MD, DO, NP, DC, OD -- Who deserves the title PCP? - page 6

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   zenman
    Quote from patnshan
    What I do stand-by, exactly as I said it earlier, is that nursing experience is NOT a substitute for learning how to be a midlevel medical provider. That is the beef I have. The training is too "thin" to adequately do this. NP's must "catch up" more than other disciplines because of this.
    Frankly you would have to be an idiot not to pick up "some learning" during years of nursing. My God, you know all your drugs, how to do procedures, the protocols for a number of conditions, how to interact with patients, etc, etc.. It's not a 'substitute" but it is some of the most valuable experience one could have.
  2. by   zenman
    Quote from patnshan
    And for Zenman's comment about PA's only being able to practice medicine. For your info, ALL of nursing is in the scope of practice of a physician. PA's can do ANYTHING that their supervising physician does. That includes start IV's, give injections, change dressings, teach patients, perform counseling, etc.
    So, don't flatter yourself with that, "Can only practice medicine" stuff. There is not much that this scope of practice does not cover.

    Pat
    Let me flatter you with my years of experience! I've taught many full blown MDs a lot of those procedures you mentioned...cause they didn't learn it in school or clinical rotations. Just a few out of hundreds of my real life experiences include the MD who said he had never drawn blood in his life; the resident during a code who had the face mask on upside down; wrong dosages, some of the worse aseptic techniques I've seen; pushing "dangerous drugs" rapidly because "No one ever told me how, etc, etc.." Granted, many MDs don't have to do a lot of the procedures that nursing does...guess there is a reason. I don't care whether one is a PA or NP student, any prior experience, including age is a benefit.
  3. by   FNP/DNP
    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.
    Why are you rambling on about cardiothoracic surgery or neurosurgery training? I'm not certain what that has to do with the original post. As a rural health nurse practitioner I understand what OP is saying. Many patients are assigned to my collaborating physician and yet have never in 4 years seen him- only me. He has to sign their paperwork without even knowing the patient. It doesn't make sense, and gives him more work that he doesn't need. What is it that you think nurse practitioners do all day in the office or hospital? Change bedpans? Give baths or pass meds? Are we specialists at this?
  4. by   patnshan
    Quote from zenman
    Frankly you would have to be an idiot not to pick up "some learning" during years of nursing. My God, you know all your drugs, how to do procedures, the protocols for a number of conditions, how to interact with patients, etc, etc.. It's not a 'substitute" but it is some of the most valuable experience one could have.
    I agree. I did not say it is not useful, I said it is not a substitute, and stand by that. That is why the "soft" instruction method of NP programs is still not enough.

    Pat
  5. by   patnshan
    Quote from zenman
    Let me flatter you with my years of experience! I've taught many full blown MDs a lot of those procedures you mentioned...cause they didn't learn it in school or clinical rotations. Just a few out of hundreds of my real life experiences include the MD who said he had never drawn blood in his life; the resident during a code who had the face mask on upside down; wrong dosages, some of the worse aseptic techniques I've seen; pushing "dangerous drugs" rapidly because "No one ever told me how, etc, etc.." Granted, many MDs don't have to do a lot of the procedures that nursing does...guess there is a reason. I don't care whether one is a PA or NP student, any prior experience, including age is a benefit.
    I'm not flattered, but as I said above, nursing experience is most certainly helpful. It is NOT a substitute for rigorous, medical education, which should be required prior to practicing medicine. NP's do not obtain this rigorous medical training, but still practice medicine upon graduation.

    Pat
  6. by   patnshan
    Quote from dorisemoore1
    Hey pat
    I agree with you the NP is a "softer" course compared to a PA course. I volunteer at a hosp in minneapolis and I brought this topic to them doing lunch. And the NP's agree about what you said. Both is great professions but one is just in-depth though medince than another. Nothing wrong with that in my book. I guess if people want more than they need to go to med school....just my thought on this topic

    wish every luck
    from the twin cities
    Thanks dorise,
    I truly believe most NP's do understand this.

    Everyday I hear from nurses that I work with something like this:

    "I'd really like to be a PA, but I don't have time to go full-time for three years. I think I'll just do the NP thing so I can stay working full-time here and go to school part-time. I can still get finished in two years."

    Pat
  7. by   cgfnp
    Quote from patnshan
    Thanks dorise,
    I truly believe most NP's do understand this.

    Everyday I hear from nurses that I work with something like this:

    "I'd really like to be a PA, but I don't have time to go full-time for three years. I think I'll just do the NP thing so I can stay working full-time here and go to school part-time. I can still get finished in two years."

    Pat
    Part time would take longer than 2 years, but it really doesn't matter. The education (at least where I went) sucks something fierce. I learned more by reading medical journals while the instructors were talking about the glory of Florence Nightengale.
  8. by   Traveler
    A while back in this thread there was discussion about how the nursing model of care differs (or doesn't depending upon one's view). I recently came across an article that I had copied. I don't have the full article or the author's name, but it came from the journal: Primary Health Care Research and Development 2004: 5: 351-358 and is titled: Nurses' role in advancing primary health care

    "For nurses, the client is always viewed within the context of family (e.g., culture, celiefs and values) and environment (e.g., housing employment, social support). Since nursing has biological, psychological and social health as an end in view, the outcomes of nursing practice reflect practitioners' contributions to promoting individual and family development during periods of transition or critis(nurtrative function). There should also be evidence that nursing has influenced changes in health state or behaviour (generative function), in a manner that safeguards respect for individuals and families, and promotes self-reliance (protective function). Nursing assessment is inherently focused on understanding the relationship between determinants of health and actual health status and nursing intervention is directed at helping individuals, families or communities develop strategies to achieve imporved health and well-being, in the spirit of self-reliance."

    Ann
  9. by   sbic56
    Quote from Traveler
    All right, I'll jump in here. I am an RN with ten years of expereince. My goal is to earn my MSN and FNP but it is slow going. I have been in home health for years and have been around many MD's, PAs and nurse practitioners. Here is my take. The nursing model of care promotes a more holistic model. There may not be much of a difference with the way the pt with CP is treated. However, where ongoing primary care is concerned- this is where I think the difference is seen. Because the nursing model of care promotes holistic thinking the np is going to be more likely to ask a broad range of questions related to the entire patient and not just the presenting problem. Will be more likely to counsel as far as nutrition, etc. If a patient with a wound on their foot comes into the office, I would think that the np would be more likely to look and teach about nutritional status as well as basic wound care. The np would be more likely to assess things like: what type of shoes is the patient wearing that may be counterproductive to the wound. This is why np's are such a good fit with primary care.
    I agree that NP's view the patient more holistically than do MD's. I thought it interesting that this definition of a DO, very much reflects the way NP's practice: "They view the patient as a 'total person" and focus on preventative care. They view the whole body rather than treat specific symptoms or illness." Working with Osteopaths for many years and seeing the difference between the way they practice compared to MD's, I find it rather amusing that in definition they more closely resemble APN's, despite their similar education to MD's. Makes me realize it really is more about politics than anything!
  10. by   glittergrl1998
    So I have been reading all this and I gotta say that this is crazy. Yeah, I am in Nursing school because I don't want to go to med school because of time restraints and such (by the way, which doesn't make me a bad person), but I will eventuall be a APN too. So here's what I think. After a certain period of time in a specialized practioner setting, not schooling, a APN should have the priveledges of a PA, not an MD! The PA is the closest,more respected with priveldges job in our discussion so far. By the time a FNP has got the same number of years under her or his belt as a PA, MD or Hell, even an Pharm D has to do their rotations and residency, then she or he should get the prescribing role and such- yeah a new group of letters will have to go at the end of the name for this to happen, but so what- a pin only costs a few bucks. This is my opinion, because you damn well, that we are equivalent in practice scope by that time. So I guess I partially agree with the whole "if you want to be a doctor , go to med school thing." If we all try to play doctor, that just gives them even more reason to thrust all that extra work upon us that they already do anyway. We just are legally protected right now to say "oh, no, that's your job" (or that is at least for the ones of us who ain't afraid to say so). The question here is does that APN want the title to look good in the work she does, or want that change so that they can do their job to their best ability by having more priveldges like prescribing without practing under a MD. But, let's be realistic, it's not gonna change. There is too much at stake for both boards, and advancement for nurses isn't the problem here. It seems to me that it is more about being called a doctor for the purpose of glory...I mean, as a NP you get to play doctor without as much legal problems, and you still get to have a family. Most NP's I know do their jobs as they see fit and prove themselves to their supervising MD enough, that the MD recognizes them as an equal who just got on the job training and not as much class time. God, ya'll are making way to much out of this.
  11. by   glittergrl1998
    Quote from glittergrl1998
    So I have been reading all this and I gotta say that this is crazy. Yeah, I am in Nursing school because I don't want to go to med school because of time restraints and such (by the way, which doesn't make me a bad person), but I will eventuall be a APN too. So here's what I think. After a certain period of time in a specialized practioner setting, not schooling, a APN should have the priveledges of a PA, not an MD! The PA is the closest,more respected with priveldges job in our discussion so far. By the time a FNP has got the same number of years under her or his belt as a PA, MD or Hell, even an Pharm D has to do their rotations and residency, then she or he should get the prescribing role and such- yeah a new group of letters will have to go at the end of the name for this to happen, but so what- a pin only costs a few bucks. This is my opinion, because you damn well, that we are equivalent in practice scope by that time. So I guess I partially agree with the whole "if you want to be a doctor , go to med school thing." If we all try to play doctor, that just gives them even more reason to thrust all that extra work upon us that they already do anyway. We just are legally protected right now to say "oh, no, that's your job" (or that is at least for the ones of us who ain't afraid to say so). The question here is does that APN want the title to look good in the work she does, or want that change so that they can do their job to their best ability by having more priveldges like prescribing without practing under a MD. But, let's be realistic, it's not gonna change. There is too much at stake for both boards, and advancement for nurses isn't the problem here. It seems to me that it is more about being called a doctor for the purpose of glory...I mean, as a NP you get to play doctor without as much legal problems, and you still get to have a family. Most NP's I know do their jobs as they see fit and prove themselves to their supervising MD enough, that the MD recognizes them as an equal who just got on the job training and not as much class time. God, ya'll are making way to much out of this.
    oh yeah and I don't know about where you are from, but a NP definitely gets way more credit for smarts than a DO does around here! That should say something for how it works in the professions.
  12. by   cgfnp
    Quote from glittergrl1998
    God, ya'll are making way to much out of this.
    Don't worry about all the computer crap. To make these forums fun you have to realize that everyone who posts regularly and is serious instead of using it for fun is only taking advantage of the depersonalization and perceived anomynity of it, so they're saying on here what they really wouldn't say in real life. Most are just spouting off to make themselves feel better for whatever they are. Just find it amuzing as I do and go about your day.

    If you get into this stuff seriously, it's only gonna piss you off because that's mostly what people who come to these things try to do. It could be a great source of networking and info, but for the most part, they're battlefields for pissing matches. Have fun!!!
  13. by   sbic56
    Quote from glittergrl1998
    oh yeah and I don't know about where you are from, but a NP definitely gets way more credit for smarts than a DO does around here! That should say something for how it works in the professions.
    Whaaaa?

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