Should NPs become COMPLETELY independent?

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wow....there are some well-informed folks on here.....yeah...no one should be downplaying another profession......that doesn't help.....I think it is truly a semantic debate here....be it DOCTOR is a professional title but we all know a euphymysm for a medical caregiver.......who here has not been called 'doc' by your patients???...but....who should be called physicians?? some seem to think we should.....well, if we're arguing for rights as advanced practice nurses why would we WANT to be called a physician....we have to be careful what we are asking for here....it is becoming a slippery slope.....we may lose the support of those who are well established and on our sides....we are NOT physicians....some NPs argue that doctors of chiropractic and optometry carry the title physician while they don't fully care for the entire patient in the same medical manner.........let the non allopathic and osteopathic practitioners of optometry and chiropractic have the title I suppose....traditionally they always have.....fighting for the same or similar RIGHTS is a different story....

I've been giving it alot of thought and really trying to see the big picture......people are getting so hung up on titles and credentials and wording and program curricula......arguing who's better a PA...an NP.....a physician...??? I used to have the theory that if you took an NP, a PA and a physician right out of school.....I think the physician is hands down more prepared, more skilled, more educated.......but, 10 years 15 years down the road....how much does experience and insight and continued learning and study develop each practitioner? could the PA end up being the brightest and most informed and best medical decision maker...?? yes, I think so....could it be the physician, the NP? sure.....doesn't it depend on all kinds of factors that take priority after education? drive? ability to integrate knowledge and medical literature? experiential and acuity exposure in practice? etc...etc.....

I think the definition on this site sums it up well........ A Nurse Practitioner (NP) is a registered nurse with advanced academic and clinical experience in diagnosing and managing most common acute and chronic illnesses either independently or in collaboration with a physician.

we just want to do what we are doing and be who we are and be rightfully recognized and legitimized for it, no???

no we don't have the same training as physicians.....could we safely take on the primary care needs of the population.......sure.....I think we could..........aren't we pretty much doing that now.....as it is....???? won't we still call on our physician and NP and PA colleagues for insight and expertise and experience when ours falls short.....???? yes...I think we will.......

I guess I kind of enjoy basically being independent and still legal having an attachment to a physician who in many cases knows more than I do......

I guess I don't need to be able to say I'M INDEPENDENT to boost my ego.......while some seem to have that need.....

I've heard some folks make a few decent arguments as to why dissolve of collaborative practice agreements is a good and/or founded thing......such as: a rightful move based on our experience and quality and scope of practice; would free up care for those who have independent clinics should something happen to their physician supervisor (death or move or stop practicing)

I guess the facts are coming in and I'm still on the fence......

can anyone else offer other reasons for why this move is so necessary or deserved....???? thanks........

I've worked in rehab settings and the psychologists would always introduced themselves as, "I'm Dr. Smith, I'm a psychologist." They all seemed self-respecting, lol!

I am kinda equivocal about that one. I don't really care one way or another. Psych is really in its own realm of "medicine" and I am still not so sure I would include it under the title of "medicine." It has diverged so much that it kinda surprises me that you need an MD/DO for psych except for in patient/med-psych

I am kinda equivocal about that one. I don't really care one way or another. Psych is really in its own realm of "medicine" and I am still not so sure I would include it under the title of "medicine." It has diverged so much that it kinda surprises me that you need an MD/DO for psych except for in patient/med-psych

Actually, I was talking about physical medicine & rehab, but there are psychologists running around in psych units also.

I am kinda equivocal about that one. I don't really care one way or another. Psych is really in its own realm of "medicine" and I am still not so sure I would include it under the title of "medicine." It has diverged so much that it kinda surprises me that you need an MD/DO for psych except for in patient/med-psych

Gee, so not only is anyone not a physician not allowed to be referred to as "Doctor," despite holding a doctoral degree, in clinical settings, but psychiatrists aren't really practicing medicine?? That would be big news to all the psychiatrists I know, esp. since all they do, all day every day (even in outpatient settings), is diagnose people and prescribe meds (after graduating from medical school and completing a residency). How would you define that, if not practicing "medicine"??

Actually, I was talking about physical medicine & rehab, but there are psychologists running around in psych units also.

Yes. I've worked in psych nursing for 25 years now, and I've known quite a few clinical psychologists working in clinical psych settings. Every one has referred to her/himself (and everyone else has referred to them, at least in front of clients and families) as "Dr. XYZ" -- I've never encoutered clients having any difficulty keeping track of who was who, and I've never heard anyone, including physicians, suggest that that was inappropriate in any way.

Gee, so not only is anyone not a physician not allowed to be referred to as "Doctor," despite holding a doctoral degree, in clinical settings, but psychiatrists aren't really practicing medicine?? That would be big news to all the psychiatrists I know, esp. since all they do, all day every day (even in outpatient settings), is diagnose people and prescribe meds (after graduating from medical school and completing a residency). How would you define that, if not practicing "medicine"??

Technically they are practicing psychiatry. I can tell you as a consultant for medicine that psychiatry is definitely not practicing Medicine (although they are medical docs). Haha. But the field of psychiatry is kind of in its own world. If you look at any of the other medical specialties, psych is really an outlier.

Yes. I've worked in psych nursing for 25 years now, and I've known quite a few clinical psychologists working in clinical psych settings. Every one has referred to her/himself (and everyone else has referred to them, at least in front of clients and families) as "Dr. XYZ" -- I've never encoutered clients having any difficulty keeping track of who was who, and I've never heard anyone, including physicians, suggest that that was inappropriate in any way.

Yeah, again, this doesn't bother me.

Specializes in CCU,ED, Hospice.
technically they are practicing psychiatry. i can tell you as a consultant for medicine that psychiatry is definitely not practicing medicine (although they are medical docs).

always thought that medicine was the the science of healing; diagnosing, treating, curing, and preventing disease with the goal of improving and preserving health. and disease, a pathological condition resulting from various causes and characterized by an identifiable group of signs or symptoms.

so mental health/ psychiatry is not medicine? :yawn:

always thought that medicine was the the science of healing; diagnosing, treating, curing, and preventing disease with the goal of improving and preserving health. and disease, a pathological condition resulting from various causes and characterized by an identifiable group of signs or symptoms.

so mental health/ psychiatry is not medicine? :yawn:

psychiatry is in its own world that does not deal with medical conditions. it deals only with psychiatric conditions- so much so that most of the docs have lost the ability to manage common medical conditions like you learn in medical school. you don't find this in surgery or medicine. so compared to all surgery and medicine specialties, psychiatry is really in its own little niche. no reason to get touchy. it's just how it is.

Psychiatry is in its own world that does not deal with medical conditions. It deals only with psychiatric conditions- so much so that most of the docs have lost the ability to manage common medical conditions like you learn in medical school. You don't find this in surgery or medicine. So compared to all surgery and medicine specialties, psychiatry is really in its own little niche. No reason to get touchy. It's just how it is.

While I have no particular interest in debating this with you, I have to say I'm curious about where you're getting this idea from. Your impression of the "world" of psychiatry certainly does not jive with my experience. The psychiatric client population has significant levels of comorbidity, and, while, obviously, people's medical problems are not treated in outpatient psychiatric settings, nearly all the psychiatrists I've known over the years have combined outpatient and inpatient practice, and psychiatrists in inpatient settings are routinely managing people's HTN, DM, GI problems, cardiac problems, acute infections, etc., etc., etc. It's rare nowadays to encounter a client in an inpatient psychiatric setting who doesn't have one or more chronic or acute medical conditions, and psychiatrists deal with those every day. (I fervently wish we only had to deal with psychiatric problems in mental health settings!!!) While I certainly would not seek out a psychiatrist as my first choice to treat an acute or chronic medical problem (just as I would not go to an internist for psychiatric treatment), I don't see how one can say they have "lost the ability to manage common medical conditions." The psychiatrists I have worked with over the years do it as a regular, daily matter.

Just out of curiosity, which other medical specialties do you not count as practicing medicine?

While I have no particular interest in debating this with you, I have to say I'm curious about where you're getting this idea from. Your impression of the "world" of psychiatry certainly does not jive with my experience. The psychiatric client population has significant levels of comorbidity, and, while, obviously, people's medical problems are not treated in outpatient psychiatric settings, nearly all the psychiatrists I've known over the years have combined outpatient and inpatient practice, and psychiatrists in inpatient settings are routinely managing people's HTN, DM, GI problems, cardiac problems, acute infections, etc., etc., etc. It's rare nowadays to encounter a client in an inpatient psychiatric setting who doesn't have one or more chronic or acute medical conditions, and psychiatrists deal with those every day. (I fervently wish we only had to deal with psychiatric problems in mental health settings!!!) While I certainly would not seek out a psychiatrist as my first choice to treat an acute or chronic medical problem (just as I would not go to an internist for psychiatric treatment), I don't see how one can say they have "lost the ability to manage common medical conditions." The psychiatrists I have worked with over the years do it as a regular, daily matter.

Just out of curiosity, which other medical specialties do you not count as practicing medicine?

I see this everyday as a consultant for medicine. The vast majority of our consults come from psych. In my experience, psych doesn't manage any of those things by themselves. They consult medicine for everything medicine related (ESPECIALLY those things listed)- and they should quite frankly because they don't manage those things well. Just like medicine doesn't manage psych issues well, psych doesn't manage medicine issues well. Most other services manage med problems adequately but psych seems a bit lost when it comes to med problems. This is my experience at 2 well known academic centers. Perhaps it is different at your hospital.

Specializes in CCU,ED, Hospice.
Psychiatry is in its own world that does not deal with medical conditions. It deals only with psychiatric conditions- so much so that most of the docs have lost the ability to manage common medical conditions like you learn in medical school. You don't find this in surgery or medicine. So compared to all surgery and medicine specialties, psychiatry is really in its own little niche. No reason to get touchy. It's just how it is.

Not touchy, just have a difference of opinion and a broader view of what is considered medicine. Treating mental illness is practicing medicine if one goes by the definition. Diagnosing, prescribing and treating.........

Also, in that mental illness disrupts homeostasis and exacerbates other conditions.. it is a medical condition.

Medicine is not Internal Med alone..

Side note, our inpatient psych unit does not consult Internal Med. The Psychiatrist handle any comorbidities that the patient may have.

Not touchy, just have a difference of opinion and a broader view of what is considered medicine. Treating mental illness is practicing medicine if one goes by the definition. Diagnosing, prescribing and treating.........

Also, in that mental illness disrupts homeostasis and exacerbates other conditions.. it is a medical condition.

Medicine is not Internal Med alone..

Side note, our inpatient psych unit does not consult Internal Med. The Psychiatrist handle any comorbidities that the patient may have.

That's nice for us that the psychiatrists handle comorbidities on their own (seriously not being sarcastic). At my current hospital we get consulted for a ton of basic issues.

If one goes by the definition that diagnosing, prescribing and treating is practicing medicine than all nurse practitioners are practicing medicine

Side note, our inpatient psych unit does not consult Internal Med. The Psychiatrist handle any comorbidities that the patient may have.

I'm not entirely sure if the bolded is true. Sure, while psychiatrists have a general medical education (from med school and internship), that really shouldn't be enough for them to be flying solo with comorbidities outside the realm of psychiatry. Especially in this litigious society. I have a hard time imagining psychiatrists tackling cardiovascular or renal problems without cards/nephro/hospitalists involved. For example, you don't usually see radoncs taking care of any non-cancer/radiation-related problems...rather, it's the med oncs that do (since they have gone through a 3 year IM residency already).

Specializes in CCU,ED, Hospice.
If one goes by the definition that diagnosing, prescribing and treating is practicing medicine than all nurse practitioners are practicing medicine

In there lies the ISSUE and a debate for another thread and another time! :p

I'm not entirely sure if the bolded is true. Sure, while psychiatrists have a general medical education (from med school and internship), that really shouldn't be enough for them to be flying solo with comorbidities outside the realm of psychiatry. Especially in this litigious society. I have a hard time imagining psychiatrists tackling cardiovascular or renal problems without cards/nephro/hospitalists involved. For example, you don't usually see radoncs taking care of any non-cancer/radiation-related problems...rather, it's the med oncs that do (since they have gone through a 3 year IM residency already).

It is true that if a patient in psych were to have a significant medical crisis the patient would be refered to an Internal Med MD, but I do know they manage coumadin, hyper/hypo thyroid, DM and other chronic illness and adjust medications accordingly. Each place is different. We are a RURAL and I mean Rural hospital so we do not have specialists in house or readily available.. makes it rather difficult to consult..

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