[core0]

Originally Posted by DRFP

This is 100% wrong

US MD grads can be licensed after 1 year of residency true but cannot practice without finishing a residency, it is all specialties now, Family practice is 3 years, IM 4 years, you cannot just "Practice" you need the full license, if they are a FMG then they must complete a residency before License, at least 3 years.

No insurance company will pay for care without this anyway.

For someone that purports to be in medical school you certainly need to study more. First IM=3 years. Second you can practice in many states after finishing one year of residency (1-3 if an IMG). There are only a few states that you need to finish a residency to practice in. You are correct about being credentialled with insurance companies. So that would be a 33% mark on this post. For more information on licensing requirements please visit the FSMB here:
http://www.fsmb.org/usmle_eliinitial.html

Welcome to allnurses

David Carpenter, PA-C

[RN to Medschool]

Core0 You fullfill my expectations of a PA, LOL Insults are very mature......

IM is now 4 years in many progrems, there are a Few that are 3 Years, , I was speaking in general but when Nurses and PA's start to argue, emotions are used as facts. This is one reason why I'm becoming a Doctor verses staying an RN, just tired of the BS in the profession.

For someone that purports to be in medical school

Yea right as much as we are to believe you are a PA-C,

I will not prove my resume on the forum. But what has been posted here about Medical training is wrong, I'm in my 4th year of Medical School.

2 years of Basic science and 2 years of clinicals, then you are a MD but with a training License,

US grads can get a full License in many states after 1 yr Residency
FMG grads can get a Full License in 3 yrs Residency

Licensing is state by state not universal.

people tend to insult others on these forums when they are frustrated when faced with the facts posted.

MD's and DO's have years more training then a PA/NP/DNP in Medicine, it is a fact that undisputatble.

I do not consider my 20 years as an RN medical training and neither do the Medical Schools.

[RN to Medschool]

CORE0, it must frustrate you that DNP's, NP's and PA's will not by law be called Doctor in the clinical setting, if you want that there is Medical School.

As far as training for full License Here's Ga law for an example

Applicants must have official transcripts of all medical and premedical education
mailed directly to the Board from the school where such education was taken. If the
transcripts are in a foreign language, applicants must furnish a certified English
translation. Transcripts must include the dates the applicant attended the school and the
grades received in all courses taken to fulfill the requirements of the degree granted. In
the Board’s discretion, the transcript requirement may be waived and the results of the
Federation of State Medical Boards (FSMB) verification service may be accepted if the
applicant adequately demonstrates that all diligent efforts have been made to secure
transcripts from the school. In such a case, the Board may require the applicant to appear
for a personal interview before the Board or the committee.
(d) Proof of post-graduate/residency training as follows:
1. This requirement does not apply to applicants who were licensed in another state on or
before July 1, 1967.
2. Graduates of United States medical schools must complete post-graduate year one in a
program approved by the Accreditation Council for Graduate Medical Education
(ACGME), the American Osteopathic Association (AOA) or the Royal College of
Physicians and Surgeons of Canada or the College of Family Physicians of Canada
(CFPC).
3. Graduates of Canadian medical schools must complete postgraduate year one in a
program approved by the Accreditation Council of Graduate Medical Education
(ACGME), the American Osteopathic Association (AOA), or the Royal College of
Physicians and Surgeons of Canada or the College of Family Physicians of Canada
(CFPC).
4. For graduates of all other foreign medical schools and Fifth Pathway applicants:
(i) Applicants who graduated from medical school on or before July 1, 1985 must
complete one year of post-graduate training in the United States in a program approved
by the Accreditation Council of Graduate Medical Education (ACGME) or the American
Osteopathic Association (AOA) or one year of post-graduate training in Canada in a
program approved by the Royal College of Physicians and Surgeons of Canada or the
College of Family Physicians of Canada (CFPC).
(ii) Applicants who graduated from medical school after July 1, 1985 must complete
three years of post-graduate training in the United States in a program approved by the
Accreditation Council of Graduate Medical Education (ACGME) or the American
Osteopathic Association (AOA) or three years of post-graduate training in Canada in a
program approved by the Royal College of Physicians and Surgeons of Canada or the
College of Family Physicians of Canada (CFPC). The Board may consider current
certification of any applicant by a member board of the American Board of Medical
Specialties as evidence that such applicant’s postgraduate medical training has satisfied
the requirements of this paragraph.
(e) Graduates of foreign medical schools outside of Canada must provide proof of
certification by the Educational Commission for Foreign Medical Graduates (ECFMG)

I put in bold the 3 years.

This is typical of many states laws and should be the standard posted.

You see Medical Students do not pick the lowest standard as a rule we pick the highest.

Good Luck

[RN to Medschool]

PA's in GA are kept under close Physician supervision even in satellite offices:

360-5-.08 Remote Practice Sites. Amended.
(1) In addition to the requirements of licensure outlined elsewhere in these rules,
Physician’s Assistants applying for remote site approval shall be required to provide
appropriate documentation of one year of acceptable clinical experience or one year of
post-graduate training approved by the board.
(2) In addition to the documentation required to be submitted in connection with an
application for licensure as a Physician’s Assistant contained elsewhere in these rules, the
supervising physician shall submit a letter of intent to utilize a Physician’s Assistant in a
remote site, to be accompanied by a proposed utilization plan addressing the criteria
outlined in Rule 360-5-.08(3).
(3) The remote site must qualify as a principal office where the supervising physician(s)
regularly sees patients. For the purposes of this section principal offices shall mean an
office, clinic, or facility maintained by the supervising physician(s) for the purpose of
providing primary care services and at which the supervising physician( s) is physically
present for at least 25% of the time the site is open for patient care or calls. For purposes
of this Rule, a supervising physician may qualify no more than three offices or practice
settings as principal offices.
(a) To qualify as a “remote site”, it must be shown to the satisfaction of the Board that
there is a shortage and a maldistribution of health care services. The following factors
may be considered: (i) the physician-patient ratio in the area in question; (ii) the distance
between patients and existing physicians or other medical facilities; (iii) the
maldistribution of particular types of specialty care; (iv) whether the area is designated or
eligible for designation at the time of application by the Secretary of Health and Human
Services as a “Health Manpower Shortage Area” pursuant to 42 U.S.C. Sec. 254(e); (v)
any other factors which are indicative of shortage and maldistribution of health care
services or any other factors which are indicative of an absence of adequate physician
services in or reasonably accessible to the area in question.
(b) The Physician’s Assistant to be utilized in the remote site must meet the requirements
of Rule 360-5-.03(b).
(c) The supervising physician(s) must be available for supervision at the remote site as
needed and shall be immediately available to the physician’s assistant for consultation
and supervision either personally or via telecommunications. Provided, however, that the
supervising physician shall be physically present to review patient records and personally
provide patient care at the remote site as needed and at a minimum of at least twice
weekly and provided further that the supervising physician must provide patient medical
record review on a daily basis.
(d) Any patient seen on a regular basis by the Physician’s Assistant shall be scheduled to
be seen by the supervising physician at routine intervals as deemed necessary in the
particular setting and as outlined in the physician application and proposed job
description.
(e) A predetermined plan for the initial management and referral of emergencies must be
established for each individual site and submitted in the physician application and
proposed job description.
(f) All entries made by the Physician’s Assistant in patient medical records must be
co-signed by the supervising physician(s) within

In regular settings:

360-5-.04 Changes in Job Descriptions or Applying Physicians. Amended.
(1) When a physician applies to supervise a Physician’s Assistant who has previously
been certified by the Board, the Board may issue a written notice of temporary approval;
provided, however, that the Physician’s Assistant’s duties shall be limited to those
contained in the Basic Job Description.
(2) A Physician’s Assistant may only perform those tasks which are specified, and for the
physician(s), named, in his job description then currently on file with and approved by the
Board; provided, however, that tasks outside the job description may be performed by the
Physician’s Assistant under the direct supervision and in the presence of the physician(s)
utilizing him. Provided further, however, that the Board will not approve any task or
procedure in a Physician’s Assistant job description which is experimental or
investigational; for the purpose of this last proviso acupuncture is deemed by the Board to
be an experimental procedure.
(3) Requests for changes in the job description of the Physician’s Assistant, including
addition of specialized duties and tasks, shall be submitted by the supervising
physician(s) to the Board for prior approval.
(4) Termination of a Physician’s Assistant/Applying Physician(s) relationship.
Immediately upon termination of the physician/Physician’s Assistant’s relationship, the
Physician’s Assistant and the applying physician are required to give notice and date of
termination to the Board by certified mail. Failure to notify the Board immediately may
result in disciplinary action against the Physician’s Assistant and/or the applying
physician(s). Expiration of license and identification card by failure to renew will not be
considered an exception of the requirements of this paragraph.
Authority O.C.G.A. Secs. 43-1-25, 43-34-103, 43-34-108. History. Original Rule entitled “Changes in Job
Descriptions or Applying Physicians” adopted. F. Sept. 11, 1972; eff. Oct. 1, 1972. Amended: F. Sept. 16,
1974; eff. Oct. 6, 1974. Repealed: New Rule of same title adopted. F. Dec. 4, 1981; eff. Jan. 1, 1982, as
specified by the Agency. Amended: F. Apr. 8, 1985; eff. Apr. 28, 1985. Amended: F. Sept. 6, 1985; eff.
Sept. 26, 1985. Amended: F. July 15, 1988; eff. Aug. 4, 1988. Amended: F. Mar. 18, 1998; eff. Apr. 7,
1998.

If you are not practicing this way in GA ( as the other PA's ) then the law is being broken.

Not a good thing.

[Tammy79, RN]

Originally Posted by DRFP

I'm sorry but they are in no way equal

I agree and it sounds like you have experience to back that up since you have been through both DNP and MD training.

Originally Posted by DRFP

Medical school cannot be done on the internet and by law in some state you will not be Licensed.

Really? http://www.medscape.com/viewarticle/443292

Originally Posted by DRFP

Look I'm not here to argue but this "I'm a Doctor" Just like a MD scares me and is not lawful, you will not be Licensed to practice medicine as a physician but be licensed as a Nurse Practitioner.

It scares me, too. Thats why policy, regulation and statute has to be enacted to protect the consumer. All physicians should have to clearly state with each pt. encounter that they are not trained DNP's and that their doctorate degree is only in medicine and they have no training or license to practice nursing, either on a basic or advance level.

Originally Posted by DRFP

Some states have already enacted laws that Physicians are to be called "Doctor" in the clinical setting to help with the confusion.

To true. And at one time there were no states in which APN's could practice independently. Thank goodness wisdom, experience and common sense (coupled with consumer-support based on outcomes and evidence) continues to prevail which is why NP's can practice independently in 23 states.

Originally Posted by DRFP

NP's, PA's DNP's can be and are valuable care givers and are needed in the health care system but this should not be to replace Physicians, it is not meant to do that, it is meant to deliver a higher level of care to the public, that scheme includes Physcians not excludes them.

I agree, and I also feel that there is even room and a place for physicians too.

[Tammy79, RN]

Originally Posted by DRFP

As I said I'm an RN, for 20 years, Trauma, ICU, ED and Homecare.
Uh I have been to medical school and I gotta tell you, you are far from the truth here, Nursing is different then Medical School and did not prepare me well for it, it is not the same and the other Nurses and even 2 NP's who went to my school said the same thing.

Just curious, did you have to go through medical school after being a nurse for 20 years and consult with others to discover that the nursing and medicine are a bit different?

Originally Posted by DRFP

Nursing focuses on more Psych social and care delivery issues, as well as prevention, Medicine focuses on Diagnosis and Treatment more, just the way it is.
and the amount of knowledge, heck I study all the time and just about never stop.

And these fundamentals underscore the importance and popularity of NP's with the consumer. You see, some clients actually want more than a label and a pill.

Originally Posted by DRFP

and the amount of knowledge, heck I study all the time and just about never stop.

And its a good thing to study. I know you must have a very low opinion of NP's, especially in the context of your soon to be physician status which I believe we all can't wait, but you must consider that NP's too open a book from time to time.

[Tammy79, RN]

Originally Posted by DRFP

CORE0, it must frustrate you that DNP's, NP's and PA's will not by law be called Doctor in the clinical setting, if you want that there is Medical School.

In keeping with your pattern, you are again misinformed. As far as the title "Doctor" for DNP's, out of all 50 states and DC there are only 7 non-enlightened states (relax, Georgia is one of them) by which have restrictions for NP's using the title doctor.

http://www.webnp.net/ajnp.html

[core0]

Originally Posted by DRFP

Core0 You fullfill my expectations of a PA, LOL Insults are very mature......

IM is now 4 years in many progrems, there are a Few that are 3 Years, , I was speaking in general but when Nurses and PA's start to argue, emotions are used as facts. This is one reason why I'm becoming a Doctor verses staying an RN, just tired of the BS in the profession.



Yea right as much as we are to believe you are a PA-C,

I will not prove my resume on the forum. But what has been posted here about Medical training is wrong, I'm in my 4th year of Medical School.

2 years of Basic science and 2 years of clinicals, then you are a MD but with a training License,

US grads can get a full License in many states after 1 yr Residency
FMG grads can get a Full License in 3 yrs Residency

Licensing is state by state not universal.

people tend to insult others on these forums when they are frustrated when faced with the facts posted.

MD's and DO's have years more training then a PA/NP/DNP in Medicine, it is a fact that undisputatble.

I do not consider my 20 years as an RN medical training and neither do the Medical Schools.

I understand from reading your SDN posts that you dislike PAs. Sadly I agree with you on many issues. I work in a profession where the physician is the captain of the ship as it were. I believe that as the only holder of an unrestricted license to practice medicine or surgery thats the way that it should be. I also agree that its inappropriate for non-physicians to use the term Doctor in a clinical medical setting.

Having studied health care education extensively I also agree that physicians have more clinical and didactic training than any other medical professional.
The best study of medical school education is probably the one here:
http://www.ncbi.nlm.nih.gov/pubmed/9737032
There are a lot of problems with the actual paper, but the analysis of medical education is pretty solid. The caveats are its only three schools and it was done in 1995 before PBL was the rage.
The important part is here:
" The medical school curriculum in many ways follows a similar format (Table 8). In the first year the basic sciences comprised 79% (706 hours) of the program, whereas the clinical sciences comprised 21% (184 hours), However, in year 2, the basic sciences decreased to 64% (590 hours) and the clinical sci- increased to 36% (335 hours). In years 3 and 4, the students are in a series of clinical clerkships.

Year One. The following program is included in the first year microscopic anatomy (129 hours), biological chemistry (144 hours), gross anatomy (178 hours), physiology (136 hours), basic neurology (95 hours), biomathematics (24 hours), clinical sciences doctoring (129 hours), clinical sciences interactive teaching

(32 hours), clinical application (2-3 hours), and assignments (100 hours). The total contact hours in year I are 890 (184 in clinical sciences, 706 in basic sciences) with an additional 100 hours in assignment& The scheduled hours per week are 30 (for 33 weeks).

Year Two. In the second year, the curriculum includes the following- microbiology and immunology (151 hours), patholo- (140 hours), pharmacology (83 hours), pathophysiology of diseases (246 hours), psychopathology (41 hours), doctoring/clinical fundamentals (212 hours), genetics (35 ), and clinical pharmacology (17 hours). The total contact hours in year 2 are 925 (590 in bask sciences, 335 in clinical sciences). An additional 100 hours are spent in assignments, and the scheduled hours per week are 30.

Year Three. The third year of the medical program involves 52 weeks of core clinical clerkships for a total of 1878 hours. The average number of hours scheduled per week is approximately 36.

Year Four. The fourth year is also dedicated to clinical activities and composed of required student selected electives (selectives) for 26 weeks with a total of 936 student contact hours. An additional 571 hours are spent in electives, which on average add 16 weeks to the program. The contact hours scheduled per week are 36. The total program is 5200 hours."

If you look at didactic contact hours for the first two years it works out to 1815 over two years. The issue in comparing it with nursing is that nursing coursework is measured in semester not contact hours. A typical FNP course will have approximately 40-45 didactic semester hours and 12-15 clinical semester hours (representing ~600 clinical hours). Here is a fairly typical program:
http://ahn.mnsu.edu/nursing/graduate..._schedule.html
The usual conversion from semester to contact hours is 16 contact hours per semester credit so the 41 semester credits in the Minnesota program represent 656 contact hours.

The Minnesota DNP adds 36 credits to the FNP with 24 of those being didactic and 12 being clinical (representing 400 clinical hours). The 24 credits represent 384 contact hours.

For direct comparison
FNP + DNP (University of Minnesota) Didactic 1040 contact hours clinical ~1000 hours for a total of 2040 hours.

MD didactic 1815 hours clinical 3385 hours for a total of 5200 hours.

To practice medicine in most states also requires an intern year which in our institution is 70.4 hours x 48 weeks or another 3379 hours. What most people miss is there is an average of 12.7 hours of formal didactic instruction per week in internship. So this adds up to another 597 didactic hours and 2800 hours of clinical work. Total minimum to practice medicine in most states (for a US grad) 2412 didactic hours and 6815 clinical hours.

To say that both the DNP and the MD are four year degrees after undergraduate school is technically true. To imply that the DNP and the MD are equivalent in either didactic or clinical training is simply false.

I don't really have a hard time supporting physicians in this, I do have a hard time supporting you. Nursing will now have to make up a new term when horizontal violence is practiced by a former nurse now practicing medicine. I precept medical students, PA students and NPs. I understand the difference in educational models and how to respect people.

David Carpenter, PA-C

[RN to Medschool]

Originally Posted by DRFP

Medical school cannot be done on the internet and by law in some state you will not be Licensed.

Really? http://www.medscape.com/viewarticle/443292

What? Medical School and CME's are not the same thing? You understand this right?

Re: Do you think NP's are "midlevels"?
Originally Posted by DRFP

As I said I'm an RN, for 20 years, Trauma, ICU, ED and Homecare.
Uh I have been to medical school and I gotta tell you, you are far from the truth here, Nursing is different then Medical School and did not prepare me well for it, it is not the same and the other Nurses and even 2 NP's who went to my school said the same thing.

Just curious, did you have to go through medical school after being a nurse for 20 years and consult with others to discover that the nursing and medicine are a bit different?

YES, I did need to go to medical school to understand this, like many other nurses here I thought there was not so much difference, now I understand there are differences, a RN is not almost a MD like some believe.

Originally Posted by DRFP

Nursing focuses on more Psych social and care delivery issues, as well as prevention, Medicine focuses on Diagnosis and Treatment more, just the way it is.
and the amount of knowledge, heck I study all the time and just about never stop.

And these fundamentals underscore the importance and popularity of NP's with the consumer. You see, some clients actually want more than a label and a pill.

I think the public want accurate treatments and Diagnosis, what good is care delivery if it is the wrong treatment and the Patient Dies,

Plus many MD's and DO's treat the whole Patient not just "Push Pills" this is very condescending and cynical, nurses do more then "Just clean Butts too" we can through insults all day.

Originally Posted by DRFP

Look I'm not here to argue but this "I'm a Doctor" Just like a MD scares me and is not lawful, you will not be Licensed to practice medicine as a physician but be licensed as a Nurse Practitioner.

It scares me, too. Thats why policy, regulation and statute has to be enacted to protect the consumer. All physicians should have to clearly state with each pt. encounter that they are not trained DNP's and that their doctorate degree is only in medicine and they have no training or license to practice nursing, either on a basic or advance level.

Doctors do not usually say they are Nurses, but do give Nurses orders and in my state NP's and DNP's,

Plus I guess I can say I'm an RN too since I am and I hold a current License.

Originally Posted by DRFP

Some states have already enacted laws that Physicians are to be called "Doctor" in the clinical setting to help with the confusion.

To true. And at one time there were no states in which APN's could practice independently. Thank goodness wisdom, experience and common sense (coupled with consumer-support based on outcomes and evidence) continues to prevail which is why NP's can practice independently in 23 states.

I have already done the research on this and its not 23 states, its about 4. Advocates want to count states where NP's can write scripts as independent practice, when in all but 4 NP's must have collaboration with MD's at least! this is not 100% independent, I doubt on a Nursing forum I will ever get agreement. But this is a fact. A recent study was done that has charts to prove this...

Originally Posted by DRFP

NP's, PA's DNP's can be and are valuable care givers and are needed in the health care system but this should not be to replace Physicians, it is not meant to do that, it is meant to deliver a higher level of care to the public, that scheme includes Physcians not excludes them.

I agree, and I also feel that there is even room and a place for physicians too.

I expect open hostility from Nurses towards Physicians, a copy of this should go to congress un altered to show the logic of some nurses, I do not know why you want to try and replace MD's and DO's and the high level of education required to practice medicine, how does this better medical care?

[wowza]

I am not going to deny that there is much that doctors can learn about patient satisfaction from nurses however patient satisfaction has very little to do with the competency of the provider. Let's not front like it does. There are doctors out there that have a terrible bedside manner but are the absolute leader in their field. Would you rather have someone hold your hand as you die or be callous as they cure you? What I am trying to say is that they are neither mutually inclusive nor exclusive. They are unrelated.

Now the assertion that a DNP program is equal in scope and information to a FP doc is ridiculous. The sheer fact that DNPs do not take the same licensing exams and are asking the NBME to create a separate exam affirms this point.

Now for the breakdown:
Look at the clinical hours required. From my brief research, all of the programs I have found range from 800-1000 hours of clinicals. That is the equivalent of 10-15 weeks of residency. Hardly adequate.

Many of the programs assert that a full time student can finish the program in 3 semesters... not exactly the same time frame as 4 years of medical school and 3+ years of residency. There is a reason that medical residencies have been lengthened; you just cannot have adequate knowledge to be a primary provider with less. As more is learned, the residencies will have to be lengthened.

The part time nature of some of the programs and the distance learning is equally troubling.

I am all for DNPs if the didactics are equivalent and are accredited by an equally stringent board like the LCME. Lord knows that many medical students are being pushed away from primary care by rising education costs and decreasing reimbursements. An adequate replacement needs to be found. This is about what is best for the patient. Decreasing the time spent learning is not an adequate solution. It is not as if medical school is wrought with superfluous information and wasted time. Cutting out didactics, time spent in clinicals and basic sciences and calling it equivalent is irresponsible.

The underlying assumption of these programs is that NPs do not have enough training to be the primary caregiver and that these programs will fill in the gaps to make an adequate PCP. I selected a program where it was easy to find their classes (Wright State) and took a look.

You find a few classes that are clearly as they should be: like nursing theory and determinants of health. These make up 6 credits.

The rest resemble an MPH or an administrative program: leadership, informatics, policy leadership and ethics, information technology, statistics, epidemiology, and entrepreneurship. These make up 34-38 credits.

To get clinical specialty certification you add clincals plus 3 credits of pathophysiology and 3 credits of pharmacology.

http://www.nursing.wayne.edu/Academi.../DNP3Paths.pdf

So you have around 12 credits of foundational courses and 34 of that are inconsequential to clinical practice.

Let's call a spade a spade.