NPs can now do dermatology residencies

[JaggerPlate]

Aside from the name tags mentioned above, which are a good idea, the best way to distinguish yourself as a physician is probably to NOT wear a white coat. Now that the nursing students are wearing them, it's only a matter of time before the custodial staff and security guards want in on the action.

Yup. At the ER I was in, everrryonnne except the physicians wore white coats. It was seriously the best way to tell. I think DO/MDs just need to adopt a new coat color and keep switching it up every decade or so when the trend catches on.

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Members don't see this ad.

 

[Charles_Carmichael]

Yup. At the ER I was in, everrryonnne except the physicians wore white coats. It was seriously the best way to tell. I think DO/MDs just need to adopt a new coat color and keep switching it up every decade or so when the trend catches on.

Physicians need to start wearing pink coats from now on or dress up in Halloween costumes or something. I'm sure that nurses, etc, will follow though, stating that it helps patient care...

 

[JaggerPlate]

Physicians need to start wearing pink coats from now on or dress up in Halloween costumes or something. I'm sure that nurses, etc, will follow though, stating that it helps patient care...

It's all about the Nip/Tuck blue:

http://entertainment.ca.msn.com/tv/gallery.aspx?cp-documentid=21286402&page=23

 

[jake2]

The white coat thing is a big pet peeve of mine. In what other field of human endeavor do people wear somebody else's pointless uniform in order to feel important? I don't see law clerks wearing judicial robes and then telling the judges they are *******s for thinking it is odd and sometimes inappropriate.

It's just plain illegal in to wear a military or police uniform without the proper authorization. Why? Because people may abuse the position of authority those uniforms signify. Granted it's orders of magnitude different for the white coat thing but still.

At my hospital, the following groups of people wear long white coats: chaplains, the IT staff, nursing students, floor nurses, respiratory therapy, PT/OT, dieticians, and, yes, even a janitor every now and then.

And don't tell me they're to keep patient vomit off of you. Every white coat I see on a non-physician is always spotlessly clean and recently pressed.

Thus ends my little rant. More to the point, some of these NP residency things really scare the hell out of me. There are cardiology "residencies" being offered!

 

[Socrates25]

So we all know that Columbia is the epicenter of the militant NP movement. "DOCTOR" Mary Mundinger works there and set up this so-called "clinic" that is staffed 100% by NPs with no MD involvement.

http://www.capna.com/CAPNA/whatwhere.html

For the residents up there -- whats your interaction with them, if any? I'm assuming they put NP students on your teams for their required "inpatient" experience.

Does Mundinger's clinic admit to your service? Or do they run their own internal medicine NP service?

What are your attendings' thoughts on this?

 

[J-Rad]

Since we already have an active and robust thread discussing the issue of ARNPs and its relationship to residency issues, I am merging this post into that ongoing thread.

 

[JohnHolmes]

As a dermatology resident, I am not too worried about this. I think that APRN and DNP's will continue to be employed within the capacity of physician extenders in the setting of Dermatologic practice. I do not think that we will see many APRNs or DNPs out in group practice with only other advanced practice nurses. The dermatologic training proposed is not intended to be comparable to a dermatologic residency.

Furthermore, nursing practice in dermatology would be significantly limited by limitations in training in procedural dermatology and skin surgeries. A dermatology practice of advanced practice nurses would be very limited in their capacity to treat and deal with the treatment cutaneous malignancies, one of the mainstays of dermatologic practice, as compared to an integrated dermatology practice of physicians and nurses. Dermatology nursing residency does not deal with the complexity of skin surgeries and wound care required to perform the surgeries. Even if such training was offered, advanced practice nurses graduating such a residency would not have the training or fluency with dermatopathology needed for complex clinical decision at the point of care for for disposition of these skin cancers. Rendering treatments for such skin cancers without this important training would lead to an unacceptably high number of over- or under-treatment. Routinely referring routine skin surgeries and procedures to procedural dermatologists and surgeons would represent an create unnecessary and potentially harmful delays in care for definitive treatments and significant hardship for many patients.

Lastly, such arrangements could result in unacceptable diagnostic delay with profoundly negative implications for patient care in non-routine cases. While studies have consistently established APRNs are able to achieve similar performance bench marks as dermatologic physicians when managing atopic dermatitis in patients with a previously established diagnosis, the much more rare entities such as acrokeratosis neoplastica and acrodermatitis enteropathica present a diagnostic dilemma, and may be either missed by practitioners not actively considering the diagnosis or grossly mismanaged with topical steroids as "refractory eczema" until resection with curative intent of the underlying glucagonoma is no longer possible.

Using legislative and regulatory changes to practice beyond the scope of clinical training creates unacceptable risks to patient safety and compromises clinical care.

 

[justaregularmed]

As a dermatology resident, I am not too worried about this. I think that APRN and DNP's will continue to be employed within the capacity of physician extenders in the setting of Dermatologic practice. I do not think that we will see many APRNs or DNPs out in group practice with only other advanced practice nurses. The dermatologic training proposed is not intended to be comparable to a dermatologic residency.

Furthermore, nursing practice in dermatology would be significantly limited by limitations in training in procedural dermatology and skin surgeries. A dermatology practice of advanced practice nurses would be very limited in their capacity to treat and deal with the treatment cutaneous malignancies, one of the mainstays of dermatologic practice, as compared to an integrated dermatology practice of physicians and nurses. Dermatology nursing residency does not deal with the complexity of skin surgeries and wound care required to perform the surgeries. Even if such training was offered, advanced practice nurses graduating such a residency would not have the training or fluency with dermatopathology needed for complex clinical decision at the point of care for for disposition of these skin cancers. Rendering treatments for such skin cancers without this important training would lead to an unacceptably high number of over- or under-treatment. Routinely referring routine skin surgeries and procedures to procedural dermatologists and surgeons would represent an create unnecessary and potentially harmful delays in care for definitive treatments and significant hardship for many patients.

Lastly, such arrangements could result in unacceptable diagnostic delay with profoundly negative implications for patient care in non-routine cases. While studies have consistently established APRNs are able to achieve similar performance bench marks as dermatologic physicians when managing atopic dermatitis in patients with a previously established diagnosis, the much more rare entities such as acrokeratosis neoplastica and acrodermatitis enteropathica present a diagnostic dilemma, and may be either missed by practitioners not actively considering the diagnosis or grossly mismanaged with topical steroids as "refractory eczema" until resection with curative intent of the underlying glucagonoma is no longer possible.

Using legislative and regulatory changes to practice beyond the scope of clinical training creates unacceptable risks to patient safety and compromises clinical care.

Bwhahaha, what a well thought out and concise post.

The question is will opposing the nursing unions be worth the lost votes and money, that's what we're up against. You can expect a wonderful litany of poor studies to prove your assertions incorrect.

 

[Carboxide]

This coat debate is hilarious. I work at a MAJOR teaching hospital (I'm sure you've heard of it), and everyone there - EVERYONE - gets a long white coat. I recently had a blood draw done on me by an RN with a long coat. Not even an NP. No. An RN. She bruised the crap out of my arm, too.

I, of course, wear my short coat because: a). it is awesome, and b). I'm going to have a doctorate, so I deserve it. After all, 8 years of didactic learning and a 2 year residency is a lot. But a lot of the pharmacy techs here wear long coats (unembroidered) and I think it's weird.

 

[oldiebutgoodie]

This coat debate is hilarious. I work at a MAJOR teaching hospital (I'm sure you've heard of it), and everyone there - EVERYONE - gets a long white coat. I recently had a blood draw done on me by an RN with a long coat. Not even an NP. No. An RN. She bruised the crap out of my arm, too.

Well, of course she bruised up your arm. Only the phlebotomists can really do a good job drawing blood.

Oldiebutgoodie

 

[Long Dong]

Bwhahaha, what a well thought out and concise post.
.

Yeah because he's one of the smartest dudes I know.

 

[karizma098]

This coat debate is hilarious. I work at a MAJOR teaching hospital (I'm sure you've heard of it), and everyone there - EVERYONE - gets a long white coat. I recently had a blood draw done on me by an RN with a long coat. Not even an NP. No. An RN. She bruised the crap out of my arm, too.

I, of course, wear my short coat because: a). it is awesome, and b). I'm going to have a doctorate, so I deserve it. After all, 8 years of didactic learning and a 2 year residency is a lot. But a lot of the pharmacy techs here wear long coats (unembroidered) and I think it's weird.

do you really consider 4 years of college 'didactice training'

 

[Paddington]

Interesting, I wasn't aware that we had such a shortage of dermatological care. What is the DNP's excuse this time?

Whole Dermatology field is a racket. They've done one thing well, which is to limit the supply of Dermatologists. Therefore, every Dermatologist in this country has a huge waiting list of patients. They have considereable power to charge what they want and get away with it.

Of course, they get away with it because of the nature of their field. If the Pediatricians, for example, attempted this strategy, there would be lots of kids dropping dead all over the place. With Derm, most of the conditions aren't emergencies. There's also some cross coverage there. Allergists can see and treat a number of conditions (esp. the ones that don't need interventions). Plastic surgeons can do biopsies, excisions, as well as cosmetic procedures. EM doctors can take care of emergencies, etc.

I don't have a problem with other people trying to get in on Derm's turf.

 

[Nellyakgo]

So we all know that Columbia is the epicenter of the militant NP movement. "DOCTOR" Mary Mundinger works there and set up this so-called "clinic" that is staffed 100% by NPs with no MD involvement.

http://www.capna.com/CAPNA/whatwhere.html


Does Mundinger's clinic admit to your service? Or do they run their own internal medicine NP service?

What are your attendings' thoughts on this?

According to their FAQ page, yes, they have admitting privileges to NY Presbyterian Hospital.

Separately - I recently went to see a dermatologist at a famous teaching hospital. Later I telephoned with a super simple question which I thought the nurse would answer. The first nurse I talked to couldn't answer the question and wouldn't even attemp to. Then I called a second location where the doctor was that day. The nurse there, rather than trying to answer the Q put me through to the doctor so fast - I can only say I am mightly unimpressed by the nurses at these 2 clinics affiliated with this major university teaching hospital.

 

[Nellyakgo]

Well, of course she bruised up your arm. Only the phlebotomists can really do a good job drawing blood.

Oldiebutgoodie

Whaaaaat?!! I take major issue with that. Some people are good with their hands and some aren't. It doesn't matter for how long they've being doing it the bad ones will always be clumsy. I think every doctor too, should be able to do it reasonably well at least.

 

[bawer234]

Maybe medical students and doctors should swap coats. Doc's could starting wearing the short coats and med students could wear the long ones.

That way doc's could actually be identified and med students would be more on par with everyone else's experience level in the hospital who wear the long coats.

 

[karizma098]

Maybe medical students and doctors should swap coats. Doc's could starting wearing the short coats and med students could wear the long ones.

That way doc's could actually be identified and med students would be more on par with everyone else's experience level in the hospital who wear the long coats.

at mass general/harvard, all the attendings wear short coats. they consider themselves 'lifelong students'.

 

[Clp321]

Wondering why the lawyers of the world haven't come after them for incompetent practice yet? I should just get my MD/JD and make a killing off of suing the DNPs and NPs for their general incompetence

 

[RandySavage]

New article in today's NYT: http://www.nytimes.com/2011/10/02/health/policy/02docs.html?_r=1&ref=health

Some highlights from the article

Nursing leaders say that their push to have more nurses earn doctorates has nothing to do with their fight of several decades in state legislatures to give nurses more autonomy, money and prescriptive power.

Physical therapists once needed only bachelor's degrees, too, but the profession will require doctorates of all students by 2015 — the same year that nursing leaders intend to require doctorates of all those becoming nurse practitioners.

Last year, 153 nursing schools gave doctor of nursing practice degrees to 7,037 nurses, compared with four schools that gave the degrees to 170 nurses in 2004, when the association of nursing schools voted to embrace the new degree. In 2008, there were 375,794 nurses with master's degrees and 28,369 with doctorates, according to a recent government survey.

Dr. Potempa said that nurses with master's degrees were every bit as capable of treating patients as those with doctorates.

While instruction at each school varies, Dr. McCarver took classes in statistics, epidemiology and health care economics to earn her doctor of nursing practice degree. These additional classes, at Vanderbilt University, did not delve into how to treat specific illnesses, but taught Dr. McCarver the scientific and economic underpinnings of the care she was already providing and how they fit into the nation's health care system.

Studies have shown that nurses with master's level training offer care in many primary care settings that is as good as and sometimes better than care given by physicians, who generally have far more extensive training.

Not true, Dr. Potempa said — the new degree simply ensures that nurses stay competent. "It's not like a group of us woke up one day to create a degree as a way to compete with another profession," she said. "Nurses are very proud of the fact that they're nurses, and if nurses had wanted to be doctors, they would have gone to medical school."

"Dr." Potempa almost made the argument against the DNP degree on her own admission, first stating, "nurses with master's degrees were every bit as capable of treating patients as those with doctorates," and then with the last bolded portion of the article.

 

[Taurus]

New article in today's NYT: http://www.nytimes.com/2011/10/02/health/policy/02docs.html?_r=1&ref=health

Some highlights from the article

"Dr." Potempa almost made the argument against the DNP degree on her own admission, first stating, "nurses with master’s degrees were every bit as capable of treating patients as those with doctorates," and then with the last bolded portion of the article.

That was probably the most balanced article on the DNP I've read by the mainstream media. They really hit on the weaknesses of the DNP in terms of their training and being no better than a master's level NP clinically.

 

[bungholio]

This coat debate is hilarious. I work at a MAJOR teaching hospital (I'm sure you've heard of it), and everyone there - EVERYONE - gets a long white coat. I recently had a blood draw done on me by an RN with a long coat. Not even an NP. No. An RN. She bruised the crap out of my arm, too.

As a medical student, I was in a clinic with a high school student shadowing. (she got to shadow because she was in AP bio at a local school.) She had an embroidered long while coat - with her name and her high school on it. I still had my short coat. The indignity was palpable.

 

[Top Gun]

The same could be said about doctors of osteopathy. It was designed to supply primary care in underserved areas but many go on to specialize. And most are beginning to accept DO as equivalent to MD. Let's face it, being a doctor isn't rocket science. The hardest part of medicine is getting into medical school.

There's a big difference between the DO and NP. The DO receives the same training as an MD. The only thing different is that DO's also receive training in manipulation. An NP receives an abridged version of the training that a physician receives.
So, if NPs wish to practice, they should stick to managing simple medical problems, and leave the more complex ones to physicians, and also work in collaboration with a physician.

 

[Palintology]

Did this garbage go under? The website is now defunct.

 

[startswithb]

Yeah, what's up??

 

[bongyonghorangi]

I've been reading through this forum and I wanted to add my 2 cents. I'm not a physician or a nurse. I'm not in school for either. I'm just a young mother of two who is taking classes at a community college. I love to learn and I love the in dept knowledge that is required to become an MD. I do appreciate it and understand it's place in your work.
I'm a little horrified that someone with subpar education can get a pass on this. I'm also quite annoyed as many of you have said, with all hospital employee wearing the white coat, I thought I was the only one who noticed that as being kinda unethical. I bring my daughter and son in to see their PCP, and they are almost always seen by a NP. I'm not trying to devalue anyone's hard work or education. I do think mid-levels have an important part in the health care system, but a doctor's job should be left to a doctor (as in MD physician) when it comes to diagnosing and prescribing medications (this NP has diagnosed wrong twice), not to mention anesthesia!

I do think many people could care less, as long as their cost (if they even pay) is reduced and they are seem as soon as possible. Kinda a McDonaldization so to speak. I understand their complaints but I'm still worried about how all this will play out in the long run.

 

[DrNEW]

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.

Absolutely agree. "Doctor" is supposed to give credit to where/whom the credit due (academic achievements), not a monopoly and certainly not just for medical field/specialty.

 

[deleted87716]

Absolutely agree. "Doctor" is supposed to give credit to where/whom the credit due (academic achievements), not a monopoly and certainly not just for medical field/specialty.

Absolutely.

 

[DrAwsome]

Absolutely.

In my humble opinion, I think this is your best post thus far.
I wonder what the scope of practice of Dr. Pepper is?

 

[cdmguy]

Does this clinic sound fishy? Vascular surgeon with no diplomate supervising a nurse practitioner in a clinic that does everything from laser skin resurfacing to G spot orgasm enhancement shots.

http://www.bodychicnj.com/
Marla Lynne Bell NP
Body Chic
Somerville, NJ
11/21/2012
Check out the mental health of the lead practitioner noctor (copied from a Yelp review):

I am the brother of the co-owner of this establishment, Marla Lynne Bell NP. Bell is a greedy, bullying, elitist botox nurse who seems to think she is at the same esthetic skill level as a plastic surgeon after taking a few weekend classes, getting certified and putting up a web site. She mistakenly asserts that unrelated work experience supervising nurse practitioner students and credentials as a first surgical assistant and cardiology nurse are somehow relevant to cosmetic procedures. Her partner Ed Buch MD is a vascular surgeon who similarly exaggerates his esthetics expertise. It appears that Dr. Buch handles the vein treatments (which he is well qualified for) while leaving the other procedures up to Bell, who technically he is supposed to be supervising! How he could supervise her when his certification is in vein treatments is beyond me. Along these lines, I'm not surprised at all to see a report here of Bell demeaning and bullying Groupon customers and getting mediocre clinical results. I consider anyone going to see her basically consenting to be a guinea pig to a basically unsupervised nurse practitioner calling the shots (due to Dr. Buch's lack of experience as a plastic surgeon, dermatologist or at least the necessary certification and diplomate status in laser surgery and aesthetics), and this is how she gets the bulk of her esthetics experience. One other thing, isn't it interesting that all of the before pictures for liposuction type treatments on her website are taken closer to the camera than the after pictures so that the distorted silhouettes exaggerate the fat loss? Pretty sneaky and the after pictures still have wrinkles and plenty of cellulite.

Despite her certifications, I think very little of her as a person and do not trust her in any position of responsibility. Her usual manner is to put on a false front of friendliness that only lasts are long as a person is useful to her. Do not trust any representation she makes without confirmation. She is extremely hostile to any criticism and her usual response is a childish over reaction that tries to deflect criticism with vicious false personal attacks against her critics who she blames for problems rather than simply being gracious, admitting any fault and working to improve the situation. Here is one example of this in action. Before Bell turned on me, I once attended a Thanksgiving dinner at her house where she complained about past wedding guests not giving her expensive enough gifts; this charming discussion was followed by a racist joke against blacks by her husband NJ detective Sean Bell. When I brought this up to her she turned on me and started accusing me without evidence of being a pedophile (which she maintains in emails). Bell claims that a hypnotist at college uncovered a repressed memory proving her uncle, who was babysitting her. sexually molested her at age 3! She then actually called social services on the uncle (who found no problems) and excommunicated every family member who didn't believe her.

As result of this "us versus them" thinking, she recently excommunicated her own disabled elderly mother whom she even stole $5,000 from prior to excommunicating her (the money was given to her to hold temporarily and she refused several requests to return it), causing her destitute mother a great deal of hardship which Bell relished. See http://bit.ly/TDuMZU pages 2 and 5 for more background information regarding serious anger problems, a personal life filled with broken relationships and history of abusing others to get her desires (there are also libelous retaliation posts that most likely are written by her). The only people who should be seeing Bell are mental health professionals-to treat her. She has a history of mental illness and this explains why she is this way. She had a severe nervous breakdown at Rutgers University that required treatment. Unfortunately at this point I don't see her getting help voluntarily.

It has also been reported to me that she was responsible for but escaped charges in three serious auto accidents due to inattentive driving.

I strongly advise people to not support Bell's abusive treatment of others and her questionable training by avoiding her spa. Go to one with a good reputation; one that is supervised by a real plastic surgeon or dermatologist-the acknowledged leaders in the field. See the following link for advice on finding a good office (especially the warning about poorly trained practitioners by Raffy Karamanoukian MD). http://bit.ly/vrj9hE

Take a look at the web page for the best Med Spa in NJ 2009, 2010, 2011 & 2012. Notice that it is led by a physician who, although he isn't a plastic surgeon or dermatologist, still has the highest cosmetic certifications available for the procedures done.
http://anaramedspa.com/s…

Do you really want to take any chances by going to a second rate med spa run by an unethical provider with anger issues?