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

  1. 1
    our professional scope of practice asserts that our role is to assess, diagnose, and treat in health and illness.

    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(r)(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(r)(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(r)(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. 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(r)(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
    Sillysally514 likes this.
  2. Get our hottest nursing topics delivered to your inbox.

  3. 29,440 Visits
    Find Similar Topics
  4. 62 Comments so far...

  5. 1
    RMartin:

    Thank you for posting. I agree, it is imperitive to participate writing to our government officials to get the recognition deserved by the APN.

    As I started writing the note myself, I realized how complex the letter could be to write for those less impassioned as yourself. It is important we use our own wording, of course. Would you mind writing a sample of what you might write to your representative? I am sure, as I said, your passion is far greater on this matter as you are literally "in the trenches".

    Again, thank you very much for bringing this matter to our attention.

    Respectfully,

    night
    CuriousMe likes this.
  6. 0
    As I have held many times, complete professional acknowledgment and respect will only come through autonomy. Chiropractors and optometrists are seen through the eyes of the public as professionals (and therefore get the due recognition and respect) because the are autonomous. On the other hand, teachers are at best see as only semi-professionals. They are unionized like blue collar workers and work as employee rather than work as autonomous white collar professionals. There is really only two paths - non-professional blue collar or atonomous white collar - and only one path to full recognition as a professional.
  7. 0
    Quote from WyomingRN
    As I have held many times, complete professional acknowledgment and respect will only come through autonomy. Chiropractors and optometrists are seen through the eyes of the public as professionals (and therefore get the due recognition and respect) because the are autonomous. On the other hand, teachers are at best see as only semi-professionals. They are unionized like blue collar workers and work as employee rather than work as autonomous white collar professionals. There is really only two paths - non-professional blue collar or atonomous white collar - and only one path to full recognition as a professional.
    I'd like to know what studies confirm this suggestion of causality. I could just as easily say that the reason that both of these professions (nursing, teaching) have less "recognition" is that they are female dominated and we live in a chauvenist society. Furthermore, advanced practice nurses could easily obtain professional autonomy from physicians while using the proven effective tactics of collective bargaining. In the end, the problem is simply turf related. Optometrists and chiropractors don't really threaten the pt base of doctors like autonomous AP nurses would. The physicians therefore use their abundant influence with legislators everywhere to limit the autonomy of nurses. Remember the vile history of the AMA? They even fought against the early professionalization of bedside nurses.
  8. 0
    Here is a sample of the note I sent. RNMartin, has listed the email links to send the info to. Here tis':

    Dear Representative:
    I am writing this email to draw to your attention the need to updated CMS Sec. 410.20 and SSA 1861(r)(1) to help Advanced Nurse Practitioner (APN) across the nation do their job. We need to recognize the APN as literally as we do Doctors, Chiropractors, and Optometrists.

    Everyday, the Advanced Nurse Practitioner makes full healthcare decisions; pays for liability coverage just like a physician, chiropractor, or optometrist. Please allow us the same dignity as these other professionals and include us in the rank of CMS Sec. 410.20 and SSA 1861(r)(1).

    Respectfully,
  9. 0
    Quote from WyomingRN
    As I have held many times, complete professional acknowledgment and respect will only come through autonomy. Chiropractors and optometrists are seen through the eyes of the public as professionals (and therefore get the due recognition and respect) because the are autonomous. On the other hand, teachers are at best see as only semi-professionals. They are unionized like blue collar workers and work as employee rather than work as autonomous white collar professionals. There is really only two paths - non-professional blue collar or atonomous white collar - and only one path to full recognition as a professional.
    The only true path to autonomy and empowerment (for me) is independence. Remember who is on the decision making board when you try to subcontract as a Vendor to a hospital. Is the facility interested in cutting out the middle man? I have seen they are not when at the risk of givng a nurse equal ground to contracted physician's.

    I have done better to get the desired better rate by working through an agency that has a contract in place or can negotiate for you. Also, larger facilites and those in greatest need do indeed work with independent contractors (nurses) directly; the later is tough to find but not impossible.

    ------ I didn't mean to get off the track and focus of the post. I did want to talk about this here so I could empahsize how it all ties in, to me, to the big picture of empowerment.

    night
  10. 1
    Quote from RMARTINNC

    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(r)(1) of the SSA,and CMS Sec. 410.20 -- are designated a physician with all of the privileges and honors of that professional designation.
    2.5 gpa, 65 college credit hours? Those are the bare minimum requirements any prospective optometry student need to even be considered for admission. The average gpa to get into optometry school is a 3.3 (same gpa to get into DO school) with a 330 out of 400 on their entrance exam (almost the same test pre-dental students take). Nearly 90% of all optometry students have a 4 year degree or higher. You are looking at 8 years of college to become an optometrist.

    I don't think you should downplay any profession's educational requirements. The title physician is granted so managed care plans would reimburse optometrists for their services. To me...the only real physicians are MD/DO/DPM.
    Last edit by mav80 on Nov 7, '05
    HeartsOpenWide likes this.
  11. 0
    Quote from nightngale1998
    Here is a sample of the note I sent. RNMartin, has listed the email links to send the info to. Here tis':

    Dear Representative:
    I am writing this email to draw to your attention the need to updated CMS Sec. 410.20 and SSA 1861(r)(1) to help Advanced Nurse Practitioner (APN) across the nation do their job. We need to recognize the APN as literally as we do Doctors, Chiropractors, and Optometrists.

    Everyday, the Advanced Nurse Practitioner makes full healthcare decisions; pays for liability coverage just like a physician, chiropractor, or optometrist. Please allow us the same dignity as these other professionals and include us in the rank of CMS Sec. 410.20 and SSA 1861(r)(1).

    Respectfully,
    Beautiful!
  12. 0
    Hi,

    I don't think chiropractors and optometris are considered physicians. When they graduate from school, they are awarded a doctorate in their field and are then called Dr. so & so but they are not MD's in any sense of the word.

    In my opinion, the only person who deserves to be called a physician is the person who went to medical school, & from the list above, that would be the DO and MD.
  13. 0
    I had a chance to view the language at the Social Security site. It is true, the APN is viewed as a professional working in collaboration with the physician. Social Security do view the Optometrist, Chriopractor as a physician. The reason; they all carry the title doctor, nurses do not carry the title doctor. This is one reason why AACN is pushing for the practice doctorate for APN's. It brings a terminal degree to your profession and a prestigious public view. It will also help attrack others to the profession.
    We have a long way to go. The AACN has proposed that the year 2010 will start the entry level of practice for APN's at the Doctorate level.


Top