Nurse Practitioners (DNP) the new DO?

[GUH]

...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. _____."...

Recently did an OB rotation. I had never before realized the magnitude of our demographic problems, especially lack of education and basic cultural awareness and English language skills among those who reproduce the most. The future frightens me.

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[GUH]

So the program director for the first one is: Mary Nolen, ANP, BC, DCNP
What does that alphabet soup even mean? What is DCNP?? Also isn't DNP the next level degree above ANP? Why would you list both? That's like listing your bachelor's degree when you have a masters in the same subject...

Maybe we could compete by issuing a degree after each year of medical school:
John Doe, High School Diploma, BS, MS-I, MS-II, MS-III, MS-IV, MD
Seems pretty impressive.

 

[EM/CC_23]

I think every staff member in the hospital *potentially* has something truly valuable to offer to patients and the team. I've learned alot about lac repairs and slit lamp exams from a PA I worked with in FastTrack in the ED, and have seen nurses do amazing things for critically-ill patients (like spare them central lines by managing to access veins in unimaginable places!). I've also seen RT intubate people in a community hospital when the IM-trained hospitalist wasn't able to do it (and anesthesia was too busy to help right away). However, what really bothers me is that I too often see certain midlevel providers wearing long white coats with their hospital ID badge turned around (!of course unintentionally!), and then not introducing themselves as PA/NP to patients, and responding to patients when being called "Dr." and not correcting the patient. If a med student did that, they would be toast...and for good reason. This is an ethical, patient safety, and liability concern, and unfortunately it is not only the midlevel's license on the line, but the attending who is "supervising" them and co-signing their notes/orders.

I've also seen ED pharmacists block MD orders, and require the MD to print out a scholarly paper proving he was right about the dosing/route of drug administration in a critically ill patient. Its one thing for a pharmacist to inquire about a possible error they've picked up, and its another to require a senior attending to prove to you that he's right, when he not only has 4 more years of training than you do, but understands patient care from a perspective you haven't experienced...

As a fourth year med student, I would be the last person to claim I am ready to take care of patients independently. I have only had 2 years of pre-clinical and 1.5 years of clinical education. However, I also am aware that PA's/NP's often have similar/less amounts of education than I do, but far more autonomy. I don't want that autonomy at this point, because I'm not ready (yet)! However, if I'm not ready, I worry they might not be either...despite their outward appearance.

 

[IslandStyle808]

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.

You got read more than wiki to understand why they gained parity. A large reason was because D.O. schools adopted the subjects that M.D. schools were teaching, few of which Dr. Still never wanted to see in the osteopathic curriculum. However, by doing this, the state governments more readily acknowledge their degree and practicing rights.

Until NP have the same curriculum and post-grad training as MD and DO schools, they won't have the same level of acknowledgement and autonomy.

 

[AlteredScale]

DO's have conformed to a preclinical education that makes them eligible for medical licensing but back in the day, AT Still was no fan of pharma that's for sure. A board that oversaw these schools approved of the teaching of pharmacology despite his protests. I believe this was a few years before he passed away.

As @IslandStyle808 said, until NP's have a standardized curriculum that is similar to medical schools, they will not have a medical license and they will not be physicians with the same autonomy. If they want to hold their distinction as a "different model" they can continue walking around pretending to be a doctor and hiding there badge with NURSE placed right under there ID. The majority of NP's have little to no grasp on the basic sciences/scholarly activity that medical students must wade through and it should stay that way.

 

[Mjolner]

It's your training/education that makes you a physician. Not the initials after your name. NP training/education does not approach that of a physician.
I don't know why SOME NP don't understand this when they will tout their more rigorous training/education as to why they're superior to other classifications of nurses and why they are entitled to more practice rights and more compensation.
Seems hypocritical.

 

[wxman393]

So the program director for the first one is: Mary Nolen, ANP, BC, DCNP
What does that alphabet soup even mean? What is DCNP?? Also isn't DNP the next level degree above ANP? Why would you list both? That's like listing your bachelor's degree when you have a masters in the same subject...

DCNP = Dermatology Certified Nurse Practitioner. Apparently it's "governed" by the Dermatology Nursing Certification Board (https://www.cnetnurse.com/dermatology/dermatology-nurse-certified-dnc/). I will say that the website looks super high speed.......

On another note, I think someone had mentioned about DNP's introducing themselves as "Doctor" while in the clinic/hospital/etc. How is this ethical? I earned my PhD before starting medical school but I don't go around introducing myself as "doctor" to anyone, especially standardized patients/patients/clinicians/residents/attendings/etc.

 

[Mjolner]

DCNP = Dermatology Certified Nurse Practitioner. Apparently it's "governed" by the Dermatology Nursing Certification Board (https://www.cnetnurse.com/dermatology/dermatology-nurse-certified-dnc/). I will say that the website looks super high speed.......

On another note, I think someone had mentioned about DNP's introducing themselves as "Doctor" while in the clinic/hospital/etc. How is this ethical? I earned my PhD before starting medical school but I don't go around introducing myself as "doctor" to anyone, especially standardized patients/patients/clinicians/residents/attendings/etc.

I have classmates who are PhDs and when other classmates have used the term Dr. Blahblah they have responded, "not that type of Doctor, give me 4 years"

 

[bd290]

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

Because those same attendings are making a killing off of employing people like this and they know that by the time crap hits the fan they'll already be retired. AKA - all baby boomers.

 

[NontradCA]

Maybe we could compete by issuing a degree after each year of medical school:
John Doe, High School Diploma, BS, MS-I, MS-II, MS-III, MS-IV, MD
Seems pretty impressive.

I know you're joking, but that's actually not a bad idea given the stupidity of the general public. And that's the dilemma. To win at healthcare politics means to exploit patients, and physician standard, both legally and ethically, make exploiting them implausible.

 

[dwgrubbs1s]

Speaking as a BSN (bachelors of science in nursing) graduate who is currently finishing up pre reqs for medical school, I can say that the undergraduate work is even laughable. For instance, my BSN program requires A&P 1&2, 1 semester of chemistry, 1 semester of microbiology to apply. Then the two years strictly of nursing classes that are based on nursing and doesn't explain anything from a scientific standpoint. This doesn't come close to the undergraduate science classes pre meds have to take to get into MD/DO school (inorganic,o-Chem,general biology, etc). Not to mention the MCAT. If this big of a difference takes place at an undergraduate level, the difference in the doctorate levels have to be even worse. NP's lack education in fundamental hard sciences. Once they graduate and go to NP DNP schools, they have a few pathophysilogy,assessment, and pharm classes. With no real understanding of the basic principals of science, I find it hard to be efficient in these areas and treat patients with 100% competence. This is no disrespect to NP's in any way, it is they just lack the fundamental hard sciences which is what MD/DO schools require one to have a strong base knowledge in to be efficient.

 

[thepoopologist]

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.

The reality is that you and everyone else will bump into them in hospitals and other healthcare settings and they will range from very, very bad to very, very good and will have to be dealt with just like any other person who can prescribe and dictate the care of a patient. The market wants what it wants. It doesn't mean we have to bend over backwards and let them do whatever they want but the reality is you will be dealing with them, like it or not.

 

[thepoopologist]

While I think this healthcare model will lead to worse patient outcomes, particularly in cases where thinking outside the box is required, I can't begrudge a person for recognizing a faster and more financially reasonable route to becoming a (mid-level) clinician and going that way instead of ours. Six figures, can get a doctorate online, physicians everywhere to ask for help when poop hits the fan

 

[cbrons]

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

Yes the benedict arnolds don't want their mid-levels denigrated because they are using them to run their revolving door clinics and making them lots of $ in the process. When those mid-levels finally decide to step out from under their shadow and employ themselves (with the help of politicians), perhaps those attendings will regret their decision to give inch after inch in favor of the $.

 

[cbrons]

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.

Noble history lol.

It's MONEY. Not hard to figure out.

 

[DrMaccoman]

A quick look at some nursing forums, a lot of dnps enjoy introducing themselves as Dr XYZ to their patients. A lot of them say they earned the right to be called doctor.

Also, Just because they don't teach the same curriculumn does not mean that they will not gain parity.

 

[jthedestroyr]

Yes the benedict arnolds don't want their mid-levels denigrated because they are using them to run their revolving door clinics and making them lots of $ in the process. When those mid-levels finally decide to step out from under their shadow and employ themselves (with the help of politicians), perhaps those attendings will regret their decision to give inch after inch in favor of the $.

It's already happening. As a resident they aren't afraid to speak freely around us and I hear mid levels all the time bad mouthing attendings. Hell even PA/pharmD students wear short white coats like medical students.

I've never heard NP/PA introduce themselves as Dr. to a patient, but you'd better believe I'd correct them if I heard that.

 

[TwinsFan]

Noble history lol.

It's MONEY. Not hard to figure out.

Go back far enough and nursing did have a noble history. Now it seems much of that is lost based on what leaders are claiming and pushing for.

 

[oncology2020]

I think every staff member in the hospital *potentially* has something truly valuable to offer to patients and the team. I've learned alot about lac repairs and slit lamp exams from a PA I worked with in FastTrack in the ED, and have seen nurses do amazing things for critically-ill patients (like spare them central lines by managing to access veins in unimaginable places!). I've also seen RT intubate people in a community hospital when the IM-trained hospitalist wasn't able to do it (and anesthesia was too busy to help right away). However, what really bothers me is that I too often see certain midlevel providers wearing long white coats with their hospital ID badge turned around (!of course unintentionally!), and then not introducing themselves as PA/NP to patients, and responding to patients when being called "Dr." and not correcting the patient. If a med student did that, they would be toast...and for good reason. This is an ethical, patient safety, and liability concern, and unfortunately it is not only the midlevel's license on the line, but the attending who is "supervising" them and co-signing their notes/orders.

I've also seen ED pharmacists block MD orders, and require the MD to print out a scholarly paper proving he was right about the dosing/route of drug administration in a critically ill patient. Its one thing for a pharmacist to inquire about a possible error they've picked up, and its another to require a senior attending to prove to you that he's right, when he not only has 4 more years of training than you do, but understands patient care from a perspective you haven't experienced...

As a fourth year med student, I would be the last person to claim I am ready to take care of patients independently. I have only had 2 years of pre-clinical and 1.5 years of clinical education. However, I also am aware that PA's/NP's often have similar/less amounts of education than I do, but far more autonomy. I don't want that autonomy at this point, because I'm not ready (yet)! However, if I'm not ready, I worry they might not be either...despite their outward appearance.

The pharmacists at my hospital are also becoming emboldened..there is one who is notorious for doing this also..she will block MD orders and then question why we are doing what we are doing without any knowledge of the patient..she once called me several times and spent literally 5 minutes each call arguing the use of propranolol in the prevention of esophageal varices..arguing with me that the clinical studies were small studies..it was ridiculous

 

[TheTao]

The pharmacists at my hospital are also becoming emboldened..there is one who is notorious for doing this also..she will block MD orders and then question why we are doing what we are doing without any knowledge of the patient..she once called me several times and spent literally 5 minutes each call arguing the use of propranolol in the prevention of esophageal varices..arguing with me that the clinical studies were small studies..it was ridiculous

This isn't nearly as comparable is the NP versus Physicians debate because PharmDs DO learn and know more about drugs than Physicians.

 

[TheTao]

IMHO, the easiest solution to the "who gets called Doctor" problem, is for MDs/DOs to be called Physicians from now on.

I think most people know what a Physician is.

 

[Psai]

IMHO, the easiest solution to the "who gets called Doctor" problem, is for MDs/DOs to be called Physicians from now on.

I think most people know what a Physician is.

Tell that to the podiatrists and the chiropractors

 

[PhillyMed777]

The pharmacists at my hospital are also becoming emboldened..there is one who is notorious for doing this also..she will block MD orders and then question why we are doing what we are doing without any knowledge of the patient..she once called me several times and spent literally 5 minutes each call arguing the use of propranolol in the prevention of esophageal varices..arguing with me that the clinical studies were small studies..it was ridiculous

This story is infuriating me. I am literally sitting here fuming.

 

[Doudline]

This story is infuriating me. I am literally sitting here fuming.

You are infuriated because an attending pharmacist questioned a medical student's order?
Take up yoga or something.

 

[Psai]

You are infuriated because an attending pharmacist questioned a medical student's order?
Take up yoga or something.

Attending pharmacist?

 

[Doudline]

Attending pharmacist?

I would have to look into the history of the term, but I'm pretty sure "attending" simply refers to someone out of training and licensed to provide service/care.

 

[PhillyMed777]

You are infuriated because an attending pharmacist questioned a medical student's order?
Take up yoga or something.

can you read? the pharmacist blocked a PHYSICIAN'S orders.
also, i don't care what the historical use of the word "attending" is. It's only used for physician attendings. I can also bet a pharm doesn't know fraction of what even an medical student knows. I worked with pharms on a research project once. Good enough sample size for me.
Finally, I hate yoga and consider it a joke of an exercise.

 

[GUH]

I would have to look into the history of the term, but I'm pretty sure "attending" simply refers to someone out of training and licensed to provide service/care.

Attending nurse
Attending EMT-B
Attending CNA

 

[Doudline]

Attending nurse
Attending EMT-B
Attending CNA

Attending engineer
Attending electrician
Attending firefighter
Attending pimp

etc

 

[Doudline]

can you read? the pharmacist blocked a PHYSICIAN'S orders.
also, i don't care what the historical use of the word "attending" is. It's only used for physician attendings. I can also bet a pharm doesn't know fraction of what even an medical student knows. I worked with pharms on a research project once. Good enough sample size for me.
Finally, I hate yoga and consider it a joke of an exercise.

You are more competent at pharm than pharmacists... OK.
Delusion is strong.

 

[PhillyMed777]

You are more competent at pharm than pharmacists... OK.
Delusion is strong.

did i even mention competency in pharm? If that is what you thought let me clarify by saying that I was referring to general knowledge in a clinical setting. And im not surprised considering medical school.

 

[TheTao]

The pharms couldn't manage to break the average in college chemistry, therefore they don't get the opportunity to learn this now.

I think this statement speaks more to where you attended undergrad (lower tier perhaps?) than a PharmDs chemistry acumen.

 

[bingbongbink]

I see the pharmacy students call their precepting pharmacist 'Dr' all the time.

 

[PhillyMed777]

I think this statement speaks more to where you attended undergrad (lower tier perhaps?) than a PharmDs chemistry acumen.

I don't understand what you are talking about. I went to an upper tier undergrad in a city with other upper tier undergrads. It was well established that the "losers" of the pre-medical curriculum get to go to optometry, pharm, Caribbean, whatever

Other than that, why we are talking chemistry accumen otherwise. That stuff isn't relevant. My chemistry can be 100x weaker than any pharm's chem and it doesn't count for anything in the wards/office. It is important to know the clinically relevant stuff (i.e. it doesn't matter if you know a million irrelevant things about drugs). Also, i'm done with the conversation, so please don't respond, because it will further derail the thread. Thanks.

 

[Psai]

You are more competent at pharm than pharmacists... OK.
Delusion is strong.

Your reading needs improvement

 

[oncology2020]

You are infuriated because an attending pharmacist questioned a medical student's order?
Take up yoga or something.

I'm a resident..haven't updated my status

huge difference between a pharmacist correcting a wrong order vs. arguing about well documented clinical decision making

 

[TheTao]

I don't understand what you are talking about. I went to an upper tier undergrad in a city with other upper tier undergrads. It was well established that the "losers" of the pre-medical curriculum get to go to optometry, pharm, Caribbean, whatever

Yet another dumb comment in a dumb thread. BTW, upper tier undergrad means you're an Ivy league "loser", right? And don't worry, this is my last response to a dumb comment in a dumb thread.

 

[samac]

I was looking at my school's rotation sites and this really grinds my gears. THAT IS NOT A PHYSICIAN, SHE SHOULDN'T BE UNDER FIND A DAMN PHYSICIAN. That's just the picture, didn't search anything. That's their face.
I appreciate nurse practitioners more than most. Hell, my mother is one and I watched her work her butt off to get there after years as an RN. But she doesn't even try to pretend she's a physician, why would a hospital market them as such?

 

[Psai]

View attachment 197483 I was looking at my school's rotation sites and this really grinds my gears. THAT IS NOT A PHYSICIAN, SHE SHOULDN'T BE UNDER FIND A DAMN PHYSICIAN. That's just the picture, didn't search anything. That's their face.
I appreciate nurse practitioners more than most. Hell, my mother is one and I watched her work her butt off to get there after years as an RN. But she doesn't even try to pretend she's a physician, why would a hospital market them as such?

Patients feel better when they think they're surrounded by doctors

 

[NaOH]

Boy, this thread escalated quickly.

I see the pharmacy students call their precepting pharmacist 'Dr' all the time.

Well, yes. They have doctorate degrees. And in an academic setting, I think it's appropriate. That said, 90% of my preceptors asked that I address them by name. The two that didn't were in fact professors at the COP.

I don't understand what you are talking about. I went to an upper tier undergrad in a city with other upper tier undergrads. It was well established that the "losers" of the pre-medical curriculum get to go to optometry, pharm, Caribbean, whatever

Nice generalization. Can't we all just get along?

 

[Modeselektor]

All this butthurt about two letters.

 

[chipwhitley]

DCNP = Dermatology Certified Nurse Practitioner. Apparently it's "governed" by the Dermatology Nursing Certification Board (https://www.cnetnurse.com/dermatology/dermatology-nurse-certified-dnc/). I will say that the website looks super high speed.......

On another note, I think someone had mentioned about DNP's introducing themselves as "Doctor" while in the clinic/hospital/etc. How is this ethical? I earned my PhD before starting medical school but I don't go around introducing myself as "doctor" to anyone, especially standardized patients/patients/clinicians/residents/attendings/etc.

I have actually asked a recent DNP grad about this. She believes it is ethical to introduce herself as 'doctor' because her doctorate degree is directly related to her role as a healthcare provider, whereas a PhD would be unrelated. She also pointed out that 'doctor' in colloquial usage does not mean "MD" or "physician", but simply a practitioner licensed to provide medical diagnosis and treatment services who possesses a doctorate level of education, which is her role / degree as a DNP family nurse practitioner, therefore it is entirely appropriate for her to use that title.

 

[chipwhitley]

View attachment 197483 I was looking at my school's rotation sites and this really grinds my gears. THAT IS NOT A PHYSICIAN, SHE SHOULDN'T BE UNDER FIND A DAMN PHYSICIAN. That's just the picture, didn't search anything. That's their face.
I appreciate nurse practitioners more than most. Hell, my mother is one and I watched her work her butt off to get there after years as an RN. But she doesn't even try to pretend she's a physician, why would a hospital market them as such?

I think in that case it might be a problem of the website not having the ability to separate physicians from other providers. However, you are correct that in many cases NPs are listed under "physicians" or "medical staff" when in fact they are nursing staff.

 

[TheTao]

I appreciate nurse practitioners more than most. Hell, my mother is one and I watched her work her butt off to get there after years as an RN. But she doesn't even try to pretend she's a physician, why would a hospital market them as such?

A friend of mine that's a DNP (Anesthesia) is also listed on his school's website under "Physician Services".

I think it's time to face the fact that while the AMA was CLEARLY "asleep" the Nursing lobby was at work! What's worse, the AMA members that were "asleep" don't really give a crap because they're all either retired or nearing retirement!

Put another way, more than a few of you need to whip both your parents AND grandparents (ie legacy Docs) a**** for this mess!

 

[chipwhitley]

A friend of mine that's a DNP (Anesthesia) is also listed on his school's website under "Physician Services".

I think it's time to face the fact that while the AMA was CLEARLY "asleep" the Nursing lobby was at work! What's worse, the AMA members that were "asleep" don't really give a crap because they're all either retired or nearing retirement!

Put another way, more than a few of you need to whip both your parents AND grandparents (ie legacy Docs) a**** for this mess!

First of all the AMA doesn't even come close to properly representing doctors and secondly, doctors make tons of money off of hiring NPs and seeing more patients as a result. Therefore, the incentive for docs to curb NPs in the past was low.

 

[Psai]

Boy, this thread escalated quickly.

Well, yes. They have doctorate degrees. And in an academic setting, I think it's appropriate. That said, 90% of my preceptors asked that I address them by name. The two that didn't were in fact professors at the COP.

Nice generalization. Can't we all just get along?

Doctorate degree LOL
Explain to me how the pharm.d. differs in any way from the b.s.pharm

 

[NaOH]

Doctorate degree LOL
Explain to me how the pharm.d. differs in any way from the b.s.pharm

It has a 'D' on the end.

 

[Psai]

It has a 'D' on the end.

Exactly. No change in coursework or rigor. There's much more to being a doctor than putting a D on your name

 

[chipwhitley]

Exactly. No change in coursework or rigor. There's much more to being a doctor than putting a D on your name

It's called degree creep. MD's invented it when we started giving out a doctorate degree without having to do a thesis.

 

[TheTao]

Exactly. No change in coursework or rigor. There's much more to being a doctor than putting a D on your name

The PharmD (6 years) is not only LONGER than the BS in Pharm (4 years) EVER was, many programsrequire a research/thesis type project for graduation.

Geez, the IGNORANCE is THICK in this one!

And the reason I KNOW this is because my sister is a PharmD and a cousin first finished with a BS in Pharm then went back to school to become a PharmD.