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

[OTD]

4) Your math on years of education is off generally speaking. A DNP is required to have a BSN (4 years), DNP school (another 4 years) and almost every program I've seen requires 1 year on the job as an RN, prefer 2 (and yes I disagree with those that are will to "fast track BSNs" to DNP. Part of the point of our not needing a residency is that we worked in the real world for at least a bit. By my count BS is 4 years, 4 years med, 3 years residency makes the total 11 vs 9. Considering compensation and scope differences, I'm a bit disappointed in some medical specialties getting off so light.

I'm afraid it is you that has your math off.

NP school where I am at is 18 months, so that's 4 years of nursing school, no requirement for clinical expereince, and 18 months of "nursing theory". 5.5 years. Add in a DNP on top of that, what's that 1 year to 18 months extra tops if they already have the NP? So 7 years? But, since your time is off in my area I will bet you are correct in your local area so say it is 9 years.

Now for medicine you are SOMEWHAT correct, 4 years of undergrad, 4 years of medschool and 3 years of residency for family practice/IM. OB is 4 years of residency, cardiology is an IM residency plus a fellowship, Surgery is 5-7 years of residency, CT surgery is that plus fellowship, peds surgery same thing. So no, the specialties don't "get off light".

So, aside from being so wrong about the sepcialties best case you have 9 years vs 11 years. Now try and compare them.

Undergrad
Nursing Math vs Calculus and Phyisics
Chemistry 101 vs Organic Chemistry
On and on and on.

Now get to medical school and NP school.

What others have said is true, you can't fathom the degree of difficulty until you have been there. You can THINK you know, but you have no clue. You cover the amount of material of a week of a 400 level science course in one lecture, so each week of med school is roughly one month of 400 level science courses. It's like drinking from a fire hydrant.

Where as NP school, which I have no personal knowledge except rotating with our own, is more low keyed, on the pace of basic undergraduate courses with a few clinical hours thrown in. The have to read a whole four chapters for the exam, while their med student counterparts have to read 4 chapters for their 1 hour lecture. It's apples and oranges.

Then you have residency, 80 hours per week every week for a minimum of 3 years, 10-12 years depending on the speciality.

I had more hours in first year of medical school than a DNP gets in their entire education (it was an eye opener to realize that 15 hours by the catalog in med school is in reality 40 if calculated like undergrad).

It's not even close.

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[zenman]

Well I went to a DI school, and talked to a lot of the football players. So that means I know what it's like to play in the NFL...

No, you bunch of idiots (respectfully), it doesn't mean you know anything, only that you can repeat the experiences of the ones actually doing it.

 

[deleted50478]

I'm afraid it is you that has your math off.

NP school where I am at is 18 months, so that's 4 years of nursing school, no requirement for clinical expereince, and 18 months of "nursing theory". 5.5 years. Add in a DNP on top of that, what's that 1 year to 18 months extra tops if they already have the NP? So 7 years? But, since your time is off in my area I will bet you are correct in your local area so say it is 9 years.

Now for medicine you are SOMEWHAT correct, 4 years of undergrad, 4 years of medschool and 3 years of residency for family practice/IM. OB is 4 years of residency, cardiology is an IM residency plus a fellowship, Surgery is 5-7 years of residency, CT surgery is that plus fellowship, peds surgery same thing. So no, the specialties don't "get off light".

So, aside from being so wrong about the sepcialties best case you have 9 years vs 11 years. Now try and compare them.

Undergrad
Nursing Math vs Calculus and Phyisics
Chemistry 101 vs Organic Chemistry
On and on and on.

Now get to medical school and NP school.

What others have said is true, you can't fathom the degree of difficulty until you have been there. You can THINK you know, but you have no clue. You cover the amount of material of a week of a 400 level science course in one lecture, so each week of med school is roughly one month of 400 level science courses. It's like drinking from a fire hydrant.

Where as NP school, which I have no personal knowledge except rotating with our own, is more low keyed, on the pace of basic undergraduate courses with a few clinical hours thrown in. The have to read a whole four chapters for the exam, while their med student counterparts have to read 4 chapters for their 1 hour lecture. It's apples and oranges.

Then you have residency, 80 hours per week every week for a minimum of 3 years, 10-12 years depending on the speciality.

I had more hours in first year of medical school than a DNP gets in their entire education (it was an eye opener to realize that 15 hours by the catalog in med school is in reality 40 if calculated like undergrad).

It's not even close.

I know a guy who transfered colleges 3-4 times, took a few hours some semesters, and ended up graduating from college in 8 years.
His education must have been twice as good as me since I only took 4 years!
Years of training is so relevant...

 

[scube]

No, you bunch of idiots (respectfully), it doesn't mean you know anything, only that you can repeat the experiences of the ones actually doing it.

thats how all the nurses get the patients to like them. they say something mean and then say "respectfully" or " i meant that in the nicest way possible" afterward. Then everything is fine.

I really don't think adding respectfully makes it ok

 

[zenman]

thats how all the nurses get the patients to like them. they say something mean and then say "respectfully" or " i meant that in the nicest way possible" afterward. Then everything is fine.

I really don't think adding respectfully makes it ok

Well, consider it slap therapy, or provocative therapy. I was hoping normal cognitive ability was at work here as well as reading comprehension for my original post. So again, I don't have to know what medical school is like when I can just ask those who have been there, or see the outcome. You can do the same with nurses; just ask them about nursing school. Hopefully, none of you will not miss important info on a patient's chart

But, I do like all you guys, especially having to pay all those loans back and deal with the current health care crap, or nurses.

 

[silas2642]

I know a guy who transfered colleges 3-4 times, took a few hours some semesters, and ended up graduating from college in 8 years.
His education must have been twice as good as me since I only took 4 years!
Years of training is so relevant...

Years of training becomes extremely relevant when the training is as rigorous as med school and residency. Undergrad is undergrad-- it's cake. Once you get into med school it's a new ballgame.

 

[deleted50478]

Years of training becomes extremely relevant when the training is as rigorous as med school and residency. Undergrad is undergrad-- it's cake. Once you get into med school it's a new ballgame.

My point is that years of training is not a reasonable substitution for amount of knowledge and relevant medical training.

The other thing is that nursing school and CRNA school are not years of medical experience. They are years of nursing experience. That's why CRNAs practice protocol anesthesia, they're nurses.

 

[TTPHUS]

Its just wrong for nurses to try and play doctor . Go to medical school if you want to be called doctor in the clinical arena !!

 

[TTPHUS]

Make your voices heard . Say NO to the DNP/NP expansion plan . Below is one of the best arguments against this nonsenical DNP program .

schutzhund :
" Tipps, you are WAY off base. Its insulting actually. I get really tired of the XYZ practitioner is as good as a doctor because of ABC. It's completely and utterly off base.

I think I can speak about this just as much or more than anyone else here. I was (am) an RN with LOTS of experience (including MICU, CVICU and others). I went to an NP program. I am now a physician. I can tell you unequivicaly that the level of understanding is no where near the same between the two. In almost all circumstances, people make similarity claims because they have an inferiority complex and really wanted to be a doctor but either could not or didn't have the fortitude to dedicate so much time to achieve their goal. It's true. People won't admit it but it's the truth. I felt the same way years ago.

Back to your post. Of course a new intern or resident doesn't have the same judgment as a seasoned nurse. They're not supposed to. That's why they are a resident. These arguments demonstrate your lack of understanding of medical education. Medical school teaches you science. It's not meant to prepare to function in a clinical setting by yourself right out of school. That's a major difference between nursing school and medical school. Medical students graduate with a tremendous base of science (anatomy, physiology, pharmacology, etc) but they don't really learn what to do with that until post-graduate training. That's why residency is 3-8 more years and it's required. Nobody can practice medicine straight out of school.

A NP will NEVER be a replacement for a physician. The difference in knowledge is beyond what you could imagine (and as a reminder, I've done both). Sure, an NP can function well in a clinical setting but they lack the depth of understanding and complex decision making that a doctor has. Experience is great but it doesn't replace knowledge. I could give an LPN a chart on JNC7 and they could manage hypertension, but that not mean they understand it.

Knowing what I know now, I am petrified of what I could have missed as an NP. There are whole categories of disease that I didn't even know existed.

Sorry, but your argument is foolish, incorrect, insulting, and quit frankly embarrassing. "

 

[Winged Scapula]

Since we don't need 3 separate threads on the same topic (or multiple posts on the same topic by the same user), I am merging this with the other existing DNP threads...

 

[Cp22kjer]

Make your voices heard . Say NO to the DNP/NP expansion plan . Below is one of the best arguments against this nonsenical DNP program .

Whats a student entering med school in August like myself supposed to do? Write AMSA? Contact the AMA? Many future docs are not even in the know of what a DNP is....let alone have an opinion about it.

I think the DNP degree is here to stay even after AMA opposition:

http://www.aafp.org/online/en/home/...ow/professional-issues/20090316nbme-folo.html

Looks like now its all about denouncing any kind of DNP = Physician talk.

 

[Taurus]

Whats a student entering med school in August like myself supposed to do? Write AMSA? Contact the AMA? Many future docs are not even in the know of what a DNP is....let alone have an opinion about it.

I think the DNP degree is here to stay even after AMA opposition:

http://www.aafp.org/online/en/home/...ow/professional-issues/20090316nbme-folo.html

Looks like now its all about denouncing any kind of DNP = Physician talk.

You can contribute to the AMA. Educate your fellow med students and med faculty. You can follow your conscience and preferentially hire PA's and AA's. You can get elected to your state legislature or Congress. There are many things you can do.

 

[Cp22kjer]

You can contribute to the AMA. Educate your fellow med students and med faculty. You can follow your conscience and preferentially hire PA's and AA's. You can get elected to your state legislature or Congress. There are many things you can do.

Taurus, I've admired your sig and I agree. That being said, I've tried to be out spoken about the issue to students in my undergrad (who will start med school next year) and my family. While attending medical school I plan to confront many of my professors on the issue.

At this point the biggest dilemma is AWARENESS......

 

[TTPHUS]

Taurus, I've admired your sig and I agree. That being said, I've tried to be out spoken about the issue to students in my undergrad (who will start med school next year) and my family. While attending medical school I plan to confront many of my professors on the issue.

At this point the biggest dilemma is AWARENESS......

You can write letters to your elected officials and the AMA . ALso through AMSA , you can write letters and start petions to stop this nonsense. NPs are encroaching too far and its really professional misconduct to try and usurp the role of medical doctors ( and this is exactly their covert and sometimes not so covert agenda ) . NPs are NOT equal in training and never will be equivalent to a medical doctor . To claim equivalence is professionally , ethically and morally wrong . Time for the Physician Community to put a stop to this nonsense.

 

[Shah_Patel_PT]

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!

You might want to get that cough checked out by a physician.

It may be something the physician extender missed or is beyond his/her scope of practice.

 

[Pascal8]

feel like vomiting when I read that nps are given independent practice priveleges in many states . Why is this allowed ???

 

[mig26x]

feel like vomiting when I read that nps are given independent practice priveleges in many states . Why is this allowed ???

The most insulting thing is that us as residents have to precept every patient we see with an attending while this NP's who havent set a foot in medical school are now allowed to run clinics with supervision of MD's (not equal to precepting every case) and in some instances to practice independently!!!

To me as a resident that's a freaking big insult!!!

 

[TTPHUS]

The most insulting thing is that us as residents have to precept every patient we see with an attending while this NP's who havent set a foot in medical school are now allowed to run clinics with supervision of MD's (not equal to precepting every case) and in some instances to practice independently!!!

To me as a resident that's a freaking big insult!!!

what are you gonna do about it ?

 

[mig26x]

what are you gonna do about it ?

I have emailed AMA, ACP, my congress people, Massachusset medical society like some other residents here who have emailed their representatives!.

there;s no much we can do as residents and when I become an attending I would not hire an NP/DNP.

 

[psychforme]

I overheard super-competent nurses discussing pathology the other day. "Kidneys... ummm.... eh.... produce hypertension!"

BINGO!

No you halfwit, kidneys produce urine and that's not even pathology.

 

[badasshairday]

I overheard super-competent nurses discussing pathology the other day. "Kidneys... ummm.... eh.... produce hypertension!"

BINGO!

No you halfwit, kidneys produce urine and that's not even pathology.

I produce hypertension with my ridiculously good looks.

 

[dragonfly99]

Venerable Yoda,
I think some of what you say is correct (regarding the likelihood of further cuts for things like administering chemo, etc.) and some of that is probably O.K. I don't think that physician salaries have much to do with the inflation of health care costs in the past 20 years or so, though...so even if you cut doctors' reimbursements more, it isn't going to do much to control costs. There is only so much "fat" there for cutting. Obama's administration is about to go after home health and some other areas which are more promising in that regard...

I disagree that a medical degree is just a master's degree, or like vo-tech school. I have done master's level course work in science and it was not the same intensity as medical school, by any stretch of the imagination. I'm not saying that getting a master's (or particularly, a PhD) is not difficult, but it IS different than med school. PhD's have their own crossed to bear with "publish or perish" and writing a thesis, but it's not the same type of thing as med school. You are right we are paying to basically do working during 3rd and 4th years of med school, and med school should be cheaper, but I don't see that happening any time soon.

I agree with the comment about the cough + scope of practice. Not that we give medical advice on here

The thing with providing medical care, especially primary care, is this - the common things presenting in the common way are common, but sometimes bad things can present like the common things, or rare things can present like the common things, and if you don't know all of those bad or weird or rare things, and maybe haven't ever seen them, then how are you going to diagnose them? There's nothing wrong with PA's or NP's, but I think they should practice within their scope of practice, and especially for the generally young and health patients. However, I have done internal medicine x 5 years now, and I can tell you that it isn't necessarily simple, cookbook, or something that lends itself to mere "vocational education". What the general public does not see is the complexity of the decision making that goes on, particularly in hospitalized patients. It is not that easy.

 

[zenman]

A NP will NEVER be a replacement for a physician. The difference in knowledge is beyond what you could imagine (and as a reminder, I've done both). Sure, an NP can function well in a clinical setting but they lack the depth of understanding and complex decision making that a doctor has. Experience is great but it doesn't replace knowledge. I could give an LPN a chart on JNC7 and they could manage hypertension, but that not mean they understand it.

Most NPs don't want to be a replacement for a physician. I'm a psych NP student and I'd love to have you around especially since I really don't care to get much deeper than Stahl's psychopharm, especially after having to read eight chapters before the course even started.

 

[Cp22kjer]

Most NPs don't want to be a replacement for a physician. I'm a psych NP student and I'd love to have you around especially since I really don't care to get much deeper than Stahl's psychopharm, especially after having to read eight chapters before the course even started.

I'm curious......... how do you feel about your leading brethren pushing for complete autonomy?

Or Mundinger and crew claiming DNP = PCP: (http://online.wsj.com/article/SB120710036831882059.html)?

 

[badasshairday]

DNPs want to be physicians. Their watered down Step 3 starts questions with prose like, "You have been the physician of this patient for 5 years, and ...."

Just read the quote in my signature, DNP does not equal MD. As much as they want it to be true, it is not.

 

[MDman87]

http://online.wsj.com/article/SB120710036831882059.html

Thanks for the link. Mundinger never ceases to amaze me

The [DNP] programs create a "hybrid practitioner"

They're hybrid alright: one part rejected medical school applicant, one part arrogant NP, one part patient endangerment, and 3 parts lunatic

Mary Mundinger, dean of New York's Columbia University School of Nursing

I must give her credit for one thing. She certainly has made a name for herself. . .

Nurse practitioners fear the doctoral programs might be raising the bar too high for their profession

Couldn't agree more. The mere thought of being required to take those outlandish general chemistry classes just sends chills down my spine!

Nursing schools had to turn away 40,285 qualified applicants to bachelor's and graduate nursing programs in 2007

Honestly, how qualified could they be?! They were rejected by a nursing school!

Dr. Mundinger, of Columbia, says the primary aim of the DNP is not to usurp the role of the physician

OK, she works at Columbia. I had almost forgotten (see above). And I feel pretty confident that that's exactly the aim of the DNP

The planned DNP exam will be narrower in scope than the three-step exam that doctors take. . . The planned certification exam won't be a requirement for licensing of DNPs

So, let's recap. Take the simplest of the three medical licensing exams, water it down, and then make it optional. My, how far nursing has come!

Jeanette Lancaster, president of the American Association of Colleges of Nursing says "we are keeping an open mind as to whether [the DNP certification exam] will add another level of validation of competency."

If by "keeping an open mind" she means "waiting to see if more than 50% of DNPs can pass this watered-down test," I would encourage her to not get her hopes up. Validation of competency? Give me a break

 

[zenman]

I'm curious......... how do you feel about your leading brethren pushing for complete autonomy?

The physician has the most education and is the team leader.
The DNP program looks like an MPH degree.
NP programs need some work and more clinical hours.
Basic nursing programs need help, specifically in developing one entry level program not three friggin ones.

So basically, NPs and DNPs need some kind of physician relationship. I don't want all the biochem, etc. background of a physician. I'm in NP school just to have more knowledge and to help those I can, especially if they have no other option.

That's basically it.

 

[scube]

The physician has the most education and is the team leader.
The DNP program looks like an MPH degree.
NP programs need some work and more clinical hours.
Basic nursing programs need help, specifically in developing one entry level program not three friggin ones.

So basically, NPs and DNPs need some kind of physician relationship. I don't want all the biochem, etc. background of a physician. I'm in NP school just to have more knowledge and to help those I can, especially if they have no other option.

That's basically it.

This doesn't reflect what is actually going on(the stuff we're talking about).

 

[zenman]

This doesn't reflect what is actually going on(the stuff we're talking about).

I was only answering the question, "I'm curious......... how do you feel about your leading brethren pushing for complete autonomy?" not all the other stuff you're talking about.

But, for a concrete answer I think there needs to be a chain of command, but people also need to be respected for what they know and their abilities. Yesterday, a physician told me, "You know more about this than I know (discussing a psych patient). I think in order to have complete autonomy, DNPs need a different niche than anyone else in the healthcare team, otherwise you just piss people off. The current DNP program is not something I'd want to spend my money on.

 

[TTPHUS]

I was only answering the question, "I'm curious......... how do you feel about your leading brethren pushing for complete autonomy?" not all the other stuff you're talking about.

But, for a concrete answer I think there needs to be a chain of command, but people also need to be respected for what they know and their abilities. Yesterday, a physician told me, "You know more about this than I know (discussing a psych patient). I think in order to have complete autonomy, DNPs need a different niche than anyone else in the healthcare team, otherwise you just piss people off. The current DNP program is not something I'd want to spend my money on.

And you think your physician was being serious about you knowing more ? No , he was just being humble ( a quality thats missing in nurses ) .

I won't be surprised if somehow your quote makes its way into the NP = MD movement .

NPs = spin doctors is more like it !

 

[zenman]

And you think your physician was being serious about you knowing more ? No , he was just being humble ( a quality thats missing in nurses ) .

I won't be surprised if somehow your quote makes its way into the NP = MD movement .

NPs = spin doctors is more like it !

Did I step on your little toes and invade the cognitive realm reserved only for those who can understand big words?

Give me a break fellow. "She" does not prefer psych patients and yes, I was telling her we needed to reconsider a diagnosis on a patient.

No one is the keeper of all the knowledge. As such there are things I know that you will never have access to so get over it.

I am a humble person, but I don't back down when confronted with idiocy or when I know my stuff.

 

[TTPHUS]

Did I step on your little toes and invade the cognitive realm reserved only for those who can understand big words?

Give me a break fellow. "She" does not prefer psych patients and yes, I was telling her we needed to reconsider a diagnosis on a patient.

No one is the keeper of all the knowledge. As such there are things I know that you will never have access to so get over it.

I am a humble person, but I don't back down when confronted with idiocy or when I know my stuff.

yes and you know MORE than the doctor . Try taking some real courses and a real test to see what you know instead of what you THINK you know . Ps - this is not me being personal with you . I mean "you" as the generic NP who wants to play doctor

 

[zenman]

yes and you know MORE than the doctor . Try taking some real courses and a real test to see what you know instead of what you THINK you know . Ps - this is not me being personal with you . I mean "you" as the generic NP who wants to play doctor

I think most "generic" NPs/PAs know their place in the game. My courses are real, such as the psychpharm one I'm now taking, using a "real" book by Stahl. You probably had to read that one also. But, I'll let you lay claim to the highest levels of your craft.

 

[later2pharm]

to be accurate, only people who hold Ph'd hold the correct title of "Doctor" . "Doctor" historically was not a medical term and originates from latin, meaning to teach, or teacher. the degree awarded historically was not and MD but a "Bachelor of Medicine"...and even today in many other countries its still called that. and Dr. is only awarded when the physician finishes a thesis.

i know i wont be calling myself Dr. Pharmacist, lol. i wish they never came up with this pharmD bs but oh well what can i do?

but maybe Dr's need to check their egos at the MD/DO graduation ceremony.

But me being neither and having no desire to be nurse or doctor, can say THIS IS A BAD IDEA. This will lead to mass patient confusion and anger. We cannot have a system where the nurse intros him/herself as Dr.XXX and 5 minutes later the doctor walks in and intros him/herself as Dr. XXX and the patient asks "I though I already spoke with the doctor?...then the doctor must go and explain oh no that was the nurse.


and i find the attitute of future MDs in here very sad. nurses are the back bone of our health care system and each and every one of them are to be respected for the important role they play in our health care system.

 

[TTPHUS]

I think most "generic" NPs/PAs know their place in the game. My courses are real, such as the psychpharm one I'm now taking, using a "real" book by Stahl. You probably had to read that one also. But, I'll let you lay claim to the highest levels of your craft.

No,generic NP's are constantly fighting the system to get more scope of practice . ANDyou are FULLY AWARE of this . Being a spin doctor , I can't blame you .

BTW - I can have my 15 yr old cousin read the same textbook - doesn't mean she understands it at a medical docotorate level .( why am I wasting my words with you - you just don't understand that UNTIL you take a real test such a medical school exam or a real board exam such as step 1 or 2 , "you "have NO claim to equiavlence with regards to knowledge base ( and this is only scrathcing the surface )

FYI - I think you are LYING about the psychiatrist telling you that you know more and I seriously would not be surprised if your "claim" becomes apart of some "study "claiming NPs = MDS ..and this is EXACTLY their misplaced mission .

Even though I'm sure you are telling a tall tale , an attending wanted me to ask you the following question :

Zenman is Clearly over his/her head and delusional. " Ask her/him in a post what exactly did she say to the doctor about said diagnosis and why did she think it needed to be reconsidered. Im curious about the specifics about the situation. "

Go ahead and tell us some more lies Zenman . We all know you made up the whole story - you with a few chapters of psychpharm" know more than the doctor "

 

[TTPHUS]

to be accurate, only people who hold Ph'd hold the correct title of "Doctor" . "Doctor" historically was not a medical term and originates from latin, meaning to teach, or teacher. the degree awarded historically was not and MD but a "Bachelor of Medicine"...and even today in many other countries its still called that. and Dr. is only awarded when the physician finishes a thesis.

i know i wont be calling myself Dr. Pharmacist, lol. i wish they never came up with this pharmD bs but oh well what can i do?

but maybe Dr's need to check their egos at the MD/DO graduation ceremony.

But me being neither and having no desire to be nurse or doctor, can say THIS IS A BAD IDEA. This will lead to mass patient confusion and anger. We cannot have a system where the nurse intros him/herself as Dr.XXX and 5 minutes later the doctor walks in and intros him/herself as Dr. XXX and the patient asks "I though I already spoke with the doctor?...then the doctor must go and explain oh no that was the nurse.


and i find the attitute of future MDs in here very sad. nurses are the back bone of our health care system and each and every one of them are to be respected for the important role they play in our health care system.

nurses are an INTEGRAL part ofthe health care team . Medicine would not be able to function without nurses . The problem is with nurses who want to play doctor . Just thought I'd clear that up ..

 

[Bach]

I am a FMG, recently passed NCLEX-RN, and will start reviewing for USMLE Step 1. I am disappointed that all these titles had not served the most important subject: the patient

The freud is childish yet the consequences are grave. I see now why all my colleagues warned me not to let my future peers to know that I'm a FMG. To many, it is about fame and fortune but what is it ?---- really...

 

[benjee]

I am a FMG, recently passed NCLEX-RN, and will start reviewing for USMLE Step 1. I am disappointed that all these titles had not served the most important subject: the patient

The freud is childish yet the consequences are grave. I see now why all my colleagues warned me not to let my future peers to know that I'm a FMG. To many, it is about fame and fortune but what is it ?---- really...

It's good that you are FMG at least you have some medical background but that does not mean that you are familiar with the approach of how to practice medicine in US and that can jeopardize in treating patients. Let's take prescriptions, maybe in other countries, certain drugs don't require any supervison and can be purchased at a local grocery store while it take highly supervision in US . yeah, i understand you already pass the exam NCLEX RN, but there is still a difference between a RN/FMG and a licensed MD which required at least a few years of residency training after passing usmle 1,2,3 .due to this discrepency, there can be a big difference in helping pts, it's not about fame or fortune, it's actually about preventing any tragedy happening in future. hope no offense.

 

[mig26x]

I am a FMG, recently passed NCLEX-RN, and will start reviewing for USMLE Step 1. I am disappointed that all these titles had not served the most important subject: the patient

The freud is childish yet the consequences are grave. I see now why all my colleagues warned me not to let my future peers to know that I'm a FMG. To many, it is about fame and fortune but what is it ?---- really...

you have to hurry up, between US med school increasing their seat capacity and RN/DNP now fighting to have privileges as doctors and wanting to participate in residency training things dont look to good for FMG to obtain a residency position in the near future.

 

[dragonfly99]

OK,
I've been staying out of this discussion because of all the vitriol, etc. that is here.
First of all, I think you all are being unnecessarily harsh on Zenman. Please keep this civil...no reason to accuse him of lying/making stuff up.
I think it is true that most NP's don't want to replace physicians...most of them just want to take their nursing to the next level, and participate more in patient care.

I do have a problem with some of the stuff Ms. Mundinger says, and has said, in the past. I think she thinks that a general practice NP is = to the same thing as a family practice physician, and I just don't really think that is true. I don't think doing away with traditional primary care docs (like family practice docs, general internists, etc.) and using NP's or PA's instead is a good idea. I think there are things that MD/DO school plus 3 years of residency teach you that nursing school + nursing practice does not. Also, I think that the rigor of nursing programs varies more than that of MD/DO training (just personal opinion here, but I think it is true...there are just more nursing programs and I don't think the tight regulation of admissions standards and curriculum is there).

I also think it will confuse patients if you have nurses going around introducing themselves as "Dr. so-and-so". I don't think there is anything wrong with being a nurse practitioner, or pharmacist, or physical therapist, etc. but I really think in a medical setting it would be better if people introduced themselves as such. Most patients don't really understand about stuff in the medical setting, and I don't think it's fair to confuse them. I do think there is a subset of nurses, particularly among NP's, who do want to pass as physicians but I don't think that is fair/right, unless you did med school + residency. I know some RN's who get sick of some of the NP's and the way some of them like to throw their weight around and try to put the regular RN's in their places and act sort of snobbish in the hospital. I don't think arrogance is limited to MD's or DO's...there are arrogant NP's with chips on their shoulders as well. This really serves nobody in the medical setting, any more than having cocky physicians running around acting like that.

Actually, I think this recent proliferation of doctoral degrees has more to do with some universities wanting to make money than with providing a better education. I mean, really do the PT schools need to collect 3 years of tuition (what is it, 20 or 30,000/year now?) and keep people in school for 3 years, even when they already have an undergrad degree with science classes taken, etc. Do the nursing schools really need to make a DNP degree when they could do a nurse practitioner master's degree that is couple of years, with a heavy clinical and/or public health component, that would provide the same thing? Do more standardized exams and a degree that says "doctor" rather than what they used to have (? NP master's degree) really make a more competent NP than in the past? I think this is kind of like all the med schools now, getting medical students to sign up to pay an extra year of tuition to get combined degrees like MD/MBA and MD/MPH when half of them will probably never use the degree anyway.

 

[dragonfly99]

I agree with Zenman that NP's need to figure out a niche for themselves, if they really want to stay around. It seems to me like promotion of public health, perhaps care coordination for large clinics, etc. that have lots of patients, and getting heavy duty into patient education programs would be good ones. There are quite a few situations where I think it would be helpful to get someone with more patient care knowledge and experience than most general RN's have, and yet where it might not be necessary (or cost effective) to have a physician carrying out all the duties.

 

[MDman87]

There are arrogant NP's with chips on their shoulders as well

+1. These are the NPs who want to - and think they can - play doctor. A few bad apples are threatening the reputation of all nurses. The vast majority of nurses recognize and accept their role in healthcare, providing a vital service to doctors and patients alike. But there are a few out there who are arrogant (and ignorant) enough to think that they can do everything a physician does, and this simply is not true

 

[TTPHUS]

+1. These are the NPs who want to - and think they can - play doctor. A few bad apples are threatening the reputation of all nurses. The vast majority of nurses recognize and accept their role in healthcare, providing a vital service to doctors and patients alike. But there are a few out there who are arrogant (and ignorant) enough to think that they can do everything a physician does, and this simply is not true

Its more than a Few . I'd say its few Nps who truly want to "just" be a nurse . Why do you think they have been successful in repealing the laws in many states . They are constantly fighting for more expansion of their scope of practice . Read up on Ms Mundinger - that will give you a clue as to their mission .

 

[mig26x]

Im my continuity clinic I have a few patients that are follow up at the cardiology clinic and a NP is the one that follows the patient and then consults with the cardiologist. The patients have always refer to them as doctor and that's where I always explain to them they are nurses that work for the doctor and all the decisions they take are consulted with the cardiologist. I really don't think this particular nurses are presenting themselves as doctors but sometimes patients see white coat and quickly think MD/DO.

 

[womp]

Medical Doctors in the clinical setting should just all be called Misters like surgeons in the UK. That way all the DNP's and Pharmacists can go ahead and call themselves Doctors in the clinical setting if they like the word so much.

It's silly to think that language won't naturally evolve to reflect contrasting connotations.

 

[Cp22kjer]

sometimes patients see white coat and quickly think MD/DO.

This is part of the problem. You get DNP/NPs trying to "pass" as a physician with at white coat and stethoscope hanging around their neck.


Zenman thanks for your input earlier.

 

[zenman]

FYI - I think you are LYING about the psychiatrist telling you that you know more and I seriously would not be surprised if your "claim" becomes apart of some "study "claiming NPs = MDS ..and this is EXACTLY their misplaced mission .

Even though I'm sure you are telling a tall tale , an attending wanted me to ask you the following question :

Zenman is Clearly over his/her head and delusional. " Ask her/him in a post what exactly did she say to the doctor about said diagnosis and why did she think it needed to be reconsidered. Im curious about the specifics about the situation. "

Go ahead and tell us some more lies Zenman . We all know you made up the whole story - you with a few chapters of psychpharm" know more than the doctor "

Why don't you get your attending on here? Maybe he/she will be more fun than you to play with, lol. First, you must learn to fully assess the situation (and hopefully your patients). The doctor in question is not a psychiatrist and I never said she was. She is a GP. Tell your attending the patient in question had SI with a plan to OD and lie on the railroad tracks. I got her to do a suicide contract and an appt to see the GP in question. I also made her go straight to the pharmacy and get an antidepressant (that I ordered). A week later when she saw the GP she was much improved, too improved. So, I was telling the GP that we need to change the antidepressant monotherapy, consider a bipolar II diagnoses and put her on a mood stabilizer. That's when the GP made her comment to me. Tell your attending that for me would you? Notice how I work seamlessly with physicians?

 

[zenman]

OK,
I've been staying out of this discussion because of all the vitriol, etc. that is here.
First of all, I think you all are being unnecessarily harsh on Zenman. Please keep this civil...no reason to accuse him of lying/making stuff up.
I think it is true that most NP's don't want to replace physicians...most of them just want to take their nursing to the next level, and participate more in patient care.

I do have a problem with some of the stuff Ms. Mundinger says, and has said, in the past.

Thanks for your support, dragonfly. All I want to do, personally, is to see those patients many docs don't want, the chronic ones, fibro, etc. as well as vets suffering from PTSD. They are screwed over by the system so bad it's nutz.

And Mundinger is an idiot.

 

[zenman]

Im my continuity clinic I have a few patients that are follow up at the cardiology clinic and a NP is the one that follows the patient and then consults with the cardiologist. The patients have always refer to them as doctor and that's where I always explain to them they are nurses that work for the doctor and all the decisions they take are consulted with the cardiologist. I really don't think this particular nurses are presenting themselves as doctors but sometimes patients see white coat and quickly think MD/DO.

I was called "doc" as an ARMY medic. As a nurses aide and through out my entire career, I've been called "doctor," probably because I'm tall and handsome...well, used to be. At some point you just get so tired of telling people over and over that you're not a doctor that you just give up. And I don't remember ever wearing a white coat, but did wear my stethoscope around my neck because it was easier to use that way.

Here's what I think happened and now people just whine about it. Physicians didn't have the power (for what ever reason) to limit the white coat to themselves. Deal with it.

Less physicians are going into primary care so naturally someone else is going to step in and fill the gap. A physician, for Christ's sake, developed the PA. Psychologist are getting prescription rights to fullfill a need where no psychiatrists are available. So, basically I hear people complaining because they don't want some other group to take care of people who need it....

 

[EternalMD]

the patient in question had SI with a plan to OD and lie on the railroad tracks. I got her to do a suicide contract and an appt to see the GP in question. I also made her go straight to the pharmacy and get an antidepressant (that I ordered). A week later when she saw the GP she was much improved, too improved. So, I was telling the GP that we need to change the antidepressant monotherapy, consider a bipolar II diagnoses and put her on a mood stabilizer. That's when the GP made her comment to me. Tell your attending that for me would you? Notice how I work seamlessly with physicians?

So a patient with suicidal ideation AND a plan was sent home to get some antidepressants which take time to kick in usually with followup in a week? Makes me question your reasoning behind such an action. Also, what medication did you recommend? You should know since you ordered it right? Maybe there were details left out but I personally would want a more detailed assessment than just go on what you said if i were the attending physician. Secondly, do you even know what qualifies as a Bipolar II? The patient came back with a much improved mood and automatically you think Bipolar II without re-assessing the patient to figure out if they even meet the DSM criteria? I guess that's the difference between a physician and a wanna-be-physician