NP lies

[Nick Name]

Reading other threads on the DNP's etc I have come to feel much of their encroachment into medicine is being established by lies.

Case in point : Impression number 3 on Page 5 http://www.webnp.net/downloads/pearson_report08/ajnp_pearson08.pdf The author asks "why" do family medicine residencies fill their positions with IMG's considering "NP's ability to provide primary care. The author states this is unfair to foreign countries who lose their doctors (I don't know, maybe this is true)

The author states that the number of IMG's matching into family medicine residencies equal ("match") the number of AMG's who match into family medicine residency. This is completely contradicted by data at NRMP which shows 494 IMG's matched into FP compared to 1,156 AMG seniors , 69 US grads and 264 DO grads (which are also technically AMG medical doctors). You can see he actual statistics on page 5 (page 13 as you scroll down) http://www.nrmp.org/data/resultsanddata2008.pdf

This is just one example of distortion and lying I found when reading the NP propaganda. Its one thing to fight the good fight based on data and facts and another to snake ones way into underserved positions based on lies.

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[mig26x]

and ms mundinger, or whatever the hell her name is, is an expert at lying when trying to push for the DNP.

I gag everytime I hear or read this lady comments at how DNP candidates are equally prepare than physicians for clinical work!!!

 

[maceo]

advanced practice nurses dont even have a basic chemistry course and a basic mathematics course under their belts. How can anyone take their call for independence seriously? This is the most basic requirement for any scientific pursuit. You know how hard you worked as an undergrad during orgo 1 and 2. those abstract mathemtatics principles in calculus, remember physics lab? nurses take elementary algebra and thats it and a chemistry class called "chemistry and you". are you ****ing kiddin me?

 

[McGillGrad]

Why is there such resistance to having them practice? How does it affect you?

Just make sure they pay full malpractice insurance and have to go to court when they screw up. The rest will take care of itself. For once, the courts and help physicians instead of fleecing them.

 

[niranjan162]

Why is there such resistance to having them practice? How does it affect you?

Just make sure they pay full malpractice insurance and have to go to court when they screw up. The rest will take care of itself. For once, the courts and help physicians instead of fleecing them.

thats a pretty short sighted view. Their entry in PC erodes your profession and endangers patients.

Would you rather see an NP or dr?

 

[lowbudget]

thats a pretty short sighted view. Their entry in PC erodes your profession and endangers patients.

Would you rather see an NP or dr?

Exactly. Caveat emptor. Patients should ask that question and let the thing speak for itself.

FYI, regarding "their entry in PC"... in case you haven't noticed, they're in every specialty in every setting.

 

[McGillGrad]

You are mistaken in your logical reasoning. The long-term view is what I am focusing on and if you would think for a second, it will become clear that simply ignoring the future explosion of morbid elderly patients is short sighted.

thats a pretty short sighted view. Their entry in PC erodes your profession and endangers patients.

Would you rather see an NP or dr?

 

[niranjan162]

Exactly. Caveat emptor. Patients should ask that question and let the thing speak for itself.

FYI, regarding "their entry in PC"... in case you haven't noticed, they're in every specialty in every setting.

true, but they are in those settings as mid-levels. IF they were to take over PC, they would be the sole provider. Then they will try to burrow into other settings as sole providers as much as possible.

You are mistaken in your logical reasoning. The long-term view is what I am focusing on and if you would think for a second, it will become clear that simply ignoring the future explosion of morbid elderly patients is short sighted.

If im mistaken please correct me. As I see it, the long term view, is one that includes what happens after the baby boomer generation inevitably dies, does it not?

Since your farther along in training then I am, could you clarify something for me. Don't older patients need more complex medical care, such as that provided by an internist?

So would fixing the family practice shortage really help this subset of people?

In addition don't elderly people suffer from multiple conditions, which makes it more difficult to treat, requiring more education and rigorous training to do so?

If my reasoning is incorrect please enlighten me.

 

[McGillGrad]

You'll have to excuse my reply because I was under the impression that this was the other thread on this topic which I posted a longer reply (that is quoted below the image). Yes, the post-boomer demographics are considered. As an aside, here's the US pyramid and you can see that there are still large numbers after the boomers so it is a long-term problem:

Here it is again:

The real issue that needs to be addressed is the absolute role of a DNP in the every-day hospital environment. If they are there to provide basic primary care to patients who are admitted for chronic and/or common medical issues, then we should welcome them.

As with all types of philosophical paradigm shifts, this may be an opportune time to step back and take advantage of this situation to both box in the absolute (read: legally binding) scope of DNPs while creating a situation that will relinquish some of our traditionally MD/DO duties of elementary primary care in order to reap a great deal of benefits via increased efficiency, pay and leisure time.

In other words, we should be working to marginalize (not said in a negative manner) the role of a DNP in practicing medicine while increasing our grip on more rewarding aspects of being a physician.

If you think this a queer concept, consider the invaluable role that PA's and NP's play in the majority of private practice clinics. They are often utilized to perform vital, yet sometimes mundane, tasks which increase revenue while also allowing the MD/DO more free time and flexibility.

Denying that baby boomers will be a burden in less than a decade (if things remain the same) is an unhealthy copying mechanism. Something must change and it is imperative that we dictate the most agreeable terms to that change.

t
If im mistaken please correct me. As I see it, the long term view, is one that includes what happens after the baby boomer generation inevitably dies, does it not?

Since your farther along in training then I am, could you clarify something for me. Don't older patients need more complex medical care, such as that provided by an internist?

So would fixing the family practice shortage really help this subset of people?

In addition don't elderly people suffer from multiple conditions, which makes it more difficult to treat, requiring more education and rigorous training to do so?

If my reasoning is incorrect please enlighten me.

 

[niranjan162]

You'll have to excuse my reply because I was under the impression that this was the other thread on this topic which I posted a longer reply (that is quoted below the image). Yes, the post-boomer demographics are considered. As an aside, here's the US pyramid and you can see that there are still large numbers after the boomers so it is a long-term problem:

Here it is again:

Ok, i looked at the 2004 data and it shows more of decline in future population. Regardless. There should be efforts to reform healthcare for future generations.

My problem with the utilizing DNPs and other mid levels is with the whole marginalizing aspect. I believe that I also said this in the other thread that your post is from. Doctors can't even police themselves as a profession. Nurses are very politcal and unionized.

How do stop them from encroaching on other aspects of medicine?
I guess my main point is that, letting them take over PC sets a precendent, whether it be good or bad doesnt matter. They will use that precendent to try and expand their profession at the deteriment of medicine and even patient care.

How do you propose preventing this?

 

[mercaptovizadeh]

Ok, i looked at the 2004 data and it shows more of decline in future population. Regardless. There should be efforts to reform healthcare for future generations.

My problem with the utilizing DNPs and other mid levels is with the whole marginalizing aspect. I believe that I also said this in the other thread that your post is from. Doctors can't even police themselves as a profession. Nurses are very politcal and unionized.

How do stop them from encroaching on other aspects of medicine?
I guess my main point is that, letting them take over PC sets a precendent, whether it be good or bad doesnt matter. They will use that precendent to try and expand their profession at the deteriment of medicine and even patient care.

How do you propose preventing this?

The key is for the physicians to reject the NP as any sort of assistant. Letting them fly solo, which is what Mundinger and her clique would love anyway, would result in bad patient outcomes and litigation. Eventually, only the NPs who *really* know what they are doing would survive (and there's probably not too many of them anyway), which is not such a bad thing, and the doctor wannabe clowns/clownettes who know nothing would be sued out of their deranged delusions.

Ironically introducing tort reform may be counterproductive in that it would protect these idiots when they mess up. In the end, the "market" self corrects and patients will flee from injurious quacks to the people who know what they're doing.

 

[McGillGrad]

The key is for the physicians to reject the NP as any sort of assistant. Letting them fly solo, which is what Mundinger and her clique would love anyway, would result in bad patient outcomes and litigation. Eventually, only the NPs who *really* know what they are doing would survive (and there's probably not too many of them anyway), which is not such a bad thing, and the doctor wannabe clowns/clownettes who know nothing would be sued out of their deranged delusions.

Exactly...

 

[niranjan162]

The key is for the physicians to reject the NP as any sort of assistant. Letting them fly solo, which is what Mundinger and her clique would love anyway, would result in bad patient outcomes and litigation. Eventually, only the NPs who *really* know what they are doing would survive (and there's probably not too many of them anyway), which is not such a bad thing, and the doctor wannabe clowns/clownettes who know nothing would be sued out of their deranged delusions.

Ironically introducing tort reform may be counterproductive in that it would protect these idiots when they mess up. In the end, the "market" self corrects and patients will flee from injurious quacks to the people who know what they're doing.

To counter this medicine should take a page outta the DNP playbook. They are so adamant on saying they're becoming doctors of nursing. Separate tort reform accordingly. Tort reform for medicine and tort reform for nursing. Whoever pays them wont want to take on the added risk when letting them practice independently, thus separating the ranks even more and making it more difficult for them to practice medicine.

 

[tibor75]

I've met as many bad NPs as I've met bad doctors.

The concept that NPs are a threat to doctors is laughable and usually felt by those doctors insecure in their own abilities.

 

[mdx2x]

I've met as many bad NPs as I've met bad doctors.

The concept that NPs are a threat to doctors is laughable and usually felt by those doctors insecure in their own abilities.

Time to churn out Bachelors of Medicine graduates again to counteract the nurses

or maybe they can get those who are trained in the British way and train those nurses

 

[McGillGrad]

Not looking to start anything but all of our medical degrees are Bachelors of Medicine. The residency is technically the graduate portion with fellowships maxing out at master's level.

Time to churn out graduates again to counteract the nurses

or maybe they can get those who are trained in the British way and train those nurses

 

[exPCM]

Reading other threads on the DNP's etc I have come to feel much of their encroachment into medicine is being established by lies.

Case in point : Impression number 3 on Page 5 http://www.webnp.net/downloads/pearson_report08/ajnp_pearson08.pdf The author asks "why" do family medicine residencies fill their positions with IMG's considering "NP's ability to provide primary care. The author states this is unfair to foreign countries who lose their doctors (I don't know, maybe this is true)

The author states that the number of IMG's matching into family medicine residencies equal ("match") the number of AMG's who match into family medicine residency. This is completely contradicted by data at NRMP which shows 494 IMG's matched into FP compared to 1,156 AMG seniors , 69 US grads and 264 DO grads (which are also technically AMG medical doctors). You can see he actual statistics on page 5 (page 13 as you scroll down) http://www.nrmp.org/data/resultsanddata2008.pdf

This is just one example of distortion and lying I found when reading the NP propaganda. Its one thing to fight the good fight based on data and facts and another to snake ones way into underserved positions based on lies.

You must consider the complete picture. The match numbers do not account for the large number of IMGs that get spots outside the match or in the scramble.
See: http://www.stfm.org/fmhub/fm2008/September/Perry563.pdf
This shows the true picture.

 

[Nick Name]

To counter this medicine should take a page outta the DNP playbook. They are so adamant on saying they're becoming doctors of nursing. Separate tort reform accordingly. Tort reform for medicine and tort reform for nursing. Whoever pays them wont want to take on the added risk when letting them practice independently, thus separating the ranks even more and making it more difficult for them to practice medicine.

This is a good idea, very good. But how do we accomplish it. Who do we educate? WHo can make this sort of legal change?

The key is for the physicians to reject the NP as any sort of assistant. Letting them fly solo, .

They already fly completely solo in many states. You can't keep the pigs from getting out once the gate is open and several are already free.

advanced practice nurses dont even have a basic chemistry course and a basic mathematics course under their belts. How can anyone take their call for independence seriously? This is the most basic requirement for any scientific pursuit. You know how hard you worked as an undergrad during orgo 1 and 2. those abstract mathemtatics principles in calculus, remember physics lab? nurses take elementary algebra and thats it and a chemistry class called "chemistry and you". are you ****ing kiddin me?

Seriously....LOL...chemistry and you? You gotta be making that up.

Anyway, good point. These courses train future medical candidates minds, and weed out potentially unsuitable minds. The medical curricula is designed to produce professionals with high levels of critical thinking and reasoning. Without this preparation you can end up with poor practice skills, the implementation of poorly reasoned treatment protocols, and inability to see poor outcomes (with subsequent lack of early appropriate referrals etc).

Hopefully residency programs receive raw residents who have the ability to understand the when, the why and importantly the why not of medicine. The "how" is the easy part. How to treat is easy - a computer algorythm can be programmed to do that : If gram negative anaerobic bacteria give X antibiotic. This is just the pure science of health care. The when, the why, and the why not is the art of health care and is not always easily taught or learned. Its a highly responsible position and while its possible mediocre students can learn this, is it a responsible way to try and produce doctors?

and ms mundinger, or whatever the hell her name is, is an expert at lying when trying to push for the DNP.

I gag everytime I hear or read this lady comments at how DNP candidates are equally prepare than physicians for clinical work!!!

Yeah for real. I do think it would be much better to take more IMG's, FMG's and create more PCP residency positions than to put DNP's into the position. The logic behind the one false comment I show above is : Taking IMG's robs other countries of doctors (we are killing people in India by letting IMG's come here), nurses can do the job as well or better, help Americans and save dying people in other countries by making nurses doctors instead - pay us like doctors, treat us like doctors, pay us like doctors, call us doctors, but most importantly pay us like doctors.

You just cannot shortcut any system and call it equivelant. 10,000-15,000 hours of residency training, rotations in so many specialities etc to be a PCP medical doctor cannot be recreated by a few additional courses.

To become a PCP is perhaps a bit of overkill, but that is best. Ex. I want to be a PCP, and in medical school I did 3 months of surgery rotations - something like 600 hours. I did dozens of lap chole's, some appendectomies, even a cardiac surgery rotation. I scrubbed in and first assisted many many times. I did a few small procedures like removing a lipoma start to finish , under verbal guidance. After a family residency I will have done at least 2 more months of general surgery as well as probably first assisting numerous c-sections. All of this to remove a toenail in my office. Its in the patients best interest to have someone who has thrown hundreds of superficial sutures, and a few deep sutures in the abdomen in residency, be the person who sutures a skin laceration for their first time in private practice. It might be a bit of overkill to have someone practice that much in medical school and residency just to do minor in-office surgical procedures like a punch biopsy; but it beats filling the field with undertrained people.

 

[Nick Name]

You must consider the complete picture. The match numbers do not account for the large number of IMGs that get spots outside the match or in the scramble.
See: http://www.stfm.org/fmhub/fm2008/September/Perry563.pdf
This shows the true picture.

From your graph it looks to me like in 2008 20% went to IMG, and roughly 20% went to US citizen FMG's. The DNP article I posted a link to says half the position goes to IMG's from other countries (20% does not equal 50% any more than a DNP equals an MD). Its still a lie. And a lie that is supposed to support their agenda of filling PCP positions as the equal of any medical doctor. Taking 400 and some odd IMG's from other countries per year into family does not kill off another continent - its a lie. Saying 50% of the family medicine positions go to IMG's from other countries is also a lie. A simple question is do you want to support liars like this, and where do the lies stop.

Once a person so blatantly lies what is next - falsifying patient records? Lying about factors that would interfere with the ability to practice medicine competently such as an addiction, or a serious mental illness like psychosis? The DNP's are shown to be blatant liars for one thing, and its VERY much like falsifying patient records

The say taking IMG's from other countries robs those countries of their doctors - its obvious the DNP wants to either reduce the number of available PCP residency slots by the number filled with IMG's, or take them themselves - but either way they are trying to take over the roll of PCP.

 

[dragonfly99]

We could make a few more physicians of our own here in the US, not make more DNP's to fill the primary care residencies. I think NP's and PA's are fine, if they stay within their scope of practice. I am worried about misdiagnosis and overstepping the bounds of their knowledge.

To those who say, "Just let them practice, and let them get sued if they mess up!":
The problem is many DNP's would be practicing under the auspices of something like the VA or a hospital or community health center, and a physician likely would be required to sign off/"supervise" them in at least some remote fashion, and the physician will then be liable. Many if not most primary care docs are now employees - they don't have their own private practices. In this situation they can be required to supervise PA's and NP's and would not have any choice in the matter. I know this happens because I've see docs complain about this (i.e. "I've been required to supervise this PA or NP for the past 4 months, but he/she just doesn't seem to be working that hard, or not catching on, and I'm afraid is making mistakes I'll be liable for, yet my hospital won't get rid of the person or allow me to stop supervising her/him"). Also, if DNP's practice primary care but don't take hospital call or take care of inpatients, that will force more of the complex cases on to physicians, who might still be trying to maintain their outpatient practices, etc. I think it would be major bad news for family practice docs...the internists can always run away to become hospitalists or maybe even a subspecialist (i.e. go back for a fellowship) but many fp's will be stuck. If they have good inpatient skills, they can bail to become hospitalists too, but I'm afraid the DNP thing will be another nail in the coffin of traditional primary care physicians.

 

[Nick Name]

Another lie is "impression #4" on page 5 : " NP's are treasures waiting to be released from unneccessary restrictions". She mentions that malpractice is lower for NP's compared to MDs. As a comparison in many locales nurse midwives can independantly deliver babies - and have lower malpractice - largely because they manage less risky cases and have less assets to seize. They do not manage Marfan's patients for example.

So nurse midwives get sued less often as they take less complex cases and are literally poorer targets - I mean if an MD carries 1 mill/3 mill insurance and is sued for 5 mill, they might look to other assets to cover the difference in awarded settlement. NPs often don't have significant other assets to go after. So why sue?

She uses this lie to promote the idea that NPs are unfairly held back by the evil MDs and the man, that they are this rare treasure that is never sued because they are so highly skilled. When in reality NPs are just poor targets for a lawsuit (not as deep pockets), don't handle challenging cases (which is the way it should be - they should take care of constipation and not Porphyria) so are less likely to be sued, and there is usually an MD in the que ahead of them to take the brunt of the lawsuit. So again they are lying or distorting facts to make themselves look like some super doctor.


But again, who do we tell and how?

 

[Nick Name]

The key is for the physicians to reject the NP as any sort of assistant. .

What about NRMP? Isn't it NRMP that adds credibility to the DNP by allowing them some sort of token optional "doctor" licensing exam?

For a medical student to become a Doctor, they HAVE to pass step 1, step 2 CK, step 2 CS and step 3 - to the tune of several thousand dollars into NRMP pockets. For a nurse to become a "doctor" they can take some little token exam (i.e color the correct picture showing a IM injection into the deltoid muscle) IF THEY WANT.

Talk about stacking the tables against medical doctors : 4 years of undergrad, 4 years of medical or osteopathic medical school, minimum 3 years of residency plus coughing up thousands of dollars for mandatory licensing exams and THEN you can identify yourself as a doctor VERSUS being a nurse, some additional coursework with no residency and take a DNP exam if you feel like it. The AMA and all medical schools should be screaming at NRMP about this affirmative action, punish the hard worker attitude of theirs against medicine and towards nursing. NRMP certainly has forgotten which side their bread is buttered on.

 

[Taurus]

The key is for the physicians to reject the NP as any sort of assistant. Letting them fly solo, which is what Mundinger and her clique would love anyway, would result in bad patient outcomes and litigation. Eventually, only the NPs who *really* know what they are doing would survive (and there's probably not too many of them anyway), which is not such a bad thing, and the doctor wannabe clowns/clownettes who know nothing would be sued out of their deranged delusions.

Ironically introducing tort reform may be counterproductive in that it would protect these idiots when they mess up. In the end, the "market" self corrects and patients will flee from injurious quacks to the people who know what they're doing.

The problem is that nurses want the prestige, privileges, and earnings comparable with physicians, but they don't want the liability. The nurses don't want any supervision when it comes to diagnosis, prescribing, and management. Yet, if there is a lawsuit, they want to be as close as possible to a physician. That's why the Pearson report misleadingly says that because NP's are sued less than physicians then it is because they are as safe or safer than physicians.

Btw, that's also why CRNA's will say with one breath that they don't want to be supervised by anesthesiologists but with the other breath they say that they are "supervised" by the surgeon or dentist. Even if the CRNA screws up, the surgeon or dentist will get hit with the lawsuit.

If this is their strategy, then it would behoof any physician to stay away from them. Do not form any remote supervising or collaboration agreements with any solo NP's. Hire PA's if you need help. If they are allowed more autonomy, let the NP/DNP's fly on their own.

However, my concern, as others have pointed out, is that NP/DNP's don't want to do primary care anymore than most physicians. They don't like the hours, paperwork, or low income. What they ultimately want is to get into the specialties. If NP/DNP's become a major force in primary care, it won't take long for you to hear about them wanting to do cardiology, dermatology, GI, nephrology, etc. If NP/DNP's are allowed the same scope and privileges as physicians, what is to stop them from going into the specialties?

That's why anybody who says, let's open the doors to the NP/DNP's and not care, is rather naive. That is why the AMA and ASA are taking such strong positions against the DNP. They understand what the nurses ultimately want. They understand that this talk about primary care is just a smoke screen, just like how the nurses initially said that they wanted autonomy so that they can go to the underserved communities to provide care. Did that happen? Nope.

 

[tr]

Not looking to start anything but all of our medical degrees are Bachelors of Medicine. The residency is technically the graduate portion with fellowships maxing out at master's level.

Not in the US. In Canada, most European countries, India, etc. you start fresh out of high school and get a bachelor's of medicine but in the US a bachelor's is a prerequisite for entry to medical school, which is a graduate degree. Residency is considered postgraduate training.

 

[McGillGrad]

Actually, in Canada you need a 4 year degree, just like the US and it is still a bachelor's of medicine.

Also, in European countries, it is not straight from high school but rather 6 years after high school for a medical degree.

India, I have no idea.

Nice try, though.

Not in the US. In Canada, most European countries, India, etc. you start fresh out of high school and get a bachelor's of medicine but in the US a bachelor's is a prerequisite for entry to medical school, which is a graduate degree. Residency is considered postgraduate training.

 

[firefly333]

I was really excited for Match Day, but after reading all of the recent posts not only on the general residency issues forum, but on the anesthesiology forum as well ( I am matching into anesthesiology)....I am really feeling concerned.

It seems from reading all of these posts that physicians are concerned about losing their fields to less qualified health service practitioners. When I decided upon a career, my mother gave me one piece of advice - she said, "Do not look for just a job, look for a career - look for a field that you can be invested in and a position that no one can take away from you." My mother was an accountant, and found that biology majors were working in the accounting department doing finance, with very poor results. I already loved science and of course assumed who could take a physician's job away from them? So it was natural for me to become a medical student. Now I am very confused as to how stability in the most demanding profession anyone can practice in has been lost to those less qualified? Who has been asleep at the wheel for the past decade?

 

[mercaptovizadeh]

The problem is that nurses want the prestige, privileges, and earnings comparable with physicians, but they don't want the liability. The nurses don't want any supervision when it comes to diagnosis, prescribing, and management. Yet, if there is a lawsuit, they want to be as close as possible to a physician. That's why the Pearson report misleadingly says that because NP's are sued less than physicians then it is because they are as safe or safer than physicians.

Btw, that's also why CRNA's will say with one breath that they don't want to be supervised by anesthesiologists but with the other breath they say that they are "supervised" by the surgeon or dentist. Even if the CRNA screws up, the surgeon or dentist will get hit with the lawsuit.

If this is their strategy, then it would behoof any physician to stay away from them. Do not form any remote supervising or collaboration agreements with any solo NP's. Hire PA's if you need help. If they are allowed more autonomy, let the NP/DNP's fly on their own.

However, my concern, as others have pointed out, is that NP/DNP's don't want to do primary care anymore than most physicians. They don't like the hours, paperwork, or low income. What they ultimately want is to get into the specialties. If NP/DNP's become a major force in primary care, it won't take long for you to hear about them wanting to do cardiology, dermatology, GI, nephrology, etc. If NP/DNP's are allowed the same scope and privileges as physicians, what is to stop them from going into the specialties?

That's why anybody who says, let's open the doors to the NP/DNP's and not care, is rather naive. That is why the AMA and ASA are taking such strong positions against the DNP. They understand what the nurses ultimately want. They understand that this talk about primary care is just a smoke screen, just like how the nurses initially said that they wanted autonomy so that they can go to the underserved communities to provide care. Did that happen? Nope.

That's precisely the problem. Doctors are allowing themselves to become whipping boys/girls by tethering themselves with proverbial handcuffs to the NPs. They should reject ALL association with them - anathematize them if need be. If they want to practice medicine, so be it, but then they're on their own - and liable for all the mess they make.

AND I would forbid their working at hospitals, only independent clinics. No abusing of MDs by consulting them to death on each and every case.

As for PAs, how come they are not a threat?

Finally, for the specialties I think it's just absurd. Everyone knows that some of the IM subspecialties are some of the most intellectual branches of medicine - particularly fields like nephrology and ID. On the other hand, what you foresee may yet happen. Many procedures could be shifted into the hands of the midlevels and MDs would have more of a consult/diagnostic function.

 

[mercaptovizadeh]

I was really excited for Match Day, but after reading all of the recent posts not only on the general residency issues forum, but on the anesthesiology forum as well ( I am matching into anesthesiology)....I am really feeling concerned.

It seems from reading all of these posts that physicians are concerned about losing their fields to less qualified health service practitioners. When I decided upon a career, my mother gave me one piece of advice - she said, "Do not look for just a job, look for a career - look for a field that you can be invested in and a position that no one can take away from you." My mother was an accountant, and found that biology majors were working in the accounting department doing finance, with very poor results. I already loved science and of course assumed who could take a physician's job away from them? So it was natural for me to become a medical student. Now I am very confused as to how stability in the most demanding profession anyone can practice in has been lost to those less qualified? Who has been asleep at the wheel for the past decade?

Function of greed by doctors themselves. Not opening enough residency spots for MDs to fulfill society's needs and a desire to cut costs by shifting work onto midlevels, who were all too eager to 'play doctor' and it has gone to their head and they'd like to bite [off] the hand that feeds them. We have to thank the previous generation of MDs for this. And the fact that specialties that form the core of medicine such as IM/peds/ob-gyn/general surgery have become unappealing because of lifestyle, reimbursement, paperwork, and litigation.

 

[Nick Name]

Actually, in Canada you need a 4 year degree, just like the US and it is still a bachelor's of medicine.

How high are you? There is no way a US medical degree is a bachelors. It requires a bachelors as a prerequisite (1 year of physics etc) except for a few schools. An MD is a doctorate, post -graduate.

Dude, seriously - put the bong down.

MacGillgrad - the first guy I add to my ignore list. Over time I am sure this will save me from wasting precious minutes from my life reading his posts

 

[mercaptovizadeh]

The M.D. is a first professional degree. It's not quite analogous to a Ph.D. On the other hand, it isn't really a bachelor's either. It resembles a bachelor's in the sense that it's about learning and assimilating information and skills (more hands-on that in the bachelors, of course), but it is much more rigorous than a bachelors and prepares us for the execution of professional duties. It isn't quite like a Ph.D. in that it isn't principally about training you in research and teaching. However, to ignore the fact that a huge amount of basic biomedical and even basic biological research has been done by non-Ph.D. M.D.'s would be unwise. American M.D.'s are clearly at a far advanced level above a liberal arts bachelor, no doubt about that. Also, I think the Ph.D. is no longer what it was, that training in teaching is minimal, the breadth of understanding of an overall field is weak (I've seen too many bio Ph.D.'s who know little biology outside their field, or organic chemistry Ph.D.'s who can't hack physical chemistry, not to mention the ivory tower hyperspecialization of humanities Ph.D.'s) and for a Ph.D. to be successful, it should fundamentally train you in designing experiments, critiqueing results, writing publications, giving attractive talks and presentations, and writing grants and getting them funded. So it has nothing to do with philosophy or the abstract nature of the science being investigated. It's become very technical, as technical as medicine even, although the skills are much more paper-based than those that medicine requires.

 

[tr]

Actually, in Canada you need a 4 year degree, just like the US and it is still a bachelor's of medicine.

Also, in European countries, it is not straight from high school but rather 6 years after high school for a medical degree.

India, I have no idea.

Nice try, though.

I'm going to give you Canada because I only know one person IRL who has been to med school there (from her info it sounded like people started med school significantly younger than they do here).

But I know a number of people who went through med school in different European countries and they all started straight out of high school. (You *finish* med school 6 years after that.) In all those countries, medicine is an alternative undergraduate track (it does usually take longer than most other programs though, typically 6 instead of 4-5).

I also know a couple of people who went through in India and their degrees are MBBCh/S, just like the UK system.

http://en.wikipedia.org/wiki/Bachelor_of_Medicine_and_Surgery

 

[cbass1350]

If they want to have a go at it let them try. Once they are actually burdened with some real responsibilities (aka legal) they will be singing a different tune.

 

[NPR]

However, my concern, as others have pointed out, is that NP/DNP's don't want to do primary care anymore than most physicians. They don't like the hours, paperwork, or low income. What they ultimately want is to get into the specialties. If NP/DNP's become a major force in primary care, it won't take long for you to hear about them wanting to do cardiology, dermatology, GI, nephrology, etc. If NP/DNP's are allowed the same scope and privileges as physicians, what is to stop them from going into the specialties?

Scary? Yes.

Possible? Yes.

Probable? No. People are already questioning the ability of NP/DNP's when it comes to primary care. Does any seriously think they can handle even dermatology? (probably the easiest field you listed there)

 

[Taurus]

Probable? No. People are already questioning the ability of NP/DNP's when it comes to primary care. Does any seriously think they can handle even dermatology? (probably the easiest field you listed there)

But that is the genius behind their strategy. They will not be anywhere close to being qualified as a board-certified as a derm, GI, or cards. What they want is to cherry pick the easy cases for themselves and anything remotely complex they will refer out to the doctors. The easy cases mean good income and low liability.

If you're an NP and you've worked for a derm for 3 years, there's a good chance you've seen 80% of all routine derm cases and you know how to manage them.

A patient comes in with a rash. Slap some corticosteroids on it and see if it goes away. If it doesn't, send to a derm.

That's the strategy that want to employ for primary care. It's no secret; they openly admit that's what they have in mind. That's the same strategy they will employ in the specialties.

 

[dragonfly99]

I think derm is easier than primary care, except for the biopsies and minor surgical stuff.

 

[McGillGrad]

You seem to have some anger issues...lol

I understand that it is diffuclt to think outside the narrow confines of your limited abilities, but the term 'bachelor of...' is not restricted to arts and sceinece undergraduate education in college.


Unless you learned medicine in undergrad (which no ones does, it is a rhetorical scenario), then your medical degree is a bachelors in medicine. Your residency is your graduate training to specialize.

How high are you? There is no way a US medical degree is a bachelors. It requires a bachelors as a prerequisite (1 year of physics etc) except for a few schools. An MD is a doctorate, post -graduate.

Dude, seriously - put the bong down.

MacGillgrad - the first guy I add to my ignore list. Over time I am sure this will save me from wasting precious minutes from my life reading his posts

 

[Taurus]

The Pearson report assumes accurate reporting and integrity of the National Practitioner Data Bank (NPDB) to make its claims

total number of accumulated malpractice and adverse actions in the NPDB
against that group of providers, were 1 in 173 for NPs, 1 in 4 for DOs, and 1 in 4 for MDs​

The problem is that NP's are underreporting their adverse events to the NPDB.

Sadly, state boards of nursing may be underreporting unprofessional behavior and incompetence to the National Practitioner Data Bank, according to one government representative who spoke at the meeting.

many cases...in which [California Board of Nursing] regulators acted belatedly or not at all, even when explicitly told that nurses had committed serious crimes. Some were handed renewals after reporting their own felonies to the bureau.​

The Pearson report uses flawed data to make its case. Yet, that won't stop the nurses from pushing this analysis on lawmakers and the public to advance their agenda. Again, nursing uses propaganda and lies as its tools to get what it wants. When will somebody in medicine stand up to this crap and say enough is enough?!

 

[NPR]

But that is the genius behind their strategy. They will not be anywhere close to being qualified as a board-certified as a derm, GI, or cards. What they want is to cherry pick the easy cases for themselves and anything remotely complex they will refer out to the doctors. The easy cases mean good income and low liability.

If you're an NP and you've worked for a derm for 3 years, there's a good chance you've seen 80% of all routine derm cases and you know how to manage them.

A patient comes in with a rash. Slap some corticosteroids on it and see if it goes away. If it doesn't, send to a derm.

That's the strategy that want to employ for primary care. It's no secret; they openly admit that's what they have in mind. That's the same strategy they will employ in the specialties.

True but PCPs have been doing that for years and derm offices are still flooded.

Besides, dermies will keep all their acne-ridden teenagers because they've got the Accutane

What should be concerning to cosmetic dermatologists would be influx of DNPs commandeering cosmetic procedures.

"They look like doctors, they have white coats, they're even called doctors. Botox please!"

 

[firefly333]

You seem to have some anger issues...lol

I understand that it is diffuclt to think outside the narrow confines of your limited abilities, but the term 'bachelor of...' is not restricted to arts and sceinece undergraduate education in college.


Unless you learned medicine in undergrad (which no ones does, it is a rhetorical scenario), then your medical degree is a bachelors in medicine. Your residency is your graduate training to specialize.

I just registered for my cap and gown today. You had to select your degree - I selected Doctorate of Medicine (MD) not Bachelors of Medicine. Thanks.

 

[firefly333]

The Pearson report assumes accurate reporting and integrity of the National Practitioner Data Bank (NPDB) to make its claims

total number of accumulated malpractice and adverse actions in the NPDB
against that group of providers, were 1 in 173 for NPs, 1 in 4 for DOs, and 1 in 4 for MDs
​

The problem is that NP's are underreporting their adverse events to the NPDB.

Sadly, state boards of nursing may be underreporting unprofessional behavior and incompetence to the National Practitioner Data Bank, according to one government representative who spoke at the meeting.

many cases...in which [California Board of Nursing] regulators acted belatedly or not at all, even when explicitly told that nurses had committed serious crimes. Some were handed renewals after reporting their own felonies to the bureau.
​

The Pearson report uses flawed data to make its case. Yet, that won't stop the nurses from pushing this analysis on lawmakers and the public to advance their agenda. Again, nursing uses propaganda and lies as its tools to get what it wants. When will somebody in medicine stand up to this crap and say enough is enough?!

As a start - Every president of every medical specialty society needs to write a letter to the NBME (as the ASA did) to comment upon the DNP certification examination using the Step III question materials.

 

[Nick Name]

It isn't quite like a Ph.D. in that it isn't principally about training you in research and teaching..

A good primary care physician should be involved heavily in teaching - teaching patients about diet, lifestyle, proper use of medications, warning signs of appropriate diseases they are at risk for based on age and gender and race etc. Granted I do feel many primary care doctors fall short on this task, but it is one of the primary jobs of a primary care physician.

Other than evaluation, decision making, and treating patients; a doctor should spend a major part of his time in education. Their classroom is their office, and most of their instruction is one on one, but over the course of a few years a doctor has the opportunity to teach thousands of students (patients).

A medical doctors education is really not complete until the end of residency. Every residency I interviewed at provides ample opportunity for original research.

Much of a Ph.D's "original" research is based off previous published research - I mean in all honesty there are very very few entirely original research papers. Most of it comes as an extension of other published data. Likewise, much of a medical doctors research is personal case histories, and the recipient of their day to day collecting of data in patient charts is the doctor themselves.

 

[McGillGrad]

I just registered for my cap and gown today. You had to select your degree - I selected Doctorate of Medicine (MD) not Bachelors of Medicine. Thanks.

Yes, hence the title, Doctor of Medicine. That is not a PhD, though. A doctorate in medicine is a professional designation, not a academic doctorate.

It is interesting how many people can become an MD without basic reading comprehension skills.

 

[McGillGrad]

Your post is about as sound as a 300lb man on 1cm of ice on a lake.

A good primary care physician should be involved heavily in teaching - teaching patients about diet, lifestyle, proper use of medications, warning signs of appropriate diseases they are at risk for based on age and gender and race etc. Granted I do feel many primary care doctors fall short on this task, but it is one of the primary jobs of a primary care physician.

Other than evaluation, decision making, and treating patients; a doctor should spend a major part of his time in education. Their classroom is their office, and most of their instruction is one on one, but over the course of a few years a doctor has the opportunity to teach thousands of students (patients).

A medical doctors education is really not complete until the end of residency. Every residency I interviewed at provides ample opportunity for original research.

Much of a Ph.D's "original" research is based off previous published research - I mean in all honesty there are very very few entirely original research papers. Most of it comes as an extension of other published data. Likewise, much of a medical doctors research is personal case histories, and the recipient of their day to day collecting of data in patient charts is the doctor themselves.

 

[Nick Name]

But that is the genius behind their strategy. They will not be anywhere close to being qualified as a board-certified as a derm, GI, or cards. What they want is to cherry pick the easy cases for themselves and anything remotely complex they will refer out to the doctors. The easy cases mean good income and low liability.

If you're an NP and you've worked for a derm for 3 years, there's a good chance you've seen 80% of all routine derm cases and you know how to manage them.

A patient comes in with a rash. Slap some corticosteroids on it and see if it goes away. If it doesn't, send to a derm.

That's the strategy that want to employ for primary care. It's no secret; they openly admit that's what they have in mind. That's the same strategy they will employ in the specialties.

Excellent points. While doing OB rotation in medical school, trainwrecks would come in through the ER that were mismanaged by nurse midwives - and then the obstetrician was expected to clean up the mess and save the day. I am sure this will happen in every field the nurse touches - either they will get lucky with easy cases or leave the real experts to clean up the mess. I pity the unlucky MD who gets caught in the medicolegal wringer by having to take over a mismanaged nurse patient.

The Pearson report assumes accurate reporting and integrity of the National Practitioner Data Bank (NPDB) to make its claims

total number of accumulated malpractice and adverse actions in the NPDB
against that group of providers, were 1 in 173 for NPs, 1 in 4 for DOs, and 1 in 4 for MDs​

The problem is that NP's are underreporting their adverse events to the NPDB.

Sadly, state boards of nursing may be underreporting unprofessional behavior and incompetence to the National Practitioner Data Bank, according to one government representative who spoke at the meeting.

many cases...in which [California Board of Nursing] regulators acted belatedly or not at all, even when explicitly told that nurses had committed serious crimes. Some were handed renewals after reporting their own felonies to the bureau.​

The Pearson report uses flawed data to make its case. Yet, that won't stop the nurses from pushing this analysis on lawmakers and the public to advance their agenda. Again, nursing uses propaganda and lies as its tools to get what it wants. When will somebody in medicine stand up to this crap and say enough is enough?!

Our medical society leaders do need to contact NBME (which I mistakenly called NRMP earlier)

 

[Nick Name]

As a start - Every president of every medical specialty society needs to write a letter to the NBME (as the ASA did) to comment upon the DNP certification examination using the Step III question materials.

Very true. Trouble is many of the NBME are old timers who are or soon will be semi-retired at best and I am not sure they feel they have a dog in the fight anymore. I think I mistakenly referred to the NBME as NRMP.

I love seeing : MacGill Grad --- this user is on your ignore list

 

[McGillGrad]

Very true. Trouble is many of the NBME are old timers who are or soon will be semi-retired at best and I am not sure they feel they have a dog in the fight anymore. I think I mistakenly referred to the NBME as NRMP.

I love seeing : MacGill Grad --- this user is on your ignore list

I love it even more that you are paying attention to someone on your ignore list

 

[tr]

But that is the genius behind their strategy. They will not be anywhere close to being qualified as a board-certified as a derm, GI, or cards. What they want is to cherry pick the easy cases for themselves and anything remotely complex they will refer out to the doctors. The easy cases mean good income and low liability.

But one of the complaints I've heard about outpatient medical practice in many fields is that docs get bored seeing the same low-acuity cases.

Add to that, there don't seem to be enough doctors to go around.

Why not segue to a system where midlevels handle basics and MDs take the complex cases?

I think a more concerning question is, are the midlevels going to *recognize* when they need to call in backup? I'd be more worried about targeting their education towards knowing when to call for help and less worried about taking contact dermatitis cases away from MDs.

While doing OB rotation in medical school, trainwrecks would come in through the ER that were mismanaged by nurse midwives - and then the obstetrician was expected to clean up the mess and save the day.

The OBs aren't even interested in low-risk NSVDs. They totally ignore them through the 20-hour labor, then show up for the last 5 minutes and catch the baby. They're just not interested in labor management. Which is fine, because 95% of their training is targeted towards the 5% of the time that stuff goes wrong. I don't see why we shouldn't have nurse midwives - who enjoy the management of normal L&D and are more experienced in it to boot, since they actually spend time with laboring women - do that part, and refer up to OBs when things get hairy. Division of labor.

 

[silas2642]

But one of the complaints I've heard about outpatient medical practice in many fields is that docs get bored seeing the same low-acuity cases.

Add to that, there don't seem to be enough doctors to go around.

Why not segue to a system where midlevels handle basics and MDs take the complex cases?

I think a more concerning question is, are the midlevels going to *recognize* when they need to call in backup? I'd be more worried about targeting their education towards knowing when to call for help and less worried about taking contact dermatitis cases away from MDs.

The OBs aren't even interested in low-risk NSVDs. They totally ignore them through the 20-hour labor, then show up for the last 5 minutes and catch the baby. They're just not interested in labor management. Which is fine, because 95% of their training is targeted towards the 5% of the time that stuff goes wrong. I don't see why we shouldn't have nurse midwives - who enjoy the management of normal L&D and are more experienced in it to boot, since they actually spend time with laboring women - do that part, and refer up to OBs when things get hairy. Division of labor.

So I know I'm fresh to the game here, but I think that if you mosey on over to allnurses.com and into the NP forum, you'll kind of get your answer-- my impression is that they think you, the physician/lowly resident (who btw, should not even be called a "doctor" because you're not an attending and just screw everything up-- no joke, this is really what they said in one of their threads.)= uncompassionate idiot. I'm pretty certain that they think they can do your job better than you can based on anecdotal evidence because right now their job consists of running after you cleaning up after all your messes-- i.e. explaining procedures to patients, saving patients lives after you wrote an order that could potentially kill them, etc. They think you're a jerk and hate your guts.

Go to that forum and you'll see exactly what nurses think of physicians and how they see themselves-- scary.

 

[tr]

So I know I'm fresh to the game here, but I think that if you mosey on over to allnurses.com and into the NP forum, you'll kind of get your answer-- my impression is that they think you, the physician/lowly resident (who btw, should not even be called a "doctor" because you're not an attending and just screw everything up-- no joke, this is really what they said in one of their threads.)= uncompassionate idiot. I'm pretty certain that they think they can do your job better than you can based on anecdotal evidence because right now their job consists of running after you cleaning up after all your messes-- i.e. explaining procedures to patients, saving patients lives after you wrote an order that could potentially kill them, etc. They think you're a jerk and hate your guts.

Go to that forum and you'll see exactly what nurses think of physicians and how they see themselves-- scary.

I've been to allnurses.com. My impression is that they b1tch about us approximately as much as we b1tch about them. (Do a search for "stupid calls from nurses" on sdn why don't you?)

But anyway, how is that at all relevant to the question of whether they ought, with appropriate training, be allowed to manage low-complexity cases?

 

[SouthernSurgeon]

Excellent points. While doing OB rotation in medical school, trainwrecks would come in through the ER that were mismanaged by nurse midwives - and then the obstetrician was expected to clean up the mess and save the day. I am sure this will happen in every field the nurse touches - either they will get lucky with easy cases or leave the real experts to clean up the mess. I pity the unlucky MD who gets caught in the medicolegal wringer by having to take over a mismanaged nurse patient.

Oh, the midwives...

We have midwives and OBs deliver in the same L&D area; the medical team doesn't touch the midwife patients unless asked to...but frequently whenever the midwives have a difficult delivery the OB residents just sit there watching the monitor with their jaws on the floor at the awful mismanagement, waiting to get pulled in to take care of things.

And they occasionally get pulled in for these absurd consults - "no I'm not going to try a forceps delivery for a patient who is at a -2 station!"