Status and Titles

[Ale16ozPOprn]

If "practicing medicine" is defined as examining, diagnosing, and treating acute and chronic illness in a manor consistent with scientific evidence, then who practices medicine? If the term physician means one who practices medicine, then who is a physician? I notice nurse practitioners and physician assistants going about the duties of their jobs in primary care offices in such a way that without a name tag, would be indistinguishable from their MD/DO counterparts. Some nurse practitioners now have a "Doctor of Nursing Practice" or DNP degree, which is a doctoral degree that technically constitutes that he or she is academically considered a 'doctor.' Yes, physician assistants must have a collaborating agreement with a physician, but in many states, nurse practitioners are now able to practice without any collaborative agreement at all. Of course, any intelligent nurse practitioner would collaborate with more experienced physicians, PAs, or NPs to provide excellent care regardless of if they are required to collaborate or not (just like any good physician does). The discussion I am looking to provoke is on the topic of why MD/DO physicians and physician so strongly oppose the advancement of "mid-level" providers, even though research evidence has proven multiple times that the care provided by midlevels, especially nurse practitioners, is equal to that of an MD or DO. Of course, a nurse practitioner who was educated in a Family Nurse Practitioner program should not be practicing surgery, oncology, cardiology, etc. independently. But family medicine is what these individuals were educated and credentialed in, and have proven to practice competently in. Wouldn't it be acceptable to call one's self a "family physician" or a "family doctor?" Or introduce one's self as "Hello, I am Dr. Smith, family nurse practitioner?" I know this is a provoking topic for many, and there will be a lot of NP-bashing, but I hear from patients far too often that "my doctor is a nurse practitioner" or calling a PA "Doctor Smith," only to be followed by stern correction from physicians or other staff. Why make patients feel as if they cannot trust their PA or NP? Part of me thinks 'let them be called whatever title they have earned or learned and worry about ourselves.' Thoughts?

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[pamac]

In the movie G.I Jane, there is scene where Demi Moore is in an office telling her commanding officer that she isn't trying to make a statement by becoming a Navy SEAL, and wanted to be treated like the other male trainees, rather than being given weaker standards to reach because she felt humiliated at the lower expectations. The commander's response always stuck with me: "if you were like everyone else, I suspect we wouldn't be making statements about not making statements, would we?"

To segue to this thread, I would say this: If titles don't matter, then why feel the need to muddy the waters by insisting that one profession be allowed to take on the name of another profession? It definately wouldn't be the physicians who would want to call themselves nurse practitioners or physician assistants. So why would anyone feel the need to push that in the reverse, if not to enhance the image of the profession with less training?

I'm an NP student. I have no desire to try to pass myself off as a physician, with the inevitable explanation later on that I'm not really a physician, but a nurse practitioner claiming the physician title. They are different roles at the core, and there's nothing wrong with acknowledging that. I think if seems there are egos involved, that's probably more to do with outsiders perceptions. Physicians train hard enough to have the right to the public correctly identify them without confusion, and it's likely to be less out of a desire for honorifics. I'm a nurse, and it makes more sense for folks that are not nurses (aides, ER techs, medical assistants, etc) to be correctly identified, even though as a nurse, I also perform aid duties from time to time, and sometimes they perform tasks that could be considered "nursing". Granted, they could probably do almost all of my nursing jobs with proper on the job training. But in the end, I'm the nurse. I don't get excited with the title, it's just a role. I'm excited that my paycheck is a nurses paycheck, but I'm not excited when i have to do harder nurses work than the aides do. Everyone wants physician pay, and physician level respect without the physician schooling and physician residency, the physician sacrifice of family time, and the physician responsibility when things go south.

That said, if I'm an NP putting my licence on the line as an independent provider, I want appropriate compensation for my effort and risk, but I think it's foolish to maintain that there's equivalence in the two roles, because the training simply isn't the same, even if some of the work is. As a consumer of healthcare, I find it appropriate to know who I'm dealing with, and as a nurse, I want to know as well. Like I said, if titles don't matter, then why have this discussion that's probably been churned up hundreds of times? It's clear that the answer to that is because you want to stir the pot.

 

[deleted480308]

If "practicing medicine" is defined as examining, diagnosing, and treating acute and chronic illness in a manor consistent with scientific evidence, then who practices medicine? If the term physician means one who practices medicine, then who is a physician? I notice nurse practitioners and physician assistants going about the duties of their jobs in primary care offices in such a way that without a name tag, would be indistinguishable from their MD/DO counterparts. Some nurse practitioners now have a "Doctor of Nursing Practice" or DNP degree, which is a doctoral degree that technically constitutes that he or she is academically considered a 'doctor.' Yes, physician assistants must have a collaborating agreement with a physician, but in many states, nurse practitioners are now able to practice without any collaborative agreement at all. Of course, any intelligent nurse practitioner would collaborate with more experienced physicians, PAs, or NPs to provide excellent care regardless of if they are required to collaborate or not (just like any good physician does). The discussion I am looking to provoke is on the topic of why MD/DO physicians and physician so strongly oppose the advancement of "mid-level" providers, even though research evidence has proven multiple times that the care provided by midlevels, especially nurse practitioners, is equal to that of an MD or DO. Of course, a nurse practitioner who was educated in a Family Nurse Practitioner program should not be practicing surgery, oncology, cardiology, etc. independently. But family medicine is what these individuals were educated and credentialed in, and have proven to practice competently in. Wouldn't it be acceptable to call one's self a "family physician" or a "family doctor?" Or introduce one's self as "Hello, I am Dr. Smith, family nurse practitioner?" I know this is a provoking topic for many, and there will be a lot of NP-bashing, but I hear from patients far too often that "my doctor is a nurse practitioner" or calling a PA "Doctor Smith," only to be followed by stern correction from physicians or other staff. Why make patients feel as if they cannot trust their PA or NP? Part of me thinks 'let them be called whatever title they have earned or learned and worry about ourselves.' Thoughts?

Post the research that proves it....we'll go over it, again, and show you it doesn't. To save time, pick only 5

 

[Ale16ozPOprn]

So perhaps an FNP should complete a family med residency?
What does one tell a patient that asks "oh shouldn't I be seeing a physician" during a wellness visit? Or to the patient that refers to the DNP as "doc" casually, even after clarification is made?

...yes, I know it stirs the pot. Doctors of Osteopathy were once opposed by the AMA (From “Doctor of Osteopathy” to “Doctor of Osteopathic Medicine”: A Title Change in the Push for Equality | The Journal of the American Osteopathic Association), and they stood for their independence and equality in the field. A nurse practitioner should never lead a patient to believe they hold a medical doctorate. Doctor of nursing practice, or dare I even say physician at some point in the future, absolutely!

 

[deleted480308]

What does one tell a patient that asks "oh shouldn't I be seeing a physician" during a wellness visit? Or to the patient that refers to the DNP as "doc" casually, even after clarification is made?

"Sorry, I'm not a doctor. I'm a nurse practitioner. What brings you in today?"

 

[Ale16ozPOprn]

So they have something to be sorry about? Is it another way of saying "sorry, you ONLY get JUST nurse practitioner?"

 

[deleted480308]

So they have something to be sorry about? Is it another way of saying "sorry, you ONLY get JUST nurse practitioner?"

that's not my implication.....if someone addressed me by the wrong name I would respond the same way. "Sorry, I'm not ryan reynolds, I'm actually sb247. What brings you in today?"

 

[Ale16ozPOprn]

Do you get called "Ryan Reynolds" multiple times per week, if not daily?

 

[deleted480308]

Do you get called "Ryan Reynolds" multiple times per week, if not daily?

it's exhausting.

but for real, please post that research and we'll go through it

 

[Sgàile]

sb you should change your avatar to deadpool now.

 

[762513]

Before we can really start this debate we need to ask the question; is nursing its own unique discipline?

 

[AlteredScale]

So perhaps an FNP should complete a family med residency?
What does one tell a patient that asks "oh shouldn't I be seeing a physician" during a wellness visit? Or to the patient that refers to the DNP as "doc" casually, even after clarification is made?

...yes, I know it stirs the pot. Doctors of Osteopathy were once opposed by the AMA (From “Doctor of Osteopathy” to “Doctor of Osteopathic Medicine”: A Title Change in the Push for Equality | The Journal of the American Osteopathic Association), and they stood for their independence and equality in the field. A nurse practitioner should never lead a patient to believe they hold a medical doctorate. Doctor of nursing practice, or dare I even say physician at some point in the future, absolutely!

DOs didn't stand their ground. They started teaching pharmacology and pathophysiology in order to be considered equal to the MD counterpart. Prior to that the degree was only focused on OMM and surround fields in anatomy and some physiology.


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[Ale16ozPOprn]

Which is exactly what NP schools do.

 

[pamac]

They do teach those things at NP school, and the folks that graduate from NP schools are called NPs. Just like high school graduates are called high school graduates, or folks graduating from DO programs are called physicians. Why would there be a need to call a nurse practitioner or a PA a physician? Being a physician indicates that the med school graduate qualifies for medical residencies that are geared to the knowledge base that medical school graduates have obtained. If nursing schools trained us to that level and can demonstrate medical school level competencies, then go on to perform well in residencies, then sure, call them physicians. But to land a residency, one would have to prove not only that they could perform residency functions, but also that they were taught to do those things. Only then could nursing go hat in hand to the powers that be and say "can we give it a shot?". even though women can now serve in combat, they don't let anyone show up to ranger training, you have to qualify for ranger training. You can't qualify for ranger training unless you went to boot camp, even if you show up and say "I'm a girl that likes to camp, shoot, and work out a lot". That's all well and good, but there's more to being a soldier than those things. There's a structure to physician training, and the name physician has been attathed to those that have followed the established path to get there. In most cases, there is even a legal connotation to that name, regardless of whomever wants to take it on based on what the roots of it are. A pastor might be a physician to the wounded soul, but that doesn't make him or her a physician.

But like I say, why muddy the waters. If titles don't matter, then why try to co opt another's title. What happens the day that being a physician is a job nobody wants, and they all work for big entities for a fraction of what they now make. Is anyone going to want to be called a physician when it's not sexy?

Not only am I fine with being called an NP, I prefer it. It's a decent title. Outside of work, there's no organizational structure to worry about, and I don't defer to expertise that doesn't apply to the situation.

 

[762513]

sb247 has some valid points about the rigor of the NP research that's out there. Although there are some decent studies out there, there aren't enough of them with big enough sample sizes. The DNP is a new degree, and once I explained it to the physicians I worked with they all said "oh... well that makes sense." So to sb247 and others I want to hear their thoughts on what is the purpose of the DNP degree.

 

[KGflyboy]

Which is exactly what NP schools do.

Despite the fact NP schools offer courses in pharmacology, pathophysiology, and other disciplines, those classes are typically not equatable to the depth and scope of the medical school courses of the same name. I'm not trying to be abrupt here, but it sounds like you are trying to equate the foundational sciences taught in NP school to those taught in medical school. If you don't believe me, take a practice USMLE Step 1 exam and see how it goes.

To address the more broad topic at hand, I will point out that you are trying to equate two different professions which are vastly different. Just because there is some overlap in what some NPs, PAs, and physicians do on a daily basis does not mean they are interchangeable. Therefore, the job titles themselves are not interchangeable.

 

[neusu]

If "practicing medicine" is defined as examining, diagnosing, and treating acute and chronic illness in a manor consistent with scientific evidence, then who practices medicine?

Shouldn't nurses practice nursing?

 

[EMDOC17]

I love the nurses I work with. I also love working with the NP's and PA's I work with. Everyone has their role. If you want to introduce yourself as "Dr." then you will have to go to medical school and complete a residency +/- a fellowship. I don't believe BS evidence that NP/PA is equal to MD/DO. Again if you want to be a doctor then go to med school.

 

[Druggernaut]

The DNP is a new degree, and once I explained it to the physicians I worked with they all said "oh... well that makes sense." So to sb247 and others I want to hear their thoughts on what is the purpose of the DNP degree.

I think most physicians recognize the DNP for what it is: political gamesmanship to claim equivalence to physicians so that they can gain independence and increased reimbursement.

 

[NP 2 DPM]

If "practicing medicine" is defined as examining, diagnosing, and treating acute and chronic illness in a manor consistent with scientific evidence, then who practices medicine? If the term physician means one who practices medicine, then who is a physician? I notice nurse practitioners and physician assistants going about the duties of their jobs in primary care offices in such a way that without a name tag, would be indistinguishable from their MD/DO counterparts. Some nurse practitioners now have a "Doctor of Nursing Practice" or DNP degree, which is a doctoral degree that technically constitutes that he or she is academically considered a 'doctor.' Yes, physician assistants must have a collaborating agreement with a physician, but in many states, nurse practitioners are now able to practice without any collaborative agreement at all. Of course, any intelligent nurse practitioner would collaborate with more experienced physicians, PAs, or NPs to provide excellent care regardless of if they are required to collaborate or not (just like any good physician does). The discussion I am looking to provoke is on the topic of why MD/DO physicians and physician so strongly oppose the advancement of "mid-level" providers, even though research evidence has proven multiple times that the care provided by midlevels, especially nurse practitioners, is equal to that of an MD or DO. Of course, a nurse practitioner who was educated in a Family Nurse Practitioner program should not be practicing surgery, oncology, cardiology, etc. independently. But family medicine is what these individuals were educated and credentialed in, and have proven to practice competently in. Wouldn't it be acceptable to call one's self a "family physician" or a "family doctor?" Or introduce one's self as "Hello, I am Dr. Smith, family nurse practitioner?" I know this is a provoking topic for many, and there will be a lot of NP-bashing, but I hear from patients far too often that "my doctor is a nurse practitioner" or calling a PA "Doctor Smith," only to be followed by stern correction from physicians or other staff. Why make patients feel as if they cannot trust their PA or NP? Part of me thinks 'let them be called whatever title they have earned or learned and worry about ourselves.' Thoughts?

A clinical practitioner who has a clinical doctorate may refer to himself as a 'Doctor' provided that they specify their position and their scope of practice, especially if theyre working in the hospital setting where there are Physicians , Nurse Practitioners or Physician Assistants.

For example if a Nurse Practitioner who holds a DNP with a specialization in Women's Health / Obstetrics can introduce herself as:

"Hello, I'm Dr. Smith, I'm the Obstetrics Nurse Practitioner. So what brings you to the clinic today?"

It is important to make sure and to delineate your specialty and scope of practice. This way it doesn't lead to confusion.

 

[NP 2 DPM]

I think most physicians recognize the DNP for what it is: political gamesmanship to claim equivalence to physicians so that they can gain independence and increased reimbursement.

If i may impart my opinion, Dr. @Druggernaut (i'm assuming you're a physician and hope you are one).

The Doctor of Nursing Practice does not make a clinician 'equivalent' to a Physician. The only equivalent of a physician is another physician. The DNP is merely the most terminal degree for Nursing Practice for Nurse Practitioners. The equivalency between NPs and MD/DOs is impossible because NPs are governed by the Board of Nursing and the latter are governed by the Board of Medicine.

Advanced Practice Nurses don't claim equivalency with Physicians (at least i hope they don't), and neither should they. Our Physician colleagues are reserved that right to primacy due in part to their medical expertise and education.

(which may be hard to swallow for some proud APNs and PAs, but its just the truth).

 

[GypsyHummus]

Again if you want to be a doctor then go to med school.

And/or podiatry school.

 

[762513]

I think most physicians recognize the DNP for what it is: political gamesmanship to claim equivalence to physicians so that they can gain independence and increased reimbursement.

If an honest discussion is possible on these boards, let's attempt it. Can I have a physician explain to me what a DNP is?

 

[DizzyJon]

A clinical practitioner who has a clinical doctorate may refer to himself as a 'Doctor' provided that they specify their position and their scope of practice, especially if theyre working in the hospital setting where there are Physicians , Nurse Practitioners or Physician Assistants.

A DNP isn't really a clinical doctorate. Take for instance this DNP program at Madonna University, that appears to be similar to a handful of other program I've looked at, and the curriculum is ethics, policy, quality improvement, Advanced Scientific Perspectives Informing Nursing Practice (whatever that means), Transformative and Collaborative Leadership for Promoting Innovation, Concepts and Methods of Health Care Informatics and Data Mining, Analytic Methods for Evaluation of Clinical Practice, a practicum project and a capstone. Where are the clinical courses? Not putting down the program, but just showing how it is not what I would consider clinical. My doctorate is not clinical either. Now compare this to the doctorate of medical science (DMS) at Lincoln Memorial with courses in immunology, ultrasound, Neurology, Psychiatry, Pulmonology, Cardiology, Nephrology, Gastroenterology, Endocrinology, Hematology and Infectious Disease. That is a clinical doctorate in my opinion.

 

[762513]

A DNP isn't really a clinical doctorate. Take for instance this DNP program at Madonna University, that appears to be similar to a handful of other program I've looked at, and the curriculum is ethics, policy, quality improvement, Advanced Scientific Perspectives Informing Nursing Practice (whatever that means), Transformative and Collaborative Leadership for Promoting Innovation, Concepts and Methods of Health Care Informatics and Data Mining, Analytic Methods for Evaluation of Clinical Practice, a practicum project and a capstone. Where are the clinical courses? Not putting down the program, but just showing how it is not what I would consider clinical. My doctorate is not clinical either. Now compare this to the doctorate of medical science (DMS) at Lincoln Memorial with courses in immunology, ultrasound, Neurology, Psychiatry, Pulmonology, Cardiology, Nephrology, Gastroenterology, Endocrinology, Hematology and Infectious Disease. That is a clinical doctorate in my opinion.

We all know what the DNP isn't (and doesn't claim to be) which is an equivalent to an MD.

You're on the right track, but what gap is the DNP designed to fill?

 

[DizzyJon]

We all know what the DNP isn't (and doesn't claim to be) which is an equivalent to an MD.

You're on the right track, but what gap is the DNP designed to fill?

In my opinion...a DNP is good for academics. One should hold a degree higher then they are teaching (until teaching at the doctoral level) and the DNP fills that gap. How many NP program faculty have doctorates? I'm not sure, but now there are more available to fill those spots. Clinically, there is no gap filled as an MSN NP is clinically equivalent to a DNP. A DNP can provided additional education that could be beneficial to going into administration. Now, if you ask some hey may feel the DNP is filling the gap in healthcare to put NPs on equal ground to physicians...and this is not true in my opinion.

 

[762513]

In my opinion...a DNP is good for academics. One should hold a degree higher then they are teaching (until teaching at the doctoral level) and the DNP fills that gap. How many NP program faculty have doctorates? I'm not sure, but now there are more available to fill those spots. Clinically, there is no gap filled as an MSN NP is clinically equivalent to a DNP. A DNP can provided additional education that could be beneficial to going into administration. Now, if you ask some hey may feel the DNP is filling the gap in healthcare to put NPs on equal ground to physicians...and this is not true in my opinion.

That's not the gap I was referring to. The DNP is designed to fill a specific gap, and is not merely a title grab. The DNP graduate has the research background to evaluate the strength of healthcare studies, the leadership training to work within complex systems, and the mandate to translate research into practice. The PhD creates the research, the DNP implemented it at the bedside.

Research that could benefit patients and hospitals often dies in the journals. The DNP is a practice doctorate, not a clinical or academic one. That is what a DNP is.

 

[DizzyJon]

That's not the gap I was referring to. The DNP is designed to fill a specific gap, and is not merely a title grab. The DNP graduate has the research background to evaluate the strength of healthcare studies, the leadership training to work within complex systems, and the mandate to translate research into practice. The PhD creates the research, the DNP implemented it at the bedside.

Research that could benefit patients and hospitals often dies in the journals. The DNP is a practice doctorate, not a clinical or academic one. That is what a DNP is.

Maybe that was the intent, but I'm not sure that is what the reality is. Do we have any DNPs here who got a DNP in order to translate research into practice??? I would like your input. Does one need a doctorate to even do this? If one is practicing medicine (advanced nursing) shouldn't they already know how to implement research? I had stats/research methods in undergrad. I think this is taught already in master's NP/PA programs.

 

[762513]

Maybe that was the intent, but I'm not sure that is what the reality is. Do we have any DNPs here who got a DNP in order to translate research into practice??? I would like your input. Does one need a doctorate to even do this? If one is practicing medicine (advanced nursing) shouldn't they already know how to implement research? I had stats/research methods in undergrad. I think this is taught already in master's NP/PA programs.

I'm a DNP student in my 6th of 8 semesters. The masters program does not have the research focus to be able to evaluate a healthcare study. The DNP is a mini PhD/MPH/leadership hybrid. It is very well suited for the intent of the degree.

 

[DizzyJon]

I'm a DNP student in my 6th of 8 semesters. The masters program does not have the research focus to be able to evaluate a healthcare study. The DNP is a mini PhD/MPH/leadership hybrid. It is very well suited for the intent of the degree.

Oh cool. Bet you're excited to be done.

 

[762513]

Oh cool. Bet you're excited to be done.

It's a long road, and I still have a mini thesis of 540 hours to complete.

As everyone knows it's a marathon, not a sprint.

 

[AdmiralChz]

I'm a DNP student in my 6th of 8 semesters. The masters program does not have the research focus to be able to evaluate a healthcare study. The DNP is a mini PhD/MPH/leadership hybrid. It is very well suited for the intent of the degree.

Fascinating... I continue to be disappointed with the lack of raw clinical didactics being taught in NP school. Instead it's often a focus on peripheral subjects like ethics - I understand the value I suppose in a nursing model but such online-based education doesn't carry the same academic rigor physicians go through, or even PAs for that matter unfortunately.

 

[762513]

Fascinating... I continue to be disappointed with the lack of raw clinical didactics being taught in NP school. Instead it's often a focus on peripheral subjects like ethics - I understand the value I suppose in a nursing model but such online-based education doesn't carry the same academic rigor physicians go through, or even PAs for that matter unfortunately.

The DNP is not about growing the bedside clinical skills to physician parity. This is a topic most people continue to misinterpret. Most of the people with the strongest and most negative opinions on the DNP (not you, obviously) don't actually know what the DNP is.

As a side note I attend a on campus DNP program at a R1 college. I have prelims and a thesis to defend.

 

[Mad Jack]

sb you should change your avatar to deadpool now.

Deadpool is too progressive

 

[Boatswain2PA]

Fascinating... I continue to be disappointed with the lack of raw clinical didactics being taught in NP school. Instead it's often a focus on peripheral subjects like ethics - I understand the value I suppose in a nursing model but such online-based education doesn't carry the same academic rigor physicians go through, or even PAs for that matter unfortunately.

PA school is 2.5 years of drinking medical education from a firehose. Not saying it's to the depth of med school, but it is significant medical education (and a smidge of research/ethics/leadership).

 

[762513]

PA school is 2.5 years of drinking medical education from a firehose. Not saying it's to the depth of med school, but it is significant medical education (and a smidge of research/ethics/leadership).

Yawn.

 

[pamac]

PA school is 1 year or so of class and 1 year or so of clinical. I personally think it's probably decent quality, but I also don't believe in overselling it. I sat through a lecture at an average ranked program on a mid semester visit, and didn't consider the material they were covering to be difficult. I was surprised at how hard the material was to sink in to the class based on how many of them had to keep asking questions about a pretty basic concept until the instructor basically had to say "let's move on now", only to get bogged down on the next PowerPoint slide in similar fashion. Maybe not their finest moment, or even typical of the broader picture, to be fair. But only a firehose for the folks in the room with no healthcare experience (which was pretty much the whole room except for the faculty and the visitors). The students in the room that "got it", ended up milling about eating snacks and breaking open different powerpoints they printed from other classes to study while the remedial folks held the floor. Finally a second time, the instructor mercifully moved it along, while the firehose apparently drowned the folks who couldn't wrap their heads around birth control. But they did offer to follow up after lecture with those that were still struggling.

Incidentally, that experience reinforced to me how much I've hated the classroom setting, where other students seem to slow things down as much as they can. I've hated that ever since I can remember, whether it was organic chemistry or nursing courses. I'd show up having read the chapters, and others wanted their hands held. I discovered online coursework and never looked back. Watch the lecture, pause it if I have a question to look up, keep moving. Love it. Worked for a professor that was like "students need the in person interaction", and I was like "they aren't asking you anything more than pretty basic stuff". Didn't sink in for him, but he had a job to protect.

 

[DizzyJon]

I've heard the firehouse analogy many of times. While I can understand it and at times think it is very relevant, this does depend on the student and agree with PAMAC on this point. In my experience I went through undergrad taking 11-12 credits per semester with one class always being online. I worked full time and school was pretty easy for me, but I didn't give it 100% of my attention and my grads reflected that. Then going to PA school was a big wake up call. My semesters then went to 21-22 credits and sitting in class M-F 8-5pm with few exceptions to that schedule. In one month I had 22 exams and quizzes combined. It was "like drinking water from a firehouse"....However, once I got the hang of things and new what to expect it became much easier to juggle all the requirements. I also worked 8-16 hours week during didactic and clinical. It was front desk at a hotel with lots of down time to study, but I was one of the few who attempted to work.

 

[Boatswain2PA]

Your sitting in on one lecture certainly didn't give you the same impression that I got sitting through 26 months of a PA program.

13 months of pretty deep lectures to every....single...aspect of medicine. OB/Gyn to neonatal to peds to adult to geriatrics. Derm to neuro to cards to renal to psych to ortho to heme/onc to opthal to GI to....you name it.

Then another 13 months in rotations, including mandatory rotations in surgery, OB/GYN, family practice, EM and others.

Then a standardized test to ensure you got it all.

The rigor of PA education certainly doesn't equate to med school & residency, but it is much better than the non-standardized, often on-line, NP education that frequently focuses more on healthcare bureaucracy than on medicine.

But back to the OP: A janitor with a PhD in music should not introduce him/herself to my patient as a "doctor" because it's confusing to patients. Same thing with a nurse with a DNP/PhD/EdD/etc, or a PA with a DSc/etc.

 

[Owlgal]

Your sitting in on one lecture certainly didn't give you the same impression that I got sitting through 26 months of a PA program.

13 months of pretty deep lectures to every....single...aspect of medicine. OB/Gyn to neonatal to peds to adult to geriatrics. Derm to neuro to cards to renal to psych to ortho to heme/onc to opthal to GI to....you name it.

Then another 13 months in rotations, including mandatory rotations in surgery, OB/GYN, family practice, EM and others.

Then a standardized test to ensure you got it all.

The rigor of PA education certainly doesn't equate to med school & residency, but it is much better than the non-standardized, often on-line, NP education that frequently focuses more on healthcare bureaucracy than on medicine.

So, you went to school for 2.5 years and you think it compares to the 4-5 years of RN coursework and the additional 2-3 years of NP school? -- Yeah. I don't think so. 13 months of rotations? NPs do more than that and that's not even counting the clinical rotations they do as part of their RN. NP's aren't physicians by any means, but PAs are even further from that, IMO.

 

[deleted480308]

So, you went to school for 2.5 years and you think it compares to the 4-5 years of RN coursework and the additional 2-3 years of NP school? -- Yeah. I don't think so. 13 months of rotations? NPs do more than that and that's not even counting the clinical rotations they do as part of their RN. NP's aren't physicians by any means, but PAs are even further from that, IMO.

You're being a little disengenous here. An RN isn't 4-5 years of actual medicine courses. And the NP isn't all actual medicine courses either.

 

[Boatswain2PA]

So, you went to school for 2.5 years and you think it compares to the 4-5 years of RN coursework and the additional 2-3 years of NP school? -- Yeah. I don't think so. 13 months of rotations? NPs do more than that and that's not even counting the clinical rotations they do as part of their RN. NP's aren't physicians by any means, but PAs are even further from that, IMO.

I think my 20 years of search & rescue as a medic, my BS in emergency management, and my Masters in Public Health exceeds your proposed 4-5 years of RN coursework.

And I think the 4 year BS in Biology, chemistry, or other hard sciences that most of my classmates had is equivalent to your proposed RN education.

Those 13 months of rotations in PA programs are full time (plus) totations. 50-60 hour work weeks are normal, with some approaching 80 hours a week. Standard for total hours is 2500 during those 13 months.

Meanwhile the standard for NP education is only 500 hours.

 

[Mad Jack]

So, you went to school for 2.5 years and you think it compares to the 4-5 years of RN coursework and the additional 2-3 years of NP school? -- Yeah. I don't think so. 13 months of rotations? NPs do more than that and that's not even counting the clinical rotations they do as part of their RN. NP's aren't physicians by any means, but PAs are even further from that, IMO.

RNs do around 700 hours in all their "advanced" self-arranged rotations at different outpatient providers. They do plenty in nursing school, but that's at a lower level- just as no amount of hours as a CNA can make you a nurse, no amount of hours at the RN level can magically turn you into an autonomous provider. It's like the difference between a mechanic and an engineer- a mechanic can take cars apart and put them together, and he may have a good idea of how engines work, but without advanced engineering coursework that covers materials, combustion, design, etc, he can't make an engine of his own from scratch. NPs should have a full 2,500-3,000 hours of clinical time at the advanced setting, overseen by competent providers in a variety of settings like PAs. I mean, hell, you look at doctors- we've only really got one year of standard rotations, everything else is electives. After that first year you could do nothing but allergy and dermatology rotations and you'd still be able to enter whatever specialty you wanted, so long as you managed to fit in an extra surgery rotation at some point that will likely be minimally relevant to your career.

We come out from that competent enough to learn more, which is basically where PAs come out. That's why they work alongside us, generally, not as independent providers. And we teach them what we know and help them become better providers. Unlike nurses that are basically unleashed on the general public with no oversight in more states than not, free to practice with all the skills a minimum of 650 hours of clinical time and an education that is largely nursing theory and systems management can afford them.

 

[Mad Jack]

You're being a little disengenous here. An RN isn't 4-5 years of actual medicine courses. And the NP isn't all actual medicine courses either.

The minimum hours for nurses in the United States at the bachelor's level is actually so low that European countries won't even accept US credentials most of the time, as they don't consider American nurses to meet minimum competency standards.

 

[precisiongraphic]

RNs do around 700 hours in all their "advanced" self-arranged rotations at different outpatient providers. They do plenty in nursing school, but that's at a lower level- just as no amount of hours as a CNA can make you a nurse, no amount of hours at the RN level can magically turn you into an autonomous provider. It's like the difference between a mechanic and an engineer- a mechanic can take cars apart and put them together, and he may have a good idea of how engines work, but without advanced engineering coursework that covers materials, combustion, design, etc, he can't make an engine of his own from scratch. NPs should have a full 2,500-3,000 hours of clinical time at the advanced setting, overseen by competent providers in a variety of settings like PAs. I mean, hell, you look at doctors- we've only really got one year of standard rotations, everything else is electives. After that first year you could do nothing but allergy and dermatology rotations and you'd still be able to enter whatever specialty you wanted, so long as you managed to fit in an extra surgery rotation at some point that will likely be minimally relevant to your career.

We come out from that competent enough to learn more, which is basically where PAs come out. That's why they work alongside us, generally, not as independent providers. And we teach them what we know and help them become better providers. Unlike nurses that are basically unleashed on the general public with no oversight in more states than not, free to practice with all the skills a minimum of 650 hours of clinical time and an education that is largely nursing theory and systems management can afford them.

Not all NP programs are online and I'd say most of the better ones find preceptors for students - like, for example,Vanderbilt which finds preceptors for its students. They aren't all "self-arranged". I do agree that some programs are lower quality but it does no one any favors to lump all NPs and NP programs in with the weak programs.

 

[Mad Jack]

Not all NP programs are online and I'd say most of the better ones find preceptors for students - like, for example,Vanderbilt which finds preceptors for its students. They aren't all "self-arranged". I do agree that some programs are lower quality but it does no one any favors to lump all NPs and NP programs in with the weak programs.

Few require more than 1,000 hours of clinical practice and fewer still don't have most of their hours under community NP preceprors.

 

[precisiongraphic]

Few require more than 1,000 hours of clinical practice and fewer still don't have most of their hours under community NP preceprors.

That doesn't change the fact that your statement that I bolded above is incorrect and not factual.

 

[762513]

I think my 20 years of search & rescue as a medic, my BS in emergency management, and my Masters in Public Health exceeds your proposed 4-5 years of RN coursework.

And I think the 4 year BS in Biology, chemistry, or other hard sciences that most of my classmates had is equivalent to your proposed RN education.

Those 13 months of rotations in PA programs are full time (plus) totations. 50-60 hour work weeks are normal, with some approaching 80 hours a week. Standard for total hours is 2500 during those 13 months.

Meanwhile the standard for NP education is only 500 hours.

You're amazing.

 

[Boatswain2PA]

That doesn't change the fact that your statement that I bolded above is incorrect and not factual.

So, put a "many", or even a "most", in front of his statement and it is correct and factual.

Worse yet, "many" NP programs only require 500 "clinical hours".

 

[Makati2008]

Let's get back on topic guys.


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