discussion regarding education of NP (DNP) and PA compared to MD/DO

springing · Feb 25, 2010

i really don't think there need to be any changes in the current curriculum for nurse practitioners other than to simply make it more uniform across programs. i also would agree that requiring a doctoral degree doesn't add anything in terms of value to nurse practitioners. i think their education and training levels are fine for them to be independent providers within their scope of practice. i think that people in medical professions get very hung up on titles. it is actually worse than politicians are about it. i think it is silly to go around calling yourself doctor or to expect other people to call you that. it is condescending. titles are antiquated. the healthcare industry needs to get over itself on a lot of antiquated notions.

the dnp is there to inflate the ego and the bank accounts of mundinger (i'm aware she's resigned) and a select few other school administrators...the extra year+ of schooling doesn't actually add anything to your clinical knowledge base, but it works for what it was intended to do...pad the pockets of university staff and exploit nurses who are weary of the disregard and disrespect so often slung their way and want to be able to tell people they have a doctoral degree, even if it only took them 3 years to obtain it.

but that still doesn't change the fact that the two years of the old np curriculum - 1 and a half if you delete the classes that provide no clinical knowledge - pale in comparison to what other healthcare providers are receiving. and i don't understand and have never received any good explanation for why this isn't seen as a problem. you receive a fraction of the clinical hours of the pa, and thus you are unable to move specialties, but it takes you the same amount of time to receive your degree because you fill the space with classes that won't help you diagnosis or treat. a pa, in theory, can work in an emergency department, an infusion center, a dermatologist's office, planned parenthood, a community health clinic. they can do that because they received that training. an np has a narrower scope of practice. how is that advantageous?

what is alarming to me is the lack of concern this inspires in future and current nps. what on earth is wrong with more clinical hours? you have countless posts on this forum asking for information on how to become an np the fastest. which route is best? which route will get me there quicker? i have not seen one post yet that asks which program is best. which program will teach me the most. i went through 15 pages of posts here. i didn't see one. there are over 100 accredited np programs in the country, none of which are held to a standardized format, and few people are concerned about which are the best. that is a problem. you get a lot of "which specialty will open up the most jobs?" not a lot of "will i be prepared for all those different jobs?" i did a search and did find one person asking about nurse practitioner fellowships.

let's compare. here's what you have to do to start a new medical school in this country.

http://www.lcme.org/procedur.htm

http://www.lcme.org/standard.htm

http://www.lcme.org/newschoolprocess.htm

what do you have to do to start an np program? get mundinger to show up and cut the ribbon, i guess.

bajasauce07 · Feb 25, 2010

antiquated notions like education?

mbreaz1 · Feb 25, 2010

antiquated notions like education?

What?

mbreaz1 · Feb 25, 2010

The DNP is there to inflate the ego and the bank accounts of Mundinger (I'm aware she's resigned) and a select few other school administrators...the extra year+ of schooling doesn't actually add anything to your CLINICAL knowledge base, but it works for what it was intended to do...pad the pockets of university staff and exploit nurses who are weary of the disregard and disrespect so often slung their way and want to be able to tell people they have a doctoral degree, even if it only took them 3 years to obtain it.
But that still doesn't change the fact that the two years of the old NP curriculum - 1 and a half if you delete the classes that provide no clinical knowledge - pale in comparison to what other healthcare providers are receiving. And I don't understand and have never received any good explanation for why this isn't seen as a problem. You receive a fraction of the clinical hours of the PA, and thus you are unable to move specialties, but it takes you the same amount of time to receive your degree because you fill the space with classes that won't help you diagnosis or treat. A PA, in theory, can work in an emergency department, an infusion center, a dermatologist's office, Planned Parenthood, a community health clinic. They can do that because they received that training. An NP has a narrower scope of practice. How is that advantageous?
How exactly do you define that narrower scope of practice and why do you think it isn't advantageous? Advantageous to whom?
What is alarming to me is the lack of concern this inspires in future and current NPs. What on earth is wrong with more clinical hours? You have countless posts on this forum asking for information on how to become an NP the fastest. Which route is best? Which route will get me there quicker? I have not seen one post yet that asks which program is best. Which program will teach me the most. I went through 15 pages of posts here. I didn't see one. There are over 100 accredited NP programs in the country, NONE of which are held to a standardized format, and few people are concerned about which are the best. THAT is a problem. You get a lot of "Which specialty will open up the most jobs?" not a lot of "Will I be prepared for all those different jobs?" I did a search and did find one person asking about nurse practitioner fellowships.
Let's compare. Here's what you have to do to start a new medical school in this country.
http://www.lcme.org/procedur.htm
http://www.lcme.org/standard.htm
http://www.lcme.org/newschoolprocess.htm
What do you have to do to start an NP program? Get Mundinger to show up and cut the ribbon, I guess.

The truth is that these accreditation procedures for medical schools are specifically designed to limit competition and have done so since their inception. That could be one reason that the poor physicians graduate with so much student loan debt. But you certainly guessed wrong about the accreditation process for an NP program. Maybe you should complete your research and not try to be so one sided in your argument.

springing · Feb 26, 2010

The truth is that these accreditation procedures for medical schools are specifically designed to limit competition and have done so since their inception. That could be one reason that the poor physicians graduate with so much student loan debt. But you certainly guessed wrong about the accreditation process for an NP program. Maybe you should complete your research and not try to be so one sided in your argument.

How does having fewer medical schools contribute to more debt?

mbreaz1 · Feb 26, 2010

How does having fewer medical schools contribute to more debt?

Simple law of supply and demand. If there are fewer, it costs more.

springing · Feb 26, 2010

6 new medical schools have opened in the past few years and tuition has gone up. 11 more allopathic medical schools are set to open in the next 4 years. I would bet every single penny in my savings account that they won't stay the increase of tuition rates a whit.

Your argument that the accrediting process is there to hinder new medical schools (not to actually make sure they PRODUCE WORTHY DOCTORS) and that raises tuition carries no water. I've heard the "AMA keeps the supply artificially low" argument before, but never using accreditation procedures as proof. I'm pretty sure most PATIENTS would agree that the procedures are necessary.

mbreaz1 · Feb 26, 2010

6 new medical schools have opened in the past few years and tuition has gone up. 11 more allopathic medical schools are set to open in the next 4 years. I would bet every single penny in my savings account that they won't stay the increase of tuition rates a whit.
Your argument that the accrediting process is there to hinder new medical schools (not to actually make sure they PRODUCE WORTHY DOCTORS) and that raises tuition carries no water. I've heard the "AMA keeps the supply artificially low" argument before, but never using accreditation procedures as proof. I'm pretty sure most PATIENTS would agree that the procedures are necessary.

Sure, they would agree accreditation is necessary, but not to the extent that the medical profession does it to limit competition. The AMA is the most anti-competitive group in the country. I don't know what you are talking about that my argument doesn't hold water. Plenty of people agree, including federal courts:

in Wilk v. American Medical Association (1990), a federal court concluded that it was anticompetitive for the AMA to pass an "accreditation rule" that forced hospitals to exclude chiropractors from access to medical facilities. The AMA claimed the exclusion was necessary because the chiropractors were not using proven methods of health care. However, the court decided that this choice should be made by consumers themselves and not through coerced exclusion of chiropractors from the market.

dgenthusiast · Feb 26, 2010

Wilk v. American Medical Association (1990), a federal court concluded that it was anticompetitive for the AMA to pass an "accreditation rule" that forced hospitals to exclude chiropractors from access to medical facilities. The AMA claimed the exclusion was necessary because the chiropractors were not using proven methods of health care. However, the court decided that this choice should be made by consumers themselves and not through coerced exclusion of chiropractors from the market.

You should reread about that lawsuit. There's nothing there about letting "consumers" choose for themselves what provider to go to. It mainly had to do with the AMA failing to present enough evidence that chiropractic was unscientific and that eliminating the chiropractic profession is not the only way the AMA's concerns regarding the lack of the scientific method in chiropractic could be addressed.

Once again, nothing about letting consumers choose their provider. Most people would realize that "consumers" who don't know much about what they're buying (ie. medical care) would probably choose poorly. Unless you're suggesting the avg. American has enough medical knowledge to know exactly what the quality of care they're receiving is?

dgenthusiast · Feb 26, 2010

Wilk v. American Medical Association (1990), a federal court concluded that it was anticompetitive for the AMA to pass an "accreditation rule" that forced hospitals to exclude chiropractors from access to medical facilities. The AMA claimed the exclusion was necessary because the chiropractors were not using proven methods of health care. However, the court decided that this choice should be made by consumers themselves and not through coerced exclusion of chiropractors from the market.

You should reread about that lawsuit. There's nothing there about letting "consumers" choose for themselves what provider to go to. It mainly had to do with the AMA failing to present enough evidence that chiropractic was unscientific and that eliminating the chiropractic profession is not the only way the AMA's concerns regarding the lack of the scientific method in chiropractic could be addressed.

Once again, nothing about letting consumers choose their provider. Most people would realize that "consumers" who don't know much about what they're buying (ie. medical care) would probably choose poorly. Unless you're suggesting the avg. American has enough medical knowledge to know exactly what the quality of care they're receiving is?

mbreaz1 · Feb 26, 2010

You should reread about that lawsuit. There's nothing there about letting "consumers" choose for themselves what provider to go to. It mainly had to do with the AMA failing to present enough evidence that chiropractic was unscientific and that eliminating the chiropractic profession is not the only way the AMA's concerns regarding the lack of the scientific method in chiropractic could be addressed.
Once again, nothing about letting consumers choose their provider. Most people would realize that "consumers" who don't know much about what they're buying (ie. medical care) would probably choose poorly. Unless you're suggesting the avg. American has enough medical knowledge to know exactly what the quality of care they're receiving is?

I did read the lawsuit. The ruling wasthat the AMA violated the Sherman Antitrust Act, which means they were GUILTY of unlawful restraint of trade.QUOTE FROM THE OPINION:]]

This conduct constituted a conspiracy among the AMA and its members and an unreasonable restraint of trade in violation of Section I of the Sherman Act.

It is all about letting consumers choose for themselves what provider to go to. Why is it that everytime someone posts a study or comment that is contrary to your opinion, you never produce any evidence to counter it, you just simply say that is a poorly designed study and doesn't constitute evidence, or that their comment is incorrect? You made absolutely no point in your above post other than the fact that you don't understand the law and you were displeased with the outcome of the case, so you thought you would cry about it like the physicians probably did.

Listen to yourself on this stuff about consumers. You are saying that most people realize that they are too stupid to choose a medical provider that is right for them? I don't think that more than 50% of the population would tell you that if you polled them.

Do you really think that every poor soul who walks the earth who isn't a physician is a complete moron? I'm guessing that would include you since you claim you are not a physician. Are you actually suggesting that educated people can't understand what primary care provider is right for them?

dgenthusiast · Feb 26, 2010

I did read the lawsuit. The ruling wasthat the AMA violated the Sherman Antitrust Act, which means they were GUILTY of unlawful restraint of trade.QUOTE FROM THE OPINION:]]
This conduct constituted a conspiracy among the AMA and its members and an unreasonable restraint of trade in violation of Section I of the Sherman Act.

It is all about letting consumers choose for themselves what provider to go to. Why is it that everytime someone posts a study or comment that is contrary to your opinion, you never produce any evidence to counter it, you just simply say that is a poorly designed study and doesn't constitute evidence, or that their comment is incorrect? You made absolutely no point in your above post other than the fact that you don't understand the law and you were displeased with the outcome of the case, so you thought you would cry about it like the physicians probably did.
Listen to yourself on this stuff about consumers. You are saying that most people realize that they are too stupid to choose a medical provider that is right for them? I don't think that more than 50% of the population would tell you that if you polled them.
Do you really think that every poor soul who walks the earth who isn't a physician is a complete moron? I'm guessing that would include you since you claim you are not a physician. Are you actually suggesting that educated people can't understand what primary care provider is right for them?

Haha, where did I cry? Where did I show displeasure at the outcome? All I said was that the conclusion you reached was wrong and that the reason the courts acted against the AMA was not because they wanted consumers to choose their providers. That was the point since you appear to have missed it.

I never said anything about people choosing what medical provider is appropriate for them. You really should read my post before hitting the reply button. I said that most people don't know if they're receiving quality medical care or not because they don't have the medical knowledge to do so. It's easy for people to choose a provider. For example, you've got cancer? Easy...go to the oncologist. Heart problem? Cardiologist. See? Pretty easy. You don't have to be educated to come to those conclusions. The problem is that when the person goes to said provider, they don't know how good the medical care (not patient satisfaction, btw) they're receiving is.

Do you finally understand what we're saying now? Or are you still going to stick with that same line of yours saying that we're crying and that we're scared of competition?

Edit: Also, everytime someone provided a study, I did counter it and broke down exactly what was wrong with the studies. Do you really not remember? I debunked a couple of studies you yourself linked. Go back and look at my previous posts if you need to refresh your memory. It's YOU who doesn't provide any evidence. Remember you're the one who said you don't need any studies to show that NPs/DNPs are better than physicians because you see it everyday? Yea, that was you. You're the one who refuses to critically analyze studies, not me. So, you're turning a bit hypocritical now, aren't you? You're losing a logical argument by failing to provide logical counterarguments and thus, you're resorting to personal attacks (ie. calling others stupid for disagreeing with you) and making up stuff (ie. that whole previous post of yours regarding what I wrote).