NYT Today: "Nurses are Not Doctors"

[exsanguination]

And my classmates have made fun of me for my concern over NP ever expanding "scope of practice".

You know, I never see these sentiments or discussions brought up anywhere outside of SDN. I've never heard anybody speak about this in person, never heard an anesthesiologist rag on CRNAs, never heard a GP complaining about NPs... It's all just polite/PC "oh they're extremely helpful and very knowledgable!"

I suppose there's a stigma about this subject in the public forum among doctors. What's hilarious is that nurses will spare no opportunity to rag on doctors amongst each other; they'll even do it in front of patients and to other doctors. When's the last time you heard a doctor say anything bad about nursing as a profession?

Last point I'd like to make: one of my friends' fiance is currently in school obtaining her DNP (graduated with a BSN) and she's FLABBERGASTED at the amount of institutionalized doctor-hate among her program. She routinely hears her superiors, professors, and mentors warn the NP students to never trust the doctor's advice or diagnosis. They're beating it into them from day 1 of her DNP program. When's the last time you heard any MD professor in your MS1-2 class include slides about how nurses are killing your patients left and right? All I remember from medical school was my mentors and professors praise the hard work and care displayed by ALL the nurses with whom they've worked. Nothing but respect, professionalism, and collegiality.

Our own profession's values will be our undoing - I just hope that it will be our saving grace once the s#it hits the fan.

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[Microshaft]

i am a DNP
i can do your job
you mad?

 

[DocVapor]

i am a DNP
i can do your job
you mad?

This is funny coming from someone named "Micro shaft."

 

[DrCharlemagne]

i am a DNP
i can do your job
you mad?

Can you pass our boards?

 

[NickNaylor]

Perhaps I shouldn't have used the word "kill." I basically meant reimbursement might suffer compared to states where only psychiatrists can dole out drugs.

There will always be people willing and able to pay extra for care if they feel that the care is better. You've already seen plenty of comments from people here and in the comments of the article that state that position. I think there will always be room to carve out a "niche" practice if this is a real priority for you. I think most physicians don't care as a matter of principle, though, and would rather take the well-traveled path of least resistance that inevitably results in the use of NPs/PAs to increase productivity.

 

[CherryRedDracul]

i am a DNP
i can do your job
you mad?

 

[Ionian]

You guys are tempting me, but I'm not going to read the comments this time. I would rather preserve what neurons I have left.

Those comments are scorching my retinas.

Thanks obama

 

[Kaputt]

Sure, I agree that reimbursements might decrease.

But who knows... the VA recently (2012) passed a motion to boost psychiatrist salary cap upward by 50k. On the other hand, they also have taken more interest in opening the door to NP's from what I hear.

As you know, unfortunately, much of everything is just up to uncle sam and our good friends the politicians.

Props to the VA for increasing funding for mental health. It is much needed.

I did lots of rotations at my local VA, including my medicine acting internship. A lot of the patients had NPs as PCPs with minimal physician oversight. Like that one time a patient came in with "chronic renal disease" that his NP had diagnosed but never worked up or talked to any physician about...turns out it was his massive prostate blocking his urethra for the past 5 years. Ended up with severe post-obstructive acute tubular necrosis which was entirely preventable. I always gave NPs the benefit of the doubt till I saw that patient.

 

[NeedBeats]

All the arguing aside, not sure if this has been posted on the tread: http://www.cumc.columbia.edu/nursing/dnpcert/rates.shtml.

The pass rate is concerning, we are tested to protect the public. The "point" of each step/level is to ensure we have the minimum required knowledge to practice at the corresponding level, thus minimizing harm to patients. If that is indeed the purpose of 3 1/2 licensing exams, and board cert, and recert, then the same logic should stand for all providers. Judging by the results listed by the ABCC, expanding independent rights is dangerous without improved educational models, and training.

Just my 2 cents, carry on.

 

[fancymylotus]

guys, quiet!

or the nurses from that nurses-r-us or all-nurses or whatever forum will come back and yell at us.

> <

 

[PL198]

i am a DNP
i can do your job
you mad?

Nah taking online classes, having relatively little to no clinic experience and screwing up people's lives is a perfectly noble pursuit for a health-care professional . Keep at it.

 

[SouthernSurgeon]

guys, quiet!

or the nurses from that nurses-r-us or all-nurses or whatever forum will come back and yell at us.

> <

I'm a little surprised it hasn't happened yet.

 

[Nasrudin]

I'd argue that psychiatry is actually one of the fields most easily taken over by other providers. Look at all the different types of clinical psychologists, therapists, and related psych-associated professions. There are so many of them. If any of them get prescribing rights (imagine a clinical psychologist with prescribing rights) the game is over for psychiatrists.

Sure, as stated above, there will be the select few one-percenters that can afford to demand MD-level treatment. However, setting up this kind of practice will require the perfect location (desirable) and payor mix (rich), and there's likely going to be INTENSE competition to get those patients in your office. Competition for desirable practice set ups such as a cushy cash-only MD child psych in beverly hills are going to go to a very very very small lucky select few.

I wouldn't bank on psychiatry as a specialty that's immune to the discussion in this thread. However, as always, if you love the subject matter, and can see yourself accepting whatever practice environment you get, then sure go ahead and do psych.

You're right, psych is extremely vulnerable in theory. But in practice...nobody is clamoring to do it, including us. And we have one the oldest physician work forces in the business. So I think we fit squarely in this discussion but it's currently consisting of those who worry about the future and for those who will come after us.

That goes for all of us here I think. I think we all can count on 10 years or so more of enough income leverage to tackle huge chunks or all of our student loans. But when I get to that point, I don't want to be working with residents and medical students of my tribe that will be f@cked.

So that's why I'm here at this rally thread now.

 

[BestDoctorEver]

You know, I never see these sentiments or discussions brought up anywhere outside of SDN. I've never heard anybody speak about this in person, never heard an anesthesiologist rag on CRNAs, never heard a GP complaining about NPs... It's all just polite/PC "oh they're extremely helpful and very knowledgable!"

I suppose there's a stigma about this subject in the public forum among doctors. What's hilarious is that nurses will spare no opportunity to rag on doctors amongst each other; they'll even do it in front of patients and to other doctors. When's the last time you heard a doctor say anything bad about nursing as a profession?

Last point I'd like to make: one of my friends' fiance is currently in school obtaining her DNP (graduated with a BSN) and she's FLABBERGASTED at the amount of institutionalized doctor-hate among her program. She routinely hears her superiors, professors, and mentors warn the NP students to never trust the doctor's advice or diagnosis. They're beating it into them from day 1 of her DNP program. When's the last time you heard any MD professor in your MS1-2 class include slides about how nurses are killing your patients left and right? All I remember from medical school was my mentors and professors praise the hard work and care displayed by ALL the nurses with whom they've worked. Nothing but respect, professionalism, and collegiality.

Our own profession's values will be our undoing - I just hope that it will be our saving grace once the s#it hits the fan.

You are right that they teach them not to like physicians. That what goes on in my circle of friends who are nurses like me . In fact, a few months ago, I had an argument with old classmate attending an NP program now, and she insisted that her education is on par with physician's education and she should get paid the same. Once I become a physician I am going to fight them fire with fire. I will use PA instead of NP if I have to... If I order consults, I will write in the them that patients are not to be seen by NP... I have seen a couple of physicians do that... I think physicians should start fighting back because if we don't, the profession will suffer irreparable damages.

 

[DocVapor]

If I order consults, I will write in the them that patients are not to be seen by NP... I have seen a couple of physicians do that...

I never thought of doing that. I can't applaud this idea enough.

 

[PL198]

Im curious of how a resident and a NP interact when working together.

 

[touchpause13]

I never thought of doing that. I can't applaud this idea enough.

Right? I kind of love it

 

[Successful BM]

You're pulling stuff out of a hat. I completely agree with you, yet you jumped on me to be the cool guy that says " no professor may 10th is a saturday, we can't have an exam then." when everyone knows what he/she means. I completely agree with what you are stating. Hence my question. When you ALLOW nurses to do more, that they are not as qualified/trained to do (while still being allowed) it's going to compromise care and safety eventually. It's just hilarious that the exact essence of my question is what you are saying as well.

Is this is why physicians are losing the political fight? Can't seem to stop arguing with each other about the dumbest things?

 

[Anastomoses]

Once I become a physician I am going to fight them fire with fire. I will use PA instead of NP if I have to... If I order consults, I will write in the them that patients are not to be seen by NP... I have seen a couple of physicians do that... I think physicians should start fighting back because if we don't, the profession will suffer irreparable damages.

Use a PA instead of an NP?

I won't even use a PA. Screw that. And I will actively raise an eyebrow when any personal friend has a visit with anything other than a proper physician.

As for psychiatry, I'm pretty surprised that it's a field with encroachment. I sort of naively thought it would be one area where the public just wants a properly trained doctor sorting out their mental patterns. Counselors always seemed to draw too much from their "personal" emotional experiences/biases with too little academics for my taste.

 

[Nasrudin]

Use a PA instead of an NP?

I won't even use a PA. Screw that. And I will actively raise an eyebrow when any personal friend has a visit with anything other than a proper physician.

As for psychiatry, I'm pretty surprised that it's a field with encroachment. I sort of naively thought it would be one area where the public just wants a properly trained doctor sorting out their mental patterns. Counselors always seemed to draw too much from their "personal" emotional experiences/biases with too little academics for my taste.

Well you're a high end, highly educated potential client. Of course your criteria would be more discerning. But for the morbidly mentally ill, basic life organization can be a lofty goal.

Psychiatry is very easy to do badly. Our patients are vulnerable and often without social support. They don't sue typically. And the state of the knowledge base in terms of unknowns is fertile ground for charlatans of all sorts. NP's with no residency training included.

 

[Arkangeloid]

Well you're a high end, highly educated potential client. Of course your criteria would be more discerning. But for the morbidly mentally ill, basic life organization can be a lofty goal.

Psychiatry is very easy to do badly. Our patients are vulnerable and often without social support. They don't sue typically. And the state of the knowledge base in terms of unknowns is fertile ground for charlatans of all sorts. NP's with no residency training included.

Uh, why do you use the term "our"?

 

[touchpause13]

Uh, why do you use the term "our"?

Our patients, as in psychiatry patients

 

[AnonymousD.O.]

75 year old Patient presents with high blood pressure, migraine and some weight loss. She goes to her primary care clinic and visited by a NP. Seems like a pretty straight forward case right? The patient has never had these migraines before. But because the NP never took Medical School level pathology, she doesn't think to palpate the temporal artery, looking for pulsation or bulging, so Giant Cell Arteritis (a relatively rare disease that the NP probably didn't see in her 6 month clinical experience, or even as a nurse....and if the NP did see it, didn't learn much about it) So, the NP goes on to modify the patients blood pressure, which decreases and everything is good.

2 weeks later the patient notices some vision loss. She was never told by the NP to look for this as a progressive sign of GCA because GCA was never on the NPs differential. The patient wasn't started on steroids, the temporal artery never biopsied, and she is starting to get concerned about her vision loss, but thinks it is probably just do to aging. She'll wait 2 weeks from now when she visits the Optho for a routine screening. By then though, the window to intervene with steroids have passed, and she presents to optho with irreversible vision loss.

Sure, this case could also be for a physician missing the diagnosis. But, lets be honest, the NP will miss it more often. Doctors should be seeing patients. Having NPs run the show with help is bad enough.

Sure NPs do "the same thing as doctors on a day to day basis, especially in primary care." but they may miss the important things because the didn't receive the 4 years of medical school and residency. Sorry, they shouldn't be given this autonomy.

 

[Nasrudin]

Sure, this case could also be for a physician missing the diagnosis. But, lets be honest, the NP will miss it more often.

I understand your point but, unfortunately, systemically it's rarely this clear. What happens is that NP's usually work under closer supervision as new graduates and are trained to work very collaboratively such that they consult more, they ask their supervisor when in doubt, they work slower with fewer patients, and most of the more obviously complicated patients are filtered from their work schedules. They are constantly aware that they lack what we have and therefore are typically very motivated to learn academic stuff as they go. Very much like us as residents. Only working like proper English gentry and getting paid twice as much.

This is what obfuscates comparisons. Their like parasitic species living in our corpus. It's impossible to isolate them from their host for proper evaluation to determine fitness for independence.

Uh, why do you use the term "our"?

By way of me matching psychiatry and segregating by chief complaint to our service. I suppose I should I wait 2 months for that to be accurate. My apologies, M1.

 

[evilbooyaa]

Use a PA instead of an NP?

I won't even use a PA. Screw that. And I will actively raise an eyebrow when any personal friend has a visit with anything other than a proper physician.

As for psychiatry, I'm pretty surprised that it's a field with encroachment. I sort of naively thought it would be one area where the public just wants a properly trained doctor sorting out their mental patterns. Counselors always seemed to draw too much from their "personal" emotional experiences/biases with too little academics for my taste.

There's a certain level of militism to have. Not using NPs is fine. However, PAs are under the board of medicine, and aren't really shooting for independent practice like the NP lobby is.

In my future practice, I would rather hire PAs than NPs anyday of the week.

 

[AnonymousD.O.]

hmm

 

[DoctorKrieger]

Proposal to form the Physicians' Syndicate. This guy is on board: http://online.wsj.com/news/articles/SB10001424052702304279904579518273176775310

 

[sobored]

There's a certain level of militism to have. Not using NPs is fine. However, PAs are under the board of medicine, and aren't really shooting for independent practice like the NP lobby is.

In my future practice, I would rather hire PAs than NPs anyday of the week.

Give it time. They probably will eventually.

 

[Siggy]

guys, quiet!

or the nurses from that nurses-r-us or all-nurses or whatever forum will come back and yell at us.

> <

Oh, you mean like this thread where there's plenty of "Well, we have the EXPERIENCE to do their job, besides "doctor" is a generic term!"

http://allnurses.com/general-nursing-discussion/nurses-not-doctors-921716.html

What's hilarious is then they go and complain about CNAs doing the same thing to RNs that the NPs are doing to physicians.
http://allnurses.com/nurse-colleague-patient/cna-tudes-921775.html

 

[postbacpremed87]

Oh, you mean like this thread where there's plenty of "Well, we have the EXPERIENCE to do their job, besides "doctor" is a generic term!"

http://allnurses.com/general-nursing-discussion/nurses-not-doctors-921716.html

What's hilarious is then they go and complain about CNAs doing the same thing to RNs that the NPs are doing to physicians.
http://allnurses.com/nurse-colleague-patient/cna-tudes-921775.html

Jealousy breeds resentment.

We should band together and strengthen medicine's future. Heck, doctors signed the declaration of independence. We have been isolated and removed from public discourse. It is high time we go on the offensive. We will catch them off balance. They don't expect us to fight back because we haven't for decades.

 

[Brain Bucket]

Why is this still a discussion?

 

[sobored]

Why is this still a discussion?

We're med students. We have to b*tch about something. Duh.

 

[Siggy]

75 year old Patient presents with high blood pressure, migraine and some weight loss. She goes to her primary care clinic and visited by a NP. Seems like a pretty straight forward case right? The patient has never had these migraines before. But because the NP never took Medical School level pathology, she doesn't think to palpate the temporal artery, looking for pulsation or bulging, so Giant Cell Arteritis (a relatively rare disease that the NP probably didn't see in her 6 month clinical experience, or even as a nurse....and if the NP did see it, didn't learn much about it) So, the NP goes on to modify the patients blood pressure, which decreases and everything is good.

2 weeks later the patient notices some vision loss. She was never told by the NP to look for this as a progressive sign of GCA because GCA was never on the NPs differential. The patient wasn't started on steroids, the temporal artery never biopsied, and she is starting to get concerned about her vision loss, but thinks it is probably just do to aging. She'll wait 2 weeks from now when she visits the Optho for a routine screening. By then though, the window to intervene with steroids have passed, and she presents to optho with irreversible vision loss.

Sure, this case could also be for a physician missing the diagnosis. But, lets be honest, the NP will miss it more often. Doctors should be seeing patients. Having NPs run the show with help is bad enough.

Sure NPs do "the same thing as doctors on a day to day basis, especially in primary care." but they may miss the important things because the didn't receive the 4 years of medical school and residency. Sorry, they shouldn't be given this autonomy.

I wounder what would happen if we start a database of something like this. I had a middle age female patient present to the ED for cough x 1 month and hemoptysis x 1 week. Saw NP in her PCP clinic who prescribed a Z-pak with no imaging. The problem? History of breast CA with brain mets. Imaging showed extensive lung mets now. Patient expired 3 days later in the ICU. Would it have changed the outcome? Probably not, but the NP robbed the patient of her last week with her family. After all, if you knew that you were going to die really really soon, you would probably spend your remaining time differently than if your life expectancy was still decades.

 

[Siggy]

Jealousy breeds resentment.

We should band together and strengthen medicine's future. Heck, doctors signed the declaration of independence. We have been isolated and removed from public discourse. It is high time we go on the offensive. We will catch them off balance. They don't expect us to fight back because we haven't for decades.

...but the interprofessional education courses I had to take in medical school said that nurses were perfect beings who should never be criticized because they're nurses. After all, they might think that physicians are mean!

 

[postbacpremed87]

...but the interprofessional education courses I had to take in medical school said that nurses were perfect beings who should never be criticized because they're nurses. After all, they might think that physicians are mean!

I have no problem with nurses. I love nurses. I think the nurses playing doctor are the threat. When we work to the full extent of OUR ROLE...patients win.

 

[KinasePro]

If that's the case then ALL doctors should be specialists and no residency positions should be afforded to primary care residencies at all. We could start by taking all those Family Medicine residencies and put them either in specialties or in ones that can specialize right after: IM and Peds.

Honestly, I see no problem with this. Just make all IM/Peds specialties 4-5 year integrated programs. Might save some federal dollars in the long run.

Could alternatively require a commitment to primary care residencies at the med school admissions stage. There are more than enough applicants, some who otherwise might not be admitted to medical school in the first place, who'd probably be ecstatic for the opportunity to be PCPs.

We should expand concierge care to the upper middle and middle classes, so we get PCPs, and poor/rural people have to go with NPs.

Well, that's probably going to happen anyways if the NPs have their way.

Sad to say this is also inevitable. A two tiered healthcare system is without a doubt on the horizon if the people like Zeke Emanuel continue to have an influence on healthcare policy.

 

[Coffee Machine]

What's hilarious is then they go and complain about CNAs doing the same thing to RNs that the NPs are doing to physicians.
http://allnurses.com/nurse-colleague-patient/cna-tudes-921775.html

This is the example I gave my wife (an RN) to help her understand why physicians are so against NPs encroaching on clinical medicine. It's actually a really useful example when discussing this issue with nurses; it's respectful, non-inflammatory, and puts it in terms that they're familiar with.

 

[Coffee Machine]

Oh, you mean like this thread where there's plenty of "Well, we have the EXPERIENCE to do their job, besides "doctor" is a generic term!"

http://allnurses.com/general-nursing-discussion/nurses-not-doctors-921716.html

This is actually a really interesting thread. Like in the real world, there are some nurses who "get it" and understand the limitations of NP training, and others who frankly don't and repeat the same tired nonsense that their national orgs do, ie "DNP is a DOCTORATE so WE SHOULD BE CALLED DOCTORS IT'S ONLY PROPER", and "NPs specialize from day 1, so they know everything a specialized physician does in less time".

It goes to show you that there really are nurses out there that support the physician-led team idea. Unfortunately, especially on a national scale, they're drowned out by those who would have NPs practice completely autonomously.

Bonus points for the ongoing discussion about how foreign doctors only have the US equivalent of bachelor's degrees but THEY get to be called doctor (referring to the MBBS degree).

 

[postbacpremed87]

This is actually a really interesting thread. Like in the real world, there are some nurses who "get it" and understand the limitations of NP training, and others who frankly don't and repeat the same tired nonsense that their national orgs do, ie "DNP is a DOCTORATE so WE SHOULD BE CALLED DOCTORS IT'S ONLY PROPER", and "NPs specialize from day 1, so they know everything a specialized physician does in less time".

It goes to show you that there really are nurses out there that support the physician-led team idea. Unfortunately, especially on a national scale, they're drowned out by those who would have NPs practice completely autonomously.

Bonus points for the ongoing discussion about how foreign doctors only have the US equivalent of bachelor's degrees but THEY get to be called doctor (referring to the MBBS degree).

Someone should make a documentary about the level of material required of each path from the beginning (Pre-Med) and (Pre-Nursing) to the end. I mean it is night and day from Day #1. Pre-med General Chemistry vs. Nursing Chemistry.

Follow med students and nursing students...film the classes they are in and the material.

Nevermind...they probably won't even look at it.

 

[Frazier]

Someone should make a documentary about the level of material required of each path from the beginning (Pre-Med) and (Pre-Nursing) to the end. I mean it is night and day from Day #1. Pre-med General Chemistry vs. Nursing Chemistry.

Follow med students and nursing students...film the classes they are in and the material.

Nevermind...they probably won't even look at it.

lol yeah, before I got to your final line I was thinking to myself:
"not a single soul would sit down to watch a documentary about that".

 

[touchpause13]

Omg I just read that thread. I though WE crapped on FMGs. Damnnnn

 

[NickNaylor]

Omg I just read that thread. I though WE crapped on FMGs. Damnnnn

Somehow they seem to think that because an NP can provide valuable input to a medical student/resident during their training, NP >> MD.

wat is this I don't even


Sent from my iPhone using Tapatalk

 

[touchpause13]

Someone should go over there and tell them how wrong they are.

Not me though. I have a low tolerance for stupid

 

[postbacpremed87]

Someone should go over there and tell them how wrong they are.

Not me though. I have a low tolerance for stupid

That makes you the right person.

 

[mmmcdowe]

This ones my favorite (second paragraph is an np response to the first):


Quote from RNperdiemTurf battles. This topic reminds me of the issues nurses face with medical assistants. Maybe physicians are facing the same thing with NPs.

The difference is that NPs do not think they are doctors the way so many MAs think / say they are nurses.

 

[postbacpremed87]

This ones my favorite:


Quote from RNperdiemTurf battles. This topic reminds me of the issues nurses face with medical assistants. Maybe physicians are facing the same thing with NPs.

The difference is that NPs do not think they are doctors the way so many MAs think / say they are nurses.

Whaaaa?

 

[Gifted Hands]

I read the thread too. While some get it, others I just wanted to bang my head on a wall.

Please someone go over there and drop some knowledge. opcorn:

 

[FiveOClock]

Perhaps america deserves the collapse of primary care. We have treated the practitioners like crap for so long that far less qualified individuals are destroying the art of primary care medicine. In the future maybe we should simply phase out MD primary care, all specialize, and see how that works out for everybody!

 

[DocVapor]

Perhaps america deserves the collapse of primary care. We have treated the practitioners like crap for so long that far less qualified individuals are destroying the art of primary care medicine. In the future maybe we should simply phase out MD primary care, all specialize, and see how that works out for everybody!

I would posit that most of us came to medicine because we actually care about people. This would be a tough pill to swallow. Which is why NP's have us by the balls.

 

[FiveOClock]

I would posit that most of us came to medicine because we actually care about people. This would be a tough pill to swallow. Which is why NP's have us by the balls.

No doubt. I really like what I've seen of primary care but I really am uncomfortable with the fact that NPs would assume that they have the physiological understanding to do that job. Although I'm sure many of them are very capable, they simply are not put through a rigorous enough, critical-thinking based curriculum to merit diagnosing and prescribing privileges (except for your clear cut strep, etc).