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Nurse Practitioners – Doctors?

By Barbara Ficarra

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

  1. In a hospital setting, should medical doctors be the only doctors allowed to use the title doctor?
  2. 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?
  3. Will patients be confused by a nurse practitioner calling themselves doctor?
  4. If nurse practitioners are very clear in introducing themselves as a doctor of nursing practice, will that alleviate the confusion?
  5. Should nurse practitioners be called doctor only in an academic setting and not in a hospital setting?
  6. 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.
  7. 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.

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518 replies »

  1. It means she has a clinical Doctorate degree (in addition to a Master’s degree) in advanced Nursing Practice. The “C” means she is also board certified. She’s a doctor but not a physician. Similar to how an OD is an ophthalmic doctor, but they are not physicians. Nonetheless they have reached the terminal degree that qualifies them to practice in their area. You should ask her about it– I’m sure she would be happy to tell you about her credentials.

  2. I thought I was seeing a doctor until I looked at her business card. She has “Dr.” before her name, but the “DNP-C” behind it. That’s how I ended up at this website; I wondered what the DNP-C stands for. That’s interesting. I do like her, but she is not really a physician. Wow.

  3. Upon reading the “commentary” it is quite clear why the public has such a low opinion of physicians. Your academic accomplishments create entitlement issues and your colleagues reinforce your false beliefs. Group ideology is amazing…you guys sound like you are members of a cult. Your degree establishes you as a physician. Here is the reality, there are other doctors out there besides medical doctors. Your clinical time, training, and sacrifice earned you the title of physician. Societal beliefs and your inflated sense of self advocates ownership of the title of doctor. DNPs are in fact doctors…they are not physicians!

  4. Your analogy is very over simplified. While I agree NPs generally should follow conservative healthcare and use guidelines (they shouldnt experiment into new frontiers or do invasive/off-label things as the foundation of their practice)… Don’t discount that NPs have a lot of training that make them excellent healthcare providers. NPs have had far more training beyond their RN role to enhance and develop their skill set. They add a lot to the healthcare system… An absolute hierarchy when it comes to healthcare is not in the best interest of effectively getting healthcare services to the population. Everyone brings things to the table to help meet a patients needs.

  5. There’s a reason why “officers” who were promoted from enlisted ranks are only allowed to go so far. THE SKILL SET LEARNED IS DIFFERENT. Doctors are Generals, setting strategy. Nurses are Sergeants, executing the plan.

  6. That sounds like a terrible working envirornment. I can assure you i have worked with many ICU PAs and NPs personally… and they are fantastic. Sometimes even attending physicians would ask for their input on certain issues they may not see as often as the NP because they only rotate in the ICU on service a few months a year. Bottom line: There are good physicians and bad physicians. There are also good NPs and bad NPs…. I would highly encourage you to take the proper channels necessary to address safety issues with any unsafe healthcare provider. If we don’t do anything… We are contributing to the problem.

  7. I’m a 20 year ICU nurse.
    Our hospital just hired a 5 year experienced nurse practitioner who comes with none of the professionalism discussed here.
    She is book smart. That’s it. And she’s pushing her weight around our ICU.
    And she’s 300 pounds of obnoxious, full of herself “wisdom.”

    We are actually, passively, “teaching” her on the job. This idiot will order ventilator changes without any concept of the pulmonologist being on the case.
    She will come to her own conclusions about weaning a patient from the vent.

    I’ve asked her, “Do you really want to start weaning with a CXR that looks like that, and a peek pressure like that?” And then I’d see her trot her fat ass down the hall trying to figure out what I’ve told her.

    She is dangerous. I don’t follow her “orders.” I follow the neurologists orders and then I butt heads with her. Daily.

    But that’s what our hospital wants, huh? A cut-rate “specialist” with a doctorate in “nursing” writing orders on a brain damaged patient with no real time experience or proctored education. She’s just turned loose on society, and they gave her prescription priviligk es on top of that.

    Ridiculous.

  8. Hi, I do think this is a great website. I stumbledupon it 😉 I’m going to come back once again since i have bookmarked it. Money and freedom is the greatest way to change, may you be rich and continue to help other people.

  9. Jad, do your research. What you have said ,on all accounts, is not accurate. You have a misunderstanding of the requirements.

  10. James,

    Not trying to be a dick…and though I think I know what you’re hinting at, I’m a bit confused by your lack of syntax. Please elaborate, I think you may have some valuable insights.

  11. Nope, not a nurse or doctor, however, as a squadron medic I got called ‘doc’ a lot in the military. Been around hospitals, Doctors and Nurses a long time and there has always been a certain level of resentment by nurses toward Doctors, primarily because the Nurse spends so much more time with and caring for the patient, as they feel they know more about the patients needs. There are good and bad Doctors, there are good and bad nurses.

    But, personally, I don’t think this is about anything in this discussion. I’m afraid that it’s about the Affordable Care Act and setting the stage for a shortage of MD/DOs that will occur if fully enacted. The patients will still be seeing a “Doctor”.

    Just a thought

  12. No points lost for grammar. (I’m working on a phone too… Lol)

    Yes we are saying a lot of the same things. 🙂

    I understand you, as a physician, not wanting to share the title of doctor in a clinical setting. This is human nature… To me, you don’t seem arrogant… I expect someone who is trained as extensively in one field to be biased towards that field or profession. It means you chose a field you resonate well with and are passionate about. 😉

    I am certainly not expecting any physicians to lobby for nurses. Nurses who expect that are in for a life of unhappiness. (Police officers don’t lobby for lawyers. Architects don’t lobby for contractors. Why would it be different for nurses?)

    I think most RNs NPs and patients understand that a physician sacrifices a lot and is an expert. To me it seems pretty well accepted so I’m surprised you feel you have to defend your degree. As you advance you’ll feel it more…maybe as a resident not as much. I think there are a lot of experienced NPs who have been discounted by physicians. And this makes them more defensive.

    Just because something has been though historically, doesn’t mean it should still be. If that were the case our country would look a lot different. We would have separate bathrooms for races, not everyone would be able to vote, and we mighg still have slaves. So your argument isn’t that strong (if its just “well thats how it is”) for taking away people’s option to use the title if they earned it. (Dramatic, I know… haha) Personally, in the futureI see more NPs, particularly DNPs, opening up their own primary care practices and people will know they are seeing the NP because its an NP office. While you may have some in the hospitals… they really are best serving the community. in this case, the title of doctor is to demonstrate competence. Really primary care is moving more towards protocols, guidelines, and managing/triaging referrals… case management/ nursing. Primary care is no longer a one stop shop where you go for broken bones, allergies, pain, minor surgery, OBGYN… Now adays there is a specialist for everything (makes sense as there is a lot more to know!)

    PS. I agree on the white coats. It’s ridiculous. They are germ spreading reservoirs and vectors. Personally, I think white coats are for residents (who get a kick out of it) and people who need it as a confidence booster. I think it looks much more professional when someone has the confidence to forego the white coat and just dress professionally. In that case, I have to hand it to the radiologists. They don’t have anyone to put a show on for… So they keep it real, despite their different personalities . Haha.

    Good luck with your studies! And Happy Thanksgiving. 🙂

  13. Kelly,

    I think we’re arguing about semantics for the most part. I’m one of the few, soon-to-be docs who is in favor of letting NPs practice independently in general practice…I see the value and the need. The only caveat of course, that I propose and some programs do, is that all the NP’s fresh from graduation ought to be supervised for 2 years by an MD/DO or another senior NP, prior to being able to set up his/her practice. You could think of it as an NP residency of sorts, except that the NP’s get the same pay commensurate with their experience, as it is today.

    AKA…I’m not advocating an NP in the ED should all of a sudden make $50k just because he or she is under supervision for 2 years. The NP should still make $80-100+k in that setting, as it is today, depending on location, experience etc. Then after 2 years he/she can practice independently.

    Going back to the DNP issue where we disagree.

    Perhaps if I formulate my reasoning differently, you might see where I’m coming from?

    We both seem to agree that the education is different – and serves different purposes. If I seemed arrogant and contrived at times, its really because I feel/maybe even incorrectly assume that some RN and NP don’t appreciate what makes me different, and how truly hard it is to become a physician.

    The term Doctor has been historically applied to physicians in a clinical setting. It’s not that Dr’s have a strangle hold on the title. Physicians have a strangle hold of that title IN THE CLINICAL setting. This is how people identify who the terminal expert is. This is how it has been for decades if not centuries.

    Think of it as an honorary title of distinction that society has imposed on us. I don’t like having to defend my degree, which by the way is far from over once I enter residency…

    I agree with you that nursing has evolved. That more is expected of the advanced practice nurses. But doesn’t it have an aura of ridiculousness to it…. Dr. Nurse?

    Alos, everybody wears white coats as well nowadays, so you really have to read the initials on the ID to even know who’s who anymore. I personally could care less who wears a white coat, its just an illustration of the “I want to be cool” and be perceived as a doctor complex. I get along with all the nurses on my rotations, and SHOCK even grab food with some of them…but lets face it, even the nurses that I know, chuckle at the x-ray techs wearing white coats, parading around, while the radiologists comes in wearing a cardigan, khakis and Birkenstocks. LOL.

    Can we at least agree on that every radiologist we’ve encountered is an odd duck? Seriously it never stops to amaze as they never disappoint. The international guys are the exception though…most of them are ok 🙂

    Secondly, I personally feel, that your illustration of DC, DDS,DMD, etc. doesn’t really apply, because these people work in their own offices/are not part of a hospital and are not surrounded by ancillary personnel and allied health professionals. I mean can you see my point?

    A lot of lay people know the difference between healthcare professionals, but many don’t as well. I’m not a 23 year old med student. I got in medical school at 29 (MS1) after doing years of other things I’ve hinted at in previous posts, so I feel I have a modicum of experience with patient interaction. And if by chance regular people do know the difference, being able to discern one form the other is paramount to their understanding of whom they are dealing with.

    Even at the dentist’s office, people often confuse the hygienist with the dentist.

    Anyways, I need to stop and study… thank you for the work that you do. Have a Happy Thanksgiving!

  14. Engineers don’t work with patients, but in their settings they are referred to as Dr. by fellow co-workers. Their doctorate doesn’t relate to patient care, it relates to engineering.

    You are certainly entitled to your opinion. But, I think patients are a lot smarter than you give them credit for. They know the different between their podiatrist, chiropractor, veterinarian, dentist and brain surgeon.

    There are a lot of degrees that didnt exist in the past… But our knowledge has grown and therefore we have more degrees to obtain and demonstrate that knowledge.

    In other countries they don’t put NPs through the ringer as much to be able to take care of patients independently. There is always an argument in the US about them not having enough education compared to physicians… And that they need supervision above state boards of education… So the DNP degree adds more education to start to address this.

    Personally I am not a fan of using the title of doctor for anyone, just say what you are and leave it at that. But no one who does all that work should be told they cannot use the title.

  15. Kelly, most physician’s have not forgotten the basic underlying principles of science…those that specialize, have grown and extrapolated in their respective field, and as a result become experts. You may not use everything you’ve once learned, but the principles, the very foundation of the life sciences is not lost on you after 10-15 years of practice. That’s just silly.
    Good job, you’ve amassed anecdotal evidence by having talked to a few physicians who have admitted this to you. What sort of sampling representation is this?

    A PhD, as a study track (there is a big distinction between a formal 4 year study track, vs. ingenuity, and scientific contribution on a period of longer duration) is not “harder” than a MD.

    The reasons are:

    NUMBER ONE, unlimited number of PhD spots, the average PhD grades and test scores required to get in, are lower than the average MD. Fact!. Look it up. Stop spouting contrived quotes from a “few people” you’ve talked to. Secondly, a physicist, or an engineer would never address themselves as Droctor in a clinical setting…even the one’s I’ve worked with in the research hospitals designing and creating new ocular imaging techniques and devices, wouldn’t have the balls to say the things you’re saying.

    I have a BSME (mechanical engineering) and worked in nuclear research labs, and devised cutting edge research in magnetics…I could have stayed on and earned my PhD, but it wasn’t necessary. A PhD in engineering is, in my experience, the publication of your original work, that is peer reviewed, but you’re using the skills that you’ve already established in your undergraduate engineering degree. It is not needed to invent or be entrepreneurial. I also wanted to apply my knowledge of the physical sciences in the medical field..guess what, I need an MD for that.

    Researchers (PhD candidates) take their time and study differently than MD’s. Medical students and MD’s as GME’s, are responsible for an asinine amount of information in a shorter period of time- that’s the distinction, and which is also why the degree is “harder” to obtain.

    I need you to pay attention now… “harder” does not designate more important. Should the interventional cardiologist be praised for saving a life, while the Bio-mechanical engineer that invented the stent, be neglected?

    No, both serve a purpose. But the physicist/engineer would never introduce himself to the patient, IN A CLINICAL setting, as Dr. XYZ.

    If you want to quantify the intellectual veracity that is required to be a rock-star physicist, vs a rock-star neurosurgeon, 9 times out of 10, I’d give the Physicist the edge in innate intelligence. But it’s not a question of innate intelligence, the argument is based on “difficulty of the degree.” Edge, the MD. Hands down.

    An analogy might be: the world class Olympic sprinter or gymnast, who 9/10 times is innately more athletic and gifted than a Navy SEAL. But he or she isn’t a SEAL, b/c they didn’t go through BUDS or anything related to SEAL training, and thus shouldn’t say “well I’m almost a SEAL, I mean look at my power and speed and agility, I can handle obstacle courses just as well,” while neglecting the other 90% of things it takes to be a SEAL.

    As a patient, would you want to be treated by the guys and gals who invent the stuff and enhance the field on a daily basis? Or would you want to be treated by a DNP, somebody who has a more holistic treatment perspective? I believe it depends on the situation. Specialists will treat the severe cases. DNP will be subjugated to GP.

    But why confuse the patient population? I’m Dr. Kelly, your nurse practitioner…what? Haven’t you asked yourself why does this degree not exist in any other country? Because people don’t understand the need to get a professional doctorate in nursing. It doesn’t equate.

  16. There are a handful of typos in my post. Apologies… I was working off a phone this morning.

  17. If you are defensive use your earned title, physician. No one else can use that title unless they aren’t an MD or DO. (There are far more doctors than just MDs). The argument about what’s harder is irrelevant. Quite frankly I’ve even had several physicians admit its much easier to be a physician than have a doctorate in physics, quantum mechanics, or any Mathematical PhD. But who cares? It’s about demonstrating that you are qualified to do what you do.

    A DNP still has 8 years of college. This includes a masters degree along with clinical experience with patients before their doctorate (which MDs do not). Of course the education is not the same. A DNPs training is more focused to the population they are going to be certified to work with. Its more about applying research and guidelines for pt care than inventing them. The title of doctor is about demonstrating to patients that their provider is competent to do those things because they are someone who has reached the terminal level of education. Its not about demonstrating that one could pass some difficult entry level chem and physics classes (of which you will forget the material after several years of practice).I agree there should not be coercion, it should be Dr Smith DNP. While there is some overlap, there is a difference in the types of things NPs and physicians do, as you have pointed out. We don’t experiment on Pts to invent new treatments and procedures… We incorporate science but put the patient and their quality if life at the center. It doesn’t make us any leas deserving of being about to use our titles as dictated by out degrees. With regard to using the title followed by the degree… the true is same of MDs, DOs, ODs, DDSs, DMDs, DCs, DVMs, etc.

  18. As a medical student (and as a former EMT/ER tech) and recent MPH graduate, I am of the opinion, only in regards to primary care, that qualified NP’s should be allowed to independently practice…why not? The shortage of physician’s in our nation’s rural areas is appalling, these nurses would provide a valuable service in preventative healthcare.

    *By qualified NP’s I mean: two years of supervision, post program completion, under a physician or senior NP.

    I do have my reservations of nurses calling themselves “Doctor.” In a clinical setting, only physician’s should be allowed to call themselves Doctor. Those who bring up the “PhD in History argument” etc, are operating on a logical fallacy – one that neglects independent variables based on a methodology conceived through bias.

    It is an honor, to bestow the scientific and clinical title, because we worked so hard to get there. The level of academic rigor and detail, is simply not present in nursing curricula, BSN or advanced. I have tremendous respect for Nurses, PhD’s, etc…but if you did not put yourself through medical school, then in a clinical setting, do not call yourself doctor. In lecture, on publications, on letterhead, sure no problem. “Dr. Jane Doe, DNP.” is perfectly acceptable. In the end, it will be the MD/DO initials that count the most…and so it does in the eyes of most patients.

    Our citizens in rural America, will be happy to be treated effectively by NP’s for GP purposes. Major complicatins will require the NP to seek out transport to the nearest ED anyways, where specialists will descend upon the patient, and blot out the sun! 😉

    I often understand RN’s frustrations, as they see procedures repeated ad nauseum, but just because you think you know what to do and what is going on because you’ve seen it a thousand times…doesn’t mean you know why. 90% of the time, healthcare and its affiliated procedures are technical/mechanical, but for those rare occasion’s where things do not run smoothly you’re going to want a physician at your bedside, because he or she will know at a fundamental molecular level what to do. Period.

    My pre-med courses and the necessary GPA requirements of these said courses, are from an intellectual stand-point, far more challenging than any RN curriculum. It’s all books-nothing clinical and I stand by those words. Hell RN’s have to do 1-2 sequences of general chemistry, sometimes the non-major chemistry. I’d love to see an RN attempt to take o-chem, or bio-chem or p-chem…and do well!

    As physicians we are called on to be scientists and clinicians…true, the greatest percentage of Physicians only practice in clinical settings. However, a physician could and a large number still do, advance and invent procedures, therapies, drugs, etc. alongside their PhD counterparts, or independently among their cohort of fellow MD’s and DO’s. That’s the difference. Physicians are the end of the line. So, yes, I get defensive over this issue, because “you” haven’t earned the title.

  19. Kelly, I think you have made an interesting point thus far. In my opinion if you have reached the highest level of training in a specified field and obtained a doctorate degree then what is the problem with being referred to as a doctor? Every one of my professors who have a PhD, I refer to them as doctors. You guys are acting like a Nurse Practitioner degree is just a chip off the old block; it’s still an 8 year educational program. I’m sure every “doctor” knows the role they are suppose to play, rather its in education or an institution. I’m pretty sure a DNP knows he/she is not as educated in the “medicine” aspect as an MD is, but does that make them any less of a doctor? Do you think someone with a PhD in Psychology is going to as much in Sociology than someone who has a PhD in Sociology? Yet both of these people would be referred to as doctors holding the highest level of degree in their field and neither one frowned upon more than the other. My point is that these two type of doctors are taught different aspects of the medical field, both playing major roles. If I went to school for 8 years and obtained a DNP, “DOCTOR” of nursing practice, your damn right I would want people to consider me a doctor! The emphasis is on level of education, not the type of education.

  20. This isn’t a battle about who is better. There are some things nurses are better for and there are some things physicians are better for.

    As medicine advances… primary care services become well established protocols and standards of care. That’s what nurses are great at— taking well established things… and using them to put the patient’s quality of life and preferences at the center of what they do. It’s no longer a “science experiment” to provide primary care services. The primary care physician is no longer the “jack-of-all trades.” Most abnormal things now get referred to a physician specialist… AKA: “the scientist.” People with a medical mind want to practice science… that may be why, in part, we have such a shortage of primary care providers.

    Regarding your statement “Until u pass through the prequiste training its not just the same you would never be able to know as much as the physician.the amount of knowledge that separates us is a lot more wider than you think.” I disagree… nothing “magical” happens to someone in medical school. Medical school is not a mystical place that transforms someone as a human being. Many physcians will tell you that after years of practice they can’t remeber the first thing about the fundamentals they learned in medical school. Everyone gets into their area and only uses only what pertains to their practice. In medical school students read a lot of books, attend a lot of lectures, and spend learning in the field. Other programs and methods of education can teach people what they need to know using the same format, they don’t need the title of “medical school.” One is either capable or one is not. There is a path to deal with ANY professional who proves they are unsafe and not capable. With many physicians not wanting to do primary care anymore… we need something to fill the gap in a way that maintains standards and promotes quality of care.

    No one here is suggeting that DNPs are physicians or MDs. It’s about raising the bar for education though so that nurses who are providing primary care services can say they have a level of education that makes them a leader and scholar in their area. People don’t tell their dentist, optometrist, or veterinarian that they are trying to be a MD when they use the title Dr. The title serves to show the public that they are well educated experts in their field. The same should be true for a DNP.

  21. Idk y this is as issue. No matter how well trained or how many degrees and number of years of experience a nurse has they would NEVER be as good as the physician.Now talking about the number of years of experience and how it relates to how better an experienced Dnp is…well if d level of knowledge of an experienced DNP or PA (say 30yrs of experience) can be equated to not a Dr who has had d same number Of yrs of experience but to an intern of 1st or 2nd Year resident , that only means that There’s no basis for these arguments it clearly shows how deficient they are in the area of knowledge.it only shows that because of the number of years they hv acquired just a little of the Skill but There’s more to that. You hv to know the reasons behind what you are doing. You also need to know what To look for and how to go about it. I bet the DNPs are also lacking in that Regard so it would be dangerous for the avarage man out there if u allow the nurses to offer primary health care services. Nurses are wonderful people and are a very important part of the health sector but this whole Dr -Nurse-advancedNP issue wouldn’t be an issue If only they didn’t have self esteem issues becausethey think for some reason that doctors are arrogant , understood who they are and their importance and relevance to the health sector, and the limitations of their practice. Because no matter how much you are Being called a DR its never the same. Until u pass through the prequiste training its not just the same you would never be able to know as much as the physician.the amount of knowledge that separates us is a lot more wider than you think. So I think offering the best services to our patients would be the sole aim of advancing ourselves And getting higher degrees not proving that u know better than the average intern. Let the Nurses be satisfied with. Who they are and Their place in the Health sector and let the nurses be content with that. If u want to be callled an MD go through med sch acquire the training go through residency……pls lets learn to do the right thing . Because this Dr-nurse battle Leaves the health sector no where rather its the patient that is exposed to a half-baked Quality of service. Even if u re called a Dr it Doesn’t and can Never keep u on d same strata with the average physician rather it would only be constiuting an unnecessary confusion for the lay man out there. Nurses we appreciate you but pls for the sake of our Patients KNOW YOUR PLACE.

  22. I’d like you guys the patient’s perspective. I’ve known many MDs, RNs, and I’ve worked at a medical insurance company. I have epilepsy, been through many surgeries, medications, and doctors, both good and bad. I find this bickering over who is called “Doctor” petty and disheartening.

    In my experience, nurse practitioners are more accessible (easier to get quick appointments) and patient-centric , and willing to listen. In theory, they should also be more cost-effective. NPs are allowed to provide primary care in some states, and they should be. But patients must be made to know that they are not doctors (although my NP performs her duties far better than any previous MD), and I think the role of a non-MD should be carved out so that they can provide routine care (including clinics) and advice at a lower cost. Going beyond that really blurs the lines.

    Most patients (myself included) don’t really know what all of our options really are…we demand more transparency. The internet is making a big difference with that now, but for those who don’t stay informed, they have to know there is *someone* they can go to that doesn’t break the bank. I am personally tired of people taking up ER resources (some of our best doctors) with the flu…

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  24. I dont think anyone is suggesting RN training alone should suffice for advanved practice.

    The whole point of raising the bar for education is to promote advancement of healthcare providers using the nursing model. Converse to other models of care, the nursing model at the advanced practice level highly focuses on emotional intelligence/ dealing with patient pyschosocial issues in addition to clinical skills.

    Calculus has little to do with providing healthcare services. I would guess that most practicing physicians don’t remember much in the way of their medical school prerequisites.

    As someone who is both a nurse and who has traveled to a third world country, I can assure you… We are no where leaning towards third world by raising the bar for nurses and incorporating them into healthcare services more. Many many developed countries heavily rely on nurses and advanced practice nurses (particularly for primary care services). There is a place for everyone (MDs, NPs, DOs, PAs, RNs, ODs, DCs, etc) in the healthcare community to provide services without any shortage of patients.

    I am slightly troubled by your statement that nurses as a whole are unstable, uneducated people (especially since you are a nurse). As a nurse myself I have not found this to be an accurate assessment of my personal experience. I do not mean this in a negative way… but I would look at where you are working and dig deep to find out what makes you have these impressions. As a licensed professional (and the patient advocate) its our job to do this. I wouldn’t want anyone caring for me who wasn’t able to critically think and come into work with a solid emotional state.

  25. Agreed! Most of the nurses I know couldn’t make it through one semester of calculus, much less medical school. This is just so much “PC” nonsense and it is just another sign of our times. We appear to be well on our way to becoming a third world country. I am a female R.N., and most of the nurses I know are extroverted caregivers; they are not, however, very analytical or emotionally mature/stable. I would not want a nurse to care for me in the capacity of a doctor!

  26. You are correct that NPs aren’t MDs or PAs. Their education and training are different, though not necessarily less rigorous by any means. It of course depends on the specifics of the who/what/when/where of their education and experience. In fact, it is completely possible that an NP may be better educated and have better and more comprehensive experience than an MD or PA. Consider they old joke: What do you call a medical student that gets all Cs? Doctor. And there it is… the title is not the thing, but rather the abilities, experience, and education of the individual practitioner/provider, whether MD, PA, or NP. So what really fuels this debate substantively isn’t the title, but the POLITICS, POWER, and MONEY. The rest is pure rhetorical nonsense at this point (sadly).

    BTW, it should be noted that NPs are AT LEAST both bachelors and masters level educated, which is not necessarily true for PAs. Also, prior to completing med school, many MDs will have had minimal patient care experience and/or interaction comparatively to many (if not most) hospital and clinic nurses or NPs. There’s a reason that “bedside manner” is an issue that often comes up when discussing/reviewing MDs versus NPs or PAs. When it is the nature of your job to spend large volumes of time in actual patient care and interaction, it’s definitely not a “you’ve got it, or you don’t” thing. No, it’s essential and non-optional, and it’s becoming more and more relevant to providers’ interests as medical care becomes a more open market. Perhaps another reason MDs feel their feathers being ruffled…

  27. Nurse Practioners are not physicians and they are not physician assistants. While I have no issue with NPs becoming more independent and raising the bar by getting doctorates, in no way is it acceptable to have them take physician boards. If there is an issue with how rigorous our board exams are, then the advanced practice nursing boards should be made more rigorous. You don’t have optometrists and chiropractors taking physician boards, NPs should not either.

  28. Interesting post…many variegated positions on this. Ultimately, as a practitioner for over 13 years, my response is it doesnt matter. Be careful what you wish for, you just may get it. I would propose that after working with many PA’s and NP’s / supervising for many years, we can learn from each other and I have the utmost open mind and respect for their respective professions. I would say that is a PA or NP, wants more independence, then good for them. They should be able to sit for say the internal medicine board exam, and if passed, get a valid liscence and be able to have their own practice. Just remember , you will also have all the liability and cost associated with being a full partner, or solo practitioner…good luck to you all

  29. Have you ever interacted with a 3rd year medical student? They barely have the skill to talk to a patient. I just completed a Pediatrics rotation in NP school with an M3 (3rd-year med student). I figured we would be comparable to each other right? NO! Not at all. We entered rooms together and I knew way more about addressing the patient, tackling the problem, and deciding a plan than the med student. I will preface that I am 7 weeks from graduation and practically work independently at this time in my clinicals already. Of course he knew what was going on beneath the surface, I mean pathophysiologically, but so did I. Plus, I guided the interaction and asked most of the questions. No one is saying that nurse practitioners are medical doctors. But we are. and always will be good at what we do.

  30. The debate for the title “Doctor” rages on. I am a DNP student in the state of Oklahoma, where Nurse Practitioners who have earned their Doctorate in Nursing Practice are not permitted to use the title “Doctor” in the clinical setting. I do not agree with the view that patients would be confused by the title. I do not intend to become a “Physician” or represent myself as one. The term “Doctor” does not mean “Physician”. I call my optometrist, my dog’s veterinarian, my chiropractor, and my dentist “Doctor”…and I understand that when I do that they are not my “Physician”. It is ridiculous that upon earning their terminal degrees, these various practitioners can use their earned titles in their clinical settings and I will not be able to.

  31. I am a healthcare professional….a chiropractor…and I am considered a ‘primary’ care provider. As most concerns go in the healthcare arena…’Follow the Money’…..The Traditional Medical Care Universe does not like competition.

  32. “good care equals fewer lawsuits due to better outcomes and far better client relationships.”

    What a naive statement – while most lawsuits are either dropped or settled, to suggest “good care” will keep lawsuits at bay is sad. Every physician knows this is just not true…

  33. Why is there no real discussion of the fundamental issues in this debate: money and control? To hear doctors crying foul regarding NPs becoming competitive as providers is laughable, if not plain outrageous. There has been a long and growing trend of doctors employing NPs (literally and figuratively), but not for such noble and enlightened reasons as better patient care or greater coverage. Doctors have no problem with NPs as long as it serves their purposes and desires, such as increasing the number of billable patient visits, extra call coverage, etc. In fact, many doctors allow and encouage their NPs to practice without much direct (or even regular) oversight or guidance as long as the NP is seeing an adequate number of patients to generate more revenue. And then, the NP is paid much less by their doctor/employer despite effectively providing an equal or greater level of care to the patient.

    And that’s the real crux of this debate. Doctors may indeed have a greater amount of education, but that does not necessarily mean they provide better or more capable care in all cases or in all situations. In fact, it s rather presumptuous to both believe and assert that greater education necessarily means greater knowledge or capability. There are enough examples of the fallacy of that line of thinking to make it seem the exception rather than the rule.

    The fact is that NPs serve many functions, including positions as educators and mentors to med students and interns at most major medical schools. They effectively act as primary care providers in many (doctors’) offices, nursing homes, and hospitals. They do the same rounds, they write the same notes and orders, they take the same call, they treat and counsel the same patients and families, and often, they do it all better than doctors. This isn’t a matter of debate, this is fact.

    The fear doctors feel about losing their monopoly on the oh-so-beloved title of “Doctor” transcends issues of legitimacy and entitlement, and even their egotistical and vapid self-importance, cutting down to where it really hurts: the potential loss of money and control. NPs have struggled in a system that was engineered to limit their ability to reap the rewards of their abilities and services and they are tired of being taken advantage of for the sake of benefitting the disrespectful and dismissive medical doctor establishment. Doctors are now suffering the distaste of a healthy dose of their own medicine made from the seeds they planted and there’s no putting the safety cap back on the pill bottle again. Better learn to choke ’em down docs, ’cause NPs have found their stride and the rest of the world is onto you!

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  35. Your argument is nothing more than an opinion. I can guarentee you that there is a physicist somewhere in Cambridge who thinks that it is insane that physcians have held the term “doctor” hostage. I think most people with even a marginal appreciation for what a physicist does would agree that someone who works in a lab, performs out of the box experiments, and writes paperson Quantum Mechanics that have the potential to change our understanding of the universe is far more elite, scholarly, and scientific.

    So really, it’s all relative. I say, figure out what you want to accomplish, and do it. Get the highest education that you can that demonstrates expertise. That’s what the term “doctor” is supposed to mean. This is not about who is better than who.

    If you want to be a surgeon and or a specialist with an interest in a specific disease process or pattern go to medical school. If you want to focus on overall health, well being, and quality fo life go to nursing school. There is no RIGHT or WRONG. We need both of these individuals in our healthcare system.

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  37. LOL nurses are funny. With all that you said in that last post about really wanting to be a NP, how about you get paid as a regular nurse and see how much you still want to be an NP. If you think you are doing this because of your own interest and intellect, dont ask for a pay raise when you go and sign your new contract. All this is BS, nurses who become NP’s do it for the pay raise, theres no other reason why. You can pretend all you like about calling your self Dr. so and so, NP. How about addressing yourself as “im Doctor of Nursing so and so”, and medical doctors will introduce themselves as “I am Doctor of medicine so and so” and we will see how fast the patient takes the words of the MD over the words of the NP. NP’s are glorified nurses, nothing else sorry to be blatantly honest. Your “residency” is nothing like a medical residency, yes i agree you may have guided them, but you have no idea of the actual science thats involved from a molecular to physical level. You just have treatment plans memorized and able to manipulate them, but cannot create them, which is a skill MD’s have. The papers you guys write are no where near the scientific level MD’s can research and write papers on.

  38. MDs rely heavily on the RNs suggestions and thoughts for patient care. RN, NP… are very aware of the patients conditions often more than the actual physicians are. We take of them on a daily basis a lot more than MDs do. Nurses have to pay attention to details than the doctor does because the never have the time to truly know their patients. NPs are advanced nurses, who has the training and experience and compassion MDs don’t have. 20,000 hrs of “hardcore” training is good, so why are nurses asked for suggestions. MDs rely on nurses and other MDs for suggestions on the healthcare of patients. so don’t “dummy down” a nurse or NP, because from the looks of it…nurses are asked more than you know about what to do for patients of how to treat them….by MDs. Just because you are an MD, does not make that they any smarter than the rest, just paid more…

  39. My statement does not establish them as equals. It does, however, support them as independent members of the healthcare system. NPs and MDs are NOT the same. At no point can you draw lines to identify a point where there is equal education. NPs have a professional license before they ever start their NP degree. They are already taking care of patients. Medical students do not. So NO, an NP is not the equivalent of a 3rd year medical student. If you have worked with any medical students on a regular basis (as I have) you might be aware that seasoned RNs can often add a lot of the education of medical students when they are on clinical rotations.

    This education argument is ridiculous. Its an argument that is very easy to address too… (i.e. the advent of the DNP degree). If there really is an issue with an NP being incompetent take it to their state board- just as you would with an incompetent MD. That will fix any issues very quickly.

    The rest of this is just arguing for the sake of arguing.

  40. your statement is trying to establish NPs and MDs are equal. Simple math will tell you not. 20,000 hrs of hardcore training (ie residency) is lacking in NPs. NP boards are really dumbed down. NPs have the training of a 3rd year medical student so should we make 3rd year medical students take care of patients without supervision?

  41. I agree, title should correlate with training. I don’t think that anyone thinks a PA or NP should be called “doctor” if they do not have doctoral training. I am pretty sure if someone advertised themselves as Dr. Smith and they did not have doctoral training applicable to their advertised practicet… they can be charged with professional misconduct.

    However, physicians DO NOT own the title of “doctor.” The term wasn’t invented to describe a physician. (Physician is the term they own- and one cannot call themselves a physician if they did not go to MD, DO, or equivalent medical school.) There are many examples on this blog that support that there are many professions that use the title doctor.

    For me this is not about comparison at all. I am proud to be a nurse, I made a conscious choice to be a nurse instead of a physician. Those who feel the same way, but want to continue their education to become experts in their field may chose to get a Doctorate in Nursing Practice. It’s not about comparison or competition. It’s about saying to patients “I am a nurse practitioner who has spent a lot of time becoming an expert at what I do and how I care for my patients.” Patients have a right to educated providers. That’s why physicians started using the term… to describe that they are well trained, competent experts in what they do.

    If you don’t agree with “bridge programs” for PAs, that’s fine. Everyone can have their own opinion. I personally think this is reasonable since PAs are trained on the medical model of care. A doctorate for a PA seems to make sense that it would bridge to MD. (For NPs on the other hand, it is technically a different model, and I don’t think a bridge to MD makes sense)

    An advanced practice degree as an NP, PA , or any healthcare professional does not give one the title of “Doctor.” A doctorate does.

  42. This shouldn’t even be a debate answer=NO. If a NP/PA wants to be called doctor they should have went to medical school. The focus should be on the calling to the training. NP/PA are able to practice medicine and make a difference. The name of your degree is what you have been trained for, it is what it is. You are fortunate to have the independence you have to practice. This sounds more like jealousy than anything else. Quit comparing yourself to physicians and all the credit that you think they get and be grateful your in a good profession. Take pride in your work and title of NP/PA and the rest comes. I am a health care professional with an advanced degree myself.

  43. This started as a new thread last night, but I wanted it to be a reply:

    I don’t want to be a physician. I respect physicians, and I think that what they do is important. If you needed to go to medical school to accomplish what you want, I commend you. However, while they overlap in some ways the medical model is not interchangeable with the nursing model.

    I became a nurse because I want to take that which is well established and use it to promote health and well being. I don’t want to put problems in a vacuum and treat issues as a new frontier to make some kind of discovery. I dont want to experiment, I want to care for and motivate people. I want to use well established treatments to put my patient’s quality of life and preferences at the center of everything I do. Our knowledge base of well established treatments has grown to the point that makes prescribing medications and making diagnoses appropriate roles. 80 years ago common medical conditions like asthma, diabetes, hypertension, etc were mysteries… Now they are not. Physicians are onto other things. This shows with the lack if residencies filled in primary care each year. 80 years ago, people never went to physicians like they do now. Physicians exisit to treat problems. That’s why the overwhelming majority specialize in something.

    I became a nurse because I am interested in developing my assessment skills on what a healthy person looks like… Figuring out how to keep them that way… And figuring out who to send them to when they have a problem that needs to be put in a vacuum because it falls outside established guidelines of regular healthcare.

  44. Do you honestly know of any programs like this that exist? Even if something has online components, you can’t get around the clinical hours. And your license comes from the state, not from some online school.

    I went to school for a 4 year Bachelors of Science in Business. I graduated and worked for three years in medical sales. I really wanted to go back for nursing.

    In order to even apply to a “fast track program”, I had to take 3 credits of anatomy I, 3 credits of anatomy II (both with labs), 2 credits of pharmacology, 2 credits of nutrition, 3 credits of statistics (which I could transfer from my business degree), 6 credits of psychology (one class which I could tranfer from my business degree), and 2 credits of physiology. All this BEFORE I could even apply to the “fast track” 12 month program. Then I went to school for 12 months (full-time, year round- 5 days a week) where I did all the core courses, and the same number of clinical hours that a student in any other nursing program has to do. I passed the same national exam as everyone else.

    I can promise you… while some of the marketing things out there seem like they make it easy… it is not. It was a lot more work than if I had just enrolled in a 4 year degree program when I was 18 years old. I didn’t go for nursing because it was easier… I went for it because its really what I wanted to do.

  45. I am aware of the BS-RN. Infact, I hold a BS-RN, but I don’t usually make the differentiation. While (in theory) a BS-RN is a “higher academic degree” because it is conferred by the entire university… I wouldn’t go as far as to say it is “far more heavily science-based pathway than the BSN pathway.” BSNs from accredited colleges are perfectly acceptable degrees. The same holds true for a Master’s degree. You can go a MS degree or a MSN. I chose the MS degree, but I would not suggest that someone with an MSN has a problematic deficiency in their education.

    I agree with you that a lot of the physician lobby has attempted to control healthcare. Physicians do control the medical model, but they do not and should not control healthcare. Honestly, it doesnt surprise me that they want to try though. There is no point in arguing with them though. They have no training in nursing. One will never get them to support another profession to the level that promotes advancement. And the good news is, we dont have to. We need to refine our own profession, provide value to our patients, and advocate for ourselves in terms of making sure state and federal policies enable effective nurse utilization. No one can do it for us.

  46. “kelly”- actually, there’s a higher entry point for one to become an RN. That’s the BS, RN degree, which is a far more heavily science-based pathway than the BSN pathway to become an RN.

    Though most RNs go your route, I’m proud to say I went the former, which clearly, in my early years of practice made a huge difference in how I was perceived on the job, and when I next got my masters as an MSN, FNP-C, I lamented that there wasn’t a similar pathway for that degree. The DNP seems a wonderful way to achieve that long ago now, for me, goal, and I WOULD be called “Dr.” when I was through and again in practice, though I would also make it clear to my patients that the world of medicine does NOT belong to physicians, that a majority of surveys/studies have shown higher patient satisfaction with FNP care, and that not all physicians graduated with an “A”, but are, like straight people over gay, to a WORLD of rights that earn them FAR more money and prestige, simply because the AMA OWNS medicine and will stoop to anything to ensure that that dynamic doesn’t change.

    Just ask the chiropractic society whom they went after as “quacks” for decade until they were finally SUCCESSFULLY sued for trying to destroy an entire profession that was eating away at their sole economic ownership of any and every form of medicine, and were MADE to cease and desist, and apologize, if I recall it correctly.

    they are EXCELLENT at what they do as a lobby, since they’ve been at it since, get this, the 1800’s, on a Federal and STATE level across America. Its time to cut them off, so to speak, at the knees, so that the playing field is an even one.

  47. I don’t want to be a physician. I respect physicians, and I think that what they do is important. If you needed to go to medical school to accomplish what you want, I commend you. However, while they overlap in some ways the medical model is not interchangeable with the nursing model.

    I became a nurse because I want to take that which is well established and use it to promote health and well being. I don’t want to put problems in a vacuum and treat issues as a new frontier to make some kind of discovery. I dont want to experiment, I want to care for and motivate people. I want to use well established treatments to put my patient’s quality of life and preferences at the center of everything I do. Our knowledge base of well established treatments has grown to the point that makes prescribing medications and making diagnoses appropriate roles. 80 years ago common medical conditions like asthma, diabetes, hypertension, etc were mysteries… Now they are not. Physicians are onto other things. This shows with the lack if residencies filled in primary care each year. 80 years ago, people never went to physicians like they do now. Physicians exisit to treat problems. That’s why the overwhelming majority specialize in something.

    I became a nurse because I am interested in developing my assessment skills on what a healthy person looks like… Figuring out how to keep them that way… And figuring out who to send them to when they have a problem that needs to be put in a vacuum because it falls outside established guidelines of regular healthcare.

  48. so are you saying if you don’t go to “medical school” you are not a “doctor” even though the extra school and time is being put forth to earn that title? I’m sure a lot of educated professionals would have a lot to say about that comment!! We know there is a difference between a doctorate in a field and having an MD license. I wish people would stop being so hung up on titles and just enjoy life and alphabet soup. If i’ve earned my BSN, then progress to MSN and the DNP I’ve earned every alphabet in my “alphabet soup”. Dont try to take someone’s accomplishments aways simply because of the word “doctor”. Just like and MD feels proud about earning those letters, so should every one else in any other profession, including the nurses who paid their dues and earned their PhD (Doctorate).

  49. med NURSE, some nurses do not want to be an MD. MD’s tend to take out the care and compassion a “nurse” has and it’s been proven that people prefer NPs over MDs. Hopefully MDs will see that they so not have the compassion/patience that a nurse has and clean up their act. With you already being a nurse going back to med school, hopefully you won’t lose the compassionate side and prefer quality over quantity for the sake of the almighty $$$$.

  50. Kelly, I kinda understand where Jad is coming from. A lot of online schools allow people to get their nursing license without going thru clinical and actually taking care of patients before getting their degree. I have no problems with ADNs getting their degree online because they have to have the clinical experience for that, but allowing someone with a bachelor’s in engineering should have a free ride to obtaining a nursing degree without the “work” going thru nursing school.

  51. Instead of getting an alphabet soup after your name why do you go to medical school and earn an MD/OD? I’m an RN, BSN, EMT-I who is in my second year of medical school. Please keep patient confusion to a minimum and become a real doctor (MD/DO).

  52. There really is no “fast track.” The 12 month program for advance students are for students who already have a bachelors degree, plus they take about 15 credits before starting the 12 month part, then they do three semesters of clinical (hence the “12 months”). But really… It’s 6 years of college…

    ADNs go back to school for around 18 months. They already have two years of college and a bunch of experience. This is hardly a “short cut.”

    Very few jump right into their NP. It’s a minimum two year masters that most students space out over 3-4 years after they work a few years.

  53. Jad, I definitely agree with you on that. The medical field is not a field to be “toyed” with, peoples lives are at stake. I have been and LPN for 10 years and went to an accredited site down in class do clinical and paper work for 3 1/2 years, definitely not an online nurse or a “Bull Sh**Nurse” as i would call them. It is now being required that nurse practitioners get there doctorate which consists of another 3 years after getting a BSN (the real one). So that would put me at going to school to obtain my PhD in nursing a 8 year degree which i will wear the title of DNP proudly and will consider myself a “DOCTOR” of “NURSING” in every since of the word. Just like as in any field of getting a doctorate degree, you should be called “doctor”…just not of medicine and I will show my credentials proudly…….Jackie J, BSN to MSN and finally DNP!!!!…..like it or love it 😉

  54. I am not trying to insult you… But honestly, what are you talking about? There is no factual basis for your statements. NPs are BSNs that get MSNs and MS degrees. An ADN has to get their BSN before they can get an MS or MSN to become an NP. There has been a movement to further elevate the educational requirements to a doctorally prepared DNP level, which is further education on top of their Master’s. Most NPs are certified nationally, and all are certified by their State, just like any other professional.

  55. I finf it interesting that an ADN can hop over the critical thinking skils a BSN has and becone an NP quicker than a BSN four degree registered nurse can become an NP.An now there is a rush of MSN’s with not a lot of clinical experience to tale their boards before the 2015 DNP regulation comes into effect. That means that these fast track NP’s will still be out there, still practicing horrible healthcare. Programs that offer anybody with a bachelors degree in anything can enter a fast track NP program and become a registered nurse in 1 year and an NP in 2 yrs – I know I do not want of these NP’s as my clinician. nor do I want a fast track ADN to BSN be my nurse. By fast tracking to fill voids in the health care system is causing health care to fail in treatment of patients and is costing more money for the patient. Give me a 4 yr degree BSN, MD, DO any day That is my choice I do not want lousy care from fast trackers. PA:s at least they are retested not like NP’s – and who knows where their credentials come from – it’s fast track diploma’s bringing down the health care treatment to patients. To say the least with all the other health care issues our insurance companies and governement fight over.

  56. This should be embarrassing to any health care professional. Please know that this site can be seen by anyone. What would people think who just happen to find this site and see how nurses and doctors (M.D.s) are conducting themselves. The animosity is ridiculous…over the title “doctor”?…really!!!!

  57. I’m surprised by the concern of the doctors (M.D.). I am a newly graduate with my BSN interested in obtaining my doctorate in nursing. I don’t understand the what the big deal is. We know a nurse with a doctorate degree is not an M.D. by any means. But I do feel if I took the time and effort to get my doctorate degree is should be able to feel honor and privileged to consider myself a doctor (of nursing) not doctor (of medicine). Just as any one else who earned their PhD is called “doctor” a nurse should be able to wear that title just as proudly. No I don’t plan to go to medical school or nor do I want to go to medical school. As a student nurse and an LPN working with M.D.s in the hospital, they no longer have the care and bedside compassion as a nurse does. Is that the REAL problem…the public is starting to prefer NPs over MDs? If I am blessed to be able receive my doctorate, I will definitely refer to myself as Dr. Jackson, NP, but the NP will definitely be announced with the doctor so there will be no confusion as to my level of education or training. But I will give respect where respect is due and I will demand my respect when it’s due. Our main focus should be on providing safe and quality care holistically to each of our patients weather we are M.D.s or N.P.s

  58. Where I live and practice NPs are calling themselves or letting themselves be referred to as “Doctor”,nonspecificly. Even patients who are sophisticated in medical customs have been taken in. At first I thought this was a rural condition and it was more due to my clients’ lack of knowledge. However, when I was talking to some physicians I found that this was occuring in larger areas, university cities, and, I found later, even in major cities. In the later case, the NP was careful to not refer to herself as “Doctor”. but her staff did so repeatedly.

    A number of years ago, I lectured to a group of nurses as to their legal liability in the case of their growing proffesionalism and increasing demand to play a larger role in patient care. While we discussed the “captain of the ship” doctrine and the “deep pockets” rationale, I also pointed out to them about appearances. In those days I was talking more about the appearance of caring. Now I am going to say that if you put yourself out to look like a medical doctor …be prepared to be sued like one.

  59. I am not a doctor or a nurse… But the town I live in, the “doctors” if you will pretty much SUCK… They are rude, arrogant, and treat you like they have better things to do. All the while giving you minimal time, care and respect. (The ones I have seen at least) I took my son to THREE different pediatricians, INCLUDING the one who saw him in the hospital when he was born. This guy or “doctor” comes into our room, while he is on his cell phone, gives my brand new son a quick, half assed (excuse my language) once over. Then gives me the blessing of pulling the phone away from his mouth but not his ear, and asks me, “do you have any questions?” Then gets slightly irritated because I had the audacity to ask him some. Then sends me a bill in the mail for almost $800! Because his inadequate, and extremely inefficient office can’t get their ducks in a row, which ended up being a huge insurance problem for ME to solve. Now my family sees, yes, two nurse practioners. I see one, and my children, sees the BEST in my opinion, doctor. The only REAL doctor we have is my OB. She’s pretty awesome. My point is… You can slap a title on a pice of crap, and its STILL just a piece of crap. Let me guess… You’re a doctor??? Yeah there goes that arrogance thing I mentioned earlier. My NP, and now my children’s NP blows the docs outta the water.

  60. I have tried to avoid this blog for some time, as I feel that most of the comments on here are largely insensitive to the fact that this shouldn’t even be a topic of conversation. Why is this even open for discussion? it is only because we are nurses that this conversation even exists! we must be doing something right-otherwise why all of the hostility regarding a profession (nursing) allowing its members (nurses) the opportunity to obtain the highest level of education available (DNP). Nurses and physicians are apples and oranges so the people that compare the two professions make no sense. all of the health professions have a unique quality to contribute to the make up of the health care system and how that care is delivered to each and every one of its recipients. Patients have a right to choose and they have a right to know who is caring for them but there is no paradox in calling a nurse a doctor! I graduate with my DNP in August 2013. Can’t wait, it will be the greatest achievement academically and professionally for me because I have always enjoyed patient care and clinical nursing. the PhD was never an option for me and I struggled with wanting to pursue higher education in Nursing other than the Phd and beyond a masters degree and did not have that option. Now I do, now WE do! We should not have to suffer the ridicule of the AMA or any third parties because of their insecurity and persistence towards keeping us down. The newest ludicrous of all is the SB612 a new proposed law in florida-which is trying to make it a FELONY of the THIRD DEGREE for NURSES and NURSES only who introduce themselves using the title “Doctor” and do not disclose that they are not an MD or DO!! Seriously, I am HAPPY to be a NP and will be happy to be an NP with a DNP! Why would I want anyone to believe something that I am not? that would just make me look like a perpetrator, a fake, a phony-all things I am not!! when i graduate I may call myself Dr. and I may not-but it is my choice either way and your goddamn right when all is said and done whoever I am dealing with or caring for will know that they saw an NP!!

  61. “Jr says:”- “better”- yeah, cuz there’s NO such thing as a Freudian slip there, right, “Jr?”.

    IF you r a physician, it would seem to be YOUR ego problem to hear the reality of the Doctoral NP world versus the coddled, oh so hardworking MD world- cuz no one else in medicine works anywhere near as hard as you do, right? and with ALL of the money and access to MAKE even MORE HIDDEN money via ownership of all things medical, office buildings, MRI
    Centers, etc., you couldn’t simply be OVERLY greedy and egomaniacal, now could you?

    You’ve ALL been HANDED a hereditary goldmine of graft and AMA lobbyists (in my CLEAR opinion and based on ANY reading of the way in which the AMA has and continues to operate- since they essentially incontrovertibly – through NO effort of yours, have maintained ownership of ALL things medical since the 1800’s due to the 100% takeover of each state’s/Federal legislative bodies over time from that early date through to today – in my CLEAR opinion.

    an example, and for any young NPs or physicians here who are unaware of this reality, the AMA spent decades trying to DESTROY the chiropractic profession- with whole impunity. They were FINALLY taken to court where they LOST a protracted case filed AGAINST them by chiropractors in Federal court which fined them a massive amount of money, i believe, AND forced them to formally admit what they had done. Some things NEVER change.

    Reality, a hard thing or the egomaniacal to accept. they think they’ll just hurl a few more demeaning adjectives at nurses, who, BELIVE ME, quite certifiably surpass the care provided by at least a goodly number of certainly new and older physicians, per a ream of valid studies. physicians todays are SO beyond bogus, they don’t even know how to practice the most basic of evidence-based medicine.

    point in case, a 74 year old female, with no real history of UTIs got ONE- that itself was questionable via all of r/t lab results; YET she was immediately placed on a fluoroquinolone by a PHYSICIAN for 5 days. this would be the LAST abx choice any provider who KNEW what they were doing would have made in this case. further, the physician should have mentioned that she drink cranberry juice, along with taken Vitamin C while doing so. did she, of course not. she ought to be reported to the state medical board, as should have the next two recent and true physician stories.

    another lovely physician heard a male patient complain of unremitting left ankle pain after reporting having taken quite a fall down and around the end of a moving escalator. she didn’t even bother to have him remove his contralateral shoe; simply told him he should wear “orthotics” because he had pes planus. not allowing this moron to get away with practicing such grossly subpar medicine- for which she got paid PLENTY and having written to her practice manager after the truth was revealed of her “care”, naturally there was not a SINGLE response. that said, i, the FNP, demanded that we see another doctor, who rightly ordered a lumbar spine MRI which showed the ACTUAL cause of his persistent ankle pain- THREE traumatically herniated discs. THIS is physician is STILL practicing medicine today.

    another case involved another elderly female, who had a large SCC lesion, and the elderly dermatologist wanted to simply use cryotherapy to remove it UNTIL i stopped her and asked her why she was negating the updated standards that SCC lesions of HIS type are ALWAYS to be excised. she mumbled a series of lame excuses, hen set up the CORRECT surgical appt. i doubt she’d have attempted the same removal were the patient her daughter, grand daughter, etc.

    three examples of about TWENTY that i, myself have had to correct, WHILE in the room. God only knows what happens when i’m NOT in the room. doctors are HARDLY gods. they suck, at least more and more.

    as a former, much beloved, physician mentor, now den of a prestigious medical school said to me as a student, “don’t worry, a monkey can be trained to do most of what a physician does.”

  62. ‘Steven M says:”- such garbage, but given the OBVIOUS EGO problems of CERTAIN physicians, you’ve CLEARLY EXPOSED the real issue here. your MASSIVE EGO thinks that nurses WANT to get Doctoral Degrees because we “couldn’t” get into medical school.

    your thought pattern is so wrapped up into your MASSIVE EGO, and what a bedside manner you must have as a podiatrist.

    it turns out that anyone who seeks a PhD degree lives in just about the same IQ zone, so your silly, egomaniacal blather is just that. cut many toenails lately?

  63. How is this even a discussion? An NP isnt an MD. The training and the hoops to jump through dont compare. One is the top of their class for 16 years prior to schooling, the other was the average student.

    Everyone wants to be called a dr nowadays.

  64. Sounds like there is a lot to that story that goes into quite a bit of professional misconduct for both the “MD” and “NP.” Any professional who doesn’t practice in accordance with their scope should be held accountable.

    This hardly seems relevant to objecting to clinically prepared doctorates using their titles in their professional setting. Licensed Nurse Practitioners can practice autonomously in many states. In primary care, this would often include performing many of the same tasks that a physician does independently. In more tightly regulated states they are required to be supervised directly. Down the middle you have some moderate states that allow independent practice as long as they have a physician “collaborator” who reviews a certain percentage of the NPs cases every “x” amount of months.

    The issues you bring don’t seem to be related to a competent, doctorate prepared NP using the title of “Dr.”

    Rather, the actions you talk about seem to be related to two unprofessional professionals. One a physician, and one a nurse. Two very different educational backgrounds… but neither of whom were able to demonstrate evidence of proper practice. Just goes to show you… if someone is an unethical person, no level of education can save them.

  65. I myself do not think NP’s should call themselves doctors. I live in a very small rural town. At one time in this town there was a doctor who had a NP working for him. Needless to say she did most everything as he was a poor doctor. BUT he was not supervising her as he should have and most of the patients believed she was an actual MD as that is what she called herself. She was also calling in meds for people who she had not seen in the office. Ask most MD’s and they will tell you that you have to see a patient before calling in an antibiotic or several other medications. This was not happening. Several things were going on in the office that most lay persons would not know were against protocol. It was found out and reported. Needless to say they are no longer working in this community.

  66. Kelly

    You are the kind of nurse I love working with! Thank you for your opinions and comments. Sharing like that is the way to help others define what will and will not work for them in their theory and in their practice. Thank you again!

    Renee

  67. For the love of nursing, please tone it down…. This isn’t coming off how you intend it to.

  68. I’m not really sure how getting more eduation or seeking certification that demonstrates competence makes someone “a laughing stock.” DNP programs are useful programs that teach NPs how to apply clinical research (where as a PhD focuses on conducting research mroe often). Education shouldn’t be found as offensive. Nursing is a fantastic model of care. Doctoral training exists for many fields. I don’t see an issue with people who want to better themselves and develop a profession. It has nothing to do with a physcian’s esteem. They are physcians. They have zero training in nursing. I do not expect them to be able to intelligently reflect on what a doctoral level education should look like for a profession different than their own.

    I know a fair amount of DNPs and I don’t know any that really use the title “doctor.” (They could use it, but they just don’t). They didnt get the degree to get more money or increase their scope of practice… they did it because they wanted to gain a higher level of expertise in nursing provided healthcare.

  69. “Lisa K says”- are you for REAL? i think not.

    its more likely that you are either a physician or a “medical assistant” who THINKS that somehow she is a “nurse” as is often the case based on uncorrected misunderstanding by patients who call anyone who is female a “nurse”, esp elderly patients, for NO nurse in the world would allow him/herself to live in as debased a manner as you suggest ought to be the norm.

    there is NO more a a reason for physicians to be called “Doctor” for having earned that designation as the terminal endpoint of their training; just as a FNP can NOW do, after many, many years of planning (of which i was part, so know firsthand the extreme seriousness in which this pathway for the designation of a DNP-C or other Nursing doctoral terminal degrees was discussed and undetaken, and believe, me, fake nurse “Lisa”, there was not a WORD spoken during this seminal 5 day Palm Springs, CA meeting around this VERY issue of ensuring that Nurse Practitioners would need to have doctoral Degrees by 2015, or be grandfathered in if they already WERE FNPs/NPs and didn’t wish to continue on with Doctoral educational programs, about Physician Doctors.
    I, as a LONGTIME FNP-C, could CARE LESS about the world of physicians; know it quite well; work well with my COLLEAGUE physicians; and, should ANY of them ATTEMPT to treat me in some throwback way, they WILL hear about it and in a nanosecond.

    trust me, “fake nurse, Lisa”, PHYSICIAN Doctors used to practice by “letting blood”, and practicing many, many other UTTERLY unheard of practices today- like when there was no such thing called antibiotics or any treatment for diabetics or eclampsia or any of a myriad of disease states that USED to cause death or prolonged agony, then death; – but Physician Doctors STILL still called themselves Doctors.

    There is simply NO REASON on this planet earth that a well-deserved DNP-C NP should be called anything but what he/she is- a DOCTOR. If physicians do not like it- TOO DAm+ BAD!!!

    Maybe the AMA can release its stranglehold on ownership of all of the ancillary big money PHYSICIAN-owned medical sites, then NPs may feel better about them overall.

    Bottom line, the AMA has had a strangehold on “medicine” since its inception in the 1800’s, an would/will stoop to ANYTHING to ensure that only Physicians stand at the top of the heap. it may even be that the “Lisa'” of this comment line are flat out AMA plants.

  70. I’m an RN and nurse educator who thinks the whole DNP process is a joke and another effort to make us a laughingstock. FNP or CNS designation wasn’t enough; we had to go the “APRN-BC” route because our physician colleagues were “board-certified”. It’s ridiculous and I don’t blame them for being offended, frankly. It’s like we are ashamed of our own credentials. We need to get this enormous chip off our shoulders about our indispensable role in the healthcare system instead of clawing for the esteem of physicians, which is what underpins all this IMO. You want to be a doctor? Then go to medical school. I’m personally very happy to be a damned good nurse.

  71. Renee,

    Don’t forget that DOs are too physicians. I agree that they have a model of care that is a lot more holistic in its approach. However, they have integrated with MDs a lot and I believe they have lost a lot of their holistic philosophy once they get out into practice.

    I hear what you are saying about RNs with chips on their shoulders. I moved to a different city to get away from unionized crazy people who are set in their ways. I work in a very large academic medical center, and I can assure you that the overwhelming majority of nurses do not have chips on their shoulders. They are wonderful professionals who embrace their model of care and work VERY collaboratively across the interdisciplinary team. Thats the benefit of being in a Level 1 trauma center surrounded by 6 schools of nursing. They only take the best of the bunch. 🙂

    The bottom line is this regarding the MD/RN animosity… we all work for our patients. There is no such thing as getting one profession (like an MD) to be a champion of another (RNs,NPs,PAs,ODs,JDs,LMTs…. you name it…). Their expertise and preferance will always be in what their training is in. Of course they are going to reject something that doesnt mirror image their own training. While it’s good excersise to have engaging conversations with other professions (like you do with your brother)… don’t ever expect that you will change their mind. 🙂

    The DNP dilema is not about making MDs feel better. Its about raising the bar in the nursing profession. The more focus people have on clinical issues and application of clincal research, the better it is for patients and the higher level of care provider you will have.

    It wasn’t so long ago that physcians were a very poorly respected and poorly organized group. Their educations varied and their methods of practice varied from homeopathic doctors (who engaged in proecudes like blood-letting) to mad scientists. Somewhere around the 1900’s the profession got it’s act together and turned itself into the well respected and well paid profession it is today.

    As the shortage for healthcare services grows I think it’s imperative the nursing raises the bar for its profession. Be a part of the change you want to see in the (professional nursing) world… 😉

    I wish you luck in your clinical journey. My advice to you is this: What level of licensure will allow you to accomplish what you want in a way that works for you (no one else, just you)? That’s the question I had to ask myself in order to sift through all the B.S. Because at the end of the day, it is about your ability and satisfaction. A physcian once told me this and I have found it very helpful “There are 3 As in medicine, and none of them are ‘academic. The three As are what patients really need and they are someone who is amiable, able, and available.” Whatever will lead you there, that’s the way to go. 🙂

  72. Wow. I stumbled across this thread while searching for ideas when considering whether or not I’d like to go through a DO education. I have my masters in nursing and work in surgical research. I do NOT want to be a physician as I, like Kelly, don’t believe that model of care works for me personaly in regards to how I’d like to treat patients. My brother is a physician and we have very interesting conversations as you can imagine. He wants me to go to medical school, I have absolutely no desire. I work with several wonderful surgeons who happen to also be wonderful people. I work with a FEW wonderful nurses, but MANY who have that chip on their shoulders that FC so clearly displayed. It’s a shame. My fellow nurses have destroyed my respect for nursing. I would never consider furthering my career in nursing. I will either do a DO program or a completely separate PhD, but definitely not in nursing. The bitterness, anger, eating of our young, and hatred has absolutely turned me off. I know the DNP dilemma will NOT help the MD/nurse animosity at all, but hopefully its not the patients who will suffer.

  73. In your case I agree you should not use the title doctor, because it is a PhD, which is an academic doctorate. DNP (as PharmD, DPT, etc.) is a practice doctorate (which can be thought as a clinical doctorate). Nurses have the option to get PhDs in nursing too, but in the case of PhD, the title should be reserved to academia.

  74. I am a Surgical Care Practitioner in the UK which is a bit like your Nurse Practitioner in th US. I work alongside a Consultant orthopaedic hand surgeon and have my own elective clinics. I see patients with a multitude of ailments but mostly Carpal Tunnel Syndrome. I do EMG nerve conduction, steroid injections and CTS decompression surgery. I am so worried that my patients think I am a medically qualified Doctor I give them a leaflet which describes my role and states in huge capital letters that I am NOT a doctor. They read it in clinic and after the consultation they say “thank you Doctor”! I have an MSc in Advanced Surgical Practice and am about to start my PhD. When i get this I will NOT use the title doctor unless I am teaching at the Uni. It’s just too confusing. I’m proud of my achievements but you can only be called a doctor (in the clinical environment) if you have a degree in medicine.

  75. I am a nurse working towards a DNP and will be done in 2.5 years. This fight about nurses being called doctor is out of controll. I have the highest respect for MDs and what they stand for. I have not gone through med school, but I have stood behind many residents guiding them and teaching them how to be become a MD. I consider that my residency for the last 20 years. I have patiently stood beside many soon to be MDs and helped them through the decision process of what do I order and why, think of the side effects, and etc… I am proud of that fact. I WILL introduce myself to my patients as Dr. SEW, NP. I WILL not pretend to be something I am not, which is a MD. I have however put in many years to get to this point of my life and feel I deserve the proper title of doctor but not to mislead others in believing I am a MD because I am not and I accept that. I do not mean to anger anyone but we must work together to advocate for the public on all levels. thanks for reading and take care to all of you!!!

  76. Oliver, you clearly have a VERY skewed view of life. You need to remove the stick from your anal cavity and chill out. To say we have more flexible hours ( fine) less malpractice costs ( fine) but coffee breaks every two hours ( That is a gross misjudment and lumping in of a few shitty underachievers with us folks who have busted our asses to get where we are) I’m not afraid to admit it, I didn’t go to med school because I didn’t want the expense. I did however spend a pile of money on 2 bachelors degrees, a masters and a doctorate/phd. I never wanted to be a doctor. I happen to agree that NP’s should not and do not deserve the title of Doctor but your delivery is WAY off.

  77. While I am open to more pathways to physician degrees for those who want that route, I don’t agree with eliminating the DNP or NP option. DNPs and NPs are not supposed to replace Physicians. I specifically chose the nursing role because I like the nursing model of care and I knew I could accomplish what I want as an NP. Even if it was offered to me at bo cost, with a living stipend, I would not become an MD. It doesnt work with the model of care that I am drawn to. The nursing doctorate doesn’t open up scope of practice. It really just is, at this point, for
    Masters prepared NPs who want to obtain more education about nursing practice. While I think NPs can independently manage many things, I think the more specialized they get and the more complex their patients are… The more they have to refer to physicians and/or partner with them. While, the nursing model of care is simply not enough to support those patients alone.. most healthier people with few or no health issues still new healthcare and still need health management. Nursing is the best care model for these people. It’s about assessing patient, motivating them, and keepin them healthy. If something totally off the wall comes up, that’s where your MDs come in.

    Honestly, I don’t care if someone calls me doctor or not… Im not drawn to the idea of using the term “doctor” personally, but I will not be told by an MD I cannot use the title.

  78. This post just demonstrates that you have a chip on your shoulder to accompany your ego. Yes there are doctors with tremendous egos, but I believe yours can rival even the holiest of doctor complexes… speaking from a patients point of view.

  79. yes, because being the winner of a prestigious writing award over 24,000 others made me that way. its called typing fast without looking at the result, realizing that many of those to whom i am responding aren’t worth the time to even bother doing so.

    as for “jr”- its amazing how many of you physicians (and i assume you r a physician, or a poseur acting as one as a way to try to inflate your own ego where no one can tell, i.e. a blog) try to label ME as an egotist, which, as a 30 year meditator is a riot to read- as it proves that YOU r the ones’ whose “egos” are overly involved and don’t like being taken down a notch.

    as for nurses “helping out doctors”- sorry, dude, but we do NOT exist to “help” you; maybe an RN does, but a FNP certainly wouldn’t; especially the majority of those who’ve responded on this blog.

    and, ah, “jr”, writing on a blog that includes as many comments from NPs as it does a dying “STUCK” profession of MDs, actually writing of NPs as “they” even as THEY are in your audience of readers would be a better example of one with an ego problem. generally if one is speaking WITH another, he doesn’t refer to him/her in the third person directly in front of said “they.” now, THAT’s an ego problem, but you don’t see that , do you, cuz you r a high and mighty, actual DOCTOR, while those with the terminal NP degree of a DNP are just “theys”, and lowly one at that, apparently because we don’t help “real” doctors. what century do you live in?

    something tells me ALL of you rage-fillled “DOCTORS” are bitter, old, and republican.

  80. Keeping in mind, that afterwards they would be physicians… and not “nurses parading as doctors” as some are concerned of with the DNP

  81. Ive have thought about this and would be in support of a pathway for NP to obtain MD. I dont think it would be a disaster, because I believe training would be as rigorous as anyone else obtaining and MD. It seems more logical than a DNP — which as much as I respect kelly points so far — I dont see the purpose of.

  82. FC you come off as a troll. You are a prime example of nursing trying to exacerbate the tension between MD and Nurses. Honestly, you are the only one who has been coming off as the better one thorough this discussion. The other pro Dr.Nurse should be weary of you speaking on their behalf. I can just imagin how taxing it is as a patient, nurse or doctor to get any work done whiles managing you ego.

  83. If you wanna be a good pilot, you should go to pilot school. Flight attendants make pretty sucky pilots. Nurses make sucky doctors. Amen.

    PS. “fc” is illiterate.

  84. And we also know how to refer when something is beyond us. Unlike many MDs who end up with way more malpractice for failure to refer.

    I want to do primary care. Nursing was the best way to get started. FNP was the best way for me to do it as a provider after 5 years in nursing. People graduating medical dont even see the value of using that kind of education to be family practice providers anymore. and if i went to med school i would feel the same. who wants to make $120,000 a year as an over worked pcp, when you can go be a gi doc and make $750,000. It doesn’t pay well compared to what else they can do. I knew what u wanted and picked a good path to it.

    People learn to MDs in residency. Not medical school. After 15-20 years o practice MDs don’t remember any of the details of gross anatomy (except in the organs they now specialize in), systems they don’t specialize in, and every detail of the Krebs cycle and clotting factor cascade. Give me a break.

  85. “So, I’m looking forward to more flexible hours, less malpractice costs and coffee breaks every two hours . . .”- its my belief that you are not even a physician. first off, if you HAD the requisite normative IQ necessary to become a physician, you’d have noted that the lessor malpractice costs for a FNP are SOLELY related to our BETTER provision of care, i.e. our care doesn’t result in LAW SUITS, as we actually KNOW how to provide high level, holistic medicine such that we DON’T get sued and have the correlative astronomical malpractice costs.

    good care equals fewer lawsuits due to better outcomes and far better client relationships.
    besides, with your written attitude as part on your DNP application, you wouldn’t stand a chance in HELL of being accepted. you’d probably be reported to your state’s medical board.

  86. Kelly, I’ve never met an NP or PA who makes it clear that he/she is not a physician. Very few will correct the patient. So, I doubt that DNPs will.

    I don’t understand your rationale for becoming an NP. You could’ve done all of that as a physician and you’d have far better training. But becoming an NP is far easier and far less expensive. So, I get it, even though you’re not admitting it.

    A PA to MD pathway would be a disaster. Some PAs are really good at what they do. But even though they know how to do something they tend to not know why they’re doing it. That’s not “competence.” That kind of medicine is dangerous. NPs have the same deficit in their training. I don’t think that watering down admission criteria to the MD degree is the answer to delivering healthcare. It’s already bothersome that some oral surgery programs provide MD degrees for their oral surgery residents even though they never go to medical school (this phenomenon allows an oral surgeon in my hometown to do boob jobs).

    But I am interested in an MD to DNP pathway. By your reasoning I already have a DNP. Or at least I deserve one. So, I’m looking forward to more flexible hours, less malpractice costs and coffee breaks every two hours . . .

  87. Well, hey, thanks. 🙂

    I don’t think nurses make good physicians. For the few NPs that have DNPs, I dont really care if they use the title doctor or not as long as they are clear that they are not a physician. Personally, I don’t want my patients to call me doctor. But I cannot speak for others.

    I thought long and hard about if I wanted to go to medical school, and I chose nursing because I could accomplish what I want to accomplish best a NP. Nursing is not the same as being a doctor. It’s a great model of care though. It puts the patient’s enviornment, quality of life, and perception at the center of what you are doing and still takes into account proven medical treatments. Medicine really puts science in the center–and focusing on above all else treating conditions in a vaccum (which sometimes is GOOD and preferable!). Sometimes however, this is BAD. When we are talking about how so many chronic conditions are the result of poor patient complaince and poor self-care, I think the NP role is ideal. As an advanced practice nurse, my goal really is to work as a primary care provider and keep them out of the hospital. Its to figure out how help them manage their hypertension, obesity, diabetes, chronic pain, etc… and then refer things that are way outside of normal to specialists. Unlike chiropractors, naturopaths, and some other alternatives it takes into account medical advancements and does teach practioners to refer to physcians when something is too specific.

    I think we both are coming from different perspectives. If I had to guess what type of attending you were, I would say you are probably a surgeon of some kind. And surgery is really is a tricky arena for so called midlevels. I think if any NP wants to get really specialized they have to be willing to accept medical supervision. I do not think NPs should be doing surgery on people and or doing procedures like drilling holes in their skulls. I agree, if you want to do that, go to med school. You’re an NP working on the nursing model of care… and while I beleive that should be independent in many aspects… I dont think that the operating room is the place.

    PAs are bit of a different animal. They look similar to an NP in a hospital, but really there are more issues. At least NPs technically come from a different licensure, and they have a different model of care. PAs conversely were created for no other reason than to be an extension of the MD. They ARE trained on the medical model of care… and they think becoming a PA sounds great when they are 22… but they end up bitter and pissed when they are 52 and know more than the 36 yo MDs they are working for. (And don’t tell me that a good PA with 25 years of experience cant know was much a new attending… you know that is not true.) I dont agree with them getting a “doctorate in physician assisting” because they work on the same model of care. I think the best way to address this issue is for the AMA to lobby for medical schools to create a realistic bridge programs for PAs. It is not realistic to tell a PA that if they want independence that they need to go back and take 4 years of med school and 4 years of residency when they already have a MUCH higher level of competency than a first or second year resident. BUT, if you made something more realistic I think it would solve the PA issue. For example: Take a PA who has a Masters Degree and at least 4 years exerience in a certain area (lets say they are an internal medcine PA) and allow them to take a one year 12 month all intensive med school bridge program to fill in the gaps and then allow them to do a 2-3 residency in the area that they ALREADY have their 4 years of PA experience in (in this care internal medicine). Have them take all the same exams and boards, minus MCAT. I think that this is a very realistic way to practically add more medical doctors quickly that doesnt sacrifice on the amount of clinical practice or class room experience people have.

  88. Kelly, I like you. But I don’t agree with you. Nurses don’t make good doctors, not matter how hard they try. And I wouldn’t make a good nurse.

    Is there a role for NPs? Sure. But they need to be supervised. Unfortunately, all that I see are overzealous, undereducated NPs who barely do more good than harm. DNP degrees will make the problem worse and confuse the public even more. The public is already confused about PAs, NPs, chiropractors, naturopaths, dentists doing plastic surgery (sic), etc.

    PAs are trying to do the same thing as nurses. There’s a movement in the PA world to change PA from meaning “physician assistant” to “physician associate.” And Baylor apparently offers a “Doctorate of Physician Assisting,” which is nearly as silly sounding as “Nurse Doctor.”

    You’re wrong about the nursing lobbies. They’re far more organized than doctors’ organizations, which is why nurses have been able to expand their scope of practice without opposition. The AMA used to be a potent force, but that was 25 years ago.

    Advice on how to double your salary? Get out of academics.

  89. The persistent “nursing lobby”? I have to say that made me chuckle a little. You don’t think the AMA is a stronger lobbying power than Nursing? That’s simly not true. The AMA has way more money and political power than the “Nursing Lobby.” (Can we at least agree that a doctor’s salary is higher than a nurse’s? And with money comes the ability to lobby?) The AMA has lobbied publically with ad campaigns to discredit DOs for many years (until they eventually stopped), chiropractors, and pharamcists. MDs used to diagnose patients, patients would take a diagnosis to a pharmacist and the pharmacist would select an appropraite medication. Thanks to the AMA they have made pharmacists nothing more than glorified pill counters in many (not all) pharmacy positions. You under estimate the lobbying power of the AMA greatly. They have changed our society so much that the public now worships the “allopathic medicine god” to the point that they have unrealistic expectations of science and medicine. People fall at the medical alter with such blind faith that they waste tens of thousands of dollars– even when things hit a point where medicine can not help they keep going.

    Nurses are only just starting to get organized, which is a good thing I think. It is strange to me that you can have RNs with equal scopes of practice coming with so many different types of education… ranging from diploma nurse to bachelor’s degree. There is nothing wrong with becoming more unified. We arent even unified in a single lobbying group like the AMA. If there are issues with scope-of-practice that you have there is a path to deal with that. Most NPs are not crazy wing nuts that want to start drilling holes in peoples skills. There are a few… but I think that is human nature. It exists in the physician community too… just ask any “real surgeon” about how they feel about OBGYNs or Family Practitioners calling themselves “Surgeons” and by doing poorly performed c-sections. I feel there is a lot of research and patients who support that NPs are useful. Additionally necessity is the mother of invention… if they were not useful, they would not exist.

    If you find issues with the care ANYONE with a license gives, why would you just “be annoyed” and not say anything. In general the healthcare world “covers-up” for each other way too much. Doctors do it. Nurses do it. PAs do it. They all do it. You wouldnt see that among lawyers, I can assure you. 🙂 Instead of just over generalizing that NPs are “crap,” use your knowledge to educate your co-workers about mismanagement and also report things are seriously mismanaged. We all have a responsibility to keep each other in check for our patients. This responsibility doesnt mean just writing off an entire group of professionals and it doesnt mean just looking the other way when we see something unacceptable.

    Nurses at any level aren’t here to serve physcians. They are here to work with physicians to serve patients with healthcare needs. If someone nees intensive medicine for some specific disease, I agree a NP cant replace what an MD can do in all cases. However, there are many patients who simply need standard, well-established healthcare. Thats where the origin of the independent NP role came into play. I think both NPs and MDs working together make healthcare better for patients. Even in specialties NPs add value when working with MDs. As a nurse that is how I see it. As someone who works in a big academic medical center… that is how it plays out where I work. The raise you get when you finish your Masters and start as an NP is about 10%, not double. If you can tell me where I can double my salary… please let me know.. 🙂

  90. Kelly, it’s a matter of time before NPs start doing burr holes for subdural hematomas. CRNAs are fighting in every state to do X-ray guided spine procedures. They’re not trying to help the physicians. They’re trying to compete with them.

    Making up a DNP degree has nothing to do with providing better care and everything to do with leveling the playing field between doctors and nurses. Nurses want the title of “doctor” but don’t want to do the work. And the public suffers. Ignorance and confidence is a bad combination. I’m really tired of patients getting mismanaged by NPs, CRNAs, etc. I see it all the time. So do my colleagues. We’re all tired of it. I’m not threatened by it, just annoyed.

    Why do NPs persist? It’s not because they’re helpful. It’s because of the aggressive nursing lobby. Physicians have traditionally done a terrible job representing their own interests. They’re either complacent or simply too busy taking care of patients to get involved. The AMA Is completely ineffectual and naive. Only 15% of physicians are members. I’d love to see a public relations campaign by physicians. Perhaps a billboard that reads “Is your doctor really a doctor?”

    I’ll add that it’s curious that nurses are okay recommending their brand of medicine to the public but always demand to be seen by the best board certified physician in town when health care problems affect them or their relatives. I say, go to a DNP.

  91. Wow. This has gone very far off. I don’t want to see war between two groups. Rather a mutal respect and interaction between the two groups working for the better of patients. I think each profession brings A LOT to the table… and there is certainly NO shortage of patients that we can both help.

    I dont know how your friend can get a DNP online in 12-18 months without having a master’s degree first. If that’s happening, I agree, it’s NOT a proper education. I can imagine that this is an accredited program. If your friend is really serious about providing healthcare services… she should make sure she’s not just getting a piece of paper. I’ve never heard of floor RN to DNP in 12-18 months online. The goal of the DNP is really to augment an EXISTING master’s trained NPs education so that they are better at looking at reaserch and incorporating it into practice. With the advent of technology, there is more and more evidenced based practice that is coming into play and I think that is particularly where NPs are going to be useful in primary care.

    I work in a large university health center, in a city where there are several large nursing schools. So maybe I am spoiled a little bit in terms of the quality of nursing education and nursing professionals.

    I am NOT saying NPs replace physicians. They do not. But I do think that they deliver excellent healthcare and that they bring good to our community. Nursing is a wonderful practice and a great profession. Just like there are doctors that give medicine a bad name, there are nurses that do the same for nursing and Advanced Practice Nursing. Just like the non-board certified cardiologist who killed Michael Jackson using medications unsafely in a field he was not trained in… there are RNs and NPs that might mislead someone or do something unsafe. This is NOT every or even the majority of RNs and NPs, just and Michael Jackson’s doctor is not every doctor. It troubles me when people don’t see the benefit of NPs and when people are threatened by it– even angered by it.

    I can assure you that the studies I reference were not “garbage.” I am not suggesting that NPs are going to become brain surgeons. But NPs do have a lot of value, especially in primary care. There are less an less MDs going into primary care, and really 90% of what a primary care MD handles can be handled by a seasoned NP. This is good for patients and good for physicians. NPs have been around for more than 50 years. They wouldn’t be growing as a group if they were not helpful.

    There is a path for anyone who does not practice within their scope of practice and does not provide safe care. Patients will not tolerate bad care and are very ready to take legal action if something is done wrong. We don’t need a “witch hunt” in the meantime comparing apples to oranges. Nurses at any level are trained to work with other memebers of the healtcare team and refer things off that they are not trained to deal with. This is not different when one becomes an NP.

  92. 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.

  93. 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.

  94. 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.

  95. 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.

  96. 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.

  97. “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.

  98. 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.

  99. 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.

  100. 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.)

  101. 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.

  102. 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.

  103. 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.

  104. 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.

  105. 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…

  106. 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.”

  107. 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?

  108. 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.

  109. 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.

  110. 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.

  111. 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!

  112. 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!

  113. 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.

  114. 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.

  115. 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…

  116. 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.

  117. “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.

  118. @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!

  119. “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.

  120. 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! 😉 )

  121. 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.

  122. “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.

  123. 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.

  124. 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?

  125. (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.

  126. 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

  127. 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.

  128. 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.

  129. 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.

  130. 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.)

  131. 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.

  132. 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.

  133. 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.

  134. 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.

  135. 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.

  136. 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.

  137. 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.

  138. 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.”

  139. 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.

  140. 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.

  141. 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.

  142. 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.

  143. “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?

  144. 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.

  145. “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.

  146. 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.

  147. 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 .

  148. 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.

  149. 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.

  150. 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.

  151. 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!

  152. 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 *

  153. 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.

  154. I am glad that at least some can see through the smokescreen. You hit the nail on the head.

  155. 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.

  156. 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!

  157. 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 :)!!!

  158. 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.

  159. 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.

  160. 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.

  161. 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.

  162. 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.

  163. 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.

  164. …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…

  165. “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.

  166. 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.

  167. 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.

  168. 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.

  169. 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?”.

  170. 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.

  171. 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).

  172. 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.

  173. 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.

  174. “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.

  175. 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.

  176. 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.

  177. ALI…what made your NP inadequate? was it just the fact that they had an NP behind their name?

  178. 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.

  179. 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.

  180. 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.

  181. 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.

  182. 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.

  183. 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…

  184. 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.

  185. 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.

  186. Sorry, you are so off!!!!! I don’t even know where to begin. Do your research and try again.

  187. 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.

  188. 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?”

  189. 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.

  190. 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

  191. 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.

  192. 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”…

  193. 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.

  194. 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…..

  195. 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.

  196. 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.

  197. 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.

  198. 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.

  199. 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

  200. 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.

  201. 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

  202. 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!

  203. 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!

  204. 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!

  205. 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.

  206. 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!

  207. 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.

  208. 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.

  209. 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.

  210. 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.

  211. 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.

  212. 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.

  213. 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.

  214. 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!

  215. 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.

  216. 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.

  217. 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 !!

  218. 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.

  219. 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.

  220. 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.

  221. 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.

  222. 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.

  223. ….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…….

  224. 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

  225. 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..

  226. 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.

  227. 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.

  228. 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.

  229. 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.

  230. 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.

  231. 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.

  232. 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.

  233. more like just Dr. Keischa, DNP, MBA, NP-C, Family practice. I agree that all the crap behind the name is a little much but I don’t think we will get away from that since we must clarify what profession we are.

    Thanks for the wishes of congratulations. I understand your frustration but I want you to know that I just truly like scholarship and giving good evidence based care. I appreciate collaborating with my MD, pharmD, DPT counterparts. I hope that you will to.

  234. 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.

  235. 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.

  236. 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.

  237. 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.

  238. 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!

  239. Good luck with your daughter. Navigating a complex medical system can be challenging, even without people trying to deceive the public.

  240. 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).

  241. “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!

  242. 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.

  243. 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.

  244. 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.

  245. “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.

  246. 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.

  247. 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.

  248. 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?

  249. If all you got from Gern’s post was “physician bullying and superiority complex”, you completely missed the point. Entirely.

  250. 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!

  251. Absolutely not. They wouldnt dare demand a physician address them as such, so whats the point?

  252. 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.

  253. 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.

  254. “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.

  255. 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.

  256. You are doing the work that is “required” of you. I will not argue with that statement. I am sorry that my opinions have caused you to resort to foul language to defend your one day a week dual advanced degree program. Congratulations on being published in a nursing journal. Sorry that the editors did not share your opinion on your other three manuscripts that you submitted.
    I am good friends with a colleague who is pursuing an online DNP. I am sorry that you were not able to find a program as easy as hers. It sounds as if you have chosen the most difficult program in the country. I am not sure she would be able to stand up to the rigors of one day a week.

  257. Just a hint, Dr Melworth is arguing the same point you are. You are attacking someone who is on your side. Please carry on as usual.

  258. You proved my point below. You stated that you have worked full-time and gone to school full time for two different degrees (DNP and MBA). You are clearly doing 300%. Of course you think it is challenging. You are tired because you are taking a “full load” of classes for two “advanced” degrees one day a week and working 40 hours a week. I expect that you would find that challenging. Most would. Consider, however, that perhaps they are not that challenging if they allow you to pursue two “advanced” degrees full time and you can do it in one day a week while still keeping your full time job to pay all of your bills. How may med student/residents do you know that hold down a full time job while pursuing their 12 years of training and only devote 1 day a week to that pursuit? It is impossible to do.
    Kudos to you. You have located the quick way to a couple of advanced degrees that will probably land you a good job earning a lot of money to compensate you for your one day a week of schooling to get your “advanced” degrees. Thankfully, you will have no school debt when you finish up your degree. Maybe you should also be considered equal to a CEO since you will also have your well earned MBA.
    Here is your name tag:
    “Dr Keischa, DNP, MBA, RN, NP, MSN, LOL”

    Best of luck to you.

  259. 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.

  260. you don’t make any sense. in your first sentence you stated, ” The title of doctor is used for anyone with a phD. Doctor of history, sociology, religion and on and on. MDs do not own the title of doctor” but then you go on to say that, ” i do not see the value of the DNP education as of yet and have not pursued it because of that. If I ever did, I would never introduce myself as a doctor. I chose to be a nurse”. if the title of doctor is an academic credential and you earned it then why wouldn’t you introduce yourself with the title you earned. you can still make it very clear that you are an NP despite the fact that you have a doctorate in nursing. Nurses need to stop berating Nurses. no wonder we can’t get anything accomplished. You haven’t embraced the DNP education, but maybe you should it is a valuable degree and if we don’t embrace it as our practice doctorate then all we have to look forward to is the PhD, and most of us don’t want to do a PhD because we are not interested in research. I will tell you that it is a valuable education and I saw differences in approaches to practice already in comparison to my non DNP counterparts. I am just saying that Nurses need to advocate for nurses if you don’t feel that the education or degree is worth it to you then don’t persue it. the dNP is still in early stages and the education is going to evolve and students give feedback on what they liked and didn’t like. I agree with you that we should all just be happy with who it is that we are. I am proud to be a Nurse and always have been, but I am still proud that I am earning my highest designation in the DNP and I am not going to hide that fact by not using my earned title just because another discipline believes that it infringes on their territory somehow!

  261. Im sure you can. Many, however, cannot. My fiance (RN) constantly complains at the lack of basic medical sciences her classmates have, especially the ones who took watered down prereqs (most). this is a top school too.

  262. “You are not “just” settling for a nursing doctorate degree. You are choosing it because of its philosophies and approach of care.”

    Then why all the fuss about being called a doctor when you chose nursing…

  263. My fiance is an NP and she has basically agreed with NB on this issue. I know may people who suffered through med school just to get the MD for the title. The last thing we need to do is avert our eyes here.

  264. This I can agree with. You are right to point out problems in physician practice. I’m glad you wrote this. I always am bewildered by the same practices. However I concur with others that DNPs should introduce themselves as “Dr. X, nurse practitioner” for patients to understand. IF DNPs are just as good patients won’t see them any different, as they dont with DOs.

  265. Sounds awesome. Lets just get rid of MDs and DOs then and let DNP’s figure it all out since they’re no less than a doctor. They can also do the brain surgeries and diagnose the abnormal presentation of paramyotonia congenita.

    This is a simple issue of piggy backing onto other people’s credentials. Of course doctors are territorial about something they earned with an other group pretending to have done the same (please, this is really what this debate is about). what do you expect. You think they’re just going to forget about all they had to put up with that DNPs never had to deal with? lay down and pretend they’re the same? Hey DNPs, how about we start calling all the CNAs and RNs doctors too? they can do online courses for 18-24 months and we can not do some double blind randomized trials on patient outcomes! sound good?! Its all for the patients so don’t be pompous arrogant jerks and look down your nose at them please…

  266. 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.

  267. actually. no. I worked full time because my school offers all the classes on one day, all day. so i go to school on monday from 7-9 at night and work the other days of the week tues thru saturday to get my 40 hours in. No breaks for me. when I am not at school, I am at work and when I am not at work, I am doing school work. so don’t give me your bull about the online classes cause it doesn’t apply to me!

  268. and I suppose you want someone to call you a Dr. of history? because you know alot about history? I bet you also don’t believe that Nurses should be called Doctor’s because they also don’t fulfill their educational requirements according to your standards to be a nurse or a physician? because if your standards are to be a physician then-no, of course not! but if your standards are to be a Nurse-then I can assure you that if you look at the DNP educational requirements you will find that the curriculum falls right in line with what we as NURSES as educated to do! so if you think that the DNP is crap- well then I think that a Doctor of History smells like Bullshit too then!

  269. you obviously know nothing Gern. You make ridiculously stupid points that have no fact. you are quick to go on and on about what you have to do in medical school and completely misrepresent the facts about Nusing school and the DNP curriculum. truth of the matter is even if a nurse goes to get their nursing degree in 2 years they still have to go the additional 2 years to get their bachelors before they can even get their masters. not to mention I had to have 3 years of clinical experience before i could even apply to nursing school. furthermore because of the faculty shortage, unlike what some of the other dummies have posted, there is high competition to get into nursing programs because there are not enough professors to teach at high levels. what is your deal against online classes? have you even taken one before? online classes are no less challenging than on campus classes. physicians shouldn’t be mad they should be glad that we are more educated in our discipline. nobody is saying that they are a physician so really what is your problem? the truth of the matter is if you meet educational requirements you earn the degree. some classes being online doesn’t mean the credits don’t count.

  270. I am doing the work. I am doing the work that is required of me. who the hell are you to tell me that I am not. the DNP is not a made up degree, It does hold weight and it is a valuable degree. Nurses that don’t believe in it won’t because they are not in a DNP program, physicians don’t buy it because we don’t do as much didactic and have residencies like them, who cares! why do you care, I fulfill my requirements just like you. we are not just doing stupid projects to complete the degree either. we are doing meaningful and practice changing projects that go through rigorous scrutiny by a major professor (who by the way holds a Phd) and two other doctorally prepared faculty before we can even get an approval to do it. it’s not something you can just put together in a semester and be done with it. We have to write project proposals which can take months with several re-writes before even getting approval to go in front of a university Institutional review board (IRB) prior to implementation of the project. I find it hard to believe that you people believe it is so simple and have never even taken a course in a DNP program but somehow are knowledgeable enough to sit behind a computer and scrutinize the rigor of something you know nothing about. we are forced to be knowledgeable about evidence based practice, comprehension of research, statistics, epidemiology, and business concepts and are expected to use this in every facet of our program. we are expected to use this knowledge of research and statistics in every paper we write and are expected to be able to disseminate this knowledge. we are required to submit for publication and alot of my fellow students including myself have published several times before they even graduate. furthermore, we can’t just submit to any journal they must be Peer reviewed journals as a requirement for every single class that I am in. I can assure you that this is not a cake walk. often times the articles submitted for publication require rewrites that run across semesters and require time beside your normal course load, clinical hours and usually full time work life to get done. I have published 1 article so far and have submitted at least 3 that I felt were worthy. competition and scholarship is high for paper space in those journals and I beg anyone of you to challenge me to the rigor of my DNP program. please! don’t speak about what you don’t know because most of you know shit about what we do in Nursing school and what is required of us beyond what you read on a college website and course descriptions of our curriculums.

  271. the funny part is we don’t have to do this. all of you doctors are bitching about how much schooling you got compared to how much schooling nurses got! to say what? you went to school for medicine and we went to school for nursing! I don’t have to do all of the bullshit you just mentioned to get your degree because I don’t want to be a physician. stop getting pissed at Nurses because we don’t take the same courses as you! why would we if we are getting a degree in Nursing, Physical Therapy, or Pharmacy? are you all so worried about this DEGREE CREEP that you talk about? It’s ludicrous to sit here and argue the credentials of another profession and compare it to yours when they are different disciplines and require different skill sets and areas of knowledge. to say that we should go to medical school to be called doctors is stupid! to say that we should do residencies to be called a doctor is more stupid! to say that we should take USMLE exams because you do is dumb, since those exams are constructed for someone who has taken courses concurrent with medical school programs to be able to pass! of course without alot of studying we probably wouldn’t do well on those USMLE because it is not designed to test based on what we learn. you see the funny part about this is don’t give me this bullshit about all of this coursework you had to do because I don’t care! so what! I had a lot of coursework to get through to. I put in my blood sweat and tears just like you! I had sleep less nights and long clinical days just like you! It’s not Degree creep if you put in the time and the effort and complete your designated curriculum-who the hell are you to tell me that I don’t deserve to call myself Doctor! everyone of you physicians are missing the point on this web page. No one cares that you went to school forever, you chose that. I chose to go to Nursing school and I would never sit here and say that if you want to be called doctor then you should go to Nursing school and do the 4 year undergrad and the additional 4 years of grad school to be called doctor because somehow the two disciplines are equivalent. this has everything to do with the fact that physicians want everyone to know that they went to school for a long time bla blah blah blah blah blah!!!!! all of us went to school for a long time! are you somehow better than me because you went longer if you went for something completely different? you are pathetic!! pathetic! pathetic!! who cares what someone in a completely different profession has to do to meet their requirements! why do you care? I am finishing my DNP and getting my MBA at the same time 52 credits for my DNP and 48 credits for my MBA. two of my classes have been online and they are more work usually than the ones in person. where are you getting your bogus information about our classes being all online? they aren’t! furthermore, if studies show that we are doing just as good if not better at primary care compared to MD’s our education and training must not be that bad if we are doing equal or better than you with what you seem to think is less education. with that said what does that say about you? get real….and stop being so ignorant, grow up and learn to respect something and someone else than you obvious over inflated ego!

  272. 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?

  273. 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!

  274. 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.

  275. Anyone who thinks that NP’s, DNP’s, CRNA’s etc should practice independently doesn’t know how much they don’t know. As mentioned elsewhere, the foundation is not there for them. They have superficial knowledge but little real understanding of why they do something. So, when the situation varies from the norm, they get lost and frequently make the wrong decisions. It is not their fault that they never learned it. Nurses get very basic level training throughout from undergrad on. They take science for non science majors and very superficial anatomy and physiology classes. How could we expect them to understand that which was never taught to them.
    Ask a DNP very basic questions about cardiac physiology, the coagulation cascade, renin angiotensin system, or the adrenergic system. You will get blank stares (please don’t post your google search results…we know you know how to use it). These are the basic foundations for all of medicine. They learn it in such a cursory way, that they have no real grasp of how to interpret any of it.
    It is like building a custom home on dirt instead of a foundation. It will look good with a cursory inspection and you will do fine with it for a little while. But with time or stormy weather, you will see how poorly it holds up.
    I know several NP’s and CRNA’s who quit and went to med school. Every one of them states that they had no idea the huge difference. They all said, “I had no idea how much I didn’t know.”
    It is not about lacking empathy as you state above. Why should I have empathy for someone who wishes to play doctor by taking a shortcut? Some of my best friends and family members are nurses and we get along great. But then, they are not proclaiming that they are doctors either.
    This is something that should be regulated by state boards, but nursing boards in every state are pushing the envelope as far as they can with little to no regard for patients. The medical boards have no jurisdiction to control them because they only oversee the practice of medicine. Nurses call it the practice of nursing and throw anything they can up on the wall to see what will stick. The DNP garbage stuck and here we are.
    CRNA’s opening pain clinics and claiming to be qualified to perform transesophageal echocardiography. DNP’s demanding to be treated as MD equivalents in name and practice.
    It is fraud on the grandest scale and because I choose to speak up about it, you act as if I am the bad guy. Like the bank robber suing the bank for the injury he received while robbing the bank. It is so absurd it is funny. Except it is really the patients that will eventually suffer, and they don’t even know enough to realize they are getting the wool pulled over their eyes. It is quite shameful. The disingenuous nurses pulling off this scam are the real villains.

    I recognize that this really hurts your pride for the truth to be revealed. But get used to it. Physicians everywhere are figuring out the hidden nursing agenda and the “degree creep” that you are all perpetrating. The next generation of physicians has no intention of rolling over to be marginalized as you would like. Prepare to have your lies challenged.

  276. 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.

  277. Just from reading the comments here, I believe it would apply more accurately to you, Mr. Blanston.

    Particularly:
    (3) believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
    (4) requires excessive admiration
    (5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
    (7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
    (8) is often envious of others or believes that others are envious of him or her
    (9) shows arrogant, haughty behaviors or attitudes

  278. ^^^ Yes, that fits the DNP demanding to be called doctor in a clinical setting to a tee.
    Especially this one:
    (1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

  279. PAs have more training in both the basic sciences and clinical training than any NP or DNP program offers. You don’t see PAs fighting for independent practice though. Know why? It’s because, with more education, you come to realize how complex medical issues are. Most of the time, you’re working with partial information and have to rely on what you learned in training to think through and solve problems.

    I think my PA colleagues and the majority of physicians agree that PAs are better trained than DNPs are. Heck, compare the curricula yourself if you don’t believe me! If you have a choice between a PA and an NP or DNP, always go with the PA. Not only do we have better training and a better knowledge base, we also collaborate with physicians significantly (since we have to). This way, there’s always physician oversight in case we miss anything.

    To all those nurses shouting that their nursing experience makes up for lack of clinical training in NP and DNP programs, not it does not. Your own nursing organizations published researching showing that prior nursing experience has no impact on how you function as an NP. Know why? Because as an NP, you’re practicing medicine, not nursing, while conveniently calling it “advanced practice nursing.” LOL! What a load…

  280. It’s great that you know the difference between a nurse and a doctor. You’re still one of the rare patients who does though. Most patients think pretty much anyone with a white coat on is a doctor (ie. a medical doctor). There are multiple survey studies done on this that the majority of patients are confused as to who is actually providing care for them and what their credentials are.

    I also work with DNPs who insist to their patients that they’re doctors and are equal to me and my physician colleagues. No, they’re not. I’ve spent 10 years in medical training AFTER college. They did an online degree in 2.5 years while still working! Can they diagnose a common cold the same as I can? Yea. But so can any mom who doesn’t have an ounce of medical training. Once a patient shows up whose symptoms are not “textbook” symptoms (ie. not classic symptoms), these nurse practitioners’ ability to form a differential diagnosis and rule out/rule in various processes breaks down. This type of critical thinking isn’t something you can develop overnight or part-time over 2-3 years. I’ve spent over 20,000 hours in clinical training alone (not even taking into account classroom education) and it still scares me how much there is that we don’t know. So, when I see these cocky NPs/DNPs with less than 10% of the training that I have claiming that their knowledge-base and expertise is equal to mine, that’s extremely insulting. These practitioners have less training than a 3rd year medical student does, as a previous poster mentioned. Do you want to be treated independently by a 3rd year med student?

    All the NP/DNP degree is, is a shortcut. It’s for people who don’t want to put in the effort that’s required to truly become an expert. And that’s fine. Lots of people have family obligations and other extenuating circumstances that doesn’t allow them to be willing to go through a minimum of 7 years of rigorous training (not easy online courses). But, with that being said, they should not claim that they’re equal to those of us who do go through this intense medical training and have spent nearly a decade or more honing our skills as clinicians. There is no well-done study that shows equivalence between board-certified physicians and nursing midlevels. Some people will point to the JAMA study: that was significantly flawed study headed by a DNP who has publicly claimed that DNPs are superior (not just equal) to physicians. I wonder what the look on her face was when 50% of her DNP students failed a watered down version of the easiest Step exam physicians take. But this study got accepted to JAMA! Yea, so what? The Andrew Wakefield study regarding vaccination and autism got accepted into The Lancet, a far more prestigious journal than JAMA, and we know how bad that study design was.

    So, ask yourself again. Do you want to be treated independently by someone who has less training than a 3rd year medical student? Do you trust them with something as important as your health?

    PS. I don’t have any problems at all with NPs/DNPs that collaborate with physicians. These tend to be the best NPs/DNPs since they understand their limits and know when you get the physician in for help. I have a problem with independently practicing NPs/DNPs who think they know just as much as physicians and continue to handle issues themselves even when they’re in over their heads because of an ego issue. I’ve already had several patients referred to me who have permanent damage because their NP was unwilling to admit that he/she didn’t know what was going on but refused to send the patient to a physician. Two of those NPs are currently facing malpractice lawsuits.

  281. First of all let me say I am neither a physician nor a nurse. I am a patient. Remember me? The one everyone seems to be arguing about? If anyone cares about my point of view on this topic, here it is.

    I believe all patients have come to recognize the role of NP’s and DNP’s in the healthcare field. I along with many of my friends often opt to see the NP or if available a DNP instead of the MD when making an appointment for “small” ailments (I know every ailment could potentially be a symptom of something larger) like a sinus infection or other common ailments. Notice I said “opt” to see a NP or DNP. It is always my choice as to which member of my healthcare team I will see for that ailment.

    When I opt to see the NP or DNP it is for the following reasons:
    1. It is always quicker to get in to see the NP or DNP.
    2. In my opinion and the opinion shared by my friends, both are very qualified to treat common ailments (see disclaimer above).
    3. Given the choice I usually choose the DNP because it just makes sense the DNP has more education than the NP.
    3. I know both my NP and DNP will consult with my MD on my treatment and care. I know that because it is made clear to me by my MD’s staff.

    Sometimes I opt to see my MD. For things like my yearly physical and lab work I prefer my MD perform a comprehensive analysis of my overall health. Again, I don’t know if that is necessary but it is how I manage my own heath care. That is what gives me peace of mind. To each their own.

    I do not confuse an MD with a NP or DNP. In my MD’s office the DNP is referred to as the Doctor-Nurse and the NP is referred to as the … well, NP.

    I address my DNP as Doctor because that is what my MD calls her. That doesn’t mean I am a confused and consider the DNP to be the same as the MD. I recognize they have different skill sets. I consider it my MD’s job to ensure I am educated about the options I have for care while in her office.

    For all the MD’s on this blog; thank you for your dedication to your field of practice. We need you and respect you for what you have done, not for your title. But be very clear, the days of seeing you as a demi-God are over. You are instead a cherished member of my health care team and I take your advice and counsel seriously, but not without using my own resources and common sense. That was my parent’s generation, not mine. (I am 49 yrs old).

    One more thing then I will get off my soapbox. My parents live in a very rural area and were thrilled when a DNP opened a practice within 10 miles of their home. Even old as they are they are not confused about the skill set their new “Doctor” is bringing. They just like having someone close for common ailments rather than having to travel 40 miles to their “Real Doctor” as they call him. It’s a wonderful option for their small community.

    For all the DNP’s on this blog; thank you for your dedication to your field of practice (nursing). Although I love my MD I sometimes want and need your extra level of caring for my whole health not just what I walked in the door complaining about that day. I know you are also very busy but I guess you are just better at bedside manner than my MD. Thank you for that.

    For all the NP’s: Love you too and thank you for stepping outside the hospital and into my MD’s office to provide me with your knowledge and care.

    So… that is what Ms. Average Patient has to say to this blog which by the way I came across because my friend said his daughter just got a medical degree as a Doctors Assistant. I admit I am still confused about what a PA is. LOL.
    But I promise you I will figure it out. As will we all. Remember, we can be taught and we can learn.

    Bottom line; do not under estimate your client base. We are much smarter than you think. I have been personally offended by Gern on this blog. Really, come on down from Mt. Olympus and join the rest of us when you are ready. My Doc is nothing like you even though she has the same credentials. She lifts up her “helpers” and shows them the upmost respect which in turn builds my confidence in their abilities.

    Before you even start… I am not an MD nor a Nurse nor a NP nor a DNP nor a PA nor a… whatever else there is. I am a Project Manager with a Telecom company. I’m just a little tired of being an underestimated client/patient. I love having options managing my own healthcare. I don’t care what ANY of you label yourself. Just keep doing what you do.

  282. ^^^^^ Since the end of this thread is close I will reply here…My diatribe? Have you not proofed all of your comments on this site? So what’s next, the 20/20 means I “want to be an ophthalmologist”? Wrong, try Trauma (Emergency Medicine). You are a true idiot and it is sad to see you in the physician community. My case in point is all physicians are doctors not all doctors or physicians. Let’s worry being the best at healthcare and the rest will work itself out.

  283. “Diagnostic criteria for 301.81 Narcissistic Personality Disorder (DSM IV – TR)

    A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

    (1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

    (2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

    (3) believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

    (4) requires excessive admiration

    (5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

    (6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

    (7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

    (8) is often envious of others or believes that others are envious of him or her

    (9) shows arrogant, haughty behaviors or attitudes”

    Reference:
    American Psychiatric Association. (2000). Diagnostic and statistical
    manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

  284. Who cares what the nps want to call themselves, they just send patients to specialists like primary docs

  285. It is a sad day when a group tries to gain through deception what another group earned through education and hard work. One group took a dangerous shortcut. When you cut corners, the quality will eventually suffer. I am sorry that I do not celebrate made up doctoral degrees.

  286. I agree with you 100%. The medical field would be lost without nurses. They are wonderful at what they do and very bright and caring. They are, however, not doctors. Inventing a phony degree out of thin air and calling it a doctorate is shenanigans. That is what people are upset about. This is not about diminishing the role of nurses. This is about exposing the scandal that is being perpetrated across the country by nursing schools and nursing leadership.

  287. If it took you four years, you were on a part time track, or you failed some of your on line nursing philosophy classes. And no, I will not be calling you doctor.

  288. JD, those real prospective, double blinded, randomized, controlled studies will never be done because they are not ethical. You take 500 patients in each arm of the study and tell them they will never be seen by a physician and will at no point have the option of being seen by a physician but instead will be seen by a “nurse doctor,” no matter how sick or complicated the patient may be. What IRB would allow that? It is unethical and the public would not buy into it. The scandal would be bigger than the Tuskegee syphilis experiment.

  289. To MD20/20,
    Your cover is blown. You are not a medical student. Your speech is straight out of the canned speeches that militant nursing organizations use. Even on the internet, you are portraying yourself as something you are not. Where do the lies end? Your initials?? Nice try at recovery but the rest of your diatribe gave you away.

  290. Just out of curiosity for the nurses here. If a Certified Nurse Assistant at your practice told the patients and everyone else that they were a “nurse,” would that bother you. Would you feel as though they were misrepresenting their education? Would it bother you that it took you 4 years to get a nursing degree and a person that took a 3 month certifying class was representing themselves as your equal? Be honest with yourself. Would that rub you the wrong way a bit? I suspect a flurry of “incident reports” would be generated, wouldn’t they?
    I work with many nurses, NP’s, and other advanced practice nurses. At the local level, I get along with them fine. TheNurse asked what I was so upset about up above. It is the lie being perpetrated by the nursing organizations on the national level to attempt to gain through legislation what physicians have gained through education. There is no shortcut when the lives of your loved ones are what is at stake. Nurses play a vital role in the care of patients. No one has ever questioned that. I do, however, resent when the nursing organizations and their militant members get on internet forums and claim equivalence to physicians based on an invented online degree that is nothing more than nursing philosophy classes and internet busy work for the purpose of lining the pockets of nursing educators and deceiving the public with bogus credentials that have no real medical application (see the typical curriculum outlined above). If no one explains the real truth, their deception sits out here on the internet for an unsuspecting person to read and believe as truth. If you tell a lie long enough, you can actually even start to believe it yourself. As long as they continue to deceive, I will continue to tell the truth to refute their lies.

  291. ^^^truthteller^^^
    Thank you for the response. You are exactly correct. The DNP approach is similar to starting the Boston Marathon, running a mile, leaving the race and getting in a car, then going to have lunch and a nap, then getting back in the car to be dropped off a mile from the finish line. Then crossing the finish line basking in all of the glory and telling everyone how tough it was and how accomplished you are as a runner.
    Don’t claim to have run the race if you didn’t. It is a lie. We don’t accept it in long distance running. Why do we accept it in the medical field?

  292. To TheNurse,
    You are the exception to the rule if you were not able to work more than 3-4 shifts/month during your DNP studies. I’m not sure of your time management skills if that is the case. Most DNP programs are completely “on-line” and completed by nurses already in practice and living a long distance from the school they “attend.” I’m not sure why you didn’t get the memo on how it is done in the real world. Here is the blurb from one of the most popular programs:

    The practice doctorate in nursing provides the terminal academic preparation for nursing practice. The *** *** University Doctor of Nursing Practice program is fully accredited by the Commission on Collegiate Nursing Education (CCNE), completely online, and designed to prepare students to assume clinical leadership positions in a variety of healthcare, business, government, and educational organizations.

    And here is another blurb from another large state school program. They actually make you attend the actual campus 5 days a year:

    The DNP is similar to other practice doctorates such as the MD, JD, and PharmD.
    All students are expected to come to campus for a robust 5-day Resident Intensive Summer Experience (RISE) each year for the first three years of doctoral study. RISE attendance for part-time students may vary. Tentative dates for RISE are as follows: Yr. 2012-August 13th-17th.

    Somehow, in my mind, the above statements don’t really add up. One sentence says it is similar to an MD or a JD. The next describes that you attend actual classes and show up on campus 5 days a year. Are you really trying to defend that as equivalent? Seriously???? See my typical curriculum post above. Let the public be the judge. This whole comment section is filled with DNP’s and DNP students who defend this as similar to an MD or a DO degree. That is disingenuous. It is human nature to try to justify this and it is not surprising that a DNP would argue indignantly to defend what they just spent their time and money on, but for the rest of the public who might read this, the truth needs to be told. You can call me bitter if you wish, but that is just a cop out argument trying to defend the indefensible stance that you and your ilk have taken in this matter. It is embarrassing for the medical community that it has gotten this far and embarrassing for AACN and AANA and all of the other militant nursing organizations who have propped this up through deception and lies with the help of Sebelius and other political leaders with an agenda. The fact that they have pushed it through so easily is a little (a whole lot) scary.

    When you have children, will you teach them to gain as much as possible through deception and chicanery or will you teach them to put in the hard work needed to gain the in depth knowledge that is needed to practice medicine? Saying that the DNP provides as much real knowledge to practice medicine independently is akin to saying Dr. Seuss should be allowed to perform surgery.

    If the general public accepts this, then they deserve what they get. If you have ever seen Mike Judge’s movie “Idiocracy,” you know what lies ahead.

  293. It depends what you consider “continued to work.” You imply that all RNs work full time as they work on their DNP (which from my experience in a top ranked/renowned school, it is not doable). Worked per diem – 1 to 4 shifts a month (simply to maintain affiliation with a health care system).

    All of the course work was in classrooms and/or clinical sites (with the exception of “clinical research”). Hours upon hours spent in clinical training and research design/application. So my point is maintained, your opinion appears biased and judgmental. A DNP is hardly something that you just pay and do a couple google searches.
    The DNP was a choice. For many reasons that do not include “taking a shortcut” (since it really is not one). I had the option between 2 great medical schools and 3 great doctorate in nursing programs (yes, all in which I was accepted). For reasons that you’d probably never comprehend I made my choice and do not regret it for one second. I am proud of being a nurse and happy to work with physicians, RNs, PAs, social workers, support staff, etc., that respect me for my professionalism and expertise in advanced nursing care.

    Anyway, I am curious, what makes you so motivated to this “cause” of putting down advanced practice nurses? What makes you so resistant to a different point of view/philosophy? And why so threatened? NPs never wanted or attempted to take anybody’s place, the nursing model supports team work and collaboration. We respect the medical model and understand its importance. However, the nursing model and nursing care, advanced practice or not, is equally important to the overall care of the patient.

  294. I’m finishing up 3rd year of medical school and I already know more than the NPs that work in my hospital. These are NPs with 5+ years of experience. Several of them have already come to me (and the other M3s and M4s on service) before rounds with questions on their patients. Why, you ask? Because, multiple times, they’ve messed up during their patient presentations or failed to come up with a proper differential diagnosis and when the attending points that out and asks the med students, we end up answering correctly and generating appropriate differentials.

    The fact is, even with just 3 years of medical school (and I still have a minimum of 3 years of medical training left), we can already come up with a larger, more accurate differential than most experienced NPs can. Why? Because we spend an entire rigorous year on pathology and pathophysiology, not just an easy online course (LOL!). For any given set of symptoms, the avg. 3rd or 4th year med student can come up with a longer list of differentials simply because we know more than the NPs.

    Why don’t you guys lobby for allowing med students to practice independently? I want to save time and money (less tuition!). Let me practice independently now; I’ve already proven on the wards that my knowledge-base and training is superior to what DNPs receive.

  295. True or false? You continued to work while you did your DNP and much of the course work was distance learning on line.

  296. DNPs are not trying to be a medical doctor. That’s why they are “doctor of nursing practice.” Different, not better nor worse. Most patients are becoming more educated and understanding the strengths of different professional roles within the health care system. This way they are able to make an educated decision on what or who to seek in different scenarios. I recommend you do the same.

  297. Nurses are not ashamed of their profession. We are very proud of it, and this is why we seek further education to become better at what we do. NPs do not claim to be equals to physicians, and never have. The curriculum that you have been posting and claiming to be “night school as you work” standard, is not the case.
    Nobody is lying here. However your opinions are so biased. It is a perfect example of the violence that nurses have been dealing with for many years. Luckily many physicians recognize and appreciate advanced practice nurses, something that you and “OLDONE” have a hard time doing. For your information, NPs are not something new, they have been around since the 60s, check your history (yes, you do not know it all).

  298. Actually MD 20/20 is the one who is NOT naive here. His/her concern in on patient care and service provided, and not some personal issue that you may seem to be having. I am not quite sure why, but “Gern Blanston” seems to be extremely insecure. It is coming through rather desperate and narcissistic if you ask me.
    As it was posed, “if a MD gets beat out of a position by an NP… then maybe it was more factors involve other that level of training.”

  299. Well one thing is true assumptions will make an @ss out of you. MD, those are my initials, 200 k in debt… it would be more like 350k, but I have a scholarship to cover all my expenses. Once again focus is on the wrong thing. People would not care if Earl the mechanic could get them well as long as they got well. I went the medical school route because I like all the additional information that we must process. Will we use all of it??? Good chances is no, especially once we specialize, but I am sure you can attest to that. I just feel instead of debating and worrying about who has what TITLE, lets worry about who has the proper skill set… if a MD gets beat out of a position by an NP… then maybe it was more factors involve other that level of training. Don’t give me the “it’s because the NP is cheaper hiring option”. If they are then you have to “sell” yourself to be a better option. That goes to all, other MD’s/DO’s or whoever is applying for the position. Is that not how the free market works???

  300. ^^^^naive^^^^
    Of course you don’t care. You are already representing yourself as an MD in your screen name. When you actually earn it and another group tries to claim equality, you will mind. You just haven’t been through it yet. You are in the early stages of your training and you have not seen the actions behind the scenes to marginalize the role of the physician in medicine. Go ahead with your beliefs while we work to right the ship. You should hope we do a good job so that there is something left for you when you get done with medical school with your $200 K in debt and a nurse has just taken your job that you earned through blood, sweat, and tears because you and others were asleep at the switch. Ultimately, it will be the patients that suffer as they receive substandard medical care. The public will not even realize most of the time, because the differences will be subtle. The delayed diagnosis that leads to increased morbidity and mortality. The failure to rescue in an emergency situation. The inappropriate prescription etc.

  301. This thread is as dumb as it gets. As a medical student I am not worried about who gets called what. I will be the best physician I can be. Yes I stated best PHYSICIAN, not DOCTOR. I will be working as a physician. Doctor of _____ represents the level of education you receive. Doctor of jurisprudence, level of education- title of position, Lawyer… Doctor of Medicine, level of education- title of position, Physician… Doctor of Nursing Practice, level of education-title of position, Nurse Practitioner… Doctor of Philosophy in XYZ level of education-title of position, Researcher, Professor, Janitor and etc. You’d think that people with the highest level of education could find something more beneficial to have discussions and debates about.

  302. You are right to be worried. Stand up for the rights of you and others. Truth and transparency is needed. Not deception and outright lies.
    Nursing is a noble profession. Why are so many nurses so ashamed of it that they want to portray themselves as something they are not? It is shameful.

  303. I’m an aging baby boomer. I worry about what is happening to our medical system. I have been healthy and have taken good care of myself but I realize that my health will fade through the years. I want physicians, not nurses (of any variety) taking care of my wife and I and my friends.

    It’s sickening to me that the old noble career of RN’s, who impact patients so much, are trying to be more than what their education warrants. You didn’t do the premed prereqs, you didn’t go to med school, you didn’t do residency. You’re not a medical doctor because you don’t have the knowledge and training. Be an RN and be proud of it. If you want to practice medicine go to medical school!

  304. Here is the truth:
    A physician trains for 4 years of undergrad, 4 years of medical school, a year of internship, 2-6 years of residency (depending on the specialty) and 1-3 additional years of fellowship for subspecialtiy training. At each point along the way, there is a weeding out process and only the best and brightest advance to the next level. This occurs at the MCAT level when applying to med school. It occurs after year two of medical school when you take step I of the USMLE. It occurs at the end of 3rd year of medical school as you utake step II of the USMLE. It occurs at the end of every clerkship as you take the national shelf exam for each specialty (medicine, surgery, psych, pedi, ob/gyn etc). It occurs at the end of medical school as you compete nationally for the best internships and residencies. Once in your intern year, you clear step III of the USMLE before you can get a license to practice. Each year of residency, you take the in training exam which helps determine if you get to advance to the next level of training. If you get past that, you apply to fellowships where only a small percentage are accepted to the most competitive spots. Once you finish residency, you get to take a written board exam, many of which are so difficult that the pass rate is in the 70 percent range. If you pass the written exam, you get to sit for the oral exam (one of the most stressful experiences any person can ever be subjected to). The pass rate is 70-80% for many oral exams. At the same time, many young doctors are enrolled in fellowships or paying their dues doing additional “chief” years so that they can be eligible for 1-3 year fellowships. All of this time, still being paid minimal salaries and working long hours. Once finished with fellowship, then they must sit for their subspecialty board exams. Once complete, it is now time for recertification in their primary board within the next couple of years. And so it continues. At any step along the way, the weak or unqualified are weeded out.

    Compare that to this:
    A person decides they want to be a nurse. They enroll and take science courses for non science majors for a couple of semesters. They do their clinical rotations following other nurses around and implementing physician orders. They graduate and get a job within 2-4 years of making the decision to be a nurse. They are in high demand because all of their nursing colleagues with any ambition are either nurse practitioners or clipboard carriers. They are paid well and work hard. They see additional opportunity and sign up for a DNP, CRNA, or NP program and 2-3 years later, they are done, all the while earning a great living as a nurse while doing the entire DNP or NP process through on line courses at their own convenience. They arrive at the end of training with no debt and no sweat equity and very little actual “medical knowledge.” At no point in the process was there a weeding out process to separate the qualified from the unqualified. Their entire time is spent following physician orders and not in formulating treatment plans or learning how to diagnose the difficult patients. It is assumed that if you make the decision to go to nursing school, you will be a nurse. If a person makes a decision to go to medical school, their is only a small chance that their dream will come to fruition because most get weeded out along the way and most don’t have the drive and stamina to complete the mission.
    Meanwhile, nurses join their nursing political action committee and lobby the politicians to claim equality. In their minds, they really believe it. That is the scary part. “They don’t know what they don’t know.”
    And here we are years later having this argument over the internet about who is better at being a “doctor” or who should be called “doctor.”
    Hopefully, after reading the above, the general public will be educated about the paths required to achieve each degree.
    Nurses and physicians are not equal and the public should not be deceived to believe that they are. If a person wants to be a real doctor and be called so in a hospital clinical setting, do the work needed and go to medical school.
    The public deserves to know the truth and not be deceived by the militant nursing PAC’s along the way that wish to gain by legislation and hospital policy what physicians have achieved through hard work and education. So, yes, that upsets me when they claim equality with only a fraction of the education and experience.

  305. Name the hospital that prefers DNP’s do their central lines. I smell something fishy here.

  306. Well said Gern. I agree completely. You want to be named doctor in a hospital setting? Then do the work and go to medical school, do a residency and put in the minimum of 10,000 hours of hard work it takes to become one.

  307. Here is the truth:
    A physician trains for 4 years of undergrad, 4 years of medical school, a year of internship, 2-6 years of residency (depending on the specialty) and 1-3 additional years of fellowship for subspecialtiy training. At each point along the way, there is a weeding out process and only the best and brightest advance to the next level. This occurs at the MCAT level when applying to med school. It occurs after year two of medical school when you take step I of the USMLE. It occurs at the end of 3rd year of medical school as you utake step II of the USMLE. It occurs at the end of every clerkship as you take the national shelf exam for each specialty (medicine, surgery, psych, pedi, ob/gyn etc). It occurs at the end of medical school as you compete nationally for the best internships and residencies. Once in your intern year, you clear step III of the USMLE before you can get a license to practice. Each year of residency, you take the in training exam which helps determine if you get to advance to the next level of training. If you get past that, you apply to fellowships where only a small percentage are accepted to the most competitive spots. Once you finish residency, you get to take a written board exam, many of which are so difficult that the pass rate is in the 70 percent range. If you pass the written exam, you get to sit for the oral exam (one of the most stressful experiences any person can ever be subjected to). The pass rate is 70-80% for many oral exams. At the same time, many young doctors are enrolled in fellowships or paying their dues doing additional “chief” years so that they can be eligible for 1-3 year fellowships. All of this time, still being paid minimal salaries and working long hours. Once finished with fellowship, then they must sit for their subspecialty board exams. Once complete, it is now time for recertification in their primary board within the next couple of years. And so it continues. At any step along the way, the weak or unqualified are weeded out.

    Compare that to this:
    A person decides they want to be a nurse. They enroll and take science courses for non science majors for a couple of semesters. They do their clinical rotations following other nurses around and implementing physician orders. They graduate and get a job within 2-4 years of making the decision to be a nurse. They are in high demand because all of their nursing colleagues with any ambition are either nurse practitioners or clipboard carriers. They are paid well and work hard. They see additional opportunity and sign up for a DNP, CRNA, or NP program and 2-3 years later, they are done, all the while earning a great living as a nurse while doing the entire DNP or NP process through on line courses at their own convenience. They arrive at the end of training with no debt and no sweat equity and very little actual “medical knowledge.” At no point in the process was there a weeding out process to separate the qualified from the unqualified. Their entire time is spent following physician orders and not in formulating treatment plans or learning how to diagnose the difficult patients. It is assumed that if you make the decision to go to nursing school, you will be a nurse. If a person makes a decision to go to medical school, their is only a small chance that their dream will come to fruition because most get weeded out along the way and most don’t have the drive and stamina to complete the mission.
    Meanwhile, nurses join their nursing political action committee and lobby the politicians to claim equality. In their minds, they really believe it. That is the scary part. “They don’t know what they don’t know.”
    And here we are years later having this argument over the internet about who is better at being a “doctor” or who should be called “doctor.”
    Hopefully, after reading the above, the general public will be educated about the paths required to achieve each degree.
    Nurses and physicians are not equal and the public should not be deceived to believe that they are. If a person wants to be a real doctor and be called so in a hospital clinical setting, do the work needed and go to medical school.
    The public deserves to know the truth and not be deceived by the militant nursing PAC’s along the way that wish to gain by legislation and hospital policy what physicians have achieved through hard work and education. So, yes, that upsets me when they claim equality with only a fraction of the education and experience.

  308. Nicole,
    A doctor only trains for 4 years?? You have apparently been drinking the kool aid the nursing instructors are giving you. A physician trains for 4 years of undergrad, 4 years of medical school, a year of internship, 2-6 years of residency (depending on the specialty) and 1-3 additional years of fellowship for subspecialtiy training.
    Nurses attend college to gain a nursing degree in 2-4 years and work as a nurse making good money and take on line DNP classes at night and call it equivalent. And you wonder why physicians are upset while you pass off blatant lies as the truth?

  309. Agree! A made up degree which is a shortcut or an end around through the back door. Do the work if you want the title.

  310. and yet she is exactly correct. Surveys of patients have overwhelmingly shown that patients prefer the word “doctor” to refer to the MD/DO and not to someone else with a doctorate unrelated to medicine.

    DNPs want to be called doctor in a hospital/clinic setting to confuse the patients. Shouldn’t they be proud of their own training and not try to piggy back on the reputations of a different group of professionals?

  311. 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 & Leadershp Concepts in Health Care

    Analytical Core for Evidence-Based Practice

    Applied Informatics to Evaluate Hlth 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 *

  312. Anonym,
    The point is, people are taking shortcuts and trying to gain, through legislation and hospital policy, something they did not gain through education. A doctor of nursing practice curriculum does nothing to improve a nurse’s ability to diagnose or care for a patient. Look at the curriculum and try to defend that. It is a degree invented to blur the lines and mislead the public. Nurses have a long history of adding extra letters behind their name that mean nothing. Just look at their titles. It is ridiculous. They finally got to the point where they decided a few on line courses would constitute a doctoral degree and somebody bought off on the idea and here we are having this argument. Show me where in your “doctoral” curriculum that you did anything on line that made you better qualified to diagnose or treat a patient. I will show you medical school, residency and fellowship that were all years of doing just that…preparing physicians to better care for patients. These were not years spent at a keyboard doing google searches to finish a term paper for “night school” while earning a nurses salary during your day job. This was years of lives spent dedicated to learning a trade, while nurse have been lobbying politicians and then sneaking in the back door to arrive at the same place and say “we are equals.” Pardon me if I am appalled by that.

  313. You sound quite bitter. And your point is rather flawed. If you bothered to learn about what NPs do, you would realize that they are “advanced practice nurses,” trained and educated specifically to formulate treatment plans. In your comments you are rather quick to pull the trigger and judge other disciplines on their level of expertise and training. Mind you, anyone with a lot of money, average intelligence, and some free time can go to the Caribbean (or many other schools in the USA) and become a doctor in medicine. We have all seen it happen.
    Luckily most physicians I know are not in the stone age as you appear to be (and actually appreciate the collaborative relationship with other advanced care providers – including NPs and DNPs).

  314. Sure, and paralegals are the same as attorneys, right? It is all for the client’s benefit, so why would those jerk attorneys be upset if paralegals started calling themselves attorneys. Everyone knows it is the paralegals that do all of the grunt work behind the scenes and often have the best ideas to help a client. It would be selfish and egotistical to not let them call themselves attorneys.

    Flight attendants should also be able to have the same rights and privileges as pilots. They have been on just as many flights. Sure, most of their career has been spent taking orders from the cockpit crew, but they are the real customer advocates and care for the whole passenger. Not just worrying about the one area, the cockpit. Senior level flight attendants know just as much as these newbie pilots about the airline industry. Pilots are just jerks that are trying to sleep with all of the hot flight attendants. Anybody could do what they do, especially flight attendants that have been doing this for years.
    Architects are another arrogant group. I know plenty of people who have built awesome decks and sheds. They are outstanding carpenters and can build circles around most architects I know. There is no reason that these people should not be immediately elevated to architecture status. The degrees and wasted time for architects is their own problem. There is no study that exists that shows that architects are better architects than a really good carpenter.
    Dental assistants are just as knowledgeable about the teeth as dentists. There is no reason that they should not take a few online courses and then open their own practice. Pulling teeth??? How hard is that? Don’t even get me started on orthodontists…their assistants are the ones doing all of the work and the orthodontist pops in for a quick little look see. They don’t need help with formulating a treatment plan. They could learn that easily on line in a matter of a few weeks. Arrogant orthodontists!!!

  315. Ha. So, you were one of the rare nurses smart enough to get into medical school, but you were not willing to put in the work to do it, so you took a short cut. No matter how much you dress it up or how sad your sob story is, you should not be called Dr in the clinical setting.
    The fact that you even made the statement that your friend is the “2nd best chiropractor” in your state illustrates your lack of understanding.
    Just so you know, I feel the same way about PT’s calling themselves Dr.
    Chiropractors and dentists can call themselves Dr for all I care. When someone goes to a chiropractor, they know that. When someone goes to a hospital or a doctors office and someone introduces themselves as doctor, the patient expects they are speaking to a DO or and MD. It is called truth and transparency.
    A doctorate gotten on line is as legitimate as a hoaky on line PhD. Don’t kid yourself that paying a bunch of money and taking on line courses in nurse management and philosophy is really a doctorate. It is as cheap and phony as all of the other on line degrees and I can’t believe it has gotten to the point it has. You and all others who have gone this route have paid for a doctorate that cost you dollars and time wasted with on line internet courses and a couple of college level “dissertations” that amount to nothing more than on line internet searches.
    What a joke.. How come no one is actually looking into what these DNP requirements are. The courses are a joke. Any nurse with money, a little bit of time, and an internet service provider is going to have a DNP within a few years. All at very little personal sacrifice and very little actual knowledge.

  316. I agree with Vic. A NP is totally not a “doctor’s assistant.” Otherwise they would have been in a PA’s program instead as they are the real physician assistants. I really think that if somebody has no clear idea of what a certain thing is, or what this debate is referring to as per “titles” and terminologies– it is much better to keep silent because ignorance only makes this debate complicated. I suggest to anyone who wants to comment here to really research what is what first before even adding more confusion to public.

    And oh… why can’t some people accept it when ‘ceasar’s should get ceasar’s as it is due?’ If these NPs have finished a doctorate degree, they are entitled to a name just as anyone is who finished such level. They may or may not asked to be called as such but I don’t think public are that dumb not to distinguish between different doctorate levels as to MDs, Pharmacists etc. Questions about MDs protesting about NPs not deserving the title is really obnoxious now. This is not a stone age. Nurses have come a long way already and not “all” of them really can be under the MDs’ skirts or pants like it was of the war’s era. It’s disgusting how these protesting title greedy people defend their points of argument, when really and truly, it’s just a matter of wanting to be on a “higher ground.”
    As of the pharmacists not really minding what they should be called; hello?!! they don’t do primary care….should they even join the confusion? And mind you they really appreciate it when we address them drs at work even if it’s a joke! Soooo, give them their title too- they earned it! A doctor title is not only in the medicine world.

  317. Well said… I am a “Doctor of Medicine” student, but you are so right. This fight is so asinine. Doctor is the level of educate one receives. Physician, Professor, Plumber and etc. are the title of your job. The going rhetoric is patients get confused if people other than physicians use the title doctor, well if doctor is the highest level of education and also translates “teacher” why not just educate people on level of education and title of position if confusion is truly the problem???

  318. If DNPs should be called doctors, JDs (any lawyers) should be called doctors, too. How come no lawyers address themselves as doctors??
    Nice try, but it is what it is. Just be happy with what/who you are.

    BTW, Ph.D., by definition and tradition (almost 1000 yrs), is the highest achievable academic degree in any field.

    To me, DNP is a made-up degree. If you are an NP and want a doctorate degree, you should get a Ph.D. in nursing, which is much more rigorous than DNPs, btw.

  319. “Let ladies who wish to be doctors as well as nurses train themselves in an appropriate medical school, and leave the humbler but no less honorable profession of nursing to those who have the common sense to see that the training of a nursing institution can never make them properly qualified medical practitioners.” — Sir Seymor Sharkey commenting upon the establishment of institutionalized nursing schools, 1880.

    Things don’t change much. Those with power and status will always struggle to preserve the status quot, and all the trappings thereof.

    James Melworth, Doctor of history.

  320. “How come no one ever chastised them for using the title Dr. in a clinical setting. They did in no way have their MD, just a DPT. “. It’s a superiority complex. For many years nurses have been the individuals who relegated to a inferior position compared to a doctor. Of course the MDs are feel that their territory is being crowded when a nurse who has a doctorate degree wants to be called a Doctor. They don’t want to share the title with a profession with a simple nurse! That’s a crock!!! Why the hell do MDs go to med school? To walk around with a big ego and look down their noses at the Nurses, or to practice their skill which is to HELP PEOPLE!!!

  321. If a DNP can not be called a doctor, then neither should a PhD. The title DOCTOR is one of prestige….it is a title achievement and I can only say “how dare you try and take that away because of your own insecurities!” Did the people who have earned those titles work any LESS harder that you did? Did you know that to become a DNP you have to go through 5 YEARS (4 years bachelors, 2 years masters and 1-2 years for the DNP)of educational training, which doesn’t included the experience requirements (minimum 2 years and preferable 5 years) to get into a DECENT graduate program to become a DNP? Not only do they have to renew their license to be a nurse to be also hold that specialty. A regular doctor only spends 4 years (grueling as are the years to become a nurse) to become an MD: Medical Doctor. You are a DOCTOR of Medicine. A PhD is a Philosophical DOCTOR. A DNP is a DOCTOR of Nursing Practice. A JD, is a Juris DOCTOR.

  322. Ok… This article is a little weird. When they say that nurse practitioners want to be called “doctor” they don’t mean MD (which stands for medical doctor). It would be DNP (which stands for doctor of nurse pratitioner). Obviously there would be a difference. The reason they want nurses to get their DNP is because they are trying to make the training to become an NP a little longer and more uniform throughout. Its like if you were to get your doctrate in physical therapy. Nobody is saying that they have an MD. So… this argument is just stupid. That would be like doctors getting angry at a guy who gets his doctrate in philosophy or ecomnomics and threw a fit because we started their name with “Dr.”

  323. All of this talk is pathetic.. The title of doctor is used for anyone with a phD. Doctor of history, sociology, religion and on and on. MDs do not own the title of doctor. With that being said, I am a 20 year RN and NP. I do not see the value of the DNP education as of yet and have not pursued it because of that. If I ever did, I would never introduce myself and a doctor. I chose to be a nurse. I was premed and accepted into medical school. Some life events changed the course for me and I became an RN. I thought about MD school prior to going to NP school and ALL the doctors I worked with discouraged me and were huge advocates of NP school. Reasons given were malpractice insurance, length of education, running a business, lower reimbursement costs, health care reform etc. NPs can do great things and are at their best when colloborating with MDs in my opinion. Comparing MDs to NPs is like comparing apples to oranges. NPs do not have the same education and are not Physician equivilants. All my life I have heard people pumping themself up over how much better they are then others. Reminds me of 5th grade history and talking about the Puritans. FP MDS are dumb, internal medicine is better….specialists are the really smart ones, no I think it is surgeons, LVNS don’t know anything, only RNs and of course I mean BSNs…..Everbody get over yourself!!!! No shame in being a nurse, no shame in being a doctor. The world needs both. Grow up.

  324. Jim stalians, Dr Carr, Annemarie and other bonafide nurses, (you are my role models) urologist and a host of other health practitioners who hav thrown sentiments to the background and viewed this dicey issue objectively know what’s good for the best for our teaming clients. Because nurses are the caretakers of the health industry, we have come of age to hold sway and secure firmly our rightful place in the medical field. Gone are the days when physicians were seen as gods, and nurses, handmaidens. From all i have gathered, it is clear to me that physicians and some health professionals are just being clogs in the wheel of nursing profession’s success and are not ready to work as team members they are for reasons which can be diagnosed as obcessive compulsive disorder and are in a denial stage of reality, or better still, altered level of consciousness with a glasgow coma scale score of 4.I am still waiting to see a physician who can do wat a nurse can do. Its analogous to the popular jingle ”what a man can do, a woman can do better”. So just calm your nerves and do not trespass into our territory, it would be detrimental to our clients’ safety.

  325. DNP – Doctor of Nursing Practice
    MD – Medical Doctor

    The only reason why the MD’s are kicking up a big stink is because they feel that the DNP’s are taking their beloved title away from them.

    That’s not the agenda for DNP’s. The DNP title is an academic title similar in concept to a Doctor of Philosophy or Doctor of Science. It is supposed to be the highest level of education a NURSE can achieve in their vocation.
    Something to be respected and proud of.

    Furthermore, nurse practitioners who have the appropriate medical training according to the American Medical Association, provide PRIMARY CARE services comparable to that of PRIMARY CARE MD’s.

    To reiterate what Jim Stalians had previously posted
    “The Journal of the American Medical Association (JAMA) published the results of a clinical trial in which 1,316 subjects were randomly assigned to the care of either a nurse practitioner or physician. After six months of care the researchers, which included four physicians, concluded that there were no appreciable differences in patient outcomes between the two groups (Mundinger, et al., 2000). A two-year follow-up study by Lenz, Mundinger, Kane, Hopkins, and Lin (2004) supported the original findings. Numerous other studies have since supported similar findings in other populations and settings. ”

    IS THIS NOT POSITIVE EVIDENCE THAT NURSE PRACTITIONERS ARE VALUABLE?

    If the medical exams required to be written by all NP’s in differing states and provinces in Canada hold NP’s to a certain standard that is acceptable within our own medical community, then there should be no bickering.

    Nursing and Medicine are opposite sides of the same coin. If there were no nurses, MD’s would be SCREWED and if there were no MD’s, nurses would be SCREWED.

    It is a TEAM effort.

    As long as a NP and MD do their jobs within their scope of training and put the patient first then everyone wins.

  326. Internists do not do surgery. Nor can do a surgery consult. Only SURGEONS can do a surgery consult.

  327. Do they call you doctor? You should be called Dr. ___ because you are a doctor just like when we called our professors Dr. _____ because they were an EdD or a PhD the DNP should be called doctor because that is their educational level – keep in mind that many of these are administrators and professors.

  328. I have several different vets for my horses and some of them have NOT be a doctor of veterinary medicine but a bachelors in veterinary medicine (ie the BVSC) and still call themselves a doctor and have Dr. soandso on their badge

  329. Exactly – and if they did have the DNP (Which is a clinical nursing doctorate) they would most likely want to be called doctor – because that is what their degree is – I would also clarify to patients that they are a DNP as opposed to an MD – if that matters to the patient.

  330. Here is where the problem in this argument is:

    Physicians (MD’s) – are generally trained in primary care OR a specialty

    A physician is NOT trained to handle ALL of your medical issues.

    A primary care MD will take care of general complaints

    when you need care for some problem such as your heart or your kidneys – your primary MD will REFER you out to a specialist. – Such as a CARDIOLOGIST or a NEPHROLOGIST

    The NP with their DNP will also sse you for their specialty or for primary care – If the DNP is a family NP then they will treat primary care – if they have specialtized in OB/GYN then they will deliver babies and care for mothers just like an OB.GYN

    If you have a problem with your heart or your kidneys, the DNP will refer you out to a CARDIOLOGIST or a NEPHROLOGIST

    My point is that MD’s cannot care for all problems, that is why there are specialists and the DNP also cannot care for all problems.

  331. Does a nurse have a choice in what they are titled once they have received the highest level of education in nursing? I think it comes down to attitude and demands. I am a nurse who is considering expanding my education and wanting to become a NP. With the new educational guidelines, it appears that it is just the way it is going to be DNP.
    We all know when professors with a Ph.D demand to be called doctors, they are simply trying to get more respect and admiration. But in reality, we cringe to the idea of having to call them doctor.
    Dear MD and DO’s,
    I have respect and admiration for the hours and slave labor you had to go through in medical school and residency. I personally would never want to take the title of doctor away from you. You earned it fair and square. I did not make the rule that after i graduate I will have the title Doctor of Nursing Practice. After all is said and done I will have gone through 15 years of school some full time, some part time. But I know you suffered more and didn’t have the luxury of doing online school. But guess what? You still make more money then we do. We still have to work under you. You are still “ABOVE” us. It’s going to be okay.

  332. Honestly this is a moot point. The fact remains anyone who got their RN, then got an MSN one year later, then did a diploma mill online DNP (with your “thesis” projects on whatever) is not equivalent to someone who did 4 years of a b.s in biological sciences (Inositol triphosphate? tyrosine kinase receptor anyone? clathrin coated pits pathway? these are all the basis of physiology, oh wait i forget you went to nursing school), 4 years of medical school , then 3-4 years of residency (17,000 hours). Vs 5-7 years of on the job training. Please, just like the Rph, the Master of physical therapy now doctorate of physical therapy. ITS DEGREE CREEP. 90% of you could not pass USMLE 1, 2, 3, CK and then take the american board of internal medicine board exam every 10 years. but its all good right? because you got your patient’s A1c below 7 and they loooove you cause you spend 40 minutes cause of your reduced panel size. give me a break. The most dangerous thing in medicine is deluding yourself into thinking you know more than you actually do.

  333. As I continue my schooling in DNP, I’m less and less impressed with Medical Physician’s Knowledge and Talent. Like Dr. Carr, I could of been a physician if I wanted to, I did just as well on My MCATs and was accepted into Medical School. But nursing’s ability to see the whole picture, and more importantly to see the patient in that picture, is what drew me in. I serve the patient not the ailment. I see more than just numbers.

    I also do not think it is fair for a Doctorate of Nurse Practitioner to include what they have a Doctor in. Physician’s don’t, Therapists don’t, Professors don’t. Physician’s need to stop living in the past where all they did was tell nurses what to do and sit back for the data to come in. They are scared because their distinction will no longer be superior.

    We are a healthcare team who serves the patient, plain and simple.

  334. Patient, I agree when you say “I don’t believe that the scope of a DNPs care and knowledge is equal to that of a medical doctor in all cases.”
    You are absolutely right, they are different. However, it is important to note that “different” should not imply “lesser.”

    The scope of practice and philosophy of a DNP is different than a MD, with its own advantages, strengths and of course weaknesses. While I agree that in certain situations (especially those involving complex pathophysiology) I would prefer a MD, in other situations (in which the needed care transcends to different realms of health and well-being) I might opt for a DNP.

  335. These providers (physical therapists, eye doctors, pharmacists) are called “doctor” under a seperate pretense. When I go to the eye doctor, I expect to see a qualified professional of the highest possible degree of training who can manage the care of my eyes. Same for my medications when dealing with a pharmacist. If I am an inpatient in the hospital, I expect that someone who introduces themselves as “doctor” has the highest possible degree of training (both clinical and didactic education) in whole-health-care management. While a DNP does have the highest degree of training in his/her respective field (and, in most cases, is among the most qualified primary care providers), I don’t believe that they have the highest degree of training to deal with ALL diagnoses and ALL care-planning. I do believe, in many circumstances, that my care can be managed by a DNP. But, if I were to have a multifactorial health issue that required detailed knowledge of obscurely atypical pathology/pathophysiology, I know I would MUCH rather my care be handled by a qualified medical doctor. I could see myself being confused by a DNP introduced simply as “doctor”.

    When a pharmacist comes into the room and introduces herself as “doctor”, I understand the limits of her knowledge, the background of her education, and the scope of her practice. When I visit a doctor for health-care, I would like the title “doctor” to define the limits of THAT person’s knowledge, the background of THAT person’s education, and the scope of THAT person’s practice. Because DNPs provide the same type of care as primary care medical doctors, the term doctor, to me, does not allow me to make the distinctions listed above. While DNPs are as competent and as capable as primary care MDs/DOs in many respects, this is not true in 100% of cases. They do not have the same knowledge, education, and scope as medical doctors. I want to know WHO I am dealing with so that I, as a patient, can make the best decisions about my own care. If I think that I have a health issue that would be better addressed by a medical doctor because of its complexity, I would like to know what my provider’s qualifications really are.

    I understand that a doctoral degree in any field is tough to come by and involves rigorous training, but I don’t believe that the scope of a DNPs care and knowledge is equal to that of a medical doctor in all cases. I want to know what I’m dealing with so that I AS A PATIENT CAN BE MORE EQUIPPED TO MAKE MY OWN DECISIONS.

    Annemarie, I’m going to assume you are a student in a DNP program or are a licensed DNP. If so, congratulations! Regardless, you need to understand that these decisions are NOT TO BE MADE BY EITHER DOCTORS OR NURSES! These decisions should stem from your patients. Ultimately, we are what it is all about. Don’t allow a system to be created that doesn’t allow patients to innately know the qualifications of their providers.

  336. I am very concerned and discouraged after reviewing all these thoughts regarding the debate of having DNPs called doctors. I do not understand why this should even be an issue if a DNP has completed and earned the right to be addressed as a doctor. The comparison of the term doctor being used for physicians and nurses is valid and does occur in practice, but why the huge debate? Is there a serious problem with other doctors, such as pharmacists, philosophers, etc not being able to use their earned doctor title because it causes confusion? Why just the fight with nurses. I know physicians and nurses practice together as a team and if this is only about not causing confusion. Then it is simple to have the nurse practitioner identify herself as Dr. Reed, Nurse Practitioner and have the physician identify himself by their appropriate title. Do not rob the DNP of the right to use their justly earned title of Dr. just because their might be feelings of NPs trying to grab some of physicians’ turf. In the healthcare world containing a shortage of primary care practitioners there is plenty of pie to go around. We should all work as a team and collaborate our focus in providing the best care for our patients, and not focus our energy on silly arguments about titles.

  337. It is a sad day when we cannot unite and celebrate the progression of a discpline. I wonder what happened to the words ” healthcare team”. Whether you are called doctor or not, we all are here to accomplish the mission of promoting health.

    Nurses have come a long way as did every other healthcare profession in developing the members of the discpline. So now we have evovled to the the DNP. I do not see the problem. Other members of healthcare should celebrate that nursing took the initiative to improve on a profession so that your team members are even more valuable contributors to the team. Applaud!

  338. Honestly, if my name was changed to hospital affiliate tomorrow, I would still go to work and do my best to take care of my patient’s needs. I have interviewed various DNPs for jobs in my practice, and quite frankly I’ve grown to really appreciate the Nurse Practitioners. The Doctors of Nursing Practice always seemed to make the way we address them a priority. To me there was no difference in clinical ability between the two and the NP seemed more patient friendly. I absolutely love the NPs that work with me because they are respectful and good at what they do, and in return I show them my utmost respect as well. Having the title Dr. does not automatically give you the respect some of you put before your patients. MDs and DOs themselves are not respected if they fall behind the standard set by the physicians. What does having Dr. do for your job as a health care professional? Heck, some days I don’t ever wear my white coat and introduce myself as Mr. instead of Dr. because it plays no role in helping me be a better physician.

    In my opinion Nurse Practitioners are so good at what they good because they don’t have to worry about everything. All these health-care providers want independence but say that their model is different and what not. It makes no sense to me. When I enter a room, I question the patients on their problem as fast as I can so I can move on to the next patient who needs me. As I worry about making sure the patient gets the right treatment, my NP then has the opportunity to really get to understand and get the know the patient without a care about the next patient or billing or any of the annoying things that I will have to attend to later. While I’m in surgery or running tests they spend as much time as needed on the patient and that is why all my patients love them.

    This is what health care should be like, A TEAM APPROACH. Not bickering about a title as if it will help you do your job better. Take away the physician from the equation and what do you have? You have a Nurse Practitioner who won’t be as effective because they will be too occupied worrying about their next patients, billing, and getting sued. I will take an NP over a DNP any day and many of my colleagues agree with me on this.

  339. I am a DNP student but also a nurse practitioner in a large community hospital. What I am learning in my program I am actively applying to my practice. Once graduated I plan to wear the DNP embroidered next to my name as I will be very proud of the credential and I will explain it if patients or others ask…. but may not incorporate the title of “Doctor”. I like the personal (first name basis) and professional relationship that my patients, my physicians, and I share. Many times when a patient’s condition begins to deteriorate…. the attending physician is no where around or like the other day..one MD tapped me on the shoulder and asked me softly “You got this?” and I confidently nodded “yes” and he left the room The physician is comfortable with the nurse practitioner handling their patients on an emergent basis. as they know we will contact them with questions or situations outside of our scope of practice…………….I’m saying all of that to say……I think that titles are secondary…….primary is how confident and comfortable with the provider the patient is…..after all healthcare is all about the patient!…I do not want to get into a shouting match about titles…it takes time away from patient care.

    However our doctors do not refer to the DNPs, PharmDs, as “doctors” but they do however refer to the psychologists (PhD) as “doctor” makes you want to say…uummm…

  340. I have a hard time believing you are a NP.

    Anyway, DNPs are not trying to overstep any boundaries. Simply trying to be respected. Again, they are not better nor worse than MDs. They are just different professionals, with their own set of skills and knowledge.

  341. You must realize, many nurses not only carry an undergraduate degree in nursing, but also a bachelors degree in other fields of study. I myself am a Nurse Practitioner, and I have a BS in Medical Microbiology and Biotechnology, and yes all the prerequisites for medical school. There are many nurses who hold similar backgrounds, and to say nurses are not educated in the sciences is completely incorrect. As a future DNP, I assure you I can grasp scientific principles.

  342. There is no need for disagreement or arguement on this topic. The word -doctor- as stated above, originally refered to teacher. As things stand currently, almost every discipline has a terminal degree which comes with the title of “doctor”. Even though the word commonly refers to medical doctors, it does not belong them. As for the possible confusion of patients, as long as we educate the patients regarding what kind of “doctor” we are, I see no problem there. A big part of healthcare today is increasing patient awareness through education, our patients are more than capable of understanding the difference in their health care providers, we just have to teach them.

  343. Haha I have to say this is funny. DNP and that mudslinger did a test on the so called physician equivalent DNP. The nurses took a WATER-DOWN version of the USMLE (which is the easiest exam a physician will take on their quest to becoming board-certified) and 50 PERCENT FAILED. Thats quite scary. The national average for physicians is about 90 percent. Yet, they’re still equal right? Its funny because I actually hope DNPs start going into business. Lawyers will love it. I can already picture all the lawsuits. Yes DNP are superior because they are nicer and more patients like them right?
    Mudslinger and her minions are actually not very well liked in the nursing community (which are mostly NPs) and actually reject this idea of the DNP. http://allnurses.com/nurse-practitioners-np/dnps-taking-certification-301106-page2.html

    I have talked with NPs who attended medical school and had their eyes opened to the things they just didn’t know. I can understand the want to become doctorate, but implying it to be better or as good as your boss is a very stupid way of doing it. All I can say to you nurses is

    WHY DID YOU BECOME A NURSE IF YOU DIDN’T WANT TO BE CALLED NURSES?

    Look at the PA’s. They want to change their names to Physician Associate and they are getting help from all over the place because they didn’t overstep any boundaries.
    Although I can see your want to increase your role, most DNPs I’ve met are in an executive role and barely practice medicine. Its the high ego-ed nurses who just HATE being called being “a nurse” that is doing damage to this.

    I am a very intelligent, trustworthy and passionate nurse. I am proud to be a Nurse Practitioner. I don’t need to be called Doctor to get my job done.

  344. Does he have his doctorate degree? If not, why would he? I have never met a NP who calls themselves a doctor unless they have EARNED their doctorate degree- ya know- post graduate degree…

  345. A doctorate is the highest degree available in any field of knowledge. Nurses that have worked for the highest degree available in their profession have earned the doctorate degree, therefore, have the right to be called “doctor”. A mathematics professor, sociology professor, or biology professor at the university level that has earned their doctorate are called “doctor”. Why is it different that a nurse that has earned his doctorate should not be called by the same title? There are arguments about the possible confusion of role in the eyes of the patient. Nurse practitioners should clearly identify themselves as “Dr. So-and-so, nurse practitioner”. The truth of the matter is that nurses are entering more specialty and advanced roles. Some are independently practicing. The Doctorate of Nursing Practice (DNP) is not a physician, but is an important health care professional helping to ease the burden of the physician shortage. The advanced practice nurse should be viewed as a complement to, not in competition with the physician.
    Recently, there has been consideration given to requiring universal board certification of both physicians and doctorate of nursing practice nurses. The supporters believe that those that pass the certification could then earn the title of “doctor”. Like any hot topic, there are valid points worthy of review on both sides. The bottom line about the title of “doctor” is that it refers to highest degree available to any field of knowledge, that includes nursing.

  346. I think its time to educate the general public regarding the title of ‘Doctor’. The title is not just for MDs only anymore. With doctorate degrees being held by nurses, pharmacists, physical therapists, and other healthcare disciplines, the public needs to understand that those having the highest level of education within their specific discipline have earned the title.

  347. In the state of Texas, nurses are allowed to use the title “Doctor,” but also must follow with the appropriate credential such as DNP or PhD (Texas Board of Nursing, 2011) as many states require as a result of physicians. Why are physicians so concentrated on oppressing nurses? This oppression occurs in the workplace and has extended out into attempts to control the profession of nursing. In the workplace, changing this has been a very long road and still has miles to go. Interestingly, at one point administration did not blink an eye at the mistreatment of nurses at the hands of physicians and this continues in some organizations. Now physicians and the American Medical Association seek to continue oppressing nurses through dictating the use of the prefix of “Doctor” when we have the doctoral degree.
    The origin of the term doctor comes from the latin term meaning to “teach, show, cause to know” in 1300, then in 1400 the meaning “holder of the highest degree level in a university” was used. But it was not until 1600 that the term was used in meaning a “medical professional” (Harper, 2012). A nurse with a doctorate is a medical professional and received the highest degree of education at the university level. The designation of “doctor” is not owned by medical doctors and should not be treated as such. Other professions use the title of “doctor” if they have completed the educational level of doctor.
    If the importance of a care provider identifying one’s credentials and licensure is important then physicians should not discriminate against nurses. The American Physical Therapy Society (2012) supports the use of the title of “Doctor” being used by physical therapist who have completed a doctoral program. Do doctors who went to allopathic school or osteopathic school have to identify their credentials clearly to the public? No, but they should because sometimes they misrepresent themselves. All people have the opportunity for misrepresentation such as in the case of a physician trained in family practice but practices as a dermatologist enters a room with a patient and state “I am doctor so and so, I am not a dermatologist but will act as one today?” No. Dentists, veterinarians, doctors of psychology, and doctors of pharmacy all utilize the term as well, but have not received the attacks nursing has endured. So what is the basis for their argument?
    DNP curriculum is not the same as medical doctors, has different material involved, but is no less a doctorate. If nurses wanted to be physicians, then we would go back to medical school. Many nurses view their form of practice as superior to the medical doctors, because we show more care and give more education to the patients. Medical doctors are not prepared for the roles DNPs and Phds of nursing are prepared for, but still assume the roles such as leaders in committees. Most doctors spend 4 years of college, 4 years of medical school, then years of residency being isolated from people. Medical school does not include any class on leadership, but medical doctors are taught that they are to assume authority through simply the position of medical doctor. Medical Doctor only grants one the right to serve people in their ailments, nothing else.
    American Physical Therapy Society. (2012). Retrieved from http://www.apta.org
    Douglas Harper (2012). Online etymology dictionary. Retrieved from
    http://www.etymonline.com/index.php?term=doctor&allowed_in_frame=0
    Texas Board of Nursing. (2011). When the profession is nursing and the title is Doctor. Texas State Board
    Of Nursing Bulletin, 42(3), 4. Retrieved from http://www.bon.texas.gov/about/pdfs/july11.pdf

  348. After reading several of these posts, I realized that there seems to be a fundamental misunderstanding of what this issue is really about. Doctors of Nursing Practice DO NOT WANT TO BE PHYSICIANS!!!! If we did, we would of gone to medical school (And yes, I had the grades to attend medical school). I chose nursing! I keep reading all these comments from MD’s about how DNP’S are inferior in knowledge and do not go through the same depth of education and therefore are trying to be “fake doctors.” I do not want to be a physician, and did not choose my degree so I could pretend to be one. I do not pretend that my education will prepare me to do what a medical doctor does. I am not qualified to practice as a physician, and that is not what the DNP’s are trying to say. I think the physicans are misunderstanding. DNP’S are qualified to practice as a Doctor of Nursing and the curriculum adequately prepares them for that role. The issue here is that MD’s, and much of the general public, misuse the word “doctor” and interpret it to mean physician… and this is not correct. I have a friend who received her doctorate in the culinary arts, and so she is basically a doctor of food! LoL. A “doctor” is just someone who obtained a doctorate level of education. I don’t want to be called physician Blackwell, or be mistaken for a physician. In fact, I am very much a proponent for a specific title for us like Prac. Blackwell instead of Dr. Blackwell because I WANT my patients to know that I am something different. I have a different skill set, scope of practice, and unique method of practice based upon my background in nursing…and many patients prefer it! I don’t WANT to be mistaken for a physician. It does, however, infuriate me that physicians apparently think they own the title of “doctor” and I can’t receive the due respect of that title even though I earned it. Again, let me reiterate this because many seem confused, I did not earn the right to be called a physican…but I did earn the right to be called a doctor if I want to. I would also like to say that I see what some of the MD’s are saying… Many patients think “doctor” means physician, and I can definitely see how this could confuse the general public, because it seems to have confused many of the physicians and nurse practioners alike responding to this post. We all just need to accept that the face of healthcare is changing! If there isn’t a place for the DNP’S in the medical field, then they will disappear. Physicians need not feel like we are trying to step on your toes! Don’t you guys want help with the large patient loads? DNPs know that medical doctors are a wealth of knowledge, and utilize and depend on them accordingly. Why does it have to be a competition?

  349. A DNP has earned a doctoral degree in advanced nursing practice not in medicine, this individual has worked hard and met all the demands of the program and deserves to be recognized as doctors in nursing practice. The problem arise with the title being so long and the public’s preference to acknowledge the public by shortcutting the title; a doctor is not called medical doctor is called only doctor. The fear is that when the DNP introduces self as doctor in nursing practice the public will just take the short cut and call them doctors; it is just a matter of getting used to the long title and acknowledging what the person deserves. It wouldn’t be fair to call a medical doctor “medic” just because we want to take the short cut would it?

  350. You miss the point of the article and discussion. Nobody is asking whether nurses (RNs) should be called doctor. The article clearly discusses the use of ‘Doctor” for nurse practitioners (DNPs).

    A DNP is indeed a doctor. A doctor of nursing practice. They have earned the “Doctor” title by achieving that level of education. The same is true for any one else who has earned any doctorate degree.

    Refer to the article above more attentively. It explains in very simple terms all the fundamentals that you seem to be missing (e.g. origin of the title, degrees, etc).

  351. My point is we do not call ourselves something we are not.

    When one of these nurses come in and state “hello, I am Doctor Collins” that is misleading and a lie.

    Want that title? Go to school and earn it.

    Also go look at the education needed to obtain a Medical degree and a nursing degree… to claim a nurse is equally educated, is ingorant as well as a bold faced lie.

  352. “Why did you just stop at nursing and not persue that Medical Degree?”

    – You are not “just” settling for a nursing doctorate degree. You are choosing it because of its philosophies and approach of care.

    “You can do surgery? You seriously have the knowledge and training to do surgery consults and the procedures?”

    -Can all MDs do surgery? Ask this to psychiatrists, pediatricians, pathologists, etc….

    And, your husband does not call himself doctor because he is a physician assistant, that is his actual title. The degree for a PA is not doctorate level. So he is not a doctor, nor a physician. He is a physician assistant, which is just as important member of the medical community.

  353. Mr Carr, you are in fact a nurse.

    As a patient, parent, military veteran and paramedic, it is my duty to inform you that I would never allow my children or myself, to just “settle for a nurse, instead of having a real doctor.

    Why did you just stop at nursing and not persue that Medical Degree?

    You call it your practice
    You say you collaborate not confer with the doctor like you are on the same level as that doctor?

    You can do surgery? You seriously have the knowledge and training to do surgery consults and the procedures?

    I find that difficult to believe.

    Personally I say no thanks.

    My husband is a PA, and doesnt call himself a doctor…..

  354. I have had this argument with many of my colleagues. I do not think that DNP’s should be called doctors because they are simply not Doctors. I am an Infection Control Practitioner and am Director of Infection Control . However, my credentials are BSMLS, (ASCP,(M)), MPH (CIC), Phd (ABMM), quite different from a nurse and a Doctor. However, as Director I found myself in the line of fire between nursing staff and the medical staff (MD and DO’s). Doctors refused to call DNP’s Doctors because they are simply not Doctors. Nurses do not have the appropriate education to be called Doctors. I am quite disguised when an DNP introduce themselves as Doctors because it is very misleading to patients and to fellow colleagues. Its an insult to individuals whom have dedicated their life to science and whom have achieved academic success to become Doctors. I will NEVER call a nurse a Doctor because:
    1) They believe that they know more than everyone.
    2) They can run the hospital with out any other profession
    3) They only needed basic science class.
    4) Their egos are extremely high

    I wil never call a nurse a Doctor 🙂

  355. I’m sorry, I made a couple of mistakes;
    – As a PharmD. I do NOT refer to myself as Dr at work.
    – Nurses are not “lower”, however, if a person obsesses about titles and privliges at work, then they will inevitabely convince themselves that they are lower.
    I do think that Medicine is going backwards if Pharmacists and Nurses are given prescriber rights, solely to free up a Doctors time. he govt doesn’t want to spend in the nation’s welfare, and so is trying to buy cheaper labour by handing over physician roles to others.

  356. Considering the amount of work to achieve a DNP level (in addition to the number of years), I doubt that “just wanting a title” would ever be a reason for a nurse to choose to go back to school to become a NP (or DNP for that matter). The scope of practice of a NP is different, as it focuses in an advanced-practice specialty.
    NPs order, perform and interpret diagnostic tests, diagnose and treat acute and chronic conditions, prescribe medications and other treatments, manage patients’ overall care, spend time counseling patients, etc.

  357. I think you miss the point of the discussion. The article specifically talks about advanced practice nurses, who have reached a doctorate level of training (DNP). As a PharmD you refer to yourself as “Doctor” while at work, so why shouldn’t a DNPs?

    It surprises me that you mention that “Nursing by definition is in place to assist,” especially since you state that you were/are a nurse yourself. I would be curious to know the source of such definition (since in my nursing career I have never heard of such).

    While RNs focus largely on “care,” perhaps you should become more acquainted with the role of a Nurse Practitioner. As the AANP defines “NPs are advanced practice nurses who provide high-quality healthcare services similar to those of a physician. NPs diagnose and treat a wide range of health problems. They have a unique approach and stress both care and cure. Besides clinical care, NPs focus on health promotion, disease prevention, health education and counseling.”

    Throughout my nursing education, I have not heard once of nurses taking cheap shot at medical doctors. If anything, they always emphasize the optimal team work mechanics and the specific roles of each professional. Moreover, it is immature and rather ignorant for you to say that “nurses will always be lower than Docs.” It is not very hard to comprehend that both roles are different (and there is no better or worse, inferior or superior).

    However you seem to miss this point as well when you state “I know far more about drugs than the Docs, but that doesn’t mean I’m equal to an MD in his profession.” Your profession is DIFFERENT of a MD, so evidently you would not be equal, but that does not mean that one has to be better. The same holds true for DNPs. They are not trying to be MDs. They expand their training, education and knowledge to provide high-quality care (without ever forgetting their nursing roots). As the AANP states, “NPs have distinguished themselves from other healthcare providers by focusing on the whole person when treating specific health problems and educating their patients on the effects those problems will have on them, their loved ones and their communities.”

    So are DNP equal to MDs? Of course not. Are they “worse” or “lower” to MDs? No. They are simply different, with their own set of skills, strengths and weaknesses, just like any other health care provider.

  358. I have a great deal of respect for people who pursue nursing and those who pursue medicine. They are meant to serve as complimentary parts to a person’s wellbeing and for their healthcare needs. Bearing this in mind, true, by all technicality, a doctorate level program earns a person the right to use the title “Doctor.” However, we should definitely tread carefully when dealing with the public in the health setting when using titles such as these, so as to not confuse and mislead…that would not be helpful whatsoever and may cause a patient to be mistrusting. Careful consideration should be given to the intent for seeking out the doctorate in nursing, are nurses wanting to expand their horizons to improve healthcare and move nursing into a highly recognized and trusted field or are they just wanting the title? Anyone going to school for a title would be a bad fit in the healthcare system and they need not apply.

  359. I’m a Pharmacist, and ex-nurse. I have a DPharm, and do introduce myself as Doctor, but never outside work. It seems that Nurses have a chip on their shoulder, and always will. There are many idiotic Doctors, usually the younger ones, who’ve helped nurses develop that inferiority complex, but then again Nursing by definition is in place to assist. They focus on CARE, and not as much treatment. Sure they do care about the patient more than the MDs,but they don’t have the same skill set. I’ve seen:
    -Nurses telling me they know more about drugs than Pharmacists, lol.
    – Nurses prescribe dose strengths that don’t exist.
    – Lecturers at Nursing school take cheap shots at Docs.
    – Saying that they do all the Docs job anyway etc

    To every Nurse reading this, if u keep stressing about your status, you are pathetic and should know that you’ll always be lower than Docs. Any Doc is higher up the ladder. But that’s if u choose to look at it like that. And some Docs need to respect the nursing staff more, especially interns. Nurses should defo get paid more, but anyone who thinks Nurses have the same calibar inMedical practice, as they certainly do in Nursing, needs to see a doctor. I know far more about drugs than the Docs, but that doesn’t mean I’m equal to an MD in his proffession.

  360. I beg to differ Dr. Vet, I am a hospitalist DNP who also has a busy clinic practice based on the patients who dumped their MD after meeting me. I have numerous letters and referrals from patients of MD’s doing exactly what you say doesn’t happen, they rather see me as a DNP than their old MD. Most of the time because the MD misdiagnosed them, didn’t listen, was to busy etc. I see more patients admitted to the hospital because of poor medical treatment than anything else. Just another little note, at my hospital, the preferred provider to place central lines is the DNP, why you asked? The hospital did a two year study on infection rates, complications and patient satisfaction the DNP outcomes were so superior the hospital administrators asked us to re inservice the almighty doctors. So yeah, your way off, it is not how it is. Sorry! The public is smart! Just because you have an MD doesn’t relate to better care. I can tell you one thing that scares the hell out of me about doctors, they don’t ask for help when they don’t know something and they really don’t know what they don’t know because they have been trained to think they know it all. If you want to know the real difference between a DNP and MD, that’s it! I know that I can’t know everything, but will damn sure find someone who does, which is usually a specialist MD, that should help the ego log. Thanks

  361. This really made me confused. My question, what is a Nurse Practitioner? reading through this topic gave me an idea that they may have a lot of similarities when it comes to their practices but I think Nurse Practitioners will still be like nurse. To me it’s like they are higher than RNs but they are not as high as MDs when it comes to the skills and knowledge, the ‘know how’ and the ‘how to’. Thank you for sharing your opinion on this.

  362. The role of the nurse practitioner (NP) began in the 1960’s, when Loretta Ford (nurse) and Henry Silver (pediatrician) developed a continuing education program in response to the health care demands for primary care providers in underserved and rural areas. The NP role has evolved over time. Educational and clinical training has become more rigorous, as it should. The health care need of the 1960’s has not changed drastically; however, the face of health care has become more complex.

    The Doctor of Nursing Practice (DNP) as the terminal degree for the NP is a natural progression of the advancement of the nurse practitioner role in health care. There are some individuals in health care who do not believe NP’s should be called doctor in the clinical setting despite having earned the degree. I do agree nurses should identify themselves as Dr. XYZ followed by, I am the nurse practitioner.

    More recently, the use of the title of “doctor” by NP’s has been receiving a lot of opposition and attention from physician groups who oppose NP’s using the title in clinical practice. Physician groups have gone so far as to lobby the New York Senate legislature for sole ownership of the title. Senate bill (S02250) was introduced in January 2011, the purpose was to define who and who cannot use the term “doctor.” According to the state Assembly’s website the bill

    “Restricts use of the title “doctor” in advertisements to medical doctors, dentists, chiropractors, veterinarians, podiatrists, and optometrists who have received a degree in the appropriate profession and have met all professional requirements of the appropriate program registered by the New York state education department or accredited by an accrediting organization acceptable to such department or are otherwise licensed to practice in the state of New York.”
    The bill was referred to the New York Senate Consumer Protection Committee.

    Any NP who has completed a doctoral program has earned the right to be called doctor by virtue of their education and should not expect anything less. NP’s are not physicians, nor do they pretend to be. They are however, nurses who are skilled clinicians.

    According to the Institute of Medicine 2010 report, The Future of Nursing
    “Nurses with DNPs are clinical scholars who have the capacity to translate research, shape systems of care, potentiate individual care into care needed to serve populations, and ask the clinical questions that influence organizational-level research to improve performance using informatics and quality improvement models”

    The semantics surrounding the use of the title “doctor” detracts from the bigger issue of a troubled health care system and the need for a unified voice from both physicians and nurses to address the growing health care crisis.

    Respectfully,
    Kim Kintz, Adult Nurse Practitioner and Doctoral Student
    Oregon Health & Science University
    Portland, Oregon

  363. I think part of the problem is the disconnect between what to address someone and their profession. I have no problem with a DNP introducing themselves or being referred to as “Dr. Smith” just as a dentist, pharmacist or professor would. But just as a dentist would never tell anyone that they are a doctor, nor should a DNP.

  364. Rita,

    A nurse practitioner is an advanced practice nurse, and not a “Doctor’s assistant.” In many states they can work independently.
    In fact, the terms “physician extender” or “doctor’s assistant” are not appropriate when referring to a nurse practitioner (and can actually be rather offensive).

  365. As a patient, I know it will be confusing to have the MD/doctor and the NP who is a “Doctor’s assistant” with the same clinical title. Recognizing academic credentials are important and a doctorate in Nursing means being at the top of the nursing profession. If we call a NP “doctor” it will imply to the patients that the NP has the same academic credentials of the MD/doctor…isn’t this a form of ‘fraudlent misrepresentation” …?
    May be the solution is to call the NP with a doctorate in nursing:”Doctor-Nurse” and the MD/Doctor: “Medical Doctor” …by this logic, we can then call the specialist who has more education than the MD/GP: “Medical Doctor Specialist” … or, maybe the clinical title of “Doctor” should be confined to the MD only as this would serve to simplyfy the confusion caused by the perceived need to be the “top dog” – afterall, the patient should come first; not our egos.

  366. When a patient is looking for care they primarily look for an MD or a DO. I don’t know anyone who would be looking for a Nurse Practitioner (no offense, just the way it is).

    If a patient notices their physician is not a Medical DOCTOR, they won’t want to call that person a doctor, regardless of whether the Nurse Practitioner wants to be thought of as that. If the nurse has reached a doctorate level, and wants to be regarded by others as a doctor, he or she will have a hell of a time trying to do so.

    …And this is coming from a Doctor of Veterinary Medicine.

  367. DNP’s do not aspire to be MD’s. DNP’s are experienced nurses with advanced degrees and many many hours of clinical experience. The recent shift in policy to expand Nurse Practitioner programs, to include additional courses to fulfull doctoral levels of education, has caused much debate amongst us as well as our collegues concerning what we should call ourselves. We have no intention of misleading the public into believing that we are doctors of medicine. But we are doctors of nursing practice and have earned the right to utilize the title. Doctors of medicine do not own the word “doctor”, and if they don’t want the rest of the doctoral prepared community to use the same title they use than I think they should be tasked with coming up with a new title for themselves.

  368. To hear how so many physicians are upset regarding DNP’s using thier Doctorate title is heart wrenching. It seems to me that physicians will continue to belittle nurses, no matter how smart the nurse is, or how many advanced degrees the nurse obtains. It doesnt take a rocket science to understand the educational level between the DNP and MD. Nursing programs are very demanding and rigorous. No, it doesnt compare to Medical school, but its no cake walk either. Registered Nurses, LPNs, And Advanced Practice Nurses are the glue to HealthCare, without nurses healthcare wouldnt survive. Since the MDs have much education beyond any APN, why dont MDs attempt to run clinics and hospitals without RNs, LPNs, and APNs. Maybe medical school and residency revealed to them how to work without nurses!!!!!!!

  369. Now maybe you know how LPN’s who have worked in every facet of nursing and have even run buildings (assisted living) and been in management feel when we are not considered nurses.

  370. As a basic RN and Paramedic I am shocked at how poorly every MD I have seen could not or just did not care enough to allow me to take a full breath when listening -lung sounds. Most in fact did not bother. My fellow Nurses and Paramedics tend to spend more time assessing Patients than I have been given by any MD. That has been my experience. MDs if I’m lucky will look up to say hi. Most of the time PCPs have there face in the clipboard, throw a script at me, usually an antibiotic, that i did not need and walk out of the exam room. Most PCPs rush rush and act like they don’t care,,Abt resistance is the direct cause of the I don’t care PCP not explaining that pts do not need an Abt for a cold. Keeps me busy giving Vancomycin in the HH infusion industry. Majority of MDs are not that great and how often do they really wash there hands. I’m not a DNP or NP but
    The ones I know are like detectives and good luck getting pain Meds through them if your addicted to narcs. MDs could learn from a good Dr of Nursing Practice.

  371. I completely agree. As I have with Bryan’s comment towards the beginning of the comments.

    NP’s should know their limits. If they are an NP then I do not think they should be called doctors. BUT if they have exceeded towards DNP then yes, they should be called doctors, doctor in nursing. And should address their patients as a doctor in nursing practice. No matter what anyone says, there will always be a difference. There’s a reason why in undergrad pre-med students take more math more physics and more science than nursing students.

    I’m a pre med student that runs an organization on campus that seeks out MDs, DOs, RNs and NPs as special guest speakers. There were two NPs that came to our classroom and I asked them what’s the difference between MD’s and NPs. The answer was, I quote: “There isn’t, I don’t know why we have doctors! Just kidding. We are equal. They just have tee bit more training. We are no different at all.”

    I really didn’t like their answer. But nodded anyway. Please don’t tell me you have a BSN, and a Masters and you are equal to an MD and DO that had double the schooling you have and trainining =(

  372. I completely agree with Bryan. One should not compare the academic lengths of an MD and a DO with an NP.

    When it comes to it, it’s just a title right? My mother can be called a doctor if she wants. But is she one? No. When it really breaks down to science knowledge and training, MD and DO’s have more experience before actually going out and heal.

    I work at a clinic as an interpreter where there’s 3 NPs and 2 MDs and a DO. Most of the time after NPs see a patient they leave the patient room to ask a MD or the DO questions before going back into the room. I never see that with MDs or DOs. NP’s are gentle and extremely sweet and take their time with every patient. Bu just in a general practice clinic I can see the difference between an NP, DO and MDs, on who has more training and knowledge than the other.

    I guess the question is: Is an NP an equivalent PHYSICIAN to a MD and a DO.

    And this is coming from a interpreter/patient not a health professional.

  373. Ahh how this takes me back. I’ve been a internal medicine hospitalist for about 4 years now, and I started my first job as a hospitalist when I was 26.

    My first job was in Philidelphia. I loved the job and my 7 on/ 7 off schedule and had 2 PA’s and 2 NP’s working with me-all which were almost 5-20 years older than me. I respected them and their experience which made my job a whole lot easier. It was a good team, but there were two people that caused me distress. An NP and an PA. They were both experienced and in their 40’s. One day, a patient came in with severe pain on her foot, where we saw a small sore. The two men were simply convinced it was just a small infection, but the tests did not add up. I suspected is was something more, so I told them to wait and run a few blood tests. I reviewed the tests myself after and went home.

    The next day I came back to find out, they had stepped out of their grounds by lieing and telling the patient they were medical doctors and given the patient a bactrin which had caused complications causing her to go in septic shock. When i confronted the men they both snapped and told said

    “We are just as qualified as you are.

    “You doctors think you’re just the **** because you wasted your lives in medical school and residency. I know just as much and even more than you do and i should be earning as much.”

    I called security right after and the two men were stripped of their right to practice medicine and sued for pretending to be doctors. I quickly called a oncologist because i believed the sore to be skin cancer and he confirmed and treated her and thank god, he saved her life.

    I don’t have a problem against NP’s or PA’s. I honestly love them, but they SHOULD NOT overstep their boundaries and try to be doctors. They should know their limits and leave so should doctors.

  374. I have read so many of these arguments over the years, and all of them are the same. There are a few people saying they had a great experience seeing a nurse practitioner, a few saying they will never see one again, or they don’t know what they are talking about. Then i see the angry frustrated MD, arguing that all DNP’s are doing nothing but trying to play doctor. Then there is the actual ARNP that says all they want to do is use they title that they earned and provide the care they are trained to give. Every one of these blogs, comments, yada yada yada are all the same. I have sat back and read most of these comments on this one and i just cannot sit here and not say anything. To the few MD’s that have said so many demeaning, and degrading comments about nurses, you all should be ashamed of yourselves. I could never imagine working with any of you people. You want to call yourselves superior to us because you have an MD after your name. I have worked with some amazing doctors and some amazing nurses, I have also worked with some terrible on both ends. They were all colleges of mine and I would never in a million years talk down, or degrade any of them like you all have in this post.
    To the doctor from india or wherever, as to say i became a nurse, and then a DNP because I wasn’t smart enough for med school, made me laugh. I went to a tech school for my LPN right after high school, all i ever wanted to do was help people. Being a doctor was my number one goal but i wanted to start right away. A year after I finished my LPN i decided i wanted to work on being an MD. I double majored through school in nursing and pre-med. I worked as an RN through most of it. I hit a cross roads at that point wondering what i wanted to do. After taking the MCATs i and being accepted to med school (don’t ever tell me i wasn’t smart enough to get in, I held a 3.6 GPA while double majoring, and working full time, and scored a 34 on my MCATs)
    My life was flipped upside down right before the start of my second year of med school, when an unfortunate accident almost killed me. It was a long recovery, and at that point i decided that i wanted to stay in nursing. After my recovery i went back to work, and also started working on my NP. I now have my DNP and I have my own practice. I am partnered up with one other DNP, and an MD, who approached me for the opportunity to start this practice. The doctor i work with does not oversee me, but does in fact collaborate with me. I have never and will never do anything out of my scope of practice. Oh and i do carry and pay for my own malpractice ins.
    For the most part i understand where both sides are coming from, and I agree that it can be confusing when not identified in the right manner. But to say i am trying to be a fake doctor, and use a title that i did not earn is an outright insult. When i was a charge nurse, I remember a couple of physical therapists, enter a room and introduce themselves by saying, “Hello my name is DR. Smith and I’m your physical therapist. Now how come no one ever chastised them for using the title Dr. in a clinical setting. They did in no way have their MD, just a DPT. Yet to this day they are still able to use that title, and you all have not said one word. And I have a good friend who is a chiropractor, one of the best in this state. (not my opinion, he rated as the second best in our state) He uses the title Dr. when he sees patients, but hes not an MD. Should he stop as well, because he is going around telling patients he is a doctor, but has not received his MD. For the most part my patients know when they enter they are seeing a NP, when i introduce myself to new patients, I always address myself as Dr. Carr, and tell them that i am the Nurse practitioner. I have never not identified myself as a physician, nor have I ever not told the patient, that i am a nurse practitioner. It is also on my name badge, and my name and title are embroidered on my lab coat.
    It is all a pointless war between nurses and doctors. I for one am tired of doctors like the ones that have posted on this site, and pray to God that i never have to work with any like you, and that no one i know ever has to be a patient of yours. We can just put the he said she said BS to bed, and call this argument what it is. A large group of doctors claiming they should be the only ones to carry the title DOCTOR. They funniest part is most of you have missed or forgotten the part where MD’s had to fight at one time to use the title of doctor. It was originally used only for students who had reached the highest level of their law degree. The term doctor originated as meaning teacher in the first place, not medical care giver. Lets teach each other, i know that i would not be where I am today if it wasn’t for the Doctor that i am partnered with at my practice. He has also learned a lot from me, with my nursing background. At the end of the day its all about the patient( i couldn’t care less if you guys say NP’s only say this to try and end an argument because my first priority is my patients, not what you all think) not the titles, or the bureaucracy.

    Dr. Thomas Carr, ARNP, DNP

  375. Ms. Ficarra,
    The various responses to your question ”should nurse practitioners be called doctors (DNP)?” have raised several issues; appropriate use of the title of doctor, formal education of doctors of nursing practice (DNPs), scientific foundation of DNPs, clinical experience and collaboration. I will speak to two of these issues; patient outcomes for those treated by nurse practitioners (NPs) and use of the title of doctor. You quoted a physician as saying, “They only have experiential knowledge…” and “it would be like allowing flight attendants to land an airplane.” Presumably, this meant allowing DNPs to practice independently was similar to allowing flight attendants to land a passenger plane. These comments show either an ignorance of DNP education and training or an emotional loss of objectivity. A nurse practitioner that has earned a doctorate degree in nursing practice has a minimum of seven years of college education. This education includes courses in the hard sciences such as chemistry, biochemistry, anatomy, physiology, pathophysiology and genetics to name a few. Additionally, DNPs are licensed registered nurses and pass certifying board exams to practice as advanced practice nurses in an area of specialty. The licensure and certification process ensures competency and public safety. Doctors of nursing practice, as well as other NPs are fully qualified to promote health and disease prevention, as well as independently diagnosis and manage health issues within her or his specialty area.
    The Journal of the American Medical Association (JAMA) published the results of a clinical trial in which 1,316 subjects were randomly assigned to the care of either a nurse practitioner or physician. After six months of care the researchers, which included four physicians, concluded that there were no appreciable differences in patient outcomes between the two groups (Mundinger, et al., 2000). A two-year follow-up study by Lenz, Mundinger, Kane, Hopkins, and Lin (2004) supported the original findings. Numerous other studies have since supported similar findings in other populations and settings. Nurse practitioners are trained to take care of patients and they do it well. There can be no reasonable analogy made between patient care rendered by a nurse practitioner and a flight attendant landing an airplane.
    You quote another physician, Dr. Doug Farrago as stating “you just can’t call yourself one [a doctor] because you, well, just want to.” While this statement is technically correct, it is irrelevant to the conversation. This discussion is about nurses using a title they have legitimately earned. I believe Dr. Farrago’s additional comments get to the real issue physician’s have with DNPs. Dr. Farrago continued by categorizing NPS as “in direct competition with us.” In your article, you presented a history of the title of doctor. You additionally present numerous other examples of various fields which award doctorate degrees so I wont restate these here. I was encouraged to see the comments by Dr. Kevin Soden who agreed that if a nurse has completed doctorate education then it would be appropriate to use the title of doctor. Doctors of nursing practice have done just that, completed a doctorate program of study.
    Lastly, I cannot help but feel there is a gender issue involved in this debate. Historically, physicians were primarily men and nurses primarily women. A 2011 survey has shown that the gap between male and female physician’s pay is actually widening, even when adjusted for hours worked and area of specialty (Reuters, 2011). Similarly, a 2006 study showed that male NPs earned between 7.9 and 8.2% more pay than their female counterparts (Newland, 2006). This is relevant because in our society financial compensation is linked to one’s value and power in the market place, and therefore value and power in society. From this standpoint, women are not as valued in the workforce as men. We now have a predominately male dominated group feeling economically challenged by a predominately female group. The physician responses seen in this blog reflect an emotionally driven attempt to deny nurses use of a rightfully earned degree title and limit use of their training due to fear of economic infringement. In light of well documented support for the care provided by nurse practitioners, these emotional responses are astounding.

    References:
    Ficarra, B. (2011). Nurse Practitioners – Doctors? The Health Care Blog. Retrieved from https://thehealthcareblog.com/blog/2010/05/12/nurse-practitioners-doctors/

    Lenz, E. R., Mundinger, M.O., Kane, R.L., Hopkins, S.C., & Lin, S.X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow-up. Medical Care Research and Review, 61, 332-351. doi: 10.1177/1077558704266821

    Mundinger, M.O., Kane, R.L., Lenz, E.R., Totten, A.M., Tsai, W.Y., Cleary, P.D., …Shelanski, M.L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians. The Journal of the American Medical Association, 283(1), 59-68. doi: 10.1001/jama.283.1.59

    Newland, J.A. (2006). 2006 Nurse practitioner salary & practice survey. The Nurse Practitioner: The American Journal of Primary Health Care, 31(5), 39-43.

    Reuters. (2011). Pay gap between male and female doctors widens. Retrieved from http://chicagobreakingbusiness.com/2011/02/pay-gap-between-male-female-doctors-widens.html

  376. Randall, regarding your claim that MDs have allowed (after a fight) DOs to work as equals and, as such, should allow DNP to work as such… please note:

    MDs and DOs adhere to the same academic schedule: 4 years of undergraduate work, 4 years of strenuous graduate work (of which 2 years are academic and 2 years are clinical in nature), 3-5 years of post graduate work (internship and residency), 1-2 years of post residency fellowship (often), and 1-2 years of fellowship involved research (less often). Please note that at each step of education there is a terribly difficult selection process that each individual must pass through, or else their medical training is discontinued.

    Thus, physicians who are colloquially referred to as “doctors” by the general population must complete between 11 and 17 years of highly competitive and strenuous training before they can practice clinically and independently in their respective field. It must, therefore, be implied, that during this 11 to 17 years of difficult work that 11 to 17 years of valuable knowledge and ability has been obtained. Understanding this, the knowledge and ability of nurse practitioners who complete 6-8 years of (arguably less competitive and, possible, less strenuous) work is nearly 50% of that obtained by a DO or MD.

  377. If I spend (at least) 4 years in graduate level nursing courses to complete my DNP, someone had better call me “Dr”. If those who receive a PhD in engineering, philosophy, or psychology are called “Dr”, then why would it make sense to deny a Nurse Practitioner the recognition of advanced education and training? I understand that it may be confusing to patients, but one simple sentence could easily clear up any confusion. Something like, “My name is Dr. So-and-so; I received my doctorate in nursing practice.” Personally, I wouldn’t mind NOT being called “Dr.” in a clinic setting, but the fact that I would be denied this well deserved title really rubs me the wrong way. Respect for one another in a health care setting is crucial for the recovery of a patient, and it is unprofessional for providers to have such harsh views of one another. An ad campaign to the general public about the role of the Nurse Practitioner is a great idea.
    Ultimately, doctors of nursing and doctors of medicine entered the health care field to provide better lives for others, and they should work together to achieve a common goal.

  378. The ego driven Medical Doctors here need to support their position with studies and not unsubstantiated opinion. The bottom line is that studies, as referred to above, clearly support that nurse practitioners provide care equivalent to that provided by physicians. If the care provided is equal, is there even a concern if a patient confuses a Medical Doctor with a Doctor of Nursing, apart from the Medical Doctor’s ego? I think not. The danger of title confusion among patients is unsubstantiated and ridiculous. If a Nurse Practitioner achieves a doctorate level education, the title Doctor is a clear and accurate description of the degree conferred.

  379. All through nursing school, they learn little science and more sociology… All of a sudden at a dnp level you expect them to grasp the scientific principles which form the foundation of medical practice? So you build the foundation after you have built the building. Interesting! Why have dnp? Just increase the intake for the medical course. Or do away with doctors altogether. Phase them out and let there only be nurses. I don’t know how it is in the us, but in india, only those students chose to become nurses who tried, but couldn’t qualify to get through the premedical test. After qualifying as nurses, they tend to introduce themselves as ‘doctor’ even if they only have a diploma in nursing. So i do believe that a lot of this has to do with the coveted prestige that they couldn’t get, and can’t stomach the different prestige that they enjoy. The msc nurses do try to overstep their bounds but their lack of knowledge of fundamental science and resultant errors become readily apparent due to their symptomatic and experiential approach to problem solving. As far as “experienced nurses getting same level of knowledge as an md” goes, 10 years of experience probably gives them what a student in medschool knows. That same student 10 years after residency would know a lot more than an equally experienced nurse. And the training an md receives is pyramidal with a wide base in fundamental sciences then life sciences then human biology and then finally in medical sciences tapering off to subspecialities. A nurse is trained more in social studies shifts to basic applications in medical sciences and continues as a straight pole to basic applications in subspecialities. A pyramid is definitely more stable than a pole. Statistical conclusions cited by nurses are based on the outcome of a small sample of diseases, even a basic knowledge of statistics (a fundamental SCIENCE and not sociology hence incomprehensible to nurses as they have little scientific background) should tell you that more diverse the sample studied, the more accurate is the inference to the actual truth. How do you judge competence on the basis of only 3 conditions and those too, among the easiest to diagnose and relatively easy to treat. Surely, there are more diseases than just the 3 mentioned, seen in primary care. Are the others not important? Well, they are to the patient atleast and nurses are definitely more concerned about the patients than the doctors! The sad part is that the ones to offer an “honest” and “unbiased” opinion are the ones with even less knowledge about the field than the nurses so there isn’t much more to expect from them. However, let the nurses be prepared to take the same responsibilities and risks as the physician if they wish to enjoy the same status as the physicians. I’m proud to be a doctor and why shouldn’t i expect that prestige when i have given the best years of my youth in the long and arduous study of the science for 8 years, sacrificed leisure and time with my family, spent 90 hours a week, including 2 spells of 32 continuous hours of clinics (sometimes on holidays when others are enjoying) for 4 years as compared to truncated syllabus for 5 and a half years, 8 hour clinical shifts, 52 hours a week for 6 months and 3 hour clinical shifts at 21 hours a week for 2 years?

  380. Too much emotion. The facts: there is in the state of Minneosota, at the University of Minnesota a curriculum in which a Nurse Practioner can obtain a Doctorate in Nursing. The course work is completed in approximately an 18 month time frame, costs about $18,000. Much can be done on-line. It’s used mostly for those who teach in academic centers- their pay and advancement is better. Unfortunately, in private practice medicine, this Doctorate in Nursing does not confer any higher payment from third party contracts. A nurse practioner is reimbursed about the same as an MD for a similar patient encounter, whether they have this doctorate or not. This is why most don’t get this degree. I work with 8 NP’s in my OB/GYN practice and have an excellent relationship with them and find them to be quite competent in their care. But they don’t want to be called “Doctors” simply because they don’t have that degree.
    Robert Stocker MD

  381. What I find interesting about this debate is that it revolves solely around doctors and nurses. Plenty of other healthcare professionals in hospital settings that are NOT M.D.s are referred to as “doctors” but somehow that doesn’t seem to cause as much debate as the idea of a nurse being called “doctor”.
    In the units where I work, Pharm.D’s and psychologists are referred to as doctors. Podiatrists and Optometrists and Dentists are always referred to as doctors but these practitioners are not MDs anymore than DNPs will be but there seems to be no concern with calling them “doctors”.
    For anyone to say that nurses should be the ONLY healthcare professionals who are not allowed to call themselves doctors when they obtain a doctoral degree really suggests that this is debate is about something else.

  382. OK, let’s stop the crap. Many studies show that an NP providing primary care does so at a level equal to an MD (the AMA sponsored one such study and it was published by JAMA see: http://jama.ama-assn.org/cgi/content/abstract/283/1/59.) The AMA sponsored study was published in 2000–and we are still having this conversation and it is driven by MDs that quote AMA studies when it pleases them and ignores them when it is a strike against their position.
    So, here’s the deal:
    NPs are as good as MDs or primary care. (AMA says so—see above)
    DNPs are NPs who are as good as MDs for primary care.
    So, DNPs and MDs are both doctors with essentially the same outcomes in primary care.
    Thus, a Doctor in a primary care setting (which may include a hospital folks!) is a Doctor whether he/she is a DNP or an MD.
    Does the DNP role compete with MDs in primary medicine specialties? Yes, and as it should. The AMA and its approved medical schools cannot produce enough MDs to fill the demand required. Therefore, the DNP folks are stepping up—it’s just supply and demand.
    So, do DNPs want to be seen as primary care doctors? YES, and anyone who says differently is dissembling.
    But wait, this fight has happened before. The AMA fought the DO crowd as they expanded beyond high-class chiropractic and became physicians.
    SO, will the DNPs need to expand their training as they come of age as a respected member of the primary care team? Yes, and it will–after all no outside group is forcing the DNP designation.
    Finally, the AMA and the MDs and DOs need to step back and realize that the DNPs are showing up and the genie is out of the bottle.
    Oh, and to all the MDs posting that it’s not about the title–I agree–so stop arguing and fighting the title. If a DNP can provide the same level of care as you then why should you worry that this exceptional provider of primary care is calling her/himself by the same title as you? After all, it’s not about the title. Or is it?

  383. > “Studies conducted for the NPs are based on outcomes where
    a physician or physician-specialist is serving as back-up for the
    NPs for referral purposes.”
    Again, this is the point. See my note about cases 2 and 3 above.
    The Nurse lobby is attempting to obtain the right to the independent
    practice of medicine (by any of several mechanisms, including
    relabeling medicine as nursing practice and moving it under the
    state boards of nursing), BASED ON THESE “STUDIES”.
    Based on the same studies, they claim equivalence with physicians.
    But these studies do not address and cannot detect the more difficult
    to diagnose cases (2 and 3) above.
    In fact, nurses have nowhere near the knowledge base required to
    cover these cases. And no studies have the goal or the power to
    investigate whether nurses can diagnose or treat them.
    Instead, when the NP does not know the relevant medicine, he/she relies
    on referral to a physician.
    None of this is a legitimate reason for a full scope license to practice
    medicine independently.
    Because primary care IS NOT “simple care.” Cases 2 and 3 DO arise in
    primary care. While such cases individually are rare, COLLECTIVELY they
    are NOT, because of the rather large number of cases 2 and 3 distributed
    in the general population.
    The current arrogance of the NP/Nurse lobby does not permit the
    recognition of this simple truth, and neither does the lefitst
    liberal Nurse agenda in the Universities.
    AGAIN: It is absurd and insane for Mudinger and the IOM lobby
    of the Nurses to argue for full practice rights for medical
    practice based on the training in Nursing school, including the
    NP Master’s and the (politically correct) DNP degree with all
    its sociology and ethics and “collaboration” coursework.
    They are arguing they should get a medical license because
    they can equivalently treat ASTHMA, DIABETES and
    HIGH BLOOD PRESSURE. Perhaps a few other common and
    simple disorders.
    Further: This country is finally awakening to the fact that the
    liberal agenda has and is bankrupting the United States.
    The current “mandate” to add 32 million more people to the
    insurance rolls may well be blocked by Congress in the
    near future by refusing to allocate precious resources to
    accomplish this Herculean task.
    Thus, the attempt by the NPs to expand their practice rights
    by POLITICAL instead of educational means by citing the
    tremendous new influx may well become a moot point.
    America has reached such a low point on quality standards
    in its relentless pursuit of mindless political correctness,
    that PERHAPS the people have FINALLY decided to begin
    to return to our former high standards in the professions.

  384. The IOM report:
    -It has been pointed out on fiercehealthcare blogs that
    the IOM committee is nothing other than the UMDNJ
    Nurse lobby.
    -A quick review of the committee reveals the chair is Donna
    Shalala, a Ph.D. in political science and a politician in the
    Clinton administration.
    -The vice chair is the Chief Nurse Officer at Cedar-Sinai in LA.
    -Of the few docs on the committee, one is chief medical officer of
    CVS Caremark( pharmacy), and the other is at a Dartmouth
    Institute for”Policy”and “clinical practice”.
    And the rest of these “experts”??
    -Big Business, Big Pharma, Public Health Schools, and Nursing, Nursing
    and more Nursing.
    With this review of authorship comes understanding:
    -This is not an objective, balanced review with any significant input
    by physicians in academia, or in practice in primary care medicine,
    or any sub-specialties.
    -A few of the physician leaders state that the report draws “illogical”
    conclusions.
    -It is more likely that the report draws POLITICAL conclusions- those
    that are designed to cheapen and weaken standards of medical care
    in the United States so as to force Universal Health Care coverage
    for all people at lower standards that, while they will be forced on
    medicine, will never be acknowledged-because the Nurse lobby
    has its “studies”.
    – In this manner, the bankrupt federal government AVOIDS the spending
    needed to increase the number of residency slots in family medicine
    or primary care, as well as avoids paying docs in those specialties
    their fair market value to attract docs into these areas. Instead,
    it opts for persons with far less training, experience and understanding,
    proclaims them equals, and insists that they will be the new primary care
    captains of the ship of health care.
    – One is reminded that in all Socialist/Communist take-overs everywhere
    in the World, one of the very first objectives is to kill the professionals-
    because they represent an educated threat to the Socialist take-over.
    -Conclusion: This new IOM report is likely an extension of the Socialist-
    Communist take-over of the US (the healthcare part of that take-over).
    -Viewed in this light, the report is not “illogical” at all.
    It is an instrument of war (in the Machiavellian sense) by the
    current Left-leaning Communist-Socialist government for the
    take-over of US medicine and its attendant required diminution
    of the medical profession. It makes perfect sense, after all.

  385. test: Thanks for the cite on the October 5th IOM report. I just downloaded it from the IOM website.

  386. Further comment to Christensen:
    -The study you cite measured physiologic outcomes in
    6 months for ONLY THREE COMMON DISEASES:
    Asthma, Diabetes and Hypertension.
    The utter stupidity of basing medical licensing and
    responsibility decisions on three of the simplest and most
    common disorders is beyond absurd-it is simply crazy.
    You cannot draw the general conclusions referenced above
    in your quote-but of course you will do it anyway.
    Take a good look through Harrison’s Principles of
    Internal Medicine, and, assuming only that you have
    at least a minimal understanding of logic, you will
    see that the studies cited by NPs do not support their
    grandiose conclusions. They are almost certainly as a group
    not qualified to diagnose even moderately rare or unusal
    disorders, nor those that are common but present in an
    unusual fashion or with complications-
    WHICH IS WHY THEY NEED SUPERVISION OR
    “COLLABORATION.”

  387. Agreement on several levels:
    The new Institute of Medicine Report on Nursing is now
    published.
    It advocates a far greater role for the full medical licensing
    and privileging of advanced nurse practitioners and it cites
    the same studies by Mudinger et.al.
    I will attempt to explain why these studies do not reveal the
    full truth about medical practice, however the points I make will
    not make a difference ultimately on the fate of primary medical care
    in the United States.
    The studies conducted for the NPs are based on outcomes where
    a physician or physician-specialist is serving as back-up for the NPs
    for referral purposes. The studies do demonstrate equivalent outcomes
    for NPs, as for physicians.
    However, the ability of NPs to refer to physicians for complicated cases
    acts as the confounding factor for the conclusion advocated by the Nurse
    Lobby: What the studies have shown is that NPs, acting with physician
    collaboration when needed, deliver equivalent medical care.
    For the NPs to show that their knowledge and skill base is identical and
    thus they merit medical licenses, they would have to prove equal outcomes
    for all patient types with no MD involvement ever-even by referral and
    consult in hospitals.
    And this cannot be done. It cannot even be demonstrated by objective
    written exam, because the results demonstrate otherwise.
    Now, as William Osler pointed out long ago, patients present in three general
    ways:
    1). Common conditions commonly presenting;
    2) Common conditions presenting in an uncommon manner, and
    3) Uncommon conditions presenting [“zebras”]
    The 4th logical possibility is omitted due to incredible rarity.
    None of us doubt that NPs can handle case number 1.
    Cases 2 and 3 are the problem and generate the question:
    Have the NP studies been large enough and objective enough to
    prove that NPs have equal outcomes with docs for cases 2 and 3??
    In general, the medical profession believes no study has had the
    statistical power to investigate, let alone answer, this question.
    By observation, most of us are certain the answer is probably not.
    Now the politics:
    – the answer does not matter, because a proven case for the first
    condition will be assumed to prove the same for cases 2 and 3.
    -the driving force for this logical error will absolutely be cost:
    NPs will cheaply replace primary care physicians.
    I do not believe the medical profession can successfully make this
    argument or case because the cost savings the government and
    politicians see for the Medicare and other entitlement programs is
    far too enticing.
    I actually believe that NPs will replace FPs, Peds, internists, dermatologists,
    perhaps radiologists, OB-GYNs, and Rehab medicine specialists and
    perhaps a few other specialties.
    Medical students will almost certainly not go into primary care again, and
    much of the backbone of the medical profession in the United States will
    erode. Why be a primary care physician, when the same income is obtained and work can be done as an NP? Their will be no incentive of any kind.
    So you may as well start calling your nurse practitioners “doctor”: they will
    be that in fact as well as in name.
    Only over the course of much time will the secondary effects,
    such as the weakening of medicine and the medical conditions that
    are missed and not understood begin to stack up, slowly, with time-
    perhaps as long as 10 years (as seen on a national scale).
    But in 10 years time, with all these forces and factors in place,
    few if any physicians will be in primary care and related specialties.
    Thus, I actually agree that the likely outcome is: the new primary care
    “doctors” will actually be Nurses.

  388. “I can hardly believe the extent to which this nation is now willing, ready and able to lower professional standards for the practice of medicine.”
    I can. And, so does a group of Columbia University physicians who published the following article in the Journal of American Medical Association (JAMA):
    G.S. Dr Mundinger, et.al., “Health Outcomes Among Patients Treated by Nurse Practitioners or Physicians,” Journal of American Medical Association, Vol. 283 No. 19.
    The above author states that patient outcomes in a primary care setting are little different between the NP and physician.
    What counts? Results. Apparently, Dr. Mundinger agrees. Like several of us had been advocating through this message thread (and to get back on topic): There is no reason whatsoever why a DNP cannot, and should not refer to him/herself as, for example, “I am Dr. John Doe, your Nurse Practitioner.” Clear, concise, and no patient confusion.
    The only potential for patient confusion will occur when the public continues to find that many NPs are taking better care of their needs in the primary care setting than their traditional physician – and will be further confused as to why physicians are charging more for the same, or better level of primary care services — and why is it that Medicare is reimbursing physicians at a percentage more than the NP for the *exact* same level of patient care?
    Medicare is now realizing what’s happening as are the insurance companies who will continue to find news ways to drive down health care costs while continuing to provide competent patient care.

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  390. Clear Examples:
    Here are a few clear examples why and how NPs should not,
    by changes to state statutes or regulations, be simply granted
    independent practice rights despite a primary care doc shortage:
    [And YES, the push by the Nurse academic lobby to be called “doctor”
    is exactly a push for this ulterior motive]
    1). See: http:// http://www.protectingpatientrights.com/blog/expanding-role-of-nurse-practitoners.
    -attorney John Fisher details how an NP failed to order or
    even consider a blood culture and missed bacterial
    endocarditis in a fever-of-unknown origin case. The patient
    was seen many times by the NP, never by a doc, and suffered
    a stroke after 3 months.
    2). My own experience in an US military facility, where NPs hang on for years
    because they get rank and admin positions, while all the docs leave
    federal service:
    An elderly lady is seen for “headache” many times by the clinic
    NPs- and ends up getting narcotics. With no improvement,
    they send her to the only internal medicine doctor in the clinic.
    The pain is in the distribution of the posterior auricular artery
    BEHIND the ear, instead of in front of it. Had it been a
    “classic” case, it would have been the “temporal arteritis” that
    most NPs would diagnose.
    What did the NPs NOT know? -That there are multiple branches
    of the external carotid, and that this was an ATYPICAL case of
    “temporal” arteritis. The risk to the patient??
    -BLINDNESS without steroids IMMEDIATELY
    The NPs in this clinic were highly political and resented the fact
    that docs get more pay for “equal” work.
    [They get more pay because of longer, tougher training
    at higher standards, both for entry into their profession and
    for graduation and practice].
    3. A review of the DNP curriculum at UMDNJ school of nursing reveals that
    a majority of the credits are in “health promotion across diverse cultures”,
    and “Leadership, quality and Collaboration”, as well as “healthcare
    economics and the Business of Practice.”
    -Very little hard core Science or Medical Science.
    Mostly policy, economics, cross-cultural,
    “social studies” dynamics
    – Even the “foundational” courses are information technology,
    and “Healthcare Ethics for the Nurse Leader”.
    And for all of this, the NPs want independent practice rights, the same pay
    as primary care docs, the “doctor” title in the clinical setting”, and so on.
    The Nurse lobby cites “studies” showing “equal” care to the docs, but they
    invariably are for control of common illness, with common markers of
    outcomes, like diabetes and its measure of control by Hemoglobin A1c.
    What the Nurse lobby withholds from the public and the legislators is that
    these studies are not designed to detect any differences in diagnosis and
    treatment of uncommon (but serious) diseases or of common and serious
    disease presenting in unusual ways. These studies almost always have
    physician back up for any serious illnesses, and so prove at most that
    NPs, with the ability to refer to physicians, can provide good routine
    uncomplicated medical care (on the whole, as an average).
    This is hardly a reason to give them real or de-facto (via nursing state boards)
    medical licenses.
    I can hardly believe the extent to which this nation is now willing, ready and
    able to lower professional standards for the practice of medicine.
    But economic duress and bankruptcy can and do result in these outcomes.
    The NPs, backed by their powerful Nurse Lobby and by politicians and
    lawyers looking for the cheapest and most convenient solution to the
    desire for universal health care coverage will take this avenue.
    In the end, physicians will be even more reluctant to go into primary care
    medicine, and the result will invariably be that the nations’ primary care
    physicians will be undermined by the Nurse lobby, the lawyers and the
    politicians, and tyrannical government bureaucrats. And please, all this
    “team collaboration” is just the easiest method to insert the leverage to make
    it happen.

  391. The confusion theory is not a theory.
    I have many times witnessed NPs who insist that they are
    doctors and are perfectly happy to pretend that they are what
    they simply are not.
    As to uninformed, scared, confused, defiant, and resistant-
    Feel free to throw all the ad-hominem adjectives you like,
    but you are quite correct that I will never allow some politically
    correct government- lawyer bureaucrat, who like many of his
    ilk actually hate the physicians in this country, to offer the pretense
    of his own expert opinion on these matters without any
    reasonable opposing response.
    Perhaps you can explain for all to understand why your opinions are
    so much more correct than the medical professions’ opinion.
    No, I do not agree with you. Further, you demonstrate no reasoning
    and no evidence to induce rational belief.
    In fact, I am neither uninformed or scared or confused.
    I am resistant and “defiant” to the unjustifiable money and power
    grabbing that the nursing lobby is REALLY all about with its DNP
    movement.

  392. >”There is a point where an NP can attain just as much knowledge
    and skill as the supervising/attending physician. If a NICU/NP
    is working many years in that environment, almost certainly he/she
    will attain the same knowledge base as the MD.”
    1). This is just an assertion, perhaps based on a notion of social
    justice and an idea that work experience of any specialized sort
    will always equate to formal academic training-if its long enough.
    However, it is easily possible to become a ICU/NP for decades in
    an ICU and never have taken college-level physics. So, the ICU
    NP who never studied physics never really understands the basis
    of a Swan-Gantz catheter (although she knows how to use them).
    Your bald assertion raises two problems:
    a). Proof of the assertion-despite its appeal to social justice
    and its (what you believe is) a common-sense assumption
    about how medicine (or science) can be learned, it is often
    the case that, in medicine, one’s common sense fails in
    reality.
    b). How will you judge when your (N)Icu/NP has attained this
    state of equal knowledge and skills, so that she should be
    given an independent license? So far, USMLE data do NOT
    support your common-sense assumptions.
    In reality, the assertion you make here is similar to arguing that
    because a car mechanic or engine mechanic spends years
    working in the environment of challenging mechanical problems
    with engines, their will come a point where their knowledge and
    skills will equal that of the Ph. D. engineer who supervises them and
    works in the same company every day. After all, who needs
    differential equations in practice, right?
    This is just as false for physicians as it is for engineers. In
    science and medicine, the foundations must be laid brick by
    brick. Your assertion is easy to make, and has a nice common-
    sense feel to it, BUT will be difficult or impossible to prove, and
    indeed, may well prove false. The initial data [USMLE part 3,
    as shortened and simplified by the Nurse lobby for the DNP
    exam] does NOT support your assertion.
    >”There is enough legal work for anyone with a good reputation”
    Then why is unemployment among new law school graduates at
    an all time high? I imagine few of your colleagues agree with you-
    perhaps you are referring only to paralegals with decades of
    experience.
    >” If physicians practice good medicine and avert negligent care, the
    exploitation by attorneys will disappear”
    I have never seen or talked with even one physician who agrees
    with you. I will warrant that, absent only physicians who now make a
    living as “expert witnesses” in med-mal cases, that there is virtually
    NO physician in the United States who will give his/her assent to the
    above statement. This is why tort reform is a perennial issue
    in the United States.
    I will also speculate that when DNPs have exactly the same med-mal
    insurance polices (dollar coverage) written (if that ever occurs with
    their “full’ licensure), the medical malpractice cases brought against
    them as independent “doctors” will experience a rising curve up to
    the level that physicians currently experience.
    Medical malpractice in the U.S. is a thriving industry unequaled
    in the other developed countries of the world. I guess this must be
    because of our physicians, not our lawyer super-abundance.

  393. > “The allied health field doctoral degrees all reflect their own areas of specialization and have never been confused with the roles in health care that physicians undertake. Thus…”
    And for each of the medically-related doctoral degrees mentioned, each and every one was new at one time, and at the introduction of each, patients had to learn their respective roles. But consumers are better armed today to understand these differences than at any other time in history. The “confusion” myth is nothing more than a red herring that is being spread like a cancer by frightened medical associations.
    The “Confusion Theory” is being advocated by physicians out of a self-preservation instinct without any basis in fact. However, the rest of us are not buying into it.
    > “So i guess I better be certain that I have a Constitutional right to call myself a real doctor..”
    You have a Constitutional right to call yourself anything you like, including “uninformed, scared, intolerant, resistant, and defiant.”

  394. On the difference between the DNP degree and other “doctoral” degrees
    in the allied health fields: A difference in agenda/purpose and propaganda.
    The allied health field doctoral degrees all reflect their own areas of
    specialization and have never been confused with the roles in health care
    that physicians undertake. Thus:
    D.V.M.-veterinary medicine.
    D.D.S.-dental medicine-usually taught in dental schools
    D.C.-Chiropractors-manual treatment of spinal alignment, usually not
    involved in drugs or surgery
    D.P.M.-medical disorders of the feet below the ankles
    Pharm D.- Expertise in drug dosing and drug-drug interactions.
    D.P.T.-physical therapy-always useful in all forms of rehabilitation for
    for many chronic disorders.
    Ph.D.-a research degree-a degree which indicates a proven ability to
    do original research.
    Each degree with its niche and its purpose.
    M.D./D.O. – a general medical degree whose purpose is to prepare
    graduates with sufficient depth of knowledge in medical
    science and clinical medicine for the purpose of allowing its
    holders to take further training in ANY branch of medicine
    and surgery. This is the American definition of a physician.
    The further training taken may be in Surgery, Medicine, Obstetrics,
    Pediatrics, or any of their subspecialties by means of a Residency.
    The medical areas include primary care medicine-Internal med,
    family practice and pediatrics.
    DNP- Essentially being framed as a degree to at least perform the same
    medical tasks/management decisions as a primary care
    physician. And to do so independently, thereby implying
    a right to a medical license-or at least a license with the
    laws of the several States rewritten so as to be a de-facto
    medical license in name if not in fact (through a Nursing
    State Board).
    Note, however, that already their is a DNP “residency” at USF
    in “Dermatology.”
    Their is also an AMA -assisted lawsuit by the Iowa Board of
    Medicine against NPs trying through their nursing board to
    gain the right to supervise radiology procedures in Iowa.
    And Nurses do not even take college-level physics as a
    requirement for their nursing degree!!
    Conclusion: The DNP is a political movement to allow
    nurses to practice medicine without its holders/members
    achieving the same level of training or academic standards as
    medicine (physicians). That is why the docs do not want to call
    them “doctors”.
    BUT this is not a matter of law. They can be called doctors
    as much as they like, especially in Nursing schools.
    But to do this in hospitals and clinics (as a social convention,
    NOT a matter of law) is to aid and abet this scheme of the
    nurse lobby.
    By law, no doubt the DNP graduates can call themselves
    “doctor”-with the specification of “nursing practice”.
    And here is my response to the world- it will be on my door
    of a clinic or hospital if DNPs are parading around and calling
    themselves “doctor”- My response will be to introduce
    myself to patients as Dr. so-and-so. And yes, I am a real doctor
    because I actually went to medical school.
    And yes, i consider it obnoxious to have to say “real doctor”,
    until I remember that the only reason for it is the far greater
    initial obnoxiousness of the Nurse lobby and its DNP
    degree.
    So i guess I better be certain that I have a Constitutional
    right to call myself a real doctor because I went to medical
    school, and because, by social convention, patients in
    hospitals and clinics typically expect their “doctors” to
    HAVE ACTUALLY GONE TO MEDICAL SCHOOL.

  395. > “The POINT, however, is that NPs working in a given area of medicine need competent supervision by physicians working in the SAME area of medicine.”
    The point, within the scope of this discussion, relates to the use of a title. Your comments fall far outside the relevancy of the topic. However, I’ll address a few…
    There’s a point where a NP can attain just as much knowledge and skill as the supervising/attending physician. If an NICU NP is working many years in that environment, almost certainly will s/he attain the same knowledge base as the MD — and far more exposure to complex medicine than the family practice physician or chiropractor, who also calls him/herself “doctor.” The development of skills and knowledge doesn’t end with a set of letters on a diploma.
    To your point, if a paralegal attains just as much knowledge as an attorney, why not allow that person to sit for the state bar exam? Myself, I have no issue with it. In fact, paralegals in some states will soon be licensed by the state. From there, paralegals may one day perform functions now under the sole domain of the attorney. If the paralegal can perform services as competently as a licensed attorney, the public will have an alternate resource. There’s enough legal work for anyone with a good reputation. The same holds true for all the professions.
    > “4). LAWYERS, not physicians, created the PI area- and they ruthlessly exploit it-and for far more than medical malpractice.”
    Agreed with the exploitation. If physicians practice good medicine and avert negligent care, the exploitation by attorneys will disappear.

  396. Further comment to Christensen:
    Another point you fail to appreciate is the mistake of making
    a cross-comparison between specialties:
    Of course an NP who works for or with an internal medicine
    physician ( I am an Internist) will see “more advanced” clinical
    practices in some instances than globally trained family practice
    docs.
    The POINT, however, is that NPs working in a given area of
    medicine need competent supervision by physicians working in
    the SAME area of medicine.
    Thus, your comparison of apples to oranges is nonsense- the fact
    that an NP may have seen medical practices done “routinely” in subspecialty
    medicine that FPs do not train in is utterly irrelevant (those NP s also
    know no peds or obstetrics that the well-rounded FP trains in).
    Thus, the reasonable and prudent method of practice is that
    the internal medicine SUBSPECIALIST is, and properly should be, the
    physician supervising NPs practicing in that area-NOT family practice docs.
    Thus, your argument commits the fallacy of irrelevant comparison-
    the comparison of FP physicians to NPs working in IM areas cannot support
    your illogical conclusion.
    Finally, (and I have observed this to be universally true)- the nurses
    know WHAT is routinely done in many areas of medical practice-BUT they are
    nearly universally ignorant of the scientific principles that lie behind
    what is done and therefore fail to appreciate the limits of techniques.
    They DO NOT have the scientific background, as a GROUP, to make careful
    judgements about the limitations of routine medical practices.
    When serious disease presents, with life-threatening consequences,
    one wants fully trained physicians and consultants in the relevant
    specialty, NOT NPs who have seen “advanced clinical training”
    functioning in an unjustifiable manner as independent physicians, who
    in reality have very little understanding of the science behind the
    medicine that they routinely see practiced. The difference is similar to
    the difference between the scientist and the technician in physics and
    chemistry.
    Perhaps, as a “transactional attorney” you should confine
    your opining to “transactional law.”

  397. Response to Christensen:
    1). Statements about individuals are of very limited value for
    public policy.
    It does not matter at all what experience an individual NP has
    or does not have.
    2). The results of the Part III medical boards (USMLE) make it crystal
    clear that the DNP population knows far less medicine than graduating
    first-year interns- and they know far less medical science than
    do PAs. Only a 50% pass rate on a shorter, easier exam than real doctors
    actually take. Virtually all the docs pass this easiest of licensing exams
    while interns-without studying.
    3). The DNP lowers dramatically the academic and scientific standards for
    medical practice.
    4). LAWYERS, not physicians, created the PI area- and they ruthlessly
    exploit it-and for far more than medical malpractice.
    5). The medical profession should never allow lawyers to try to tell the
    the public who is and who is not qualified to practice medicine.
    After all the nonsense is done with, the DNP movement is just
    a scam to let nurses without the same training practice medicine.
    The DNP WILL be used to argue for independent medical licensing
    for nurses.
    The only thing the docs can do to try to uphold standards of medical
    training in this country is to continue to present the facts and exam
    results to legislators- and many of them are lawyers.
    6). Finally, Mr. Christensen, I would like to point out that the paralegals
    and legal assistants really should be given law licenses and allowed
    to practice law-because all the lawyers do is fill out forms.
    And many lawyers are idiots with J.D. degrees, while paralegals
    actually talk to and spend time with clients.
    So, the U.S. really needs a “Doctor of Paralegal Practice” degree,
    so that justice can be readily available at minimum costs for
    all citizens. They simply must be admitted to practice in
    US courts.
    I know you agree Christensen-any other stand on your part
    would obviously be hypocrisy.

  398. > “thay have not receieve the medical training and differential diagnostic grilling that physicians recieve in medical school and through years of internships.”
    That depends on the level of individual training. We can cite numerous examples of physicians practicing medicine in areas for which they have little or no competency, or where they demonstrate negligence in patient care. The world of medical personal injury is a multi-million dollar business for PI attorneys. Physicians created this industry on their own without the assistance of DNPs.
    Moreover, DNPs in specialty areas are receiving clinical training far more advanced than what many family practice physicians are receiving. On one extreme, we have physicians in an office setting who are taking care of the colds, aches, and sniffles. By contrast, a DNP who is has received extensive clinical training in internal medicine, often trumps the knowledge base of a family practice physician. Yet, we have no issue with calling one a doctor, but not the other even through both have received doctorate-prepared academics and training?
    That said, what’s at issue here whether or not a DNP can introduce one’s self as a doctor in a patient setting. At least for the foreseeable future, it’s reasonable that a DNP can, and should, introduce him/herself as, for example, “Doctor John Doe, your Nurse Practitioner.”

  399. Nurse practitioners save money and handle simple diagnosis and follow-up that frees the physician up to see more patients. . .they have a role.
    My concern is that on occaission, they are treated and practice as physicians, the patient is at risk because thay have not receieve the medical training and differential diagnostic grilling that physicians recieve in medical school and through years of internships.

  400. “why it will be a heartache to call a nurse a title that he/she deserves it?”
    There shouldn’t be heartache except from those who believe their social status is being usurped.
    I am a transactional attorney (no, I do not represent clients in medical PI matters). I work extensively in U.S. Department of Labor (USDOL) issues. If one looks at the USDOL’s Standard Occupational Codes (SOC), it will be discovered that the occupation of “doctor” does not exist. Rather, the correct term is “physician,” and is the term recognized by USDOL. According to USDOL, a physician is either a M.D. or D.O.
    No doubt if one researches the word “doctor” in a dictionary, it will also reference the term physician.
    The doctor term, as it applies to physicians is rooted in historical terminology. At some point around the turn of the last century, the doctor term appears to have superceded the use of the physician term. What’s easier to say and spell?
    What we really need to distinguish is the occupation from the academic achievement. Clearly, “doctors” in the medical setting exist in the form of D.V.M., M.D., D.O., D.D.S., D.C., D.P.M., D.N.Sc., Pharm.D., D.P.T., Ph.D., Ed.D., and today’s hot topic, the D.N.P.
    As a practical matter, there are just too many legal issues that would allow state and federal governments to preclude use of the doctor term for DNPs. First, it would necessarily require all non-physicians to stop using the doctor term and that includes the O.D., D.D.S., D.P.M., and D.C.s Why? It becomes an equal-protection issue under the Constitution’s 14th Amendment. While a private medical center could prohibit the use of the term as a matter of internal policy, the government cannot.
    Secondly, the government’s limitation of an occupational title also touches upon First Amendment freedoms of commercial speech. A DNP who states that he is “Doctor John Doe, your Nurse Practitioner” is entitled to such an introduction based upon his academic achievement (the doctor part), and that no part of the introduction is fraudulent, incorrect, inaccurate, nor confusing to a patient. Let’s dispense with this “patient confusion” red herring and recognize it for what it truly is: a fear-mongering technique advocated by the AMA.
    If I was a DNP, I would wear my ‘doctor’ title proudly.