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Doctors like to assert, maintain control and continuously patrol over their territories; at least some do. In a recent post on THCB, “Nurseanomics” by Maggie Mahar addresses the heated debate over the difference between a doctor and a nurse. Mahar takles the question that Legislators in twenty-eight states are dealing with. Should a nurse practitioner (NP) with an advanced degree provide primary care, without an M.D. being in charge? But another pressing question that needs to be addressed is: Should nurse practitioners be called doctors (DNP)? (DNP is a Doctor of Nursing Practice.) That is the question that I will address here. I reached out to the medical community to get their reaction. It’s not surprising that the immediate response of some doctors when asked if nurse practitioners should be called doctors (DNP) is “No!” evidenced by Dr. Stangl’s comment.
“NO! Nurse practitioners should NOT be called “doctors” because they are NOT! While many NPs do an excellent job of handling certain types of problems in certain settings, they do not have near the depth or length of education that physicians do and should be credited for what they Do have, which is their nursing background and expertise.” Susan Stangl, MD
Take a look at this comment that appears in THCB:
“An NP has mostly on the job training…they NEVER went to a formal hard-to-get into school like medical school,” wrote one doctor. “I have worked with NPs before, and their basic knowledge of medical science is extremely weak. They only have experiential knowledge and very little of the underpinning principles. It would be like allowing flight attendants to land an airplane because pilots are too expensive. HEY NURSIE, IF YOU WANT TO WORK LIKE A DOCTOR…THEN GET YOUR BUTT INTO MEDICAL SCHOOL AND THEN DO RESIDENCY FOR ANOTHER 3-4 YEARS. NO ONE IS PREVENTING YOU IF YOU COULD HACK IT![his emphasis]”
It’s clear that for these doctors, the simple answer is No. After all, why would doctors want additional prey in their territory? Even with the shortage of primary care physicians, doctors aren’t looking at nurses to help fill the void. The medical profession is quick to respond, and in some cases, with outlandish comments (evidenced in Mayer’s post) against a group of professionals who have earned an advanced degree. I posed the question again to my (yes) colleagues in the medical community. The question again: Should nurse practitioners be called doctors (DNP)? Doug Farrago, MD, explains:
“It is about the word DOCTOR. If you want to be a doctor, then by all means, I implore you to become one. We need you. The training is a bitch and; unfortunately, a gauntlet you have to get through. You don’t get that in NP school. You will be all the better for it, though. It really comes down to paying your dues. You just can’t call yourself one because you, well, just want to. Nurse practitioners came about to strengthen the healthcare system by making them “physician extenders” not “physician competitors”. By going this new route the NP group has made this relationship uncomfortable at best. I will get “hate email” over this but I didn’t do anything. The NPs are blatantly changing their strategy, demanding to be called doctors and are in direct competition with us yet I know they will rip me for pointing this out. The bottom line is the you are not a doctor. You are an nurse practitioner. It is a fact and it is not demeaning to say it. It is just a term. Get over it. I call myself the KING of medicine but just because I call myself one doesn’t mean I am one. Or does it?”
OK, I believe this is where we need to dissect the question. Although the question is simple and direct, it is being answered very quickly, without stepping outside the box. Doctors have a tendency to stay within their own territory. Yes, Dr. Farrago it is about the word “Doctors.” So when the question, “Should nurse practitioners be called doctors (DNP)”? is asked, the immediate reaction from most doctors, adamantly is “no!”. When you think about the question, the answer makes sense; a nurse is a nurse, so how can a nurse be called a doctor? That is the black and white response, but like many questions and areas in life, there’s more than black and white, we need to look into the gray areas for a different approach. We need to step outside the box. Remember, the question is should nurse practitioners be called doctors (DNP)? It does not ask if nurse practitioners should be called medical doctors. (In that case, there’s a simple answer and that would be no, not unless they attended medical school and obtained the Doctor of Medicine Degree.) Kevin Soden, MD, medical journalist has this to say:
“This is a fairly straightforward answer. A nurse practitioner should not be called doctor unless they have gone through a well-defined course of study showing mastering of a prescribed content like any other doctorate program. The danger that I can see for the lay public is the confusion that may arise if a person gets a doctorate degree in nursing and when they see patients, they or their staff refer to themselves as doctor. The average patient might think they are seeing a medical doctor with more advanced training in diagnosis and treatment. It’s important that the patient be educated in this regard.”
Here’s an interesting comment by Michael Blumenfield, MD -
“I see more downside to upside to calling NPs “doctor” in the hospital setting. It would suggest to patients that nurses who were not NPs were somehow not as important, responsible or critical to the patient’s care. In fact at times the opposite is true i.e. in trauma and critical care units etc as well as other places [take out psych] such as psych units etc where they have just as important roles and have had as much training as NP. I see this as even more important than the blurring of identification with physicians which might create some minor problems. Nurses deserve a great deal of respect which I believe that they have. I would hope that the hospital environment not become the place for working out political agendas.”
Time to scrutinize the question, Let’s look at the history. What does doctor mean?
Doctor originates from the Latin word (gen.: doctoris) which means teacher, it is abbreviated “Dr” or “Dr. and it’s used as a designation for a person who has obtained a doctorate-level degree.
Doctorate “is an academic degree or professional degree that in most countries represents the highest level of formal study or research in a provided field. In some countries it also refers to a class of degrees which qualify the holder to practice in a specific profession, such as law or medicine. Examples of the former are the Ph.D. (Doctor of Philosophy) and the S.J.D. (Doctor of Juridical Science), while examples of the latter include the U.S. degrees Doctor of Medicine, and the Dutch Professional Doctorate in Engineering.”
Doctorate dates back to the Middle Ages, the Medieval Era as a license to teach.
The first university, the University of Bologna, was founded as a school of law by four famous legal scholars in the 12th century, and the first academic degrees were all law degrees, and the first law degrees were doctorates as stated in Wikipedia.
Theology, law, and medicine were the earliest doctoral degrees.
The term “doctor” refers to an individual who has earned a degree of Doctor of Philosophy, or Ph.D. Beyond academia and in the classical professions, such as medicine and law, professional doctorates emerged such as the Doctor of Medicine M.D. (an abbreviation of the Latin Medicinæ Doctor), Doctor of Osteopathic Medicine D.O.
While many US lawyers and physicians who pursue purely academic and research careers in law and medicine do so after having earned a J.D. or M.D., respectively, these degrees are considered professional doctorates because most who earn them pursue careers as working professionals. In more recent times, other professional doctorates have emerged such as the EdD (usually held by school administrators), the DBA and the DPA (nearly always earned by prior recipients of the M.B.A. and the M.P.A., who continue to pursue ongoing professional careers in business and public administration) and the Doctor of Physical Therapy (DPT.)
There are other health professions such as physical therapy, podiatry, dentistry, chiropractic medicine, optometry, and veterinary medicine, where the title “doctor” is used professionally.
What is the issue?
First, it is true that some doctors can be territorial, but is this really the issue? I had a long conversation with a good friend of mine who’s a medical doctor and not surprisingly, he’s not a proponent of nurse practitioners being called doctors. He said, “The problem as I see it is that the academic term “Doctor” is distinctly different than the common understanding of “Doctor”. Having Nurse Practitioners use the term “Doctor” just mixes up the two uses and is confusing for the majority of people. If somebody wants to be a common “Doctor” then they need to go to medicals school and residency.” He adds, “…territorial is irrelevant. PATIENTS go to their DOCTOR. That is just common vernacular that has developed over several centuries.” While medical doctors aren’t the only doctors; does the issue become academic vs. institution. Is it okay to call a nurse practitioner “Doctor” when he or she is in an academic setting and NOT in an institutional setting? Shouldn’t it go both ways?
Heated Debate
This ostensibly will remain an intense heated debate. Kevin Pho, MD, founder of KevinMD writes a blog addressing the role of nurse practitioners. “Merely bringing up this idea brings out the worst in turf battles, with most discussions devolving into nurse versus doctor cat-fights,” writes Kevin Pho, MD.
Cat-fights we can do without – team is the best approach
KevinMD writes, “…doctors and nurses have to realize that it’s the patients who come first, and to care best for them, a team-based approach is needed.” Will this debate lead to cat-fights between doctors and nurses? As health care continues to change, perhaps it’s time we move out of the box and greet the DNP, the doctor, the teacher, the doctorate as a health care provider. If DNP is a Doctor of Nursing Practice, that simply means that they are teachers of nursing practice; it does not mean they are medical doctors. And yes, in regards to Dr. Soden’s comment, what simply needs to be done when the DNP sees a patient is to introduce her or himself and make it clear that she/he is a Doctor of Nursing Practice, not a medical doctor. DNP will be an asset to patients, but it’s important to realize what Dr. Blumenfield points out. There are many exceptional nurses who provide excellent care and they may not be an NP or DNP. It’s important to note that there are health care professionals who believe that by obtaining the highest level of learning, that they should be called doctors.
“OF COURSE THEY SHOULD BE CALLED DOCTORS,” says Michael Butler, DC, MS, R NCS T says in an email. He adds, “THEY PASSED CERTIFICATION OF HIGHER LEVEL OF LEARNING. THE PATIENTS THEY SERVE RECOGNIZE THEIR EXPERTISE.” Bonnie Marting, DNP, ARNP replies: “Regarding the question of whether NPs should be called doctors: Using the term “doctor” implies a higher education than the masters prepared nurse practitioner. It is an excellent opportunity to introduce the patient to the ever-evolving world of healthcare and the extent of the education this type of healthcare provider has. It does not confuse one with “physician”, simply clarifies.”
Bottom Line
We need to tread the waters very carefully here. The last thing health care needs are fighting nurses and doctors. Both groups are professionals with advanced degrees and we need to recognize that each entity in health care is unique and special. While medical doctors aren’t the only doctors; does the issue become academic vs. institution. Is it about titles and territory? Or is it about the patient? It’s vital that in the 21st century and with changing health care policies, that it’s time that both doctors and nurses work together as professionals for the good of the patient. No matter the title and the number of degrees, it’s vital that communication with patients is transparent and that they know who you are and are not misled.
Questions to think about
- In a hospital setting, should medical doctors be the only doctors allowed to use the title doctor?
- Lawyers can technically be called doctors since they obtain a Juris Doctorate degree, but they do not use that title. Should the same go for nurse practitioners that obtain the Doctorate of Nursing Practice (DNP)? Should they obtain the DNP but not be called doctor in a hospital setting to minimize any confusion to patients?
- Will patients be confused by a nurse practitioner calling themselves doctor?
- If nurse practitioners are very clear in introducing themselves as a doctor of nursing practice, will that alleviate the confusion?
- Should nurse practitioners be called doctor only in an academic setting and not in a hospital setting?
- Is it time to change the “common vernacular” of Doctor? – Doctor in a hospital setting does not necessarily now mean medical doctor since the advent of the DNP.
- Should Colleges and Universities along with the American Association of Colleges of Nursing present an ad campaign to the general public to educate them on the new title of nurse practitioners? After all patients should not be misled, and transparency is critical.
Your turn: What do you think? Should nurse practitioners be called doctors (DNP)?
Barbara Ficarra, RN, BSN, MPA is the executive producer and host of the Health in 30® Radio Show and founder of Healthin30.com, a featured writer on Huffington Post, and an administrative head nurse at a teaching hospital.
This thread is filled with misunderstanding. The implied assumption that nurse practitioners (NPs) WANT to masquerade as medical doctors is outrageous- NPs are proud of their title and role. Yes, title protection is extremely important, however no one discipline has ever owned the title “doctor “. Why is it that nursing is the ONLY discipline that has to defend itself because some choose to earn the highest academic degree- the doctorate? The message seems to be: “How dare we?” In whose best interest is it that nurses “stay in their place?” Will this persistent handmaiden image continue to block full access to the desperately needed care that nurse practitioners are capable of providing? The idea of nurses earning doctoral degrees is NOT NEW. Nurses have earned doctoral degrees for many years both in nursing and in fields outside of nursing. In fact, most universities REQUIRE nurse faculty to have an earned doctorate.
Inaccurate media reports continue to misrepresent the DNP as the hijacking of medicine, and just fans the turf battle flames. The DNP degree as an option for nurses emerged because of recommendations by the Institute of MEDICINE as one of many ways to improve patient safety. <“>http://www.aacn.nche.edu/Media/FactSheets/dnp.htm>
The heart and soul of the DNP is to better equip nurses to apply research findings to clinical practice to improve patient outcomes. Better educated nurses= better patient outcomes. It’s all about the patient!
I am a medical practice consultant and not a clinician. However, if I were a patient, I would rather doctor over a NP. I am sure NPs can competently perform many functions a physician is supposed to be doing; however, since it is my health, I would rather a more qualified person to assess my health.
How many “walk-in follow-up”‘s do I have to see in a 15 minute appt, because they are not new patients since the NP gave them a Z-Pack for “sinusitis”, thereby getting more paind than I do in the follow-up? I spend more than 1/2 hour figuring out what is going on, along with the Afib I could hear upon listening to the heart.
If they want to be doctors, then for go** Da** also take responsibility as one and be ready to get sued as one. However, I bet you when it comes to push and something goes wrong we will see two things:
*referring to the walk-in note saying “follow-up with primary care”.
*Referring to the overworked ER-doc that “cosigned” the NP’s fairy tales.
Facts are very simple. An educated NP has LESS education in total than a 2nd year medical student (and probably knows even less” and still wants to call themselves “doctors”. Guess what, as soon as that happens, next thingh would be for them to demand “same pay for same work”.
I have started REFUSING to cosign or review anything an NP wants me to do when I am on call. I have seen to much garbage to be willing to risk my license over incompetence endorsed by the nursing unions.
Maybe we should have the NP’s take over primary care entirely since they are so great?!? Expect to see cardiologists getting flooded with referral every time the NP “is not sure” about the EKG and there is no MD around willing to stick his/her neck out to assume liability.
question
Not long ago, the nurses ran a campaign, asking public to insist on an RN to take care of them, in the hospital; then, semantics was very important to them. Now, suddenly, they feel they should be called Doctors, by creating a DNP degree. The DNP degree was created solely, so that they could call themselves Doctors. They even tried to get the medical board to administer, just the Part III exam, so they can claim they were taking the same exam as Doctors. They conveniently did not want to take the first two very difficult exams, dealing with the firm grounding of the medical sciences, that doctors have to take.
If the patient tells the NP, that she wants to call him a Doctor, that is one thing; but that does not justify your masquerading as one.
Perhaps, we could get the LPNs to ” Register” in a Registry; then they could call themselves Registered Nurse. What is wrong with that? They are Registered, are’nt they?
Barbara Glickstein, we are tired of you nurses playing the gender card. Remember, that almost half the Doctors are female, and nursing is now very popular amongst men.
Jane Miller, you think Doctors are afraid of your stepping into their territory; well, can I get my CNA of 38 years, to step into yours, take a 6 month online course and call herself a Psych Mental Health Nurse, and then do a few more online courses and then call herself a Nurse Practitioner? Surely, you are not concerned about someone stepping into your territory?
Just want to point out that the “equivalency” studies that
NPs always try to use to advance their scope of practice
cannot be logically used in this way.
What such studies show at most is that NPs can achieve
equivalent outcomes in primary care WHEN they have
a medical system (MD/DO) to refer sick patients to-either
via direct supervision or collaboration or referral.
If NPs had absolutely no one to refer to but themselves
they could not possibly obtain equivalent outcomes.
Since they are already “plugged into” the system,
they SHOULD get similar outcomes-just to be allowed to
see patients AT ALL.
However, none of these equivalent studies justifies truly
independent practice where they can build their own
hospitals and subspecialists-they just do not
have the academic/scientific expertise to warrant
a truly independent practice.
Also, just because the NPs get a practice area shifted over
to the Nursing State Board and then relabeled as “nursing”
does not make it so- its really medical practice that was
stolen from the docs and relabeled by administrative tricks.
In the clinical setting seeing patients, it is the CUSTOM
everywhere to address as “doctor” those who actually went
to medical school. That is SIMPLE TRUTH that should never change.
The DNP degree is a con job and an “in your face” attitude toward
the docs. When the DNP introduces herself as “doctor so-and-so”,
let me suggest that the docs introduce themselves as the REAL
DOCTOR. This scheme of Mudinger’s is the most obnoxious
arrogance to come out of nursing in many years.
Disgusting.
Most “doctors” just out of med school get schooled by seasoned RNs.
Its the RNs who prevent the “doctors” from killing people.
Lets face the facts… it takes years of practice to get good at what you do, whether you are a teacher, a physician, nurse practitioner, lawyer, farmer. It takes a long time to become very confident, competent, an expert. Do DNPs deserve to be called the title of their academic accomplishment like physicians, OTs, PTs, pharmacists, vets..? Of course. Does it make it confusing? No. If a patient doesn’t know who their provider is… they should ask… the provider (DNP/DO/MD) can put their name on the white board, just like the RN. The other people who come into a room can introduce themselves… “hi I’m Bob the Respiratory Therapist…” for example. There is no competition going on here. The fact is that the level of care NPs are providing would be better met with a doctorate degree. Lets not forget that physicians used to think babies didn’t feel pain and would operate on them without pain meds. Every profession has its evolution and development, medicine has its own learning curve. DNPs will continue to be great medical resources to meet the needs of our communities. MDs would be better practitioners if they focused less on comparing themselves to NPs and everyone else and more on patient care.
You are entitled to your opinion, Simon.
And I am entitled to mine.
For myself, I will never again accept political correctness.
I know what it took/cost to get through medical school
and residency.
And I know the DNP will never be equivalent.
So, I will NOT accept DNPs as equals, no matter how much
political correctness and blather about “team playing” and
all the other nonsense is repeated.
Political correctness is the very reason standards in
America are so low today.
For myself, I am absolutely convinced that Mudinger’s
scheme here is to displace (REAL) docs from primary care,
because she thinks it such a “simple” practice.
No other profession [engineering, law] would put up
with this kind of nonsense from lesser-trained personnel.
America’s docs do it because they are ground down by
politics and PC, and, really, a weakened AMA.
Also, as far as I am concerned, the DNP is absolutely an
attempt to “blur” professional boundaries. In a clinic,
anyone who wears a white coat and stethoscope and sees
patients will be considered by those patients to be a physician-
that is just the nature of the beast in clinical practice.
This really is not about evolution-its about blurring boundaries,
and its about theft by the mechanism of degree inflation from
those that actually earned the title.
The NPs NOW are claiming parity with docs for quality of care-
and already are “great resources”- so why the DNP?
Your assertion holds no logic; the real reasons are trivially clear.
The Nurses THEMSELVES make great distinctions between “RN” and
“LPN”-although I have never seen an enormous difference.
Yet, when the docs finally object to the DNP- well, how
insensitive we all are to patient needs! How politically incorrect
of us!!
What is the definition of hypocrisy?
One solution for medicine is to aggressively partner
with PAs, and insure every medical school has a
PA program. Then, a well-trained FP or IM can partner
with 3 or 4 PAs in satellite offices (changing laws in legislatures
just like the NPs do) and QUINTUPLE the volume and geographic areas
that can be well served.
Virtually any doc that agrees to work with the NPs is, frankly, a fool.
The NP are attempting outright theft and its lobby is attempting to
change all the laws with an aggressive “in-your-face” attitude.
It is long past time for the primary care docs to forget PC and
stand up for themselves.
Here is irrefutable proof that DNPs have only a fraction of
the knowledge that graduating MD/DOs have to practice
medicine.
The 2008 pass rates of the USMLE step 3 for MD and DO were
both 95%. NINETY FIVE PERCENT.
The self-selected small group of DNPs (45 of them)
who took the old retired and WATERED DOWN and
SHORTER and EASIER GRADING standards NBME 3 exam
only achieved 50% pass rates. FIFTY PERCENT.
Further the MDs/DOs taking step 3 already passed tougher
basic science exams with 96% and 81% passing rates for the
two groups themselves- yes, D.O. grads know a little less basic
science, but the difference is fairly small.
There can be no better definitive proof that interns know more
about medical science and clinical medicine.
And in 3 MORE years the Internal medicine exams for board
certification make the USMLE look like high school exams.
So please, ladies, just knock off the nonsense- it can NEVER
FLY and the proof is right there in the exams.
Also, it has been suggested Mudinger had a conflict
of interest in pushing this stuff because she was on the Boards
of Directors of various insurances/companies who stand to
REDUCE THEIR EXPENSES if fully qualified physicians are
replaced with lesser-trained personnel like NPs.
I am curious to know if this RUMOR/SUGGESTION about
Mudinger is actually TRUE??
If this rumor is true, it would explain this DNP push
phenomenon ( and in rather unfortunate terms).
Does anyone know the scoop on Mudinger in this regard??
I am a nurse and I was in school for ANP. I agree with those doctors that a NURSE is a nurse and a DOCTOR is a doctor. However, a DNP should be called by what he/she deserves to be called. Do we feel hurt when a nursing assistant comes introduce to patient “I am your nurse” instead of “I am nursing assistant”? The doctors have their special trainings but it does not mean they are BETTER than a DNPs, who are trained in a different way. Talking about years of training, yes, DNPs have the same amount of training such as doctors do. They need 6 years for ANP and 2 years for DNP, Total is 8 years, plus their on-the-job experiences as well. They have been take care of the patients long before they obtain their degree. Does it count as “special training”?
I think the answer to this debate is very easy. The training it takes to become a doctor as well as the screening process to enter the medical profession is much much more rigorous. When I was in college I saw nursing students being able to take the “Intro to chemistry” or “Intro to biology” classes while I had to slog through Organic Chemistry and Advanced Physiology or Biochemistry. Following this I went to 4 years of medical school with in depth didactic and clinical training while a BSN is released onto the wards after only those four years of training and a RN with less still. I then had to go through residency with another 4 years of journeyman training where I worked 80 hours a week to gain experience. I had to pass very difficult tests of my knowledge to ensure that I had learned vast differentials of various diseases. Nurses do not have this level of testing and to imply that they do to the public is a disservice to the patient.
If nurses want to confuse a patient by claiming to have a level of training they do not have, then they will suffer the repercussions when they injure patients. A nurse claiming to be a doctor is lying to their patients about the level of expertise and testing that they have had to overcome to be in the position they are. There is no comparrison between the two training programs. If I took all of the nursing courses and then failed my medical boards, do I then get to be called a doctor?
Perhaps they should have to pay doctor level liability insurance for their new-found level of expertise they claim to possess. I do not claim to be a mechanic, I do not claim to be an rocket scientist, I only claim to be what I am, a doctor.
It is so true that if you want to be called a doctor then go to doctor school. However, what I mention here is if a nurse practitioner has a doctoral degree, why she should not be called a doctor? A DOCTOR title doesn’t have to be a MEDICAL DOCTOR. There has no problem in other disciplines to call a doctorate degree a DOCTOR, why it will be a heartache to call a nurse a title that he/she deserves it? Is there a discrimination between a medical doctor and a doctor of nurse practitioner? If this is the case, then bases on what point to discriminate. Is it one is smarter than other, one is master of organic chemistry and other is struggling with introduction chemistry? Why shouldn’t we talk about psychology rather than physiology or biochemistry? Don’t nurses learn about diseases and how to treat them? Yes, nurses do if they go for nurse practitioners. WHy don’t we differentiate a MD from a DO?
There are many more questions that people must find the answers before they say that they are smarter then others.
Should we have to consider patients care first before we try to degrade our professional partners? Or just because only nurse practitioner cares about his/her patients, therefore, he//she is careless about the title.
Mr. Le:
In the CLINICAL setting (seeing patients) it has for a very long time
been the custom to refer to ONLY those people who actually went
to medical school as doctors.
By what right do you demand an end to this tradition based
on a nursing doctorate founded on far less rigorous and far less
lengthy and difficult training? Just because it exists?
The mailmen in the post office can invent a 6-month doctoral
degree in handling mail. Are you going to call them
doctor mailman? ( Go right ahead-it would be hilarious).
Nursing “doctors” do not have equal background or training
and do not perform anywhere near as well on (even modified and
easy) board testing-not even on the easiest part 3 only.
Why do you demand that real physicians accept them as our
equals in terms of title and pay scales? That is just fraud, pure and
simple. Worse, its political correctness. And even more
disgustingly, it is a naked attempt to steal from the physicians
a title granted in recognition for their own achievements and
sacrifices.
No different than pretending to serve in the military with honors
and wear ribbons of military honors when you never actually
served at all. Such actions are rightfully despised.
In clinical settings, doctor school means MEDICAL SCHOOL,
not nurse “doctor school.”
You should be absolutely ashamed- both by your attempt to
deceive others and by your attempt to deceive even yourself.
One more critical point- the only thing really shown to benefit
humanity is scientific experiment and progress.
Solving real medical problems requires in-depth knowledge of
physiology and organic chemistry- and anatomy and all the
scientific disciplines.
Psychology is quite limited in its applicability- and even then,
the non-physicians DO NOT understand the many physical and
medical causes of psychiatric illness.
All the psychology in the world cannot help you if you do not
understand the link between hypothyroid disease and depression
or porphyria and psychosis- and those links go straight through
Physiology and Biochemistry.
Thus, it is plainly apparent that your arguments for equality of the
nursing doctorate are based on egotism and ignorance together-
a horrible combination.
But I really detest your implication that because the docs (the real ones)
do NOT agree with your absurd position, then those docs somehow
care less about patients. That is total bull***t, and you know it.
Please keep your politically correct baloney to yourself.
To sum up: If you want to call yourself “doctor” in non-clinical
settings ( like some school environment)- go right ahead
( who cares?).
But if you have the gall to call your self a “doctor” around
patients in some clinic where medicine is practiced- if I practice
there also, I will ABSOLUTELY hang up a sign that reminds
everyone concerned with patient care that REAL DOCTORS WENT
TO MEDICAL SCHOOL (not nurse school). Because I absolutely will
NOT tolerate this kind of arrogance and theft from nurses.
Finally there will appear a second sign: Political correctness is
one of the MAIN REASONS for the decay of professional and
business standards in modern America today.
Hi Dr. QUESTION,
I believe that you have had a heart attack while you were writing this response to my post. Unfortunately, you forgot the point that no one DEMANDS to be EQUAL with a MEDICAL DOCTOR as you said. Absolutely, a DOCTOR in clinical setting is a MEDICAL DOCTOR. Who says it is not? Keep in mind FOREVER that a DNP is a DOCTOR of NURSE PRACTITIONER. To be fair as you concern, a DNP should have introduced to the patient like this:
“Hi Mr. Dump, I am Doctor of Nurse Practitioner and this is YOUR Medical Doctor, Mr. Question.”
Does the patient care who is who? Of course not. So, before you accused ME of DEMANDING REAL PHYSICIANS LIKE YOU “TO ACCEPT THEM AS OUR EQUALS IN TERMS OF TITLE AND PAY SCALE.”, you must re-read my post again. Maybe you DO have problem in READING regardless of your title. It is a shame for you that a DOCTOR can’t read and comprehends English. I thought I am supposed to be LIKE THAT because English is my second language. In fact, I don’t.
Ironically, a high educated person with a title of a MEDICAL DOCTOR sounded extremely ANGRY in his/her post because he/she is afraid that a NURSE will BE CALLED a DOCTOR (regardless that the nurse IS a DOCTOR of NURSE PRACTITIONER). How many times I have to spell out the titles correctly, but I don’t think YOU UNDERSTAND ENGLISH. Besides, using profanity in the post is not a nice thing to do, and it is appropriate with a title of a MEDICAL DOCTOR.
Have you ever curse a patient when he/she says something that you don’t like? I wish you never do that.
ANother fact that I need to remind you that there are FAKE DOCTORS too, we just never know who is who. When someone has a DOCTORAL DEGREE, this person should introduce himself/herself “I am Doctor of ”
Who does care about being a MEDICAL DOCTOR or DOCTOR <specialty"?
I guess just people who think they are REAL MEDICAL DOCTORS.
I feel pity for those who are afraid of loosing their title and patient's trust.
Mr. Le:
I cannot make the case any more plainly than I already have.
You yourself are claiming that DNPs should be introduced as
“doctor of nurse practitioner”- that is, “doctor nurse”
as a short hand reference.
I am not at all afraid of losing a patient’s trust. But that is because
I do not misrepresent myself.
As to whether the patient “cares” as to who is who- you will
discover very quickly the reality that they absolutely do care
when you become involved with a medical malpractice case.
Real doctors take on the hardest cases and the sickest patients
and consequently are more frequently involved in malpractice cases.
They are also more involved because attorneys go after the policies of
those with the largest coverage.
Of course these facts do not stop the NPs from pointing out that
they are sued less -that is because of course they are more
compassionate clinicians (of course- read sarcasm here, Mr. Le).
I wonder if the NPs realize just how much they have alienated the
medical profession with all their outrageous stunts.
The notion of “doctor nurse” is a deliberate blurring of boundaries- and
there are endless examples of NPs claiming that they should have
“equal pay for equal work”.
So yes, they want equal pay, equal professional titles, they want all the
rights and privileges-independent practice, same pay, the list goes on.
When treating patients, the custom has long been that real doctors
went to medical school.
When anyone asks me what is a “doctor nurse”- I will tell them the
simple truth- these are nurses who went back for more nursing
training in nursing schools, where those nursing schools simply
dressed up that training by calling it a “doctoral” degree. I will follow
that up by stating my opinion: the nurses are using the current fashion
of political correctness to produce DNP graduates to replace primary care
physicians. Then I will explain that the DNP “primary care doctor” does
not and never will have the expertise to practice primary care at the
same level as real doctors do.
For myself, i remain convinced that this movement is essentially
a kind of fraud or scam.
I notice that you have no response to why psychology cannot
be a substitute for real training in the sciences.
For myself, I would never accept collaborating or supervising with
a “doctor nurse”- because I know what their real agenda is all about.
Of course the DNP and the NP will accuse me of prejudice and of
not putting patients first.
But excellent patient care does not require me to accept the
“doctor nurse”, and it does not require me to accept a group of
people who deliberately attempt to blur
professional boundaries, and that, in my opinion,
consistently misrepresent themselves and the level of their actual
accomplishments in medical practice.
Just to be crystal clear Mr. Le: The following is my PERSONAL opinion-
when you use the DNP to call yourself a “doctor” when seeing patients,
YOU ARE ACTUALLY A NURSE MASQUERADING AS A DOCTOR.
Mr Le, I will leave it entirely to your own judgement and your own PERSONAL
sense of integrity as to whether or not you feel you are being entirely
truthful when you represent yourself in such a manner. May you enjoy
the pleasure of “explaining” yourself to your “patients” that you are
actually a “doctor nurse”, NOT someone who actually went to medical
school ( not someone who is TRADITIONALLY called a doctor).
It should work out fine, Mr. Le. Most people will understand that you are
just basically “taking” the title for yourself. Good luck with that.
Thank you for your promptly response, Mr. Question. I guess you are a male doctor. I believe that you are going within a circle. You continue using degrading words to label a DNP who NEVER attempts to STEAL your title. People deserve what they are working for. I see you are frustrated to defense yourself, but Mr. Question, NO ONE wants your title, except you think people do. Nurses received heavy training on psychology -not that much as psychologist, a doctor of psychology. Nurses know how to deal with the patients, not give them bad bedside manner. As health care providers, we, regardless that YOU are a doctorr or I am a nurse, have to be compassionate.
Doctors make more money, so they have big law suit. It is the norm. Anyway, remind you that not ALL doctors practice ALL specialties, as you said. You received training, as you said, you know you have to choose a SPECIALTY. NO ONE CAN CLAIM THAT HE/SHE KNOWS IT ALL. It is a shame that doctors now have to be angry because of title wars. I am not, If I had a doctoral degree, I will introduce myself a doctor. IT IS MY OPINION. I don’t loose my respect to a DOCTOR but I do respect people who seek for knowledge. I don’t think degrading people will make oneself looks better. Along the line YOU will be under a nurse care. Along the line, with the health care cost arises because many LAW SUITS against doctors who don’t know what they are doing, wonderful doctors will know how they should behave.
Thank you for your aggressive and promptly responses, I am very appreciated and enjoying them,
This question is multifaceted but is related to the mythology of omnipotence that has been promoted by physician’s for years and the struggle to maintain turf and market share within the health care marketplace.
The MD degree and the DNP degree are both practitioner degrees. Both of these programs are modeled after the cottage industry model of education (i.e. apprentise, journeyman, master) as most physicians go through the intern, resident, attending process of medical education. True the MD degree is more comprehensive in many ways when compared to the DNP degree but they are in the end both academic degrees. My doctoral degree in organizational dynamics is earned through a robust process of education and research; not training. Yet, in my state I am prohibited by law to identify myself as a doctor when working in the hospital setting because it may confuse the patients. When an MD wants to become a better administrator they go back to school post-doc to get an MBA. When an MD wants to become a better researcher they go back to school post-doc to get a PhD. So the idea that an MD is all knowing and all powerful is inaccurate.
In my experience most patients are confused already. When they go to the community clinic to see John Smith, PA-C, quite often patients indicate they want to see Dr. Smith. Not because Mr. Smith has identified himself as a doctor but because the patient doesn’t have a clue and quite frankly doesn’t care as long as they receive the care they require. If I want to see a cardiologist, oncologist, orthopedist, etc. I would probably want to see an MD or DO (remember the turf fight between MDs and DOs?). However, if I am seeing a general practitioner for my everyday health care needs a NP or PA is equivalent as far as I am concerned. In fact you might get better care from a NP due to their nursing (i.e. caring) background. And, if a NP has earned the academic degree of DNP I see no reason not to acknowledge that by calling them doctor.
While MDs continue to fight for their turf they also continue to threaten the withholding of services for Medicare, Medicaid, and other capitated payors. My solution to this problem of fewer MDs willing to play in the primary health care arena has one of two potential paths. 1) Tell the doctors’ fine we don’t need you we will promote the use of the NP or PA; or, 2) tell the doctors’ that if they do not accept payments at the capitated levels they will be ineligible for licensure in the state (our country). I believe that both of these options may have an impact on the delivery of primary care in the US.
Thank you very much Mr. Bill. You explained nicely about the discussion
Indeed, if I want to have a cardiology consult, I will see a cardiologist, not a PA or a DNP who work in cardiac office. The patient has a choice of who they want to see or who will treat them. Family doctors are in great shortage because all training doctors want to go for specialties, and because primary care doctors make less money than the specialists. Meanwhile, nurse practitioners provide care and see the patients the same way as the family doctors do with a fraction of their salary. If patient needs referral for special care then NP will refers to a specialist who is a MD. In health care industry, all providers are working together and we should not step on other foot. You explanation is exactly what I am expecting from a well-educated person.
The attitude, along with the ignorance, is remarkable.
Bill, the Ph. D. suggests that docs should now be forced to accept
medicare as a condition of licensing to practice medicine.
Obviously, a license to practice medicine should be based only on
education and training.
Bill-how would you like it if you were told you could only practice
your profession if you accepted cheap reimbursement?
So really you are saying medicine should be entirely socialist.
What you further do not understand is that you ASSUME that your
routine health issues can be handled by the nurses. When you find out
(too late) that what they have assumed is allergic rhinitis, is really the
pro-drome for Churg-Strauss and you really needed systemic steroids,
it will be too late. And you will have only yourself to blame.
You are both ignorant about medicine, but insist you are correct.
It really is understandable-docs see this all the time from nurses and
Ph.Ds with attitudes- but you are nevertheless quite wrong. The NP won’t
be referring you to a cardiologist for quite a few rare conditions until it
is too late.
So feel free to gamble that the NPs can handle your health issues- if you
guess wrong, in your ignorance, you will get what you deserve.
As to forcing the docs to accept whatever the government tells us-
the reality is that that is what courts are for- to prevent fascist
tyrants from dictating to others what they will and will not accept as
payment. So, the medical associations will sue you in state and federal
courts- and they will win UNLESS the judiciary is also completely
corrupted in the United States.
Frankly, it is plainly apparent that both the Nurse Le and the Ph.D Bill
hate doctors- because doctors are widely regarded as smart, successful and
independent professionals.
Thanks for demonstrating to all the docs who read this the absolute need
to stick together politically- because the reality is that physicians are hated
by jealous government bureaucrats and many in the nursing “profession”.
They are also hated by Ph.Ds. What business does in a Ph.D in
“organization dynamics” (almost certainly the usual pompous
psychologist, or, worse, just a Ph.D. from a business school) have
telling the world that in “his opinion” NPs are just fine for primary care?
What even qualifies you, Mr. Bill, to have an opinion about medicine?
What actual qualifications do you have that anyone should even listen
to your “opinion?”
It is fine though. The docs have always known that Ph.Ds and
nurses and “allied health professionals” are just basically jealous of
the dedication and achievements of the members of the medical
profession- it is very widely understood and recognized that
getting into and through medical school is an accomplishment that
only a select group in the general population can accomplish.
In short, Mr.Bill- we all know how the Ph.Ds feel- there is nothing
new under the Sun.
As far as getting an MBA-absolutely- when a doc wants to go into
management – he acquires the needed credentials to do the job.
(Unlike the doctor nurses).
It is only too true that the problem with health care in the U.S.
is that there are 250 million “experts” and 3 Americans.
Mr. Le- you will thank anyone and anything that agrees with you.
“What even qualifies you, Mr. Bill, to have an opinion about medicine?
What actual qualifications do you have that anyone should even listen
to your “opinion?”
-The fact that Mr. Bill will ultimately be a patient receiving care is all the qualification he needs to express an opinion. MDs shouldn’t be so arrogant as to ignore the opinions of others simply because they lack credentials. All people are prospective patients. If 98% of our patients lack “qualifications”, are they not entitled to an opinion involving their care?
This is all about respect. If we truly respect the training and hardships the nurses have endured to practice in their PROFESSION then all this title grabbing wouldn’t exist. Getting MD behind your name is hard-fought, but that doesn’t justify treating colleagues who don’t have it as inferior. With that said, I am against calling DNPs doctors in the hospital setting. I think we all agree doing so would cause unnecessary confusion among patients.
Ong MD:
The opinion Mr. Bill expresses is not about his own care per se;
it is about his opinion that NPs and PAs are a satisfactory substitute for
primary care MDs.
And you absolutely need to know something about medicine to
to justify such an opinion.
Anyone can have an opinion. But if you are going to have an opinion
about which professionals can do certain jobs, you need to have
the knowledge to back that up.
And just between you and me, Dr. Ong, let me just say that the docs have
been far too reluctant to stand up to the tide of political correctness that
so destroys the standards the U.S. used to live up to.
So read again just what Bill’s opinion is actually about and then you tell
me why he should even formulate that opinion , when he ALSO tells us
what his expertise really is.
You also imply that nurses are title- grabbing because we never respected
them. That is pure nonsense.
Of all the workers in healthcare, the nurses have the highest esteem among the
general public. And I have myself intervened with patients many, many times
to insist that patients treat them with kindness and respect.
I have also noted how brutally they treat each other: How “degrading” RNs
are to LPNs and so on. No one watches “respect” more vigilantly than NURSES.
Nothing justifies their title-grabbing, just as nothing justifies your
excuses for them.
Again, for the record, I hold that political correctness in the United States
must be obliterated to return this nation to the high standards in the
professions and business that once made America the envy of the world.
The disease of political correctness is destroying this country at an ever-
increasing rate. No one can speak the truth for fear of “degrading”
some other groups’ sense of dignity.
When America was a land of integrity, a drunk was called a drunk, and
a scoundrel was called a scoundrel. And title-stealing would never even
have been contemplated.
That we have deteriorated to the extent that anyone’s opinion must be
respected regardless of whether he has any relevant knowledge or
training that actually bears on that opinion is emblematic of how
far we have lowered our standards.
So go ahead and call me arrogant, who cares?
Sure, I’m arrogant. And our standards today are quite low.
Here are my credentials for my opinion: degrees in: Biochemistry, Medicine,
and an M.P.H. from Yale. So let the world judge if Bill’s opinion should be
“respected” equally with mine.
Of course, I recognize that everyone’s opinion is to be respected equally,
and that in the America of today all opinions must be equal by definition,
and therefore Bill must be correct: NPs can do the job of primary care docs
and should accordingly be given an unrestricted medical license.
I also recognize that there are plenty of citizens who are silent and never
bought into political correctness, but just avoid the issues out of fear of
being labeled racist, insensitive, and the list goes on.
I am one of those guys who has just decided never to accept political
correctness ever again, and have decided to speak the truth as I
see it and to ignore the liberal fascists who seek to control the
thoughts of us all.
The casual tyranny of the Government bureaucrat:
A follow-up to Bill-Ph.D posting about forcing docs to take
government reimbursement rates as a condition of licensing:
See the article by William T. Cushing M.D., J.D.
“Massachusetts is attempting to force physicians into
involuntary servitude.”
This is a (obvious) violation of the 13th Amendment against
slavery and involuntary servitude.
As far as I can tell, this idea was dropped from the Massachusetts bill
to help small business with healthcare costs, recently signed into law.
For the benefit of the arrogant bureaucrat “Bill-Ph.D”, laws such as
these would become immediately blocked at the federal district court level
by emergency injunction- and rightfully so.
If the Peoples’ Republic to Massachusetts COULD enslave physicians,
it absolutely would do so.
This serves as a reminder to all you docs out there:
GOVERNMENT BUREAUCRATS HATE PHYSICIANS.
Also for the benefit of Bill: The D.Os BUILT their own medical system
in the U.S. with their own hospitals and specialists for the full care
of patients. It took them most of a century to improve their medical
schools and science departments to the point of near equality with
the regular MD schools. ONLY then were they formally accepted into
MD residencies. Now D.Os serve in MD schools and the DOs take and
and pass the MD licensing exam with scores that are quite close to the
regular medical schools. See the data at USMLE-actually nearly identical for
part 3 and only marginally lower in basic sciences.
So, over many, many decades, the DOs EARNED the recognition equivalent
to MDs, which is why they are now, for the most part, universally accepted.
The DNPs are trying to force acceptance by PC methods.
An incredible difference in attitude and “philosophy.”
One more thing to make clear regarding OngMD’s post:
The reasons to oppose calling DNPs “doctors” is not just the
“confusion” it will engender among patients.
It is ALSO (in the clinical/hospital) setting to REFUSE to lower
standards with that title and apply it to persons who have never
gone to medical school, nor done a residency. In other words,
we should not grant titles and recognition to those who have not
genuinely earned those titles or that recognition.
Yeah, I know, how arrogant not to make everyone equal.
It is so long past time to confront Communist political correctness
and our current horrific culture of refusing to state simple honest
truth for fear of “degrading” the feelings of other groups.
While I recognize that DNPs have attained more education than NPs, it simply is not in the patient’s best interest to start calling DNPs “doctors”. The fact of the matter is that patients WILL get confused. Just look at the situation with MDs and PAs. Patients already mistake one for the other (and PAs do not call themselves doctors). Imagine the confusion that would ensue if another person in a white coat introduces themselves as “doctor”. If DNPs want to be addressed as “Doctor” when in the classroom, then so be it, but to call themselves “Doctor” when it will be misinterpreted is simply irresponsible.
As others have stated, the real issue here is not “turf”. This is issue is full disclosure. Patients want to know and have a right to know the credentials of whomever is providing their treatment. Given the rapid increase in types of credentials among health care providers, patients can not reasonably be expected to keep so up-to-date with uniform and acronym trends as to understand succinctly the nature of their provider. Titles, acronyms, and uniforms are much too ambiguous for the current situation. Full introductions, using specific titles – “physician” (not “doctor”) or “physician’s assistant” (not “PA”) are the only realistic option.
Quite frankly, I don’t care what who is called…..as a patient however, when the doctor nurse in my PCP’s office sees me I spend about 15-20 minutes with him to discuss my health concerns. When I’m scheduled to see the doctor doctor, I’m lucky if I get 6 minutes with her. Titles are irrelevant – the proof is in the pudding – or in this case, the length of the visit and the “patient-centered” care I’m receiving.
Who cares if a patient gets confused who they’re being seeing by. The real danger is that the patient may be confused that they are actually being seeing by a competent provider just because they have the MD after their name. Why are there so many incompetent doctors after receiving that superior depth and breadth of training? And still they are incompetent. It’s dangerous that so many patients have confidence in a provider just because they have the MD label.
In my area it is generally known that the best GP is a nurse practitioner. Patients have left their MDs and Internist to go to her because she has superior outcomes in their care. Now that is a quandry. How can it be that a FNP can deliver superior care to an MD with all that inferior training? The doctors that have responded to this thread should be ashamed of themselves for their arrogance and profane language.
The quacks and idiots that wear the MD label are many. It’s the intelligence and experience of the provider that matters not the credentials. Patients need to seek out information about the reputation of the provider and proceed cautiously.
The conflict can be resolved quite easily: DNPs in our community are simply introducing themselves in the following manner: “I am Doctor John/Jane Doe, Nurse Practicioner.”
The public is wholly capable of distinguishing between other doctorate-prepared disciplines in the patient sttingsetting including the D.O., O.D., Pharm.D., D.C. and several others. Adding DNPs to the long list of doctors is just that – one more category that with patient education can quickly inform the public of the differences in care.
Historically, medical doctors have fought against any type of reform that encroaches upon their delicate turf. Let’s protect the patient – not the medical doctors.
If a chiropracter can be called doctor, you certainly can call a NP doc. LOL
“why it will be a heartache to call a nurse a title that he/she deserves it?”
There shouldn’t be heartache except from those who believe their social status is being usurped.
I am a transactional attorney (no, I do not represent clients in medical PI matters). I work extensively in U.S. Department of Labor (USDOL) issues. If one looks at the USDOL’s Standard Occupational Codes (SOC), it will be discovered that the occupation of “doctor” does not exist. Rather, the correct term is “physician,” and is the term recognized by USDOL. According to USDOL, a physician is either a M.D. or D.O.
No doubt if one researches the word “doctor” in a dictionary, it will also reference the term physician.
The doctor term, as it applies to physicians is rooted in historical terminology. At some point around the turn of the last century, the doctor term appears to have superceded the use of the physician term. What’s easier to say and spell?
What we really need to distinguish is the occupation from the academic achievement. Clearly, “doctors” in the medical setting exist in the form of D.V.M., M.D., D.O., D.D.S., D.C., D.P.M., D.N.Sc., Pharm.D., D.P.T., Ph.D., Ed.D., and today’s hot topic, the D.N.P.
As a practical matter, there are just too many legal issues that would allow state and federal governments to preclude use of the doctor term for DNPs. First, it would necessarily require all non-physicians to stop using the doctor term and that includes the O.D., D.D.S., D.P.M., and D.C.s Why? It becomes an equal-protection issue under the Constitution’s 14th Amendment. While a private medical center could prohibit the use of the term as a matter of internal policy, the government cannot.
Secondly, the government’s limitation of an occupational title also touches upon First Amendment freedoms of commercial speech. A DNP who states that he is “Doctor John Doe, your Nurse Practitioner” is entitled to such an introduction based upon his academic achievement (the doctor part), and that no part of the introduction is fraudulent, incorrect, inaccurate, nor confusing to a patient. Let’s dispense with this “patient confusion” red herring and recognize it for what it truly is: a fear-mongering technique advocated by the AMA.
If I was a DNP, I would wear my ‘doctor’ title proudly.
Nurse practitioners save money and handle simple diagnosis and follow-up that frees the physician up to see more patients. . .they have a role.
My concern is that on occaission, they are treated and practice as physicians, the patient is at risk because thay have not receieve the medical training and differential diagnostic grilling that physicians recieve in medical school and through years of internships.
> “thay have not receieve the medical training and differential diagnostic grilling that physicians recieve in medical school and through years of internships.”
That depends on the level of individual training. We can cite numerous examples of physicians practicing medicine in areas for which they have little or no competency, or where they demonstrate negligence in patient care. The world of medical personal injury is a multi-million dollar business for PI attorneys. Physicians created this industry on their own without the assistance of DNPs.
Moreover, DNPs in specialty areas are receiving clinical training far more advanced than what many family practice physicians are receiving. On one extreme, we have physicians in an office setting who are taking care of the colds, aches, and sniffles. By contrast, a DNP who is has received extensive clinical training in internal medicine, often trumps the knowledge base of a family practice physician. Yet, we have no issue with calling one a doctor, but not the other even through both have received doctorate-prepared academics and training?
That said, what’s at issue here whether or not a DNP can introduce one’s self as a doctor in a patient setting. At least for the foreseeable future, it’s reasonable that a DNP can, and should, introduce him/herself as, for example, “Doctor John Doe, your Nurse Practitioner.”
Response to Christensen:
1). Statements about individuals are of very limited value for
public policy.
It does not matter at all what experience an individual NP has
or does not have.
2). The results of the Part III medical boards (USMLE) make it crystal
clear that the DNP population knows far less medicine than graduating
first-year interns- and they know far less medical science than
do PAs. Only a 50% pass rate on a shorter, easier exam than real doctors
actually take. Virtually all the docs pass this easiest of licensing exams
while interns-without studying.
3). The DNP lowers dramatically the academic and scientific standards for
medical practice.
4). LAWYERS, not physicians, created the PI area- and they ruthlessly
exploit it-and for far more than medical malpractice.
5). The medical profession should never allow lawyers to try to tell the
the public who is and who is not qualified to practice medicine.
After all the nonsense is done with, the DNP movement is just
a scam to let nurses without the same training practice medicine.
The DNP WILL be used to argue for independent medical licensing
for nurses.
The only thing the docs can do to try to uphold standards of medical
training in this country is to continue to present the facts and exam
results to legislators- and many of them are lawyers.
6). Finally, Mr. Christensen, I would like to point out that the paralegals
and legal assistants really should be given law licenses and allowed
to practice law-because all the lawyers do is fill out forms.
And many lawyers are idiots with J.D. degrees, while paralegals
actually talk to and spend time with clients.
So, the U.S. really needs a “Doctor of Paralegal Practice” degree,
so that justice can be readily available at minimum costs for
all citizens. They simply must be admitted to practice in
US courts.
I know you agree Christensen-any other stand on your part
would obviously be hypocrisy.
Further comment to Christensen:
Another point you fail to appreciate is the mistake of making
a cross-comparison between specialties:
Of course an NP who works for or with an internal medicine
physician ( I am an Internist) will see “more advanced” clinical
practices in some instances than globally trained family practice
docs.
The POINT, however, is that NPs working in a given area of
medicine need competent supervision by physicians working in
the SAME area of medicine.
Thus, your comparison of apples to oranges is nonsense- the fact
that an NP may have seen medical practices done “routinely” in subspecialty
medicine that FPs do not train in is utterly irrelevant (those NP s also
know no peds or obstetrics that the well-rounded FP trains in).
Thus, the reasonable and prudent method of practice is that
the internal medicine SUBSPECIALIST is, and properly should be, the
physician supervising NPs practicing in that area-NOT family practice docs.
Thus, your argument commits the fallacy of irrelevant comparison-
the comparison of FP physicians to NPs working in IM areas cannot support
your illogical conclusion.
Finally, (and I have observed this to be universally true)- the nurses
know WHAT is routinely done in many areas of medical practice-BUT they are
nearly universally ignorant of the scientific principles that lie behind
what is done and therefore fail to appreciate the limits of techniques.
They DO NOT have the scientific background, as a GROUP, to make careful
judgements about the limitations of routine medical practices.
When serious disease presents, with life-threatening consequences,
one wants fully trained physicians and consultants in the relevant
specialty, NOT NPs who have seen “advanced clinical training”
functioning in an unjustifiable manner as independent physicians, who
in reality have very little understanding of the science behind the
medicine that they routinely see practiced. The difference is similar to
the difference between the scientist and the technician in physics and
chemistry.
Perhaps, as a “transactional attorney” you should confine
your opining to “transactional law.”
> “The POINT, however, is that NPs working in a given area of medicine need competent supervision by physicians working in the SAME area of medicine.”
The point, within the scope of this discussion, relates to the use of a title. Your comments fall far outside the relevancy of the topic. However, I’ll address a few…
There’s a point where a NP can attain just as much knowledge and skill as the supervising/attending physician. If an NICU NP is working many years in that environment, almost certainly will s/he attain the same knowledge base as the MD — and far more exposure to complex medicine than the family practice physician or chiropractor, who also calls him/herself “doctor.” The development of skills and knowledge doesn’t end with a set of letters on a diploma.
To your point, if a paralegal attains just as much knowledge as an attorney, why not allow that person to sit for the state bar exam? Myself, I have no issue with it. In fact, paralegals in some states will soon be licensed by the state. From there, paralegals may one day perform functions now under the sole domain of the attorney. If the paralegal can perform services as competently as a licensed attorney, the public will have an alternate resource. There’s enough legal work for anyone with a good reputation. The same holds true for all the professions.
> “4). LAWYERS, not physicians, created the PI area- and they ruthlessly exploit it-and for far more than medical malpractice.”
Agreed with the exploitation. If physicians practice good medicine and avert negligent care, the exploitation by attorneys will disappear.
On the difference between the DNP degree and other “doctoral” degrees
in the allied health fields: A difference in agenda/purpose and propaganda.
The allied health field doctoral degrees all reflect their own areas of
specialization and have never been confused with the roles in health care
that physicians undertake. Thus:
D.V.M.-veterinary medicine.
D.D.S.-dental medicine-usually taught in dental schools
D.C.-Chiropractors-manual treatment of spinal alignment, usually not
involved in drugs or surgery
D.P.M.-medical disorders of the feet below the ankles
Pharm D.- Expertise in drug dosing and drug-drug interactions.
D.P.T.-physical therapy-always useful in all forms of rehabilitation for
for many chronic disorders.
Ph.D.-a research degree-a degree which indicates a proven ability to
do original research.
Each degree with its niche and its purpose.
M.D./D.O. – a general medical degree whose purpose is to prepare
graduates with sufficient depth of knowledge in medical
science and clinical medicine for the purpose of allowing its
holders to take further training in ANY branch of medicine
and surgery. This is the American definition of a physician.
The further training taken may be in Surgery, Medicine, Obstetrics,
Pediatrics, or any of their subspecialties by means of a Residency.
The medical areas include primary care medicine-Internal med,
family practice and pediatrics.
DNP- Essentially being framed as a degree to at least perform the same
medical tasks/management decisions as a primary care
physician. And to do so independently, thereby implying
a right to a medical license-or at least a license with the
laws of the several States rewritten so as to be a de-facto
medical license in name if not in fact (through a Nursing
State Board).
Note, however, that already their is a DNP “residency” at USF
in “Dermatology.”
Their is also an AMA -assisted lawsuit by the Iowa Board of
Medicine against NPs trying through their nursing board to
gain the right to supervise radiology procedures in Iowa.
And Nurses do not even take college-level physics as a
requirement for their nursing degree!!
Conclusion: The DNP is a political movement to allow
nurses to practice medicine without its holders/members
achieving the same level of training or academic standards as
medicine (physicians). That is why the docs do not want to call
them “doctors”.
BUT this is not a matter of law. They can be called doctors
as much as they like, especially in Nursing schools.
But to do this in hospitals and clinics (as a social convention,
NOT a matter of law) is to aid and abet this scheme of the
nurse lobby.
By law, no doubt the DNP graduates can call themselves
“doctor”-with the specification of “nursing practice”.
And here is my response to the world- it will be on my door
of a clinic or hospital if DNPs are parading around and calling
themselves “doctor”- My response will be to introduce
myself to patients as Dr. so-and-so. And yes, I am a real doctor
because I actually went to medical school.
And yes, i consider it obnoxious to have to say “real doctor”,
until I remember that the only reason for it is the far greater
initial obnoxiousness of the Nurse lobby and its DNP
degree.
So i guess I better be certain that I have a Constitutional
right to call myself a real doctor because I went to medical
school, and because, by social convention, patients in
hospitals and clinics typically expect their “doctors” to
HAVE ACTUALLY GONE TO MEDICAL SCHOOL.
> “The allied health field doctoral degrees all reflect their own areas of specialization and have never been confused with the roles in health care that physicians undertake. Thus…”
And for each of the medically-related doctoral degrees mentioned, each and every one was new at one time, and at the introduction of each, patients had to learn their respective roles. But consumers are better armed today to understand these differences than at any other time in history. The “confusion” myth is nothing more than a red herring that is being spread like a cancer by frightened medical associations.
The “Confusion Theory” is being advocated by physicians out of a self-preservation instinct without any basis in fact. However, the rest of us are not buying into it.
> “So i guess I better be certain that I have a Constitutional right to call myself a real doctor..”
You have a Constitutional right to call yourself anything you like, including “uninformed, scared, intolerant, resistant, and defiant.”
>”There is a point where an NP can attain just as much knowledge
and skill as the supervising/attending physician. If a NICU/NP
is working many years in that environment, almost certainly he/she
will attain the same knowledge base as the MD.”
1). This is just an assertion, perhaps based on a notion of social
justice and an idea that work experience of any specialized sort
will always equate to formal academic training-if its long enough.
However, it is easily possible to become a ICU/NP for decades in
an ICU and never have taken college-level physics. So, the ICU
NP who never studied physics never really understands the basis
of a Swan-Gantz catheter (although she knows how to use them).
Your bald assertion raises two problems:
a). Proof of the assertion-despite its appeal to social justice
and its (what you believe is) a common-sense assumption
about how medicine (or science) can be learned, it is often
the case that, in medicine, one’s common sense fails in
reality.
b). How will you judge when your (N)Icu/NP has attained this
state of equal knowledge and skills, so that she should be
given an independent license? So far, USMLE data do NOT
support your common-sense assumptions.
In reality, the assertion you make here is similar to arguing that
because a car mechanic or engine mechanic spends years
working in the environment of challenging mechanical problems
with engines, their will come a point where their knowledge and
skills will equal that of the Ph. D. engineer who supervises them and
works in the same company every day. After all, who needs
differential equations in practice, right?
This is just as false for physicians as it is for engineers. In
science and medicine, the foundations must be laid brick by
brick. Your assertion is easy to make, and has a nice common-
sense feel to it, BUT will be difficult or impossible to prove, and
indeed, may well prove false. The initial data [USMLE part 3,
as shortened and simplified by the Nurse lobby for the DNP
exam] does NOT support your assertion.
>”There is enough legal work for anyone with a good reputation”
Then why is unemployment among new law school graduates at
an all time high? I imagine few of your colleagues agree with you-
perhaps you are referring only to paralegals with decades of
experience.
>” If physicians practice good medicine and avert negligent care, the
exploitation by attorneys will disappear”
I have never seen or talked with even one physician who agrees
with you. I will warrant that, absent only physicians who now make a
living as “expert witnesses” in med-mal cases, that there is virtually
NO physician in the United States who will give his/her assent to the
above statement. This is why tort reform is a perennial issue
in the United States.
I will also speculate that when DNPs have exactly the same med-mal
insurance polices (dollar coverage) written (if that ever occurs with
their “full’ licensure), the medical malpractice cases brought against
them as independent “doctors” will experience a rising curve up to
the level that physicians currently experience.
Medical malpractice in the U.S. is a thriving industry unequaled
in the other developed countries of the world. I guess this must be
because of our physicians, not our lawyer super-abundance.
The confusion theory is not a theory.
I have many times witnessed NPs who insist that they are
doctors and are perfectly happy to pretend that they are what
they simply are not.
As to uninformed, scared, confused, defiant, and resistant-
Feel free to throw all the ad-hominem adjectives you like,
but you are quite correct that I will never allow some politically
correct government- lawyer bureaucrat, who like many of his
ilk actually hate the physicians in this country, to offer the pretense
of his own expert opinion on these matters without any
reasonable opposing response.
Perhaps you can explain for all to understand why your opinions are
so much more correct than the medical professions’ opinion.
No, I do not agree with you. Further, you demonstrate no reasoning
and no evidence to induce rational belief.
In fact, I am neither uninformed or scared or confused.
I am resistant and “defiant” to the unjustifiable money and power
grabbing that the nursing lobby is REALLY all about with its DNP
movement.
Clear Examples:
Here are a few clear examples why and how NPs should not,
by changes to state statutes or regulations, be simply granted
independent practice rights despite a primary care doc shortage:
[And YES, the push by the Nurse academic lobby to be called "doctor"
is exactly a push for this ulterior motive]
1). See: http:// http://www.protectingpatientrights.com/blog/expanding-role-of-nurse-practitoners.
-attorney John Fisher details how an NP failed to order or
even consider a blood culture and missed bacterial
endocarditis in a fever-of-unknown origin case. The patient
was seen many times by the NP, never by a doc, and suffered
a stroke after 3 months.
2). My own experience in an US military facility, where NPs hang on for years
because they get rank and admin positions, while all the docs leave
federal service:
An elderly lady is seen for “headache” many times by the clinic
NPs- and ends up getting narcotics. With no improvement,
they send her to the only internal medicine doctor in the clinic.
The pain is in the distribution of the posterior auricular artery
BEHIND the ear, instead of in front of it. Had it been a
“classic” case, it would have been the “temporal arteritis” that
most NPs would diagnose.
What did the NPs NOT know? -That there are multiple branches
of the external carotid, and that this was an ATYPICAL case of
“temporal” arteritis. The risk to the patient??
-BLINDNESS without steroids IMMEDIATELY
The NPs in this clinic were highly political and resented the fact
that docs get more pay for “equal” work.
[They get more pay because of longer, tougher training
at higher standards, both for entry into their profession and
for graduation and practice].
3. A review of the DNP curriculum at UMDNJ school of nursing reveals that
a majority of the credits are in “health promotion across diverse cultures”,
and “Leadership, quality and Collaboration”, as well as “healthcare
economics and the Business of Practice.”
-Very little hard core Science or Medical Science.
Mostly policy, economics, cross-cultural,
“social studies” dynamics
- Even the “foundational” courses are information technology,
and “Healthcare Ethics for the Nurse Leader”.
And for all of this, the NPs want independent practice rights, the same pay
as primary care docs, the “doctor” title in the clinical setting”, and so on.
The Nurse lobby cites “studies” showing “equal” care to the docs, but they
invariably are for control of common illness, with common markers of
outcomes, like diabetes and its measure of control by Hemoglobin A1c.
What the Nurse lobby withholds from the public and the legislators is that
these studies are not designed to detect any differences in diagnosis and
treatment of uncommon (but serious) diseases or of common and serious
disease presenting in unusual ways. These studies almost always have
physician back up for any serious illnesses, and so prove at most that
NPs, with the ability to refer to physicians, can provide good routine
uncomplicated medical care (on the whole, as an average).
This is hardly a reason to give them real or de-facto (via nursing state boards)
medical licenses.
I can hardly believe the extent to which this nation is now willing, ready and
able to lower professional standards for the practice of medicine.
But economic duress and bankruptcy can and do result in these outcomes.
The NPs, backed by their powerful Nurse Lobby and by politicians and
lawyers looking for the cheapest and most convenient solution to the
desire for universal health care coverage will take this avenue.
In the end, physicians will be even more reluctant to go into primary care
medicine, and the result will invariably be that the nations’ primary care
physicians will be undermined by the Nurse lobby, the lawyers and the
politicians, and tyrannical government bureaucrats. And please, all this
“team collaboration” is just the easiest method to insert the leverage to make
it happen.
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“I can hardly believe the extent to which this nation is now willing, ready and able to lower professional standards for the practice of medicine.”
I can. And, so does a group of Columbia University physicians who published the following article in the Journal of American Medical Association (JAMA):
G.S. Dr Mundinger, et.al., “Health Outcomes Among Patients Treated by Nurse Practitioners or Physicians,” Journal of American Medical Association, Vol. 283 No. 19.
The above author states that patient outcomes in a primary care setting are little different between the NP and physician.
What counts? Results. Apparently, Dr. Mundinger agrees. Like several of us had been advocating through this message thread (and to get back on topic): There is no reason whatsoever why a DNP cannot, and should not refer to him/herself as, for example, “I am Dr. John Doe, your Nurse Practitioner.” Clear, concise, and no patient confusion.
The only potential for patient confusion will occur when the public continues to find that many NPs are taking better care of their needs in the primary care setting than their traditional physician – and will be further confused as to why physicians are charging more for the same, or better level of primary care services — and why is it that Medicare is reimbursing physicians at a percentage more than the NP for the *exact* same level of patient care?
Medicare is now realizing what’s happening as are the insurance companies who will continue to find news ways to drive down health care costs while continuing to provide competent patient care.
Agreement on several levels:
The new Institute of Medicine Report on Nursing is now
published.
It advocates a far greater role for the full medical licensing
and privileging of advanced nurse practitioners and it cites
the same studies by Mudinger et.al.
I will attempt to explain why these studies do not reveal the
full truth about medical practice, however the points I make will
not make a difference ultimately on the fate of primary medical care
in the United States.
The studies conducted for the NPs are based on outcomes where
a physician or physician-specialist is serving as back-up for the NPs
for referral purposes. The studies do demonstrate equivalent outcomes
for NPs, as for physicians.
However, the ability of NPs to refer to physicians for complicated cases
acts as the confounding factor for the conclusion advocated by the Nurse
Lobby: What the studies have shown is that NPs, acting with physician
collaboration when needed, deliver equivalent medical care.
For the NPs to show that their knowledge and skill base is identical and
thus they merit medical licenses, they would have to prove equal outcomes
for all patient types with no MD involvement ever-even by referral and
consult in hospitals.
And this cannot be done. It cannot even be demonstrated by objective
written exam, because the results demonstrate otherwise.
Now, as William Osler pointed out long ago, patients present in three general
ways:
1). Common conditions commonly presenting;
2) Common conditions presenting in an uncommon manner, and
3) Uncommon conditions presenting ["zebras"]
The 4th logical possibility is omitted due to incredible rarity.
None of us doubt that NPs can handle case number 1.
Cases 2 and 3 are the problem and generate the question:
Have the NP studies been large enough and objective enough to
prove that NPs have equal outcomes with docs for cases 2 and 3??
In general, the medical profession believes no study has had the
statistical power to investigate, let alone answer, this question.
By observation, most of us are certain the answer is probably not.
Now the politics:
- the answer does not matter, because a proven case for the first
condition will be assumed to prove the same for cases 2 and 3.
-the driving force for this logical error will absolutely be cost:
NPs will cheaply replace primary care physicians.
I do not believe the medical profession can successfully make this
argument or case because the cost savings the government and
politicians see for the Medicare and other entitlement programs is
far too enticing.
I actually believe that NPs will replace FPs, Peds, internists, dermatologists,
perhaps radiologists, OB-GYNs, and Rehab medicine specialists and
perhaps a few other specialties.
Medical students will almost certainly not go into primary care again, and
much of the backbone of the medical profession in the United States will
erode. Why be a primary care physician, when the same income is obtained and work can be done as an NP? Their will be no incentive of any kind.
So you may as well start calling your nurse practitioners “doctor”: they will
be that in fact as well as in name.
Only over the course of much time will the secondary effects,
such as the weakening of medicine and the medical conditions that
are missed and not understood begin to stack up, slowly, with time-
perhaps as long as 10 years (as seen on a national scale).
But in 10 years time, with all these forces and factors in place,
few if any physicians will be in primary care and related specialties.
Thus, I actually agree that the likely outcome is: the new primary care
“doctors” will actually be Nurses.
Further comment to Christensen:
-The study you cite measured physiologic outcomes in
6 months for ONLY THREE COMMON DISEASES:
Asthma, Diabetes and Hypertension.
The utter stupidity of basing medical licensing and
responsibility decisions on three of the simplest and most
common disorders is beyond absurd-it is simply crazy.
You cannot draw the general conclusions referenced above
in your quote-but of course you will do it anyway.
Take a good look through Harrison’s Principles of
Internal Medicine, and, assuming only that you have
at least a minimal understanding of logic, you will
see that the studies cited by NPs do not support their
grandiose conclusions. They are almost certainly as a group
not qualified to diagnose even moderately rare or unusal
disorders, nor those that are common but present in an
unusual fashion or with complications-
WHICH IS WHY THEY NEED SUPERVISION OR
“COLLABORATION.”
test: Thanks for the cite on the October 5th IOM report. I just downloaded it from the IOM website.
The IOM report:
-It has been pointed out on fiercehealthcare blogs that
the IOM committee is nothing other than the UMDNJ
Nurse lobby.
-A quick review of the committee reveals the chair is Donna
Shalala, a Ph.D. in political science and a politician in the
Clinton administration.
-The vice chair is the Chief Nurse Officer at Cedar-Sinai in LA.
-Of the few docs on the committee, one is chief medical officer of
CVS Caremark( pharmacy), and the other is at a Dartmouth
Institute for”Policy”and “clinical practice”.
And the rest of these “experts”??
-Big Business, Big Pharma, Public Health Schools, and Nursing, Nursing
and more Nursing.
With this review of authorship comes understanding:
-This is not an objective, balanced review with any significant input
by physicians in academia, or in practice in primary care medicine,
or any sub-specialties.
-A few of the physician leaders state that the report draws “illogical”
conclusions.
-It is more likely that the report draws POLITICAL conclusions- those
that are designed to cheapen and weaken standards of medical care
in the United States so as to force Universal Health Care coverage
for all people at lower standards that, while they will be forced on
medicine, will never be acknowledged-because the Nurse lobby
has its “studies”.
- In this manner, the bankrupt federal government AVOIDS the spending
needed to increase the number of residency slots in family medicine
or primary care, as well as avoids paying docs in those specialties
their fair market value to attract docs into these areas. Instead,
it opts for persons with far less training, experience and understanding,
proclaims them equals, and insists that they will be the new primary care
captains of the ship of health care.
- One is reminded that in all Socialist/Communist take-overs everywhere
in the World, one of the very first objectives is to kill the professionals-
because they represent an educated threat to the Socialist take-over.
-Conclusion: This new IOM report is likely an extension of the Socialist-
Communist take-over of the US (the healthcare part of that take-over).
-Viewed in this light, the report is not “illogical” at all.
It is an instrument of war (in the Machiavellian sense) by the
current Left-leaning Communist-Socialist government for the
take-over of US medicine and its attendant required diminution
of the medical profession. It makes perfect sense, after all.
The studies conducted for the NPs are based on outcomes where
a physician or physician-specialist is serving as back-up for the NPs
for referral purposes.
> “Studies conducted for the NPs are based on outcomes where
a physician or physician-specialist is serving as back-up for the
NPs for referral purposes.”
Again, this is the point. See my note about cases 2 and 3 above.
The Nurse lobby is attempting to obtain the right to the independent
practice of medicine (by any of several mechanisms, including
relabeling medicine as nursing practice and moving it under the
state boards of nursing), BASED ON THESE “STUDIES”.
Based on the same studies, they claim equivalence with physicians.
But these studies do not address and cannot detect the more difficult
to diagnose cases (2 and 3) above.
In fact, nurses have nowhere near the knowledge base required to
cover these cases. And no studies have the goal or the power to
investigate whether nurses can diagnose or treat them.
Instead, when the NP does not know the relevant medicine, he/she relies
on referral to a physician.
None of this is a legitimate reason for a full scope license to practice
medicine independently.
Because primary care IS NOT “simple care.” Cases 2 and 3 DO arise in
primary care. While such cases individually are rare, COLLECTIVELY they
are NOT, because of the rather large number of cases 2 and 3 distributed
in the general population.
The current arrogance of the NP/Nurse lobby does not permit the
recognition of this simple truth, and neither does the lefitst
liberal Nurse agenda in the Universities.
AGAIN: It is absurd and insane for Mudinger and the IOM lobby
of the Nurses to argue for full practice rights for medical
practice based on the training in Nursing school, including the
NP Master’s and the (politically correct) DNP degree with all
its sociology and ethics and “collaboration” coursework.
They are arguing they should get a medical license because
they can equivalently treat ASTHMA, DIABETES and
HIGH BLOOD PRESSURE. Perhaps a few other common and
simple disorders.
Further: This country is finally awakening to the fact that the
liberal agenda has and is bankrupting the United States.
The current “mandate” to add 32 million more people to the
insurance rolls may well be blocked by Congress in the
near future by refusing to allocate precious resources to
accomplish this Herculean task.
Thus, the attempt by the NPs to expand their practice rights
by POLITICAL instead of educational means by citing the
tremendous new influx may well become a moot point.
America has reached such a low point on quality standards
in its relentless pursuit of mindless political correctness,
that PERHAPS the people have FINALLY decided to begin
to return to our former high standards in the professions.