Potential salary for DrNP/DNP grads in California...

[Xscape]

Anyone have any idea what compensation California grads with a DrNP/DNP degree will get? I was thinking about becomng a NP, but the lure of possibly practicing independantly at some time in the future with a DrNP/DNP degree is becoming harder to resist. But if the compensation won't be much greater than an MS in NP, a DrNP/DNP degree won't justify the two additional years spent in school for me.

Anyone have any idea what the salary range will be like? I know the degree is new and no grads yet to refer to, but any good guesses would be somewhat helpful.

---

Members don't see this ad.

 

[deleted6669]

I'm guessing the pay will be the same as for an np with an ms. why would someone pay the dnp more to do the same job as an ms np?
pa's and np's with ms degrees make only slightly less than an md fp new grad so if you add more to the midlevels salary you might as well just hire a doc.....
if you are working independently your salary depends on the size of your pt panel regardless of your education or degree....how much can you bill without folks seeking cheaper healthcare elsewhere?

 

[Xscape]

Makes sense. Except this 4 year degree isn't essentially the same as a 2 year MS in NP. 2 extra years of education would advance your knowledge to some degree. In addition, Columbia makes these statements about the DrNP degree:

1) "How does the DrNP differ from the DNSc or other research doctorates?

The DrNP, or clinical doctorate, prepares the graduate to practice independently with the most complex patients, in any setting where the patient requires care, utilizing complicated informatics and evidence-based decision-making."

2) "How is this different from current APN practice?

The expanded competencies of the Doctor of Nursing Practice enable the graduate to independently provide complex care across all settings including ambulatory, acute, community and home settings. For example, the expanded curriculum will focus on the utilization of evidence-based decision-making to admit and co-manage hospitalized patients, to provide advice and treatment initiated over the phone while taking call, and to initiate specialist referrals and evaluate the subsequent advice and initiate and participate in co-management."

3) "The Doctor of Nursing Practice program will prepare nurses with the knowledge, skills and attributes necessary for fully accountable practice with patients across sites and over time. With the increasing scope of clinical scholarship in nursing and the growth of scientific knowledge in the discipline, doctoral level education is required for independent practice. The curriculum includes content which will enable the graduate to conduct complex diagnostic and treatment modalities, utilize sophisticated informatics and decision-making technology, and assimilate in-depth knowledge of biophysical, psychosocial, behavioral and clinical sciences. The Residency and portfolio will provide mastery and evidence of competency achievement."


Reading all this, I was under the impression more clinically complex cases were going to be handled by DNP's than MS's do currently, the scope of practice would be much more expanded. And it seems that therefore, a higher salary would be commanded.

Is it really possible that a DNP/DrNP would'nt make significantly more than an MS in NP?!

 

[deleted6669]

let's look at those 2 extra years though....1 year of nursing theory and research and 1 part time clinical year( say 1000 hrs) so a dnp would still have less clinical time than your average 3rd year med student.
typical ms level np program has about 500-750 hrs clinical time. add 1000 hrs and you are still well under a full year of clinical time.
most employers will be smart enough to see this.
in my book "practicing independently with the most complex pts" involves a minimum of 3 yrs md/do residency.sure the dnp can be a primary care provider but so can an ms level np or pa(as both these groups already function in this capacity).
much as they want this to be the next step in clinical medicine it is just another way of becoming a midlevel provider.
and as I mentioned in my prior post, if you raise the starting salary of a dnp by even 10k/yr you are looking at the lower end of the md salary scale so why not hire an md instead. in my neck of the woods a pa/np right out of school makes 75 k or so to start. an fp md right out of residency makes 90k or so.....do the math.....

 

[50960]

I am stepping out on a limb here, so please correct me if I am wrong. Wouldn't the laws have to change for any of this to actually mean anything? Doctorate level nursing is fine, but one would still have an NP license, and thus still have to be supervised? Can NP's admit? If I am right then it seems that that the language used regarding training DrNP's to practice in any setting, complex patients without supervision is misleading at best.
I am generally pro NP, and would support legislation change to allow more independent practice DrNP and the like, but that has not happened yet to my knowledge. Put me in my place if I am wrong...I admit I am not up on the nursing lobby/laws etc..

 

[deleted6669]

there are already practicing pa's and np's with admission priviledges as well as pa and np hospitalists....and they already do this without a doctorate......

 

[fab4fan]

The OP might be better served by looking here; there's an NP forum that may answer your question. This site is decidedly anti-NP (with a few exceptions), so the OP may get more appropriate guidance elsewhere.

 

[prince_moses]

Yo wanna make some real money become a business man, open up a walmart then watch the money fly in.

 

[50960]

Still my questions are unanswered. A PA/NP admitting is doing so under an MD's license, so that is not really a medical staff privilege. This is splitting hairs abit, but I would still like to get some of my other questions answered if possible......

 

[prince_moses]

I know everyone is thinking this already but, why dont u just go to Med school and save yourself the headache, u wont have to worry about money and best of all your free to practice without anyone telling u otherwise.

 

[Freeeedom!]

This guy is baiting EVERYONE.


Listen...an advance practice LPN is worth at least 20 bucks an hours easy.

And yep...you go to a site called "STUDENT DOCTOR" and it may be PRO physician. If you want to talk about nursing, go to a nursing site.

 

[Xscape]

Everyone thinks making more money just boils down to becoming a doctor. But med school is a tough decision. And its not tough because of what you need to get into it, its tough because of what it takes away from you. Thats 12 years of school alone, plus a minimum 3 years of residency during which, if you are living in an expensive economy such as southern california, means you are living poooooooor for those 3 years. So lets see, thats 15 years, and now, FINALLY, you are making 165,000 a year (3 year residency that pays most - IM). 15 years of missing having a family life, missing having a social life, 15 years of your prime time. Those precious years you are young. And now at the age of 32, you start earning money, and you can finally concentrate on starting a family, on being an active member IN your family.

I just want to make some money with the satisfaction I get from this field. I could go to med school, but the fact is, I DON'T WANT TO anymore. Not with my 4.0 GPA, or 97% MCAT scores, or numerous letters of recommendations from the Directors of Pediatrics and Oncology at Anaheim Memmorial - (For all those lame ppl that will imply I dont want to go because I dont have the credentials to get in).

I thought maybe with this DrNP, I could make a nice salary and still OWN MY LIFE.....

I'm keeping my fingers crossed....

I guess I could always become a CRNA, they make around $130,000 startingin SoCal, but you don't get the satisfaction of providing "comprehensive care, so to speak, like FP's do...

 

[diabeticfootdr]

I guess I could always become a CRNA, they make around $130,000 startingin SoCal, but you don't get the satisfaction of providing "comprehensive care, so to speak, like FP's do...

Sounds like you want all the benefits of being a doctor and none of the responsibilities.

“A doctor must work eighteen hours a day and seven days a week. If you cannot console yourself to this, get out of the profession.”
~Martin H. Fischer

 

[Xscape]

Sounds like you want all the benefits of being a doctor and none of the responsibilities.

And I thought we left the dark ages hundreds of years ago....

Lets get this straight....I want: 1) to help sick people in a comprehensive way, 2) and make good money doing it.

Are all these benefits solely those of doctors? NO. Again, that's NO. They say third time's a charm....sorry but its still NO.

Today, providing comprehensive health care care is NO LONGER A DOCTORS DOMAIN. Family nurse practitioners as well as doctors provide this today.

That's life. Deal with it.

So when I say I want to 'provide comprehensive health care and make good money' am I saying I want a DOCTOR'S benefits...........

Surprise surprise.....NO.

 

[deleted6669]

Everyone thinks making more money just boils down to becoming a doctor. But med school is a tough decision. And its not tough because of what you need to get into it, its tough because of what it takes away from you. Thats 12 years of school alone, plus a minimum 3 years of residency during which, if you are living in an expensive economy such as southern california, means you are living poooooooor for those 3 years. So lets see, thats 15 years, and now, FINALLY, you are making 165,000 a year (3 year residency that pays most - IM). 15 years of missing having a family life, missing having a social life, 15 years of your prime time. Those precious years you are young. And now at the age of 32, you start earning money, and you can finally concentrate on starting a family, on being an active member IN your family.

some of your #'s and facts are a little off...
medschool grad: 4 yrs for college+ 4 yrs medschool+ 3 yrs residency(min)=11. age 29 for someone who goes straight through.
max salary for 3 yr residency is certainly not IM(that is among the lowest). EM is certainly higher with new grads making 185-250k+, although I don't know which is "highest" paying 3 yr residency on avg

 

[zenman]

Yo wanna make some real money become a business man, open up a walmart then watch the money fly in.

Too much work. Do seminars instead and you won't have to worry about employee hassles.

 

[diabeticfootdr]

Lets get this straight....I want: 1) to help sick people in a comprehensive way, 2) and make good money doing it.

Are all these benefits solely those of doctors? NO.

Actually . . . YES

Why are you trying to take the "easy way out" . . . because as you stated "you don't want to dedicate your life to medicine". That is the responsibility of a doctor. Being a physician is much like being a priest, it's a calling, the day doesn't end when you go home. You should be picking up the latest journal in your specialty so that when you go to work on Monday morning you don't fail to diagnose Mrs. Jones' shoulder pain as an early sign of bone mets from her breast CA she had 13 years ago.

It's sad you said you don't want to put forth all the effort of med school, yet you want to be responsible for someones "comprehensive care".

I'd like to be an airline pilot, but instead of training as a pilot, how would it be if I first trained as a flight attendant, practiced on MS FlightSimulator -- and then hopped in the left seat of the cockpit, so I could make the big bucks too??? Analogous?

LCR

 

[Xscape]

Thanx for correcting me above, about the timeline for med school.

It is my firm belief that when dealing with life, the utmost experienced person is the bare minimum standard for providing that care.....THE DOCTOR. But just as in any other profession, there get to be these, garden variety, so to speak, type work/cases, that a mid level person could definitely be trained to handle effectively. Take for exmple, patients coming in for a sinus problem, colds, rashes....now HONESTLY, could a person not be taught in 4 years to handle these type of cases very efficiently? (the DrNP/DNP degree is 4 yrs post bachelors)

Obiously the more complex cases should always be handled by the industry standard, again the doctor. If my child had lets say pneumonia, you know who I would take her to - a doctor. If she had a cold, I would be absolutely comfortable taking her to a FNP.

I don't think a 7 year training is required to efficiently handle these garden variety type cases. Period. An ordinary person could be very well trained in 4 years to handle the least complex medical cases. And CAPNA is a living example of the truth to this statement. I think they only have 2 years of training as the MS in NP goes so far.

Again, if NP's weren't handling these cases right, causing harm to patients, etc Nurse Practitioners WOULD BE WIPED OUT. No nursing board in the world could convince the state to allow NP's to exist and provide Primary care if human beings were being harmed by an NP's delivering of primary care. The fact that NP's are still around, growing, and being granted more priveledges than ever is testament to the fact this is a highly cost effective and yet safe way of providing graden variety primary care.

 

[hospitalistpac]

Thanx for correcting me above, about the timeline for med school.

It is my firm belief that when dealing with life, the utmost experienced person is the bare minimum standard for providing that care.....THE DOCTOR. But just as in any other profession, there get to be these, garden variety, so to speak, type work/cases, that a mid level person could definitely be trained to handle effectively. Take for exmple, patients coming in for a sinus problem, colds, rashes....now HONESTLY, could a person not be taught in 4 years to handle these type of cases very efficiently? (the DrNP/DNP degree is 4 yrs post bachelors)

Obiously the more complex cases should always be handled by the industry standard, again the doctor. If my child had lets say pneumonia, you know who I would take her to - a doctor. If she had a cold, I would be absolutely comfortable taking her to a FNP.

I don't think a 7 year training is required to efficiently handle these garden variety type cases. Period. An ordinary person could be very well trained in 4 years to handle the least complex medical cases. And CAPNA is a living example of the truth to this statement. I think they only have 2 years of training as the MS in NP goes so far.

Again, if NP's weren't handling these cases right, causing harm to patients, etc Nurse Practitioners WOULD BE WIPED OUT. No nursing board in the world could convince the state to allow NP's to exist and provide Primary care if human beings were being harmed by an NP's delivering of primary care. The fact that NP's are still around, growing, and being granted more priveledges than ever is testament to the fact this is a highly cost effective and yet safe way of providing graden variety primary care.

If a DrNP is truly working "independently" with his or her own shingle, you cannot put up a sign and say "garden variey cases" or "no pneumonia please." That is why it is best not to get too carried away with the whole independence thing. You yourself said you like options.
I do not agree that an FNP "could" not handle a pneumonia or refer and treat properly. But my point is that one cannot be a "comprehensive" health care provider and expect to
a) only see garden variety and
b) stay stimulated and involved in the medicine

But I also second the motion that DrNPs will probably not make any more that MS prepared NPs

 

[diabeticfootdr]

Obiously the more complex cases should always be handled by the industry standard, again the doctor. If my child had lets say pneumonia, you know who I would take her to - a doctor. If she had a cold, I would be absolutely comfortable taking her to a FNP.

I don't think a 7 year training is required to efficiently handle these garden variety type cases. Period. An ordinary person could be very well trained in 4 years to handle the least complex medical cases. And CAPNA is a living example of the truth to this statement. I think they only have 2 years of training as the MS in NP goes so far.

I'll agree with these statements. I was confused by "comprehensive care". If you're talking about provide treatments for simple bronchitis, sinusitis, etc, then I believe that an NP is qualified. This even saves the physician time to deal with more serious cases. I'm acutally pro-NP and pro-PA (more PA than NP because it seems like every time I see a thrust for scope of practice change it ALWAYS comes from NPs). Not that I feel threatened, because I'm a subspecialist and no one is really encroaching in my territory, but I want my patients to recieve the most appropriate care when I refer for management of uncontrolled DM, or need a medicine consult in-patient for a-fib, etc.

LCR

 

[windsurfr]

Xscape-
I'm usually a well tempered man... but your posts are the absolute pinnacle of how the 'watering down' of primary care will hurt everyone.

"Take for exmple, patients coming in for a sinus problem, colds, rashes....now HONESTLY, could a person not be taught in 4 years to handle these type of cases very efficiently? (the DrNP/DNP degree is 4 yrs post bachelors)"

What if the patient were a 40 year old male with 'just a cold'... a bit of runny nose, some sinus pain. Oh also just a bit of blood in the sputum a few days ago. And oh yes, I guess the urine had been a little dark for a wee bit 'o time.
-by the way, you actually have to ASK these questions... they dont just tell you

Or the college female coming in with a sore knee (must have twisted it at volleyball)... and oh gee, a small papular rash on the lateral aspect of both feet. Hmmmm must have been walking around in the grass and had a regular old allergic reaction.

The above are two examples of 'common' presentations that if not treated accordingly can have potentially devastating consequences. There are innumerous more. I'm not trying to pretend that all MD's would pick these up, but I guarantee that WAY more would than an NP or PA. No question.

Also what is lacking in many of the midlevels I talk to is a fundamental understanding of the pathophysiology of disease, how to use that understanding to work a patient up, and understanding of pharmacology to treat the disease. And no, that cannot be taught in 4 years.

And perhaps the most rediculous notion that I hear is "the nursing model looks at health from a holistic standpoint" or "I dont like the medical model because they treat the disease and not the person". BS. Completely rediculous banter from those who do not understand diseases. Unfortunately you have to go into every "common" scenerio with the assumption that something is not right. This means asking questions (are you sure there hasn't been any blood in your sputum... are you sure your urine hasn't been different at all). And YES if you are good you can do this and have excellent, warm, respectful rapport with the patient.

So yes, like a prior poster commented, a quick 4 year training would teach you basic diagnosis and treatment of COMMON things. And yes this is a bulk of primary care. But absolutely in no way will it prepare you for the zebras of practice. And unfortunately you never know when a zebra will come in looking like a plain old horse....

 

[diabeticfootdr]

Xscape-
And yes this is a bulk of primary care. But absolutely in no way will it prepare you for the zebras of practice. And unfortunately you never know when a zebra will come in looking like a plain old horse....

speaking of zebras -- I read something interesting a few yrs ago. An article titled "When you hear hoof beats; separating zebras from horses".

The author had 4 principles of separating zebras from horses.
1. common diseases occur commonly and rare diseases occur rarely
2. the unusual presentation of a common disease is far more likely than the usual presentation of an uncommon disease
3. the human mind is an imperfect likelihood estimator
4. not everything you are taught in school is correct

I thought it was interesting enough to share.

LCR

 

[zenman]

And perhaps the most rediculous notion that I hear is "the nursing model looks at health from a holistic standpoint" or "I dont like the medical model because they treat the disease and not the person". BS. Completely rediculous banter from those who do not understand diseases.

The nursing model does look at health from a holistic standpoint while medicine rarely looks at health at all! Thankfully, medicine is coming around a little.

"Since health is defined by Western medicine as the absence of pathology, those engaged in its practice can find it frustrating not to have a model for working on improved well-being."...Gary Dolowich, M.D.

"Understand diseases." When will we "understand health?"

And where does medicine now stand as one of the leading causes of death...#2 or #3...I can't remember which.

 

[windsurfr]

1. Immunization programs
2. Hypertension control
3. Hyperlipidemia control
4. Prenatal care
5. Routine mamograms
6. Colon screening
7. Diabetes screening
8. Well child examinations
9. Thyroid screening
10. PSA screening
11. Osteoporosis screening
12. Etc, etc, etc

The above are all to PREVENT pathology or to detect it early. What else do you have in mind, Zenman?

Again, we can only try so hard to prevent disease when the bulk of americans are out to self-promote it.

I have yet to hear a good, factual, non-watered down description of what you mean by "nursing looks at health from a holistic standpoint". How does that help the man who is 100 pounds overweight, drinks too much, smokes, has diabetes, etc, that I see every day in clinic. And if you think we dont talk health modifications such as diet, exercise, vitamins, you're nuts. So... how would the nursing model do better. No spin please

 

[DRGIGGLES]

1. Immunization programs
2. Hypertension control
3. Hyperlipidemia control
4. Prenatal care
5. Routine mamograms
6. Colon screening
7. Diabetes screening
8. Well child examinations
9. Thyroid screening
10. PSA screening
11. Osteoporosis screening
12. Etc, etc, etc

The above are all to PREVENT pathology or to detect it early. What else do you have in mind, Zenman?

Again, we can only try so hard to prevent disease when the bulk of americans are out to self-promote it.

I have yet to hear a good, factual, non-watered down description of what you mean by "nursing looks at health from a holistic standpoint". How does that help the man who is 100 pounds overweight, drinks too much, smokes, has diabetes, etc, that I see every day in clinic. And if you think we dont talk health modifications such as diet, exercise, vitamins, you're nuts. So... how would the nursing model do better. No spin please

wind is so dead on with this post...so refreshing. the way some in the nursing profession (a profession i genuinely admire btw) go on and on about looking at health while docs only look at medicine is really laughable. it's presented almost as if the nursing model is somehow superior but has been "put down by da man". it's presented as if if we only followed that model rather than the naughty, sinister medical one, patients would be better off. horse kaka! if the current nursing model is so great, why add more medicine to it to fashion this new fangled DNP?

will ANYONE take up the challenge in the final paragraph of wind's last post? WHAT EXACTLY would the nursing model do in a case such as this? what outcome would you expect? we talk about evidence based medicine... are the techniques dictated by the nursing model in such a case supported by evidence based nursing? please, someone, enlighten me. i'm being serious about this. i mean, i'm an internist right...i see this kind of guy all the time...should i be sending pts like the above to nurses for a consult?


as for the OPs questions/comments, i too agree with many of the other posters in that i don't expect the DNP salary to be way out of line with the MS/NPs. as i understand it, the DNP will essentially replace the MS in the future.

finally as to the extra qualifications/responsibilities of the DNP well, i have my doubts. they may say you'll be qualified to given "comprehensive" care but looking at the curriculum (which i really have done), i just can't see how. it seems logical that in order to provide "comprehensive" care one should undergo "comprehensive" training, yes? that's not to say the extra training won't be good. hell, we can all use extra training. but to pass off the program as training people to do things they frankly won't be able to do is really disturbing.

-drgiggles

 

[Ross434]

Given that you can open your own practice as a DNP, and that NP's make around 75k, i see no reason why, with a little hard work, a DNP could make 100-120k. If you operate your own practice, you control how much money you make by how much work you put in. That's the biggest factor. As an employee, though, a DNP probably wouldnt be paid any more than a regular NP.

 

[Jengirl18]

I was wondering if the laws have changed to allow DNPs to practice completely independently. I'm wondering about this because the DNP program website (Cornell) says with this new degree it will allow NPs to practice independently without a physician. Is this a sure thing, or wishfull thinking at the moment (until/if the laws do change?) I'm just trying to get educated about this new degree.

 

[50960]

How can you open your own practice as a DnP if you still just have an NP license requiring MD supervision???

 

[windsurfr]

We got off topic with the "theories" debate... I'll start a new link for it if you're interested....

 

[zenman]

The above are all to PREVENT pathology or to detect it early. What else do you have in mind, Zenman?

What I have in mind is your definition of “preventive medicine” vs. “promote health.” Although more medical schools are teaching more holistic methods, “practicing medicine is defined as treatment with "allopathic" treatments, which by definition excludes holistic, natural, non-medical, non-drug, non-surgical forms of treatment.” Oklahoma Definition of practice of medicine. The reductionst approach of medicine, by it’s nature, just does not fit any holistic model.

Here’s a good link:
http://www.wholistichealingresearch.com/Articles/WholisIC.asp

I have yet to hear a good, factual, non-watered down description of what you mean by "nursing looks at health from a holistic standpoint". How does that help the man who is 100 pounds overweight, drinks too much, smokes, has diabetes, etc, that I see every day in clinic. And if you think we dont talk health modifications such as diet, exercise, vitamins, you're nuts. So... how would the nursing model do better. No spin please

The definition of nursing, on the other hand, according to the International Council of Nursing is:

“Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.”

The definition of the nursing model I used in school is: “Neuman’s model focuses on the person as a complete system, the subparts of which are interrelated physiological, psychological, sociocultural, spiritual, and developmental factors.”

And the American Nurses’ Association definition is: "Nursing is the diagnosis and treatment of human responses to actual or potential health problems."

In your case example above, try talking less about health modifications and listening more. When you discover the meaning in the person’s “illness” (because it is an intensely personal matter), you will have more success. But unfortunately, I really doubt you have the time to do so the way our system works.

wind is so dead on with this post...so refreshing. the way some in the nursing profession (a profession i genuinely admire btw) go on and on about looking at health while docs only look at medicine is really laughable. it's presented almost as if the nursing model is somehow superior but has been "put down by da man". it's presented as if if we only followed that model rather than the naughty, sinister medical one, patients would be better off. horse kaka! if the current nursing model is so great, why add more medicine to it to fashion this new fangled DNP?

I’m glad you admire the nursing profession, however we have our share of problems. In fact, we are together in a healthcare system which has run amuck. We often do not have enough time to focus on health aspects. My family doc, an IM guy, and I chat often on the sad state of affairs.

A focus on health can only be untaken as part of a social policy.

will ANYONE take up the challenge in the final paragraph of wind's last post? WHAT EXACTLY would the nursing model do in a case such as this? what outcome would you expect? we talk about evidence based medicine... are the techniques dictated by the nursing model in such a case supported by evidence based nursing? please, someone, enlighten me. i'm being serious about this. i mean, i'm an internist right...i see this kind of guy all the time...should i be sending pts like the above to nurses for a consult?

You can send him to me, ha, ha! See my above answer.

What good is “evidence-based” when, for example, at least three drugs were recalled lately? Was the original evidence wrong? What changed?

 

[windsurfr]

Zen, If I lived in Hawaii I'd take you out for a beer and we'd have some good discussions I'm sure (even though I'm just a young buck)

Zenman, science is a good thing... and the nature of science involves hypothesis, testing, analysis, and revision. You look back on data and try to make the best sence about evidence possible. It is unrealistic to expect (as the US public generally does) that all drugs will be perfect, with no side effects, and allow you to do yoga on a mountain top (like the drug companies say). As an aside, the evidence for the Vioxx scare isn't even that great if you boil it down......
Anyway, evidence based practice is a good thing... although I somehow doubt you think so. It allows us to objectively determine what is better: bloodletting or beta blocker, etc, and over time you find trends. It cannot happen overnight and setbacks do occur.

The specific thing I would like to see in 'Complimentary Alternative Medicine' is this (using an example of reflexology b/c I think you know something about it):
1. Randomize a group of patients with 'X' condition
2. Give one group a good footrub (relaxation, soothing, calming, etc)
3. Have a reflexologist at the other group, and 'reflexology' their feet
4. Dont tell which group is which
5. Have an independent practitioner analyze the resolution of disease 'x', whatever it may be...
6. Ask yourself, then, is there any significant difference between the two groups?

Science is beautiful.

My link 'back at ya' is this:
www.quackwatch.org
It is actually a legit site that I think all smart healthcare consumers should be aware of....
Also there is a lot of quackery in 'allopathic' medicine as well. Again, this is why evidence based practice needs to be accepted.

And finally:
Zenman, may your inner Chi flow strong...

 

[Skialta]

I am totally with Windsurfr.

It really bugs me when you get the zen, holistic, hold this herb next to your chest while I push on your arm to see if your deficient in "X" people who complain about how medicine is killing people and the pharmaceutical companies are all flying black helicopters in the middle of the night crap. Evidence based medicine makes sense, anyone who can look at a problem objectively should be able to see this. The same holds true for herbals, we know some of them are useful, but there needs to be some objective data just like there is with any other drug. Just because Chinese herbalists have been using something for 1,000 years does not mean it is safe. The Chinese could have used Vioxx for a thousand years and would have never feathered out the increased risk for MI.

Being a medical student, I have never been told in any lecture by anyone about how we should just focus on disease and systems and ignore the whole person, that is just b__sh_t.

 

[50960]

To answer my own question...NO the law has not changed in any state, so this is all just conjecture at this point. I am in favor of it happening, as it is just another move in the evolution of healthcare, but I do find the advertising from these schools unethical when a DrNP will not earn a penny more than a regular NP until laws are changed.

 

[zenman]

Science is beautiful.

I'm ok with science as long as we don't think it is the ultimate "end all to end all." We have to realize it has it's limitations, one of which is the people conducting the research.

My link 'back at ya' is this:
www.quackwatch.org
It is actually a legit site that I think all smart healthcare consumers should be aware of....

Oh God, not Barrett, the retired shrink writing out of his basement, lol! He went beserk in court recently and made a fool out of himself. He's losing ground big time. I expect him to shoot himself soon just to put himself out of his misery...sad case.

Also there is a lot of quackery in 'allopathic' medicine as well. Again, this is why evidence based practice needs to be accepted.

Yep, it's everywhere.

And finally:
Zenman, may your inner Chi flow strong...

It was last night!

 

[zenman]

I am totally with Windsurfr.

It really bugs me when you get the zen, holistic, hold this herb next to your chest while I push on your arm to see if your deficient in "X" people who complain about how medicine is killing people and the pharmaceutical companies are all flying black helicopters in the middle of the night crap. Evidence based medicine makes sense, anyone who can look at a problem objectively should be able to see this. The same holds true for herbals, we know some of them are useful, but there needs to be some objective data just like there is with any other drug. Just because Chinese herbalists have been using something for 1,000 years does not mean it is safe. The Chinese could have used Vioxx for a thousand years and would have never feathered out the increased risk for MI.

Good example of "Liver chi rising!" Try to relax will ya? I like to use the term "complimentary medicine" as Western and Eastern medicine should be blended. Each has it negatives and positives. Where allopathic deals with symptoms on a physical level, traditional healing practices are more tied to the deeper energy of life, perhaps spiritual would be a good word here. Can we judge a model of healing that has successfully treated much of the world's population for thousand of years be judged by the assumptions of a system a few hundred years old? Is complimentary medicine a science? It can be argued that since it is an internally consistent, logical system that uses a clear vocabulary, and that it has a methodology that is basically empirical and its theories, diagnosis, and treatment has been built on careful observation of patients, that it is indeed a science. Is allopathic medicine a science or does it employ the sciences? Eastern medicine often focuses on aspects of life that cannot be measured objectively, therefore it is useless to try to put all of Eastern medicine under the microscope. It is even considered unethical in China to perform double-blind studies that require witholding treatment from ill patients. What a concept!

Being a medical student, I have never been told in any lecture by anyone about how we should just focus on disease and systems and ignore the whole person, that is just b__sh_t.

Hopefully you're in more progressive school. However, the system of medicine you're studying is a reductionist approach that insists on islolating a single variable. That might be ok to some, but to me it just goes against nature. And you don't mess with Mother Nature! Much of Eastern medicine will fail in meeting the rigid requirements of Western science. Western medicine has been compared to a mechanic and Eastern medicine to a gardner.

Thomas Kuhn, the historian of science, compared generally accepted scientific practice to an inflexible box, where, "phenomena that will not fit the box are often not seen at all." Reminds me of the Hawaiians who did not, or could not see, Captain Cook's ship because such a vessel just did not fit into their perception of things.

I agree that some should continue trying to do more research on complimentary medicine as it might serve as a bridge between the two. But all things Eastern can't be measured. Eastern medicine does not separate the patient from the disease process or the practitioner from the treatment. Therefore, isolating single variables is an impossibility. And sometimes, trying to fit Eastern medicine into our system results in squeezing it into symptomatic, cookbook formulas. Doesn't work. In the western system, you "fit" a person into a category based on your assessment and a bunch of tests. Eastern medicine ask, " who is the person that has this condition and what does it mean in his life?" This results in ten patients with migraines getting ten different treatments.

Eastern medicine developed from cultures that were very close to nature and who understood it intimately. Many of us (not me) have never stepped off concrete! I would say that a doctor who hunted and fished all the time would be a better doc than on one who didn't.

Got to go, "Survivor" is coming on. You know I almost made it on the 2nd show, in Australia, damn it!

 

[Happy613]

This is complete insanity......DNP? DrNP? I am sorry but if you want to be a doctor you need a medical degree. All this talk of not wanting to sacrifice so many years in order to provide "comprehensive care?"

I think we owe patients more than the mediocrity that I am seeing here......

 

[Xscape]

Again, providing healthcare is no longer a doctor's domain!!! I didn't pass the law that allows nurses to practice treating patients, but I'm not in DENIAL about it either.

Again, if nurse's treating patients was such a big medical risk, having the potential to cause serious harm to a patient due to misdiagnosis, etc, WHY WHY WHY would this be allowed in any state?? Anywhere in the US????

Why would there be published studies depicting the identical outcomes of patients treated by doctors vs nurses.....? Where are those studies that depict the serious risks of patients being treated by nurse practitioners.....?

Enough with the nurse practitioner bashing, as of this point today, all the hypothetical imaginings of everything that can go wrong from treatment by a midlevel has no proof to back it up. Maybe providing primary care to patients via midlevels is not the best care that can be provided, maybe it does pose significant risks to patients, maybe it is the "watering down of primary care", maybe I'll cross the road tomorrow and get run over by a bus....there's a lot of maybe's but proof is what counts. There's an acceptable risk level for everything we do, after all, many of us get inside a car and drive on a day when the rain or snow is so thick we cant see more than a few cars ahad of us. Patients have a choice what risk their willing to take. Be seen by NP X or Doctor X, noone's forcing them. Apparently the acceptable risk of providing primary care through midlevels is low enough that NP's are allowed to practice primary care in every state in the US.....correct me if Im wrong plz.

As someone who is about to enter med school or nursing school....?? I'm here to expand my understanding about this DNP thing and look at this possible career choice from many viewpoints, which is exactly what everyone here has helped me do through these remarkably insightful postings..... I have those days too where I wonder, is it right for anyone besides a doctor to treat the most basic cases of primary care? Are we lowering our standards unnecessarily? Do we really need another profession out there with less training treating human lives? Can it be done successfully, SAFELY?

That's what Im here to figure out......

Here's a question, so take a med student, fresh out of school, did his 4 years of med training and now he's gonna do residency. Excpet he says to himself, u know what, I don't want to do any of the complicated primary care stuff, I will just do the basics, runny noses, colds, flus, etc. Assuming this was an option, could a 1 year residency sufficiently prepare that student to practice in that scope only?

 

[Pose]

So, why the need to practice independently from a physician? If you do not want full responsibility for the outcome of the patient, let alone a "complex" patient, are not willing to gain the full education and clinical experience, or take the USMLE/COMLEX, why open your own practice?

Is it acceptable for a medical school graduate to do an intern year, and open a practice? Or, even not take all three steps of the USMLE and practice? Would it be acceptable to graduate medical school, take the nursing board, and open a practice?

How about you at LEAST take the licensing exams, and do a full strength residency in FP. Which is what, three years? A few of you NP/DNP activists mention studies in your defense of equivalency, well, as far as I'm concerned Medical school, the USMLE, and a residency is the only proven method to provide complete and adequate care. If you aren't willing to prove yourself, why be allowed autonomy?

I really don't want to create hard feelings, I'm just perplexed. I can't figure out why you would want to have the same privileges (and equivalency) as doctors, the people that did commit their life to hell for this career, near the same salary, but none of the pitfalls (long education, countless exams, residency, long hours, holidays, lack of family time, HIGH insurance costs, full liability...to name a few). Without sounding hostile, what do you think gives you these rights?

What are your thoughts on the future of MD/DOs? And the future of nursing?

Again, no hard feelings. I just want real answers.

 

[deleted6669]

"Is it acceptable for a medical school graduate to do an intern year, and open a practice?"

actually it is and people do. you can open a general medical practice aftrer passing usmle step 3 and doing an intern year. you can also be a gmo(general medical officer) in the military. it is just hard to get hospital priviledges without being boarded in anything but you can run an outpt only practice as a "general practitioner"

 

[windsurfr]

"Is it acceptable for a medical school graduate to do an intern year, and open a practice?"

actually it is and people do. you can open a general medical practice aftrer passing usmle step 3 and doing an intern year. you can also be a gmo(general medical officer) in the military. it is just hard to get hospital priviledges without being boarded in anything but you can run an outpt only practice as a "general practitioner"

You can practice whenever you get your MD (after 4 years med school). However without being board certified (COMPLETING residency) no hospital will hire you and no insurance carrier will cover you. So in reality you cannot practice after intern year in the U.S.

Xscape-
First, there is a fundimental difference in the type of person who will devote the time to medical school and the rest who want to take the easy way out to "practice medicine". The american public knows this. They drive healthcare. I see patients in clinic routinely who are frustrated b/c they were referred to a specialist and saw a midlevel. They then tell me they will no longer go to that specialist.... patients will drive the future of medicine.

Second, the studies you cite had very poor clinical outcomes (patient satisfaction, etc). They say nothing about ability to diagnose and treat. These studies all midlevels cite make sweeping generalizations based on relatively weak study design... but they'll never tell you that will they.

Third, yes you could train someone after a year of residency to treat coughs and colds. But complicated CHF/Renal failure... no way. Unfortunately you cannot pick and choose coughs and colds... and like I said before you never know what else is going on.

Fourth, If i'm reading your post correctly (and I appologize in advance if I'm wrong) then I see that you're not yet a med or nursing student. You have zero idea of how complex medicine is.

 

[deleted6669]

"You can practice whenever you get your MD (after 4 years med school). However without being board certified (COMPLETING residency) no hospital will hire you and no insurance carrier will cover you. So in reality you cannot practice after intern year in the U.S."

see my note about gmo's above. also I know a # of md's who have opened general practice offices and/or work in outpt settings like urgent care settings with just an internship yr. I also know a bunch of em physicians who only did an internship and now practice as emergency medicine physicians(granted, these are older guys and they are stuck at their current jobs because no other hospitals will hire them without being boarded. )

 

[diabeticfootdr]

You can practice whenever you get your MD (after 4 years med school). However without being board certified (COMPLETING residency) no hospital will hire you and no insurance carrier will cover you. So in reality you cannot practice after intern year in the U.S.

This is untrue. I know many GP's who have only 1 year of post-doc training and are on staff at hospitals. Also, insurance companies do cover these physicians. I'm not saying they're great doctors, or near the level of a specialist, but they do exist.

LCR

 

[Pose]

These are rare instances, otherwise there would be no reason for a board certification in a speciality and/or subspeciality. It doesn't matter. Either way, it's unwise, and very rare.

 

[windsurfr]

This is untrue. I know many GP's who have only 1 year of post-doc training and are on staff at hospitals. Also, insurance companies do cover these physicians. I'm not saying they're great doctors, or near the level of a specialist, but they do exist.

LCR

Excuse me? "this is untrue".... yeah right.

 

[diabeticfootdr]

Excuse me? "this is untrue".... yeah right.

YES, it is.

Obviously you need to get out of the city more (Twin Cities). I'm from a small town in Missouri. I worked as a telemetrist, then a paramedic, during college there before pod school and residency (now in NYC).

These small community hospitals are run by GPs with little training. I agree with all of you -- this is unwise, and not where I would want to be admitted. But IT DOES EXIST.

LCR

 

[RAMPA]

hey good thing I want to be a PA. i know that i want to practice under the MD and not beside and "independently", yet i'll consult when i cant handle horse manure that the NP's want. one thing is to provide care, which is what NP's and PA's do. another thing is to practice medicine independently. even PA's have to go through med school is they want to be independent. why should NP's get a short cut? bunch of BS from NP's that want to be docs without the training. and another thing can someone compare a PA training to a DNP training, in term of hours not years, because some NP programs are part time.

 

[diabeticfootdr]

What if, in the future, PA's have to be supervised by a DrNP?????

 

[deleted6669]

What if, in the future, PA's have to be supervised by a DrNP?????

won't ever happen. every state law saws supervised by licensed md/do only. podiatrists/naturopaths/dc's/others do not qualify.
and to answer rampa: a certificate level pa has more clinical hrs(2200) than a dnp would have even with their part time "residency".
typical ms np program 500-750 hrs. add a part time clinical yr for dnp(1000hrs)= 1750 max......

 

[diabeticfootdr]

podiatrists/naturopaths/dc's/others do not qualify.
......

actually we do supervise PAs in our residency program . . . in order to comply with the state mandated decrease in work hours for residents (IPRO) in New York state, most departments have hired PAs to help the program/residents by doing H&Ps, pre-op work-ups, post-op care, and we have some surgically oriented ones we invite to scrub with us.

Lee

 

[deleted6669]

actually we do supervise PAs in our residency program . . . in order to comply with the state mandated decrease in work hours for residents (IPRO) in New York state, most departments have hired PAs to help the program/residents by doing H&Ps, pre-op work-ups, post-op care, and we have some surgically oriented ones we invite to scrub with us.

Lee

but you are not their supervising physicians of record with the medical board, correct? they work for surgeons and liaison to your group as needed for 1st assists?