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

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  1. by   Ellen NP
    The FNP is about the closest to a generalist for NP's. I'm not certain that we should move toward a combination acute care/primary care/1st assist model at a time that other professionas are moving away from that model. Acute care has become so specialized that we have hospitalist services to manage inpatient care. In my academic medical center, only a few patients are managed by their PCP's while care for the majority is by the hospitalist service. Our hospitalist service includes, MD/DO's, PharmD, NP's, PA's and a rapid response team(critical care RN and Resp therapist).
  2. by   juan de la cruz
    Quote from AbeFrohman
    Why doesn't nursing come up with a generalist NP is what I want to know? Why can't we have an NP that can do acute care, primary care, first assist for both children and adults? I'm not suggesting that we get rid of the specialty degrees, but why not have one that is a combination of them all? Then the doctorate could be in a 12-24 month (depending on specialty) residency experience in a specialty. So you have generalist MSN NP, and a DNP specialty. It's more school time/money but I sure as heck would've done it. Everyone is happy this way. You have your MSN specialist, your MSN generalist, and a real clinical doctorate in a specialty. if you have the MSN specialist degree you could complete the generalist degree (after a period of practicing in your specialty) and have your doctorate. All problems solved.

    I know it will never come about (not in my lifetime), but a boy can dream.

    During the early stage of the DNP discussions, I thought this was the actual direction nursing was going to take in introducing the practice doctorate. One of the weaknesses identified in the current Master's programs was the inconsistent hours and breadth of clinical rotations across the various programs. Initially, I thought the first two years of the BSN to DNP programs was going to be a generalist NP track and then the final or third year was going to be the specialization track. However, through years of opposing ideas from many groups of people who have a stake at the DNP, the current model have now emerged which essentially is no different than what we already have in the current Master's degree offerings in terms of clinical content.
  3. by   AbeFrohman
    Quote from Ellen NP
    The FNP is about the closest to a generalist for NP's. I'm not certain that we should move toward a combination acute care/primary care/1st assist model at a time that other professionas are moving away from that model. Acute care has become so specialized that we have hospitalist services to manage inpatient care. In my academic medical center, only a few patients are managed by their PCP's while care for the majority is by the hospitalist service. Our hospitalist service includes, MD/DO's, PharmD, NP's, PA's and a rapid response team(critical care RN and Resp therapist).
    I know fnp is the closest to the generalist model and itsnot close enough in my opinion.

    Who is moving away from this model? This is the model used by everyone except nursing. All other practitioners first have a generalist model and then specialty training if they desire. I'm not saying toss out the MSN NP specialties we have now, but have a true generalist for those that want it (and alot of people would go for this).

    I know acute care is specialized, that's why I included the idea of residency for the doctorate and have the MSN generalist have OTJ training in the specialty just like the MSN specialist except they would be able to switch specialties/treat all ages without having to go back for yet another certificate. RN is a generalist degree that can practice in all specialties, why don't we have an NP that could do the same?
  4. by   LisaDNP
    Should the PhD prepared nursed take an exam to prove him or herself? I took a certification exam and passed it. I'm not a physician. I'm a nurse practitioner. When I complete my DNP, I can be addressed as "Doctor" because of academic credentials alone, but not physician. A physician is a MD or DO.

    PS: A chiropractor can do pelvic exams?? I think NOT!
  5. by   Ellen NP
    I only said that acute care is more frequently being done by hospitalists rather than community physicians. At least in New England, Family practice docs are rarely doing OB these days. I'm sure that when you get away from major medical centers you'll still find the docs who do everything.

    I'd think that education of an NP generalist who could do acute and primary care and first assist would take as long as med school. I'm not against the concept, just am unsure re the demand for the role. That said, our hospitalist service employs a large number of NP's, most of whom trained as FNP's. They are certainly doing acute care, could do primary care, too if they wanted to. They didn't go back to school for additional education, aren't certified ACNP's. All of them had acute/critical care experience as RN's before their FNP programs.
  6. by   Ellen NP
    By the way, I do like the idea of a CLINICAL doctorate which would be additional education in the specialty area...much more sensible than this practice doctorate.
  7. by   viral2010
    There is absolutely ZERO reason for us, as NPs, to have people address us as "Dr" in the clinical setting. This has been talked about ad nauseum on this forum. No body owns a title but the use of it in certain situations is inappropriate. As many on here have said before, go to medical school if you want to be called Dr.
  8. by   wowza
    Quote from AbeFrohman
    Who is moving away from this model? This is the model used by everyone except nursing. All other practitioners first have a generalist model and then specialty training if they desire. I'm not saying toss out the MSN NP specialties we have now, but have a true generalist for those that want it (and alot of people would go for this).

    I know acute care is specialized, that's why I included the idea of residency for the doctorate and have the MSN generalist have OTJ training in the specialty just like the MSN specialist except they would be able to switch specialties/treat all ages without having to go back for yet another certificate. RN is a generalist degree that can practice in all specialties, why don't we have an NP that could do the same?
    The way I look at it, the NP is a shortcut degree (I am not trying to be nasty). It was made so that nurses could treat the easier cases that did not require a physician and could extend the reach of physicians. So instead of a strong foundation in basic sciences, then years of rotations and then even more years of residency and then more years of fellowship, an NP gets a specialized education. Why not just go to med school then?

    In a time when we need more providers, making it longer to be an NP (especially without adding more clinical competence) is obsurd.
  9. by   Ellen NP
    The NP is a license, the MSN is the degree and is no shortcut. Yes, the NP role was created to provide more clinicians to the public, particularly to meet primary care needs. Most NP's these days do have a good education in basic sciences in undergrad programs, supplemented in their graduate programs.

    I agree that making NP programs longer will not help the public. Not everyone can afford the time and expense of a doctoral level NP program after BSN training. Not everyone wants to be an organizational leader on the forefront of health care reform. Some of us LIKE providing care to the public. I see no value added to the clinical role by the current DNP curricula.

    I do think that some people will chose medical school over the combination of undergrad and graduate training for the proposed DNP track to the NP role. More physicians..good; fewer nurses...not good. Nursing education (both undergrad and grad)does, in my opinion, better prepare us as patient/family teachers than does current medical education.

    We should value both the NP and physician roles rather than trying to compete. We provide different levels of care. We should be trying to provide the best quality care that we can given our different traing and roles.
  10. by   AbeFrohman
    Quote from wowza
    The way I look at it, the NP is a shortcut degree (I am not trying to be nasty). It was made so that nurses could treat the easier cases that did not require a physician and could extend the reach of physicians. So instead of a strong foundation in basic sciences, then years of rotations and then even more years of residency and then more years of fellowship, an NP gets a specialized education. Why not just go to med school then?

    In a time when we need more providers, making it longer to be an NP (especially without adding more clinical competence) is obsurd.
    Yes, you are trying to be "nasty," or you would have stated you comments in such a way as to not seem nasty. I'm not talking about getting rid of the MSN tracks we have now. I'm talking about adding another generalist for those who desire it. It would still be less time than MD. Make it 3 years for the generalist MSN NP (1 year didatics, 2 year clinicals) then you can practice or do a 12-24 month (depending on specialty) for a residency completing the doctorate. Shortage is still relieved, students are given another option, competence IS added, and all are happy. There is no problem with this plan except there might not be student demand for it, but only the students can decide that. I know I would do it and I know many others would as well.
    Last edit by AbeFrohman on Aug 6, '10
  11. by   Brainiacster
    Quote from elkpark
    That is still a proposal, not a requirement. The only advanced practice group that has actually embraced the mandatory-DNP idea is the CRNAs, and I believe their target date is 2025 (and it remains to be seen whether that will actually happen).
    It's no surprise CRNA's want to upgrade their titles. However, the level of ed/training doesn't compare with that of an MD. BTW, it seems a lot of anesthesiologists are running skin clinics these days. Apparently, they got a little too rambunctious hiring CRNA's. I would suggest other MD's be a little more careful re hiring NP's lest they suffer the fate of anesthesiologists. It may be more lucrative in the short term, but it'll come back to bite you in the proverbial ass. Obamacare will, of course, accelerate that. BTW, since when does a DO even begin to compare to an MD education regarding *quality* of education, residency, and, if applicable, fellowship? DO's, of course, will argue the point. If only I had a penny for every time I've heard, "We do the same residencies." For the most part, DO's certainly don't get the cream of the crop residencies. It's also interesting how DO's downplay the chiropractic aspect of their "specialties." It seems a certain sector created the title DO to accommodate those who didn't quite qualify for acceptance into an MD program. In my book, the only people who deserve the title of "Doctor" are DVM's & MD's. Probably moot with Democrats running the show now. Get ready for Euro style medicine.
  12. by   zenman
    I'm still trying to figure out how the DNP is a doctoral program since it looks like master's level business courses have been added. When I get time I might apply to a DNP program and see just how much credit I get for my MBA and capstone project!
  13. by   Ranier
    Quote from Brainiacster
    It's no surprise CRNA's want to upgrade their titles. However, the level of ed/training doesn't compare with that of an MD. BTW, it seems a lot of anesthesiologists are running skin clinics these days. Apparently, they got a little too rambunctious hiring CRNA's. I would suggest other MD's be a little more careful re hiring NP's lest they suffer the fate of anesthesiologists. It may be more lucrative in the short term, but it'll come back to bite you in the proverbial ass. Obamacare will, of course, accelerate that. BTW, since when does a DO even begin to compare to an MD education regarding *quality* of education, residency, and, if applicable, fellowship? DO's, of course, will argue the point. If only I had a penny for every time I've heard, "We do the same residencies." For the most part, DO's certainly don't get the cream of the crop residencies. It's also interesting how DO's downplay the chiropractic aspect of their "specialties." It seems a certain sector created the title DO to accommodate those who didn't quite qualify for acceptance into an MD program. In my book, the only people who deserve the title of "Doctor" are DVM's & MD's. Probably moot with Democrats running the show now. Get ready for Euro style medicine.
    Wow, as the spouse of an osteopathic family practitioner, let me just correct you on a few points: to imply that a D.O. program "doesn't even begin to compare" to M.D. education is absolutely ludricous. You are correct in stating that there are slightly lower admission standards in D.O. programs (just as there are lower admission standards for public state university allopathic schools in comparison to Ivy League allopathic schools), although the gap in GPA/MCAT has been narrowing considerably every year for the past decade and at this point there are several top osteopathic schools with average MCAT scores higher than some of the "lowest" LCME allopathic schools- look it up.

    However, once through the med school admissions bottleneck, the education of osteopathic and allopathic medical students today is indistinguishable with the exception of the addition of OMM instruction in the D.O. programs. Please, I challenge you to name one core piece of the M.D. curriculum that is not covered in osteopathic schools. Hint- you can't. More than 50% of osteopathic students sit for both their own licensing exam (the COMLEX) as well as the allopathic exam (USMLE) and as of two or three years ago the majority of graduating D.O.'s do in fact train in ACGME residencies which means that, yes, they do in fact complete the "same" residency. Many more are training in AOA residency positions that are actually part of a dually accredited AOA/ACGME program.

    When you say that D.O.'s don't get "cream of the crop" residencies what you really mean is that they don't land the most competitive residencies in lucrative specialties like derm and ortho. More D.O.'s do go into primary care which is reflective of the missions of most D.O. schools, however the fact that family practice or pediatrics are less competitive specialties to enter does not mean that the residencies themselves are of inferior quality. In reality all that reflects, is that peds doesn't pay as much as derm, plain and simple.

    Finally as for this statement:"It seems a certain sector created the title DO to accommodate those who didn't quite qualify for acceptance into an MD program."... you do realize that the osteopathic profession and many of its schools were established way back in the 1800's right? Which makes your claim laughable. In fact, it sounds like what you are describing is actually the glut of offshore (Caribbean) medical schools that began opening in the 1970's/1980's on... schools with indisputably looser admission standards and poorer residency placement track records but schools which award upon their graduates the degree M.D., ironically making them "real"-er doctors in your book than American-educated D.O.'s. Ridiculous.

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