NPs can now do dermatology residencies

[NYRN]

I do not agree with these fast tracked DNP programs. A masters prepared NP in a good program will take a year of patho in addition to physiology at the very least. 1 semester of pharm in addition to the clinical hours is on top of whatever pharm they took in a nursing program. IF the NP has years of acute care nursing experience and attends a good NP program, they will be well prepared to work alongside physicians.


NYRN,

I will only respond to you because I want you informed. This is not a fast track DNP program. This program is for NPs who already have their MSN. Please, I ask again, make sure you know what you are saying before posting. The USF DNP derm program has over 60 credit hours with the highest amount of clinical hours required in any DNP program.

Let me ask you this then. Is this derm residency designed to open your own derm practice, or is it designed to give you more experience in derm in order to work with an MD group? State practice acts forbid NP's from opening up totally independant practices other than primary care.

I'm not sure how it's legal to open up your own derm practice unless you are disgusing it as a primary care practice and are doing derm procedures? Even in independant practice states, the law says that in order to recieve medicare reimbursement, you must have a collaborating MD.

I am also looking at doing a fellowship after graduation, but its designed to intensely train NP's in the area of this specialty in order to work with an MD group and care for inhospital patients. This particular fellowship lasts one year, and you train identically with 1st year MD fellows minus the few procedures that the 1st year fellows may do that I can't. In my opinion, this intense year (at a fellow's salary and working hours ) is going to be extremely difficult, but I know I will be better prepared for practice than taking a lot of these BS courses in the DNP program.

I do not want to say which specialty I am looking into seriously because there is only 1 in the entire US, and the internet is not anonymous, I don't want to hurt my chances just in case.

---

Members don't see this ad.

 

[medicinesux]

Watch out PM&R Docs! Looks like you got some more competition. Why in the hel! do physical therapists need a "doctorate" may I ask? This dishing out doctorates like candy has gone completely out of control now.

"UCF Celebrates First Doctor of Physical Therapy Graduates"

http://today.ucf.edu/ucf-celebrates-first-graduates-of-doctor-of-physical-therapy-program/

 

[JaggerPlate]

Watch out PM&R Docs! Looks like you got some more competition. Why in the hel! do physical therapists need a "doctorate" may I ask? This dishing out doctorates like candy has gone completely out of control now.

"UCF Celebrates First Doctor of Physical Therapy Graduates"

http://today.ucf.edu/ucf-celebrates-first-graduates-of-doctor-of-physical-therapy-program/

I thought DPT had been around for quite some time???

 

[medicinesux]

Good grief, I had no idea Just goes to show how RAPIDLY things are changing in medicine. It appears that in just 10 years time, the field of physical therapy has inflated their requirements from a bachelors right on up to a doctorate.

"There remains significant criticism[2] regarding the granting of a doctoral level degree for a field that until 1998 only required a bachelors degree.[3] The concern centers around both the need for such a degree and the possibility that physical therapists may incur substantial student debt with an extended education that pays no greater than it did when only a bachelors degree was required."

 

[DNPgator]

Actually, there are really no well-done studies that suggest NPs/DNPs have equivalent/superior outcomes compared to board certified attendings. All those studies you cited in your post have been discredited due to major flaws. I don't have time right now, but I'll definitely come back and point out the flaws of those studies when I get back home later tonight (unless someone else beats me to the punch).

It's actually kind of funny that you think someone with less than 10% of the training that physicians get can provide superior care to physicians. It doesn't even make logical sense! Who knew that less education = superior quality of care?

Actually, can you tell me where these studies, printed in medicines most respected journals in two countries, were discredited. Wanting something to be true does not make it true. These studies were conducted by MD's or PhD's not nurses. Check the sources, it is less likely you will look so ignorant in front of your friends. Also, where did you come up with 10% crap? Assigning arbitrary statistics to issues to make an invalid point just looks desperate.

 

[DNPgator]

I would wager that you don't know the origin of the word Doctor either but assumed its origin based on its latin roots instead of actually tracing the origin of the word..

If you look up the word Doctor in Oxford's English Dictionary, the standard reference in etymology, the word Doctor has an interesting history (and not as straight forward as you would think)

The word Doctor, in reference to "A doctor of medicine; in popular current use, applied to any medical practitioner. Also, a wizard or medicine-man in a primitive tribe" first appeared in the English language in 1377. Some of Chaucer's writing made reference to Doctor in 1378.

The word Doctor, in reference to teacher or instructor, first appeared in the English language in 1387.

The word Doctor, in reference to the highest degree conferred by a university, first appeared in the English language in 1377 (Doctoures of decres and of diuinitie maistres)

Doctor first appeared in the English language around 1303 in reference to Doctors of the Church, "early ‘fathers’ distinguished by their eminent learning, so as to have been teachers not only in the Church, but of the Church, and by their heroic sanctity"


So the word "doctor" when applied to the medical profession, has been around for 633 years in the English written language, and its use is just as old as the academic degree.


FYI, the term "nurse" first appeared in 1325.

Very informative. As you know, Latin predates the bastardized language of English by a couple millenium. The first doctors were clergy or religious men who treated people under the assumtion that evil spirits caused illness. Some of the first nurses were men, also in religious orders and were skilled soldiers as well. I like history too. I prefer to study word origins from the Latin and Greek roots. Understanding the original contexts helps in deciphering the original intent. Both medicine and nursing far predate the 1300's. Love Chaucer though.

 

[DNPgator]

As the head "youngling" in this thread ... let me tell you how proud I feel right now. I can't explain how great it feels to know that "Dr" Debra Shelby not only knows about this thread, but that our efforts resulted in the removal of her video from the USF site AND she's asking her minions to come here and "school" us.

Your post reads like a brochure for DNP expansion, and let me assure you of a few things:

1. Us "younglings" are sick of this crap, and simply aren't going to take it. Frankly, I've never seen medical students so energized on any single issue, and I'm personally doing everything in my power to make sure physicians and future physicians don't go down without a fight.

2. You guys are your own worst enemies in this fight. As many others have pointed out, this battle will be won based on the fact that DNPs are far, far less trained and patients are safer (and prefer working) with physicians, and this fact shines brightly. Watch the interviews on CNN and Fox News. Initially, I was enraged that the AMA didn't send a representative, but after watching one of the head NPs (err whatever) mocked on Fox, I feel comfortable with your "truth" campaign. You look insecure, misinformed, and immature.

3. No, you don't want to be a Cardiologist, or an Endocrinologist - you want to be a Dermatologist. It's smeared all over statements like "I am not a medical doctor by choice" and " I'm trained in dermatology and can out diagnose, treat, etc, any of you kids out there." First, you're correct, you aren't a medical doctor ... so stop trying to act like one. Quit parading around in a white coat, stop participating in 2 week, online Neurosurgery residencies, stop introducing yourself as Doctor in a clinical setting, and quit trying to practice medicine.

Furthermore, I'm sure many of your DNP colleagues want to be Cardiologists and Endrocrinologists (the same way you want to be a dermatologist), and it's only a matter of time before the American Association of Cardiology Nurses starts a "residency" in cardiology somewhere.

Second, take the MCAT, obtain acceptance to a US DO/MD school, complete 2 years of pre-clinical sciences and 2 years of rotations, take the USMLE/COMLEX, match into dermatology, complete the required number of years in a dermatology residency, then take all appropriate steps to gaining board certification ... THEN tell all med students and residents you're a better gunslinger. Because, frankly, you have absolutely no clue if you can do what you say. But that's your guy's mantra, isn't it? Assume you're just as good, so demand the same outcome with absolutely none of the work, while simultaneously throwing ethics, patient safety, and the liabilities out the window.

I hope this is what you were shooting for with your pithy response. This just officially kicked my drive into high gear.

Sincerely,

A Youngling.

You are fighting a battle that for all intents and purposes is already over. Do you really think you are the only person in the last 30 years of NP practice who feels as you do. Who you should get angry with us, your own AMA sold out the specialists by backing the health care reform that amongst many things provides nurse midwives full reimbursement and NP's the right to lead nurse run clinics. As far as the Fox news goes I like O'Reily too. We are not the enemy.

We have and will continue to provide care based on our training. Programs such as the one designed at USF and many other institutions around the US were in direct response to the Medical community asking that we formalize our training. We did what they asked and now your pissed. Sorry. I find it ironic that most of the arguments being shouted from the roof tops here are the same ones used in the 60's and 70's when the MD's tried to block the DO's right to practice. Come on MD students, do you really feel the DO education is as good as yours? When you are at your study groups and parties, talking amongst yourselves, you hate them too.

 

[J1515]

.

 

[Maybeknot]

Actually, can you tell me where these studies, printed in medicines most respected journals in two countries, were discredited. Wanting something to be true does not make it true. These studies were conducted by MD's or PhD's not nurses. Check the sources, it is less likely you will look so ignorant in front of your friends. Also, where did you come up with 10% crap? Assigning arbitrary statistics to issues to make an invalid point just looks desperate.

Most of the Vioxx studies showed that there was no increased cardiovascular risk after 6 months.

Most (all?) of the studies you quoted, including the landmark Mundinger study, looked at health care outcomes over 6 months. I believe in that same study, over 40% of the patients had 1 or fewer visits to either the primary care physician or NP during that time period.

And yet, this paper is STILL cited as "proof" that NPs provide equal or better care.

I wonder why?

Also, since apparently DNP's are so adept at "treating the whole patient" instead of just diseases, why are they keeping this secret knowledge to themselves? I'm sure physicians could use this remedial training. Think of the patients! Won't someone think of the patients?

 

[Dr Oops]

You are fighting a battle that for all intents and purposes is already over. Do you really think you are the only person in the last 30 years of NP practice who feels as you do. Who you should get angry with is your own AMA who sold out the specialists by backing the health care reform that amongst many things provides nurse midwives full reimbursement and NP's the right to lead nurse run clinics. As far as the Fox news goes I like O'Reily too. We are not the enemy.

We have and will continue to provide care based on our training. Programs such as the one designed at USF and many other institutions around the US were in direct response to the Medical community asking that we formalize our training. We did what they asked and now your pissed. Sorry. I find it ironic that most of the arguments being shouted from the roof tops here are the same ones used in the 60's and 70's when the MD's tried to block the DO's right to practice. Come on MD students, do you really feel the DO education is as good as yours? When you are at your study groups and parties, talking amongst yourselves, you hate them too.

The difference between DOs and DNPs is that the DOs must take the same course work with the same rigor. They take the MCAT to get in. They do rotations. If they want to apply for allopathic residencies they may take the USLME and then they do residency (a real one).

When they wanted equal practice rights, they imitated the model which is the gold standard for independent practice, they didnt push for legislation as a shortcut to make up for their lack of education. Pushing for the title doctor in the clinical setting and labeling your 1000 hour clinical training a residency and creating a board to claim board certification are all methods to blur the line between physicians and nursing.

You call the DNP programs standardized and formalized? They are anything but. Some can be done almost completely online, others not. Theres no reason for the DNP degree, it doesnt even have anything to do with clinical practice. Med students have more clinical hours before they graduate and are still deemed unfit to practice medicine.

If you are really on board with this crap, then it is YOU who doesnt care about patient safety. Its simple logic, more training and education = safer. Doesnt matter how you cut it. You can tell your patients how special they are and even kiss their feet, but it wont make up for lack of knowledge.

 

[bassstimme1]

Very informative. As you know, Latin predates the bastardized language of English by a couple millenium. The first doctors were clergy or religious men who treated people under the assumtion that evil spirits caused illness. Some of the first nurses were men, also in religious orders and were skilled soldiers as well. I like history too. I prefer to study word origins from the Latin and Greek roots. Understanding the original contexts helps in deciphering the original intent. Both medicine and nursing far predate the 1300's. Love Chaucer though.

It is true that one should understand the original context of a word, but, more importantly, one should understand the original intent of the word as it was incorporated into English from Latin. The Latin may translate as "to teach," but that is not necessarily the original English denotation, as Chaucer's usage would suggest. The Germans, for instance, took the Latin definition for the word Doktor, which is normally used to refer to a PhD, while the German word for physician is Artzt. You have to be careful when studying the Latin or Greek root of a word to take note if the definition, or connotation, of the word changed when we stole it for our "bastardized" language.
On another note, you should read some of the previous posts in which people have compared the hours of didactic/clinical training of MD/DOs and DNPs. MD/DOs really do have about 10x the training.

[/FONT

 

[DNPgator]

I have had fun with this. I am going to help you all out here. You can thank me later. I figured what I posted would get your attention. You all obviously love your chosen field and are passionate about this issue. You are idealists, I can respect that, but so were those at Jonestown. Don't be so quick to drink the hate the DNP kool-aid. "Can't we all just get along?" Rodney King

You are focusing on the wrong issue. You as a group should be applauding a formalized residency program for NP's and DNP's. These are organized by the nursing programs but are administered in large part by MD's at teaching hospitals alongside medical residents. My biggest problem with my profession as a whole is a lack of standardization in training for advanced practice. Whether you like it or not, there is a need for advanced practice nurses. We are not mid-levels or extenders. My knowledge base and ability to care for patients does not stop at a physicians umbilicus nor am I some phalic extending off the great body of medical knowledge. We, as you all have pointed out, some eloquently, others rudely, are also not physicians. We are health care providers though and most of us do a great job in our roles.

I am not a psycho like some have said nor am I a rogue NP demanding independence and equal pay. Those battles have been raging for years. Do I think we deserve this as DNP's, yes, but that is not why I chose to get this degree. I do like to ruffle feathers and hope that people will stop and think about what we DNP's with clinical degrees are trying to accomplish. Standardized training for advance practice nurses. This is the goal.

A video produced by the college of nursing for prospective nursing students where someone with a doctorate in nursing calling themselves doctor should not upset you this much. By 2015, there will be no more Masters level programs. All NP will have doctoral degrees. It is my hope, and from my understanding, it is the plan, that these programs will be transparent and the learning experiences will be more formalized.

I agree that the NP education and training at the Masters level is insufficient for independent practice, but in some states we already have it. Some of your colleagues train NP's for 6 weeks and set them loose on their patients. This leads to wide disparities in training. This is why the DNP is important.

I do not believe that we as a profession should be in a subservient role to physicians. I work alongside and in collaboration with many excellent doctors including Mohs surgeons, Plastic surgeons, cutaneous surgical oncologists, and dermatologists. They understand and respect my degree and training. I also defer to their expertise when needed. I know when that is needed.

The real patient safety issue regarding Nurse Practitioners is the lack of standardized residency programs to ensure proper training and physicians who are looking to make more money by seeing patients in clinics utilizing undertrained providers. Programs like those at USF and other DNP programs are trying to address this issue.

 

[jbz24]

I have had fun with this. I am going to help you all out here. You can thank me later. I figured what I posted would get your attention. You all obviously love your chosen field and are passionate about this issue. You are idealists, I can respect that, but so were those at Jonestown. Don't be so quick to drink the hate the DNP kool-aid. "Can't we all just get along?" Rodney King

You are focusing on the wrong issue. You as a group should be applauding a formalized residency program for NP's and DNP's. These are organized by the nursing programs but are administered in large part by MD's at teaching hospitals alongside medical residents. My biggest problem with my profession as a whole is a lack of standardization in training for advanced practice. Whether you like it or not, there is a need for advanced practice nurses. We are not mid-levels or extenders. My knowledge base and ability to care for patients does not stop at a physicians umbilicus nor am I some phalic extending off the great body of medical knowledge. We, as you all have pointed out, some eloquently, others rudely, are also not physicians. We are health care providers though and most of us do a great job in our roles.

I am not a psycho like some have said nor am I a rogue NP demanding independence and equal pay. Those battles have been raging for years. Do I think we deserve this as DNP's, yes, but that is not why I chose to get this degree. I do like to ruffle feathers and hope that people will stop and think about what we DNP's with clinical degrees are trying to accomplish. Standardized training for advance practice nurses. This is the goal.

A video produced by the college of nursing for prospective nursing students where someone with a doctorate in nursing calling themselves doctor should not upset you this much. By 2015, there will be no more Masters level programs. All NP will have doctoral degrees. It is my hope, and from my understanding, it is the plan, that these programs will be transparent and the learning experiences will be more formalized.

I agree that the NP education and training at the Masters level is insufficient for independent practice, but in some states we already have it. Some of your colleagues train NP's for 6 weeks and set them loose on their patients. This leads to wide disparities in training. This is why the DNP is important.

I do not believe that we as a profession should be in a subservient role to physicians. I work alongside and in collaboration with many excellent doctors including Mohs surgeons, Plastic surgeons, cutaneous surgical oncologists, and dermatologists. They understand and respect my degree and training. I also defer to their expertise when needed. I know when that is needed.

The real patient safety issue regarding Nurse Practitioners is the lack of standardized residency programs to ensure proper training and physicians who are looking to make more money by seeing patients in clinics utilizing undertrained providers. Programs like those at USF and other DNP programs are trying to address this issue.

This post has sufficiently irked me.

 

[NYRN]

You as a group should be applauding a formalized residency program for NP's and DNP's. These are organized by the nursing programs but are administered in large part by MD's at teaching hospitals alongside medical residents. My biggest problem with my profession as a whole is a lack of standardization in training for advanced practice. Whether you like it or not, there is a need for advanced practice nurses.

Standardized training for advance practice nurses. This is the goal.

By 2015, there will be no more Masters level programs. All NP will have doctoral degrees. It is my hope, and from my understanding, it is the plan, that these programs will be transparent and the learning experiences will be more formalized.

I agree that the NP education and training at the Masters level is insufficient for independent practice, but in some states we already have it.

I do not believe that we as a profession should be in a subservient role to physicians. I work alongside and in collaboration with many excellent doctors including Mohs surgeons, Plastic surgeons, cutaneous surgical oncologists, and dermatologists. They understand and respect my degree and training. I also defer to their expertise when needed. I know when that is needed.

The real patient safety issue regarding Nurse Practitioners is the lack of standardized residency programs to ensure proper training and physicians who are looking to make more money by seeing patients in clinics utilizing undertrained providers. Programs like those at USF and other DNP programs are trying to address this issue.

I don't see myself as subservient to MD's, and with very few exceptions, they do not treat me as subservient. Even then, once they get to know me, usually they warm up. I think we both have important roles. They can't hospitalize their patients without us, and we have no role without them. I work very well alongside the MD's now. They respect me and value my opinion based on my experience. That is what earns their respect, not the degree behind your name.

There will be masters programs well after 2015. The NP organizations state that they have no intention of closing down masters programs. Like you said above, the educational training varies too much. Most NP programs are standardized, but DNP programs are all over the place. I don't see any point in me getting my DNP ever, unless there really is some sort of benefit to me. I don't need it to practice, and I don't need classes in administration.

Independent practice states don't mean you can go off on your own. You cannot bill medicare without a collaborating MD. Sure you can practice, but you won't be getting paid for it.

I am not opposed to NP residencies with the intent of giving NP's more experience in an area they wish to persue. The whole reason we are considered LIP's is because our education is focused to is to one particular area. Adult Health, Acute Care, Peds, Oncology, Womens Health, Family, CN Midwife. Under our license we can pick any specialty that falls under the scope of practice that we trained for. I think you could be walking on thin ice by opening up a practice in which we are not covered to do on our own. If you are deferring to them when needed, isn't that the same thing as collaboration??

 

[BassCaster]

I do not believe that we as a profession should be in a subservient role to physicians. I work alongside and in collaboration with many excellent doctors including Mohs surgeons, Plastic surgeons, cutaneous surgical oncologists, and dermatologists. They understand and respect my degree and training. I also defer to their expertise when needed. I know when that is needed.

"Come on MD students, do you really feel the DO education is as good as yours? When you are at your study groups and parties, talking amongst yourselves, you hate them too."

To be fair, these MD's are probably talking more about you than their DO colleagues at this hypothetical party.

 

[reno911]

I am not claiming, nor do I want to be a surgeon, cardiologist, endocrinologist, or any one of the many specialists who provide comprehensive care to moderate and high acuity patients. I and most other NP's and DNP's know when a patient walks in the door if their problems need referral to more specialized not primary care. I specialize in dermatology and you better believe I can out diagnose, treat, and care for my patients than any of you students. You haven't been around long enough to earn an opinion on this topic.

Your whole post was misinformed or just plain wrong, but I'll focus on only this part since I don't have the time or inclination to comment on it all.

If you don't think that dermatology is as complicated as these other specialties, then it's clear that you really have no idea what you're talking about.

You're right that most dermatology patients are not at risk of imminent death (but neither are the vast majority of endocrinology patients -- which, like dermatology, is mainly an outpatient specialty, but, for some reason, in your twisted mind is in a completely separate category). That doesn't make them less complex or mean that treating them requires significantly less training (i.e., the amount you possess).

And if you're curious, I'm an actual dermatologist, and have been for a while. So, I'm sure I've "been around long enough to earn an opinion". That part was particularly funny. Perhaps when you have attained as much education as I have, I'll consider you worthy of having an opinion.

 

[JaggerPlate]

You are fighting a battle that for all intents and purposes is already over. Do you really think you are the only person in the last 30 years of NP practice who feels as you do. Who you should get angry with is your own AMA who sold out the specialists by backing the health care reform that amongst many things provides nurse midwives full reimbursement and NP's the right to lead nurse run clinics. As far as the Fox news goes I like O'Reily too. We are not the enemy.

We have and will continue to provide care based on our training. Programs such as the one designed at USF and many other institutions around the US were in direct response to the Medical community asking that we formalize our training. We did what they asked and now your pissed. Sorry. I find it ironic that most of the arguments being shouted from the roof tops here are the same ones used in the 60's and 70's when the MD's tried to block the DO's right to practice. Come on MD students, do you really feel the DO education is as good as yours? When you are at your study groups and parties, talking amongst yourselves, you hate them too.

Jesus Christ. You must be joking. If you're the "threat," I feel very confident in a patient's ability to sufficiently shut you out. Regardless, we will all continue to do the job for them.

Just for your information, all these posts are being used as ammunition in our contacts to the AMA, AAD, and the dermatology (real dermatology) residency at USF.

Keep going ... really.

 

[JaggerPlate]

I work alongside and in collaboration with many excellent doctors including Mohs surgeons, Plastic surgeons, cutaneous surgical oncologists, and dermatologists. They understand and respect my degree and training. I also defer to their expertise when needed. I know when that is needed.

HAHAHAHAHAH ...

Yeah, you work "alongside" them. "Respect?" "When needed?"

 

[JaggerPlate]

Gator ... wanted to share this thread with you:

http://forums.studentdoctor.net/showthread.php?t=722781


Good read.

 

[DNPgator]

The difference between DOs and DNPs is that the DOs must take the same course work with the same rigor. They take the MCAT to get in. They do rotations. If they want to apply for allopathic residencies they may take the USLME and then they do residency (a real one).

When they wanted equal practice rights, they imitated the model which is the gold standard for independent practice, they didnt push for legislation as a shortcut to make up for their lack of education. Pushing for the title doctor in the clinical setting and labeling your 1000 hour clinical training a residency and creating a board to claim board certification are all methods to blur the line between physicians and nursing.

You call the DNP programs standardized and formalized? They are anything but. Some can be done almost completely online, others not. Theres no reason for the DNP degree, it doesnt even have anything to do with clinical practice. Med students have more clinical hours before they graduate and are still deemed unfit to practice medicine.

If you are really on board with this crap, then it is YOU who doesnt care about patient safety. Its simple logic, more training and education = safer. Doesnt matter how you cut it. You can tell your patients how special they are and even kiss their feet, but it wont make up for lack of knowledge.

Yes or no? Do the MD's believe the DO's are equally educated and had to survive the same rigorous training or do they feel that degree is second best?

 

[smq123]

Yes or no? Do the MD's believe the DO's are equally educated and had to survive the same rigorous training or do they feel that degree is second best?

As an FYI, while I realize that the whole "DNP" thing is a very hot and controversial issue, the moderator staff will not tolerate attempts to get MDs and DOs to start flailing at each other. There is enough of that in pre-allo and I have no intention of allowing it to spill over into this forum.

Any further attempts to incite MD vs. DO arguments will be seen as trolling/trying to start a flame war, and will be infracted appropriately.

Thanks.

 

[DNPgator]

Gator ... wanted to share this thread with you:

http://forums.studentdoctor.net/showthread.php?t=722781


Good read.

It was a good read and it may surprise you but I agree completely. I feel there is a lot of confusion with role confusion in hospitals. Everyone wearing scrubs and lab coats with badges that are hard to read. The term nurse was also thrown around too loosely in hospitals which caused alot of confusion for patients that are already in a confusing place.

I have been in the same practice for almost 8 years seeing the same patients in the same community. I did not go back to school to be called doctor. I did it to address what I thought were deficiencies in my training. My patients often times call me by my first name. I don't care about that. I always let people know I am a nurse practitioner. I think that is important. They all knew I was going back to school and what it was for. They respected my decision.

 

[VA Hopeful Dr]

I want to apologize in advance to all my MD and DO colleagues whom I work with and consult with. You are a credit to your profession and the health care community. This is addressed to the younglings preparing to enter the workforce who, like most adolescents, lack a full understanding of the topics they speak of.

I was turned onto this site by a friend and colleague of mine Dr. Debra Shelby. I read all the thoughtless banter and venom spewed by the excessively opinionated and unexpectedly uneducated medical students. I have earned my Doctoral of Nursing Practice degree and the right to be called doctor just as everyone else who earns a doctoral degree. Please study up on the history and meaning of the word "doctor" it would serve the medical profession well for most of you have forgotten or never knew its origin.

I call myself doctor and pursued this educational route, not because of a lack of intelligence or work ethic as many of you have proposed on the blog, but because I love providing care to my patients.

I am not a medical doctor by choice not because I could not hack it. I would invite you all to spend a few months working alongside you RN colleagues in the hospitals before you are so quick to assert your intellectual superiority. Nurses have been providing compassionate, caring, and comprehensive care since before the time that "doctors" were treating the humors and boring holes in skulls to release evil spirits.

I do not try to hide my identity from my patients or try to fool them or mislead them. The insinuation is that everyone wants to be you because you are the standard by which all else should be measured. The arrogance of this concept is beyond reproach. In my opinion, the education that is provided to medical students is substandard because it only focuses on the physical. Mind, spirit, and body cannot be separated. They are intertwined.

Lets call a spade a spade. You don't care about patient safety, if you did then physicians would lobby for every patient to be seen in consultation with a NP. You all care about the title, presitige, and money. NP's are highly educated, well trained, and effective contributors to the health care system with or without physicians. This has been shown in multiple control trials. I will list a few:
Kinnersley et.al. BMJ 320(7241) 1043-1048
Mundinger et.al. JAMA 283(1) 59-68
Shum et.al. BMJ 320(7241) 1038-1043
Venning et.al. BMJ 320(7241) 1048-1053
Ohman et.al. Annals of Family Medicine 6: 14-22

There are many others like these but I only included a few. I would challenge all of you to find one that says otherwise. In primary care of patients, NP's and now DNP's have provided comparable and at times superior care than our physician brethren. Those are the facts. Not opinion as were all of your posts. The truth of the matter is that we are better at caring for people than you. People prefer our services to yours time and time again. There are no studies that show to the contrary. We also do a much better job at educating patients on disease processes than you. This is also not an opinion, but proven in these studies, printed in your journals. Doctor comes from the latin docere which means to teach. As a profession you get a failing grade. The days of dictating care to patients and getting complience because you are the alwighty doctor are over!!! Patients are more educated than ever and demand to be treated with respect. If you are all so brilliant as it seems you think you are, maybe you could find a way to teach each other how to educate your patients in terms they can understand. GET OVER YOURSELVES!!!!! Join the battle for better healthcare and quit worrying about your bank accounts. No one cares when we treat the indigent, underserved, and rural areas without physician supervision but you get your panties in a wad when we say we don't need you to take 70% of what we earn and put it in your pockets despite not doing a damn thing to treat a patient.

I am not claiming, nor do I want to be a surgeon, cardiologist, endocrinologist, or any one of the many specialists who provide comprehensive care to moderate and high acuity patients. I and most other NP's and DNP's know when a patient walks in the door if their problems need referral to more specialized not primary care. I specialize in dermatology and you better believe I can out diagnose, treat, and care for my patients than any of you students. You haven't been around long enough to earn an opinion on this topic.

Ignoring the fact that you're being a huge jackass despite many of us trying our best NOT to come off that way... I'm working my way through you references and providing my analysis.

Ohman et.al. Annals of Family Medicine 6: 14-22 http://www.annfammed.org/cgi/conten...ance&volume=6&firstpage=14&resourcetype=HWCIT

First, this study only looks at whether practices with NPs outperform those with PAs and physician only groups. Second, this is only in NJ and part of Penn. Third, the sample sizes were exceptionally small (N= 28 MD/DO only, N=9 for PA or NP). Fourth, in the practices that employ both MD/DOs and NPs, the study does not separate results of those NPs and those physicians. For all we know, this could just be a referendum on physicians who choose to practice without NPs (maybe they're less likely to keep up with current recommendations). Fifth, the study only uses laboratory values in this study. There is no mention of any physical findings or glucose log interpretation (which is arguably more important since A1c is only an average. A patient could have values ranging from 40-300 and still have an OK A1c and we can all agree that it isn't healthy). Now, with that out of the way, lets look at the results of NP v. MD/DO only. There were only 3 areas where NP/MO practices outperformed MD only ones were assessing A1c, assessing lipids in last 12 months, treating/assessing lipids and at goal for lipids if not treated. There were no other significant results. It also lacks any kind of evaluation on which provider type practice was better at getting patients to their goal. In short - Grade D (poorly designed, results not impressive nor based on outcome or actual clinical findings, need to compare MD only v. NP only settings)

Mundinger et.al. JAMA 283(1) 59-68 http://jama.ama-assn.org/cgi/content/full/283/1/59

The first statistically significant result in the meat of this paper is that patients saw their physician providers higher than their NP providers (p=.05) when measuring for technical skill, personal manner, and time spent with patients. The only other significant finding was that for hypertensive patients, NPs had a diastolic BP of 82mmHg compared with the 85mmHg for physicians. However, the study authors noted that as this was a small difference and both were within the guidelines for hypertension the is unlikely to actually mean much. Lastly, the authors note a number of study limitations. First, all of these patients were seen at academic primary care offices. Second, all of the patients were non-English speaking medicaid patients. Third, the three conditions under study are things that most 4th year medical students would feel comfortable managing. Heck, I spent a month in our diabetes clinic and the only time I had trouble was with pumps.
Study Grade - C+ (done OK, areas of study weak)

Kinnersley et.al. BMJ 320(7241) 1043-1048 http://www.bmj.com/cgi/content/full/320/7241/1043

This study has a lot going on. First, the statistically significant values. Overall, patient satisfaction was higher with nurses (except being told of their diagnosis). This was determined to be a result of increased time per visit and increased explanations (leading to higher time spent). However, in the patients who saw GPs, 73% would seek GP care in the future and only 8% would seek nursing care while in the NP group 32% said they would seek nursing care again while 48% said they would seek GP care in the future. In terms out outcomes, there were no clinically significant differences except some statistical significance in half the practices showing that NPs would recommend follow-up. Moving on, there are a number of limitations to the study. 30% of patients were their for URIs. The follow-up surveys which measured symptom resolution were given 2 weeks after the visit. We all know that most URIs will get better on their own within 2 weeks. These patients could have seen a monkey and gotten better within 2 weeks. The rest were a mix of the standard things GPs deal with (emesis, diarrhea, rashes, allergic/endocrine, and so on) that as mentioned previously can be handled by 4th year medical students without difficulty especially given that this was acute care only. It is also worth noting that 30% of patients were unconcerned about their symptoms which raises a host of questions about why they were there and what was actually wrong with them. It is also worth noting that none of these were NP only practices and the authors note that in about half of the practices, if viewed separately, patients were more satisfied with GP care yet looking at the other half we did not see the same results about NP care.
Study Grade - B (decently designed, no difference in outcomes, satisfaction difference in only about half of practices).

Shum et.al. BMJ 320(7241) 1038-1043 http://www.bmj.com/cgi/content/full/320/7241/1038

Once again, study was only at 5 practices and none of them NP-only. As usual, no significant outcome differences. In this case, 50% of cases were "respiratory disease" and since this was same day acute-care visits, I don't think it is unreasonable to assume that URIs make up a substantial portion. Another 15% was MSK problems and, like URIs, those tend to heal up on their own no matter what we do. Another 10% was skin conditions (rashes) which most any medical person should be able to handle. It is also worth nothing that each NP had to have their Rx signed by a doctor so there was reasonable oversight. As expected, satisfaction scores were higher for nurses, however there is a statistically significant higher satisfaction with the depth of the relationship when patients see GPs as opposed to NPs. As in the previous study, half of the GP patients would want to see the GP again while only 8% of NP patients would want to see the NP with 1/3rd wanting to see the GP next time.
Study Grade - B (very similar to previous study)

Venning et.al. BMJ 320(7241) 1048-1053 http://www.bmj.com/cgi/content/full/320/7241/1048

This study mainly looks at cost-effectiveness, as outcomes were similar and satisfaction was higher in the nursing group as was time spent. Looking at costs as a function of salary, we find the follow: costs as related to total time spent were identical in both groups. This was found to be correlated with the increased return visits recommended by nurses and the increased number of additional testing ordered by nurses which the study calls "opportunistic screening".
Study Grade - B+ (well designed for what it was investigating)

So, in review. Nurses achieved higher satisfaction scores on the whole and in each case there was more time spent talking with the patient. This is nothing new. Everyone everywhere knows that more face time with your provider makes patients happier. Outcomes showed no significance in any of the studies. Nurses were no more cost-effective than physicians, when adjusted for salary owing to increased follow-up and testing again with no outcome differences.

Basically patients like y'all more, likely because you spend more time explaining things to them. There were no outcome differences. You aren't more cost effective. These studies only looked at very basic conditions most if not all of which a decent 4th year medical student could do.

Color me unimpressed.

 

[DNPgator]

For the record. I am not Dr. Shelby nor am I affiliated with the the University of South Florida or their program (note the gator in the name, USF is the bulls). I am a NP who went back to school to try and become a better provider of care to my patients. I work in collaboration with several doctors and I am fine in that role.

My program was overseen by physicians and they support, as should everyone, providers, NP's and others, continuing to educate themselves to provide the best possible care. I think evryone would agree that the educational process, formal or otherwise, never stops.

As I stated earlier, I have been caring for people in the same practice for almost 8 years. I cannot see anything outside of the death of my collaborating physician changing that for the next 20-30 years. I love what I do and I have geat relationships within the community and with my patients.

When we read posts on blogs that attack our IQ's and intelligence it can hit a nerve.

 

[VA Hopeful Dr]

It was a good read and it may surprise you but I agree completely. I feel there is a lot of confusion with role confusion in hospitals. Everyone wearing scrubs and lab coats with badges that are hard to read. The term nurse was also thrown around too loosely in hospitals which caused alot of confusion for patients that are already in a confusing place.

I have been in the same practice for almost 8 years seeing the same patients in the same community. I did not go back to school to be called doctor. I did it to address what I thought were deficiencies in my training. My patients often times call me by my first name. I don't care about that. I always let people know I am a nurse practitioner. I think that is important. They all knew I was going back to school and what it was for. They respected my decision.

Most of us only have problems with 3 things about DNPs. Our main concern is patient confusion, and since you tell patients that you are an NP then you are 100% OK in my book. Second, we're all wary of independent practice in the subspecialties. We may not like it, but primary care independent NPs are here to stay (even in supervised states that supervision can be VERY loose). Its the idea of y'all functioning on the level of physician subspecialists. This stems from the third issue we have. I just checked. The one place in my state that offers a DNP degree is almost entirely through online education. For stuff like pharm, pathophys, and micro this is not a problem at all. This does become a problem in large part because this program only requires 1000 hours of clinical training. I got that much as a medical student in 2 rotations. I did 10 more in my training. As a resident, I'll get that in 2 months. I'll be doing 34 more of those in my training. This is only for Family Medicine. The derm people will be doing an extra 12 months on top of what I do. How does your training equate to this?

Anyway, past that first post you seem pretty reasonable and I hope we can continue this discussion without any hostility.

 

[DNPgator]

Ignoring the fact that you're being a huge jackass despite many of us trying our best NOT to come off that way... I'm working my way through you references and providing my analysis.

Ohman et.al. Annals of Family Medicine 6: 14-22 http://www.annfammed.org/cgi/conten...ance&volume=6&firstpage=14&resourcetype=HWCIT

First, this study only looks at whether practices with NPs outperform those with PAs and physician only groups. Second, this is only in NJ and part of Penn. Third, the sample sizes were exceptionally small (N= 28 MD/DO only, N=9 for PA or NP). Fourth, in the practices that employ both MD/DOs and NPs, the study does not separate results of those NPs and those physicians. For all we know, this could just be a referendum on physicians who choose to practice without NPs (maybe they're less likely to keep up with current recommendations). Fifth, the study only uses laboratory values in this study. There is no mention of any physical findings or glucose log interpretation (which is arguably more important since A1c is only an average. A patient could have values ranging from 40-300 and still have an OK A1c and we can all agree that it isn't healthy). Now, with that out of the way, lets look at the results of NP v. MD/DO only. There were only 3 areas where NP/MO practices outperformed MD only ones were assessing A1c, assessing lipids in last 12 months, treating/assessing lipids and at goal for lipids if not treated. There were no other significant results. It also lacks any kind of evaluation on which provider type practice was better at getting patients to their goal. In short - Grade D (poorly designed, results not impressive nor based on outcome or actual clinical findings, need to compare MD only v. NP only settings)

Mundinger et.al. JAMA 283(1) 59-68 http://jama.ama-assn.org/cgi/content/full/283/1/59

The first statistically significant result in the meat of this paper is that patients saw their physician providers higher than their NP providers (p=.05) when measuring for technical skill, personal manner, and time spent with patients. The only other significant finding was that for hypertensive patients, NPs had a diastolic BP of 82mmHg compared with the 85mmHg for physicians. However, the study authors noted that as this was a small difference and both were within the guidelines for hypertension the is unlikely to actually mean much. Lastly, the authors note a number of study limitations. First, all of these patients were seen at academic primary care offices. Second, all of the patients were non-English speaking medicaid patients. Third, the three conditions under study are things that most 4th year medical students would feel comfortable managing. Heck, I spent a month in our diabetes clinic and the only time I had trouble was with pumps.
Study Grade - C+ (done OK, areas of study weak)

Kinnersley et.al. BMJ 320(7241) 1043-1048 http://www.bmj.com/cgi/content/full/320/7241/1043

This study has a lot going on. First, the statistically significant values. Overall, patient satisfaction was higher with nurses (except being told of their diagnosis). This was determined to be a result of increased time per visit and increased explanations (leading to higher time spent). However, in the patients who saw GPs, 73% would seek GP care in the future and only 8% would seek nursing care while in the NP group 32% said they would seek nursing care again while 48% said they would seek GP care in the future. In terms out outcomes, there were no clinically significant differences except some statistical significance in half the practices showing that NPs would recommend follow-up. Moving on, there are a number of limitations to the study. 30% of patients were their for URIs. The follow-up surveys which measured symptom resolution were given 2 weeks after the visit. We all know that most URIs will get better on their own within 2 weeks. These patients could have seen a monkey and gotten better within 2 weeks. The rest were a mix of the standard things GPs deal with (emesis, diarrhea, rashes, allergic/endocrine, and so on) that as mentioned previously can be handled by 4th year medical students without difficulty especially given that this was acute care only. It is also worth noting that 30% of patients were unconcerned about their symptoms which raises a host of questions about why they were there and what was actually wrong with them. It is also worth noting that none of these were NP only practices and the authors note that in about half of the practices, if viewed separately, patients were more satisfied with GP care yet looking at the other half we did not see the same results about NP care.
Study Grade - B (decently designed, no difference in outcomes, satisfaction difference in only about half of practices).

Shum et.al. BMJ 320(7241) 1038-1043 http://www.bmj.com/cgi/content/full/320/7241/1038

Once again, study was only at 5 practices and none of them NP-only. As usual, no significant outcome differences. In this case, 50% of cases were "respiratory disease" and since this was same day acute-care visits, I don't think it is unreasonable to assume that URIs make up a substantial portion. Another 15% was MSK problems and, like URIs, those tend to heal up on their own no matter what we do. Another 10% was skin conditions (rashes) which most any medical person should be able to handle. It is also worth nothing that each NP had to have their Rx signed by a doctor so there was reasonable oversight. As expected, satisfaction scores were higher for nurses, however there is a statistically significant higher satisfaction with the depth of the relationship when patients see GPs as opposed to NPs. As in the previous study, half of the GP patients would want to see the GP again while only 8% of NP patients would want to see the NP with 1/3rd wanting to see the GP next time.
Study Grade - B (very similar to previous study)

Venning et.al. BMJ 320(7241) 1048-1053 http://www.bmj.com/cgi/content/full/320/7241/1048

This study mainly looks at cost-effectiveness, as outcomes were similar and satisfaction was higher in the nursing group as was time spent. Looking at costs as a function of salary, we find the follow: costs as related to total time spent were identical in both groups. This was found to be correlated with the increased return visits recommended by nurses and the increased number of additional testing ordered by nurses which the study calls "opportunistic screening".
Study Grade - B+ (well designed for what it was investigating)

So, in review. Nurses achieved higher satisfaction scores on the whole and in each case there was more time spent talking with the patient. This is nothing new. Everyone everywhere knows that more face time with your provider makes patients happier. Outcomes showed no significance in any of the studies. Nurses were no more cost-effective than physicians, when adjusted for salary owing to increased follow-up and testing again with no outcome differences.

Basically patients like y'all more, likely because you spend more time explaining things to them. There were no outcome differences. You aren't more cost effective. These studies only looked at very basic conditions most if not all of which a decent 4th year medical student could do.

Color me unimpressed.

Excellent synopsis. Don't you think this is where we can find common ground? We can see those patients with more primary concerns and manage them and free you all up to address the more complicated higher acuity people. Then you can spend more time managing their condition? That is the model I advocate.

 

[goosew]

This will push FP's (generalists) out of medical practice in that case won't it?

 

[Rabbit Hole]

Ignoring the fact that you're being a huge jackass despite many of us trying our best NOT to come off that way... I'm working my way through you references and providing my analysis.

Ohman et.al. Annals of Family Medicine 6: 14-22 http://www.annfammed.org/cgi/conten...ance&volume=6&firstpage=14&resourcetype=HWCIT

First, this study only looks at whether practices with NPs outperform those with PAs and physician only groups. Second, this is only in NJ and part of Penn. Third, the sample sizes were exceptionally small (N= 28 MD/DO only, N=9 for PA or NP). Fourth, in the practices that employ both MD/DOs and NPs, the study does not separate results of those NPs and those physicians. For all we know, this could just be a referendum on physicians who choose to practice without NPs (maybe they're less likely to keep up with current recommendations). Fifth, the study only uses laboratory values in this study. There is no mention of any physical findings or glucose log interpretation (which is arguably more important since A1c is only an average. A patient could have values ranging from 40-300 and still have an OK A1c and we can all agree that it isn't healthy). Now, with that out of the way, lets look at the results of NP v. MD/DO only. There were only 3 areas where NP/MO practices outperformed MD only ones were assessing A1c, assessing lipids in last 12 months, treating/assessing lipids and at goal for lipids if not treated. There were no other significant results. It also lacks any kind of evaluation on which provider type practice was better at getting patients to their goal. In short - Grade D (poorly designed, results not impressive nor based on outcome or actual clinical findings, need to compare MD only v. NP only settings)

Side question, not trying to nitpick here.. What's up with the title of this article? I thought the whole apostrophe business was a big no-no in the PA arena. Physician Assistants not Physician's Assistants right?

Quality of Diabetes Care in Family Medicine Practices: Influence of Nurse-Practitioners and Physician's Assistants

Also, I think we're being trolled.

 

[NYRN]

Second, we're all wary of independent practice in the subspecialties. Its the idea of y'all functioning on the level of physician subspecialists

Honestly, not that I want that anyway, but I just never see this happening. Any specialty that requires surgical or invasive procedures are off limits based on that fact alone. We are considered LIP's because we are trained to practice in specific areas, not all areas like MD students are. If you want a very different specialty, you need to go back to school.

I have not brought this up yet in any of these threads, but I will tell you what I imagine for myself as an NP working in a specialty practice.

There are several MD's that I work with in the hospital who have private practices, and they work with the hospital affiliated clinic. There is an MD fellowship also. The attendings and fellows do not take in house call. I would love to be able to take overnight call, take care of consults called at night. I would discuss the patient with the fellow and/or attending, tell them of the findings, and they make the decision of they need to get out of bed and come in to see the patient now or if it can wait till AM.

As many specialists with private practices will tell you, probably 99% of the calls they get on their answering services in the middle of the night are not emergent. I know the MD's would be willing to pay me to take the BS calls in order for a good nights rest. If its not in fact BS or if I am not sure, I can always call the MD and let him make the decision.

If the MD's have a new admission at night to either service or one of their private patients, I can be there to put admission orders in for them. Patient needs certain orders prior to a procedure? I'll put it in for them so they know its done, and not have to rely on an overworked medicine resident to remember.

In the private offices, I can call patients with results of blood tests and biopsies and such that are normal or not serious enough to warrant a follow up visit. That alone the MD's say would save them so much time. I can do patient teaching when they are prescribed new medication and how to prepare for procedures. There are minor procedures that the MD's don't have time to do in the office, but NP's would be allowed to. They are keen on the idea that I can bring them money by doing these. If they hired another MD they would have to share thier procedures with, they don't have to think about with me because I can't (nor do I want) to do them.

The MD's are willing to take me without the fellowship, but I want to do it so that I can get the best training in this specialty that is available to me. Since the fellowship is training is identical (minus any procedures they might do) with 1st year fellows who are doing (amoung other things)consult service and inhospital care, I feel that I would be better prepared for my role than a DNP degree which will teach me nothing. This fellowship is not designed or does it claim to train an NP to be the same as someone in an MD fellowship. It is to train you, in real life, to be a valuble asset to the MD's you work with. I know that this will be the most difficult thing that I will ever do as it pertains to my training, and I bet many people who do it don't make it. I am going to give it my best and get through it.

 

[badasshairday]

Good grief, I had no idea Just goes to show how RAPIDLY things are changing in medicine. It appears that in just 10 years time, the field of physical therapy has inflated their requirements from a bachelors right on up to a doctorate.

"There remains significant criticism[2] regarding the granting of a doctoral level degree for a field that until 1998 only required a bachelors degree.[3] The concern centers around both the need for such a degree and the possibility that physical therapists may incur substantial student debt with an extended education that pays no greater than it did when only a bachelors degree was required."

It is pretty lame. My significant other is in PA school at a university with other professional programs. She has friends in the PT school as well. It was really amusing watching one of her PT school friends talk about how PA's get paid better than PT's despite PT's having a "DOCTORATE," OMG!

 

[Maybeknot]

Excellent synopsis. Don't you think this is where we can find common ground? We can see those patients with more primary concerns and manage them and free you all up to address the more complicated higher acuity people. Then you can spend more time managing their condition? That is the model I advocate.

Except Mary Mundinger, who spearheaded the whole nurse-as-doctor movement who gets a ton of press, who is endlessly cited as the authority on this matter, says that nurses should be running health care teams and doctors should report to them.

You know, because nurses treat the patient and doctors treat the disease.

 

[badasshairday]

Side question, not trying to nitpick here.. What's up with the title of this article? I thought the whole apostrophe business was a big no-no in the PA arena. Physician Assistants not Physician's Assistants right?

Quality of Diabetes Care in Family Medicine Practices: Influence of Nurse-Practitioners and Physician's Assistants

Also, I think we're being trolled.

We are being trolled. And what a stupid title of a study, they can't even get the full PA name correct. Throw it in the trash.

 

[NYRN]

nurses should be running health care teams and doctors should report to them[/B].

You know, because nurses treat the patient and doctors treat the disease.

What???? I have never heard of such a ridiculous thing! This is the opinion of one rogue NP. None of the NP's or the professors I have had advocate this in any way.

 

[DNPgator]

Most of us only have problems with 3 things about DNPs. Our main concern is patient confusion, and since you tell patients that you are an NP then you are 100% OK in my book. Second, we're all wary of independent practice in the subspecialties. We may not like it, but primary care independent NPs are here to stay (even in supervised states that supervision can be VERY loose). Its the idea of y'all functioning on the level of physician subspecialists. This stems from the third issue we have. I just checked. The one place in my state that offers a DNP degree is almost entirely through online education. For stuff like pharm, pathophys, and micro this is not a problem at all. This does become a problem in large part because this program only requires 1000 hours of clinical training. I got that much as a medical student in 2 rotations. I did 10 more in my training. As a resident, I'll get that in 2 months. I'll be doing 34 more of those in my training. This is only for Family Medicine. The derm people will be doing an extra 12 months on top of what I do. How does your training equate to this?

Anyway, past that first post you seem pretty reasonable and I hope we can continue this discussion without any hostility.

My first post I was a little ticked off. I do not equate my training to that of a medical resident. That would be foolish. We are given credit at this time in the programs for our internships we did to get our Masters degrees and become nurse practitioners (2000 hrs in my case). We also had two years of supervised hospital experience as RN students prior to that. Most of us worked in hospitals while attending graduate school to get our Masters. I worked full time nights as an oncology RN. I loved that job. It was the physicians who encouraged me to continue my education. To demean and insult a profession and those in it by citing IQ scores as some did I think you would agree is silly.

I cannot speak for other DNP's or ARNP's but I think personally that it is important to continually expand upon our knowledge base and attempt to find ways to better care for patients. I feel the online DNP programs that require no clinical experience are a farce just as you do. I would like to be able to find a way to ensure that these programs cannot use this term.

We are new at the doctoral level. It was my understanding that the clinical programs like the one at Columbia, which is being followed by USF, UF and others, was created to address concerns brought forward by physicians concerning our training. Physicians are an integral part of our continued training at the DNP level as well.

I think if we get past the surface issues, we really want the same thing.

 

[keeping-it-real]

Nurses often forget that they were not trained to act as diagnosticians. Coincidentally, PAs, who were in fact trained as diagnosticians, are often said to be less qualified by NPs. But PAs aren't doctors like DNPs, so I guess they must not be as qualified. I would like to know how technical and academic nursing can be, though, that there is a need for doctorate-level coursework...or even Master's level work.

For those not familiar, google "the Downing effect" as it provides an explanation for nursing behavior.

 

[keeping-it-real]

My first post I was a little ticked off. I do not equate my training to that of a medical resident. That would be foolish. We are given credit at this time in the programs for our internships we did to get our Masters degrees and become nurse practitioners (2000 hrs in my case). We also had two years of supervised hospital experience as RN students prior to that. Most of us worked in hospitals while attending graduate school to get our Masters. I worked full time nights as an oncology RN. I loved that job. It was the physicians who encouraged me to continue my education. To demean and insult a profession and those in it by citing IQ scores as some did I think you would agree is silly.

I cannot speak for other DNP's or ARNP's but I think personally that it is important to continually expand upon our knowledge base and attempt to find ways to better care for patients. I feel the online DNP programs that require no clinical experience are a farce just as you do. I would like to be able to find a way to ensure that these programs cannot use this term.

We are new at the doctoral level. It was my understanding that the clinical programs like the one at Columbia, which is being followed by USF, UF and others, was created to address concerns brought forward by physicians concerning our training. Physicians are an integral part of our continued training at the DNP level as well.

I think if we get past the surface issues, we really want the same thing.

It's pretty clear you and your colleagues just don't get it. Your groups can continue to fabricate degrees in order to ostensibly justify your knowledge, but the reality is that you still aren't qualified to practice medicine.

The two concepts that continue to evade nurses are: 1) There is no substitution for knowledge and experience and 2) Garbage in = garbage out. Create all the degrees you guys like. Call it "Supreme master of the universe" degree, or "Presidential knowledge" degree. Walk around with white coats and inflated senses of self-esteem...

It doesn't change the fact that nobody is trained to practice medicine until the proper subject matter has been studied and until it has been appropriately practiced for an appropriate amount of time.

An aerospace engineer with a BSc who couldn't fly an F-22 is still equally incapable of flying an F-22 after getting his/her PhD.

 

[BassCaster]

We are new at the doctoral level. It was my understanding that the clinical programs like the one at Columbia, which is being followed by USF, UF and others, was created to address concerns brought forward by physicians concerning our training. Physicians are an integral part of our continued training at the DNP level as well.

I think if we get past the surface issues, we really want the same thing.

To be called doctor and same reimbursements

 

[VA Hopeful Dr]

Excellent synopsis. Don't you think this is where we can find common ground? We can see those patients with more primary concerns and manage them and free you all up to address the more complicated higher acuity people. Then you can spend more time managing their condition? That is the model I advocate.

That's where we are now, and I'm OK with that.

Honestly, not that I want that anyway, but I just never see this happening. Any specialty that requires surgical or invasive procedures are off limits based on that fact alone. We are considered LIP's because we are trained to practice in specific areas, not all areas like MD students are. If you want a very different specialty, you need to go back to school.

I have not brought this up yet in any of these threads, but I will tell you what I imagine for myself as an NP working in a specialty practice.

There are several MD's that I work with in the hospital who have private practices, and they work with the hospital affiliated clinic. There is an MD fellowship also. The attendings and fellows do not take in house call. I would love to be able to take overnight call, take care of consults called at night. I would discuss the patient with the fellow and/or attending, tell them of the findings, and they make the decision of they need to get out of bed and come in to see the patient now or if it can wait till AM.

As many specialists with private practices will tell you, probably 99% of the calls they get on their answering services in the middle of the night are not emergent. I know the MD's would be willing to pay me to take the BS calls in order for a good nights rest. If its not in fact BS or if I am not sure, I can always call the MD and let him make the decision.

If the MD's have a new admission at night to either service or one of their private patients, I can be there to put admission orders in for them. Patient needs certain orders prior to a procedure? I'll put it in for them so they know its done, and not have to rely on an overworked medicine resident to remember.

In the private offices, I can call patients with results of blood tests and biopsies and such that are normal or not serious enough to warrant a follow up visit. That alone the MD's say would save them so much time. I can do patient teaching when they are prescribed new medication and how to prepare for procedures. There are minor procedures that the MD's don't have time to do in the office, but NP's would be allowed to. They are keen on the idea that I can bring them money by doing these. If they hired another MD they would have to share thier procedures with, they don't have to think about with me because I can't (nor do I want) to do them.

The MD's are willing to take me without the fellowship, but I want to do it so that I can get the best training in this specialty that is available to me. Since the fellowship is training is identical (minus any procedures they might do) with 1st year fellows who are doing (amoung other things)consult service and inhospital care, I feel that I would be better prepared for my role than a DNP degree which will teach me nothing. This fellowship is not designed or does it claim to train an NP to be the same as someone in an MD fellowship. It is to train you, in real life, to be a valuble asset to the MD's you work with. I know that this will be the most difficult thing that I will ever do as it pertains to my training, and I bet many people who do it don't make it. I am going to give it my best and get through it.

I'm OK with the role you've described. You're working with the MDs not off by yourself. Also, and this is what started this whole thing, you won't be calling yourself a "residency trained doctor" like some of the NPs/DNPs on the news have been doing. I certainly applaud anyone going for additional knowledge, but I do have a question. Looking at my state's major medical university, I see that it takes 3-4 years to get a BSN. After that, it takes 2 years to get an NP OR you can take 4 years and get your DNP. If you have your masters NP you can get your DNP in 2 years. This has us looking at between 7-8 years of school. If we include another 2-3 years either for work or if doing the degrees part time we'll hit 10-11 years. I can be a family doctor in 11. You're taking the same amount of time to train and producing a product which, with all respects, is less prepared. I'm not questioning your knowledge of general intelligence, merely pointing out that after my 11 years I fully expect to have more medical knowledge than a person who did what I outlined above. This is due to the differences in curriculum mainly and isn't a critique of the people who are nurses.

For example, to get your DNP from this place if you already have a MSN you must take the following courses.
Semester 1 - Organizational Theory and Health Care Management, Frameworks for Leadership and Interprofessional Collaboration, Biostatistics.

Semester 2 - Advanced Health Policy and Advocacy, Research Use and EBM, and Intoduction to Social and Applied Epidemiology.

Quite frankly, I feel to see how those classes really improve upon your clinical skills. Of note, if you're done MSN courses in any other and get a B, the course will be waived and you get credit for it.

Semester 3 - Applied Health Care Economics and Finance, Informatics in Health Care Delivery, and Health Program Planning.

Semester 4 - Knowledge Dissemination and Translation and a 6 hour "residency" with semester 5 have the same residency requirement.

Other than those 12 hours of clinical work, how does this make you a better practitioner?

My first post I was a little ticked off. I do not equate my training to that of a medical resident. That would be foolish. We are given credit at this time in the programs for our internships we did to get our Masters degrees and become nurse practitioners (2000 hrs in my case). We also had two years of supervised hospital experience as RN students prior to that. Most of us worked in hospitals while attending graduate school to get our Masters. I worked full time nights as an oncology RN. I loved that job. It was the physicians who encouraged me to continue my education. To demean and insult a profession and those in it by citing IQ scores as some did I think you would agree is silly.

I cannot speak for other DNP's or ARNP's but I think personally that it is important to continually expand upon our knowledge base and attempt to find ways to better care for patients. I feel the online DNP programs that require no clinical experience are a farce just as you do. I would like to be able to find a way to ensure that these programs cannot use this term.

We are new at the doctoral level. It was my understanding that the clinical programs like the one at Columbia, which is being followed by USF, UF and others, was created to address concerns brought forward by physicians concerning our training. Physicians are an integral part of our continued training at the DNP level as well.

I think if we get past the surface issues, we really want the same thing.

No worries, this is a heated discussion after all.

Similar to my original point above this, it sounds like you are wanting a curriculum that provides you with enough training to do about half of what your general PCP does but at the same time expense. What's the point of that especially as I listed above that many of the classes to get that DNP are useless fluff.

 

[NYRN]

Nurses often forget that they were not trained to act as diagnosticians. Coincidentally, PAs, who were in fact trained as diagnosticians, are often said to be less qualified by NPs. But PAs aren't doctors like DNPs, so I guess they must not be as qualified. I would like to know how technical and academic nursing can be, though, that there is a need for doctorate-level coursework...or even Master's level work.

For those not familiar, google "the Downing effect" as it provides an explanation for nursing behavior.

This i just ignorant. You are talking out of your ass. Are you saying that a PA with no clinical experience before enrolling, and has 2 years of training in school not all of which is clinicals is going to be better off than an NP who had 10 years of RN experience before entering school is going to be? I don't think so. I work with PA's who are excellent practitioners, but it takes experience to get there. Some had medical experience before going to PA school, and the difference between those people and those who had candystriper experience before enrolling is huge. PA's and NP's are taught how to diagnose. PA's work under an MD so they are always covered and NP's are taught to diagnose in their specialized field of training. That is the point of school.

If you don't know how academic or technical nursing can be, than don't comment on it. Many nursing studies that deal with care have been embraced by the medical community. Experts and researchers from medical and nursing groups are often working together to improve care. For instance the ENA and ACEP are working to improve emergency care.

If you really think that RN's are simply puppets who are controlled by you, than I have a hard time believing you have ever worked in a hospital. Are RN's trained to diagnose? No, but you better believe that we are trained to take data and assessment of the patient to come up with a decision of what might be wrong with this patient. Do you want a nurse who is a robot and simply follows order without thinking on his/her own, or do you want the nurse that sees your patient is diaphoretic, pale and is clutching his chest to call you and say, I think this patient is having an MI, come and see him. Is that making a diagnosis? No it isn't, but taking the knowledge and experience you have and collecting data to figure out what is wrong with the patient is the first step to creating a diagnosis, or in my case, trying to figure out what the diagnosis would be so I can take the appropriate steps to prevent this patient from coding.

 

[VA Hopeful Dr]

Side question, not trying to nitpick here.. What's up with the title of this article? I thought the whole apostrophe business was a big no-no in the PA arena. Physician Assistants not Physician's Assistants right?

Quality of Diabetes Care in Family Medicine Practices: Influence of Nurse-Practitioners and Physician's Assistants

Also, I think we're being trolled.

That's why this article wasn't published in a PA journal. I bet if you gave 1000 MDs a survey that said "A PA is: a) A physician's assistant b) a physician assistant" that you'd get a whole lot of As.

Original purpose may have been to troll, but I'm getting some reasonable responses here.

 

[sore eye asses]

I have had fun with this. I am going to help you all out here. You can thank me later. I figured what I posted would get your attention. You all obviously love your chosen field and are passionate about this issue. You are idealists, I can respect that, but so were those at Jonestown. Don't be so quick to drink the hate the DNP kool-aid. "Can't we all just get along?" Rodney King

You are focusing on the wrong issue. You as a group should be applauding a formalized residency program for NP's and DNP's. These are organized by the nursing programs but are administered in large part by MD's at teaching hospitals alongside medical residents. My biggest problem with my profession as a whole is a lack of standardization in training for advanced practice. Whether you like it or not, there is a need for advanced practice nurses. We are not mid-levels or extenders. My knowledge base and ability to care for patients does not stop at a physicians umbilicus nor am I some phalic extending off the great body of medical knowledge. We, as you all have pointed out, some eloquently, others rudely, are also not physicians. We are health care providers though and most of us do a great job in our roles.

I am not a psycho like some have said nor am I a rogue NP demanding independence and equal pay. Those battles have been raging for years. Do I think we deserve this as DNP's, yes, but that is not why I chose to get this degree. I do like to ruffle feathers and hope that people will stop and think about what we DNP's with clinical degrees are trying to accomplish. Standardized training for advance practice nurses. This is the goal.

A video produced by the college of nursing for prospective nursing students where someone with a doctorate in nursing calling themselves doctor should not upset you this much. By 2015, there will be no more Masters level programs. All NP will have doctoral degrees. It is my hope, and from my understanding, it is the plan, that these programs will be transparent and the learning experiences will be more formalized.

I agree that the NP education and training at the Masters level is insufficient for independent practice, but in some states we already have it. Some of your colleagues train NP's for 6 weeks and set them loose on their patients. This leads to wide disparities in training. This is why the DNP is important.

I do not believe that we as a profession should be in a subservient role to physicians. I work alongside and in collaboration with many excellent doctors including Mohs surgeons, Plastic surgeons, cutaneous surgical oncologists, and dermatologists. They understand and respect my degree and training. I also defer to their expertise when needed. I know when that is needed.

The real patient safety issue regarding Nurse Practitioners is the lack of standardized residency programs to ensure proper training and physicians who are looking to make more money by seeing patients in clinics utilizing undertrained providers. Programs like those at USF and other DNP programs are trying to address this issue.

The real point, DNPgator, is that pay and title should be commensurate with skill and knowledge base.

If you can prove to me that your attenuated education (compared to an MD or DO) is equivalent to or better than the 20,000+ hours of training a BC derm gets, then I will cede all arguments.

The problem is, you're asking for something you did not earn, and it's offensive to those of us who sacrificed (or are currently in the process of sacrificing) so much to get where we are.

An analogy would be a medical assistant asking to be referred to as a nurse. She would claim that despite her having far less training, she still does 90% of what a nurse does. She cares for the patient just the same. Would this offend you, as a nurse? Would this cheapen the hard work you had put in to become a nurse? What if it wasn't just one MA that was making these claims, but a whole group? And what if that group was lobbying to make themselves appear equal to nurses in the clinical setting? Would this offend you? Would this frighten you? It ought to. Would you wonder why they just didn't go to nursing school if they wanted to have the rights and priviledges that go along with that title?

And as a final note, I take no issue with DNP derm programs. Just, when you finish, refer to yourself by your earned title, that of DNP. To call yourself doctor, and leave it at that, purposely creates confusion.

 

[VA Hopeful Dr]

We are being trolled. And what a stupid title of a study, they can't even get the full PA name correct. Throw it in the trash.

Of course, because a title isn't what you think it should be then its not worth anything.

Good God man, if its in a physician journal its at least worth reading the abstract.

 

[sore eye asses]

DNPgator,

care to comment on Reno911's post from yesterday? See, up until this point you had been arguing the issue with medical students, who despite being passionate about the subject, lack the insight of a BC dermatologist. However, now we have some input from a real dermatologist who takes issue with many of your claims. Just wondering if you have any rebuttal?

 

[carrigallen]

To be called doctor and same reimbursements

 

[NYRN]

VA, I see what you are saying. It doesn't make sense that someone could go through all that nursing school or do med school and be finished at the same time. I think the reason is, not everyone can make the sacrifice of the 4 years plus residency for a variety of reasons. In the end does the 11 years of nursing ed equal the med school + residency? No, but that is the choice you make if you choose to take an advance practice role over an MD role.

Do I wish I would have went straight to MD? I have thought about it in the past, but I am happy with what I am doing. If I had some strong desire to do surgery or interventional rads or something, than I would go back and do med school because NP is not going to get me anywhere near that.

 

[DNPgator]

The real point, DNPgator, is that pay and title should be commensurate with skill and knowledge base.

If you can prove to me that your attenuated education (compared to an MD or DO) is equivalent to or better than the 20,000+ hours of training a BC derm gets, then I will cede all arguments.

The problem is, you're asking for something you did not earn, and it's offensive to those of us who sacrificed (or are currently in the process of sacrificing) so much to get where we are.

An analogy would be a medical assistant asking to be referred to as a nurse. She would claim that despite her having far less training, she still does 90% of what a nurse does. She cares for the patient just the same. Would this offend you, as a nurse? Would this cheapen the hard work you had put in to become a nurse? What if it wasn't just one MA that was making these claims, but a whole group? And what if that group was lobbying to make themselves appear equal to nurses in the clinical setting? Would this offend you? Would this frighten you? It ought to. Would you wonder why they just didn't go to nursing school if they wanted to have the rights and priviledges that go along with that title?

And as a final note, I take no issue with DNP derm programs. Just, when you finish, refer to yourself by your earned title, that of DNP. To call yourself doctor, and leave it at that, purposely creates confusion.

Good analogy. It is funny that most doctors I have worked with call their MA's nurses when in fact they are not. This is also confusing to patients. I do refer to myself as a DNP.

 

[jbz24]

It's times like these when I wish our profession had a true voice (or union, although I don't like unions) to do away with NPs/DNP rights altogether. Really, the role of a PA makes much more sense than a NP/DNP ever will.

 

[keeping-it-real]

This i just ignorant. You are talking out of your ass. Are you saying that a PA with no clinical experience before enrolling, and has 2 years of training in school not all of which is clinicals is going to be better off than an NP who had 10 years of RN experience before entering school is going to be? I don't think so. I work with PA's who are excellent practitioners, but it takes experience to get there. Some had medical experience before going to PA school, and the difference between those people and those who had candystriper experience before enrolling is huge. PA's and NP's are taught how to diagnose. PA's work under an MD so they are always covered and NP's are taught to diagnose in their specialized field of training. That is the point of school.

If you don't know how academic or technical nursing can be, than don't comment on it. Many nursing studies that deal with care have been embraced by the medical community. Experts and researchers from medical and nursing groups are often working together to improve care. For instance the ENA and ACEP are working to improve emergency care.

If you really think that RN's are simply puppets who are controlled by you, than I have a hard time believing you have ever worked in a hospital. Are RN's trained to diagnose? No, but you better believe that we are trained to take data and assessment of the patient to come up with a decision of what might be wrong with this patient. Do you want a nurse who is a robot and simply follows order without thinking on his/her own, or do you want the nurse that sees your patient is diaphoretic, pale and is clutching his chest to call you and say, I think this patient is having an MI, come and see him. Is that making a diagnosis? No it isn't, but taking the knowledge and experience you have and collecting data to figure out what is wrong with the patient is the first step to creating a diagnosis, or in my case, trying to figure out what the diagnosis would be so I can take the appropriate steps to prevent this patient from coding.

You are missing the point that experience alone is not sufficient. Nurses are not trained to diagnose and manage patients. PAs are. The training of a PA is much more alligned with the training of a physician. PAs, while not physicians, are trained in taking histories, formulating differential diagnoses, and rendering treatment. Nurses are never given such training, and that is the difference. 10 years as an RN does not replace 2 years of formal training learning about disease process, presentation, and diagnosis.

Your analogy to calling the MD to evaluate your "MI" patient is a great one that exemplifies why you aren't and shouldn't be managing your own patients. Experience can teach you to recognize a sick patient. It cannot alone, though, teach you to consider the multitude of disease processes that may be taking place but appear similar. Your immediate diagnosis of "MI" might be spot-on or it may cause you to fail to consider other equally dangerous disease processes taking place. Your ability to perform a limited assessment is not a replacement for actual knowledge.

The primary role of a nurse is not to diagnose and manage. The fact that experience may provide a bit of extra medical knowledge doesn't change this fact. By thinking that you know more than you actually do, you're only putting yourself in a situation to cause even more damage when something is missed. The problem many nurses have is that they simply don't know how much there is to know, and because of this they fail to adequately recognize their limitations.

 

[keeping-it-real]

Good analogy. It is funny that most doctors I have worked with call their MA's nurses when in fact they are not. This is also confusing to patients. I do refer to myself as a DNP.

DNP = Doctor, Not Physician?

 

[DNPgator]

DNPgator,

care to comment on Reno911's post from yesterday? See, up until this point you had been arguing the issue with medical students, who despite being passionate about the subject, lack the insight of a BC dermatologist. However, now we have some input from a real dermatologist who takes issue with many of your claims. Just wondering if you have any rebuttal?

I like the show Reno911. Its pretty funny. As you can see though my points were not directed at Dermatologists nor any other specialty. I defer to their expertise. My biggest issue has always been the way in which some have been degrading the nursing profession as a whole. Calling into question the IQ and intelligence of those who work with you is not the best team building strategy. I have never even seen the video that started this whole debate, but I was upset by the ways in which nursing as a whole was being belittled.