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

ep71 · May 6, 2004

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 - diabetes, thrombosis, heart disease, infection, emphysema, hep c, hiv, etc, to rendering prenatal care, and preventative care - we are primary care providers. we make life and death decisions each day with our patients in managing disease - thrombosis management and prevention; hep c management; hiv management, heart disease and cva management; women's health - yet we are given less legitimacy in the social security act and cms section 410.20 than a chiropractor or optometrist.
i have nothing against chiropractic physicians mind you, but take a look at chiropractic.
cannot prescribe - not even an aspirin
procedures? - scant more than "moist heat";
assessment - can't even look into your ear according to their scope of practice
educational requirements? - a bachelors degree?, nope - about a year and a half of college study (90 credits), a 2.5 gpa, and 3 yrs of study at a chiropractic school.
how do chiropractors see themselves? go to http://schools.naturalhealers.com/lifewest/
chiropractic is a total-body healthcare system, and not a method of pain management. as a gatekeeper for direct access to the health delivery system, the responsibilities of the doctor of chiropractic as a primary care clinician include wellness promotion, health assessment, diagnosis, and the chiropractic management of the patient's health care needs. when indicated, the doctor of chiropractic may also co-manage, consult with, or refer to other health care providers
optometry - about the same. 65 college credit hours (a year and change), 2.5 gpa, a 4 yr program. -- then - slit lamp, snellen, better or worse, eyeglasses or contacts? see you in two years.
that's all fine. but, here's the rub. the chiropractor and optometrist - according to section 1861®(1) of the ssa,and cms sec. 410.20 -- are designated a physician with all of the privileges and honors of that professional designation.
the apn? nope. even though our scope of practice is much, much broader; our responsibility and liability - far greater. yet we are still treated as hand-maids, and put in our place as second class providers - the extenders, the mid-levels. none of us treat mid-way; perform half of a procedure; help the patient heal only half the way through a disease.
does any other primary care provider treat heart disease more or differently than you as a provider treat heart disease? does the physician carry more responsibility or liability? no. a pcp is a pcp. and god bless all of us, md, do, apn.
there is no comparison.the nurse practitioner's contribution to the health of our nation is every bit as important as the md, or do, and far above that of the dc or od. in the clinic we shoulder the responsibilities and liabilities - every one of our actions or inactions as a provider -- every moment we spend with a patient is legally ours to bear alone....
yet how many times have you been told - sorry, we need a physicians signature on that... you can't order that - it has to be ordered by a physician. we can't send that to you - we have to send it to the physician. sorry, we only credential physicians.
am i the only apn that feels a little bewildered and disgusted by this?
i have no innate yearning or desire to be called a physician mind you, its not an ego thing. but what i do have is a desire for, is to be respected for my role as a primary care provider by hospitals, insurers, labs, etc, so that i can do my job.
why i'm writing this.
as health care and our roles evolve, i believe that it is our responsibility to lobby for the advancement of our professional role, and with that updates to the ssa and cms sec. 410.20, two of the main documents that define the apn to other professionals. this is critical so that other professionals will not be confused about our role, our education, our abilities, and our responsibilities to our patients.
we regularly talk about fighting battles in my home state of tennessee, but are we only treating the symptoms of our professional legislative, political, and administrative woes? - shouldn't we also be addressing the root problems from which most of these arise - such as our absence from ssa 1861®(1)and cms sec. 410.20.
it may be time for each individual apn to write, call, or otherwise encourage other apn's as well as our advocates at ana, and our legislators to argue in favor of apn pcp's inclusion in cms sec. 410.20 and ssa 1861®(1).
because as the role of the nurse practitioner continues to evolve in response to changing societal and health care needs, so should the ssa and other government acts that define us to the nation.
social security act 1861
http://www.ssa.gov/op_home/ssact/title18/1861.htm
so. if you agree, take a moment and write someone. don't sit back and do nothing. :rotfl:change happens because of you. :) write a short note to your local chapter of ana, the national ana, george bush, your senators and your representatives and voice your desire for an updated cms sec. 410.20 and ssa 1861®(1) to help apn's across the nation do their job. thanks gang. http://www.firstgov.gov/contact/elected.shtml
respectfully,
r. martin
family nurse practitioner, chief manager and primary care provider
campbell station primary care associates
11541 kingston pike, ste 101
knoxville, tn 37922

edited by moderator

ep71 · May 6, 2004

i just fully read your post and i have to say you're way out of line. if you want all of the privileges of a dr., become one. i do understand your desire to be respected for being a competent professional but you chose the role you decided to lead and that's just the way things are. you're not a dr., and you shouldn't have the full privileges of one. no offense to the nurse practitioner profession but to give a nurse practitioner the same privileges as a pediatric neurosurgeon is simply absurd. that's basically what you're asking for. i understand that you want to have more responsibility as a primary care provider but the privileges that you're asking for extend much farther than those of your current profession. you're asking to be put on the same playing field as a cardiologist, internist, pediatric oncologist, cardiothoracic surgeon and all of the other medical specialist that perform the duties that you are requesting. it's simply out of the question.

ep71 · May 6, 2004

optometry - about the same. 65 college credit hours (a year and change), 2.5 gpa, a 4 yr program. -- then - slit lamp, snellen, better or worse, eyeglasses or contacts? see you in two years.
that's all fine. but, here's the rub. the chiropractor and optometrist - according to section 1861®(1) of the ssa,and cms sec. 410.20 -- are designated a physician with all of the privileges and honors of that professional designation.
the apn? nope. even though our scope of practice is much, much broader; our responsibility and liability - far greater. yet we are still treated as hand-maids, and put in our place as second class providers - the extenders, the mid-levels. none of us treat mid-way; perform half of a procedure; help the patient heal only half the way through a disease.
does any other primary care provider treat heart disease more or differently than you as a provider treat heart disease? does the physician carry more responsibility or liability? no. a pcp is a pcp. and god bless all of us, md, do, apn.
there is no comparison.the nurse practitioner's contribution to the health of our nation is every bit as important as the md, or do, and far above that of the dc or od. in the clinic we shoulder the responsibilities and liabilities - every one of our actions or inactions as a provider -- every moment we spend with a patient is legally ours to bear alone....
knoxville, tn 37922

to say that you play a more important role in medicine than an optometrist and chiropractor is simply outrageous. i am not fully aware of the duties of a chiropractor however, i am little familiar with the profession of optometry. optometrist diagnose and treat diseases of the eye. they are indeed true professionals in every sense of the word. they have every privilege of an ophthalmologist except that they don't perform surgery. they are indeed physicians in every since of the word. unlike np's, they are drs., they do diagnose and treat all diseases of the eye, and they do practice without the supervision of an m.d. even while working in an m.d. office, they still practice completely alone and need neither a signature nor approval of an m.d. to diagnose a disease or prescribe medication. 60 hrs is two years and change not one. the majority of optometry schools wont accept you unless you have a bs/ba. same as md/do, you only have to have 90 credit hours, but the majority wont accept you unless you have a bs/ba. optometrist also have to take medical school prerequisites.(chemistry, organic chemistry, physics, biology, calculus, biochemistry) it generally takes 8 years to be an optometrist.and 2.5 is the basic minimum gpa, medical school has the same gpa requirement (2.5). that doesn't mean that they will accept you. to say that you have more responsibility than an optometrist is outrageously absurd.

chris_at_lucas_RN, RN · May 6, 2004

RMARTINNC, All that energy for topics and issues the writer is (by own admission) only slightly aware? Puh-lease!

OP, I'm with you. I recently changed from my MD (who was and is excellent) to the CNP who works in his office--and I see a world of difference. The personal caring element is there. The holism is there. I believe this is the difference between good care and excellent care. She has been more "up" on health issues that I'm interested in, more aware and insightful. But when I am referred for a consult, or my labwork gets sent out, or I make my selection on my insurance, who is the PCP? Who signs the scrips she writes (apparently trusting her judgment implicitly--as do I)? The MD I never see.

If I have brain cancer, I certainly want a neurosurgeon, and an APN is just not going to do the trick. But the vast majority of health care provided in this country is minor in comparison, and over priced.

But it's a matter of politics. To me, it often boils down to the question of which professions are traditionally male and which are traditionally female, and who has the bucks (and therefore the political voice) and who doesn't (same thing as the gender difference, maybe).

I don't think it's hopeless, and I do think grassroots activism can make a difference, but the best change is probably slow change, even when we know we are right. Arguments like ep71's won't survive a close inspection but the realities of health care in the 21st century--how long can we afford to support the life styles of the upper echelons?--will eventually force a change.

Thanks for your post.

zacarias, ASN, RN · May 6, 2004

no offense to the nurse practitioner profession but to give a nurse practitioner the same privileges as a pediatric neurosurgeon is simply absurd.

ep,

just to clarify, the op never mentioned wanting to have the same privileges as a pediatric neurosurgeon. he/she was talking about wanting more recognition as primary care provider.

ep71 · May 6, 2004

EP,
Just to clarify, the OP never mentioned wanting to have the same privileges as a pediatric neurosurgeon. He/she was talking about wanting more recognition as primary care provider.

You are not grasping the point that I was attempting to make nor are you fully understanding what the OP desires. The OP wants to have more privileges in his/her field of profession. The privileges that s/he wants are only allowed to Medical Doctors(Cardiologist Neurologists etc..) The privileges that she wants ARE indeed that of a pediatric neurosurgeon. Although she isn't likely to be doing pediatric neurosurgery, she's lobbying for the privileges of one. She's lobbying for the privileges of an M.D. Not just a Pediatric Neurosurgeon, but all M.D.'s. If you give a NP the same power as a Primary Care Provider(M.D.), you're giving him the same power as a Cardiothoracic Surgeon. If you want the privileges, go to Medical School.

lalaxton · May 6, 2004

to say that you play a more important role in medicine than an optometrist and chiropractor is simply outrageous. i am not fully aware of the duties of a chiropractor however, i am little familiar with the profession of optometry. optometrist diagnose and treat diseases of the eye. they are indeed true professionals in every sense of the word. they have every privilege of an ophthalmologist except that they don't perform surgery. they are indeed physicians in every since of the word. unlike np's, they are drs., they do diagnose and treat all diseases of the eye, and they do practice without the supervision of an m.d. even while working in an m.d. office, they still practice completely alone and need neither a signature nor approval of an m.d. to diagnose a disease or prescribe medication. 60 hrs is two years and change not one. the majority of optometry schools wont accept you unless you have a bs/ba. same as md/do, you only have to have 90 credit hours, but the majority wont accept you unless you have a bs/ba. optometrist also have to take medical school prerequisites.(chemistry, organic chemistry, physics, biology, calculus, biochemistry) it generally takes 8 years to be an optometrist.and 2.5 is the basic minimum gpa, medical school has the same gpa requirement (2.5). that doesn't mean that they will accept you. to say that you have more responsibility than an optometrist is outrageously absurd.

ep71,

sounds like you don't really understand what nurse practitioners do and how they practice. just as a pediatric neurosurgeon and a family practice doc have the same basic training and have the the same basic 'priviledges' i doubt you would find a fp doc doing neurosurgery. nurse practitioners are indeed professionals who, in some states, can diagnose, oder tests and prescribe a full range of medications completely independently. in this regard they do practice similarly to a physician. just as optometrists have expertise in a certain area so do np's. most np's don't want to be md's. they just want to be recognized for their areas of expertise and treated as such. i truly believe that physicians have to start realizing that they are not the only ones who can deliver quality patient care.

ep71 · May 6, 2004

EP71,
Sounds like you don't really understand what Nurse Practitioners do and how they practice. Just as a Pediatric Neurosurgeon and a Family Practice doc have the same basic training and have the the same basic 'priviledges' I doubt you would find a FP doc doing Neurosurgery. Nurse Practitioners are indeed professionals who, in some states, can diagnose, oder tests and prescribe a full range of medications completely independently. In this regard they do practice similarly to a physician. Just as Optometrists have expertise in a certain area so do NP's. Most NP's don't want to be MD's. They just want to be recognized for their areas of expertise and treated as such. I truly believe that physicians have to start realizing that they are not the only ones who can deliver quality patient care.

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.

ayndim · May 6, 2004

to say that you play a more important role in medicine than an optometrist and chiropractor is simply outrageous. i am not fully aware of the duties of a chiropractor however, i am little familiar with the profession of optometry. optometrist diagnose and treat diseases of the eye. they are indeed true professionals in every sense of the word. they have every privilege of an ophthalmologist except that they don't perform surgery. they are indeed physicians in every since of the word. unlike np's, they are drs., they do diagnose and treat all diseases of the eye, and they do practice without the supervision of an m.d. even while working in an m.d. office, they still practice completely alone and need neither a signature nor approval of an m.d. to diagnose a disease or prescribe medication. 60 hrs is two years and change not one. the majority of optometry schools wont accept you unless you have a bs/ba. same as md/do, you only have to have 90 credit hours, but the majority wont accept you unless you have a bs/ba. optometrist also have to take medical school prerequisites.(chemistry, organic chemistry, physics, biology, calculus, biochemistry) it generally takes 8 years to be an optometrist.and 2.5 is the basic minimum gpa, medical school has the same gpa requirement (2.5). that doesn't mean that they will accept you. to say that you have more responsibility than an optometrist is outrageously absurd.

actually a np has more responsibilities than a chiropractor or an optometrist. i think you need to do a little more research. only an opthomologist (sp?) can diagnose and treat eye diseases in most states. in some states optometrists have limited rights to treat eye diseases. i don't know any optometrist that can prescribe meds, nor any chiropractor. a english professor with a phd is also a dr but would you want them to treat your illness or to have privelages of a md. a optometrist is not a md and is no where close to being one. on the other hand np's are skilled medical professionals. i see a np and she can do most things, prescribe meds and order the same tests as a pcp can. when my infant was ill and in the er he saw a np. don't kid yourself, chiropractors or optometrists are nowhere near an md or a np. :angryfire

np's have a bsn followed by a msn. that is a minimum of six years of education. plus, they have to have at least one years experience in nursing. and most schools want more than that. i am beyond anger and am sitting here in disbelief that someone actually thinks a chiropractor or optometrist is closer to a md and better qualified than a np. grrrrrr :rolleyes:

ophthalmologists, optometrists and opticians all provide eye care services. it is important to understand what each of the "three os" is qualified to do.

ophthalmologists

an ophthalmologist is a physician (doctor of medicine, m.d., or doctor of osteopathy, d.o.) who specializes in the medical and surgical care of the eyes and visual system and in the prevention of eye disease and injury. an ophthalmologist has completed four or more years of college premedical education, four or more years of medical school, one year of internship and three or more years of specialized medical and surgical and refractive training and experience in eye care. an ophthalmologist is a specialist who is qualified by lengthy medical education, training and experience to diagnose, treat and manage all eye and visual systems and is licensed by a state regulatory board to practice medicine and surgery. an ophthalmologist is a medically trained specialist who can deliver total eye care: primary, secondary and tertiary (i.e., vision services, contact lenses, eye examinations, medical eye care and surgical eye care), diagnose general diseases of the body and treat ocular manifestations of systemic diseases.

optometrists

an optometrist is a health service provider who is involved exclusively with vision problems. optometrists are specifically educated and trained by an accredited optometry college in a four year course, but have not attended medical school. they are state licensed to examine the eyes and to determine the presence of vision problems. optometrists determine visual acuity and prescribe spectacles, contact lenses and eye exercises. optometrists may perform all services listed under the definition of an optician. some states permit optometrists to give limited treatments of some eye conditions.

opticians

an optician is a technician who makes, verifies and delivers lenses, frames and other specially fabricated optical devices and/or contact lenses upon prescription to the intended wearer. the opticians' functions include prescription analysis and interpretation; determination of the lens forms best suited to the wearer's needs; the preparation and delivery of work orders for the grinding of lenses and the fabrication of eye wear, the verification of the finished ophthalmic products; and the adjustment, replacement, repair and reproduction of previously prepared ophthalmic lenses, frames and other specially fabricated ophthalmic devices.

(http://www.bartmd.com/opthamologist.htm)

ep71 · May 6, 2004

Actually a NP has more responsibilities than a chiropractor or an optometrist. I think you need to do a little more research. Only an opthomologist (sp?) can diagnose and treat eye diseases in most states. In some states optometrists have LIMITED rights to treat eye diseases. I don't know any optometrist that can prescribe meds, nor any chiropractor. A english professor with a PhD is also a dr but would you want them to treat your illness or to have privelages of a MD. A optometrist is not a MD and is NO WHERE CLOSE to being one. On the other hand NP's are skilled medical professionals. I see a NP and she can do most things, prescribe meds and order the same tests as a PCP can. When my infant was ill and in the ER he saw a NP. Don't kid yourself, chiropractors or optometrists are nowhere near an MD or a NP. :angryfire
NP's have a BSN followed by a MSN. That is a minimum of six years of education. Plus, they have to have at least one years experience in nursing. And most schools want more than that. I am beyond anger and am sitting here in disbelief that someone actually thinks a chiropractor or optometrist is closer to a MD and better qualified than a NP. GRRRRRR
Ophthalmologists, optometrists and opticians all provide eye care services. It is important to understand what each of the "three Os" is qualified to do.
Ophthalmologists
An ophthalmologist is a physician (doctor of medicine, M.D., or doctor of osteopathy, D.O.) who specializes in the medical and surgical care of the eyes and visual system and in the prevention of eye disease and injury. An ophthalmologist has completed four or more years of college premedical education, four or more years of medical school, one year of internship and three or more years of specialized medical and surgical and refractive training and experience in eye care. An ophthalmologist is a specialist who is qualified by lengthy medical education, training and experience to diagnose, treat and manage all eye and visual systems and is licensed by a state regulatory board to practice medicine and surgery. An ophthalmologist is a medically trained specialist who can deliver total eye care: primary, secondary and tertiary (i.e., vision services, contact lenses, eye examinations, medical eye care and surgical eye care), diagnose general diseases of the body and treat ocular manifestations of systemic diseases.
Optometrists
An optometrist is a health service provider who is involved exclusively with vision problems. Optometrists are specifically educated and trained by an accredited optometry college in a four year course, but have not attended medical school. They are state licensed to examine the eyes and to determine the presence of vision problems. Optometrists determine visual acuity and prescribe spectacles, contact lenses and eye exercises. Optometrists may perform all services listed under the definition of an optician. Some states permit optometrists to give limited treatments of some eye conditions.
Opticians
An optician is a technician who makes, verifies and delivers lenses, frames and other specially fabricated optical devices and/or contact lenses upon prescription to the intended wearer. The opticians' functions include prescription analysis and interpretation; determination of the lens forms best suited to the wearer's needs; the preparation and delivery of work orders for the grinding of lenses and the fabrication of eye wear, the verification of the finished ophthalmic products; and the adjustment, replacement, repair and reproduction of previously prepared ophthalmic lenses, frames and other specially fabricated ophthalmic devices.
(http://www.bartmd.com/opthamologist.htm)

What does that have to do with anything. I know what optometrists ophthalmologists and opticians are and do. Optometrists diagnose diseases of the eye. they treat diagnosed diseases of the eye. It only takes two years to be an Optician. it takes 8 yrs to be an optometrist. They are indeed Primary Care Physicians. I understand that NP's diagnose some illnesses and treat some diseases. but they are still nurses. I'm aware that optometrist don't attend medical school but they are Primary Care Physicians. You obviously don't know what an Optometrist actually does. An optician prescribes glasses, an Optometrist DIAGNOSES AND TREATS DISEASES of the eye. An Ophthalmologist performs surgery of the eye. What you see in wal-mart is not a true reflection of an Optometrist. They are indeed Physicians in every sense of the word. You can't just go to school for two years and go to Optometry School. You have to have a BS/BA degree. You have to take Medical School prerequisites. You have to be extremely competitive.

AnnaN5 · May 6, 2004

I just wanted to comment on some of the original statements made about optometry. Here in Michigan, in order to get into optometry school you have to have a BS/BA and a very high gpa. A friend of mine just got into optometry school and it was a very hard process to go through.