MD, DO, NP, DC, OD -- Who deserves the title PCP? - page 3

our professional scope of practice asserts that our role is to assess, diagnose, and treat in health and illness - head to toe, physical and behavioral. from assessing, diagnosing, treating -... Read More

  1. by   Tenesma
    cardiacNP01 - your post is mildly misleading... no matter how much experience an NP has, they will NOT be equivalent to an MD trained in a primary specialty.... (except maybe for family practice - that is debatable)

    I remember even as an intern (just a few months out of med school) having to correct NPs who had 15-20 years of experience, just because they didn't have the breadth of knowledge that I did. I think it is interesting how NPs try to extend their scope of practice because they have become comfortable with their surroundings and their patient population, only to come screaming for help when something is out of their range (usually after they try to manage the problem under the false belief that they can do everything a primary care practitioner can do).

    As far as studies go: there are only a few (and poorly done I might add)... and those primarily revolve around patient satisfaction. A few have shown similar long-term outcomes in the management of primary/straightfoward medically-responsive hypertension, and mild to mild intermittent asthma...
    but that is it.


    so back to the original poster: yes NPs (in my eyes) are primary care providers - they aren't physicians... but that is okay, because they provide a valuable service to patients. That is what we should be worrying about: what can we do to improve the health/care of our patient? Instead of worrying about titles... as far as i am concerned the only Dr. who doesn't deserve the title Dr. is a Naturopath (but that is my own biased opinion - and since that is my own biased opinions, flame-wars won't change my opinion)
  2. by   TMnurse
    The bottomline is EP71 is neither a NP/OD/MD/DO/RN/PC/PA. Sorry ep71. You make some valid points but I think first and foremost you have very little exp seeing any type of patient(s). For what I can tell, you have done your research and know ON PAPER what each professin does. I am guessing you are looking for the right profession. I hope that last few posts haven't turn you off from becoming an NP. The fact is all the above profession seek more autonomy and security in their respective field (MDs included). If you don't cont. to lobby for yourself (as a profession) no one will. NPs see a huge range of patients... and just occasionaly step on the toes of others (sometimes). I find it odd that any time some writes about NPs expanding the scope of practice somebody really gets offended. However, the range of where NPs practice and the care they perform will only expand as our health care system change. Neither you nor I can change that. Soooo if you really want to do eye examines all day maybe becoming an OD is your thing. If you want a cool job become an MD/DO/PA/NP Good Luck.
  3. by   PA-C in Texas
    Well, my worthy NP colleagues, continue to fight the good fight. Educate, Educate, Educate. There are lots of misconceptions about APN's just like there are about P.A.'s. Most people think P.A. is still a certificate program for old army medics, and that you can't do anything except examine a patient and then run to the doc to report. Its actually a three year Masters program, I have full hospital privileges and my own prescription pad, thank you.

    Even though I am not a PCP right now, I have been (work in an ER now, so I guess it is sort of PCP with the way things are going these days). However, I am NOT a physician. I have virtually the same supervisory requirements as NPs in my state, but I know my limit. It doesn't mean that PA's or NP's must have physicians hovering over them at every waking moment, it just means that we know when to refer.

    When I was in family practice, I had patients that I saw exclusively- I was their primary care provider. I was the one who got the calls when they had to be seen in the ER, etc.

    So continue the crusade! One of these days you will be recognized for what you can do and not the letters behind your name.

    BTW, I am going to be starting medical school this summer, so you will have an advocate on the dark side.
  4. by   ep71
    Quote from PA-C in Texas
    Well, my worthy NP colleagues, continue to fight the good fight. Educate, Educate, Educate. There are lots of misconceptions about APN's just like there are about P.A.'s. Most people think P.A. is still a certificate program for old army medics, and that you can't do anything except examine a patient and then run to the doc to report. Its actually a three year Masters program, I have full hospital privileges and my own prescription pad, thank you.

    Even though I am not a PCP right now, I have been (work in an ER now, so I guess it is sort of PCP with the way things are going these days). However, I am NOT a physician. I have virtually the same supervisory requirements as NPs in my state, but I know my limit. It doesn't mean that PA's or NP's must have physicians hovering over them at every waking moment, it just means that we know when to refer.

    When I was in family practice, I had patients that I saw exclusively- I was their primary care provider. I was the one who got the calls when they had to be seen in the ER, etc.

    So continue the crusade! One of these days you will be recognized for what you can do and not the letters behind your name.

    BTW, I am going to be starting medical school this summer, so you will have an advocate on the dark side.
    If it's so dark why are you going over there...Do you want to be evil? Do you want to trade your soul for some money? Do tell us your attraction to the "dark side".
  5. by   PA-C in Texas
    No, actually I want to be a surgeon.
  6. by   ep71
    Quote from PA-C in Texas
    No, actually I want to be a surgeon.
    What does that have to do with going over to the "dark side"
  7. by   RMARTINNC
    It's nice to see a spirited debate around this subject. I need to ask PA-C, when you said, "we need to know when to refer" to whom did you mean? For example, when you worked in a Primary Care Practice, and worked up a patient who had Cholelithiasis or biliary dyskinesia, who did you refer to? Another PCP in your practice? Or a Surgeon?
    I refer to a Surgeon.
    Who would an MD refer to? A Surgeon.
    So are you saying that my referral to a surgeon is somehow different than an MD's referral to a surgeon? Or are you saying something different. I'm not sure I understand.

    PA-C thanks for your insight and good luck in Medical School.
    Rob
  8. by   RuralNP
    This is a really big topic, but you can bypass a lot of wasted bandwith by skipping the arrogance and false assumptions. A big threat to our patients is the assumption you know what you're talking about when you really don't. I've seen some huge knowledge vacancies filled with incorrect information in this thread. If you can do that, you can make big medical mistakes and think you're doing the right thing.

    NP's often catch MD mistakes and vice versa. Has much less to do with training, a lot to do with how good you want to be and how much attention you're paying. If you have specialty experience even as a staff RN, you're going to run circles around a newly minted family practice MD in your area of expertise. And don't forget, everyone makes mistakes.

    On top of that, to arrogantly assume that any training protects you from being outdiagnosed is incorrect. There's not enough room in your brain for everything you really need to know to do this job right all the time. Somebody always knows something you don't, sometimes it's the orderly.

    After a few years in practice the field levels out and whatever you've learned in the past becomes less important that the character of your practice, how hard your working to keep up on the new stuff, and how hard you try not to forget the old stuff. There are many more mistakes made by lack of attention than lack of training. That's why NPs and PAs do so well in head to head comparisons with MDs. AND by the way the literature has some REALLY good studies that measure objective medical endpoints in RANDOMIZED, controlled trials that have been published in well respected peer-review magazine including the REAL medical journals.

    I remember one local doc that picked up a Erythema Nodosum that I missed as a new grad (I thought it was bug bites), the next week I picked up a Ramsay-Hunt Syndrome that he missed (he was treating for simple otitis). That was in the old days when there were more of us around. Now I hardly ever talk to anyone who's not a specialist. I haven't worked side by side with an MD in the office or the ER in over 5 years. Fact of the matter is, out in the jungle it doesn't matter what you call yourself. If the system sets you up to be a primary provider, you either do it or you don't. There are good and bad PCPs and the title doesn't tell you which is which. But make no mistake, NPs and PAs are real, autonomous PCPs all over this country.

    As far as Optometrists go, in my fine state, they don't prescribe so there's a real wall to their practice. You could hardly call them comprehensive providers. They examine, diagnose (some things), and make glasses. Any medical problems they send to a Opthomologist. If they could prescribe, I bet many would be just as good as Opthomologists in office practice. Just like NPs and PAs showed that they could be just as good as family practice docs.
  9. by   Nurse GOODNIGHT
    Wanted to respond but the idea has already been expressed. I wanted to second this though. YOU CAN GET POOR CARE FROM ANYONE AT ANY TIME ON ANY GIVEN DAY REGARDLESS OF THE INTITIALS. IMHO, this is the bottom line.
  10. by   RMARTINNC
    Tenesma,
    Thanks for your post. Each of us can probably recall a personal experience where we knew more (or less) than another provider. For example I can recall asking a veteran internist how he teaches his patients to do Kegel exercises. He said that he tells them to get a suzanne summers thigh master, and that will do the trick. Just because I had to correct him, and he had 15-20 years of experience as an MD and I was a new NP, I don't feel that he is any more or less of a PCP than I am. I certainly wouldn't say that I had a greater breadth of knowledge than he did. By the same token, I'm not sure it was fair for you to say that you had a greater breadth of knowledge than those NP's -- maybe you did, but acknowledge, well... maybe you didn't. Please don't assume that because someone has MD after their name, they automatically have a greater breadth of knowledge than someone who has APRN, BC after their name. I'm sure we can agree on that.
    Thanks for your post and your interest in this topic.
    Rob
    Primary Care Physician
    Definition: Physician responsible for a person's general health care (General Practitioner, or Family Doctor).


    Quote from Tenesma
    cardiacNP01 - your post is mildly misleading... no matter how much experience an NP has, they will NOT be equivalent to an MD trained in a primary specialty.... (except maybe for family practice - that is debatable)

    I remember even as an intern (just a few months out of med school) having to correct NPs who had 15-20 years of experience, just because they didn't have the breadth of knowledge that I did. I think it is interesting how NPs try to extend their scope of practice because they have become comfortable with their surroundings and their patient population, only to come screaming for help when something is out of their range (usually after they try to manage the problem under the false belief that they can do everything a primary care practitioner can do).

    As far as studies go: there are only a few (and poorly done I might add)... and those primarily revolve around patient satisfaction. A few have shown similar long-term outcomes in the management of primary/straightfoward medically-responsive hypertension, and mild to mild intermittent asthma...
    but that is it.


    so back to the original poster: yes NPs (in my eyes) are primary care providers - they aren't physicians... but that is okay, because they provide a valuable service to patients. That is what we should be worrying about_: what can we do to improve the health/care of our patient? Instead of worrying about titles... as far as i am concerned the only Dr. who doesn't deserve the title Dr. is a Naturopath (but that is my own biased opinion - and since that is my own biased opinions, flame-wars won't change my opinion)
  11. by   RMARTINNC
    PS. that definition at the end of my last post was not meant to be a signatory ie Primary Care Physician -- it just looks that way because of the placement in the text below my name. I won't consider myself a Primary Care Physician until the government gives me the authority to use the title "physician" - no sooner.



    Quote from RMARTINNC
    Tenesma,
    Thanks for your post. Each of us can probably recall a personal experience where we knew more (or less) than another provider. For example I can recall asking a veteran internist how he teaches his patients to do Kegel exercises. He said that he tells them to get a suzanne summers thigh master, and that will do the trick. Just because I had to correct him, and he had 15-20 years of experience as an MD and I was a new NP, I don't feel that he is any more or less of a PCP than I am. I certainly wouldn't say that I had a greater breadth of knowledge than he did. By the same token, I'm not sure it was fair for you to say that you had a greater breadth of knowledge than those NP's -- maybe you did, but acknowledge, well... maybe you didn't. Please don't assume that because someone has MD after their name, they automatically have a greater breadth of knowledge than someone who has APRN, BC after their name. I'm sure we can agree on that.
    Thanks for your post and your interest in this topic.
    Rob
    Primary Care Physician
    Definition: Physician responsible for a person's general health care (General Practitioner, or Family Doctor).
  12. by   CardiacNP01
    While I haven't had a chance to respond before now, I feel that RuralNP stated it beautifully. Additionally, I've had experiences similar to that of RNMARTINNC. With all due respect to Tenesma, I've had to correct dozens of overzealous interns (with greater than three months experience) and R1s from making potentially fatal med errors within a CVICU in Memphis. Additionally, the thought of an intern with three months experience providing greater quality of care versus an NP or PA with 15 to 20 years experience is implausible at best. At worst, this thinking could prove to be very dangerous for an unsuspecting patient. Granted, the education of an M.D. vastly differs from that of an NP. Certainly no one can argue that point. Yet, the aforementioned post by RuralNP addresses this issue very well.

    It seems that we all agree that the quality of care provided is the most important issue for the patient, regardless of their title. That's good to know.
  13. by   melpn
    NP's deserve to be called PCP's; that 's what they are, what they were trained for, what Medicare reimburses for, etc. No, they are not physicians, but as was pointed out, that term is about as meaningful as "technician" these days. Medical care as rendered from the nursing perspective is a very valuable thing. I see the NP's my ob/gyn and PCP have whenever possible for my own healthcare; let's support our own! No, an NP is not a peds neurosurgeon, but they aren't claiming to be either. We are all aware of the different training and experience that all healthcare workers have. We all have our roles in patient care; operating within your scope of practice is the name of the game.

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