part that bothers me the most. Nurses and other ancillary staff often talk about "shift" work. When their shift is done, they're done. As much as we try to make it that way, medicine just isn't like that. During med school you live medical school. When you're not in class you're volunteering for something medical related or you're studying. Third year of medical school is basically 24 hours a day of either medicine or sleep, unless you get on vacation or a weekend off in which case you have to study for the tests you couldn't find time to study for during the week. I am in pathology residency so my time commitments are not as severe, but still I am at the hospital upwards of 60-70 hours a week and most of my free time is spent studying. I can't afford to treat it like a 9-5 job.

I have no doubt that nurses have great clinical skills and contribute a ton to patient management, etc etc. But what is reflected in the above statement gets at some of the real problems of "equivalency." And patient care will ultimately suffer if the role of primary caregiver comes down to shiftwork.

In addition, the post I quoted above also referenced getting hours to spend with a few patients, instead of 15 minute visits. Yet the reported salaries are going to be nearly equivalent. That doesn't compute. Doctors aren't seeing more patients in a small amount of time because they want to or because it's more lucrative. It's because it's the only way to get reasonably reimbursed. How can nurses see fewer patients, work fewer hours (if they work more, surely there would be overtime?), etc, yet get paid only 10-20% less?

What is going to happen when nurses have to work more than their shift work? No one is going to pay out overtime to a physician equivalent - physicians never get paid overtime for doing our jobs.

 

[genesis09]

Sigh, you people are forgetting what the people is demanding and wanting: cheap primary care access. That is why the pharmacy clinics have done well because they provide a needed, wanted service, i.e. cheap urgent care during the weekends and evenings. MDs have already shot themselves in the foot in terms of primary care. Only a third of current doctors are practicing in primary care (IM, FM, Peds). A good managed care program likes to keep people from seeing specialists at all costs. People go to specialists even when they are not needed. In Europe, PCPs make up 2/3s of the MD population.
This trend of decreasing doctor utilization is here to stay. It will be up to you MDs to decide what you want to do about it. Your clout in state legislatures/Congress is not what it used to be. We might see the emergence of the third class of drugs or FDA might cleverly classify them as a subset of OTCs. We might see NPs/PAs/DNPs become the dominant player in Primary Care. We might see independent pharmacist prescribing authority. The list goes on and on.

 

[soonereng]

Screw steps 1 and 2? At this point I can't take you seriously anymore. You are just trying to rile us up, right?

There have been others who posted that they should take steps 1-3, and I was proposing something different, and maybe really only screw step 1 for this experiment. What I was saying is that if they can pass our culminatory step what does that say about our education system vs the testing system?

What the heck is a first or even second year who doesn't even know that a flu and stage I ALL will present similarly in a 40 year old doing tell everyone it doesnt matter not to know the basic science?

I don't think I've ever said basic science was unimportant. Midlevels are taught basic science too. You guys are acting like all they are taught is how to do an H & P, given a diploma, and set loose on society.

As for the ALL, the dx might be missed regardless who you see if it was in the middle flu season. I had a friend whose adult onset type 1 DM was misdiagnosed as flu b/c she had the misfortune of presenting at the height of flu season. Only 6 days later did her PCP order a blood test to expand his differential, but by that time she was in DKA and got to spend half a week in the hospital. Hell, some of the community FPs that I rotated with recently (we have early clinical exposure at my school) diagnosed flu w/out even doing a flu screen. Your ALL pt could have been initially missed by an MD just 4 wks ago. Fortunately the incidence of ALL in the US is only about 5500/yr with a supermajority of those being pediatric, so statistically, those FPs are pretty safe.

 

[CigarTragic]

NPs/DNPs are not going to want to be completely in charge. They're like the 4yo's at the neighborhood playground, going just far enough away from Mommy that they're "independent" but not "responsible" for whatever happens.

I like you. You're a feisty one.

 

[tantrum]

WTF!!!! Step 3 of the USMLE is the freakingly easiest among all the steps. Let them take the equivalent of Steps 1, 2CK, 2CS, and 3 and I don't agree with the hybird/fast-tracked one year residency. This is getting to be very absurd. I have a lot of relatives in Nursing school and I can tell you that their basic science is a joke.

 

[oldManDO2009]

There have been others who posted that they should take steps 1-3, and I was proposing something different, and maybe really only screw step 1 for this experiment. What I was saying is that if they can pass our culminatory step what does that say about our education system vs the testing system?



I don't think I've ever said basic science was unimportant. Mid levels are taught basic science too. You guys are acting like all they are taught is how to do an H & P, given a diploma, and set loose on society.

As for the ALL, the dx might be missed regardless who you see if it was in the middle flu season. I had a friend whose adult onset type 1 DM was misdiagnosed as flu b/c she had the misfortune of presenting at the height of flu season. Only 6 days later did her PCP order a blood test to expand his differential, but by that time she was in DKA and got to spend half a week in the hospital. Hell, some of the community FPs that I rotated with recently (we have early clinical exposure at my school) diagnosed flu w/out even doing a flu screen. Your ALL pt could have been initially missed by an MD just 4 wks ago. Fortunately the incidence of ALL in the US is only about 5500/yr with a supermajority of those being pediatric, so statistically, those FPs are pretty safe.

either your wife watches you as you type or you are an apologist either way you have no idea what you are talking about. If they want to declare equivalency then their current educational system has to be overhauled.

Have you reviewed the ridiculous curriculum they take - most are one year of "advanced" pharm/path THAT IS IT!!!! They state their undergraduate science courses where sufficient. I took the more difficult science courses and they were not sufficient for medicine and I have a lot more to learn. On line courses, weekend clinical, diluted requirements are not acceptable.

The study that appears to be the holy grail of YOUR cause is junk because the patients were already diagnosed - my 4 year old could manage them.

If they want to be a PCP then their education must include the same rigorous training we go through - NO SHORT CUTS BECAUSE PEOPLE DIE!!!

I get it your wife is an NP and you want to stand up for her because she tells you how stupid doctors are and she does the same thing. Well she doesn't and she does not know what she does not know - her training was limited to a handful of conditions, she was taught how to manage a diagnosis - I am taught to develop a diagnosis. It always look so easy and everyone thinks "I could do that" until all your initial thoughts about what is wrong does not pan out and the patient requires more complex care then what are you going to do - refer to a specialist? Who? I have to develop a diagnosis and even if it is not right on I know what is is not and what I need to do and no year of "advance" pharm/path with 850 hours of "clinical" is going to get you anywhere close to figuring that out....

you are a first year come back when you are a fourth year and have worked with a bunch of nurses and mid-levels and let know what you think then....

I have done this for a year or two and most mid-levles can not practice even close to the level of your average IM/FP doc.

 

[soonereng]

I have to develop a diagnosis and even if it is not right on I know what is is not and what I need to do and no year of "advance" pharm/path with 850 hours of "clinical" is going to get you anywhere close to figuring that out.

The last time I checked, my MD training only has one year of pharm and path...so I don't know what you want to do with that.

Plus I don't appreciate your ignorant comments about my wife. In my experience people who start making personal attacks have no other ideas to submit.

I will add that my wife is nothing like your characterization. Instead, she is quite the opposite. She knows that she isn't a doctor. She doesn't want to be a doctor. She also knows her limits and knows when to get a consult. But for what she does, working in the ambulatory setting, she is adequately trained.

I'll tell you something else about her though. She previously worked in an ENT clinic for 2 yrs. Her experience there has given her skills in diagnosis and treatment of that particular set of diseases that a FP physician doesn't have. She was trained in flexible laryngoscopy and saw more cases than a FP resident ever does in their ENT rotations.

As a matter of fact, the FP docs that she works with consult her with pts who have ENT issues that aren't necessarily surgical. Recently she treated a pt who had seen her previous employer multiple times for their complaint with no alleviation. The referring doc was in her practice so he sent the pt to my wife who diagnosed and treated the problem. Like I said in an earlier post, the docs that my wife works with love her.

 

[cpants]

There have been others who posted that they should take steps 1-3, and I was proposing something different, and maybe really only screw step 1 for this experiment. What I was saying is that if they can pass our culminatory step what does that say about our education system vs the testing system?

It says nothing. Step 3 isn't a "culminatory step" that covers all of the knowledge necessary to be a physician. The USMLE in its entirety, steps 1-3, covers the information you need to be a physician. Just because a nurse who preps for it could pass one of 3 steps does not mean she has equivalent education, skills, or knowledge to an MD/DO.

Maybe we shouldn't "screw" any of the steps and then declare NP's equivalently competent. IMO Step 1 is probably the most important step. It contains the bulk of the anatomy, phys, path, pharm knowledge.

 

[soonereng]

Just because a nurse who preps for it could pass one of 3 steps does not mean she has equivalent education, skills, or knowledge to an MD/DO.

That was precisely my point. If 2/3 of the steps for MDs don't test the real knowledge necessary to diagnose and treat pts, what does that say about the licensing process?

I have never said anywhere that midlevel training was the same as physician training. I have never said that midlevels are equivalent to physicians. I am merely posing the question regarding what level is necessary to be competent, particulary in the ambulatory/primary care setting. I had assumed that the Steps test this minimum ability. If our licensing examinations don't test this then what is the point of having these exams at all? Just let the medical schools self-certify their graduates.

 

[oldManDO2009]

"The last time I checked, my MD training only has one year of pharm and path...so I don't know what you want to do with that."


wait until your second year and you will have accumulated an immense amount of knowledge that will far out pace what ANY NP has learned in their entire program to include their undergraduate "training"

I have worked with many NP's and you are right most do not want to be doctors and are happy working with doctors and I have no problem with that model.

It is the Columbia nurse Nazi's that want to make DNP equivalent to physicians and I have a problem with that.

I will accept your arguments of equivalent education when you compare your education with any DNP program and find that it is equivalent. The ability to pass a test does not make our educations the same.

As for your wife I do not know her and have not worked with her and should have clarified my comments to include the NP's I have worked with instead of applying this generalization to your wife specifically though you are an apologist

 

[cpants]

That was precisely my point. If 2/3 of the steps for MDs don't test the real knowledge necessary to diagnose and treat pts, what does that say about the licensing process?

I have never said anywhere that midlevel training was the same as physician training. I have never said that midlevels are equivalent to physicians. I am merely posing the question regarding what level is necessary to be competent, particulary in the ambulatory/primary care setting. I had assumed that the Steps test this minimum ability. If our licensing examinations don't test this then what is the point of having these exams at all? Just let the medical schools self-certify their graduates.

But why do you assume that Step 3 tests all "the real knowledge necessary to diagnose and treat pts"? Just because thats the only step NP's want to take? I argue that the licensing exam in its entirety does test all the knowledge you need. The third part alone does not test this knowledge.

I'm glad you don't think that midlevels have training and treatment ability equivalent to PC MD's. I agree, and thats why we should not be calling nurses "Doctor" in a clinical setting. Unlike you and I, our patients might not be savvy enough to realize that this "Doctor" is a DNP and not an actual physician.

 

[soonereng]

...though you are an apologist

Perhaps I should have gone to law school instead....

 

[nonesuchgirl]

I like you. You're a feisty one.

Why, thank you, darlin'.

 

[soonereng]

I argue that the licensing exam in its entirety does test all the knowledge you need. The third part alone does not test this knowledge.

Ok, so let's say that the average, but not necessarily all, midlevel could pass Step 3 (may or may not be true, but I'm just posing a scenario). Let's also say that these same people could pass Step 2, not blow it out with a 250 or anything, but pass it.

Then would we be saying that the only gap in these people's abilities is learning the material is tested on Step 1 (which they have already learned a subset of through their training which probably varies by program)? If so, what if they studied real hard and passed this test too? Would that equate to functional equivalence?

 

[waldenwoods]

That was precisely my point. If 2/3 of the steps for MDs don't test the real knowledge necessary to diagnose and treat pts, what does that say about the licensing process?

I have never said anywhere that midlevel training was the same as physician training. I have never said that midlevels are equivalent to physicians. I am merely posing the question regarding what level is necessary to be competent, particulary in the ambulatory/primary care setting. I had assumed that the Steps test this minimum ability. If our licensing examinations don't test this then what is the point of having these exams at all? Just let the medical schools self-certify their graduates.

I'd say that our Federation of State Medical Boards, the national organization of all the state licensing boards (to which we need to apply for a license to practice), thinks otherwise because it is their partnership with the NBME that sponsors the USMLE. Step 1 tests basic science knowledge, and Step 2 CK and Step 3 evaluate clinical knowledge. Step 2 CS is there to evaluate our clinical abilities.

Even the NBME/FSMB agrees that for the purpose of licensure, the exam should be improved upon. Most of us know that the NBME is in the process of changing the USMLE to be more relevant to the practice of medicine. If you haven't heard then check out this link about the Comprehensive Review of the USMLE. One thing to note in this plan is that they intend to integrate basic science into all portions of the exams that med students/residents will need to pass to obtain their license.

So to bring this back to the OP and the subject of a new exam for the DNP certification process, that exam is going to be narrower in scope than the one an MD needs to pass, so I think that when presented with that information, the more educated public is going to understand that. I don't know whether the general public will, but maybe they could. We'll have to wait and see.

After reading this thread, I can't remember anyone mentioning that in addition to having to pass all parts of the USMLE we also have to pass our specialty boards to become board-certified in our fields. I just wanted to say I think that's important too.

 

[cpants]

Ok, so let's say that the average, but not necessarily all, midlevel could pass Step 3 (may or may not be true, but I'm just posing a scenario). Let's also say that these same people could pass Step 2, not blow it out with a 250 or anything, but pass it.

Then would we be saying that the only gap in these people's abilities is learning the material is tested on Step 1 (which they have already learned a subset of through their training which probably varies by program)? If so, what if they studied real hard and passed this test too? Would that equate to functional equivalence?

The material on step 1 is the foundation of medicine. Bypassing this, going right to a step 3-like test and then calling yourself a doctor, is like building a house without its foundation. It looks like a house, you call it a house, it performs well under everyday conditions, but when a big storm comes it falls down killing everyone inside.

Would passing all three steps provide functional equivalence? Probably not, but it would be closer than just passing step 3. Nurses still would not have the residency experience of 80hr/wk training one-on-one with attendings who are teaching you how to diagnose and treat as a physician. Experience taking orders as a nurse is not equivalent to this, whether you are talking 1000 hrs or 1,000,000 hrs.

 

[oldManDO2009]

and it looks like it will be optional so one or two exceptional people may pass and this will be applied globally to the whole population much like that worthless study.

I have worked with numerous university of phoenix and on-line short cut candidates who would not be my first choice for poor ol' grandma. When I look for health care for my family, I insist on an anesthesiologist and a PCP with only one exception which was an exceptional NP who worked with my PCP.

Overall, I think mid-levels will help relieve the congestion patients complain of in health care but they should remain under supervision, which is not the case today. So I encourage all these newly minted DNP's to open up and compete with our well trained FP docs! We will win in the long run. All this holistic, I can spend more time with my patient, hand holding BS is just smoke and mirror for developing in-roads in to primary care and it should be met with a strong response form the AMA that illustrates our Superior training and the risk of DNP's inferior training and of course results based (mortality rate) malpractice premiums.

 

[soeagerun2or]

It is the Columbia nurse Nazi's that want to make DNP equivalent to physicians and I have a problem with that.

Ugh, you just Godwined our argument

Ok, so let's say that the average, but not necessarily all, midlevel could pass Step 3 (may or may not be true, but I'm just posing a scenario). Let's also say that these same people could pass Step 2, not blow it out with a 250 or anything, but pass it.

Then would we be saying that the only gap in these people's abilities is learning the material is tested on Step 1 (which they have already learned a subset of through their training which probably varies by program)? If so, what if they studied real hard and passed this test too? Would that equate to functional equivalence?

For arguments sake let's agree and say the average DrNP could pass Step 3, study hard and maybe pass Step 2, and the top 25% could go crazy studying and maybe pass Step 1; should they be granted the same privileges as MD DO? NO! Go to an accredited medical school. How is this concept difficult so difficult to accept? The average medical student could just buy BRS books and pass Step 1, do clinicals and pass Steps 2 & 3. The point of didactic and clinical education is to 1) learn to treat patients 2) immerse you in the culture of clinical medicine. There is a SIGNIFICANT difference to the way nurses and doctors approach the theory of patient care. Nurses believe in "nursing" and the touchy-feely cry with the patient team care every body is equal approach. Doctors, on the other hand, strive to both understand and cure disease. The entire point of the pre-clinical years is to have a basic understanding of human pathophysiology which, in the past, was used by all doctors (along with the scientific method) to create a greater understanding of disease for everybody to utilize in the future and therefore better patient care globally. Yes, I'm generalizing, being biased, and reaching but in an idealistic vacuum the ultimate goal of nursing and medicine are divergent and that is the source of this argument.

 

[MacGyver]

I say lets open up the steps and other licensing exams to everybody.

Hell I wanna take the CRNA licensing test and become a CRNA. I can do that, right?

Oh wait, the nurses just told me that I'm not eligible to take their exam because I havent gone thru their "training pathway."

****in hypocrites!

 

[anthroguy]

I did my undergrad at NYU which as a well-respected nursing school. It was common for premeds to take nursing science classes if they were lucky enough to find the few open spaces to fluff our science GPAs. Junior year I was able to take microbiology with them and the experience was horrifying. Here I was along with fellow premeds studying for the mcat, praying the next year for an MD/DO acceptance and still rocking the class, while the professor was devising extra credit schemes for some of the future nurses who were borderline failing. These were students mind you, a year or two from the clinical aspect of training. Having seen their science knowledge base as a premed, I would say ANY biology major knows more science than a nursing student with the difference being that the nursing classes have clinical aspects to them. In terms of nurse's scientific knowledge compared to doctors, please don't try to compare, its no where close.

The best part was when some of them started talking about CRNAs, you would have thought they were playing the lottery while already knowing the winning numbers.

 

[fab4fan]

Your understanding of a nursing degree is tenuous. It's usually (always?) a BS in nursing, and they get their RN upon graduation, not after another two years. Secondly, on-the-job experience is not the same as active education like residency, and you can't include all four years of college for a nurse and then not include them for the physician, so your comparison should actually be 7 years for the nurse and 11 years for the physician. Furthermore, the rigor of the first two years of med school is significantly greater than that of nursing school. Residency is also easily 60-80 hours a week, so that's like 6 years of residency training.

Tenuous? Wow, you're polite! I'm a nurse and I was ready call it far worse.

for your restraint.