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
  2. Visit  RMARTINNC profile page

    About RMARTINNC

    44 Years Old; Joined May '04; Posts: 12; Likes: 1.

    62 Comments so far...

  3. Visit  nightingale profile page
    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.
  4. Visit  WyomingRN profile page
    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.
  5. Visit  bluesky profile page
    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.
  6. Visit  nightingale profile page
    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,
  7. Visit  nightingale profile page
    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
  8. Visit  mav80 profile page
    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.
  9. Visit  Jessy_RN profile page
    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!
  10. Visit  icugirl33 profile page
    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.
  11. Visit  DrEdwina profile page
    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.
  12. Visit  bethm profile page
    0
    I am in my last semester of nursing school and I am writing an ethics/leadership paper on the subject as NPs as primary care providers. In my state of NC, NPs have their own practices, prescribe medications and make referrals to other HCP when the situation warrants it. Why shouldn't NP's be entitled to the same respect and autonomy as the MD? These are the questions I am raising in my paper, any thoughts from NPs would be helpful. What problems do you have in your practice relating to other providers, the public etc?
  13. Visit  DutchgirlRN profile page
    0
    I agree that only an MD, OD are medical doctors.

    Chiropractors will tell you they are not medical doctors. I do believe, however, that they are well educated. This is the cirriculum my friend is currently studying. Insurance companies would not pay for their services if they were not a necessity for some people. Same as for optometrists.

    If you want to be recognized as a "medical doctor" you will have to attend medical school. That's the only route.

    BTW I love my NP'ers. I would rather see them than the doctor anyday. They are wonderful ! They are not medical doctors and they know their boundaries. Not to worry.

    Course Load . Doctor of Chiropractic Degree
    The University.s Doctor of Chiropractic Program will expect that students complete an average of 18 credits per quarter.

    Degree Requirements
    COURSE OF STUDY
    Courses are identified by quarters, department designation and number, course title, lecture, lab, and credit hours. The following represents the current course of study for the Doctor of
    Chiropractic Program. This curricula is currently under review and a resequencing proposal is awaiting final approvals. An addendum providing the resequenced course of study will then be made available.
    First Quarter TitleLecture Lab CreditChiropractic Philosophy (Assembly)100ANAT 1101 Spinal Anatomy404ANAT 1102 Histology324CHEM 1102 Biochemistry I425CPAP 1121 Fundamentals of Chiropractic History and Principles303CPAP 1122 Health Care Terminology for the Chiropractic Sciences202CPAP 1123 Structural and Functional Basis of Chiropractic606CPAP 1124 Chiropractic Wellness I101Total 25 Second Quarter TitleLectureLabCreditChiropractic Philosophy (Assembly)100ANAT 1203 Osteology and Arthrology223ANLS 1201 Motion/Static Palpation 2 2 3ANLS 1202 Instrumentation 1 2 2CHEM 1203 Biochemistry II 4 2 5CPAP 1224 Chiropractic Principles and Interprofessional Ethics2 0 2CPAP 1225 Spinal Biomechanics 3 03PHYS 1202 Neurophysiology 5 0 5PUBH 1201 CPR/Basic Life Support 2 0 2Total 25 Third Quarter Title Lecture Lab CreditChiropractic Philosophy (Assembly) 1 0 0ANAT 1304 Gross Dissection I 44 6CPAP 1326 Chiropractic Principles and Lasting Purpose202DIAG 1301 Orthopedic Clinical Diagnosis345PHYS 1303 Visceral Physiology606RADD 1311 Normal Radiographic Anatomy223TECH 1304 Life Upper Cervical Specific Toggle Recoil Technique I223Total 25 Fourth Quarter TitleLectureLabCreditChiropractic Philosophy (Assembly)100ANAT 2105 Gross Dissection II244ANLS 2104 X-ray Full Spine Analysis223DIAG 2102 Visceral Clinical Diagnosis526PUBH 2102 Basic Nutrition505PUBH 2107 Introduction to Spinal Hygiene122TECH 2103 Life Intersegmental Specific Full Spine Technique I244TECH 2106 Life Upper Cervical Specific Toggle Recoil Technique II021Total 25 Fifth Quarter TitleLectureLabCreditChiropractic Philosophy (Assembly)100ANAT 2206 Neuroanatomy CNS324DIAG 2204 Neurological Clinical Diagnosis446MICR 2202 Bacteriology and Virology425PHYS 2204 Physiology Lab143RADD 2202 X-ray Physics425TECH 2208 Life Intersegmental Specific Full Spine Technique II042Total 25 Sixth Quarter TitleLectureLabCreditChiropractic Philosophy (Assembly)100ANAT 2307 Embryology404ANAT 2308 Neuroanatomy PNS324CPRO 2301 Clinic Proficiency223DIAG 2305 Special Senses Clinical Diagnosis324PATH 2303 Pathology I404PHYS 2305 Endocrinology404RADD 2303 X-ray Full Spine Positioning122Total 25 Seventh Quarter TitleLectureLabCreditANLS 3105 Subluxation Myopathology and Kinesiopathology223CLIN 3107 Practicum063CPAP 2311 Fundamentals of the Doctor-Patient Relationship for the Chiropractic Practice101CPAP 2312 Chiropractic Wellness II021CPRO 3102 Entrance Proficiency: Outpatient223DIAG 3106 Clinical Laboratory Studies345MICR 4229 Immunology and Disease Patterns303PATH 3104 Pathology II324RADD 5107 X-ray Extremity Positioning021TECH 3109 Basic Technique Review021Total 25 Eighth Quarter TitleLectureLabCreditChiropractic Philosophy (Assembly)100CLIN 3208 Practicum526CLIN 3209 Introduction to Clinicsl Rounds021DIAG 3208 Vertebral Subluxation Diagnosis202MICR 3205 Parasitology and Mycology303PPRL 3201 The Patient Lecture122PUBH 3202 Basic Public Health202PUBH 3203 Emergency Procedures and Toxicology Screening404RADD 3204 Skeletal Radiology I526Total 25 Ninth Quarter TitleLectureLabCreditChiropractic Philosophy (Assembly)100CLIN 3309 Practicum505CLIN 3310 Clinicsl Rounds I021DIAG 3307 Genitourinary Clinical Diagnosis202DIAG 3308 Gastroenterology Clinical Diagnosis202DIAG 3316 Case Management and Clinical Laboratory Interpretations122PSYC 3301 Human Development202PUBH 3304 Nutrition in Health and Disease404RADD 3305 Skeletal Radiology II425TECH 4211 Life J. Clay Thompson Technique122Total 25 Tenth Quarter TitleLectureLabCreditChiropractic Philosophy (Assembly)100CLIN 4110 Practicum505CLIN 4111 Clinicsl Rounds II021DIAG 4108 Clinical Diagnosis Review526DIAG 4309 Geriatric Clinical Diagnosis202RADD 4106 Radiology-Soft Tissue Pathology526RADD 5108 Advanced Imaging and Instrumentation303TECH 5214 Extra-Spinal Technique122Total 25 Eleventh Quarter TitleLectureLabCreditChiropractic Philosophy (Assembly)100CLIN 4211 Practicum606CPAP 4233 Chiropractic Philosophy and Patient Management021DIAG 4311 Pediatric Clinical Diagnosis202PPRL 4103 Ethics and Jurisprudence303PPRL 4230 Report Writing223PSYC 4203 The Chiropractor and Patient Mental Health303PUBH 4205 Obstetrics and Gynecology404TECH 4209 Life Cervical Chair/Knee Chest Technique223Total 25 Twelfth Quarter TitleLectureLabCreditChiropractic Philosophy (Assembly)100CLIN 4312 Practicum505CLIN 4313 Clinicsl Rounds III021DIAG 4310 Integrated Clinical Diagnosis505PPRL 4331 Office Management202RSCH 4301 Introduction to Research Methods202TECH 4313 Sacro-Occipital Technique223ELECTIVES: (Choose from Elective Courses) 7 Total 25 Thirteenth Qtr. TitleLectureLabCreditChiropractic Philosophy (Assembly)100CLIN 5113 Practicum606CLIN 5114 Clinical Case Study101CPAP 5113 Chiropractic Principles and Philosophy Proficiency021CPRO 5104 Exit Proficiency244PPRL 5132 Practice and Professional Relations I223PUBH 4208 Gynecological/Proctological Diagnosis021TECH 5115 Technique Review223ELECTIVES: (Choose from Elective Courses) 6 Total 25 Fourteenth Qtr. TitleLectureLabCreditChiropractic Philosophy (Assembly)100CLIN 5214 Practicum606CPAP 5222 Advanced Wellness202PPRL 5104 Ethics and Professional Relations202PPRL 5203 Practice and Professional Relations II404PPRL 5206 Practice and Professional Relations III303PPRL 5240 Personal Injury Case Management223ELECTIVES: (Choose from Elective Courses) 5 Total 25 Specific courses that make up the curriculum must be taken to earn the Doctor of Chiropractic degree.ELECTIVES Elective Course Selections Students may select from the following elective course offerings beginning in their 10th quarter of study.Electives TitleLectureLabCreditANLS 4207 Life Condylar Misalignment and Analysis122ANLS 5305 Network Spinal Analysis223ANLS 5670* Kinesiology of Sport404CPAP 5600* Exercise Physiology404DIAG 5650* Orthopedic Evaluation of the Lower Body404DIAG 5652* Orthopedic Evaluation of the Upper Body404MSHS 541 Physiological Therapeutics - Adjunct Procedures333MSHS 543 Physiological Therapeutics - Rehabilitative Procedures333MSHS 545+ Practicum Clinical Therapeutic and Rehabilitative Procedures060PPRL 3302 Practice Management202PPRL 5205 Life Principles and Direct Ethics202PSYC 4102 Clinical Psychology303PUBH 4102 Introduction to Addiction202PUBH 5612* Exercise Testing & Prescription324PUBH 5624* Strength Training and Development404PUBH 5642* On-Field Emergency Care202PUBH 5644* The Electromagnetic/Acoustic Spectrum in Athletic Training303PUBH 5646* Physical Agents in Athletic Training303PUBH 5648* Therapeutic Exercise404RADD 3104 Introduction to Chiropractic Thermography223RADD 4110 Radiographic Quality and Film Critique122TECH 3317 Activator Technique223TECH 4312 Pediatric Adjusting223TECH 5217 Life HIO Knee Chest Technique021TECH 5313 Techn. for Cranial &Visceral Dysfunction223TECH 5657* Arthrokinematics and Proprioception Lower Body404TECH 5658* Arthrokinematics and Proprioception Upper Body404* Crosslist Master level courses taught through the College of Arts and Sciences

    + Clinical Therapeutic Practicum is coordinated the Out Patient Functional Rehab Center.

    (After completion of CLIN 3107 students may select from the following elective courses, MSHS 541 and MSHS 543. After completion of MSHS 541 and 543 students may take MSHS 545.) The other electives require students to be 10th qtr or above.
    Last edit by DutchgirlRN on Nov 14, '05
  14. Visit  chiromed0 profile page
    0
    Old thread but here's my .02

    First of all the thread opens with a negative bash on chiropractic education. I know of very few, if any, students who can manage to rack up 90 credit hours in 1 1/2 years as you suggest. If they did, they are a lot smarter than most medical school applicants and very determined so what's your point?:angryfire

    Overall, chiro school is for those who can't/don't want to/shouldn't go into medical school. It may be because of grades/money/age etc. and criticizing them is for pursuing higher ed. is silly. If you haven't done a professional doctoral program yourself you have NO IDEA what any of these programs entail. Just labeling them as inferior to a medical program is not enough explanation of the demands of any doctoral level program of study regardless if you agree with what's being studied or not.

    True enough that chiro school is 3 years...that's 3 years (calendar years!). Not academic years...first you criticize a hypothetical student for completing 90 hours in 1 1/2 years (incredible academic achievement) and then you criticize a chiro student for (not hypothetical) completing a 4 year graduate professional academic program in 3! That is full time school no summers off. The programs are about 4200+ class hours, 250 or so credit hours. Not small stuff. Even medical/osteopathic programs are offering 3 year programs now. It has nothing to do with competence. It has everything to do with economics and student turnover.

    NO OTHER PROFESSION besides a medical doctor/osteopathic doctor has a right to the term 'physician' without a 'qualifier' in the United States. I don't believe ANY of the other fields ever try to pass themselves off (as a profession) as such, either. Now, yes one can refer to themselves as a chiropractic physician and it's perfectly fine, same with the other professions. However, it is not worth the effort or the arguement. Keeping it open and simple for the public interest is probably the safest bet.

    Now, taking it a step further. Who deserves the title Doctor? M.D.'s/D.O.'s? Why? Because they say so? So what? What about Phd's, DNSc, DNP's, D.C., D.D.S., D.P.M., O.D., N.D., D.PT, PharmD.?

    If they want "physician"...o.k. no problem. If they want "Doctor" (like they are pushing legislatively now) then I would argue we ALL have to have qualifiers (which is defeating the purpose of simplicity for public interest) with the term "Doctor". In fact, most academics would argue the term "Doctor" originates with them first so medical doctors would not be able to use the term generically.

    Consider in a hospital how inappropriate it would be to use "Doctor" when referring to english teacher. Just as inappropriate on a university campus when referring to your "physician" as Doctor while discussing literature in english class. That term can be just as controversial b/c anyone who earns a doctorate level degree, either a professional or academic, has the right to use it. Even your attorney.

    All the professional degree programs require the same pre-med curriculum. Yes, some differ if you really care to take the rest of a B.S. program, too. However, if you research more you will see that a great many schools now transfer back your first year of professional school credit to award a B.S. degree anyway. The incentive is to get you in their program faster since most first year didactic medical education is upper level undergraduate courses, not 5000-6000 level, but 4000.

    You have to keep this in perspective. Yes, MD/DO programs have the 'best' students on average and very determined applicants but they also are required to be the final word in healthcare with an unrestricted scope of practice. Is that necessary for someone who practices only joint manipulation, physical therapy/physiotherapy and counseling...no a lesser academically qualified student is an appropriate candidate on average for this field. Remember, too, there are Physicians who are chiropractors, Chiropractors who become physicians, dentists who are M.D.'s, M.D.'s who are nurses. The degree doesn't tell enough about the practioner, it merely qualifies them to sit for licensure. Each practitioner must be judged on their own merit. In other words I don't want a chiropractor doing injections any more than I want a physician filling my teeth!

    And how weird would that be. :trout:

Need Help Searching For Someone's Comment? Enter your keywords in the box below and we will display any comment that matches your keywords.



Nursing Jobs in every specialty and state. Visit today and find your dream job.

A Big Thank You To Our Sponsors
Top
close
close