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
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
family nurse practitioner, chief manager and primary care provider
campbell station primary care associates
11541 kingston pike, ste 101
knoxville, tn 37922
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
Nov 14, '05
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.
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