Nurses, physicians weigh in on new doctoral nurse degree

chirodoc · May 15, 2009

DC's can function as a PCP in all 50 states. I do not have to "function" or "practice" exclusively as a manipulator of the spine to use the title "Doctor". We can diagnose, but not treat most of the conditions/diseases that an Internal Medicine doctor can. We don't, simply because most normal DC's understand that we simply do not have enough patient exposure to be proficient at these diagnoses. But if talking "scope of practice", then we can function as a PCP. So then would you care to explain why I shouldn't be able to refer to myself as a doctor in my primary care practice once I have an NP?

wowza · May 15, 2009

DC's can function as a PCP in all 50 states. I do not have to "function" or "practice" exclusively as a manipulator of the spine to use the title "Doctor". We can diagnose, but not treat most of the conditions/diseases that an Internal Medicine doctor can. We don't, simply because most normal DC's understand that we simply do not have enough patient exposure to be proficient at these diagnoses. But if talking "scope of practice", then we can function as a PCP. So then would you care to explain why I shouldn't be able to refer to myself as a doctor in my primary care practice once I have an NP?

I think SirI's point is that you could get into trouble by calling yourself a doctor in a clinical setting, especially in the hospital.

Frankly I have to call BS on the bolded part. This is a hunk of malarkey that you basically call yourself out on in the next line.

The reason why you should not call yourself doctor is because you do not have the clinical experience or expertise that a physician has. And while you may have a doctorate, the word doctor in a hospital connotes physician, which you sir, are not. While with an NP you at least will have more clinical knowledge, you still will not be a physician. Calling yourself doctor is basically a fraud in that case.

Editorial Team / Admin · May 15, 2009

So then would you care to explain why I shouldn't be able to refer to myself as a doctor in my primary care practice once I have an NP?

Because if you are practicing as a nurse (APN) and unless you have a Doctorate in Nursing, you will not be able to use the title 'Doctor' for your role/job description will be that of nurse (NP) not DC.

Again, you must check with your state BON NPA and facility P and P.

chirodoc · May 16, 2009

I think SirI's point is that you could get into trouble by calling yourself a doctor in a clinical setting, especially in the hospital.
Frankly I have to call BS on the bolded part. This is a hunk of malarkey that you basically call yourself out on in the next line.
The reason why you should not call yourself doctor is because you do not have the clinical experience or expertise that a physician has. And while you may have a doctorate, the word doctor in a hospital connotes physician, which you sir, are not. While with an NP you at least will have more clinical knowledge, you still will not be a physician. Calling yourself doctor is basically a fraud in that case.

In that case, next time you go see your dentist, make sure you call him Mr. Smith. Because based on your explanation, a dentist/podiatrist/optometrist will have just as little "clinical knowledge" as a DC, DPT or a DNP. And the reason most DC's don't have as much clinical experience as an MD is not due to the lack of desire. We have the training and the education to fully function as PCP's. We are taught to interpert labs, draw blood, do urinalisys and even CBC. We have to know how to do simple GYN procedures and prostate screenings. We just can't, since our hands are tied by the insurances and the good ol' AMA. What we learn in DC school is very close to what MD's learn as far as diagnostics go. The difference is that they reinforce their knowledge as interns and residents, while we stick to musculo-skeletal conditions. But believe me, I have had plenty of times when I caught a diagnosis that their MD completely missed.

Again, this isn't about MD/DC relations or DC's ability to call themselves doctor, even though some of you seem to want to steer it that way. This is about MD's and their misguided notion that other providers are trying to steal a slice of that lucrative healthcare pie that they have had all to themselves for so many years. They see their incomes and salaries dropping and think that it's those evil "doctor wannabes" that are responsible for their "economic hardships".

elkpark · May 16, 2009

In my area there are no NP programs that will admit you with no nursing experience. I know many NP's who worked beside me in the ICU while attending school and do not know a single one with less than 3-4 years as a nurse before entering the program. Your friend would certainly be the exception rather than the rule here.

I'm glad to hear that programs in your area all require experience. However, there are many, many "direct-entry" MSN programs around the country that take people with a BA/BS in something else entirely, no nursing experience, and turn them out three years later as advanced practice nurses. I went to a school (as a "traditional" grad student, with many years of experience in my specialty area) that had both programs (traditional + direct-entry), and took all my classes with young women who had a BA in French literature, psychology, Spanish, WHATEVER, no healthcare experience of any kind, but who had decided (perhaps after they sampled the job market for French literature BAs??) that they wanted to be an NP, or CNM, or CNS -- and they had no problem in finding a program that would enable them to do that. There are lots of these programs out there now.

Editorial Team / Admin · May 16, 2009

Again, this isn't about MD/DC relations or DC's ability to call themselves doctor, even though some of you seem to want to steer it that way. This is about MD's and their misguided notion that other providers are trying to steal a slice of that lucrative healthcare pie that they have had all to themselves for so many years. They see their incomes and salaries dropping and think that it's those evil "doctor wannabes" that are responsible for their "economic hardships".

No, you brought it up. You stated you would refer to yourself as, 'Doctor', in the role of a nurse and we are tying to respectfully explain that as a nurse, you could not use the title, 'Doctor', in your practice for that is misrepresentation. Unless you have a Doctorate in Nursing and is approved by your state BON/NPA and the facility in which you are employed.

Agree, this is off-topic to the discussion.

lamazeteacher · May 16, 2009

Quote from "Chirodoc"

"BTW, I'm a DC that is going to an accelerated BSN/FNP program. So yes, I will be referring to myself as Dr in a clinical setting. I do it now, and so do my patients and colleagues. (Not just DC's, but MD's and DO's too). And honestly, MD's can get uppity about it all they want, but the reality of it is that they better get used to it."

-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-

I agree with your position regarding M.D.s. However going into nursing to further your pet peeves is not a positive way to commence a different career. You will be surprised that you'll seldom interact with physicians, unless you become an OR nurse. You may occasionally take a telephoned order from them, give them a report on their patients' progress or if you work in an "Intesive Care Unit" or ED you'll see them more often, but the needs of patients there should keep you from any long dialogues/arguments with them.

Engaging in "attitude" at work is never appropriate! If you encounter less than professional comments/behavior toward you or other nurses from a physician, after work you might ask whether you could discuss that and establish when and where. Never return attitude with attitude. Keep the discussion on an "adult to adult" level (as described by the emminent psychologist Eric Berne in his book, "Games People Play". Reporting the physician puts you in the role of "child", telling a "parent" what a bad boy the doctor was. The reverse, of course is true too.

The problem with the typical Nurse-Physician divide, is that lines of communication get crossed. According to Eric Berne, when your language or that of someone to whom you wish direct communication commences with "You should", the person saying that has crossed a direct line over to the (judgemental) "parent" part of personality directing the other as being in a "child" part of their personality.

No wonder hackles rise when that happens! Reading about that and practising straight lines of communication win every time.

I wish you good luck in your endeavors.

lamazeteacher · May 16, 2009

I don't plan on misleading patients as to what kind of a Doctor I am. And it won't be in a setting when the care provided is as an RN/NP. But when in a private practice setting, as a PCP, I am well within my right to refer to myself as Dr., as long as I am clear as to what kind of a Dr. I am.

Ummmmmm, are you clear about what kind of doctor you'll be, when practising nursing? It's such a departure from the classifications nurses and medical doctors have had for many generations, that you may have to explain to patients, what kind of doctor you are. They may then want a 2fer (get some chiropractic with nursing care). Big No!-No! Stick within one boundary (one job description) at a time.

Please don't expect your co-worker nurses to address you as "Dr. ________". That will **** them off big time!:angryfire

It's like you want to "one-up"/compete as superior, to them. Getting off on that foot won't earn you any assistance from them when (not if) you'll need it some day.

ivanh3 · May 16, 2009

np's are significantly more limited in practice than a physician.
they sure as heck don't get the paycheck that a physician does.
one of my close, high-school friends got her ob-gyn about 4 years ago. last year she cleared about $240k. i seriously doubt if a cnm or a dnp with a specialty in women's health and delivery are going to pull down those numbers because the scope of practice is not the same.

this is not about money. salary does not determine worth.

i'm requesting that our passion for the subject discussed not trigger finger pointing or name calling per our lovely terms of service to minimize moderator intervention.

i thought the entire point of this thread was about name calling...hah! sorry, lame i know, but i had to do it...i had the shot...there was no danger...

to me the sadness of this argument is the lack of importance in titles. it is not what we are called. it is what we do that defines us. being called a "doctor" doesn't make someone good or bad at their job. salaries mean nothing. some of the best among us do this for no monetary compensation at all. kind of a red herring if you ask me.

wowza · May 17, 2009

In that case, next time you go see your dentist, make sure you call him Mr. Smith. Because based on your explanation, a dentist/podiatrist/optometrist will have just as little "clinical knowledge" as a DC, DPT or a DNP.

I really don't know why people like to bring up the dentist example because in this case it is a poor one. If my patient were to have some sort of dental problem, I would be terribly equipped to deal with it... I just dont have the training. A dentist does. Dentists have a significant amt of clinical experience with regard to the mouth. Where I train we have a consult dental service in the hospital. A dentist would never say they are equipped to be a PCP although they too have training which teaches them how to interpret labs, do screenings, urinalyses etc. They have a niche and are content to be in that niche.

Dentists are the experts with regards to dental conditions so they have a right to be called doctors with regard to treating mouth conditions. Here is the distinction... Chiropractors do not have the expertise to be called doctors with relation to any medical conditions. They should not hold themselves out to be doctors in the hospital setting because frankly, chiropractics really is an outpatient modality and outside of some pain paliation, it has no business being used in an acute setting. You want to use the term Dr in your chiropractics clinic, fine. In the hospital no.

wowza · May 17, 2009

And the reason most DC's don't have as much clinical experience as an MD is not due to the lack of desire. We have the training and the education to fully function as PCP's. We are taught to interpert labs, draw blood, do urinalisys and even CBC. We have to know how to do simple GYN procedures and prostate screenings. We just can't, since our hands are tied by the insurances and the good ol' AMA. What we learn in DC school is very close to what MD's learn as far as diagnostics go. The difference is that they reinforce their knowledge as interns and residents, while we stick to musculo-skeletal conditions. But believe me, I have had plenty of times when I caught a diagnosis that their MD completely missed.
Again, this isn't about MD/DC relations or DC's ability to call themselves doctor, even though some of you seem to want to steer it that way. This is about MD's and their misguided notion that other providers are trying to steal a slice of that lucrative healthcare pie that they have had all to themselves for so many years. They see their incomes and salaries dropping and think that it's those evil "doctor wannabes" that are responsible for their "economic hardships".

You DO NOT HAVE THE TRAINING. You read it in a book and were given very cursory training in medical managment that was overshadowed by your training in MSK issues and subluxations. Reading a book and seeing the reality are 2 very, very, very different things. This is one reason why medical interns have a huge learning curve- most of their knowledge is from reading and from their 3rd/4th year rotations. They still need more clinical experience to be clinicians.

So you've learned some basic lab interpretation and perhaps learned how to do a pelvic/rectal exam on some manikins or standardized patients... k. In no way does that make you capable of being a PCP. I would much, much rather an NP be a primary care provider than a DC. At least they have some relevant training. The DC has none.

mige · May 23, 2009

DC's can function as a PCP in all 50 states. I do not have to "function" or "practice" exclusively as a manipulator of the spine to use the title "Doctor". We can diagnose, but not treat most of the conditions/diseases that an Internal Medicine doctor can. We don't, simply because most normal DC's understand that we simply do not have enough patient exposure to be proficient at these diagnoses. But if talking "scope of practice", then we can function as a PCP. So then would you care to explain why I shouldn't be able to refer to myself as a doctor in my primary care practice once I have an NP?

Im sorry but you might have taken some classes similar to med school but in no way are you prepare to deal with this day in and day out. Sure, a DC might now what's an abnormal lab value but what to do with it is another 20 bucks!!.