AMA must be disturbed - page 2

The proposed DNP as entry level for NP by 2015 must have the AMA upset. Check out the bill in front of the house.... Read More

  1. by   Josh L.Ac.
    Quote from jer_sd
    I think it is also targeting ODs and DCs. Both of these proffesions are frequently called doctor. In addition the part where if you are not a MD/DO/DDS you can not claim to have equivilent training. How does this work if say a DC finished a 3 year chiropractic radiology residency, or an OD completes a residency in ocular disease management? Both of thoes providers would be doctors who completed residencies and can be board certified. Would they then have to say

    "I am dr. Xxx. An OD who is board certified in ocular disease, I am not a md I did not attend medical school, my residency was in optometric management of ocular disease so I am not equal to a physician"

    I think this is just a way for the AMA to keep all other providers working subservient to mds. Probably the DNP was part of it but look at advances That PT has made with a push for direct access, ODs getting better rx rights, NDs becoming licensed in more states, acupuncturists now pushing for doctorial degree as well. All proffesions increase their scope of practice which makes physicians nervous.

    Actually the doctorial degree of acupuncture has no increased scope of practice, rather it is an attempt to keep the whole credential game up. The acupuncture programs that are in the high-end [in terms of curriculum] graduate persons a few hundred hours shy of having enough for a doctorate.

    From my experience, three and a half years of year-round school is a bit heavy to just have a master's degree.


    Edit: I forgot to add that for right now, a doctorate in acupuncture (if done in the US) requires the 3-year master's degree to get in, then you have two MORE years to get the doctorate.


    It. Is. Overkill.
    Last edit by Josh L.Ac. on Sep 16, '06
  2. by   shelebelle
    How about someone propose a bill that says MDs and DOs have to call themselves physicians? Let's just scrap the term "doctor" because it's really vague. I had a coworker who had a Ph.D in immunology who basically told someone over the phone that she was a doctor and needed her car fixed immediately. I'm pretty sure that was a misrepresentation.

    Every field has a doctorate and the appropriate title for those individuals is "doctor". As a future nurse practitioner, I'm wondering what the hell I should call myself. Saying "nurse so-and-so" is also vague because there are so many different types of nurses! Sometimes these titles serve to confuse more than they help. Perhaps it is time that nurse practitioners give themselves a title so we can be done with all this crap.
  3. by   MS, APRN, BC, FNP
    Quote from shelebelle
    . Perhaps it is time that nurse practitioners give themselves a title so we can be done with all this crap.
    I propose: MP (medical practitioner)

    Nurse in the title just really doesn't seem appropriate. What I do is really pretty far away from being a nurse.
  4. by   traumaRUs
    This has kinda come about from our own (nurses) disorganization. I recently started as an APN in a large practice. I haven't met all the MDs yet. However, as I'm meeting them (I am always introduced as the new NP), I correct them by saying that I'm a CNS, not an NP. However, in IL, that is mostly a semantics issue. In my practice, I work with three NPs, 4 PAs, 11 MDs and me!

    As the only CNS, I encounter a lot of questions.
  5. by   ERNP
    It would seem to me that most, if not all of the states, have some legislation on the books about protected titles. Where I live it would already be illegal for me to call myself Dr. Me. From that perspective I find the support of this bill a waste of tax dollars and congressional time.

    I would agree that this legislation was simple title protection if it were not for item #2 dealing with procedures, complex medical issues, and prescribing. Perhaps I am paranoid, but this seems like a thinly veiled introduction to overturning state laws regarding NP (et al) practice. Afterall, states can't make laws that directly conflict with federal law.

    Who decides what is complex? Someone in a congressional office or someone who has actually laid eyes on the patient? If it is someone who has actually laid eyes on the patient then #2 provides for further redundency as that is already required.

    I see this as a direct threat to prescriptive authority. Something that GA NPs finally received recently... congrats to you all.

    Further, this whole bill was written as representing the opinion of patients utilizing healthcare services. I would be curious how the sponsers of this bill devined a generalizable opinion of healthcare consumers when they can't even form a unified opinion amongst themselves.
  6. by   Papadoc
    Quote from jer_sd
    I think it is also targeting ODs and DCs. Both of these proffesions are frequently called doctor. In addition the part where if you are not a MD/DO/DDS you can not claim to have equivilent training. How does this work if say a DC finished a 3 year chiropractic radiology residency, or an OD completes a residency in ocular disease management? Both of thoes providers would be doctors who completed residencies and can be board certified. Would they then have to say

    "I am dr. Xxx. An OD who is board certified in ocular disease, I am not a md I did not attend medical school, my residency was in optometric management of ocular disease so I am not equal to a physician"

    I think this is just a way for the AMA to keep all other providers working subservient to mds. Probably the DNP was part of it but look at advances That PT has made with a push for direct access, ODs getting better rx rights, NDs becoming licensed in more states, acupuncturists now pushing for doctorial degree as well. All proffesions increase their scope of practice which makes physicians nervous.
    DCs and ODs mostly exist outside of INPATIENT clinical settings. Both, as far as I know, are not considered primary care. Tere was a crapload of both with me at ROSS University SOM back in 2004. Sorry, but MD/DO is where it is for being called a physician in the clinical setting. I understand the "cut coner" theory. And you guys, who have not gone to med school may have workd
  7. by   jer_sd
    Quote from Papadoc
    DCs and ODs mostly exist outside of INPATIENT clinical settings. Both, as far as I know, are not considered primary care. Tere was a crapload of both with me at ROSS University SOM back in 2004. Sorry, but MD/DO is where it is for being called a physician in the clinical setting. I understand the "cut coner" theory. And you guys, who have not gone to med school may have workd
    There is more to health care than the inpatient setting.

    ODs are considered primary care providers for visual health, DCs also function as primary care providers with direct patient access for musculoskeletal disorders (hopefully only that but hey in oregon they can deliver babies also)

    An interesting issue is both of thoes proffesions have physician in their respective title in some states as well.

    One thing I do not understand is the rational for this bill. Are there studies that show non MD/DO/DDS/DMD hurt prople when functioning in their respective roles? Does a DPM have worse outcomes for surgery? Will the OD give me bad contacts or miss glaucome? Will that PA or NP misdiagnose more often that a MD, does a RDH working solo not clean teeth properly or not send to a DDS if additional care is needed.

    I am a NP, I know that my training is not identical to a MD. I will not say that my training and abilities are less than a MD since I was not trained as one. There is overlap between NP practice and MD practice but they produce 2 different providers that share some functions. The MDs I work with respect my abilities and ask my opinion on issues that I have more experience in, and I do the same.

    I do not claim to be a MD, but if I obtain a clinical DNP or other degree (pharmd, psyd, dc, od....) I will put dr on my lab coat followed by the credentials and will introduce myself appropriatly if I am a dr (probably not going to happen but you never know) if I am functioning in that clinical position.
    Last edit by jer_sd on Sep 17, '06
  8. by   gauge14iv
    Visit the website for the American College of Clinicians - a nationwide group of collective NP's and PA's who are working together against this bill for a number of reasons.

    For one thing - the bill is redundant - there are already state laws in most states which do exactly what this bill is expected to do.

    This bill would add some tooth however - for instance as one PA put it - they could then require a patient to sign a consent worded something like "You will not be seeing a doctor today - you will be seeing a nurse practitioner or a PA, who does not have as much education or training as a doctor and therefore may not be able to provide you the quality of care you have come to expect"...something to that effect.

    And of course the ACC is welcoming new members and we have an email listserv where we have been discussing all of these things at length!
    http://www.amcollege.org/

    I wonder just who at the AMA loses sleep over such things - don't they have bigger things to worry about?

    Oh and as far as titles go - the one that has been bantered about the most is "Advanced Practice Clinician"
  9. by   Papadoc
    Quote from MS, APRN, BC, FNP
    I propose: MP (medical practitioner)

    Nurse in the title just really doesn't seem appropriate. What I do is really pretty far away from being a nurse.
    I propose for those who want to practice medicine, or somehow to be identified as a "medical vs nursing practitioner" should go to the medical school, and not re-invent the wheel, and confuse the general public.
    Last edit by traumaRUs on Sep 18, '06
  10. by   Papadoc
    Quote from jer_sd
    There is more to health care than the inpatient setting.

    ODs are considered primary care providers for visual health, DCs also function as primary care providers with direct patient access for musculoskeletal disorders (hopefully only that but hey in oregon they can deliver babies also)

    An interesting issue is both of thoes proffesions have physician in their respective title in some states as well.

    One thing I do not understand is the rational for this bill. Are there studies that show non MD/DO/DDS/DMD hurt prople when functioning in their respective roles? Does a DPM have worse outcomes for surgery? Will the OD give me bad contacts or miss glaucome? Will that PA or NP misdiagnose more often that a MD, does a RDH working solo not clean teeth properly or not send to a DDS if additional care is needed.

    I am a NP, I know that my training is not identical to a MD. I will not say that my training and abilities are less than a MD since I was not trained as one. There is overlap between NP practice and MD practice but they produce 2 different providers that share some functions. The MDs I work with respect my abilities and ask my opinion on issues that I have more experience in, and I do the same.

    I do not claim to be a MD, but if I obtain a clinical DNP or other degree (pharmd, psyd, dc, od....) I will put dr on my lab coat followed by the credentials and will introduce myself appropriatly if I am a dr (probably not going to happen but you never know) if I am functioning in that clinical position.
    So are you going to advise your patients that you are a non-physician provider, or you just would tell them I'm Dr. so and so? This will really be misleading for a pt, and that's the reason for this bill (one out of many to follow, I believe).
  11. by   gauge14iv
    Quote from Papadoc
    So are you going to advise your patients that you are a non-physician provider, or you just would tell them I'm Dr. so and so? This will really be misleading for a pt, and that's the reason for this bill (one out of many to follow, I believe).
    State laws in almost every state ALREADY disallow that. No need for this bill.
  12. by   jer_sd
    Quote from Papadoc
    So are you going to advise your patients that you are a non-physician provider, or you just would tell them I'm Dr. so and so? This will really be misleading for a pt, and that's the reason for this bill (one out of many to follow, I believe).
    Sorry for the confusion. When I said I would have dr. And credentials, I meant that it would clarify what type of practitioner I am. This will likley never happen since I have no desire to go for a DNP or other degree at this time.

    But if a health care provider has a terminal degree, is functioning within their respective role, and following the state laws for title..... I strongly feel they should be able to use the title Dr. They earned the degree. I agree you need to clarify to make sure patients know the type of provider but Dr. Is not only reserved for MD/DO/DDS/DMD.

    There are already laws in states to protect titles, this is simply a power move. Now if I had proof that this potential change will help patients then I might be convinced to change my mind.

    Just my opinions.
  13. by   MS, APRN, BC, FNP
    I don't see anything wrong with a DNP saying:

    "Hello, I'm Dr. Smith, your nurse practitioner today. How are you doing?"

    This way the patient can rest assured that they are not getting an MD, and are recieving the best care available.

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