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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.
Well, regardless of any opinion. A doctorate is a doctorate and the recipient of a doctorate has the right to be called Dr. ………. That is not a matter of opinion it is an educationally conferred degree.
I am an RN and I agree that nurses and physicians are different. The focus is often slightly different – sometimes very different.
I don’t think that any nurse wants to be called Dr to confuse the line between a physician and a nurse – I think that the DNP or the PhD wants to be called Dr because that is their educational level. I think that patients should know what the educational level is of their practitioner – and that it should be clearly delineated that the individual is a NP or DNP or MD or DO or OD or PhD or etc etc
It is interesitng to note that some areas such as veterinary medicine here in the USA, come out with a doctorate although their training is often equivalent to a bachelor’s degree – and in Scotland, they are not awarded a doctorate but a bachelor’s. and in Scotland, they are called Veterinary Surgeons – but here in the USA, they are called Dr – because that is their degreed title.
I do not want to go to medical school and I do not want to be a physician, I want to be an advanced practice nurse. I do not want patients to get me confused either – sometimes patients call me “Dr” and I correct them because that is not my educational level – DNP is a different type of education than medical school and there should not be confusion between the two. Certainly there is a different process for earning those degrees – but a terminal degree is a terminal degree regardless of the requirements for getting there. If there is an issue with the quality of the terminal degree, then legislation needs to be taken up to standardize or go to the board of that terminal degree to correct the deficiency.
But again, nurses do not want to be called Dr because they are trying to “fake” a medical doctorate but because that is their educational level.
Patients and all others should respect those with a terminal doctorate degree and call them Dr. It is a matter of respect.
Here is another thought, in any relationship, reciprocity is generally the respectful and polite rule of thumb. therefore, if you call me by my first name, then I am going to call you by your first name. So if my physician calls me Allen then I am going to call her Yolanda – Unless it is a matter of respect to call her Dr Jones, then she should call me Mr Jones. Anyways, interesting thought that I read in a book at one time.
I have no issue with any one being called Doctor in any setting as long as they have a doctoral degree. If patients are confused then they need to be educated. Educated, now that is funny since the “real” meaning of Doctor, is Teacher. I want to be a Physician. My question is about training. I see that the prerequisite for a lot of BSN programs are similar to PA programs. I also see that there is clinical time allotted in NP/DNP programs. So if there is didactics and clinical hours (less hours than an MD program), what is the difference in care in let’s say Family Practice? I could see there being a difference or (limit) in care for a FNP that when off into a subspecialty like surgery or orthopedics, but where is the line( if any) with general care like Family practice? Dont say pay we all know that
the reality is that whether any given practitioner is a physician or family nurse practitioner; after a few years of practice within an average primary care practice or, even, within extremely complex settings, EITHER Masters or Doctorally-prepared FNPs practice medicine at PRECISELY the same level and with PRECISELY the same degree of expertise, with precusely the SAME outcomes as their physician colleagues.
beyond that, let’s not forget that there are very FEW MDs who graduate at the TOP of their classes, therefore many physicians may actually be practicing medicine at a level BELOW that of a well-rounded FNP, such as myself.
this imbroglio is entirely about ego, power, and economics- as in the same way that the AMA (in existence since the 1800′s; hence in FULL control of federal and state legislators all across the USA at this point) tried for decades to utterly DESTROY the practice of chiropractors, for instance, using vile and underhanded tactics to the degree that most americans believed that all chiropractors were “quacks”- a commonly used term then thanks TO the AMA’s sickening tactics, UNTIL the AMA FINALLY LOST a big court case and was forced to cease and desist with this same trajectory of demonization, infantilization, dumbing down and otherwise smearing an entire profession that they are now trying to aim at Nurse Practitioners.
again, a well-educated and experienced FNP practices medicine PRECISELY as well as ANY primary care physician- well, any INTEGRATIVE HEALTH M.D.; employing holism and empathy (as is, patients have eyes that can actually be looked into at least ONCE during a visit or listened to to a degree where they feel that they are BEING felt as a patient seeking care) which must make said physicians of the type with the power/ego/its all about physicians-type filled with rage.
further, numerous studies make it CLEAR that FNPs are VERY well thought of by their patients, with patient satisfaction studies/surveys frequently demonstrating that patients would rather see a FNP than an ill-tempered, patronizing, likely profoundly over-paid (including being the owner of the MRI Center or Lab to which a patient may be sent, or other similar arrangements that the AMA has conveniently arranged to line THEIR pockets with only, without letting the patient or anyone else, except their “partners” in on their big money-maker side business enterprises.)
again, it is QUITE CLEAR that not all doctors of medicine graduated at or even near the top of their respective classes, yet are released to practice their scary profession on unwitting patients, explaining the rising malpractice suits that increase each year within the world of physician medicine, but are VERY low, indeed, in the world of NPs.
Good Luck to you!
As an experienced NP of 13 years in rural Georgia I must first start with the fact that I too attended a reputable school The Medical College of Georgia School of Nursing. I met very high standards for acceptance into this competitive program. I work with a D.O. who is not my collaborator but the only physician provider in my office. I have an in depth knowledge of patholophysiology and am well published to prove this fact. I have on more occasions been the DO’s mentor than he mine. He cannot read ECGs and really doesnt understand the pathophysiology( his program didnt require a residency) We are all aware not all human beings are created intellectually equal including the MD, DO, NP or PA types so to think physicans are naturally more intellegent or more capable is incredulous but asside from that I am an educated and capable health care provider.I understand MD, DO training is gruelling and an acomplishment. I also am aware they have training I do not but clinical years of experience kinda levels that playing field dont you think? Also to think you are the only ones who have sacrificed or put in the hours is just arrogant to a fault. I do not have to put on a white coat for my patients they know I am an NP and on many occasions, not all but a majority prefer my services after all I know my limitations as a provider and human being….When we become so egotistical that we believe that others cannot add to our medical knowledge we become very dangerous. My reason for practice is to provide top quality care to my patients and if I feel I cannot then I send them to a specialist because after 13 years of practice 60 to70 hours per week I have put in my time and I have sacrificed for my patients……Can we not work together for the common good of our patients. I dont know about the rest of you but when I majored in Biology and Chemistry I knew why I wanted to do this because I was good at it, I enjoy it and I want to make a difference in peoples lives, in their families lives…..I have a masters degree (3 years with clinical rotations at Emory, Crawford Long, Piedmont and MCG arent those reputable enough for you?) I have a bachelors degree (4 years) and two year RN BSN degree(two years) Nine years close to that of most terminal doctorate degrees but I am going on for the DNP 12 years education in all and let me say I will use the title doctor in publication and in the University setting but in clinical practice I will always be proud to say hello I am your family nurse pracitioner…
“he cannot read ecg’s and his program didn’t require a residency.” Your comments don’t make any sense. In order to get a medical license in many states you must complete a medical residency or have atleast 1-2 years of residency training. In most cases, if you don’t complete a residency 99.9% of the time your patients insurance companies wont cover their bill, and you wont find a job. If you want to play doctor, study and go to medical school, and I predict 20 years from now DNP will be fighting for advanced surgical privledges.
…One more thing…. I was meaning generally, if you want to practice medicine why not just go to medical school? Reason I’m saying this is because I know a NP that has worked with a cardiothoracic surgeon for 10 years and she believes that she could perform the bread and butter cardiac surgeries since she has had lots of hands on. Some of these surgeons trained night and day in a 7 year surgical residency and worked like horses to perfect their technique and learn how to manage life and death situations. It amazed me how untechnical she made it sound but she thinks she can do the same thing to perfection and manage technical emergencies without proper training to make sure the best outcome is provided….. Point being, if DNP’s are to serve as physician extenders, why is there a drive from the DNP community to overlap everything a MD or DO does. Why is there a subset of DNP’s hoping to get surgical privlidge. I may agree to general practice, but cannot imagine DNP surgeons practicing by experience without undergoing the drilling and hardcore training it takes to become a good handed, well-rounded surgeon. Its a tough subject…
Actually, having taught at the university level, I have my doubts that a doctorate in nursing is a true doctorate, in any sense of the term. Essentially, a BS in nursing is no more academically than two associate level degrees strung together. How do I know? Well, where I attended university, based on my academic credentials, I could have matriculated in a nursing program directly out of 12th grade. There are community colleges that allow a qualified person to finish an RN directly out of HS in two years. I had classmates in HS who did just that. Every day, I see advertisements that state that a holder of an RN degree could earn a BSN in 12-18 mos. I have a coworker who is taking a one hour college course that is part of the nursing curriculum that is similar in scope and rigor to a course I took in 9th grade, called consumer business.
To cite another example, universities typically have several general chemistry courses. There is one for people who use chemistry to satisfy their general education science requirement. There is one for nursing and other medical paraprofessional curricula. There is one for premed students. There are several for those who are planning to major in chemistry–one for a basic chemistry major, one for a chemistry major with ACS accreditation, and there is an honors level course. (Of note, where I attended university, a student couldn’t graduate with high honors in chemistry unless they had taken the ACS curriculum). So, even at the most basic level, there is a vast difference in courses typically taken by premed vs nursing majors. I know. I taught the courses. At my university, there wasn’t a “premed” major; you could major in anything. In my medical school class, there were chemistry majors, biology majors, physics majors, a violin maker, a chemical engineer, pharmacist, respiratory therapists and even a nurse or two. There were prerequisite courses for applying to medical school, and no matter the major, these courses were needed for entry. I make a note that the prerequisite courses for medical school weren’t a part of the nursing curriculum at my university. Some were third or fourth year undergraduate courses that required a year or more of prerequisites. For example, biochemistry required taking general chemistry, a first year course, and organic chemistry, which has finishing general chemistry as a prerequisite. Likewise, the basic anatomy and physiology courses required the freshman biology series that biology majors would take (not the same course required of nursing students). I could go on and on. My point is, given my academic achievement prior to college, and considering that I had advanced placement in courses, I probably could easily have obtained a BSN within three years of graduating HS. But, the same advance placement would not even have placed my in the courses that were required for the chemistry major that I chose to pursue, which in turn was a prerequisite for applying to medical school.
Now, most NP’s that I know have MS degrees, that is, two years beyond a BSN. I don’t know about the doctorate, that’s not very common around here. I have already pointed out that in terms of academic rigor, a BSN is at the associates degree level (even though it may take 3-4 or more years to obtain), So, I estimate that, based on my knowledge and experience, that the NP degree isn’t at the MS level that a chemistry major, for example would be expected to attain. Might possibly be advanced undergraduate.
Now, not to be elitist about the situation, but, most people would acknowledge that a degree from the University of Chicago or Oxford or Stanford is more prestigious than one from the local community college. I am not sure that the University of Chicago even has a NP program, but, there is a medical school (so there could well be one there). But, I know the community colleges around here have NP programs.
Your comment does not make sense in many levels.
First, what does it even mean “I estimate that, based on my knowledge and experience, that the NP degree isn’t at the MS level that a chemistry major, for example would be expected to attain.” The level of hard science courses? You do realize that a NP draws from both medical and nursing philosophies, right?
A number of prestigious schools have nurse practitioner programs, just check around. Lastly, community colleges that offer NP programs? That one is kinda laughable!
I know quite a few nurses. They are great. They fulfill an absolutely vital role. But, as others pointed out, they are not doctors. Their level of understanding about disease pathology (the most important thing a doctor can know in my opinion, and most medical schools agree) is woefully lacking. I think this is what DIane is saying. Simply stringing together a few extra years of science classes (some you can even do completely online) does not even come close to the understanding that doctors require to make the right diagnosis and foresee the potential consequences. RNs can handle routine chronic disease management, but if you have a potentially life threatening complication they may very likely be unaware it is even there. Easy to say you know as much as a doctor when you don’t know what you don’t know.
I’ll mention the elephant in the room now, and the reason MDs are fearful and DNPs are defensive. I think a lot of NPs want to call themselves “doctor”, don the white coat, and actually try to pass themselves off as MDs. They want to hide in the ambiguity and lack of patient knowledge. When MD’s point out that this is false, DNPs are quick to fall back on the claim that they’re just trying to say they are DNPs. I think this is intentionally misleading patients for personal and financial reasons.
I understand the reaction from MDs and DOs, who shell out tons of money for medical school, slave away for 15 hours a day for four years, pass countless very difficult exams, are constantly feeling stupid and belittled, and then do 3-9 year residencies getting paid less than RNs before they can say “my name is X, I’ll be your doctor today”. It is precisely this long laborious routine which makes doctors trusted and respected, and precisely why others are erroneously trying to pass themselves off as such.
You are correct.
hasapoint,
All I can say to you is, I am greatful I work with an excellent organization that includes physicans, physician’s assistants, RNs, MAs, and yes–Sorry to break it to you–Nurse practitioners. I assume that most of these negative comments are coming from the east coast, or at least far away from the west coast, where the practice of health care is attempting to be more patient oriented than fixated on the status of the healthcare provider. I collaborate with MDs daily, who tend to correct me and ask if I might call them by their first name. By the way, when I walk in the room to meet a pt, I simply say “Hello, my name is ***, I am a nurse practitioner here at the clinic” I don’t specify my degree: MSN. And if they ask, I am more than happy to explain the meaning. I plan to pursue my DNP, But I am not planning on changing the way I greet pts. The “elephant in the room” is that believe it or not, nurses also relish education, and many of us opt to pursue it to the fullest. By the way, I find your tone regarding the intellect and importance of RNs incredibly insulting and alarming. I would guess that you or a loved one has never been hospitalized–Because the best doctors, (and nurse practitioners), depend on the excellent skills of the RNs who are monitoring the patients hourly…Maybe you have simply been watching too much Gray’s Anatomy–That will rot your brain. Here’s hoping that if you are ever hospitalized, you have the courage to let your nurse know that you won’t be requiring their services…..
Actually, per research, nursing is a more respected profession than medicine. I will always say
“I am your nurse practitioner” and forego the doctor part except academically.
Ok, a few points here. MD or DNP, patient care is most important while keeping patient oriented in mind. Many MDs are being taught how to be patient oriented in school, and it comes naturally for some. Being a nurse doesn’t mean your a better communicator than someone else. On the other note, patient care is in terms of diagnosis and treatment is by whole best provided by MD/DO’s in general. DNP have nowhere near the training for management or recognition and understanding of the pathophysiology in most cases. The sole purpose of NPs was to help fill in the gap for basic medicine (on a whole, not talking about the few DNP’s who memorize thick textbooks that MD’s study from), but not take the role of managing complex disease that MD’s and DO’s are trained for from day. We are training MD’s to do that not NP’s because a physician is the standard of medicine. Like my earlier statements, some DNP’s wont know their limits and patient care will be adversely affected. You may say the same thing about some MD’s, but they have proven themselves as the standard of care through the most difficult training and testing. Everyone can argue all of this, but MD’s/DO’s are the standard of medical care, and NP’s were meant to relieve them of basic stuff that was easily handled, so they could focus on the sicker patients.
I think for some, it may be true they (NP) may want to pass as a medical doctor; however I truly believe for the majority this isn’t the case. If you are a doctor and believe that a nurse went to nursing school as opposed to medical school because they ” couldn’t handle it or they aren’t smart enough” you are not only completely wrong but also incredibly arrogant. I did not go to nursing school for any of those reasons and am not pursuing my NP license for either of those reasons. Nursing is a completely different discipline then being a physician. You are damn right if I sacrifice my time, put my heart, soul and tears ( many of them) into EARNING my doctorate then I want the deserved title of Doctor.
Well said. I think that so many people are misguided on the fact that they feel that all nurses must have wanted to be MD’s but couldn’t hack it….but, that is rarely the case, nurses chose to be nurses because we believe in a different philosophy of care than the Medical establishment. I for one am proud to be an NP and know that I am delivering high quality care that is based on evidence and current literature. To believe that Nurses “weren’t smart enough to go to medical school” is really laughable
!!!
Does this seem doctorate worthy??
Conceptual Foundations of Nursing
Ethics for the Health Professions
Health Promotion and Epidemiologic Methods *
Scientific Writing *
Teaching in Nursing *
Interpreting Health Care Policy
Organization & Leadership Concepts in Health Care
Analytical Core for Evidence-Based Practice
Applied Informatics to Evaluate Health Care Outcomes
Evaluating Research Evidence for Health Care I *
Evaluating Research Evidence for Health Care II *
Seminar in Grantsmanship *
State of Nursing Science *
Advanced Practice Core
Advanced Clinical Practicum I *
Advanced Clinical Practicum II *
DNP Capstone Course I
DNP Capstone Course II *
I noticed that all you do is suspect, because you taught at a university level, what did you teach? I notice that it was not mentioned. First, you has high school students finish a RN program 2 years after high school. What kind of students were they? Did they do duel enrollment in high school? Next, where I live you have pre-reqs (at least 2 years) before even being looked at being excepted into an RN program. In addition, you have to take HESI test and score at least a 94.
Then if you are accepted to the program then you to a 2 1/2 yr program, full time plus clinicals in addition to class and lab time. Then at least 40 hours a week for study on top of that. Oh did I mention that an 80 is considered a “C:, and “A” is 96 or higher. Also, if your grade is a 79.99 you fail the course and the clinical. You fail again and you are kicked out of the program. When you finish the program, you may have a degree but cannot work until pass a state board and become licensed.
As for the BSN in 12-18 months, these are FULL TIME programs and most you have clinical hours again. Like the one, I attended. In addition, only Universities can teach at a MASTER or DOCOTARTE level.
First off, community colleges may have a certification program as some states offer. Oh why don’t you do some more research. There is a National Boards for NP to treat and diagnosis adults and/or children you have to licensed by a national board (this is national law).
Also “NP degree isn’t at the MS level that a chemistry major” comment. Switch it around a chemistry major at a MS level is not at the same level as an NP. Well duhh because these are two different fields.
As for a DNP being called a “doctor.” We know that we are not physicians, if we wanted to be a physician we could be come it. As nurses, we are taught, from the beginning to treat the patient not the disease or numbers as MD’s do. I think it is good for patients to know if their NP has a doctorate, this builds trust. Also, as medical profession if I do not understand something I ask. That is why we have specialists.
Sorry, you are so off!!!!! I don’t even know where to begin. Do your research and try again.
what on earth are you saying? my first impression is that you ought to review,then revise your post so that whatever you are trying to say at least takes SOME degree of sense. i hope that you are NOT a nurse.
the thrust, though, seems to be, naturally, that advanced practice nurses are bad, bad, bad.
a couple of points:
-an R.N. can get there in a number of ways and in a number of different academic settings. so what? while it is true that i’d rather have graduated from yale’s nursing programs than those of UMASS (still a well-respected program, though heavy on the “women as victim’s” schtick and seemingly an extension of a women’s studies’ program rather than a rigorous nursing program, i DID graduate with a B.S, R.N; to definitely be differentiated from a lesser B.S.N. degree. More hard science, less learning how to make beds.
-i also went there to BEGIN my master’s program to become a FNP, but finally got FED UP with the uber man-hating paradigm that the lesbian lovers who were in the top two posts within the nursing department continually forced to cross and be incorporated into any/all classrooms, so wanting to at least enjoy a YEAR or so of nursing i transferred to a non-traditinal academic setting to finish my degree, where, to my GREAT relief, this absurd, but totally allowed, even with complaints, man-hating/feminist framework of teaching nursing found at UMASS was just garbage, and learned that there ARE places where the teaching of nursing, at any level, is not 100% female oriented, but i still know of NO other profession that , in 2012 is STILL headed by nearly ALL overweight white females, and where there has been LITTLE to no outreach done to include male students or to even teach the ones in a MALE style of learning, who grit their teeth to go through the gauntlet of this highly sexist program to get his degree.
- so whatever YOU are saying, it makes NO sense, but the rigor and expectations that a master’s prepared FNP is put through, is, a few years down the road of practice, one which has prepared him to practice the art AND science of medicine, just as a physician PEER does. IF one gets there via a doctoral program, darn right they ought to be called doctor, just as, bizarrely, all psychologists seem to demand they be called “Dr.” frequently through any exchange.
now, if physicians have a beef with ANY group being called doctor, i would aim your ire at psychologists or chiropractors or any other group who isn’t doing PRECISELY what a physician does- read FNP, and at the SAME level after a few years of practice, unless, of course, the REAL issue is one of power and economics. me thinks thou dost protest too much!
our family had to put up with an inadequate NP for years b/c we had no choice.
We complained to no avail – where do we go and get some satisfaction?
Just like Mick Jagger…you can’t get no satisfaction.
Sounds like you need a doctor. What prevents you from seeing one? Insurance issues? Persistence is the key. Keep asking to see the physician. I think we have learned that just asking to see the “doctor” will not solve your problem.
ALI…what made your NP inadequate? was it just the fact that they had an NP behind their name?
She didn’t make notes when I visited and when I saw a doctor there was a lot of confusion. Plus when I had to see the NP she was vague and non-commital about treatments or medications.
Thank God, she’s gone now, I’m in Canada and she’s apparently moved to the US so she’s your problem now.
The sad argument of “pt well get confused if healthcare providers other than doctors use the title” First off if you have a Doctor of Medicine degree or Doctor of Osteopathic Medicine degree you are a physician… say it with me now a P-H-Y-S-I-C-I-A-I-N. The rights for you to call yourself “doctor” is the same reason anyone else can your academic achievement of a doctoral level degree. Maybe it would be easier if everyone that came in contact with the pt says there name and “title of position”. If you are a physician introduce yourself as such: Hi I am Dr. X, your physician. If you are a Nurse practitioner with a doctoral degree then you would say: Hi, I am Dr. X your Nurse practitioner… so forth and so on. You would think professional with doctoral degrees would find something more intellectual to have a debate about. I hope by the time I graduate medical school I hope my reasoning don’t degrade to foolish grammar school arguments.
This is a silly argument.
1) If you have a doctorate degree you have the right to call yourself and use the title “Dr” ANYWHERE. Period. Its an earned academic degree. Nothing more nothing less.
2) If you are a Physician you have a protected TITLE of PHYSICIAN. USE IT.
End of story.
“This is a silly argument.
1) If you have a doctorate degree you have the right to call yourself and use the title “Dr” ANYWHERE. Period. Its an earned academic degree. Nothing more nothing less.
2) If you are a Physician you have a protected TITLE of PHYSICIAN. USE IT.
End of story.”
No. What’s silly is when one shamelessly take short cuts with the goal of creating confusion for the unsuspecting public.
Doogie
There is no shortcut to getting a DOCTORATE degree Mr. Hubris. You either have one or you do not.
As for creating confusion, show me ONE example of where that has happened. It does not. APNs are not interested in being PHYSICIANS but they certainly deserve the title of the academic rank they achieved. All badges in hospitals have to be identifying. If it says Dr. Bob Nurse Practitioner then CLEARLY there is no confusion. Most say “PHYSICIAN”, “Nurse Practitioner”, “RN” etc at the bottom, seems very clear.
The only thing you are protesting about is your bruised ego.
So, how long has the DNP degree existed? It is apparently equivalent to an MD or a PhD. Tell us about your degree plan. How long and at what financial cost to you. How much was on line? How many times were you required to be physically on campus? What was your “big research project” that made this on line degree worthy of being called a doctoral level degree?
These degrees are expensive and are part of the big hoax being perpetrated on so many levels. This is a boon for nursing schools because they can do it all on line and have minimal overhead expenses and still charge maximal tuition because they have the promise of being able to be called doctor. Nurses see it and are immediately drawn in. They believe the hype and believe that their training is equivalent to the “stupid” doctors that have treated them so poorly in the past. So they pay these steep tuition fees and enroll and after a year and a half of nursing philosophy/history/policy courses, they have a degree that tells them that they are a doctor. They have put forth minimal effort to achieve it and it is minimally disruptive in their lives but yet they believe the militant nursing leadership like the AANA who tell them that they are now just as well trained as their physician counterparts. It is a minor issue now, but as soon as the requirement for all NP’s and CRNA’s to get a DNP goes into effect, there will be a huge new crop of nurse doctors roaming the halls of our medical centers introducing themselves as Dr Keischa and Dr CRNA. The patients will hear doctor and assume they are physicians and they will do nothing to clarify, because that is what they want them to think. It already happens today. It will be 100 fold worse in 5 years.
Then they will throw terms like hubris to describe anyone who questions their training and paint them as obstructionists to patients getting good and equal care by those who care for the whole patient. Physicians are bad and nurses are good, right?
CRNA’s already call their CRNA school “residency and refer to themselves as SRNA residents.
People may get the wrong impression and think that I do not like or respect nurses. That is completely incorrect. What I dislike is when a group deliberately obfuscates their level of training in order to appear to be something they are not. We should all eschew obfuscation and I am trying to let any lay person who reads this know the truth about what is occurring. I know that I will not change the mind of Keischa as she suffers through her one day a week dual advanced degree program to become a Doctor and a CEO candidate all in one fell swoop all while working full time at a good paying job while physicians are toiling at 80 hours a week for many years and accumulating $200K+ in debt for the right to be called doctor in a clinical setting.
Militant nursing leadership seems to believe that if you repeat a lie enough times, it will suddenly become true. So far, they are having their way with the general public and physicians are helping train them. So, it seems they might be right. I just think it is time to stand up and reveal what is really going on behind the scenes with this power grab and this obfuscation of the truth.
I would never expect Keischa or the CRNA to agree with me because they have been indoctrinated to believe what they are told and what they wish to believe. And why wouldn’t they. They have spent a great deal of money to line the pockets of the nursing schools who are pulling off this money and power grab. It pains me, because the university I hold dear to my heart is one of the worst offenders in the whole scam. But the almighty dollar speaks very loudly at the universities. If an entire profession is suddenly willing to pay you exorbitant amounts of money for a degree that was “invented” just a few years ago, who am I to cast stones at them for accepting this free money for a boon of an on-line course with little overhead?
Militant nursing leadership just invented a degree just like L. Ron Hubbard invented a religion. Nursing schools stand to make a lot of money off of this by requiring all nurse practitioners/CRNA’s to get a DNP. Just like in scientology, follow the money trail and examine things a bit closer. I have outlined most of the details for any lay person interested in learning the scam being perpetrated. I have detailed curricula from a few programs and shown the type of classes they classify as doctoral level as well as shown the motivation, the money trail, and the attempt to mislead by nursing leaders. If, after reading this and doing your own investigation of the facts, you still believe the tripe that Keischa and CRNA (and many others) are passing off as truth, then you probably deserve to have the wool pulled over your eyes.
It is disconcerting to say the least.
Well said, and dead on.
Prove anything you just said here.
Oh that is right, you cant.
This is protectionism and trade restriction plain and simple. Dont pretend you give a crap about patient safety or anything else. It is about money and ego for YOU.
Here are some great truths
DNPs wont make more money for doing it, they further their education at NO BENEFIT and only a cost to them. Why? because they want to. That is it.
Dont talk crap about another doctorate when you get your CLINICAL DOCTORATE in 2 years. It takes the same amount of time. Also, keep the ‘internet crap’ off the argument. As you should be well aware the vast majority of medical schools provide all lecture material online and few actually attend lectures. This isnt a secret.
The DNP is just a new reiteration of what RNs have been doing for over 5 decades. DNsC and PhD have existed forever and both are doctorates that RNs have had forever. The DNP is just the evolution of clinical doctorate in nursing.
All DNP doctorate degrees are measured in the same way that all legitimate degrees are, by the CHEA and the U.S. Department of Education. They arent a ‘hoax’ bud.
Your assumption that people will not clarify their degree (and badges wont be clear) is propaganda. Where is the evidence for this? nada.
So lets get right to it. None of the evidence shows any difference in care by APNs of any ilk and their physician counterparts. This upsets you i know. However your groups cannot, in over 100 years of trying, come up with any evidence to the contrary. This isnt about who gets to use the term ‘Dr” on their name badge, cause anyone who earns it should get to do that. It is about your bruised ego.
Use the term you EARNED and that is PHYSICIAN to separate yourself.
The “real” studies that need to be done to show the difference will never be done because they are not ethical. No IRB would approve the studies and they shouldn’t because it would lead to patient harm. Any patient with any sense would not enroll in the study. The studies that you use to prop up your arguments pit APN’s against physicians for routine health maintenance things where APN’s show that they can use a checklist and a protocol just as effectively as a physician for basic and routine issues such as HgbA1C checks, immunization monitoring etc. That does not effectively separate the extensive knowledge gap that exists in the training to show the difference. In the case of CRNA’s, the landmark study that was funded by the AANA compares CRNA’s taking care of routine ASA 1 & 2 patients to physician taking care of all comers including the complex patients not in the CRNA sample (ASA 3 & 4) patients. The fact that the outcomes were equal for this vastly different patient population is telling. The CRNA’s had equal mortality taking care of healthy patients to the physician led group taking care of patients with advanced illness. And this is the study that you use to prop up your belief system. Why wouldn’t you? The government can’t tell the difference and doesn’t even bother to look at the fact that group paying for the research study is the same group that would benefit the most from getting certain results (the AANA). Did they teach you about conflict of interest and ethical studies in your DNP class on research?
List for me one distance learning medical school program and I will concede that one to you. While it may be true that not every lecture is required attendance, these are not online classes and the majority of the process is interactive small groups with teaching physicians, lab work with much one on one teaching, and countless hours of clinical training. You cannot get an MD from distance learning. I think you have been misled in your assessment. Perhaps the AANA “talking points” are not serving you well.
Your point about DNsC and PhD’s earned by nurses in the past is interesting. I am aware of a handful of those who I have worked with clinically. They are a rare bird, because they are degrees that actually meant something and took time, commitment and hard work to achieve. The general public generally expects that if you have achieved a PhD in something, that you have put in years of work and done a thesis, research, and defended that in front of a panel of your peers. Overall, this is a grueling process. The DNP degree which nursing has migrated to has dumbed down the process and it is now required that all ANP’s and CRNA’s who graduate from their programs must achieve the terminal degree of DNP. They have dumbed it down to the lowest common denominator and cheapened the experience for those who actually put in the work to get their PhD’s. As I have shown in other posts, the so called doctoral level degree is nothing more than on line nursing philosophy/history/ethics/business classes and provide no additional clinical expertise.
The difference between the training of nurses and the training of physicians comes down to this:
Nurses training consists of teaching nurses to carry out a plan prescribed by a physician. Their “years” of ICU experience consists of the daily carrying out of plans dictated by physicians. They are not asked to come up with the plans or ask why physicians have specific plans for patients. They carry out orders. They then take APN/CRNA classes where they continue to learn to carry out the plans of physicians. They then take some on line feel good nursing busy work classes that they have been led to believe constitute a “grueling” curriculum. Then they are ready to practice on their own and be called doctor because they have “earned” it. All along the way, there has been no weed out process to separate the top students from the bottom. Everyone willing to pay the tuition moves through the process.
Contrast that with medical students. They enroll in the pre med program with all of the other top students from their high school who think they want to be a doctor. They take the honors high level science courses which weed out 90% who thought they wanted to be a doctor but are out because they can’t make A’s in Honors Biology (not the watered down biology for non science majors that nursing programs require), Honors Chem, Genetics, BioChem, Organic Chem, Qualitative analysis, Microbiology, Anatomy and Physiology (not the watered down version). They make it through that and then many more are weeded out by the MCAT. The select few who actually make it into med school are then worked like dogs for three years (the fourth year is admittedly somewhat easier) and then have to apply for residency. During this time, they are further weeded out by the USMLE exams step I & II. You cannot progress if you do not pass and many do not. The most competitive residency fields only take the top students. Then they are subjected to an intern year of long hours and a steep learning curve. All along the way, they are learning how to be doctors and how to make the treatment plans to be carried out. They are not simply carrying out orders blindly. They are learning the hows and whys. Then residency comes and the training becomes even more rigorous as they hone their skills for 3-8 more years. They are becoming the decision makers and gaining additional autonomy to work without supervision. Then, they take step III of the USMLE and apply for fellowships for an additional 1-3 years of training. Many of their years of training are spent gaining autonomy for independent practice. That is not taken lightly.
Only then can they practice independently (12-17 years later). And they have faced a weed out process at each level. Nurses pay tuition and take their courses and rotate through their clinicals learning to give the pills the doctor prescribed and that the pharmacist put in the slot on their pyxis. The entire process does not require independent thought. It is a series of checklists, so it is not surprising they are good at following checklist protocols.
With regards to doing things outside of their scope of practice, nurses (especially CRNA’s) have no problem stepping up to attempt new procedures with no training and no real regard for the patient. They are happy to portray themselves as pain practitioners, transesophageal echocardiographers etc despite having no training on the diagnosis of chronic pain problems or in the interpretation of radiographic studies or echocardiography. They just see an opportunity and they pounce on it with full approval of their nursing licensure boards and their nursing leadership. They all in fact lobby for this, not for their best and brightest, but for ALL of their populace from the best trained to the worst trained.
Physicians, however, have more training in both cardiology and radiology and pain management. They, however, do not practice in those areas unless they have subspecialty training in those areas. A general internist has tremendously more training in cardiology and have probably even performed some TEE’s under the guidance of a faculty on their cardiology rotation. Would they ever consider performing a TEE on their own? Never! Because it is too dangerous if you do not have the expertise. Misinterpretation of the findings can lead to the wrong treatment. Improper technique can lead to misleading images. Poor technique can lead to lethal complications such as esophageal perforation. Failure to recognize this usually results in a slow and painful death from an infectious process. In addition, our medical boards actually discourage us from performing procedures outside the scope of our expertise. We can actually lose our license for doing it. Meanwhile, our nursing colleagues are advocating that they should have unrestricted rights to perform all of these dangerous procedures without supervisory oversight. And yet, the nurses are painted as the patient advocates while militant nursing organizations try to minimize and demonize physicians just as you have seen on this forum.
So, in closing, I think I have shown the vast difference between training to be a nurse and training to be a physician. The nursing organizations, however, believe that at the end of each field’s training, that we are all equivalent and should all just be regarded by the government and the public as equal and interchangeable. I and other physicians disagree with their assessment and I hope that the public will learn the difference before it is too late. We are nearing the rubicon.
“DNPs wont make more money for doing it, they further their education at NO BENEFIT and only a cost to them. Why? because they want to. That is it.”
Did you not get the memo. Your nursing leadership has required it for all APN’s and CRNA’s now. It is not because they want to, it is that they will now be required to. As I said, they have a degree that will cater to the lowest common denominator so that all can achieve it. There is an agenda here and I am sorry that you have not been let in the loop. If you paid attention to what your leaders are doing, you would know. Expansion of NP and CRNA schools without any oversight. Any nurse under 40 who is not in an advanced program should probably have their pulse checked, because everyone is doing it on their off time, online.
What do you predict will happen when all of these schools maximize their enrollment and have suddenly churned out NP’s and CRNA’s that can no longer get jobs but have spent a small fortune in tuition for their on line DNP’s? Salaries will go down because of supply and demand and interest in this will decrease. The return on investment for these on line degrees will fall greatly and many who got into the game too late will look like suckers, having lined the pockets of the nursing school administrators and the nursing organizations such as the AANA. It will be too late once they realized that their so-called leaders have sold them down the river by cheapening the degree and allowing anyone who wants one to become a doctor with no sacrifice and no quality control. The schools will continue to farm out their students to anyone who will train them and they will continue to get a huge variation in the quality of training that they receive. These diploma mills will eventually be shown for what they are. I fear that, for the medical community, the realization may come too late.
I have some off time and some time to kill so thanks for allowing me to counter your deceptions with the facts. It has certainly been a nice avenue to pass a little time. I usually choose sports forums in my off time, but this has been a nice discourse and much easier arguments to win than the highly subjective sports arguments. These are easy to win because the facts are readily available to whoever wishes to look for them. I have made it easy for the lay person to learn the real truths behind all of the obfuscation. Sorry if blew your cover
Cheers!
You people are all rediculous! Get over it, just as many M.D.s have. I work as a CNP for one of the best groups of doctors at the Cleveland Clinic Foundation. They treat me like a professional and know that I take great care of their patients. Never once have I been called Dr. And not corrected the person who called me by the incorrect title. Get over yourself and realize that by the use of midlevels and physicians care to the patient is better!
wow, thank you for this information, I will look this up more (and go through the program requirments for these doctor nurse degrees). scarry, I think I’ll ask if they are a pysician or a nurse next time I hear “Dr” and I’m not sure. & btw, I’ve had horrible experiances with NPs (the one’s where my children go)… they were arrogant, pushy, and missed a diagnosis on my daughter twice (she suffered 3 months before I called up and told them I’m not seeing that nurse this time, even though I had been asking for the doctor each time before).
Good luck with your daughter. Navigating a complex medical system can be challenging, even without people trying to deceive the public.
Mr. Gern…you need to calm down
Thanks. You can just call me Gern if you wish. No need to be so formal here. I will certainly take your advice into consideration. As I said, I am actually off for a bit and had some time to kill. I am as cool as cucumber. I just checked my pulse and it is A-OK. I am actually enjoying giving the non medical persons a bit of a “peak behind the curtain,” to reference the Wizard of Oz a bit. It is actually kind of therapeutic.
Cheers!
It is absolutely ridiculous how adamant some people get at this whole “Dr. Nurse” thing. There is a lot of misinformation going on (and it’s not coming from the AACN or any other nursing organization). First, the 2015 DNP proposal for Nurse Practitioners is only a proposal. There is no requirement in any state legislature for a Doctoral prepared Nurse Practitioner. Come 2015 and beyond there will still be many Masters level prepared Nurse Practitioners and many schools will still offer the masters level programs. Second, Nurse Practitioners are NOT Physicians and they will be the first to admit it. They can and do perform to the full scope of their training and education and are perfectly safe within their knowledge base.
“while physicians are toiling at 80 hours a week for many years and accumulating $200K+ in debt for the right to be called doctor in a clinical setting”….
Is this why you went to medical school? Seems like a silly reason to “toil” if all you wanted was a title…. and you say DNPs are the ones so greedy to use this title. I am in a DNP program to advance my education and be able to be of greater service to my patients. Do you have a brilliant idea to provide patients greater access to primary care providers? Because it seems “physicians” love to specialize cause thats where the money is right?
Lastly I have saved many a physicians ass in the ICU by NOT following their orders and catching their mistakes. We need to work as a TEAM to provide the best care to our patients.
Absolutely not. They wouldnt dare demand a physician address them as such, so whats the point?
Worse yet, they demand the patient call them that and deliberately fail to let them know they are a nurse doctor. It happens frequently. There is legislation out there in some areas that prohibit it through truth and transparency rules.
This is so laughable. I am not trying to go to War with you Gern, all I am trying to say is that you have spent a lot of time on this blog trying to tear down NP’s and it seems as though you have nothing better to do. I am enrolled in a dual degree program and it is grueling, but did it ever occur to you that maybe its possible for someone to be able to handle the workload because they are a good student? All I am saying is that what is the point of you going on and on and on and on about this? I really think that you are making a big deal out of something that you are taking way out in right field somewhere. Honestly, I can only speak for me personally but I don’t want to be a physician and enjoy being an NP all I want is the highest degree I can obtain in Nursing. Nursing is a valuable profession in health care and physicians like you who don’t seem to realize that is what is very disheartening. We are not trying ( I am not trying to steal your thunder-contrary to what I guess you believe) to take over medicine-that would be impossible! we need physicians and physicians need us….we can’t exist without one another and no matter how you look at it or whether or not you like it-we are going to have to coexist in the same shared space. Not all Nurses are like the ones you seem to have encountered or are like the ones you describe in your long monologues about physician superiority. I just get frustrated when some physicians can’t seem to accept the fact that Nurses are intelligent too and we have a lot to add to the way in which we are all able to give care to the people of our communities. We are not physicians but we do offer patients a viable option for their healthcare problems for what we are trained to do and to say that we don’t understand the science behind what it is that we are doing is false. All this is just continued Bullying by the Medical profession as they have done to other disciplines in the past because it is suffering from a superiority complex. I am not disagreeing with the fact that physicians are intelligent, and they are certainly not going to be replaced by DNP’s, I am not even saying that the DNP and the MD is equivalent (it can’t be because we are two different disciplines with a different perspective and approach towards the caring of patients. We are apples and oranges!). But- it is the constant belief and blasphemous statements about nurses and the fact that we are somehow less than you because you went to school longer for a different degree in a different discipline is ridiculous. look around, we are the two most important people on the patients side and we are bickering about a title that is unowned by the discipline of Medicine. Patients are not going to be confused, they just want good health care and health care that is well managed with appropriate referral to the necessary healthcare professional when needed. so have fun, battling everyone on this online blog about something that really shouldn’t matter to you at all-as long as you are the REAL DOCTOR you can always say that those who are not MDs are less than you! (intentonal sarcasm). Congratulations, I hope that you have many more years of bullying in your future-You’re pretty good at it!
If all you got from Gern’s post was “physician bullying and superiority complex”, you completely missed the point. Entirely.
As I have stated, I greatly appreciate nurses of all types (LVN’s, RN’s, NP’s, CRNA’s). They do a great job. What I don’t like is when nurses practice deception and chicanery to paint themselves as doctors in a clinical setting. It is intentional deception of the patients and their families. I have no intention to bully anyone. I am simply addressing each lie that I encounter and spreading the truth about what all of these advanced degrees really consist of. I am sorry if it offends you that I have revealed the disconnect that you seemed to not even notice. You provided me with the ammunition. In one sentence you went on about how grueling your path was because you were taking a dual degree for DNP and MBA at the same time as working full time as a nurse. I guess you had not realized the thing that is obvious to anyone else. If you go to school one day a week and your reward is an MBA and a so-called doctoral degree (DNP) all while keeping your same job that pays darn well, the course load is not grueling. It just isn’t.
I see it is Monday, your one “grueling” day of school for the week. Did school get out early?
“It is intentional deception of the patients and their families. ”
No one is deceiving anyone. Prove this statement.
A Dr is someone who earned a DOCTORATE. A physician is someone who earned an MD/DO. Seems pretty simple to me.
When a patient goes to the hospital and meets a doctor, they expect they are speaking to a physician. When a nurse who has earned a faux doctorate introduces themselves as “doctor” in a clinical setting (probably while wearing a long white coat), it will be the rare patient that thinks they are speaking to a nurse who happened to earn a degree that required a year and a half of on line classes.
If you put a white coat on a History PhD and sent him in to see a patient and he introduced himself as doctor, would you be okay with that? If you were the patient, would you be okay with that? If you want your friends at a social setting to refer to you as doctor, I have no issues with that. But in a clinical setting, the patients expect the doctors will be physicians. The nursing profession is trying to change the rules and act as if it is not a big deal.To the patients, it is a big deal because it is deception.
I have already explained the truth about the DNP degree in other posts. Nursing history/business/philosophy/ethics classes do not confer additional clinical knowledge or skills. They are nice for discussion around the water cooler, but they offer nothing additional for patient care and the degree was invented a few years ago with the main intent to be direct competition with physicians. Your AANA is direct proof of that as your militant leaders lobby for the right to interpret TEE’s and radiographic studies and the right to diagnose and treat chronic pain problems. All of this despite the fact that your training does not qualify you to do any of these things. Nurse practitioners all over the US are trying to advance their training into subspecialty areas such as dermatology, critical care etc, all with completely altruistic intent I am sure. Your nursing leaders have no problem throwing anything they can up against the wall to see what sticks and where else they can “creep” into to try and claim equality with physicians.
As far as “proving” this as you requested. The proof is in the daily lives of those out there who are currently misleading patients and the fresh crop who have posted on here that when they get their DNP’s, they are “darn sure” going to introduce themselves as doctor, because they darn well earned it. I very meticulously outlined the path they took to “earn” it. Described by some as grueling, I think I have effectively disproved that. Apparently, the ones that are not completely on line are one day per week, and as a bonus, you get a complimentary MBA degree to hang beside your doctoral degree. I have yet to hear anyone of these “doctoral candidates” that have effectively defended the rigor of the program. Each time someone tries to, they end up proving my argument even further than I could have myself.
So, enlighten me please.
the mba degree is not a requirement it is a choice. it is not tied at all to my DNP. in fact I got a scholarship to take the intensive training through the college of medicine. sponsored by the college of medicine and It was a initial cohort to promote interdisciplinary education. there were also pharmacy, physical therapy and public health students and med students. if they are so busy they sure had enough time to dedicate to the 16 credit, 8 week, 6 hour a day classes with no interference with their med school classes. in fact the medical students were pleasant and i enjoyed speaking and interacting with them. the DNP classes are one day a week because most of us have to work!! pretty self explanatory. just because the classes are one day a week doesn’t mean there is no rigor. Nursing school is not med school. you keep arguing points that can not be compared. medicine is not nursing and nursing is not medicine.
Your wrong. Most average folk like me think when someone says doctor in the hospital or clinic they are saying they are an MD or DO since these titles have been calling themselves that since day 1. If i went to see a doc and found out it was an NP without disclosing it I would be fumed.
I think it’s fine that loathe nurses–Gern, just say it and be proud. Afterall, you speak of history and tradition, and doctors’ loathing nurses has a long, proud tradition, unfortunately–studies also correlate this attitude and the associated behaviors with bad patient outcomes.
Mel,
I absolutely do not “loathe” nurses and I daily treat them with the utmost respect. I loathe the deception pushed by nursing leadership in the political arena.
I like all of your titles after your name. Pretty cool.
I have not even started the MBA program in its entirety. I just finished a 8 week 16 credit intensive to get the first 16 credits toward my MBA this summer, finishing in july. I did not work during those 8 weeks and took no nursing courses. It is possible to take a couple of credits here and there in the nursing program and manage those credits and the associated workload while you work, doesn’t mean that it is not rigorous enough. I still can’t figure out why you are spending so much time beating up the point about the DNP degree and trickery and deception of the public when you clearly introduce yourself as a nurse practitioner when seeing patients. I did not only get bullying and arrogance out of your message but no matter how you dress up the words that you write that is how it comes across and that is what it is. I am done with this conversation, i have no more time to waste on this silly conversation. good luck to you all, I hope that you dedicate more time to seeing and caring for patients and spend less time arguing about this nonsense.
i can’t start the MBA courses because they are not feasible for me to take my nursing classes at the same time because it would be alot of work while working full time. so i am finishing the DNP and then next may I will complete the remaining 16 credits for the MBA.
You have been a worthy adversary. Good luck in your studies. We all play within the guidelines we are allowed to. I just disagree with the nursing boards and nursing leaders on this one. I am sorry if I offended you. I may have come across harshly, but I still hold to all of my comments as true and factual. That certainly does not mean I don’t have a great deal of respect for my nursing colleagues.
While nurse practitioners say they’re practicing nursing, not medicine, I’ve never heard an explanation of how the two differ. Are you not assessing, diagnosing, and treating the patient? Aren’t you prescribing medicine? As far as I can tell, it’s just a way to dodge falling under the authority of the board of medicine so they can set their own standards.
Every nurse practitioner student I’ve known has worked full-time during their studies, and received their degree in three years. They talk about how difficult this is, and I believe them. I didn’t even quite work full-time as an undergraduate, so I can only imagine how challenging this would be. However, the ability to do this highlights that the rigors of a nurse practitioner school aren’t nearly in line with those of medical school. I’m beginning my second year as a medical student, and though I know my classmates fairly well, I can’t think of more than one or two who are working, and they aren’t doing it for more than a few hours a week. To do more verges on an impossibility. I’d describe many of my classmates as brilliant, and yet there are many of us who would describe studying for 60 hours in a week as “light.” I think it’s fair to assume that the nurse practitioner students who are working full time and completing their degree in less time than it will take me to get through medical school aren’t studying 60 hours a week after getting home from work. So, while the NP student may be working very hard during the years they pursue their degree, much of this effort is doing nursing tasks that have little bearing on their competence as an NP, and thus aren’t of educational value.
Medical students, however, are spending all those hours for all four years learning about medicine. They then go on to do a minimum of three years of residency and spend a considerable number of hours working closely with an experienced physician to learn how to apply all those years of education to actually care for the patient. They will spend more time in residency than the nurse practitioner spends in their DNP program.
As a future physician, I ask that anyone that would like to share the title “Doctor” with me in the hospital setting has had an equivalent amount of expertise in their field. Anything less does a disservice the the patient. I can’t count how many times I’ve seen a nurse or even a tech get called “doctor” with no correction by the staff member. If the patient can’t tell these people aren’t physicians, how do you expect they’ll be able to discern the differences between the nurse practitioner, who is wearing a white coat, prescribing treatment, and now even calling him or herself “Doctor,” and the physician, who they’ve learned to associate the term with when they’re in a healthcare setting?
I’ve worked with plenty of nurse practitioners, and respect the group as a whole. But since there isn’t parity between their educational level and that of physicians, there shouldn’t be parity in their titles.
Jake
With all due respect, there isnt parity in the titles. An MD/DO has the title of physician specifically and legally for them only. Anyone who obtains a doctorate of anykind officially and legally is entitled to use the title “Doctor”.
As for working in school, while some programs may be light enough to do this mine was certainly not. On average I was either in the OR or Class for between 70-90 hours a week. I was the first to arrive and the last to leave. I was not working at all on the side.
I too could tell stories about med students working, not attending class and just getting the lecture material online then taking exams… however, it would be pretty disingenuous of me to paint all med students with this brush, right?
You cannot make broad and general statements and assume they are true. Additionally, regardless of what anyone thinks “happens” in the hospital that does not change the legal right to an earned title. Plus, the reality is everyone will have a very descriptive name badge and be required to self identify as well.
This is more about ego and hubris than it is anything else. While I know that isnt you (based on your statement) it often is for others.
Correct me if I’m wrong, but you were in a CRNA program, not DNP, so the difficulty of your program doesn’t play into the current conversation. But I’m not sure: have CRNAs been lumped into the plan to require advanced practice nurses to have a doctorate?
True, I can’t claim all nurse practictioner students work, just like you can’t say the same for medical students. But would disagree that more NP students are working during their degree program than medical students? Or that there’s more variability in the content of NP courses compared to medical school courses? Or that four years of medical school are more rigorous than three years from BSN to DNP? I don’t have citations to pull out to back these things up, but I don’t think they’re unreasonable statements. And there’s no problem with them, until we begin putting the DNP on the same level as the MD or DO.
Descriptive name badges are issued to everyone, but how many patients are scrutinizing them? Clearly not the ones addressing the clearly labeled “tech” as “doctor.” And that’s not even considering the frequency with which physicians and midlevels choose not to wear their name badges in many hospitals. They’ll still self identify, but when the NP is introducing his/herself as doctor, it’s meaningless, since they’ll assume that the doctor is a physician.
I have classmates who hold PhDs. Would it be appropriate for them to introduce themselves to patients as “doctor” during clinical rotations? Or what if a history professor made a career change and was working as an RN. Can he call himself “doctor” while in the hospital? He earned the title, but it’s unnecessarily confusing in a clinical setting.
Take a look over Duke and the University of Pittsburgh’s (which can be taken online) MSN to DNP programs:
http://nursing.duke.edu/sites/default/files/academics/matplans/sample-dnp-mat-plan-postmsn-2010-duson1.pdf
http://www.online.pitt.edu/nursing/DNPFamilyNursePractitioner.php
How many of these courses will change the care delivered by a DNP compared to those of a master’s prepared NP? Maybe the 6 credits of Duke’s “Evidence Based Practice” courses, or the 10 credits of “Introduction to Genetics and Molecular Therapeutics,” “Diagnosis & Management of Psychiatric Conditions in Primary Care,” and “Clinical Diagnostics” offered at Pitt? The rest looks suspiciously like fluff and business courses that won’t impact patient care. And these are two elite universities. I’d hate to think about what no-name schools are putting together into an online program.
Do these things deserve use of the title “Doctor,” as well as spending another year in time and tuition, and contribute to better treatment of the patient? Call me cynical, but I’m of the mind that their primary value is in degree creep that can be leveraged politically for higher pay and an expanded scope of practice.
Jake you are incorrect. CRNAs are considered APN’s and all APNS are required to have a DNP. you are saying that business courses won’t impact patient care but that proves to be your ignorance. the reason for the business courses are because many healthcare professionals don’t have the business fundamentals needed to successfully run a business much less a healthcare organization. Business courses help to prepare the NP to not only understand the business of healthcare but the knowledge to use it to affect patient care. with the new health care system focusing on medical homes and ACO’s to cut health care costs and other associated expenditures it has become increasingly evident that we are in need of practitioners that are able to understand the financial implications behind the way in which they manage their patients care. so as you sit and scrutinize our education we NPs are going to benefit from these business courses while you will graduate with a prestigious medical degree and be completely ill equipped to be in a leadership position where you make crucial financial decisions for an organization. as i stated on here before, the trend (in case you didn’t know) while you were busy with apparently all of your more important med school classes is to train doctorally prepared health care professionals to get MBA’s to lead healthcare organizations to make them better practice owners and to get the healthcare system out from under the control of politicians and third party payors who have no real medical or nursing knowledge. I recently attended a business of medicine bootcamp where i completed 16 credits over the summer semester for 6 hours a day 5 days a week for 8 weeks on the fundamentals of business. Wow! did it open my eyes to the things we don’t know about how healthcare is managed. I also had to take a business practice management course as a part of My DNP program which was taught by a DNP prepared ARNP who is the clinical director for a large Federally qualified health center in Sarasota and guest lecturers from other major health care organizations in Florida. It would benefit you to get in line with this new trend and not dis it on blogs when you have no real knowledge of what these courses entail. with healthcare moving towards reimbursement based on quality of care given and meeting benchmarks, and patients being able to pick providers based on publicly disclosed “report cards” you need to know what it is your facing when you become a provider. This is what my DNP education is preparing me for. If your not getting this type of education then you will be at a disadvantage. by the way, this bootcamp I attended was sponsored by the College of Medicine and College of Business to train health care professionals in business practices. there were 9 med students, 3 PT, 4 pharm D students, 2 DNP students and 3 Public health students. I realize that I must go on to complete the MBA, which I will. however, you should take a lesson and stop reading things at face value and look at the bigger implications of our curriculums. we are learning to be well rounded as DNP prepared nurses. I bet your med school education isn’t teaching you that.
to jake,
also i would just like to point out the fact that the evidence based practice courses are important because they teach clinicians to be able to critically appraise the research evidence and apply to your clinical setting. determining and calculating statistical significance and understanding, numbers needed to treat and harm patients based on statistical evaluations given in research articles. Evidence based practice is obviously important as this is what we base our clinical decisions on. if you are unable to critically appraise the evidence from who wrote the article to where it was written and what journal and look at the statistical analysis of what you read and be able to interpret it you will have a difficult time justifying your clinical decisions with solid evidenced based literature. which clearly you don’t have since you couldn’t cite evidence for the statement you made above.
We take courses on all these things too, in about equal measure with what you seem to be doing as DNP students. But as I said in my post to your first reply, they don’t stand out quite as much since they’re mixed with approximately twice as many credits per year. Most of the students in my class took many of these things as undergraduates as well.
I wasn’t aware that I need to cite every statement I made in the comments section of a blog. I assure you I’m capable of working with evidence based literature. I’ll actually be submitting an article for publication as the primary author next month (on management, coincidentally). Wish me luck!
Medical schools have increasingly recognized the importance of giving their graduates some level of business training. We have a course on either healthcare management, insurance, or law every semester. You don’t need anything approaching an MBA to be an effective clinician. If I were interested in become a CEO, I’d have applied to MD/MBA programs, or would pursue an MBA after completing residency. But at this stage, I’m primarily interested in being an expert at treating patients, and having 10% of my coursework tied up in business (as is roughly the case with Duke and Pitt’s DNP bridge) isn’t consistent with that goal. They’re taking fewer credits to begin with, and a larger percentage are dedicated to things other than anatomy, physiology, pathology, and other medical sciences (“Effective leadership” – 3 credits out of 35?!)
When someone is called “doctor,” you assume they’re a specialist in their field. I see very little specialization in nursing (and I’ve still not received an answer about how it’s “nursing” when a DNP prescribes a statin, but it’s “medicine” when a physician does it, and so they’re governed by two different boards, but that’s a digression) by taking business and leadership courses. Ever heard the saying, “Jack of all trades, master of none?” It’s great to be well versed in a variety of things, but it seems highly questionable to call yourself an expert when you’re tossing in all these other disciplines into a program that’s thin on credits to begin with.
As a side note, I spent the summer in a program at a local hospital where my main project was instituting a new management system in one of their departments. Of all the executives who were nurses, all had MBAs in addition to their MSNs. No DNPs, however, so I’d be careful about tooting your horn about how well your normal curriculum prepares you to be an upper management. The physician executives, however, seemed to get by just fine with their MDs, and I don’t think I saw a single MBA on their name badges. Interesting.
But in case you were wondering, we have statistics and ethics courses too, as well as those management and business courses. They’re approaching the number of credits of those kinds of courses in those bridge programs. The difference is that our first year of medical school had over 60 credits total to ensure that we’re qualified to care for patients, not 35 like they’re doing to be a “doctor” at Duke.
Hey Jake
I am only going to address a couple of things in your post that you asked.
“When someone is called “doctor,” you assume they’re a specialist in their field. I see very little specialization in nursing ”
You are called doctor the day you finish medical school yet have no specialization. This is true of all clinical doctorates. Only PhDs are required to have a narrow focus for their research doctorate and only they are considered true experts in their perspective fields.
“and I’ve still not received an answer about how it’s “nursing” when a DNP prescribes a statin, but it’s “medicine” when a physician does it, and so they’re governed by two different boards”
That is because they are different professions. The medical board governs physicians not nurses and it does not matter how much overlap there is in role, that is the way it works. Under US law, anesthesia is both the practice of medicine and nursing. Frank v. South, Chalmers-Francis v. Nelson and other court decisions determined that anesthesia was the practice of Nursing as well as Medicine. As such, the practice of anesthesia in the US may be delivered by either a Nurse Anesthetist or an Anesthesiologist. The decisions have not been challenged since the Dagmar Nelson case.
Just as Chiros are not controlled by DOs, and OT/PT isnt controlled by either this is the case with all professions. The idea that a physician lobby should control their competitions ability to compete would be a violation of the sherman antitrust act of 1890.
“Ever heard the saying, “Jack of all trades, master of none?” It’s great to be well versed in a variety of things, but it seems highly questionable to call yourself an expert when you’re tossing in all these other disciplines into a program that’s thin on credits to begin with.”
You just said yourself in medical school you also do much of this. At the end of med school you call yourself a physician but have no real formal training in anything specific. That happens at residency for you. However in APN programs they learn very focused specifics about the program they understake and then continue that in clinical residencies for APNs. An APN does not go get a generalist education. APNs are highly specified to the role they choose. An FNP is quite different from an ACNP or a CRNA. The education track it also different and tailored to what the APN is doing. So the entire education of the APN is more like your residency than it is anything else. Entirely tailored to the role they will be performing.
So while you and others do not have to like APNs getting clinical doctorates this is what it will be and the titles are certainly earned and appropriate.
Correction APRNs as of now do not have to have a DNP.
Hey Jake
First, let me say it is very nice to chat with someone who isnt about attacking but just having a discussion. Says alot about you.
CRNAs also have to get a doctorate (not specifically a DNP) but CRNA schools are not required to make the switch until 2025 as opposed to many of the other APNs which must switch by 2015. The reason for this is complex but to sum it up, with all other APNs becoming doctorate entry CRNAs too had to do so.
One of the things you have to look at is the diversity of APN program types. Since these are already full time experienced RNs many do this as a part time endeavor including the clinical requirements. CRNAs are a little different since there is no part time option and the clinical time is significantly higher.
As for your classmate, that is a different situation since he is a student now (med student) and it would cause confusion. That would be like an RN in med school calling themselves a nurse while a med student. However I do not believe there is, will be, or really has been any attempts to ‘confuse’ patients.
I am an independent practice CRNA. No Anesthesiologists where I work and I do everything from Crani’s to cyctos. The vast majority are ASA 3 & 4 not 1 & 2 as those who are clueless would have everyone believe. When I introduce myself to my patients they often reply with “so you are my anesthesiologist?” and I correct them everytime. No-one is interested in confusing anyone and just as an MD/DO is proud to say they are physicians I am proud to say I am an Nurse Anesthetist and I make sure they know it was a CRNA who did their anesthesia. In my practice I do the exact same job as an MD/DO would in my practice, there is no difference regardless of what others would have people believe.
Degree creep is happening everywhere, that is nothing new. However, as a CRNA getting my masters I had to do 77 credit hours. This is MORE than most clinical doctorate programs. I was already doing the number of credits and hours to be granted a doctorate. Moving to a doctorate will change CRNA programs very little.
Scope of practice is an interesting argument. The interesting thing is that only one group tries to dictate what other groups can do and that is the physician lobby. No other group spends money and time trying to limit the scope of practice (or dictate it) to another in healthcare. Some will argue that this has to do with “patient Safety” but that flys in the face of all the research done over the last 60 years. Moreover, it disregards the simple fact that if APNs were unsafe or less safe than physicians doing the same roles they would have long since ceased to exist. That is clearly not the case. Lastly, actuaries determine risk for hospitals and we all are well aware that one major lawsuit could wipe out any cost savings to having APNs. That also has not happend and in fact APN use is increasing not decreasing or stagnant.
When one stands on the outside looking in there is only one reason why the physician lobby tries to control APNs…. Money. Nothing more nothing less. If their assertions of inferior patient care were true after a century where is all the evidence? Where are the thousands upon thousands of malpractice suits? Where are all the injured mistreated patients? You can bet if these existed the physician lobby would be flaunting them on a regular basis. The fact is there isnt any evidence and APNs have no greater malpractice rates, mistakes, lawsuits or anything else than physicians. The interesting thing is that while MD/DOs and CRNAs both have the same malpractice coverage (1 & 3 mil) the cost to me is HALF that of my physician counterparts. Some might argue that this is because they do more difficult cases. This may be true in academic centers but it isnt true anywhere else. If an Anesthesiologist worked where I do today doing the exact same cases all day long they would STILL be paying twice what I do. Why do you suppose this is? Again, actuaries examine risk to determine liability risk and they decide how much you will pay for liability. CRNAs are sued less, even when working independently. That is a fact not an opinion.
If it were so that physicians doing these jobs were better, safer, more accurate etc then it would be in their best interest to leave APNs to self destruct. However, they are not doing this. That is because they know the reality. What they have decided to do is use the veil of “patient safety” as a cover to protect their own incomes. Essentially creeping ever closer to a violation of federal trade (the sherman act). Obviously no-one is buying the patient safety dog and pony show with evidence by proclamation (ie: Im a physician and i said so therefore it must be true). The tides have turned and it will come down to competition.
In anycase, the fact of the matter is there is room for ALL of us.
True or False?
The AANA is lobbying hard against Anesthesiologist Assistants. From your statement, it would seem you believe that there room for all types of anesthesia providers. Correct me if I am wrong, but I believe that the AANA is spending millions lobbying against AA’s using the same veil of “patient safety.” Do you agree with your national leaders? If you do, pot, meet kettle.
Ah Gern again.
Actually this is significantly different. Lets quickly review.
AAs were created by the ASA ~37 years ago as a way to restrict the trade and competition of another profession, Nurse Anesthetists. They were created legally tied to MD/DOs with an inability and the training to work independently. That is what an AA is.
The AANA and state associations justifiably fight against AA proliferation because they cannot expand services, be flexible in practice or meet the needs of a facility, surgeons or patients. The model in which they are inexorably tied to is an inefficient and costly one which will not meet the needs of stakeholders in the future.
AAs are good people who have unknowingly become tools of the ASA to fight against their only competition, Nurse Anesthetists.
The AANA has not used “patient safety” as an argument against AAs in any recent literature to my knowledge. This may have happened in the past and personally I would not have agreed with it.
However, if we are going to talk about the differences between AAs and CRNAs i will do so and allow the readers to draw their own conclusions.
AAs have no requirement to have worked or ever been in healthcare prior to the DAY they start AA school. That means in their 27 month programs they not only have to learn WHAT an IV and EKG lead is and how to put it on but they also need to learn anesthesia.
This is a stark difference between Nurse Anesthetists who have to be RNs (the average is 3 years experience today) prior to being accepted into Nurse Anesthesia school. So besides the 4 years of RN training they have an average of 3 years additional experience working as an RN with the most critical patients everyday. Then, once in Nurse Anesthesia school they spend 27-36 months learning ONLY anesthesia.
So literally, AAs go from never being in a hospital to assisting Anesthesiologists with anesthesia in 27 months.
Franky, I have no concerns about AAs. They do not have the training to do what I do and therefore are not a threat to me.
To reference to your comment about monetary gain in the health care industry, there is a drastic decrease of about 50% in the enrollment of medical schools into areas such as primary care and general surgery and it is suggested that it is directly related to the fact that the reimbursement rates are lower. When MD’s feel the need to challenge the roles of the NP and APRN’s then they should fill those roles by increasing the interest and enrollment into the medical schools to care for these patients because when they don’t nurses will. Historically nurses will rise to the occasion to care for those in need, such as Lillian Wald and Clara Barton regardless of monetary gain. By the way there was no interest in the medical community to administer anesthesia in the early stages of the specialty until there was reimbursement for doing so. Of course then the medical community became involved.
Jake, I think instead devaluing the DNP programs for including business-related classes in the curriculum, you need to be asking why medical schools aren’t including business classes as part of the process of becoming a physician. Given the current climate and direction of healthcare, some understanding of law would be beneficial as well
As I said, they do. It’s just a much smaller part of our education. We’re learning to take care of patients, not how to be a CEO, and our curriculum reflects that. If you want more than the basics, go after an MBA, don’t use them to fluff out a clinical degree.
Fluff? I’d say that’s a bit shortsighted, given that physicians insist on sitting on the BOD’s and hold executive positions and make financial/budgetary decisions with little more than a technical education on steroids. If you’re going to whine and lobby to maintain collaborative agreements with NP’s that require that the MD/DO holds 51% of their business, you damn well owe it to that NP and his his/her patients to know the difference between AP and AR, how to read an aging report, etc along WITH knowing how to treat for a strep infection. If you want to continue on with that level of power and responsibility, perhaps an MBA or its equivalent should be required before you’re allowed to do anything beyond writing a prescription or ordering lab work.
I think Joe makes a good point. You see this all the time. physicians in positions of power just because of their physician status not necessarily because they have a business background. I think that business and its application of those principles is very relevant to the practice of healthcare. To say that to get a MBA only teaches you to be a CEO is nonsense. However, If me getting a MBA makes me a DNP with an additional skill set that can get me into a position where I can help make healthcare decisions that are smart and backed with a clinical knowledge base that makes healthcare better. I believe that as a healthcare provider I can make a difference at what I do. I believe that today’s healthcare climate demands clinicians that are leaders with a sense of business and have a focus on patient care. I think that the two go hand in hand. why not get a MBA or have some knowledge of business? it only makes sense…..or, should we sit back and continue to watch what these politicians and insurance companies are doing to the ways in which people in this country are receiving health care and then regulate how we are able to practice.
I agree with CRNA. there have been so many ridiculous generalized statements made on this blog and how easy an NP training is because we can do it and still go to school, or that it is all online. well i just did a business program with 9 other medical students and we had to work in groups together all the time and I can tell you at least 3/9 said that all the lecture material is online and that they don’t even go to class they just show up to take the tests, which are all multiple choice! I could easily say well that sounds pretty easy to me-you never go to class, just show up to take the test and don’t even have to know the information if you are a good test taker and can use test taking strategies to pass since they are only multiple choice tests. surely with 4 answers you can guess one correct! but i am not saying that-but everyone has been quick to point out that we have it so easy. just because we can work and go to school doesn’t mean we aren’t spending up to 60 hours a week studying and doing school work. I attend classes full time 9 credits a semester and work full time. I work 9-5 – so you know what i do? everyday after I leave work i have to go home and do work and study until 1-2 in the am to complete my work. that is not including my weekends when I sacrifice any bit of social life and am usually working on projects, papers, studying and anything else related to school. I am crazy about my grades so I spend a lot of time doing work to ensure good grades. we do study hard in nursing school, we have too. we are also not able to just get the notes online and not attend classes. I know that most of my professors expect us in class. they always say as doctoral students we expect that you attend class and we lose points in most classes for unexcused absences. the real issue here is the fact that we are nurses and physicians do not want us to use the title DOCTOR because they feel they cannot distinguish themselves and all their hard work from us. however, that is the reason why you introduce yourself as the physician as I will introduce myself as the NP. there are no shortcuts in DNP school and not all of our classes are in health policy and statistics. I have taken pharmacology, pathophysiology, gross anatomy, physiology and pathology in my program. some of those classes were electives that I chose to take-and they were not in non degree seeking classes they were taken in the College of medicine, so please leave your over generalized statements about our backgrounds, training, and level of education at the doorstep.
CAn someone tell me why someone would “need” to get their doctorate in Nursing? I get the whole “research/teaching thing”, but thats about the extent of anyone requiring a doctorate in nursing…correct? No? Yes?
If responding, would appreciate a very “brief” response…thanks..
Hi Bill
Totally fair question.
There are a couple of reasons to get a clinical doctorate.
1) It has been mandated for CRNAs graduating after 2025 and other APNs by 2015. So soon more and more APNs will be doctorate prepared and to continue being competitive many of us still early in our career will have to upgrade.
2) If you want to be faculty at any university teaching you will have to have a doctorate.
3) Most other professions are headed in this direction. Pharmacy, OT and PT already have gone there which puts pressure upon others to do so.
Lastly, the additional education is never a bad thing. The great thing about clinical doctorates is that they can be focused anyway you like. I have a few friends in anesthesia who did regional anesthesia focused doctorates and others who have done research ones which have changed their own practices.
Hope that helps
….its sad that other professions are “going that way”, because I never saw the reason why the other professions needed to “go that way” in the first place…..If its just an “arms race”, i’ll stay out…….
The use of the term “doctorally prepared” to describe on line nursing philosophy courses through distance learning is something I disagree with. I would think all real scientists who earned their PhD’s would as well.
It is akin to a trash man saying he is a sanitation engineer. He no more has any kind of engineering background than a nurse has any kind of “doctoral preparation.” It is borrowing terms from legitimate areas and applying them disingenuously where they do not belong.
Oh Gern, you are so misinformed by the ASA propaganda machine..
Lets first get some definitions correct. A PhD is a research doctorate and a DNP, PharmD, OTD, PTD and an MD/DO are CLINICAL doctorates. PhDs are very narrowly focused where as clinical doctorates do not have to be (tho some are).
Just so you know your whole 2 years of class time to get a clinical doctorate is less than many clinical doctorates and no longer than the fastest options. That is a fact.
Additionally, those who have actually done a real PhD giggle when MD/DOs pretend that they are scientists or research doctorate prepared. You are not and it was easy in comparison to a neuroscience PhD or any other science based PhD.
We both know that many medical schools are now going to the online format. You can no attend classes, watch all the lectures online and get the notes then show up to take the test. I’d be careful about throwing stones when living in a glass house there bud.
Your personal opinion is irrelevant when it comes to the quality and legitimacy of clinical doctorates. You show an incredible lack of knowledge and respect about these programs and what they require. I’d say I was surprised but frankly I am not.
Love how each time a nurse describes an MD’s education time, more and more years get forgotten. So now it is 2 years huh? When they describe their length of education, they include years of experience being a nurse (their job which is not an educational process) into the equation. I have adequately described the pathway to become a physician in another post. Eleven years is the minimum. Most do 12-16 years.
There is no medical school by distance learning that I am aware of. Please tell me what you speak of. This was discussed earlier and dispelled as propaganda.
There are many reasons for one to get a doctorate in nursing. just the reason you are asking the question begs another one-Why wouldn’t you need a doctorate in nursing? sometimes I wonder what it is the lay public and (after the reading the comments above) others think that it is we do? I think the public and physicians are confused about nurses and the science of it. Maybe I am reading your question wrong-but it is almost insulting the way you ask “why would anyone need to get their doctorate in Nursing?”
Sorry dude….Just askin a simple question.
You guys think this is heated??? You should go to websites that are ran by psychologists (Phd’s and Psyd’s) whom think they should be able to prescribe medications…LOL !!
Gern
I am not forgetting the years but i am well aware of the process. 2 years of didactic in med school 3 & 4 mostly in hospital. So your clinical doctorate is 2 years of didactic.
APNs include years of experience because they are REQUIRED.
No med schools currently do distance education that i am aware of within the USA. However, most med schools now put everything online and do not require students to goto class except for exams. I can give you many examples which are first hand from my buddies who have attended them and barely spend a day in class. Its no myth its reality. Additionally, the preponderance of evidence finds that online and distance education is MORE difficult than in class.
Turns out there are distance education Med schools who graduate with the same degree as you and are eligible to take the US exams
Actually, the first two years (pre-clinical) of Medical School may now be completed online. The 3rd and 4th year may be completed at a teaching Hospital in the U.S. (or Samoa).
http://www.oceaniamed.org
Here is an article by an MD on this very issue: http://easteadjr.org/guest.html
So again Gern, you appear to be incorrect and pretending that just because you ‘think’ something it must be a fact. It isnt.
I’m still intending to reply to your earlier responses to me, but I just wanted to touch on this now. It seems awfully unfair to begin calling medical school 2 years, and making a distinction between the pre-clinical and clinical years is meaningless. You’re not prepared to practice medicine without both (in addition to a lengthy residency, which you’re convieniently ignoring to build your argument). Would you like me to start saying that nurses only went to school for 6 months to a year, since the first two years of their degrees are common to all bachelors degrees, and the last year to year and a half are clinicals? How much dedicated class time did you have in your CRNA program? And how many credits (my program is about 120 credits for the first two years, or an additional BA/BS worth)?
Years of experience are no longer required for DNPs, though this may still be the case for CRNAs. I’ve personally known new graduates to launched into their DNP coursework immediately after graduating with their BSN. Then there’s the “clinical nurse specialists,” who can launch into their MSN program without having taken a single nursing course as long as they have a BS in another field, and may prescribe medication.
Oceania Med is a foreign medical school. You can take the US exams, but will still need to apply for residency as a foreign medical graduate, with all the challenges tied to that process. If it’s anything like some of the Caribbean medical schools (which are often seen as some of the best options for coming back to the US as a foreign medical graduate), those US rotations are still pretty shakey. It’s not a good representation of how things are here.
This is all straying pretty far from the original question of whether DNPs should be called doctor. I’d hope it’s obvious that physicians are the most completely trained medical providers (or not, in which case we’re pretty well on point), so all we’re really accomplishing at this point is a lot of mudslinging and wasting each other’s time.
Hey Jake
Good argument about the time for clinical doctorate as an MD/DO and after reading your reply I have to agree with you. I agree an MD/DO clinical doctorate is 4 years including clinical. I leave out residency because you are conferred the degree the day you finish med school not residency.
To be an APN all must have some experience in nursing to my knowledge. To be a CRNA the requirement is 1 year ICU min but the average is 3 years. A CNS must already be an RN before they can achieve the CNS designation.
I agree there is always some mudslinging and that is unfortunate. However when people like Gern talk in absolutes and start the ‘slinging’ I cannot let it go and must correct him. This is the sortof thing APNs are always confronted with and it gets old. The attitude that “im a physician and since i said it i must be right” or ‘evidence by proclamation’ is something that is tired and not factual. I dont think anyone is trying to downplay or ignore the long and arduous process that physicians go through or the breadth and width of that education. The question is, does it matter? As an example, do you need to know how to look in ears and treat otitis media as an Anesthesiologist, the answer as born out in every research study done simply says ‘no’.
If the qualifications/training of APNs were not sufficient to take care of their patients independently then doing so would have long since ceased to exist. No-one would employ APNs to work independently if they were at higher risk for litigation or bad patient outcomes or even unhappy patients. These are the sort of things that significantly impact the business of medicine/facilities. The reality is that APN independent practice is only expanding and that is proof in and of itself that the training/qualifications are just fine.
If physicians feel threatened by this then they should change how they practice to be more competitive in the free market.
States who have come out and said no to internet Courses that I know of
California
Ny
Conn
Ga
Arkansas
North Dakota
Oregon
Kansas
Florida
Texas
Pretty disingenuous to find a shady Samoan internet degree and equate it with US trained allopathic and osteopathic degrees. Most don’t recognize the aforementioned school and I feel the same about that as I do the online bridge from CRNA/NP—>DNP
In medical school, most classes are recorded or videotaped, but still the majority go to class. The recordings are used for further review and some class notes. There are only a few classes that lend themselves to no attendance. Most of the classes have laboratory work that would make it impossible to not attend. I happen to be faculty at a large medical school and am quite familiar with the process for the majority of large state schools.
In addition, as stated, CRNA programs require one year of ICU experience, but you state that the average is 3. MD’s who took more than one attempt to get into medical school or who changed careers after 10 years don’t get to count all of those extra years as training, because they are not. Those nurses who took 3 or more years were just performing a job, just like everybody else. They were not enrolled in a study program, so stop counting three years into your training. It is deceptive. To be honest, the one year should not be counted either since you are just performing a job following orders in an ICU setting for 36-40 hours a week. May help you be a better nurse, but does not prepare you to practice medicine.
Gern
So what you are telling me is that currently 10 whole states have said no…..not exactly convincing that this isnt happening or will happen more, is it?
Additionally, it does not matter what medical school someone goes to, if they pass the USMLEs and get a residency in the USA they are Physicians. It does not matter if they “equate” to MD/DO programs in the US proper now does it? No it does not. You categorically stated there were not online medical programs, you were wrong and this isnt the only one. Moreover these people are eligible to work in the USA as physicians right beside you, regardless of what you feel about it.
You are incorrect about how medical schools work and I believe your ‘faculty’ position gives you a very limited insight as to what happens. With the exception of lab components a large percentage of medical schools now provide the entire lecture online for views at the students digression. This is not new and has been occurring for over 6 years. Three of my friends have experienced exactly how I have described it. Went to class first week, stopped going did online review then took exams. You can say whatever you like but this is a reality and they lived it with no reason to lie to me. Only more distance and online education will come to medical training in the future.
Gern, the one year of ICU is required. It is both ignorant and supercilious to
make the statement that this is “just work”. The time in the ICU is spent learning everyday and expanding knowledge in multiple ways which later make one a better anesthetist. It is entirely relevant to anesthesia as opposed to the 4 years of pre med classes (which i also took) that are not relevant whatsoever.
Of course there is no point in counting all the time it took to get into medical school because it isnt relevant to the training in anyway. What a myopic comparison. When they were working at McDonalds I was taking care of the sickest of the sick and doing it alone in the night with no physicians in house. Later I was in an aircraft placing chest tubes, central lines and performing RSI on patients with NO physician. I made life and death decisions throughout my entire pre-anesthesia career without the need for physicians and I continue to do so today. So make any such suggestion that this did not significantly contribute to my skills and knowledge in anesthesia is laughable even to a layman.
Lastly, I am not prepared to practice medicine because I practice Nursing. This is a fact not an opinion.
Similar to someone who was a paralegal for 16 years and then went to law school and then claimed that their law school education consisted of 20 years. They may have picked up some pearls along the way, but there was not a formal student / teacher relationship, no exams for them to study for, no textbooks with required readings etc. There was an employer / employee relationship. They showed up for work and did as they were told for ~40 hours a week and in exchange got a paycheck. It no more prepared them for passing the bar than being a flight attendant for 20 years prepares them to fly a 747.
The states I mentioned regarding the online Samoan med school are the ones I said I knew about. I didn’t say it was all inclusive. However, as California, Florida, New York, and Texas go, so do the rest of the states, so I suspect there are many more.
While it is true that the title doctor is conferred upon graduation from medical school, the degree is useless without residency. A license cannot even be obtained until after one year of internship and a physician who does not complete a residency is pretty much unemployable in most settings. so conveniently dismissing the additional training of 3-8 years is deceptive.
Also, a Samoan trained MD is very unlikely to get a US residency in the first place. Currently, the number of med school graduates will surpass the number of residency positions available next year. The states I mentioned above also tend to have the majority of the residency positions, so a person wasting their time and money on an on line Samoan medical school is going to find quite a bit of difficulty breaking into the US medical system.
Still not sure why we are discussing what are considered foreign med schools. I am sure I could find an African nursing school that had really lax requirements in an effort to cheapen your degree. That is not what this is about.
The real crux of this is truth and transparency for patients to know who is taking care of them. That is about to get really murky in the next few years.
GB, I don’t get it. First, you write that time spent as a nurse (RN presumably) prior to entry into an NP/DNP program does not appreciably count as experience/training in the overall process because they’re simply doing their job – but then later write that residency (effectively working in the job) is part of the process of becoming a degreed MD and should receive credit as such. Give your irrational attack on nursing I’d say your either an elitist or misogynist (most nurses are women, but you knew that already), or both.
I can’t reply to JoeConsumer’s comment for some reason, but in the event that Gern isn’t looking this over anymore, his statement isn’t at all irrational. Residents are working the job that they’re training for with increasing levels of responsibility and diminishing supervision as they progress. There’s education involved, too, and that’s also directed at the career they’re headed into. RNs aren’t working as NPs… They’re working as RNs. It’s a very different skillset, and while there’s value to learning how to be a good nurse, it’s not going to show them how to operate as an NP. There just isn’t enough overlap.
Oregon has no such law, Gern. P.S. Do you know what a computer is exactly? Just wanted to make sure you recognized the meaning of the term “online”…
Mel,
When I refer to online classes, my intent is to describe the current practice of distance learning where you log on to a school’s website and do assignments and complete projects for a virtual class where there is no real classroom and are then conferred a degree without ever stepping foot on an actual campus or actually meeting your teachers in person. Sorry if my terminology was confusing you.
FYI, the “article” you posted is a “blog” by a retired physician who blogs about random things in his life. He is proposing it as a concept. It is not a program that is in current use. Just an old guy saying it should be. If that is your best evidence, I am not convinced.
Yes, but you are ineligible for ECFMG certification and therefore cannot gain residency admission or a state medical license in the US without the ECFMG certificate. So yes u can do clinicals, but practicing in the US is impossible with those restrictions. The ECFMG disqualifies if distance learning is carried out through online medical school. A certain amount of lectures are required to be in person for these international schools if you plan on getting a ECFMG cert for future U.S. practice.
Excellent observation. Thanks for clarifying.
Gern
Obviously the paralegal and flight attendant are laughable examples and not at all similar. You are grasping at straws but nice try.
You can argue the FMG and residency all you like but the fact remains that many do get residencies and there is little ability to regulate what their medical schools do. You are pushing the goalposts here.
You are correct, we are getting off topic so let us return. Your suggestion that somehow APNs are not truthful or transparent is not only insulting but frankly unfounded. Tens of thousands of RNs and APNs have had doctorates for may decades and yet none of these “issues” have occurred. You can be sure the ASA and AMA would be all over them if they had. So this is just smoke and mirrors.
Here is an idea. Why dont you use the title protected for you, Physician. Doctor is a title protected for everyone who gets a doctorate.
The issue is big enough that is has been tackled by many legislators and fought hard against by many nursing organizations, optometrists, psychologists etc.
I know that I will not change your opinion, but for the lay persons out there, look up “Healthcare Truth and Transparency Act” to see what the issue is that is being dismissed by the nurses on this board.
And, yes, the issues do occur. The AMA and other organizations have complained, but the nursing lobby is huge and the trend is obvious. It is getting murky, as I stated.
My comparisons are not laughable. They are actually pretty accurate. Try this one. If a nurse assistant went to a NA training program and then worked in a clinical setting and referred to themselves as a nurse, would you be upset? Would you feel like they were being misleading? This is actually a very hot topic in the nursing community, as I am sure you are aware. It is very similar to what I am discussing here. You can’t work to fight the NA’s for trying to steal your title without getting the education and then in the same breath, try to do the exact thing with the term doctor in a clinical setting.
I know I won’t change your opinion. You have time and money invested in this agenda. My information is for the lay public so that they know the truth about what each degree “really” means.
Cheers!
Medicine is medicine. A medical school teaches medicine. IF you come back as a FMG and make it you likely trained appropriately or you wouldn’t pass exams or there would be red flags on rotations.
Hey Gern
Even the AMA and the ASA cannot list off examples and you know they would if they had any.
In nursing we have LPNs which are not RNs. However, the protected title for registered nurses is exactly that not “Nurse”. It has been that way forever and frankly in my 14 years it has never been a ‘hot button’. A Nursing assistant cannot call themselves a Nurse because they are neither an LPN or an RN. I dont see this as backing your claims but frankly backing mine. Your protected title is Physician and no-one can take that or use it. My protected title is Nurse Anesthetist (CRNA) and no-one can use that, “Doctor” is a protected title for those who gain a doctorate degree.
Now just to throw a wrench into this whole thing for yah. I actually don’t use the term “Doctor” in the hospital setting. It would frankly take far too much effort to explain. My problem comes when other groups try and legislate how someone can use that title. I might not do it but I do not think it is wrong as long as people are clear.
Gern it has been fun bud, I take back what i said before. Yer a good dude and a fun opponent
Most of this crap is simply mental gymnastics which we play at because we are on opposite sides of a political fence. I have little doubt in person we would get along quite well over a good beer 
Cheers to you too!
I agree. I am actually good friends with many nurses, nurse practitioners, and even some CRNA’s Overall, a good, bright group of people. I don’t care much for the politics of it all either, as you can probably tell.
Cheers!
Gern
I hear yah. The politics are old and tired and our separate orgs cause alot of the problems with all their sabre rattling. It makes me cringe. But what are yah gonna do? Personally I have alot of anesthesiologist friends and we screw with each other all the time. It is fun and none of us actually give a shit
Hope all is well with you!
I have to say…after reading the majority of these arguments I have to admit the obvious. I currently am an NP student in an accredited university (not online) and most days, I spend the majority studying, studying, and studying some more. I started out on this journey because a physician treated me like I was an idiot because I had no idea that my son had a double ear infection. I left the office after receiving treatment for my child and told myself that this would never happen again. So, the following spring I enrolled in college and began my journey. Med school was the only way I wanted to go. After completing all of the prerequisites for medical school with a 4.0 I opted for nursing school (again, not online and from the same university). The reason I did this, at the time was the right decision for me and my family. This had absolutely nothing to do with the difficulty of medical school or the fear of rejection but everything to do with my age and the age I would be once I finished. So I bit and completed nursing school with honors and immedietely was employed in an ICU, ironically, one that is owned by the same med school that I had once wanted to attend. When I have a break between semesters I am back on the job because I absolutely love it. At a teaching hospital I am able to quiz physicians about anything and everything and I soak it up like a sponge. I tell you all this to say that there is no doubt that physicians are not only trained differently but are taught more in-depth. That said, a small part of me still would love to have started younger and went on to med school but the truth is, I dont have to. My goal was to do the job better than the guy who believed that because he was educated and I was not, he was somehow more worthy of respect than I was. Truth is, I have no intention to go it alone once out of school, why would I? The goal is to go work for a physician that knows what he/she is doing and learn as much as I possibly can. There is only so much one can learn from a book and I see every few months, when working, a fresh group of newbies that seem to think they know everything fall right on their heads and ask the nurse, “Any ideas?” Its entirely about the experience, I know it and everyone reading this knows it. The docs(attendings) I work with are absolutely brilliant at what they do and although an NP will probably never be looked at equally when comapred to a physician. My individual goal is to gain respect from my peers and to do that I must never stop learning, never stop asking questions because whether you are a physician or a np, you are never too smart to ask if you do not know. I find this entire discussion of who should be called a dr rather ridiculous. I say “Who cares?” Call me what you like. I personally do not want the dr title, i’m good with the John title. DO I agree with online programs, NO! What does it matter? Just like the physician’s, the only thing that separates me from other NP’s is me. I have seen ignorant docs make horrible decisions that have bad outcomes so this really isnt an argument of who should be called “DR.” or who deserves the pat on the back by the patient. It’s about using your head and having common sense, don’t guess!!!! Someones knows the answer if you do not, so figure it out. That is what makes a good provider. Thats my opinion anyways lol
I read with growing interest both the article and all the excellent responses. I have practiced as a Family Nurse Pracititoner in upstate New York for the past 27 years. Two years ago I returned to school to begin work towards a Doctor of Nursing Practice. I work in an internal medicine practice teaching internal medicine residents who have just graduated medical school During the first year of residency I am a life saver. They are lost and often confused with how to perform. Once they get their stride and begin to learn process and application of medicine. Their knowledge returns and we have many animated debates about best practice regarding many aspects of primary care. I work with them at journal club, where I not only help them to critique journal articles, but I help them to find meta-analyses of topics, that is, a wealth of articles analysed to determine if there is a better way to practice. In general their knowledge is as in depth as mine. Their application requires experiance which I have. By the third year of residency I am an idiot who lacks credibility. How unfortunate. Yet, I am thankful that their preceptors who I have practiced with for the last 17 years are very clear about my worth and knowledge base. In addition every audit performed inhouse, or by independent companies lists me at the top of the institution with regards to patient satisfaction, adherence to Medicare guidelines and patient outcomes. For example 90% of my Diabetic patients are at goal for their blood sugar, blood pressure and 75% are at goal for cholesterol 97% have seen eye doctors and foot doctors and have not been admitted to the hospital. Perhaps I am just lucky. I prefer to think of it as a great partnership with patients and colleagues, because medicine is best practiced as a team. I practice medicine and nursing. My colleagues practice medicine and look to nurses for nursing
Your original question is what to call a nurse practitioner who has a Doctor of Nursing Practice degree. I am a parallel professional to medicine and we complement each other. I can work independently and interdependently with many professionals. Should a physician, a pharmacist or a physical therapist have an issue with my care I will of course want to discuss it with them because I respect their knowledge. Likewise I would expect the same in return. I believe my outcomes are the same because I can speak to patients in a way they can relate to. I can discuss care with physicians in their language and I understand science and research to the best of my ability as it is currently presented in the 21st century. Indeed I study at the same conferences and read the same journals my physician colleagues do. However the question was of title. When one lets go of power and territory, I am a Family Nurse Pracitioner I am called what the patient feels most comfortable with. Many already call me doctor or by my given name or surname. I correct the ones who call me doctor as I am not one yet. My degree will be a clinical nursing degree. and reflects the highest scientific level in nursing parallel to medicine. Nursing is a science unto itself. Perhaps a synthesis of many other sciences worked into a new perspective that is able to communicate with many patients and disciplines to produce greater health. But, what to call me Legally I will soon be Doctor XX or XX DNP This is perfectly legal. No institution should dictate that I can or cannot use the term Doctor as there is no legally binding claim on that title. To my patients I am just me working with them and their families. To my colleagues I am a colleague. There will always be someone who is so sure of their uncomparable ability that they neglect to consider that there are more then just one way to do many things. That is unfortunate. Luckly I do not have to work with them. My practice is full, I am booking 3 months away although I always fit extra folks in when I need to. So I guess I can live with whatever I am called, as long as it is respectful.
This entire debate is ridiculous. I’m a 22 year old Air Force Veteran about to enter a BSN program, so it may be safe to state that I hold no bias in this discussion.
It seems very childish that so many medical professionals are acting so childish towards fellow care providers.
The fact of the matter is that The DNP is a professional Doctorate degree that is earned through attending an accredited academic program focused on nursing practice. The latter statement is fact -not opinion or personal bias. Therefore that the holders of the DNP title have earned the title “Dr.” Just as any PhD, MD, JD, etc. To say otherwise shows weak moral standing and serious insecurities.
It is true that DNPs’ do not have the same training and understanding of the medical model as MDs’, but the same can be said for MDs’ on the nursing model. Why would it be a problem for a patient to confuse a DNP with a MD? The DNP has a duty as well, and they are obviously seeing that patient for a reason.
If an MD specializing in Family Practice notices an unusually high red blood-cell count in a sample from a patient that lives at a moderately low altitude, and cannot figure out what the cause is, what might that MD do?? He might consult with a Hematologist! Yes, get assistance from another medical professional who’s scope of practice may help with the issue at hand. So what would stop a competent, educated DNP from doing the same thing and asking for help when an issue exceeds his/her scope of practice?
I have the opportunity, intellect, and resources to pursue either profession(medicine or nursing), but I chose nursing because of the opportunity to actually have a hands on experience with the patient. I WILL eventually become a DNP and hope at that time that I can work along with MDs’ and receive respect from my peers and patients for the care that I will one day provide. I seriously doubt DNPs’ will take the place of MDs; they are two different practices, but both have their scope of expertise.
Good luck to you
This is a fascinating and often complex debate. There should be a bridge program which will allow advanced practicing nurses to become doctors of osteopathic medicine. I’m sick to death of hearing from “territorial” and “political” doctors what does not define a practitioner; if these gifted and talented individuals have the guts to put themselves through this level of education only to come out and put up with this nonsense then create a program that is a hybrid of both because like it or not there are some really, really good practitioners out there who are as gifted as their “medical” doctor counterparts despite the differences in their training. There are nurse practitioners out there in the trenches who perform duties and make decisions in every way that are the level of their medical doctor peers who do not receive but a fraction of the pay of which their counter parts do. I agree with an earlier comment that nurse practitioners are an extension of the physician but there are those who have the talent to perform at an extremely high level and I’m sick to death of listening to this age old “we had to do it, so y’all have to do it” in regards to medical residency. I also think there should be a bit of common sense here too…society has always defined medical doctors as doctors and the only other institution where you hear folks called by their title are in education. Yes, NPs came up the ranks of nurses but their job description is not that of RNs…I think it is time to revisit a title that is unique to them that stands on its own that delineates the difference between RNs and MDs. I understand the need to make the program a doctorate level degree…and it should be, but there should be a program like warrant officers in the military that is a hybrid of both worlds which one can be given the option to be a DO if they have the talent, the gifts and the education to do so. Don’t get me wrong, I too understand that MDs are quite protective of the level of education, medical school they put themselves through, but before they shut the door on what NPs cannot do, maybe it is they who should revisit their institution and debate how there should be more inclusion if the need in our country is for individuals who are as capable as they are but dumbass attitudes prevail, not common sense.
Thank you for your support of Nurse practitioners, however, you seem to misunderstand a few key points.
1. You talk about a bridge of a NP to DO. This is like saying an orange to bridge to being an apple. Nursing in general is a science unto itself. Medicine is also a science, as its psychology and chemistry and engineering etc. So one does not bridge professions, unless one chooses to become something else entirely. I choose to be a family nurse pracitioner. As such I will treat a sinus infection as is the standard of care and I will add nursing science to help a patient adapt that medical care to their circumstances.
2. Nurse practitioners are not therefore extensions of a physician . A legal assistant studies law. Both a lawyer and a legal assistant work in law. A nurse pracitioner has studied nursing and medicine. But a physician generally does not study nursing and medicine. What I do is different then physicians and similar.
3 Other institutions that call professionals doctors. Did you forget about dentists, psychologists and vets, What about chiropractors Did you know physical therapists and pharmacists are doctors as well. Again, all have legal claim to the title.
4. My job description as an NP includes the job description of RN. The job description is to assess, diagnose, plan, implement and evaluate. This is called the nursing process. I still to this day 31 years after learning this, think about this process in situations that need special consideration. So don’t confuese an organizational job description of bedpans, bedbaths and medication passing to be the only thing an RN does. There is careful consideration of the holistic situation.
5. Finally, I believe that we don’t need to do any hybridization what we need to relaxing of trade restraints. Legislatures need to understand that we are a well studied group of professionals who accomplish much and approach our respective practices with great consideration and energy. They need to break down barriers to practice. We need to be working side by side with all health professionals. Without antagonism, which is what I think your ultimate point is.
As a patient, going for care, I have been purposely kept in the dark at my clinic about who I was seeing. It was only after my visit I realized I had just seen a P.A. It was for a routine check up so I did not mind too much. However it made me angry I was not informed when the appointment was set up. I thought the clinic was being overly friendly by just having name tags that gave the first and last name. The clinic was not able to offer an MD to me at the time because they did not have enough on staff. I found out since they have a hard time keeping MD”s. Now, if NP’s get their wish, how will I know the difference if their name tag reads Dr. What is the whole purpose of using Dr. unless it is meant to deceive? Put up a shingle and spell it out., NURSE PRACTITIONER. Clinics should not be deceptive. There should be enough respect for patients to be upfront about who they are seeing. Let us decide.
You are absolutely correct. You have the right to understand what educational preparation a practitioner has. Legally and even for etiquette reasons. I agree that all practitioners should carefully introduce themselves. My staff are always cautious about explaining that I am a nurse practitioner, that the physicians are residents who are supervised by attending physicians etc. The same is true if you see a general surgeon who is to do specialty surgery such as breast surg. The fact that they are trained as general surgeon should be clear. That doesn’t mean however that they are not adept at what they do, just trained in a different way, with post graduate training to enhance within the specialty.
You will know the difference, because although my tag will say Dr. XXX, it will also say Family Nurse Practitioner, as I am very proud of this fact.
This blog is awesome! I just happened to be a NP and a physician…3 months out of training. Gern, your arguments are true on multiple levels. I assume you are a physician and I understand the pedantic nature of your comments. However, I am the only person on this blog that can firsthand shed light on this issue. In terms of clinical competence to diagnosis and treat patients in this era of medicine…as a critical care NP and now as a critical care pulmonologist MD, I see no difference. I practice no differently with the exception of a few procedures and have only neglegible more RELEVANT knowledge then I did as a NP. My background, Undergrad bio-chem Columbia, BSN Columbia, MSN-NP Yale and finally John Hopkins for Med School, Intern, residency and fellowship John Hopkins.
Gern I appreciate your efforts and agree with you on most points. I got out of nursing for some of the same reasons you highlighted in your “Blog Manuscript”. I just want to set the record straight. You and I know the truth, it does not take a medical degree to practice medicine. MD’s use very little of medical school education in everyday practice. As a matter of fact we are doing the same thing the NP’s are doing, working off guidlines to treat patients. You know as well as I do that we have guidlines for treating most anything. JNC 7 for HTN, ATP-III for hyperlipidemia. You get the point. Good luck guys, this is a great read, I am so glad that the NP/CRNA profession has recrutited some really smart people who are passionate about the profession, I missed my fellow NP’s so much I had to go out and marry one. BTW I hired my first ACNP last week, lot to learn but we will be a great team. wish us luck! Keep up the arguments they are all relevant and important.
I’m a recent medical school graduate and I decided to go into Family Medicine. The question I get is, “Why Family Medicine?” The belief amongst medical students is that primary care is quickly being handed over to NPs and PAs. “Why not specialize?” Here are some differences I would like to offer, after observing those in training to become a NP or PA and comparing it to my training as a medical doctor:
1) Philosophies are different. When I think about nursing, I think of someone being able to nurse the patient back to health. I am fully aware of different techniques a nurse use to administer medication, timing, etc. I have no problem with this philosophy. I actually think it’s great!
2) What’s the difference?
When I look at a nurse practictioner, I’m not questioning her understanding of the pathophysiology of a disease or being able to diagnose and treat. That’s apart of being a nurse practictioner.
However, let me point out some of the differences between an NP or PA and a doctor, with an example in managing Hypertension (a chronic illness):
1) Anyone can follow the JNC7 guidelines, know the pathophysiology of the disease, epidemiology, symptoms, signs, diagnosing, and treatment plan/management. No problem. However, when asked why a NP or PA chooses a certain medication as to another medication, there lies a problem. Doctors ascertain this very knowledge, not only in medical school, but also in residency. There is a reason why you would start an AA patient on HCTZ 1st, rather than metoprolol. There is a reason why you would choose metoprolol over some other beta blockers, like propanolol, in certain patients. It’s not that NPs or PAs don’t know the foundation of diagnosing and treatment plans, but what happens when it’s not the norm. Then what?
2) Training is different. There is no amount of training as a NPor PA that will prepare you for emergency patient surgery. Yes. Most surgeries are done by a surgeon, however, the difference is that everyone who went to medical school, spent at least 1-2 months in surgery. In addition, if you’re in FM, you go through it again. Not saying we would do lap cholecystectomies, etc., but the knowledge is there if we need to tap into it. That’s evident in just the 1st year of training after dissecting the human body for nearly a year and expanding that knowledge further in the remaing years of training.
The amount of time that a PA spends doing those things above, is not the same as an MD. Even if you specialize in surgery, you still don’t have the background knowledge to know what to do if not the norm.
3)Differential Diagnoses: The training that a nurse or PA goes through is intense, but not to the point of a doctor. Having an expanding DDx is part of the fondation of an MD. To be able to think of those diseases which are NOT TYPICAL with a certain set of symptoms or signs. THIS IS WHAT OUR TRAINING OFFERS. THAT’S WHY WE THINK ABOUT A DISEASE PROCESS DIFFERENTLY. When someone comes in with high blood pressure, I’m not just thinking about treatment and management, even though 90% of high blood pressure is idiopathic. I’m thinking about secondary causes as well, even though less likely. Is she young (probably fibromuscular dysplasia)? Is is renal artery stenosis (not getting better on current HTN medications)? Is it vasomotor reaction? There is so much more thinking and knowledge with an MD degree than with NP or PA. And, it was with this very scenario I noticed the difference between an MD and those training to become an NP or PA.
4) Procedures: Extensive for MDs. As a FM practictioner, I’m not only limitied to sutures for a cut, etc. But, I can also be certified in doing colonoscopies, C-sections, etc, if I have to or want to.
5) A doctorate degree is a doctorate degree and should not be minimized. There is a reason why you call a doctor a doctor. And, there is a reason why I call my nurses by “Nurse Allen, or Nurse Jones”, becasue I understand that they went through training as well, and deserve respect.
Overall, my view is that there are clear differences between an NP or PA and a MD. I view the role of NPs and PAs as extensions of my practice, not the “quarterback.” As a MD, I view my role as being the coordinator of care. If I need to refer a patient, then I need to know who to refer the patient to and why. I surgeon is not going to unnesccessarily do surgery for something that can be managed in the office (office procedure), unless he’s one of “those” surgeons. So, agree or disagree, but there are differences between an NP or PA and a physician.
I appreciate your comment, Dr. Ross, but you are making a big generalization and mistake by putting NPs/PAs in the same group.
Please review the difference of roles and training of both professionals. They are not interchangeable (as some physicians appear to believe).
Since you mentioned that you respect nurses, I am sure you can understand this.
Moreover, NPs are part of a team and as MDs, can be the coordinator of care. They do not work FOR you, they work WITH you.
*As a side note, in many states they can practice independently, without any required collaboration with a physician (which in itself, is a big difference from the role of PAs).
I agree that it is deceptive for DNPs or anyone else who does not have an MD/DO to refer to themselves in a clinical setting as “Dr.” The centuries-old vernacular of the word “doctor” when spoken in a clinical setting is taken to mean “physician”, there is simply no debating this. To insist that physicians should take it upon themselves to start introducing themselves as “physicians” instead of “doctors” to distinguish themselves from other “clinical doctorates” is absolutely absurd. There is a very clear, ethical transparency issue at stake here. When a patient hears “doctor” they think “physician”. End of story.
As a non-medical person watching this, I find this debate interesting and somewhat laughable. Here are a few facts:
- When I go to a hospital, a doctor’s office, clinic etc. and someone is either addressed as “Dr.” or introduces him or herself as “Dr” the implicit understanding is that person is a physician, nothing else. Period.
- When I speak to someone at a party or social gathering, and they introduce themselves as “Dr.” the default interpretation is that person is a physician, period. One may get corrected during the conversation as “oh, I’m not a medical doctor, I’m a PhD in physics ………” or something like that. Such is the case
Therefore:
- when someone in the hospital introduces him or herself as a ‘Dr” and is actually NOT a medical doctor and does NOT clarify it at the outset (“Hi, I’m Doctor Jane vs. Hi I’m Doctor of Nursing Practice Jane”) it is DECEPTION by virtue of withholding of information (even if the patient didn’t ask). Period.
Whether one accepts it or not, getting into nursing school (while difficult in its own right therefore only intelligent people make it) is way way more easier than medical school and for a lay person like myself (who has kids applying to schools in the US) the difference is night and day. To me it seems like NPs instead of accepting their limitations are striving to be perceived as doctors when they are not, and are using this new DNP degree as, I’m sorry to say, a smoke screen to create the ambiguity that works just enough to prevent a patient from actually asking whether you’re a medical doctor or not.
The difference is somewhat similar to the difference between a hardware engineer (like myself) and a service technician at a computer store. Both of us get computers going, both of us are very hands on with the machine, he can do quite a few things to get a circuit board going including changing parts etc. But when something more complex is required, his expertise STOPS. Not because I’m more intelligent but because I have more training and education and have a much deeper understanding of the complexities of circuitry, processors etc. Just because he can do a certain number of things doesn’t make him a hardware engineer. In similar fashion, NPs are not doctors. The way I see things going there is a danger that NPs will fail to recognize their own limitations and continue to do the wrong thing when complex problems present themselves to them and eventually “fry” a few circuitboards
My suggestion (again, as a lay non-medical person) is to please have the courage and introduce yourselves to your patients as what you ARE (and don’t try to mimic what you are not). In other words, “Hi, I’m Dr. Jane and I’ll be your nurse practitioner today” instead of “Hi I’m Dr. Jane, what seems to be the problem?”.
As a medical student, I find that is rubbish, and would peg you more of a disgruntle old school physician than a lay non-medical person. I chose medical school b/c I like to know the ends and outs of the extreme. As I was told by those that preceded me in med school you will learn a lot more than you will ever use. I can see that being the case but I don’t mind b/c as I said I like TMI. Getting back to what’s at hand, as a student “physician” I think it is outlandish that people will refer to us as doctor like it is an occupation, it is not the occupation is physician. Doctor “of” is the educational level you receive. Talk about deception, not correcting the general population on occupational title vs. academic title seems wrong. For one example, some optometrists work in the same practice with ophthalmologist but they don’t have to defer the right to be called “doctor” in the office. They should not for they have earned the academic title “Doctor of” Optometry just in the same right a Nurse Practitioner who completes an academic program in “Doctor of” Nursing Practice.
At Univeristy of Rochester Medical Center I can tell you that this is not the case. We recognize both Opthamologists and Optometrists as “doctors.”
They are always intoroduced to the patient and “This is Dr.So-an-so your optometrist (or opthamologist).”
MDs do not own the title of doctor. Anyone practicing in their field who has a CLINICAL doctorate that is applicable to that field deserved to be recognized for reaching the terminal point of their education.
Do I think a Nurse Practitioner working in a clinic who has a Phd-Ed should demand to be called doctor… no, I do not. If they are teaching in a Univeristy, yes… this is applicable. However, a DNP is a clinical practice doctoral degree… and as long as there is no intentional misreprentation, I think it is unfair to assume an MD owns the title. Saying “Hi I am Dr.So-and-so, your Nurse Practitioner/Optometrist/Pharmacist/Podiatrist/etc” tells people that this group has a level of expertise and traning that makes them well-qualified and educated in their field.
I 100% agree with you
I am glad that at least some can see through the smokescreen. You hit the nail on the head.
I think in the case where people have a CLINCAL doctorate that is applicable to their field, they should be allowed to use it when practicing in their field (if they choose to). That applies to a DNP, Optometrist, Podiatrist, Dentist, Medical Doctor, etc…
A Doctorate recognizes someone as reaching the terminal level of education in their field. It is NOT owned by a Medical Doctor. (By the way MBBS, DO, and MD all use this title and they have different educations).
I don’t think it should be used in a deceiving fashion though. “Hi my name is Dr. Smith, and I am your (insert position… Nurse Practitioner, Physcian, Optometrist, etc).” is the way to go. I don’t see a problem with that.
The world needs to change of how they think of the world Dr. for this not to be issue.
I think as long as people practice within their scope of practice and treat things they are trained to do… What’s the difference? The world doesn’t only think of Doctors and Medical Physicians. Psychologists, Optometrists, Dentists, Veterinarians… Etc all use this title in their practice.
Nursing is a different model of care than medicine. It makes Nurse Practioners much more successful in some cases (and less ideal in other cases). If a Nurse practitioner has gone all the way and gotten the clinical doctorate of DNP (which VERY few do… So this wouldn’t apply to most NPs)… I don’t see an issue with recognizing them. While there may be some overlap in the services they provide, they do not replace the physician’s role as a scientist (ability to treat complex medical problems in a vaccuum)… This role is very necessary in certain cases. If a patient has cancer or a very complex disease, while the NP can HELP manage this patients care, their training doesn’t suit them to manage it independently. However, with regard to many chronic issues in which the standards of care are well established…. Hypertension (high blood pressure), high cholesterol, well-child care, short term bacterial/viral illness, chronic pain… NP training is ideal to manage these patients independently (until its too complex).
Anyone, whether its physician, nurse, podiatrist, pharmacist, etc who goes beyond their scope of practice will have a professional board to face. This is not about nurses wanting to be physicians…. (There are very few who would truly prefer the medical model)… But there are many that are proud of the nursing model and want to be experts… When they get their… If they want the recognition…. It’s fine with me.
Personally, I don’t need to be called doctor. But I don’t think one group has a right to tell another they can’t use it. As done said, in eye offices mixed with optometrists and opthomology physicians, they are all called doctor… And just clarify when they meet their patients.
“Kelly says:”- and you know all of this HOW?
i guess my THIRTEEN years of treating ALL manner of highly complex medical problems, on top of psychosocial, substance abuse, inmate, and socio-economic, do minor surgeries, treat serious emergencies as THE provide in charge of the “ER” of a prison setting- all with favorable outcomes as well as other co-morbidites, and doing so well, is a great big figment of my imagination, and i SHOULD have simply bee treating a runny noses al of this time, eh? WHO ARE YOU AND WHAT DO YOU DO, as you know NOTHING about the REAL world of autonomously entitled, though collegially oriented FNPS- esp out West.
oh, ad the fact, that THROUGH all of these years, UNLIKE your average sued monthly physician, i’ve NEVER once been sued, is again, a great big figment of my imagination, eh?
I agree that NPs are sued a lot less due to their model of care and training. Additionally, on a whole the nursing model emphasizes total patient assessment and conservative care management. Anytime you’re more conservative and spend time assessing the whole patient and talking to them (getting to know them)… You develop a relationship where patients trust you and would never want to sue you. (I personally feel the medical model trains providers to scientifically only look at the symptoms the patient comes in with and not get into any of the other things impacting health. There is a lot of pressure to “fix” things and move on… And for some patients it is not that simple)
I am sorry you are so angered by my post. I have degrees in business and nursing. I have 8 years of experience in medical business and nursing combined. I am certified in critical care nursing, I currently work in a specialists clinic full time and an undeserved city clinic per diem. I am working on my Advanced Practice degree. I have a tremendous love and passion of the nursing profession and would never trade what I do to be a doctor. I have done extensive research on nursing practice and have involved myself understanding and being a proponent for legislation to drop formal collaborative agreements required of NPs with MDs in my state. My philosophy above really takes into account validating NPs as sole providers that are not controlled by a group who has NO training in the nursing model of care. And this would mean they could do this in any setting, not just in settings that are under served like prisons.
I agree that after 13 years of experience you probably are more capable than some doctors. And especially if you work in an under served area your ability to serve as a sole provider is invaluable. As long as your training and experience prepare you for what you do, I would never suggest someone not do that. However, as a general rule most NPs don’t come out of school prepared to *indepently* manage (over a long term period) someone with extensive poorly controlled comorbodities. I am not suggesting an NP doesn’t have an value here, but I do think that these cases are where it’s helpful to collaborate with another provider. I get all of my primary care services from NPs, theyre great. I am not suggesting you should just see runny noses. But you better beleive, if I have stomach cancer while I’d love an NP to be involved with my care, I want a scientist working on me too.
At some point as a group we have to figure out some kind of explanation for our model of care that allows us to open independent practices in our own states if we want that route. When NPs work in specialty areas (like critical care) I think think they are naturally collaborating more with MDs and can do more than someone who just hung the shingle out in primary care. The ICU NPs I work with are fantastic. My post meant no offense to your experience or capabilities. I always like hearing from people with different perspectives who can help me understand other experiences and form a better argument for independent practice that makes sense.
Housekeepers wear scrubs…I think they are trying to be nurses!!!!
In paramedic school (more etymology! para/ medic- literally “alongside” or “auxiliary” doctor) our rotations are with the students and residents. Granted not nearly as long, however it was long enough to make a few observations. One of our lecturers (a doc) recommended the book ‘Rockefeller Medicine Men’ to grasp the history of modern medicine. And everyone should read it!
Medical schools were, one century ago, reformed to meet the rising professional aspirations of doctors, whose social status was about that of a barber. Industrialization, increasing knowledge, all served to back the AMA which by 1906 was setting higher entry requirements PRIMARILY so doctors could be groomed as ‘gentlemen’ amongst the wealthy. Only certain aspects of science, particularly molecular science, were favored. Owing mainly to politics physicians were elevated to higher status, and prohibitive entry requirements meant only wealthy and relatively select few from middling incomes would become doctors.
I am in a post-bacc pre-med program now and it’s doubtful how I can balance full time work and taking the MCAT in a reasonable timeframe. Realistically, pursuing a DNP is more attractive thanks to programs that do not exist for Paramedics to MD, in spite of what the title “Para” “Medic” suggests.
Yes DNPs should be called “doctors!” Yes their training should conform to scientific standards commensurate to the title, but medical PRACTICE comes experience, not textbooks. In practice I have not seen the practical advantage of some of my friends who are residents that excelled in o-chem, but give me an experienced MD, DO, PA, or NP ANY day of the week.
MDs, get over it. The NPs are doing what the AMA did a century ago and its time to share the sandbox.
Up with the care, training, and education. Enough with the snobbery.
Congrats! It is so rare that a paramedic has such complete understanding of all of the issues that are at the forefront of medicine and nursing. Congrats on knowing your profession as well as the medical and nursing professions. This level of expertise will serve you well in the future. The sky is the limit. Perhaps you could initiate a doctoral level paramedic degree to further solidify the teamwork that is needed.
Your broad sweeping notion that all doctors came from prosperous families could not be further from the truth. Most finish with a couple hundred thousand dollars of debt and come from modest means. Medical schools go to great lengths to admit underrepresented minorities, often accepting MCAT scores 30-40% below the average acceptable scores to make it happen.
Gern Blanston- “Medical schools go to great lengths to admit underrepresented minorities, often accepting MCAT scores 30-40% below the average acceptable scores to make it happen. “- and yet you STILL maintain your “superiority” over any other Primary Provider Group, even in the face of reams of studies that wholly disprove your sense of entitlement and superiority. FNPs ROCK, and patients AND their families know it.
We now just need to KNOCK DOWN the secret monied world where PHYSICIANS OWN all stand alone MRI, lab, etc. medical ancillary sites to whom their patients are sent, giving them even MORE disproportionate income than they deserve. GREED, GREED, and SECRECY. nice professional ethics to live and work under.
A couple clarifications! I meant to say ‘give me experienced’ MDs, etc in an emergency setting where we interact primarily, but I’m under no illusion that each have different training, philosophy, and therefore roles, and these are enormous distinctions depending on the area of medicine.
The forward-thinking doctor who made the book recommendation saw a future that is even more profoundly team-oriented, with consensus among advanced-level providers replacing the hierarchical models. Some of the best EDs I’ve seen are adopting that principle and it’s something to see.
And I don’t mean to snub all MDs in the ‘sandbox’ now, just those still living in the 1950s.
The title “Doctor” in this situation is a professional title. In the hospital setting, an MD being called “doctor” is more than just an academic recognition. Nurse is the professional title of those education in the nursing field. In an academic setting, whoever’s a doctorate can have at it and call themselves “doctor of watever it is” they were educated in.
I know plenty of lawyers, who are doctorates , who don’t insist on being called doctor where ever they go. I don’t understand why it is in the medical field that the various roles don’t respect the division of labor that has been long established. Para-legals, no matter how well qualities or hard working they have been, don’t insist on a lawyer title and nor do lawyers demand to be called Judges because they feel they are on equal ground.
Many nurse insist on being given their “respect”, but I feel like they are not respect the role of the doctor in the medical field. There is a division of labor and a triage of care through the various levels. Respect and acknowledgement of the various players should be seem from the doctors to the nurse and vice versa .
Wow… all this time I thought I was in school to be a physician, a healthcare professional with a doctoral degree. My badge will say physician, a nurse practitioners badge will reflect their respected occupational TITLE. I can also introduce myself as “your physician” as I hope they will introduce themselves as “your nurse practitioner”. “If the D.O.E. or other qualified agencies have approve someone’s program to a doctoral level, they have the prerogative to use the title Dr. That goes for JD’s, LLD, PhD, DDS, DO, OD, MD, DNP and etc.
Physician is the occupation, and “Doctor” is the title, as is the social construct of our language. Just as a lecturer’s are often called by the title of “Professors” in a teaching environment, regardless of their doctorate academic achievements. Mr or Dr’s titles aside, the means to the end of the title here is to denote him as the Professor, the educational providers. As Doctor is the medical perspective provider. and Nurses is the nursing perspective provider.
You can’t ignore the dual definition which “Doctor” takes on. I don’t think a JD would stand up if someone were to ask in need, “Is there a doctor in the house?,” and in knowing the definition in the context, a Nurse would rightly so step forward to offer her aid.
Transparency of providers is important to patients. They often times find themselves in a room with many people, and they can’t easily recognize who’s the provider, nurse, tech etc. As a result of patient concerns our hospital have all leading providers – high and mid level providers, MD PAs NP’s – wear their coats to differentiate them from the nurses, nursing aids, medical students, tech etc. ie. They don’t like to see them leaving the OR in just their scrubs.
I love a health debate (no Pun)
Let me dissect this rebuttal
Social construct of our language/society also followed JIM CROW, just because something is socially pass down does not make it right or the law. People should be educated to that fact that a title is heading/forms of address. By the law of the land(s) if you have received a doctoral degree your heading/form of address can be change to Dr.
I have many friends who have completed medical school in Melbourne Australia, but they use the “Title” Mr. and Ms. /Mrs. Why? By all rights the medical school education in Australia is on line with here in the US but awards second Bachelors (Bachelor of Medicine, Bachelor of Surgery). If my friends down under want to use the “title” Doctor they have to seek a doctoral degree after their Bachelor of Medicine, Bachelor of Surgery.
I admire the NP/DNP route but do not regret going to medical school for many reasons. A few being I am an information junkie and we get a ton of more information in school than we will ever use in practice. Another is I plan to go into a surgical specialty and there only paths for NP’s in surgery now is assisting.
You mentioned transparencies in providers and how DNP should not use the “title” doctor in clinic.
Let break this down even more. DNP (Doctor of Nursing Practice) OD (Doctor of Optometry) and MD/DO (Doctor of Medicine/ Doctor of Osteopathic Medicine). So you are getting at if you have a DNP working in the same office as MD/DO they should denounce their “title” but what about OD’s working in the same office as MD’s/DO’s? You stated the construct was that physician = doctors, OD (Doctor of Optometry) are not physicians.
Lab coats do not designate someone’s job. RNs, lab techs, med students, etc all wear white coats depending on their setting. Additionally they carry a lot of bacteria since they arent washed everyday. The less we wear them, in my opinion, the better. As mentioned earlier optometrists are doctors (OD), and they work in the same office as opthomologists (MDs) and don’t give up their rights to be recognized. The DNP is relatively new, it is not all NPs (or even the majority) . If someone wants to use it I don’t think it is right to take away that right. There is nothing wrong with “Hi am Dr Smith, one of the Family medicine nurse practitioners.” The public will come to understand the difference… A DNP has mich higher training than a typical RN, and this title quickly recognizes that and points it out to patients. As long as we are all practicing within our scope of practice and training, what difference does it make to the patient? Do people reallyalways know if they see an MD, MBBS(many foreign trained doctors have this instead if an MD), or DO (Osteopathic degree)… All of these are medical doctors that are equal… Can do all the same things and be called doctor.
I agree lab coat do not designate jobs and they are germ farms. I was just trying to point out transparency is important, and that is an example of how one hospital chose to clearly who is who here — via establishing a uniform. That’s the only concern I would see with topic.
Making a “Jim Crow” comparison is perverting the discussion beyond what it is. As a future doctor, you aren’t doing either fields a favor by doing such.
I’m not trying to make a Jim Crow discussion of it. My point is, if someone has a clinical doctoral degree that prepares them for patient care… It is not deceiving to use the title. The only time I feel it would be deceiving is if you had a Masters prepared NP who also had a PhD, also trying to be called Dr in a clinical setting. A PhD is not a degree that enhances direct patient care, and is not doctorally prepared to take care of patients. While I think transparency is good, I’m just saying its not deceiving. I have never had a DO tell me “now, Kelly, I a doctoral prepared medical provider, who is licensed to do everything I do by the state, but really just so you know… I am not an MD.” They never have and I am okay with that.
Well I am sorry you total missed my point (2 cents). You stated in so many words that it socially accepted in our language/culture that doctor is synonymous with physician. I was just pointing out something else that was socially accepted in our language/culture to emphasis just because it is it socially acceptable does not make it correct. Instead of pacifying the general public’s social view they should be educated that doctor is the title that comes along with doctoral degree. That would help open up discussion of transparency. Better yet, you know what would open up transparency even more, better information boards in medical office that explain the different education training of the providers in the office. As well as a full introduction by whomever your provider is (MD/DO…Greetings, I am Dr.____ your physician) (DNP…Greetings, I am Dr.___ your Nurse Practitioner).
The bottom line is the more the general public understands the less issue there will be with things that are socially accepted and/or transparent. Ignorance of types/duties of providers should be want the problem is, not someone proudly displaying their level of education.
Don, you’re absolutely correct. I shouldn’t be allowed on my phone at 6am! I think you make an excellent point. I do agree we should all be specifying what it is we do and work towards educating the public. I think especially in primary care (with ObamaCare we are adding a lot more consumers) we are going to see more DNP, NP, RN, and PA providers and its important to highlight their roles, education, and qualifications.
The bottom point i agree with. Transparency is the main concern, and the only thing that would really drive me to question the use of the “doctor” in a clinical setting as oppose to an academic setting. (I just was not gonna even try to discuses the Jim Crow thing. That has a whole another level of watever and a tab bit offensive.)
Firstly OD (Doctor of Optometry) DNP (Doctor of Nursing Practice), DC (Doctor of Chiropractic Medicine) DPT (Doctor of Physical Therapy) shall I go on are not clinically prepared doctoral degrees. Furthermore all degrees are academic getting back to my main point doctor does not equal physician; doctor equates doctoral level of education for a person.
Secondly you still don’t get it perhaps 3rd times the charm. You base your reasoning on why only physician should be called doctor on social construct not on what is legit and or factual. JIM CROW was also built on social construct not on what is legit and or factual. Me referencing JIM CROW, is a parable to what is accepted as social construct does NOT make it legit and or factual. As for you finding it offensive, I take wonder in that. As a black American from the south who’s older parents and grandparents living during that time, passing down the stories to me, not for me to get upset but to learn from what they had to deal with and don’t let history repeat itself. Not saying that history is going to repeat itself in the same manner as with JIM CROW but when you start basing reasoning on social construct, rather it is mild like this issue or extreme like JIM CORW having your thoughts on a matter come from social construct does not make it legit and or factual.
I can’t speak for all of those degrees but I am certain a DNP is clinical. The whole basis is clinical implementation of established research… And the center of the program revolves around a clinical practice project and doing clinical hours. I can’t imagine those other degrees don’t have that too.
“Gern Blanston”- Doctoral NP Programs would probably have existed LONG before NOW if it weren’t for your uber, fascist lobby, the AMA, in charge of all things medical since they began corralling state, then the federal government from the 1800′s through even today to ensure that THEY and THEY alone TRY to MAINTAIN all from of the economic and other forms of power and control within the medical community.
That said, I cannot TELL you how many dozens of times, I, a 13 year FNP – HIGHLY experienced with caring for complex patients AS their Primary Care Provider, has had to correct the bogus, wholly outdated or non-evidence based treatments that “physicians”, who IF they looked at, say, my mother or me even ONCE while dealing with her, would be a shock; one of whom most recently was going to “scrape” a significant SCC lesion off of her upper arm. How insane can she have been?, as she also allowed her nurse to break her sterile procedure field repeatedly, up to the point that the nurse wore NO gloves, with FILTHY FALSE fingernails, opened/closed drawers/cabinets at will- all ungloved, and actually placed a 4 x 4 in her ungloved PALM into which she then poured H2O2- ALL under the eye of this 40 year “surgeon”, who was forcefully made to get up to speed when dealing with my mom’s Squamous Cell Skin Cancer lesion, and SURGICALLY remove it for hopeful clear margins, instead of WHAT she was going to do were I NOT there, which would surely have increased my mom’s chance’s of recurrence and lung cancer. its sickening to read all of this garbage above re: the so-called superiority of physicians.
again, READ ENGLISH, even if a FNP has a few years of intensive practice behind him/her, he/she is the essential EQUAL to any but the most exceptional of physicians in terms of practice standards and, likely, surpasses said physicians in terms of patient quality surveys/studies.
Only in the EAST does this colonial and autocratic attitude exist at this level. Its sickening, though some physicians/physician groups in the WEST, I’ve noticed, are trying to insert their will more and more these days as regards the business of being a Nurse Practitioner than they did decades ago.
Of note, there ARE a few named types of NPs who are soon to NO LONGER be nationally-certified by the two major certification bodies. If their particular training has been found to be lacking, that’s one thing, but don’t EVEN try to tell me that your “experience” is somehow holy and superior to someone like that of mine or one with even MORE experience. We’ll walk circles around you and your residents.
What is the motivation behind the desire to use the “doctor” title for nurses — Is it incorrect to assume it’s largely motivated an aim to highlight their advanced academic level? What importance is this to the patient? It’ is as ridiculous as a MD are better than DO’s argument. You are qualified and what is more important is the application of what you learn in the real world and who are you in the picture.
Isn’t it more important in a clinical setting to high light your role as the provider — be it PA’s, NA, Dr’s RN or not? And I say this not thinking that Nurses should stay in their place below doctors. Nurse are a very important part of the health care system, just as doctors are. They together work to keep the system running smoothly — expanding the accessibly of care.
Personally, once I have my DNP, I will not be using the title of doctor. However, there are DNPs that do use it. It is a clinical doctorate… And means they have a level of expertise that is the terminal degree in their field. So I don’t think someone (MDs especially) should be told they CAN’T use it. The point is, MDs do not own the title “doctor.”
These stories about how nurses are better than doctors and can replace them are in the same poor taste as doctor’s telling nurse that they work below them.
Agreed. I think everyone needs to work well together and collaborate when appropriate across the board. I would never say any profession can be replaced or is better than another. It’s really got to be looked at in terms of what the individual needs. You can’t eliminate MDs, they are irreplaceable…and likewise MDs shouldn’t be threatened by NPs or DNPs because they too are irreplaceable. There is plenty of opportunity for all types of providers to help patients.
Don P says:
December 13, 2012 at 6:25 am
Firstly OD (Doctor of Optometry) DNP (Doctor of Nursing Practice), DC (Doctor of Chiropractic Medicine) DPT (Doctor of Physical Therapy) shall I go on are not clinically prepared doctoral degrees.- WRONG! A Nurse Practitioner DNP degre is a terminal CLINICAL DEGREE>
Don’t like it, too bad. Its reality, and as long as NPs vociferously fight back against the entrenched x 2 centuries, AMA, we will find a more and more balanced plying field in the world of medicine, including in ALL of the shady/hidden ways that “physician groups” own ALL diagnostic entities on the sly- making even MORE money, s they continue to TRY to squelch and diminish the HIGHLY trained world of primary care Nurse practitioners, who can stand alongside of ANY physician. There’s a bell curve. check it out. Physicians are not all lumped at the top 1/2% of performance in or after medical school.
i CANNOT TELL you HOW MANY times, as a quietly sitting “LONG-TIME PCP FNP” sitting in an exam room with my mom or another relative and watch as the “physician comes in, never ONCE looking at the patient, constantly making sometimes potentially GRAVE/outdated errors in treatment, e.g. scraping a SCC skin lesion just a week ago, until she was STOPPED in her tracks by ME, as i asked why she was not following the LATEST surgical body guidelines re: SCC skin lesions, she suddenly did the RIGHT thing, which is SCC = surgical excision. One of MANY physician errors i’ve personally had to correct over the past few years when accompanying family members, including those on hospice, whose care was appalling, as the nurses didn’t [properly know THEIR jobs and the “physician “hospice director” collected his many thousands/month salary to “run” the hospice, yet RARELY took part in ANY meaningful clinical way. What a grotesque way to show compassion to DYING human beings, as he/she live in their multi-million dollar homes and make obscene amounts of money as placeholders, that the AMA has, CURRENTLY, ensured are able to be held by physicians only.
time are a’changin.
Poor clinical practice is poor clinical practice. Doctors are guilty of it as well as nurse.
I see many NP’s having diagnostic ability. The two degrees are different. As Don P has mention, MD looks at health from a cure-detailed orientation. This is were the two degree depart and most likely the reason why less routine cases are under MD care.
I can foresee you disagreeing with this simplified stated about the division of labor and ask — From you perspective then, where do you see the role of MD’s in medicine then?
Personally, I think the market will sort itself out. There are more and more MDs and DOs who are going into specialties. There are very few chosing to go into primary care. Nearly 10% of primary care residency positions in the US went unfilled in 2010. Those physicians that do choose to go into primary care will maintain their practices as they have been. They may employ NPs and PAs to augment their practice as well. However, with less physicians entering primary care, this will leave gaps in primary care that more NPs will fill. NPs are well trained to independently handle their patients and have their own practices. They know when they need to be referred to a specialist because something has fallen outside their comfort level or training (same thing a primary care physician does). In addition, I think there will be an increase in the number of NPs and PAs working with specialty practices to help augment the care that is delivered by the physicians.
That was a typo… it was suppose to say ARE clinically prepared doctoral degrees… Kelly I see what you mean about writting early morning rushing out the door
I know, tell me about it. See what you started?
(As a side note) FC, can you seed some light on the NP vs PA position. Often time I see them working on even fields in the hospital, which confuses me to be honest. PA is a two year degree vs NP, which is a masters at the least with years of experience and training.
In the hospital I would say they are pretty much used in the same manner. PA’s are trained under the Medical Model of care. Most of them graduating these days have Master’s degrees, and the overwhelming majority have at least a Bachelor’s degree. They (PAs) do all the similar rotations a Medical Student does, so this makes it easier for them to be used in any specialty. They even train in surgery, so their education prepares them to serve as an assistant to the surgeon right out of school. The PA was really designed as a direct extension of the MD. Because of this, they are usually not able to practice independently. Even the scripts they write are supposed to be co-signed by the supervising MD within a certain time frame. Their broad training though makes them very useful in a myriad of specialties.
NPs on the other hand are, for the most part, independent practitioners. While in some states they need to formally collaborate with doctors, in other states they dont need to collaborate at all (formally that is… I would like think informal collaboration still happens). On the whole though, their scripts for medications don’t need to be co-signed by anyone. They can open up practices and independently see patients that are within their scope of training. However, because of this independence they can’t just work with ANY kind of patients. NPs have to decide what they are specializing in before they go to school. If they are pediatric NP, they just see those less than 18 years old. If they are geriatric, they just see 65+, if they are critical care… they just work in EDs, ICUs, etc, if they are family practice they have a broad range with age and type of patient but you will typically not see them in the ICU… you’ll see them in primary care more often. You can’t flip from being a geriatric NP to a pediatric NP unless you go back to school. A PA can make this switch because of broader training and higher supervision by MDs.
Another difference is that the nursing model of care really doesn’t focus on surgery. Therefore NPs have to do extra certifications and clinical if they want to work in the operating room. PAs are already prepared to work in the OR straight out of school.
“Kelly”- i’m sorry, but while you are trying to impart information and your entry is heartfelt, , you are providing misinformation in several ways:
- nurses don’t do surgery? they have been in operating rooms since nursing began in the 1800′s. i personally know TWO male FNPs who were flight nurses prior to getting their FNP degres, and both got First Surgical Assistant positions RIGHT out of FNP school.
- PA’s as a profession begin due to the MEN who were FORCED to be drafted into the Vietnam War, as children of 18, and while there, those working as medics essentially acted as full-on physicians, including doing surgeries. when they returned in droves from the Vietnam War; highly trained medically, someone somewhere realized that a place needed to be created for these men. hence, the beginning of PAs.
-FNPs can practice ANYWHERE they wish to practice, and ARE the most broadly trained of ALL Nurse Practitioners. i know this because i’ve BEEN one x 13 years.
-PAs are ONLY recently getting up to par education-wise, to some degree, and then in a spotty fashion, and I’m sorry, no turf war here, but they are chained to M.D.’s due to the AMA- 10% of al of their charts MUST be reviewed by a M.D., naturally. they are FAR more superficially trained compared to holistically and baseline MASTERS to soon to be required DOCTORALLY-prepared trained NPs.
-in CA- i knew many PAs (truly) who were hair dressers or truck drivers, then after a 9 month “certification training” program, they were suddenly PAs and scary ones. THEY give all PAs/NPs a BAD name.
@fc -I have been reading the comments of this article for quite some time and posts are interesting, for the most part.
Not to be overly picky, but your constant and random use of “all caps” is disconcerting. No need to “shout,” as it really does not make your argument any stronger. Thank you!
I think that you will see less and less hair dresser types in the way of any healthcare professional.
I think we are on the same page. I didn’t say NPs don’t do surgery, I said they have to get additional training as a first assist. Most programs for NPs don’t put this in core curriculum.
True FNPs have the broadest scope, and I believe I acknowledged that. But the fact is, if you are not an FNP (as there are many NPs who are not FNPs) you have to stick to the population you were trained to work with. This is not the case for PAs.
Lastly the AMA, while they are a huge lobbying group, does not control NP scope of practice. This is controlled by your state. So in California it may be true that 10% of charts need to be reviewed, this is not the case in every state.
“kelly”-
-its “PAs” who nationally are wholly supervised, at ALL time, by law by M.D.’s. AND they DO have to, by law, review 10% of the charts each PA under their CONTROL.
- NPs are free, free, free- as a rule, esp in the West. we ARE a WHOLE, UNIQUE and AUTONOMOUS profession. We don’t take “orders” from physicians, and if one were to try to give ME one, he/she would become quite aware of reality immediately. they are NOT Gods. That said, lest i alienate people here, i work WITH doctors, and even greatly respect them, enjoy working with them, AND appreciate any knowledge, no matter from where or whom it comes.
- and, again, you are simply WRONG about your ideas around FNPs working in surgical settings. There is NO additional training “needed” to take a position such as this. one either falls into it, has previous RN experience in the setting, or otherwise is the favorite candidate for an opening in the field. Its that simple. I’m sure there would be on the job “training”, but THAT’S the joy of being a FNP. one can do WHATEVER one wants. Period.
I misread what you wrote about 10% sign off. I am pretty sure it’s still the same, state regulated. In NYS, all orders by a PA are supposed to be “reviewed” within a certain time frame. (Sorry if I misinterpreted anything else, writing from a cell phone!
)
sorry, hadn’t seen this response!!
“Author: Random reader
Comment:
@fc -I have been reading the comments of this article for quite some time and posts are interesting, for the most part.
Not to be overly picky, but your constant and random use of “all caps” is disconcerting. No need to “shout,” as it really does not make your argument any stronger. Thank you!”
IF you live in a wold thats so picky as to make the assumption that using “CAPS” is a form of “shouting”, i think that’s a bit odd. CAPS, i find, are a useful way to highlight specific words that I want to emphasize. i guess the fact that otherwise, i use NO caps is ok with you? or does that bother you too?
you remind me of a white, uber- feminist female nursing instructor who REALLY annoyed me and whom i loved annoying back, who would accuse EVERY male who rose his MALE resonant voice in conversation with her to stop being “aggressive”, which is SO women’s studies. god forbid a male speak in HIS normative voice or that boys be allowed to act as boys- so are now heavily medicated on the word of their white female teachers with ADD/ADHD dxs, because they don’t act like passive, synchophant girls.
Firstly, I am a man.
It is okay that you are unwilling to receive to feedback. I wonder if your problems with “feminist” females in nursing (as it appears to be common for you, based on previous posts) is actually due to the fact that you are sensitive to criticism.
Solely considering your posts (and dare I say, your excessive use of “caps”) I can easily picture how you could come across aggressive in person. The things you have to say in the discussion of this article seem relevant for the most part. The delivery and choices of words are off-putting (which affects your argument). Food for thought…
frankly, none of this, but the main point of the article and THOSE argument made on THAT behalf mater; the rest was just done as a fun exercise in writing or me, if you must know.
however, having gone through an uber feminist WHITE coddled female university nursing program, that too, is real, and MUST e addressed in this world. only in the professional world of nursing, in 2013- nearly, is it A-OK that Nursing is STILL a 95% white female world. it wouldn’t be stood for in ANY other setting, including the world of physicians- which reached enforced gendee parity in record time; also, in the originally ALL MALE world of PAs- in which a similar parity was reached, but Nursing somehow is STILL allowed to exist as a coddled white female only world; ust as we need nurses more than ever.
AND, what if a man doesn’t want a FEMALE nurse- generaly its “too bad,” but god forbid any female who insists on a FEMALE nurse only has her wishes ignored.
a world of utter sexism AGAINST men; yet not a thing is done about it nor is it ever spoken of nor\or do any men EVER bring it up- they just suck it up. Nursing programs of ALL sorts must be forced to get up to speed and the times (or lose all federal/other funding), forcefully be made to effect gender parity at all levels, and ensure that the style of teaching what needs to be taught ought to be taught in a manner that MALES enjoy; not like a course i women’s studies or making beds or other silly maters.
True, nursing is very dominated by women. But I do think this is
slowly changing. I don’t think lack of male nurses is a matter of
qualified men being denied entrance into nursing schools by “sexist
coddled white women.” In fact, I think many programs favor taking male
applicants because it makes them seem more diverse. However, it is
only recently that more men are applying to nursing school. (Unless
you want to go wayyyy back hundreds of years ago when there actually
were mostly male nurses.)
I don’t think you can say schools have to be “forced” to have equal
male and female students when that is simply not reflective of the
number of applicants they are getting. You will end up forcing schools
to take less qualified applicants over more qualified ones simply so
they can meet a 50/50 gender split overnight. I think as the volume of
male applicants increases so will admission… so will people in the
profession and it will not be as possible for patients to say “I only
want a female nurse.”
It sounds like you had a terrible experience in nursing school. One of
the things that I like about the nursing school model (compared to
medical school model) is that nursing certification is based on
demonstration of competency. It is not based on how many hours or
years someone has been in school. If you cant demonstrate the
competency, you cannot pass. Conversely, the medical school model
assumes that if you do something for “x” amount of time… you must
eventually be competent at the end. I know a lot of nursing students
that were made to repeat classes or failed out because they were not
able to demonstrate competency. I can assure you that your experience
is not all nursing schools… I know my experience was not this way.
While my program was dominated by females, I had several male students
in my class and several male nurse teachers (who were excellent). The
curriculum did teach things like how to make beds (I think for proper
infection control it is important to know this!) but certainly didnt
focus on it exclusively.
I hope if you go back to school you end up in a better enviornment. I
promise that it is not all like that!
yes, i and every man at UMASS/Amherst DID have a horrendous experience at their Nursing School. That said, that was in the 90′s ,and NOTHING HAS CHANGED numbers-wise since then, so your argument is a false one.
medical schools, as soon as females started screaming about getting parity were 50% female represented within YEARS. TWENTY years since i was in school and fighting vociferously against these named uber feminists, and the complete lack of men in the programs, NOTHING has changd i the world of nursing.
if, as with law school and medical schools, this were about the FACT that MEN had wholly dominated THOSE programs, the GOVERNMENT stepped i instantly, so within a matter of YEARS, the gender proportion was and now is, i believe MORE female dominated than male; while Nursing programs REMIAN abut WHITE coddled women- with NO pressure from anyone or any government entity to FORCE these coddled, largely obese (look at the photos) Nursing “Leaders” of ANY Nursing body to cause the same gender parity that it took only a few years to occure in te MALE-dominated worlds of medicine and law.
PURE SEXISM and CODDLD WHITE FEMALES!!! Federal government and, in most other arenas, anti-male sexism, and don’t give me the bogus argument that AL wite men are SO well off and have so much compared to women. baloney. the eality is that feminists have manged to extrapolate the world of the top 1% of men to that of ALL men; most of whom are struggling as much and more than women, e.g. prison population- 99% male. don’t tell me that women don’t commit crimes. they are simply CODDLED. casey anthony- case in point. susan smith- another. andrea yates, who ran own her little boy down when this tiny child became aware that his mother was going to and DID kill him, after KILLING 5 other children- FREE. its an outrage, and THIS conversation is part of and parallels that EXACT same gender disproportion and coddling of mainly WHITE, overweight, middle-aged, bitter women, who are ALLOWED to act as sexistly as imaginable against males with complete impunity.
the federal government needs to step in and FORCE my tax-paying dollars to be used at Nursing Schools that have been MADE to display both gender parity AND male-focused teaching style/content.
The requirements are different in different states. I live in a state where only 10% chart review is not enough.
I did not say that FNPs don’t work in surgery. However, I do maintain that FNP programs are focused on preparing people for independent nursing practice. Working in surgery is not independent nursing practice, and it never has been as a general rule. Most FNPs work in primary care in independent practices either alone or with other NPs and MDs. Regarding surgery, therefore additional post-Master’s education is needed for an NP to participate in surgery. This can come as an RNFA or as you put it “on-the-job” training (if this is allowed in certain states). The bottom line is this: they need more training even if it is “on-the-job”. However, in some settings it is hard to bill for one’s time if you arent credentialed as a RNFA. RNFAs are RNs with at least 2 years experience and CNOR certification who take a class and pass a test. They need not be NPs. However, NPs can automatically take this class and test without OR experience.
I agree, nursing have been involved in surgery for hundreds of years, but they are not surgeons. As members of the surgical team, they are involved in nursing the patient: keeping them safe (preventing skin breakdown and harm from surgical equipment), making sure proper aseptic technique is maintained, making sure that the patient is comfortable, and administering anesthesia (even more-so before the advent of anesthesiologists). There are a group of NPs who actually hands on assist the MD, however in the east most of them have RNFA certification. Maybe it is different where you are.
I am not suggesting that I was unaware that there are FNPs who base their practice in working with surgeons (notice I say “with” and not “for”). However, this is not the typical FNP. My original post was to help someone generally understand the differences between PAs and NPs… and not confuse them with every contingency or possibility. I dont think any healthcare professional has license to do whatever they want, whenever they want, however they want. There are basic guidelines with exceptions and deviations as appropriate and necessary.
I’m going to school to become a FNP. I don’t want to be a doctor or be called doctor. In fact, I would like to work in a doctors office for a doctor. I don’t want my future job to be eliminated because of this doctor vs NP battle. Let me take care of the strep throats and ear infections so the doctor can see the patients needing a higher level of care. It just doesn’t hurt my feelings, I guess. I don’t know why everyone is so uptight about this. Sheesh!
Interesting… even if it is off topic. From personal experience ive always been more confident about being seen by a NP than a PA. Now I see there was some bases to it and see some if the limitations of these degrees. The PAs from the army arent necceassay the PAs of today, for that reason, l feel more comfortable with NP working along with MDs, with PAs under more a collaborative positions.
I am a second year medical student who was an ER staff nurse for 4 years. After obtaining my RN, BSN I was enrolled in a NP program (which was online) but quit due to the lack of training and rigor. I always wanted to be a doctor but decided to enroll in medical school.
I have a D.Pharm (doctor of pharmacy) and I work in a hospital setting (Im a clinical pharmacist).
However, I do not think its productive to refer to me as Doctor while in hospital for fear of confusing patients. Why should lay-people who know nothing about the health care have to be forced to analyze the meaning behind the title “Doctor”? is that person calling himelf or herself “Doctor” down the hall a medical doctor (M.D.) ? a nurse docto ? a pharacy doctor ?
Why confuse them? the title doctor is traditionally reserved to M.D. and that is what everyone is used to. Why confuse patients just so we can feel all high and mighty for being doctors of our respective professions?
So no, You should not call yourself Doctor neither should I, because its an academic title which in hospital setting will confuse patients. And after all arent we there to save patients lives?
A DNP is not an academic degree like a phd. It is a clinical degree. And people deserved to be recognized with the title if they chose to do so. There is nothing wrong with you saying “hi I’m dr. Smith, the pharmacist who’s going to review your meds.” You have a clinical doctorate that not all pharmacists have.
I understand why you don’t want to use it. I wouldn’t use it as a DNP, but there is nothing wrong with the people that do. The public won’t ever become more educated to expect clinicians with doctoral educations as experts unless they are educated and exposed.
sorry, but from i’ve heard and know, your doctoral programs don’t even teach you enough to DO anything in the clinical world, except to maybe manage a coumadin clinic, and ultimately, doctoral program or not, you mostly end up counting pills all day long for a living. period. many pharmDs NOWADAYS can’t even answer questions about medications, let alone offer anything more clinically-focused- which didn’t used to be the case.
so, DON’T try to equate YOUR program with ours. Nursing is its OWN world, beholden to NO ONE, except forced to live under the circa 1800′s lobby called the AMA, which, with a sole focus of consolidation of POWER, EGO, AND ECONOMICS in mind and deed, have had a century more than any other healthcare group to force the world of medicine to conform to their desires, via state and federal legislatures. That is being challenged.
IF Nursing had more men (a separate issue of unspoken, but completely allowed female sexism), i’m SURE we would have had parity on ALL levels DECADES ago, instead of playing nice with the “doctors” and the underhanded/loathsome AMA- my opinion, and the games it continues to play.
the AMA lost a landmark case decades ago wherein they were FORCED to make financial and other loud and open atonements to Chiropractors- when it was proven that their craven acts of trying to DESROY that profession, were uncovered and illuminated for the world to see. THIS is the world of PHYSICIANS. nice group.
The nursing field continues to make a mockery of medical education. DNP degrees are shams. Most programs are online (even at academic institutions) and can be done in 12-18 months. The coursework isn’t rigorous. A review of the local DNP curriculum shows titles such as “Information Technology in Nursing Practice” and “Leadership Skills.” DNP programs also typically don’t require entrance exams such as the GRE.
To all of the DNP advocates who have commented on this post I would encourage you to talk with nurses who have gone to medical school. It’s a rare phenomenon but I’ve met a few. The nurse-turned-physician will categorically attest to the fact that as nurses they were overconfident and woefully undereducated.
I’ve had enough interactions with nurses over the years to conclude that they have no idea what it takes to be a competent physician. Very few nurses could EVER get into medical school or complete a residency. The majority will tell you, however, that they could’ve gone to medical school if they wanted to do so. To this I say that there are no sadder words than “it might have been.”
I think you’re over generalizing. Many nurses could get into medical school, but did not want that route. Nursing is different than medicine. That’s why I chose it. I think its a specific kind of personality that shifts from nursing to medicine… and all the power to them. we should all help patients with the model that works best for us. I would never say advanced practice nursing is the same thing as being an MD/physician. It is different, but don’t sell NPs capabilities short. They are far more trained and have more experience than a typical RN. This is why they can do what they do…
Kelly, I don’t understand the argument that NPs who play doctor are somehow doing nursing. They’re not doing nursing, they’re masquerading as doctors. And what they lack in education they get with legislation, aggressive lobbying, etc. That’s not good medicine. That’s not good for the public.
NPs have far more education and training than a typical RN? Not much more. Let’s be honest. NP programs are only 18-24 months long. Sometimes shorter. And oftentimes online. DNP degrees are simply more of the same garbage.
I have yet to meet an NP or CRNA who doesn’t think that they’re equivalent to a physician. I’m okay with nurses who want to be helpful and be nurses. We need more good nurses. We don’t need nurses pretending to be doctors and confusing the public. It’s consumer fraud.
Id say about 99% of NPs are not DNPs, so this really isn’t even a big issue.
NPs typically have 4 year BSN, 2 year masters, and several years of expeience working with patients in between their degrees. You can’t just sign up online these days and become an NP, even distance learning has in person clinical requirements. A DNP has an additional year and a half on top of this. An accredited DNP program, even if done online has a big clinical component too. Most people don’t get DNPs and the ones that do, are usually excellent NPs with years of practice.
Additionally, overall nursing programs focus on competency based learning. You can’t pass unless you can’t demonstrate competency. They fail many students because of this. Medical school is really a time based model, the thought is if you spend x amount of time doing it, you must eventually learn it. The bottom line this is wrong, and even medical schools are starting to change how they evaluate students (due to med students graduating with poor ability to apply information learned) so it is more similar to the nursing model of care.
There have been many research studies that prove NPs provide safe care at lower costs to patients. In certain aspects of preventative care they have even proven more successful than physician counterparts.
While I agree an NP is not a physician, you are sorely mistaken in your estimation of their capabilities and education. It seems to me that your perception is you can sign up online an just be one, I can assure you that this is not the case.
Kelly, I don’t agree. I’d say that 99% of NPs will become DNPs because it’s so easy to do so. Why not become a “doctor” in 12 to 18 months with most of the program online? Hell, I would. Can you think of any other field that hands out “doctoral” degrees in 12 to 18 months? I can’t.
I know more than a few nurses getting NP degrees. One is at UNLV. It’s an online program. She shows up once every few months to take a test. And has a five or six month practicum at some point. Even she thinks that it’s easy. Compare that more than 10,000 hours of rigorous residency training after four years of medical school. No comparison.
Your point about competency-based learning is silly. Residency programs are all about competency. You can’t complete a residency without being competent. You’ll be kicked out. And I’ve never heard of a nursing student fail anything, which is curious because most nurses I know barely graduated from high school.
The research studies that you reference are ones published in nursing journals done by nurses. They’re biased and worthless. NPs and DNPs have lower salaries but they surely offset this savings by ordering unnecessary tests, because they don’t have the experience or clinical judgement to make good clinical decisions. Exhibit A: A radiologist friend of mine tells me that he always knows when the NPs and PAs are on call in the ER because the number of scans double.
The DNP degree is nothing more than a power play. It’s for nurses who wanna play doctor but aren’t smart enough or dedicated enough to go to medical school. It’s ironic that your profession derides ours but borrows the symbols of our profession in order to promote yours. You steal our white coats and stethoscopes. You talk about doing “residencies.” And you give yourself doctoral degrees. Enough is enough.
Unless it becomes a requiremet, there is no way you are right. why not go fdo it? Because it costs around $30,000 an doesnt give you anymore ability to practice. Most people have families and bills and cant just get more eduxation because it makes them feel good. A doctoral degree doesn’t make you a physician. Your NP friend must already be a practicing NP. You’re acting like you can go online out of highschool and become a DNP. This is simply not true. I am not saying the training for an NP is the same as a physician. However this is not a stupid group of people.
Lots of people fail out of nursing school. At least in the east, people are not just pushed through as you are suggesting. The studies I reference are peer reviewed studies, published in scholarly journals. And my reference to medical schools changing actually comes from statements made by medical societies.
You’re not well researched on this topic. You’re only asserting opinions, and quite frankly and opinion is something everyone has. It’s not factual though.
(Nurses are the first ones to wear white coats by the way.)
By the way a stethoscope is not an accessory. It is for assessing patients. It’s not a symbol of being a doctor. I you feel that carrying one to assess patients is “stealing” from the physician profession I can tell there is nothing that can be said to give you a different perspective.
Kelly, I’ve heard all of your arguments before from other nurses. I am well-researched. I’m a physician and I have a degree in public health. NP and DNP schools are nowhere near as rigorous as medical school and residency. Not even close. Nurses like yourself who assert otherwise are simply delusional. The studies that you reference are biased and unscientific. They’re garbage. My friend is not a practicing NP. Just a regular floor nurse who wants to double her salary. I’m not opposed to nurses who want to do nursing. But I am opposed to nurses who want to mislead the pubic for selfish reasons. You’re in this category.
I’m disappointed at the AMA for letting this happen. Dentists and the ADA do a far better job at regulating their mid-levels. You don’t see dental hygienists everywhere masquerading as dentists. What’s next? Doctorate of medical assisting? Doctorate of phlebotomy? Silly, I know. NPs and DNPs are little more than flight attendants who have hijacked the airplane. Heaven help American medicine.
“OliverHolmes says:
“what’s “garbage” is your attitude. you are probably some NEW resident or an early on physician who thinks you are the king/queen of the medical world. there are MANY experienced Primary Care FNPs with decades of comprehensive experience who could run circles around you- TRUST ME.
So what that you had a cadaver to work on., and may or may NOT have gone through your masochistic residency program, unless you are SO young to even know what that was like for physicians of a certain age.
I, as a seasoned FNP, did a two month residency WITH physicians in training as a hospitalist- experiencing PRECISELY what they did, and while it was edifying, there is NOTHING that separates a seasoned provider from another, of any type, after several years of practice.
you are a perfect example of who needs to be EXCISED from the world of medicine. i’m sure you’re just a joy to your patients and those who are unfortunate enough to be forced to work under you, which would NOT e a FNP. PA- yes; FNP- YOU can’t touch us!!!!
Boil your blood? Good, Pompous one.
FC, you’re delusional too. Go to medical school and do a residency and then we can speak the same language. I’m not a new physician. I’ve practice for ten years since my fellowship. No NP runs circles around me. But I do get ridiculous referrals from them on a regular basis for things that they would know how to manage if they had sufficient education. I prefer PAs over NPs because they have less attitude and better training. Your “two month residency” is further ridiculous commentary on the inadequacy of nursing education. And let me help you. Mentioning a “two month residency” is not a good argument for anything. It’s embarrassing, actually.
Attitude is EXACTLY what YOU have way too much of. someone should have firmly disciplined your coddle self as a child. as an adult and a physician, you entries read as a joke and have nothing to d with my world. i get it, you work in the south.
and, wow, 10 whole years. you’re a REAL experienced pro. try 15-20 years, THEN come back and speak to me or others like me. you probably still need an attending to watch your work, which explains your bitterness.
I am an attending, you moron. And I don’t work in the south.
you mean a “pretend” attending on your psychiatric unit, where you are the star patient. what a big boy you are to have come so far.
Dude, you write like you’re six years old. Are you handicapped?