Nurse Practitioners (DNP) the new DO?

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Will DNP's become the "New" DO's?

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  • No!

  • Possibly


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DrMaccoman

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A little over a century and a half ago, a bunch of people came together and established the Doctor of Osteopathic Medicine degree. Over the years, DO's have slowly fought to gain practicing rights throughout the United States and in modern times, have gained parity with MD's (read wiki for the history)

Nowadays, many universites are offering the DNP degree. Although some states prevent NP's from calling themselves doctors, there have been many cases where DNPs introduce themselves as doctors (simply because they have a Doctorate in nursing). Many states do not ban nurses from introducing themselves as "doctors." NP's have been fighting and succeeding to gain independent practicing rights in all the different states (much as the DO's had done) and like the DO's who operated their own DO residency programs, there are new DNP residencies poping up throughout the nation (some funded by the Affordable Care Act).

So what do you guys think? Will America in 50+ years experience a trifecta of healthcare professionals (MD, DO, DNP?) Note: I do not believe physician assistants will gain parity with physicains simply as their name suggests and the current lack of a terminal doctoral degree for PA's.

Medical schools don't want to face the same problems law schools face, yet if they do not open more medical schools to combat the aggressive crusade by NPs for autonomy, there will be a problem for allopathic physicians in the future.

EDIT: Found this to be a good comparison for the annoyance of NPs
"Would a lawyer be mad/threatened if there was a 12 month course to give a paralegal all the rights/privileges of a lawyer? Would a nurse be mad/threatened if there was a 6-month degree that allowed EMTs or MAs practice nursing? What if those "degrees" in many cases were offered online?

Of course they would be mad. Is that surprising? Why should physicians not be the same?"

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Medicine is becoming more of a business model subject to market driven pressures. As the NP's say, they offer cost effective healthcare treatment. Maybe insurance companies will prefer NP's and therefore push patients to the nurses?
 
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Another thread on this issue! my answer.. not unless they change their whole curriculum for a DNP. DO schools became successful because their education is equivalent to an MD school. DNP programs as they are now won't produce "doctors" that could successfully practice independently (at least consistently).
 
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.............definitely not. NPs claim they do things the MD/DO does just as well. If you actually looked at their curriculum, it's pretty subpar. They flood the market, are significantly less rigorously trained, and they infringe on practices that aren't theirs. You'll also notice a lot of NPs are nurses from a generation ago who went back to online school in the evenings for a nice money grab job at the cvs minute clinic.

Other practices elevated degrees up as well. Rehab did primarily due to respect and for the cost savings it has for future complications (can provide links if you want), some added curriculum, and how focused the anatomy, musculoskeletal, and neuromuscular courses and labs are.

You wont see a pt running around saying they can diagnose pathological disease or should be giving meds since they learned about it at a macro level in pharmacology, principles of disease, or differential diagnosis. Chiropractors might.

Unforunately, the nurses will.

...Itd be nice to just scrap the entire doctor term and refer to everyone based on their provider or allied healthcare status.

My two cents....you're allied healthcare unless you go MD/DO....so go to medical school if you want their provider status
 
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I think the foundation they learn is different. I don't think they could pull off the same things. Both needed but in different ways.
 
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The do degree was created by a doctor named a.t. still. Osteopathic medicine has its foundations in allopathic medicine. It is still discriminated against because of much weaker admissions standards and therefore much weaker students in general. The dnp was created for the purposes of allowing medical practice by nurses who had decades of experience in clinical nursing under the pretense that they are practiticing nursing. This is widely known to be a farce and if you look at allnurses, you will see many posts that bemoan the complete uselessness of their courses, many of which cover things like healthcare policy, business administration, advocacy, etc. There is little to no actual medicine being learned which means that the vast majority of their learning is done on the job. So they are, and will continue to be, third rate practitioners. To top it off, the people who go through these programs are now new nursing grads who do not want to spend time doing floor medicine. They spend a year or so on the job and go directly into np programs, if not directly in from undergrad because they went to nursing school with the goal of practicing medicine without going through the rigorous selection criteria and years of hard work. These new grads are indoctrinated with the nonsense that nps are just as good if not better than actual doctors and that they should be allowed to call themselves doctors with equivalent pay. This is at the same time that they claim that nps are a cost effective alternative. In the end, an inferior product made from inferior material. Their curriculum gets worse and worse with lower standards for admission every year although their hubris increases. My guess is that they will gain practice parity in everything except surgery through their legislative efforts to the detriment of patient care, all in the name of patient satisfaction and price controls. However, they will not gain the professional respect that dos have earned as you cannot turn **** into gold.

Also patients don't know the difference between a do and an md. They go to see a doctor. But people do know there is a difference between a doctor and an np. I've had patients say that they see dr whoever, who isn't really a doctor but they just call them that, for their depression meds. Also have had patients ask to not be seen by the np in the hospital or have switched outpatient primary care physicians because they only see the midlevel and not the doctor. It's not like their copay is any lower
 
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DO's became the equivalent of MD's by adopting MD training. There's no difference in training now other than DO's learn osteopathic manipulation.

The DNP education and training model is quite different. What may happen is they gain more rights and gain the right to practice independently anywhere, especially for primary care, where we have a relative shortage/distribution problem. DNP's are cheaper, handle the simple cases as well as we do, and patients generally love them (they typically get more time with their patients, and patients love people who spend time to talk and listen to them). It's a very real possibility, especially as the government tries to contain healthcare costs.

Of course, the issues is DNPs, compared to MD's, more often don't know what they don't know, so they can miss things, over-order tests, over consult, etc. But who knows, maybe they actually catch some things we miss because they can spend more time listening to the patient. I know there's a lot of research (funded by the nursing advocacy groups) that says outcomes are the same for patients with simple problems whether they see an MD/DO or a DNP, but I don't think there's any data on more complicated patients. And right now most DNPs would fail simplified USMLE exams, according to another study.

Honestly MD's are over-trained for most things we encounter--but you want someone over-trained when you're dealing with health, well-being, and well, staying alive. Kind of like how structural engineers use a large safety margin--they design a beam/truss/building to withstand the worst conditions they can imagine, and then they add in a safety multiplier. You don't just want what's cheap and efficient--you want something you know is going to last. That's why architects can't design skyscrapers, hospitals, etc., anymore without a structural engineer. However, there's no national debate over spending too much money on concrete and steel because structural engineers are over-engineering buildings...
 
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there will be a problem for allopathic physicians in the future.

I do not appreciate your attitude in comparing DO to NP and also somehow separating MD from DO.
 
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I do not appreciate your attitude in comparing DO to NP and also somehow separating MD from DO.

I understand why you are defensive but you should read up on the history of your degree first
 
Everyone saying no to this will just be like the old-timer MDs who hate on DO's.
 
Don't think so. Too much of the program is on nursing "theorems". I have a friend in his second semester of his NP program and they won't start focusing on any advanced physio until their second year.

Just attesting to what others have said about rigor. It needs to focus more on clinical medicine before you can even attempt to draw any parallels.
 
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I understand why you are defensive but you should read up on the history of your degree first

Done. Perhaps you should read a little on the history of your degree. Then understand medical education post flexner report.
 
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Done. Perhaps you should read a little on the history of your degree. Then understand medical education post flexner report.

Lmao bro your insecurity is showing. Hope you get over that soon
 
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Part of the reason DOs became accepted is that our academic preparation rose to the demands of the profession. DNP programs have as their selling points that they are easy to access and complete, with little to no clinical training beyond what little may have been needed to obtain the initial RN degree.
 
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Done. Perhaps you should read a little on the history of your degree. Then understand medical education post flexner report.
We all know DO was started because MD medicine at the time was really lacking in outcomes/research. But now, they both learn the same thing. How come you hear "nurses are just as good as doctors" but your never hear "cmon docs, you are every bit as good as NP's! " ?

I'd love to know the level at which NP learn things like path, physio, and pharm. I'm not hating on NP, but surely they don't actually think they come close to Doctor standards. Granted I have been seen by an NP at family practice and was given antibiotics for what was most likely viral rhinitis... I'll let that slide because viral rhinitis occurs 70% of the time and folks are almost always given antibiotics :D
 
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lol a nurse-resident
 
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lol a nurse-resident

Some student crnas are told to introduce themselves as residents. Instead of srna standing for student registered nurse anesthetist they're trying to play it off as resident. Everyone has a so called "residency" nowadays but it's really nothing more than a year of on the job training at half the pay. They do not resemble medical residencies
 
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I know there's a lot of research (funded by the nursing advocacy groups) that says outcomes are the same for patients with simple problems whether they see an MD/DO or a DNP,
Agree with your overall post, however, for patients with simple problems, it doesn't matter if you see a doctor, a nurse practitioner, a snake oil salesmen, a taxi cab driver, or just consult the internet. The "outcomes" for these simple cases would be pretty much the same.
 
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NP's would have to totally revamp their education, in order to recognized the same as DO's. DO's are considered equivalent to MD's, because they take an equivalent courseload to DO's, and do equivalent residencies (DO's can take also take the USLME and apply for the same residencies that MD's apply for.) There is no doubt that DO's meet the same minimum qualifications to be a doctor, that MD's meet.
However, NP's have completely different courseloads, they are not qualified and can not apply for the same residencies that DO's and MD's apply for, and when a study group of NP's took 1 of the 3 step tests that MD's take, they had a 50% failure rate. While there may be a few exceptional self-studiers, there is no doubt that the majority of NP's do not meet the mimum qualifications to be a doctor, that MD's meet.
Now, 50 years is a long time. Could NP's ramp up their program, make it equavalent to a DO/MD program, and just have some extra "nursy" classes, like DO's have their extra osteopathic classes? Sure, they could, but I think the likelihood of that happening is next to zilch. NP candidates don't want to take the strenuous coursework that MD/DO's do, nor do NP candidates want to do 80+ hour residencies. Plus NP's already have prescribing rights and the ability to bill insurances. Barring a major push-back from the public, there is no economic incentive for NP schools to change (a think a push-back from the public is possible, while many people are happy to see an NP when they want an antibiotic/medrol dose-pak for the "crud" they get every year, many people also realize there is a problem when they don't have the usual "crud", and all the NP offers is an antibiotic/medrol dose-pak.
 
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"Surgical Pracitioners": http://www.bbc.com/news/health-20629396
NPs in England can do appys, lap choles, hernia repairs, etc.

Bill would give Ohio nurses more latitude in treating patients
Monday October 26, 2015 5:12 AM

"The nurses say they’re already making their own decisions in patient care and shouldn’t have to pay a physician as much as $25,000 a year for oversight that can amount to little actual collaboration or advice"

"Cathy Hoffman, a nurse anesthetist who practices in southeastern Ohio, said she collaborates with the entire surgical team when she cares for patients. If a heart-rhythm problem arises, for example, “I’m going to call the cardiologist, just like the anesthesiologist would,” she said."

http://www.dispatch.com/content/stories/local/2015/10/26/bill-would-give-nurses-latitude.html
 
The litigious nature of our system might deter NP from wanting to become 'surgeons'. Then again these laws can be changed. Most other specialties aren't safe IMO...
 
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I mean, the progression of events here doesn't mirror the history of Osteopathic Medicine and it's relationship to mainstream Medicine as much as you might be suggesting.


The differences between NPs and DO/MDs are clear in just listening to how the two talk about the same things. I don't think they're comparable, in my limited experience.
 
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The litigious nature of our system might deter NP from wanting to become 'surgeons'. Then again these laws can be changed. Most other specialties aren't safe IMO...
Not even the IM/peds sub-specialties that require super deep knowledge of one or a few body systems? I feel as if these specialties might not be attractive to the more vocationally oriented nurses.
 
Good news on that front is there is an enormous insane knowledge gap between attending dermatologists and all other wanna-be ppl.

It's obvious to us but is it obvious to the people who are making money by abusing the system and patients? I'm not so sure.
 
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Not even the IM/peds sub-specialties that require super deep knowledge of one or a few body systems? I feel as if these specialties might not be attractive to the more vocationally oriented nurses.
A lot of them are working in IM/Peds subspecialties now and they even took care of some consults... I even saw a couple of PCPs put on their consult orders 'not to be seen by NP/PA', and these PCPs were labeled as dingus by some NP/PA...
 
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A lot of them are working in IM/Peds subspecialties now and they even took care of some consults... I even saw a couple of PCPs put on their consult orders 'not to be seen by NP/PA', and these PCPs were labeled as dingus by some NP/PA...
Essentially, there's competition between mid-levels and physicians even in the deep subspecialties?
 
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Essentially, there's competition between mid-levels and physicians even in the deep subspecialties?
There is a direct competition in primary care, psych, gas now... Not so much in the sub-specialties since they have to be employed by a MD/DO

I think the objective of the DNP degree is to blur the line even further... The next move will be to lobby congress to sponsor DNP residency and fellowship... Then NP will be able to open their own subspecialties clinic with no MD/DO supervision... and you will see in your neighborhood clinics with billboards.

Dr. Angela Jones, NP
Specialized in Gastroenterology.

and most people won't know that Dr Jones is not a physician...
 
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A lot of them are working in IM/Peds subspecialties now and they even took care of some consults... I even saw a couple of PCPs put on their consult orders 'not to be seen by NP/PA', and these PCPs were labeled as dingus by some NP/PA...

The whole point of asking a specialist to see a patient is to get a specialist's opinion so that you can get a fresh idea of what to pursue, do something that you can't do yourself or give advice on the best course of action. Mid levels help with none of those goals. I mean wtf is the point of sending a "neuro np" who doesn't have any clue about what is going on, gives a poor unhelpful differential, and can't even read the eeg to boot
 
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The whole point of asking a specialist to see a patient is to get a specialist's opinion so that you can get a fresh idea of what to pursue, do something that you can't do yourself or give advice on the best course of action. Mid levels help with none of those goals. I mean wtf is the point of sending a "neuro np" who doesn't have any clue about what is going on, gives a poor unhelpful differential, and can't even read the eeg to boot

Currently working on a epilepsy monitoring unit for one of my neuro rotations, and we have an NP who is "training" to work in a neuro clinic. Her lack of knowledge is astounding. That she will be able to work independently in a neuro clinic after ____ months of shadowing is disheartening.
 
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More intelligent and better-educated people will always be discerning when it comes to choosing which "providers" they see, and will heavily favor MDs and DOs.

However, what with the dysgenic birth patterns in the US, there will, in the future, be a great many people who will not investigate any further once they are told that they will be seen by "Dr. _____."

Frankly, I think that doctors (MDs and DOs) should be abandoning the white coat. We should be a cut above that. Countersignaling, if you will.
 
Let's dump the word "Dr." Let's dump the white coat. Form a new identity. Im ready to leave political correctness in the past. I'm not working this hard to be equated to someone who knows way less.
 
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Good news on that front is there is an enormous insane knowledge gap between attending dermatologists and all other wanna-be ppl.

I worked as a medical assistant in a dermatology practice with a DO and an NP. Like a lot of specialties there are some daily diagnoses/procedures that the NP handled just fine; on par with the doctor. I agree that it doesn't take 4 years of medical school to spray liquid nitrogen onto an actinic keratosis. However, she was constantly referencing her cell phone or a textbook after coming out of patient rooms and frequently needed the doctor to either confirm her ideas or come up with a diagnosis of his own. It was clear just how much more expertise the derm residency was worth, but obviously it made business sense to be able to see 40-50 patients a day. The idea of an NP practicing independently, however, is a little worrying to me (based off of my own, admittedly limited, experience).

It's also interesting that all of these stereotypes of the caring, empathetic NP that spends more time with her patients and the cold, thoughtless MD(DO) who's in-and-out were completely reversed. There were numerous patients that requested to see the doctor only, and not just because of the credential difference.
 
Last couple shifts on my new rotation I worked with a bunch of NPs and NP students. NP students #1 (who is 2 months from graduation) was telling me she hates when doctors use terms like "medial" and "sagital" instead of "just describing" because it is too confusing. Solid. Then later recommened valium as monotherapy for msk back pain in the ED. Then worked with 2 regular NPs who were shopping for DNP programs online: "oh this one makes you log to the chat room 5 days per week! That's too much!" 'yeah but you only have to post one comment per day, just do it on your lunch.' ...this is for a DOCTORAL degree. once per month in person class and one *comment* per day online. to earn a *doctoral* degree. To be fair then I worked with another more experienced NP who seemed smart. So, 25% smart. ok...
 
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Last couple shifts on my new rotation I worked with a bunch of NPs and NP students. NP students #1 (who is 2 months from graduation) was telling me she hates when doctors use terms like "medial" and "sagital" instead of "just describing" because it is too confusing. Solid. Then later recommened valium as monotherapy for msk back pain in the ED. Then worked with 2 regular NPs who were shopping for DNP programs online: "oh this one makes you log to the chat room 5 days per week! That's too much!" 'yeah but you only have to post one comment per day, just do it on your lunch.' ...this is for a DOCTORAL degree. once per month in person class and one *comment* per day online. to earn a *doctoral* degree. To be fair then I worked with another more experienced NP who seemed smart. So, 25% smart. ok...

Every medical student has a bunch of stories like this but as we all know thanks to some of the attendings here, we have no relevant clinical experience and nothing we say has any relevance as we are just medical students
 
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I worked as a medical assistant in a dermatology practice with a DO and an NP. Like a lot of specialties there are some daily diagnoses/procedures that the NP handled just fine; on par with the doctor. I agree that it doesn't take 4 years of medical school to spray liquid nitrogen onto an actinic keratosis. However, she was constantly referencing her cell phone or a textbook after coming out of patient rooms and frequently needed the doctor to either confirm her ideas or come u

thanks for the input
 
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MDs/DOs/DNPs are all going to be the new JDs if schools aren't careful.

But really who knows, I think it is kinda a silly question. DOs only did manipulations for a few decades before they were even allowed to practice medicine as we know it now. Maybe someday DNPs will start adopting MD standards as DOs did. I think this forum makes too big a deal about letters, quality of training is going to ultimately be what gets people hired and with some exceptions for excellent standouts the less and less desirable jobs will be given as quality of training decreases.
 
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Dumbest post EVER!!!!

A more "LOGICAL" question would have been if DNP = DO AND MD since MD's AND DO's are BOTH PHYSICIANS!!!!
 
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MDs/DOs/DNPs are all going to be the new JDs if schools aren't careful.

But really who knows, I think it is kinda a silly question. DOs only did manipulations for a few decades before they were even allowed to practice medicine as we know it now. Maybe someday DNPs will start adopting MD standards as DOs did. I think this forum makes too big a deal about letters, quality of training is going to ultimately be what gets people hired and with some exceptions for excellent standouts the less and less desirable jobs will be given as quality of training decreases.

You know those letters actually stand for something meaningful right? It's not just for giggles
 
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Last couple shifts on my new rotation I worked with a bunch of NPs and NP students. NP students #1 (who is 2 months from graduation) was telling me she hates when doctors use terms like "medial" and "sagital" instead of "just describing" because it is too confusing. Solid. Then later recommened valium as monotherapy for msk back pain in the ED. Then worked with 2 regular NPs who were shopping for DNP programs online: "oh this one makes you log to the chat room 5 days per week! That's too much!" 'yeah but you only have to post one comment per day, just do it on your lunch.' ...this is for a DOCTORAL degree. once per month in person class and one *comment* per day online. to earn a *doctoral* degree. To be fair then I worked with another more experienced NP who seemed smart. So, 25% smart. ok...

Is it the insulation of large academic medical centers, political correctness or just greed? Why are we putting our heads in the sand to let this nonsense continue; it is an embarrassment to medicine and the noble history of the nursing profession.
 
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