MD, DO, NP, DC, OD -- Who deserves the title PCP? - page 4

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   gij1
    R. Martin thanks for your recent post. You are correct in your comparision of the NP to other professions in terms of recognition and salary compensation. The nursing field orginally developed as a female dominant profession. As we know it is a sexist society and men are paid tremoundously higher for comparable work and education. Research has shown this to be true over and over. I believe our female roots is what still to this day keeps us at lower salary rate compared to other professions. It is still a sexist world, unfair, and should be stopped. The nursing profession as a whole deserves much higher pay and recognition for the education and work required to become an RN, NP, and beyond.
  2. by   Jetman
    Quote from ep71
    Ped Neurosurg and Family Practice don't have the same training. A Ped Neurosurg training is completely different from that of a primary care specialist. (ped neurosurg-7 yrs of training AFTER Med School...Primary Care 0-3 years after med school) Other than medical school, its completely different. I am fully aware of a nurse practitioners responsibilities however, they still are not Physicians. They are not their own profession. They are part of a profession.the profession of Nursing. Optometry is not a subspecialty of Ophthalmology, it is an alone sitting specialty. Ophthalmology and Optometry are two different professions. Unlike NP's which is an extention of nursing. You said that Nurse Practitioner practice similarly to Physicians and because of that, you want the privileges of a Primary Care Physician. Thats not true simply because when you say you practice similarly to a physician, you're saying that you practice similarly to a Cardiothoracic Surgeon, which is a Physician. You may practice similarly to a Medical specialist, but not a Physician. And for that, you shouldn't be given the Basic privileges of a Physican. What you're not getting is that the basic privileges of a Primary Care Physician are the same privileges of a neonatologist, cardiologist, and every other specialist. To give you that power to only practice primary care medicine would be ridiculous in every sense of the word. You are not a specialist of Medicine, you're a specialist of Nursing.
    I am an RN working in an ER that utilizes the services of NPs alongside MD's. NPs are NOT working in the same scope of practice as me. They order and interpret lab work, xrays, etc. They prescribe medications. They do not start IV's or change bedpans. Their scope of practice much closer to that of MDs than RNs. They may not be MDs but it sounds like medicine to me.
  3. by   goodknight
    Perhaps we should just say that all of these professionals serve a purpose. They each provide a unique kind of care for unique needs. None are more important or better than another, they just serve a different purpose. Each is is a care provider and should be recognized as such.
  4. by   kristinwiz
    While I assume that your comments truly are not meant to propegate the "nurses above all others mentality", this has indeed become the result of your post. I am a new member, and frankly, shocked by the ego that pervades some of these forums. Any shrink will tell you that those who brag the most are those who have the most insecurity issues. Those who are secure in their profession and abilities don't seek out the (perceived) faults in others. You have much free time to look up inaccurate information regarding other professions.

    You state that chiropractors don't have bachelor's degrees? They absolutely DO have a bachelors, and then at least four & FIVE years of graduate study before their degree is conferred. Note, I am not a chiropractor.

    You also state that there is little difference between NPs and MDs/DOs. Can you be serious? The fact that they are physicians and NPs are not should be enough to clarify this misstatement. Why try to inflate our own egos with names and titles and labels? If we are insecure, we need to go to medical school and EARN the title that physicians have spent 12 + years (and hundreds of thousands of dollars) of their lives to achieve. Until we have met that challenge ourselves, we have limited room to point fingers. Even the newbie intern is still a DOC. Yes, they may have a long road to travel to reach true competency, but how proficent were you as a student nurse? Did you not have questions, make mistakes, and defer to your supervisor when you were in trouble? Did you never make a medication error in your early years? "those who live in glass houses...."

    I also notice that nowhere in your list of "the enemy" do you even mention your clinician counterparts, the PAs. Nor do you refer to them as equal to NPs in any sense. You must realize that NPs and PAs function in essentially the same capacity. Except for the fact that PAs are trained similar to physicians in their model of medical education. They practice medicine, while NPs practice advanced nursing - not medicine. How can anyone who practices nursing, not medicine, have any claims to be comparable to a physician? This point can't be argued, because NPs have created their own Nursing Board to regulate their practice, claiming that doctors cannot/should not regulate nursing practice. If you want to start claiming to practice medicine, you had better start answering to your state's medical board instead. In my opinion, the creation of your state nursing boards was brilliant! What better way to refuse to be regulated by physicians then by claiming to refute the practice of medicine while embracing that of advanced nursing? It is only because of your nursing boards that NPs have any of the priviledges they enjoy today. Rx and Dx rights certainly would NEVER have been granted to you by the state medical boards, you realize.

    You can't have it both ways - either you practice medicine or you practice nursing. Keep up the claim that you practice medicine and see how fast the state medical boards react....you would be wise to not s&^% where you eat!

    Most jobs are even advertised for both NP/PA because they are essentially similar professions - MidLevel Practitioners, Primary Care Providers, whatever name you ascribe to them doesn't really matter. It's the care that is provided which SHOULD be the concern of all practitioners.

    We would do well to join forces with those whose goals match our own. Think about joining the American College of Clinicians.
    Last edit by kristinwiz on Nov 24, '04
  5. by   Wildcatfan
    Just an end note to this, and I'm sorry in advance for any errors in posting...I'm new. there is so much hostility in this board regarding credentials. One thing I would like to address to the recent MD who posted...there are many physicians who believe that they are infinately more knowledgable than all other patient care providers. I am well aware of the training and money it takes to become a physician, as well as the dedication-my husband is a physician in specializing in Internal Medicine and who will be completing a 3 year fellowship in pulmonary/critical care. That being said, I have worked with physicians who I just do not consider(nor does my husband) to be more knowledgeable than other providers. They have a wealth of knowledge with regards to the sciences ie microbiology, biochem, etc, but are not great when it comes to assessment and diagnosis because of the lack of interpersonal skills, etc. I am not saying that mid-level providers should perform surgery. A little side note-PHYSICIANS who are not trained in surgical specialties really cannot perform surgery. The individual who posted that ridiculous comment reagrding NP vs MD is focusing on a technicality and not reality. My husband would lose his license if her performed surgery or treated a child. I do believe that NPs should receive the same reimbursement as primary care physicians for equal services. For example, if I saw a patient and treated that patient for pneumonia and my collablorating physician saw the same type of patient, we should both be reimbursed the same amount from medicare and medicaid. THAT is the real problem. We provide the same service IN THIS INSTANCE and therefore should be reimbursed the same amount. I am not an NP who feels that nurses or physician assistants should be performing surgery or high risk procedures. I also do not feel that I should handle a patient who should be referred to a specialist, such as the case with patients with pulmonary hyperstension. they have complicated medical problems and should be treated by a specialist, NOT a primary care provider, be it an NP, PA , MD or DO.
    For those of you who think it's ok for a chiropracter to be called a "Dr".....those individuals did not go to medical or osteopathic schools, they do not have a PhD. Therefore, they should not use the title "Dr." Of course, this is all just my humble opinion.
  6. by   PA-C in Texas
    Quote from Wildcatfan
    Just an end note to this, and I'm sorry in advance for any errors in posting...I'm new. there is so much hostility in this board regarding credentials. One thing I would like to address to the recent MD who posted...there are many physicians who believe that they are infinately more knowledgable than all other patient care providers. I am well aware of the training and money it takes to become a physician, as well as the dedication-my husband is a physician in specializing in Internal Medicine and who will be completing a 3 year fellowship in pulmonary/critical care. That being said, I have worked with physicians who I just do not consider(nor does my husband) to be more knowledgeable than other providers. They have a wealth of knowledge with regards to the sciences ie microbiology, biochem, etc, but are not great when it comes to assessment and diagnosis because of the lack of interpersonal skills, etc. I am not saying that mid-level providers should perform surgery. A little side note-PHYSICIANS who are not trained in surgical specialties really cannot perform surgery. The individual who posted that ridiculous comment reagrding NP vs MD is focusing on a technicality and not reality. My husband would lose his license if her performed surgery or treated a child. I do believe that NPs should receive the same reimbursement as primary care physicians for equal services. For example, if I saw a patient and treated that patient for pneumonia and my collablorating physician saw the same type of patient, we should both be reimbursed the same amount from medicare and medicaid. THAT is the real problem. We provide the same service IN THIS INSTANCE and therefore should be reimbursed the same amount. I am not an NP who feels that nurses or physician assistants should be performing surgery or high risk procedures. I also do not feel that I should handle a patient who should be referred to a specialist, such as the case with patients with pulmonary hyperstension. they have complicated medical problems and should be treated by a specialist, NOT a primary care provider, be it an NP, PA , MD or DO.
    For those of you who think it's ok for a chiropracter to be called a "Dr".....those individuals did not go to medical or osteopathic schools, they do not have a PhD. Therefore, they should not use the title "Dr." Of course, this is all just my humble opinion.
    Ummm....... I agree with most of what you are saying, but be careful. We don't need to sensationalize things to prove a point. If your state really would pull your husband's license for treating a child, then there are serious problems. However, I doubt this is the case.

    Also, many family practice programs train their residents in some obstetrical surgery and other relatively simple procedures (ie. tonsillectomy). If a physician is qualified, they are certainly allowed to operate.
  7. by   Traveler
    This thread has been very interesting and full of many viewpoints. I am an RN with 10 years experience who is currently going back to school with the goal of MSN/FNP. I have worked in home health for the past 4 years, which is wonderful training for the role that I wish to assume once my education is complete. NP's are not MD's- nor would I want to be a MD. I prefer the nursing model of care. All disciplines bring something unique and increased knowledge in different areas for (hopefully) the benefit of the patient. For example, at my current hh position, I see tons and tons of wounds. The doctors in the area know that I am more familiar with the products and treatment of wounds than they are. They usually leave it up to us to do what we want to do with wounds. Nursing is more holisitc than medicine and they are very different in many ways. I don't know how it is in other areas- I am in the rural mountains of SE Tennessee. NP's are viewed with much esteem here. Doctors routinely work with NP's. I have a job waiting for me when I finish. Our family doctor is a great friend of mine and has been for years. She knows my background and knows that I can bring a different perspective and expertise to her practice. I will be making home visits- something I love doing and something she does not like and doesn't have time to do. NP's can have their own Medicare billing number and can also bill for care plan oversight for home health (nursing) patients. The way I see it, MD's are more likely to focus on a particular problem, and may have more knowledge about technical aspects of medicine. In contrast, NP's have been taught (thorugh the nursing model) to look at the entire patient and focus on how all things interact. To put it in very simplistic terms (and this is a broad generalization, so please don't take offense anyone), the MD tends to focus on the immediate need whereas the NP's focus is on the long haul. A good example is a patient of mine (as a HH RN) who is having chronic pain. MD put him on some extended release narcotics which has helped the pain a great deal. Yet, the MD did not even address the S/E r/t bowels for this patient. He was having quite a bit of trouble and didn't know what was wrong. I did some teaching about overall s/e, precautions to take, etc. and he is doing much better now. The MD focused on the pain only. As a NP, I would focus on lifestyle adjustments, s/e of the meds, etc. Does that make sense?
  8. by   acutecarenp
    Quote from kristinwiz
    You must realize that NPs and PAs function in essentially the same capacity. Except for the fact that PAs are trained similar to physicians in their model of medical education. They practice medicine, while NPs practice advanced nursing - not medicine. How can anyone who practices nursing, not medicine, have any claims to be comparable to a physician?
    So...NPs go to NP school...not medical school... and practice advanced nursing.... not medicine.

    PAs go to PA school ...not medical school...and practice What???? Assisting?

    When an NP and a PA order a forearm x-ray for a kid who just fell off of his bike, they both do it for the same reason....to see if anything is broken!...And so that the Doc in the main ED doesn't have to leave the bedside of the guy with the acute MI to whom he is giving thrombolytics.

    We are all very smart people and, some of us, very good writers!

    In my opinion, some of the energy spent on the "my daddy can beat up your daddy" dissertations should go in to more clearly defining our roles and lobbying for legislation which will, among other things, provide all mid-levels with appropriate compensation and universal acceptance for reimbursement by insurance payors.
    Last edit by acutecarenp on Feb 20, '05
  9. by   patnshan
    Quote from acutecarenp
    So...NPs go to NP school...not medical school... and practice advanced nursing.... not medicine.

    PAs go to PA school ...not medical school...and practice What???? Assisting?

    When an NP and a PA order a forearm x-ray for a kid who just fell off of his bike, they both do it for the same reason....to see if anything is broken!...And so that the Doc in the main ED doesn't have to leave the bedside of the guy with the acute MI to whom he is giving thrombolytics.

    We are all very smart people and, some of us, very good writers!

    In my opinion, some of the energy spent on the "my daddy can beat up your daddy" dissertations should go in to more clearly defining our roles and lobbying for legislation which will, among other things, provide all mid-levels with appropriate compensation and universal acceptance for reimbursement by insurance payors.
    Just to clarify, PA's do practice medicine. We are trained in medicine to practice medicine under the supervision of a physician.
    NP's practice medicine too, it is just that they are trained in nursing. NP's practice under the supervision of a physician too, they just call it collaboration.

    The job is really no different, just the type and level of training along with the politics. I have to hand it to nurses, they have some great politicians.

    Pat, RN, BSN, PA-C, MPAS
  10. by   CraigB-RN
    I've asked this questoin many times and no one has given me an answer. Not even a flame.

    Can someone give me SPECIFICS on the differenfce between the "medical model" vs the "Nursing Model" Even commin up on the end of 2 yeras of grad school, i havent' seen anything different than what my wife got at the end of 2 yeras of PA school. (ms level program).

    SO I figured I'd try one more time here. Be specifc. Not something generic and vague. What is the difference in practice? Personlly after 100ohrs of clniical. (i'm doing ACNP and FNP) I haven't seen anything different. The only difference is that some of my preceptors will help hte staff nurses do nurisng care. But only some of them. Most write the orders and walk on down the hall.
  11. by   patnshan
    Quote from CraigB-RN
    I've asked this questoin many times and no one has given me an answer. Not even a flame.

    Can someone give me SPECIFICS on the differenfce between the "medical model" vs the "Nursing Model" Even commin up on the end of 2 yeras of grad school, i havent' seen anything different than what my wife got at the end of 2 yeras of PA school. (ms level program).

    SO I figured I'd try one more time here. Be specifc. Not something generic and vague. What is the difference in practice? Personlly after 100ohrs of clniical. (i'm doing ACNP and FNP) I haven't seen anything different. The only difference is that some of my preceptors will help hte staff nurses do nurisng care. But only some of them. Most write the orders and walk on down the hall.
    As far as the "model" goes. I think the medical model focuses on diagnosing and treating disease. "Nursing" model focuses on "diagnosing" and treating symptoms related to the disease. After 4 yrs of nursing school, that's all I got that was worthwhile.

    As for the training. Didactic PA education includes things like gross anatomy with disection, neuroanatomy, as well as classroom instruction in most aspects of medicine and surgery by specialists in their field. Clinical rotations include 2000+ hours of full time clinical rotations. NP programs I am familiar with include part time, without summers, clinical rotations. About 400-500 hours from what I have seen.

    And no, being an RN for a couple years does not prepare you to medically diagnose and treat medical illness without adequate instruction. You need the training regardless of what your experience was.

    Pat
  12. by   CraigB-RN
    Still sounds like semantics to me. I know PA education very well, wathcing my wife go through it. I now know NP eduation very well from first hand experience.

    A patient with CP is laying on the stretcher in front of you. How would the Nursing Model treat the patient different from the Medical Model?
  13. by   patnshan
    Quote from CraigB-RN
    Still sounds like semantics to me. I know PA education very well, wathcing my wife go through it. I now know NP eduation very well from first hand experience.

    A patient with CP is laying on the stretcher in front of you. How would the Nursing Model treat the patient different from the Medical Model?
    NM- alteration is chest comfort related to lack of blood flow to the heart
    (or)
    alteration in mood related to feeling of impending doom

    MM- unstable angina (or) acute myocardial infarction

    Pat

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