NPR segment on DNP's - make your voices heard!

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Taurus

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NPR, national public radio, did a segment on DNP's. Even our friend Mary Mundinger makes a guest appearance. Listen to her speak.

Please add a comment. It's time to make our voices heard! We need to educate the public on the differences between physicians and DNP's.

New Degree Creates Doctor Nurses — And Confusion

All Things Considered, February 22, 2009 · No one wants to badmouth Florence Nightingale, but a new degree for nurses is causing bad blood between doctors and their longtime colleagues. The program confers the title of doctor on nurses, but some in the medical profession say only physicians should call themselves "doctor."

Dr. Steven Knope is a family practitioner in Tucson, Ariz. "If you're on an airline," he jokes, "and a poet with a Ph.D. is there and somebody has a heart attack, and they say 'Is there a doctor in the house?' — should the poet stand up?" Knope laughs. "Of course not."

Physicians such as Knope say the title of doctor implies a certain amount of training, hours in medical school that nurses just don't have. Dr. Ted Epperly, president of the American Association of Family Practitioners, says that while doctors place a high value on nurses, sharing the same title could confuse — and even harm — patients.

"I can just imagine a patient of mine walking into my exam room and saying, 'Now Dr. Smith, are you a doctor doctor, or are you a doctor nurse?'"

"I am a doctorally prepared nurse," says doctor nurse Ray Scarpa. A doctor, he says, "is a doctorall -prepared physician."

Scarpa works in the department of surgery at University Hospital in New Jersey. "I am not here to practice medicine, I am here to practice nursing," he says. "And I practice it at an advanced level, and I have earned the right to be called doctor."

For nursing students who begin right after college, it can take about six years to get the degree. While there is some overlap in knowledge, Scarpa says, doctors diagnose and treat while nurses have a wider focus including family, support and community.

Doctors Feel Threatened

The doctoral program for nurses is offered at more than 200 schools and began at the Columbia University School of Nursing. Dean Mary Mundinger says the tension is more about turf than patient confusion.

"It's about status," Mundinger says. "It's about ego, it's about presence. It's about standing in their community."

Here's where physicians and the new doctor nurses agree: Both groups say physicians feel threatened. They see the new breed of nurses as an invasion of their turf.

Fourth-year medical student Janet Pullockaran at University Hospital's emergency room understands the threat. "With all these new people — physician assistants, nurse practitioners coming into the field — maybe our training won't lead to a secure position in the future," she says.

A Role Doctors Can't Fill

But there's a shortage of primary caregivers, and it's possible the new nurses will help fill the void.

Louis Boeckel has throat cancer. He faces people in white coats day in and day out. He just had a tracheotomy and can't talk, so he writes notes on a pad for his wife, Carol, to read. When asked if he's worried about mixing up his physician with his nurse, Ray Scarpa, Boeckel writes, "Best doctor."

Boeckel's wife says they are concerned about who's providing their care, but to them, the title of doctor for their nurse just means he's that much more qualified.

"We view him as a doctor, because he does come and take care of all [Louis'] immediate needs as any doctor would do," she says.

The first exam to certify the doctor nurses was given in November. It's a modified version of a test given to physicians. The next test is scheduled for October, but some physicians are trying to prevent the National Board of Medical Examiners and the American Board of Comprehensive Care from administering it.​

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We're screwed, because the average person just can't understand the difference between 4 years undergrad, 4 years med school and 3+ years of residency/fellowship, and going to nursing school then getting a DNP. I personally don't care if they call themselves "doctors" but I do care about the scope of practice issues, and I don't want a nurse to be diagnosing my family members, in general, because the length and rigor and content of their training doesn't prepare them to do that.
 
As long as they are responsible for the patient (i.e malpractice insurance and legal liability) then go for it.

There's always room for more health practitioners.
 
The first exam to certify the doctor nurses was given in November. It's a modified version of a test given to physicians. The next test is scheduled for October, but some physicians are trying to prevent the National Board of Medical Examiners and the American Board of Comprehensive Care from administering it.

And it looks like only 50% could pass this watered down version of Step III ( http://www.abcc.dnpcert.org/exam_performance.shtml ).

AABC said:
The DNP Certification Examination is comparable in content, similar in format and measures the same set of competencies and applies similar performance standards as Step 3 of the United States Medical Licensing Examination (USMLE). While the CACC exam is derived from the USMLE Step 3, the certification for graduates of DNP programs is customized by CACC content experts. Whereas the Step 3 exam is the final step for licensure for MD candidates, the CACC exam is used only for certification for graduates of DNP programs. These two exams are separate and distinct. The overlap in content between these two exams provides evidence of some competencies that are common to nursing and medicine, but each profession--medicine and nursing--has additional and discipline specific requirements for licensure practice.

Who wants to bet the next version of this exam is watered down even more -- too much medicine on it...not enough "community support" :rolleyes:
 
Does anyone actually work in a hospital with Dr. Nurse's? How does this break down in the real world? Does the person intro themselves as Dr. Nurse and do the doctors call them nurse in front of patients?
 
It is amazing how far people will go just so they can "be like a doctor", yet when it is all said and done, the main person being deceived is themselves. I understand if someone gets a PhD because they want to master the art of nursing, but to go get some PhD in nursing so you can perpetuate a lifetime of self deceit and inferiority complex is strange to me.

BTW, this is off point, but I was just wondering how a child might explain to his/her friends what their Dr Nurse parent does too. Does the child say "daddy/mommy is kinda like a doctor" or "daddy/mommy is a doctor" or "daddy/mommy is a nurse" or what?
 
The main thing that would piss me off is this:

The nurse who treats patients like a physician and expects recognition like a physician would get, but runs the other way when it's litigation time.

And 'hell no' if they ever expect to get the same in salary. I've worked with 2 NP's on a rotation, and while they knew how to treat things, when you even start to ask about physiology or pathology, they just shut down.
 
And 'hell no' if they ever expect to get the same in salary. I've worked with 2 NP's on a rotation, and while they knew how to treat things, when you even start to ask about physiology or pathology, they just shut down.

Over time, salaries will decrease as the number of providers increase. This will undoubtedly happen since nurses are hellbent on practicing medicine, and the AMA won't take them to court to declare the practice of medicine is for physicians only.

Interesting that all I ever hear from nurses is how little interns know, and yet only 50% of the elite nurses could pass a dumbed down version of Step III. Of course, over 90% of interns pass this on the first attempt as it's by far the easiest of the Steps.

I couldn't help but notice the advertisement for Jacksonville School of Nursing at the top of SDN as I wrote this post. You can apparently get your entire BSN online. Then you start working on your MSN, all online of course. And after only a few more years of online course work you're Dr. Nurse, the equivalent of a physician! How sweet it is, becoming a "doctor"!
 
I have to say in defense of the NP's that most of these programs are not online. There is one @the academic medical center where I work and it's not like doing a residency, but it's not like it's useless and totally worthless, and I'm sure it's not a cakewalk to get the DNP here. But this is a top nursing school...

I personally have worked with NP's from our nursing school and I think they are fine, as long as they stay within their scope of practice (similar to most of us...). The problem is that of knowing when/what you don't know, and I think that some do and some don't.

I personally don't care if PhD folks, etc. (audiologist, physical therapist, NP, etc.) use the title of Dr. since they are PhD's. But I think it should be clearly indicated whether someone is a doctor of audiology, nursing, medicine, etc.

I mean, let's get real. We aren't going to dictate who can get a doctoral level degree just because we are doctors of medicine. We're just not.

And as far as the AMA being able to sue to stop the NP doctorate from happening, exactly how would that work? I think the probability of success in such a lawsuit would be close to zero, and it would be a total PR nightmare (evil physicians trying to oppress the nice kind nurses, etc.).

I don't think the Dr. nurses should sell themselves as being equivalent to a residency trained MD, because I think that's false. They have their own separate and different body of knowledge (with some overlap). I do resent the fact that they are trying to sell the nursing exam as the equivalent of taking Step 1,2 and 3, b/c I don't believe it is.

I think if the idea is for NP's to take over primary care, I don't think that's really a viable long term plan. There's some stuff they aren't going to know, just because you can learn a ton during a 3 year residency of up to 80 hours/week, plus 3rd and 4th years of med school...
I also am skeptical that most or all NP's will want to stay in primary care...the reason we don't have enough primary care docs is that it's a crappy lifestyle, high pressure and you get little respect. The evidence so far shows that NP's and PA's are quick to figure this out as well, and they tend to flee primary care as well.
 
I mean, let's get real. We aren't going to dictate who can get a doctoral level degree just because we are doctors of medicine. We're just not.

No clue why anyone would try and dictate who could or couldn't get a doctorate. That'd be senseless. But, I see absolutely no reason other than a nurse's ego for them to introduce themself as "Dr. Nurse" within a hospital.

And as far as the AMA being able to sue to stop the NP doctorate from happening, exactly how would that work? I think the probability of success in such a lawsuit would be close to zero, and it would be a total PR nightmare (evil physicians trying to oppress the nice kind nurses, etc.).

If a nurse seeks to provide care for patients independent of oversight, as seems the case here, then I believe that encompasses the practice of medicine (the diagnosis and treatment of disease). Seems pretty cut and dry to me. And I agree, it would be a PR nightmare, but come on, at some point do you not feel like physicians should define what exactly our role in medicine is and why equivalence with nurses is not in the best interest of the patient?



I don't think the Dr. nurses should sell themselves as being equivalent to a residency trained MD, because I think that's false. They have their own separate and different body of knowledge (with some overlap). I do resent the fact that they are trying to sell the nursing exam as the equivalent of taking Step 1,2 and 3, b/c I don't believe it is.

This was posted in the Anesthesiology forum and was taken from the ABCC website:


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.


There ya go, this test provides evidence they can give independent care to patients. So ya dumb down the easiest licensing exam we'll ever take, and by far the easiest of the Steps, and you're good to go with regards to providing independent care. I really don't see how patients are best served by any of this mess.
 
Interesting that all I ever hear from nurses is how little interns know, and yet only 50% of the elite nurses could pass a dumbed down version of Step III. Of course, over 90% of interns pass this on the first attempt as it's by far the easiest!


yeah i heard this from a nurse when i saw her at the gym.. she said.. the interns at my hospital dont know ****.. I told her... they know a helluva lot.. they must not be well versed in the logistics.. getting mris.. pulling up labs.. putting consults in the computer.. but if you have a conversation with them they know a lot..
 
I mean, let's get real. We aren't going to dictate who can get a doctoral level degree just because we are doctors of medicine. We're just not.

I agree - but I think it is appropriate to attempt to regulate who can use the title "Doctor" in a *clinical* setting. Some states limit the use of the title to MD/DOs, DDS/DMD and DPMs - and the use of "Dr." outside of those degrees in a clinic constitutes practicing medicine without a license.

I think this issue really needs to be attacked from a patient safety/disclosure standpoint - it's unfair to put the burden on the patient to understand that someone with a white coat at a clinic that introduces themselves as "Dr. X" with "DPN" on their nametag has a different education and background than someone with "MD". Hell - most patients don't understand "DO".

50% of DNPs couldn't pass the dumbed down Step 3. Even Pathologists pass Step 3 (Not a dig at pathologists - they just don't have a clinical intern year to stay fresh on things and can still pass). With independent practice rights comes independent liability. They could have a problem finding reasonable malpractice insurance....
 
Since Columbia is evidently Ground Zero for this whole debate, I'll chime in, though I'm obviously a med student and not too up on the dynamics of health teams yet.

The nursing students at Columbia are *very* different from the nursing students at my undergrad, State U's, community college system (which is the only point of reference I've got). They're not too different from medical students in certain respects-- all of them have must have a bachelor's degree before entry, and many did quite well at well-regarded colleges. Their degree is three years long, half coursework and half clinical. Most of them are looking forward to a quasi-independent practice as an NP (the DNP is given in tracks such as "Family Health Practitioner"). None of the students I know personally, or have worked with on the wards, think of themselves as physicians. They don't see themselves as inferior, but neither do they see themselves as equivalent.

I also know that within nursing school the PhDs are referred to as "Dr. X" when teaching a class, as would any other non-clinical PhD (including all of our profs in undergrad). In the hospital, they usually introduce themselves by their first names, followed by "I'm your Nurse Practitioner." There doesn't seem to be a difference between people with the DNP and a garden-variety NP.

HOWEVER, I think I can guess a bit as to the difference. The nursing students I described are for the most part <30, accomplished and self-confident people, who made the conscious decision to study nursing instead of medicine in an era when that choice was entirely open to them. I think the people clamoring the most strongly for the DNP and the title "doctor" and the respect it brings are those who went into nursing in an earlier era, when women became nurses and men became doctors, when off-color condescending jokes were common. They were treated poorly, without much respect for their experience and knowledge, that it's understandable they're pushing back.

Don't get me wrong, I don't believe that experience as a nurse magically translates into training as a doctor any more than the rest of you. I think divorcing treatment from a deep underlying understanding of mechanism is frightening. But in a way, I think the medical community is partially to blame.
 
They don't see themselves as inferior, but neither do they see themselves as equivalent.

.

So how do they see themselves? In my way of thinking if they do not see themselves as an equal, and not inferior - then do they see themselves as better? I get that feel from some of the quotes attributed to them : "We learn BOTH medicine and nursing". Its like they think they are medicine plus.,

Some of the quotes from the NPR article strike me as complete BS. One is they say the AMA had nurses removed from the "health care scene". When did that happen? I always saw nurses in all the hospitals I have been in.
 
I think they see themselves as different. Neither better nor worse, nor exactly the same thing. They believe in the comprehensive care model and think their training gives them certain strengths that doctors don't have (patient rapport, longitudinal involvement, arranging para-medical services).
 
I think they see themselves as different. Neither better nor worse, nor exactly the same thing. They believe in the comprehensive care model and think their training gives them certain strengths that doctors don't have (patient rapport, longitudinal involvement, arranging para-medical services).

What you say sounds nice. But nothing you listed would explain why a nurse would take an NBME given exam with emphasis on diagnosis and treatment, and declare it as analogous to Step 3 with aimed preparation towards independent practice. Come on, let's call a spade a spade. Does any of this sound like the practice of nursing?

We should fully support nurses gaining skills in the areas you described BD, but I'm really just a common sense type of guy, and common sense tells me they're changing the outfit of what we believe to be the practice of medicine, and calling it something different. I'm really not trying to be disrespectful towards nursing and nurses, and I fully support the furthering of education, but wearing the white coat, infiltrating primary care, taking pseudo Step 3, gaining independent practice, calling themselves "Dr." within a hospital, yeah that just sounds a whole lot like the practice of medicine to me.
 
I agree, it does. I only replied because someone asked for a report on the ground, where DNPs are actually practicing. That's what I've seen.
 
Is it really easiest of the exams? Well thinking about it, one would have experience Step1, and Step2, and completing at least a year of residency would have make it easier for someone to pass the Step 3. If you take Step 3 right away, one would not be able to string together the clinical concepts that one must know.

Interestingly, there are no review books for this exam as of yet. Yet there are hundreds for Step 3. If they modified it, then some content may or may not be the same.

Saw this practice test http://www.abcc.dnpcert.org/09DNPpractice.pdf (page 20 onewards)

Passing this test with only 45 test takers http://www.abcc.dnpcert.org/exam_performance.shtml is not a good statistic, and from what I gather this is the first time the test was administered. If they want this passing at higher rate that means more likely they need more clinical hours, there's a just a competency gap that DNP program needs to address. (As compared to 96% w/ 183 test takers passing rate when step 3 was first introduced)

I would think that schools with medical schools and DNP programs i.e. John Hopkins, Columbia, George Washington, VCU, would be the best schools to provide a program like this, not the ones that have only nursing program as their specialty.

One would think that if we have more GP's, we would not have this problem. Besides, outside the US there are many "doctors" are called Mr. because of they don't have their doctorate, yet they practice medicine with a bachelors degree and have superior physical/bedside diagnosis as compared to *gasp* US MD's
 
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Also instead of taking a modified version of Step 3, I think a more thorough exam that involves step 1 and step 2 and step 3 would be more ideal.
 
Columbia's School of Nursing is an anomaly and comes from a time when men were the only ones in medical school, and so a smart female had the only option of becoming a nurse if she wanted to work in medicine. And if we remember, that wasn't really that long ago - like only 30 years or so.

Schools like theirs are going to have superstars no matter what - but they also usually know their place in the hierarchy. Maybe, too some of it is regional. Some parts of the country it's still female = nurse, male = doctor. So that is another significant dynamic. I am regularly referred to as 'another nurse,' while the male orderlies or phlebotomists are called med student or 'doctor.'

It's the same old argument that is all over these forums. People who don't want to do the 7+ years of hard work in order to run the ship, diagnose and then be responsible (in a court of law) for those diagnoses. Yet, they want the perceived esteem that they feel comes with this position.

The thing is, patients (and staff) might think I am 'another nurse' and that's fine. But when it comes down to what needs to be done and who is going to be driving this ship - then it will be me. If they want the legal responsibility without the actual knowledge required then that's fine too. ;)
 
Ok, I am going to double-dip here because I am just hanging around with nothing to do but think about the rank list and submission. :)

As for the notion of maybe we have more nurses surging into general practice medicine because we have fewer people going into it - well, I say why don't more people go into it? I am going into FM and I hope to be an excellent doc and be a strong supporter to my patients. I also hope to have a balanced life.

General medicine is an awesome way to see all of medicine, it is a fantastic way to really understand physiology/pathology/and have a constant challenge. Why are we letting such an honorable section of our profession fade away, and why do we need ten thousand new specialists every year? Maybe, we could fix the financial failures in general medicine and do it to attract back our best and brightest.
 
Also instead of taking a modified version of Step 3, I think a more thorough exam that involves step 1 and step 2 and step 3 would be more ideal.

Ideal for what? Personally, I think a desire to practice independently requires success on the MCAT, expenditure and success on admission to medical school, 2 years of locked-down classroom labor, expenditure and success on Step 1, 2 years of dedicated work on the wards, expenditure and success on Step 2, garnering LORs, expenditure and success going through interviews and the ERAS system, matching into a 3-8 year residency program, expenditure and success on Step 3, years of medical labor at ~45k/year and no more than 80 hours/week averaged over a month, and finally, last but certainly not least, expenditure and success on oral and/or written boards of your specialty of choice.

Please, someone, anyone, explain to me why in hell's fury should the world of medicine allow a shortcut when the entrustment of patient care is so damn hard for the rest of us to garner?
 
Fixing primary care begins with each physician. There is no solution from the government. Now that we have a tiered sytem of 'providers' it should be maximized. If NPs want and have their autonomy there is one natural progression of medicine. Every PCP should immediately cease to accept insurance and medicare. Let the NPs have those patients. Whether we like it or not the powers that be (inusrance mafia) will make them the default 'provider' simply by what they are willing to pay for the positions. PCPs need to utilize their admitting privileges (which NPs will never obtain from their poor training) to market themselves as the true comprehensive physician.

If you have money and want to flee the pseudo government system of NPs and constantly being punted to specialists you will pay cash for a comprehensive physician. The future is bright for medicine, but sadly not for the patients.
 
What saddens me is just how much DNP's want to abandon nursing. Patients are thus stuck with the worst nurses taking care of them.

Maybe as more nurses leave nursing to be Doctors of Nursing, the more these nurses will start to realize just how bad nurses are and start paying attention to fixing their own fields rather than try to abandon it.

You know what? I don't care if in 20 years from now, there is a Doctor of Medical Assistant-ship or Doctor of Scheduling. All I care is that we stop screwing things up.

If giving a patient his medicine -- the right medicine, on time -- requires a PhD, the let's get all the nurses a doctorate.

If it requires a doctorate of nursing to make nurses realize that you CANNOT fabricate vital signs, then let's sign up every nurse for that course.
 
Ideal for what? Personally, I think a desire to practice independently requires success on the MCAT, expenditure and success on admission to medical school, 2 years of locked-down classroom labor, expenditure and success on Step 1, 2 years of dedicated work on the wards, expenditure and success on Step 2, garnering LORs, expenditure and success going through interviews and the ERAS system, matching into a 3-8 year residency program, expenditure and success on Step 3, years of medical labor at ~45k/year and no more than 80 hours/week averaged over a month, and finally, last but certainly not least, expenditure and success on oral and/or written boards of your specialty of choice.

Please, someone, anyone, explain to me why in hell's fury should the world of medicine allow a shortcut when the entrustment of patient care is so damn hard for the rest of us to garner?

Southpaw,
Not to mention the loans that one has to pay, the lack of sleep, social interactions and healthy choices that one has to sacrifice...

When I said ideal, I mean to test knowledge of what they know or do not know. There's no shortcut on being a physician/medical doctor. But if there are some nurses who wants to be a nursing doctor so be it, heck even doctorate PA's (DPA)... as long as they have competency of what they're doing and knows their scope of practice, unfortunately there are some who lacks knowledge even in AandP.

Who created NP/PA programs anyway? MD's

more time for golf ;)
 
And as far as the AMA being able to sue to stop the NP doctorate from happening, exactly how would that work? I think the probability of success in such a lawsuit would be close to zero, and it would be a total PR nightmare (evil physicians trying to oppress the nice kind nurses, etc.).

The AMA can't stop NP programs from converting to DNP's. The AMA may not even be able to prevent more states from allowing NP's to practice autonomously. I know that they tried to change the laws in Pennsylvania last year unsuccessfully and they're trying to change the laws in Texas this year. No, the most effective way to manage this issue is through the marketplace.

Just because your license grants you the ability to do something does not mean you should do it. While internists are able to practice surgery under their medical licenses, most are not foolish enough to do so unless they have gone through surgery residency. In a similar vein, an NP/DNP may be able to practice autonomously but make it very risky and expensive for them to do so. Educate the lawmakers and the public about the educational and training differences between DNP's and physicians. But I think it is equally or more important to educate the lawyers and insurance executives. Make the prospect of getting sued very likely if there's a bad outcome. Their malpractice premiums should even be higher than physicians' because they are less trained. Some of this is already happening. "Malpractice suits against advanced practice nurses are rising in number and increasing in severity"

The AMA can do its part by promoting true studies that compare the differences between the outcomes of physicians and NP's. Furthermore, they can highlight the differences between medical knowledge by revamping the USMLE. Combine the steps into one major comprehensive exam. Then force the DNP's to take this exam since they claim that they have "medical knowledge of a physician". Then compare the differences in passrates. The performance of the DNP's on the watered down step 3 is a promising sign to me that if we made a comprehensive exam that DNP's would struggle mightily. Remember, if only 50% of the creme de la creme of DNP's could pass a watered down step 3, which is arguably the easiest of the steps, then how will DNP's who got their degree online or from Podunk U do? I'm guessing that something like only 5% of DNP's vs. >90% of US MD's could pass a comprehensive exam. You can also make the comprehensive exam really difficult so that only 75% of US MD examinees can pass. Then take the data you get from the studies and the exams to the lawmakers, lawyers, and insurance executives.
 
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What saddens me is just how much DNP's want to abandon nursing. Patients are thus stuck with the worst nurses taking care of them.

This is a really good point. When I was in the ICU a bit ago, I was so impressed by the nurses - they took excellent care of their patients, and really knew their stuff (and were nice to boot). But it seemed like every one was in the process of getting their NP or some other advanced degree so they could get out of being a "regular" nurse.
 
What saddens me is just how much DNP's want to abandon nursing. Patients are thus stuck with the worst nurses taking care of them.

Maybe as more nurses leave nursing to be Doctors of Nursing, the more these nurses will start to realize just how bad nurses are and start paying attention to fixing their own fields rather than try to abandon it.

You know what? I don't care if in 20 years from now, there is a Doctor of Medical Assistant-ship or Doctor of Scheduling. All I care is that we stop screwing things up.

If giving a patient his medicine -- the right medicine, on time -- requires a PhD, the let's get all the nurses a doctorate.

If it requires a doctorate of nursing to make nurses realize that you CANNOT fabricate vital signs, then let's sign up every nurse for that course.
I think you landed at the crux of the problem.. nobody cares if nurses get doctorates if they stay in their fields and try to improve nursing duties.. med giving on time, less interference with physicians practice, timely calls to physicians etcetc .. but when they get their doctorate they want to do the job that a physician is already trained to do. Why wouldnt that rub a whole profession the wrong way? The states make it harder and harder for docs to practice medicine vis a vis credentialing, recertification , cme requirements, licensure and licensure renewals, maintenance of certification etc. And they make it easier and easier for midlevels to practice medicine. Gotta love our politicians.
 
Im still perplex as how I have to discuss my patients with my attending as a PGY 2 after 4 years of med school and 1 1/2 of residency but this nurses with there DNP wont have to discuss with anyone their cases. If anyone takes a look at the DNP curriculum you know its a joke.
 
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.
 
Lol even Taurus thinks that a combination of USMLE would be a good idea.
As for being the creme de la creme of the bunch, I don't think they are made the same. Some don't even have experience as being as a nurse because they can just go straight to RN to NP school. Some are career changers.

CRNA's on the other hand have at least 1 year critical care experience,usually more than that. I would say they know more of their stuff, than the average D/NP

Anyway, anyone here for PharmD's for prescribing without assessment skills?
 
I've been following some of these threads and find some of the arguments....sophomoric at best. On the face of it, this whole thing looks like a peeing match between nursing and medicine. Poor little nursing held under the thumb of the patriarchal medicine ogres all these years! (Nursing: Mwah, Mwah!!) Now, nursing/David is standing up to medicine/Goliath! (Medicine: Mwah, Mwah!!)

Hold onto your hats one and all, for I have some astute outsider observations:

1. Check your egos at the door....M.D. is nothing more than a vocational master's degree. It's really only two years of school followed by two years of on-the-job training. And get this...US med students get to pay tuition for the privilege of on-the-job training!!!! Your European counterparts mock you and are laughing aloud! To give the US students their due, the total US medical education process is comprehensive (residency, etc.). But the part that lets one call oneself "Doctor", is really a master's degree. So get off it already.

2. The reality of the economics of health care in the US has not hit home yet. Were you amazed when the housing and credit market bubbles burst? Just wait until the health care bubble bursts in a few years (or sooner). Do you like the prospect of being a primary care physician who earns a paltry $90,000/year? How about the shift in payment mode from fee-for-service to DRG....not just for hospitals anymore, but for physicians too? How about this one: physicians being banned from profiting from certain treatments they prescribe? Oncologists not being able to sell..err make that administer chemotherapy in their own offices? The ID guy not having an outpatient infusion antibiotic clinic to profit from? The orthopedist not being able to send his patients to a PT practice he has a financial interest in? That's just the tip of the iceberg. Just you wait and see!

3. The marketplace will eventually decide what is best. If DNP's provide the care people want or need, the market is going to go for it. And hey, didn't you MD people have a similar peeing match with the DO people a few years back. What about the DPM's? And many OD's can actually (ya' better hold me....I may faint on this one) , yes, OD's can write Rx's!!! Aren't you all one big happy family now?

4. If I have a cruddy upper respiratory infection that's been lingering, and coughing up yellow/green/purple goo all night is starting to tee me off, the last thing I want to do is call the MD/DO and be told the next available appointment is in 2 weeks! I might as well go to my DC that day and get my back adjusted to make my infection better!! But, the nurse practitioner can see me that day! Well, glory be!! Smack my butt and slap me upside the head!! I'm high tailing it to the nurse practitioner. So long as that person can help me with my woes, I'm going!

Oh, I have many more thoughts on this subject, and the state of healthcare. But my wonderful bed is calling for me at this late hour. So, tata for now. Can't wait to see the responses to this! :prof:
 
Lol even Taurus thinks that a combination of USMLE would be a good idea.
As for being the creme de la creme of the bunch, I don't think they are made the same. Some don't even have experience as being as a nurse because they can just go straight to RN to NP school. Some are career changers.

CRNA's on the other hand have at least 1 year critical care experience,usually more than that. I would say they know more of their stuff, than the average D/NP

Anyway, anyone here for PharmD's for prescribing without assessment skills?

Interestingly, I went into my local Walgreen's to pick up a Rx for my wife, and the pharmacist's name tag said, "Dr. xxxx xxxxx, PharmD" And you all are worried about NP's going to a doctorate?? I do believe that here in Florida, RPh's (PharmD or not) can prescribe certain medications under certain circumstances for established patients. The reality is that most are hesitant (scared?) and rightly so.
 
I've been following some of these threads and find some of the arguments....sophomoric at best. On the face of it, this whole thing looks like a peeing match between nursing and medicine. Poor little nursing held under the thumb of the patriarchal medicine ogres all these years! (Nursing: Mwah, Mwah!!) Now, nursing/David is standing up to medicine/Goliath! (Medicine: Mwah, Mwah!!)

Hold onto your hats one and all, for I have some astute outsider observations:

1. Check your egos at the door....M.D. is nothing more than a vocational master's degree. It's really only two years of school followed by two years of on-the-job training. And get this...US med students get to pay tuition for the privilege of on-the-job training!!!! Your European counterparts mock you and are laughing aloud! To give the US students their due, the total US medical education process is comprehensive (residency, etc.). But the part that lets one call oneself "Doctor", is really a master's degree. So get off it already.

2. The reality of the economics of health care in the US has not hit home yet. Were you amazed when the housing and credit market bubbles burst? Just wait until the health care bubble bursts in a few years (or sooner). Do you like the prospect of being a primary care physician who earns a paltry $90,000/year? How about the shift in payment mode from fee-for-service to DRG....not just for hospitals anymore, but for physicians too? How about this one: physicians being banned from profiting from certain treatments they prescribe? Oncologists not being able to sell..err make that administer chemotherapy in their own offices? The ID guy not having an outpatient infusion antibiotic clinic to profit from? The orthopedist not being able to send his patients to a PT practice he has a financial interest in? That's just the tip of the iceberg. Just you wait and see!

3. The marketplace will eventually decide what is best. If DNP's provide the care people want or need, the market is going to go for it. And hey, didn't you MD people have a similar peeing match with the DO people a few years back. What about the DPM's? And many OD's can actually (ya' better hold me....I may faint on this one) , yes, OD's can write Rx's!!! Aren't you all one big happy family now?

4. If I have a cruddy upper respiratory infection that's been lingering, and coughing up yellow/green/purple goo all night is starting to tee me off, the last thing I want to do is call the MD/DO and be told the next available appointment is in 2 weeks! I might as well go to my DC that day and get my back adjusted to make my infection better!! But, the nurse practitioner can see me that day! Well, glory be!! Smack my butt and slap me upside the head!! I'm high tailing it to the nurse practitioner. So long as that person can help me with my woes, I'm going!

Oh, I have many more thoughts on this subject, and the state of healthcare. But my wonderful bed is calling for me at this late hour. So, tata for now. Can't wait to see the responses to this! :prof:

Code
 
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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.

give an inch they'll take a mile. Lawyers wont waste their time taking down DNPs unless its as profitable as litigating a doctor. Which at the rate healthcare is going will probably happen at some point. But by this time they would have expended into other areas. What makes you think they will stop with primary care, why would they?

Marginalizing is opening a door to the scope of medicine. Doctors cant even police themselves as a group, how are they gonna police another group which is much more politically active and unionized. Patients will suffer, but costs will go down so the wait till they get screwed approach wont work, because money speaks to policy makers alot more than anything else.
 
An MD is not a 'master's degree,' it is a rigorous four year doctoral degree. I have a master's degree as well, and it was (for me) a one year degree - but that was because my undergrad also prepared me for this MA and I received advanced standing

It seems like this nasty fight is just another form of dogs fighting over a bone. The bone being a perceived source of revenue, as well as the perception of power and being the source of this revenue.

NP's do not have the clinical knowledge - and hence the legal standing - to diagnose as board certified physicians. The courts in this country recognize who actually has the knowledge, and therefore also the legal responsibility. But, the truth is that if a nurse diagnoses something incorrectly (outside of their clinical expectations) or makes a clinical mistake within their scope of practice (does not give the medication as ordered) he or she is definitely liable and can definitely lose their licence.

One real question would be: a nurse-in-the-box misses a completely obvious case of something really terrible, and the patient comes back and wants to sue. What is going to be the outcome? Since nurses do not have the knowledge beyond very simplistic things, how do we deal with this outcome?
 
Ok, double-dipping again!

Here is a quick google search of some information: http://nurse-practitioners.advanceweb.com/Editorial/Content/PrintFriendly.aspx?CC=102489

It seems that this is going to be a state-by-state thing, where there are pushes and shoves on both sides about how much an NP (or PA) can do or not do. Oklahoma has something about the tittle of 'dr' as well.

So, this seems like the early days with anesthesia and crna's, where there was an enormous need and the nursing side decided to step in and fill the gap. Now, many anesthesia groups regret that movement. Check out the anesthesia forums here on SDN.
 
I have a unique perspective on this. I am a physician (i.e. I actually went to medical school). I was also a nurse and took NP classes.

There is absolutely NO comparison between the two. ZERO. Most NP programs contain less actual "medical" classes than you get in one semester of real medical school. Mine was 15 credit hours. The rest is nursing theory, research, nurse political activism and such. It is so unbelievably different, you can't compare the two. The truly scary thing is that they don't how much they don't know.

NPs, DNPs have absolutely NO right to independent practice. I think there is a role for them such as running coumadin clinics, helping with post-op evals, vaccinations and other such limited practice.

They simply do not have a fraction of the knowledge that the worst FM physician has. Not even close.

Imagine this. Would you let a fourth year medical student open up a clinic and do primary care? H@(( no! And the fourth year medical student already has VAST more medical education than an NP or DNP.

If this does not bother you, it should. I've seen the inside politics of this debate. These people want your job. They hate, resent and envy you. They are cunning and very political active. If we don't stop them, it will negatively affect us all. And their pathway to "independence" will be littered with the dead bodies from their blissful ignorance and pride.
 
if anyone can google The Pearson Report and copy some of the info from the report into this discussion, it'd show some of the true motives of the NPs. Some of their issues includes:

  • showing they have less malpractice/adverse events than MDs/DOs
  • independent practice rights
  • prescribing authority
  • DEA #s
  • listing as a patient's PCP

there is among a complete laundry list of their issues, all of which would be great for people to see if someone could post the document. Regardless, people should see NPs have no interest practicing advanced nursing. Everything they seem to want seems to fall clearly within the practice of medicine.
 
I've been following some of these threads and find some of the arguments....sophomoric at best. On the face of it, this whole thing looks like a peeing match between nursing and medicine. Poor little nursing held under the thumb of the patriarchal medicine ogres all these years! (Nursing: Mwah, Mwah!!) Now, nursing/David is standing up to medicine/Goliath! (Medicine: Mwah, Mwah!!)

Hold onto your hats one and all, for I have some astute outsider observations:

1. Check your egos at the door....M.D. is nothing more than a vocational master's degree. It's really only two years of school followed by two years of on-the-job training. And get this...US med students get to pay tuition for the privilege of on-the-job training!!!! Your European counterparts mock you and are laughing aloud! To give the US students their due, the total US medical education process is comprehensive (residency, etc.). But the part that lets one call oneself "Doctor", is really a master's degree. So get off it already.

2. The reality of the economics of health care in the US has not hit home yet. Were you amazed when the housing and credit market bubbles burst? Just wait until the health care bubble bursts in a few years (or sooner). Do you like the prospect of being a primary care physician who earns a paltry $90,000/year? How about the shift in payment mode from fee-for-service to DRG....not just for hospitals anymore, but for physicians too? How about this one: physicians being banned from profiting from certain treatments they prescribe? Oncologists not being able to sell..err make that administer chemotherapy in their own offices? The ID guy not having an outpatient infusion antibiotic clinic to profit from? The orthopedist not being able to send his patients to a PT practice he has a financial interest in? That's just the tip of the iceberg. Just you wait and see!

3. The marketplace will eventually decide what is best. If DNP's provide the care people want or need, the market is going to go for it. And hey, didn't you MD people have a similar peeing match with the DO people a few years back. What about the DPM's? And many OD's can actually (ya' better hold me....I may faint on this one) , yes, OD's can write Rx's!!! Aren't you all one big happy family now?

4. If I have a cruddy upper respiratory infection that's been lingering, and coughing up yellow/green/purple goo all night is starting to tee me off, the last thing I want to do is call the MD/DO and be told the next available appointment is in 2 weeks! I might as well go to my DC that day and get my back adjusted to make my infection better!! But, the nurse practitioner can see me that day! Well, glory be!! Smack my butt and slap me upside the head!! I'm high tailing it to the nurse practitioner. So long as that person can help me with my woes, I'm going!

Oh, I have many more thoughts on this subject, and the state of healthcare. But my wonderful bed is calling for me at this late hour. So, tata for now. Can't wait to see the responses to this! :prof:
you are very ignorant of the issues.

DOs are actual doctors that go to medical school. If there was a fight, it certainly was a pissing contest because DOs have all the training that a allopathic physician has . In contrast, DNPs do not have the training that physicians have. they dont even have 1/16th of the training They dont. SO everyone should be alarmed. They havent even taken the most basic courses which are Organic chemistry which is the foundation from which everything we do emanates from. Ok let me not even bring that up. They havent even taken the more basic course... the course that comes before organic.. general chemistry with a lab. This is not required in nursing school. How are we supposed to take the contentions of the DNP organization seriously if they havent even met those most basic of basic requirements. PLease!

While you would be happy delegating your nagging cough or sore throat to a DNP who hasnt even taken an advanced math class or advanced chemistry class. I just hope all the stars and planets are aligned that day and its just a nagging cough that would go away anyway. But something tells me you would go to a chimp for your health care concerns as long as he could reach into the drawer and hand you lozenges to help you
 
Interesting post by everyone, and definetly some MAJOR changes in medicine are about to happen in a few decades due to "this". This is my two cents no major source to back this.

Money is the root of all evil...It's all Business! Stop arguing amongst ourselves or about our caring nurses.

What do I see happening is that there will be fewer physcians doing less work and delegating work to the plethora of other healthcare workers. I will open up a clinic with 10 rooms, higher 3 PA's and have them see my patient's tell me about them and I will go see the patient and sign the note. All in a good day's work. (This is what happens today!)

Shoot... what do I do with my savings... Open up another clinic!
BUT.... um... I can only be at one clinic at a time... um... let me higher another doctor to run my other clinic... um... No way... I would have to pay him too much... You know what, I like these DNP's they call themselves Doctors (a laymen is not going to know the difference between a real doctor and them!) I will higher them give them less salary and make more money for myself... yeah!!

Well, this is what came to my mind. Well the villian of this story turns out to be the greedy Physician. In our society it is really the Hospitals/Insurance companies, they don't want physicians having such large salaries when they can distribute that among more people.

What the greedy physcian and laymen from the story or the Insurance companies don't understand is that the quality of health care being provided is going down.

We should be fuming at the Executives that run our hospitals, at Medical groups that higher other healthcare workers to divide up the patient care.

Nothing happens without a reason... there is a demand for DNPs and hence we sit here fuming about the supply. Lets work on figuring out why there is a demand.
 
Here is the actual link.
Check out page 13 of the pdf (22 on the text) for summary of all states.

http://www.webnp.net/downloads/pearson_report09/ajnp_pearson09.pdf

Below is the report for the best state in the union, West Virginia

NP title(s) used in this state: ANP (advanced nurse practitioner)
Number of NPs in state? 694
National certification required for recognition/practice? Yes
BON sole state authority over NPs? Yes
Joint BON/BOM regulation over any aspect of practice? No
Physician involvement required for any aspect of practice? Yes. For details, log on to www.webnp.net
Statutory restriction against NP with doctorate being addressed as “Dr”? No
CE requirements for NP practice? Yes. For details, log on to www.webnp.net
Recent legislative/regulatory changes affecting NP practice? For details, log on to www.webnp.net
Legislative/administrative plans for state? For details, log on to www.webnp.net
NP SCOPE OF PRACTICE – DIAGNOSING & TREATING
BOM/physician involvement in diagnosing and treating? No
Any legislative prohibitions against NP hospital privileges? No
Any legislative prohibitions against NP ordering of any diagnostic tests? No
NP SCOPE OF PRACTICE – PRESCRIBING
NP/physician prescriptive agreement required? Yes
NP Rx from state-authorized formulary required? Yes. Certain drugs are excluded.
If so, explain specifics of formulary. For details, log on to www.webnp.net
BOM/physician involvement in NP prescribing? Yes. For details, log on to www.webnp.net
NP authorized to Rx controlled substances? Yes If so, which schedules? Schedules III-V. ANPs must file with the BON any restrictions on Rx authority that are agreed to within the written collaborative agreement and the collaborating physician(s).
NP name required on Rx pad? Yes
Authority to receive/dispense drug samples spelled out? Yes. For details, log on to www.webnp.net
Specified limitations or restrictions on NP drug sampling? Yes. For details, log on to www.webnp.net
OTHER FACTORS RELATED TO NP PRACTICE
Number and listing of NP schools in state: (5)
Marshall University, Huntington; Mountain State
University, Beckley; Wheeling Jesuit University,
Wheeling; Wheeling Jesuit University, Online; West
Virginia University, Morgantown
Organized opposition to NP legislative or regulatory changes? Yes. For details, log on to www.webnp.net
Cumulative number of medical malpractice reports from the National Practitioner Data Bank (NPDB) filings (9/90-9/08):
• 2 for NPs (2:694 or 1:347 ratio)
• 165 for DOs/Interns/Residents (165:685 or 1:4 ratio)
• 2125 for MDs/Interns/Residents (2125:5295 or 1:2 ratio)
Cumulative number of Healthcare Integrity and Protection Data Bank (HIPDB*) filings (1/99-9/08):
• 0 for NPs (694 or 0:694 ratio)
• 56 for DOs/Interns/Residents (56:685 or 1:12 ratio)
• 486 for MDs/Interns/Residents (486:5295 or 1:11 ratio)
*HIPDB report totals # of negative licensure actions, civil judgments, criminal convictions, and state agency/health plan reports.
2007 Consumer Choice ranking of state’s NP regulation
(100 is ideal): 79
Descriptive ranking: Grade C – State confines patient choice
 
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.

In an ideal world, that's a great concept. I think many (if not most) physicians would welcome it. However, as one or two others have mentioned, nursing organizations have not welcomed the idea of boundaries, and they have already fought rules defining specialized areas of medicine that go well beyond primary care.

Regardless of whether or not nurses are willing to go along, I do think physicians should push forward with defining what legally constitutes the practice of medicine, and allowing nurses to practice in the roles you stated at the discretion of the BOM.
 
Awesome to hear from the resident who was a nurse. :thumbup:
 
One interesting point to me is that NPs passing this exam administered by the American Board of Comprehensive Care allows the test takers to call themselves "Diplomates of Comprehensive Care". If the exam is the Step 3 equivalent which is only good for initial physician licensure that's far removed from being able to call yourself a "Diplomate of <fill in your specialty board>" which requires that you actually a) have a license b) successfully complete post-graduate training c) take a far more comprehensive and intense exam.

I sent a letter to the chair of the ABIM expressing my concerns. I would encourage you to do the same with your medical specialty board.

Incidentally the ABIM has a webpage on scam certification boards targeting physicians. This is not the same situation as this board is for NPs and not trying to scam MDs out of money for a fake exam but if you will not write a physical letter, which I think still carries more weight in this era than email the link is here:
http://www.abim.org/news/news/scam-certification-boards.aspx
 
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