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| No. 50 | 
Jun 11, 2009, 08:07 PM
 Re: Medicine decries nurse doctorate exam being touted as equal to physician testing
As a CRNA, I have lived the battle between physicians and nurses for 13 years. Never mind that nurses were the people who first administered anesthesia, and doctors caught on that anesthesia could be classified as a "specialty" and stepped in to be doctors in this area. Anesthesiologists are especially miffed with nurses at this point in time, because SO MANY anesthsia practices are hiring CRNA's as practitioners because we are much cheaper than an anesthesiologist is, and we do the exact same things. Shoot, in my opinion, if you are going to go on for higher education in nursing, why not go for something that increases your earning potential exponentially? NP's don't make s**t. I don't really know about Doctorates in Nursing----I have never really even heard of that. All I know is that doctors get their drawers in a knot when they feel threatened----if there was no threat, they couldn't care less. The problem is that doctors want to MAKE MONEY!! They feel that they will be reimbursed less money if there is someone else who can do their job and won't command the ridiculous amounts of money that the doctor wants and expects. If the docs weren't money hungry pigs then perhaps there wouldn't be such a "battle" between the initials. It all has to do with money............
 | | Advertisement Sponsored Links | | | | No. 51 |
Jun 11, 2009, 08:07 PM
Re: Medicine decries nurse doctorate exam being touted as equal to physician testing
dgenthusiast, I am starting to wonder why you evade the background question. Are you even a nurse? PA? Doctor? Medical student/intern/resident? Ranier, you too, whats your story? Not slamming you, it just helps to understand where you are coming from. You mentioned core0, a PA that posts here and brings a lot of valuable insight to this forum.
Good finds and good points guys, but you missed my point, or rather I wasn't clear. I am speaking of the training. MD 4 years undergrad, heavy sciences/patho, 4 years medical school, 10000 hours plus training NOT including clinical time during medical school. Compared to NPs who receive 4 years undergrad, light sciences, 2 years masters (plus 2 years or so for DNP, but not mandatory now) with 1000 hours give/take all total including undergrad. I still don't see where anyone has made the claim that NPs receive the same training as MD.
You guys are talking about patient outcomes, and there are plenty o' claims there. I am sure some of these studies are flawed as David (core0) has pointed out. That is almost statistically certain, eh? However, I am sure that not all of the studies are flawed. Here is one by the BMJ: http://www.bmj.com/cgi/content/full/324/7341/819
That study was a meta analysis and it looks pretty thorough and included many studies. It seems to indicate that NPs compare okay with family/GPs. NPs are not being compared to surgeons, specialist, etc. Why is this so hard to believe? Hell, there are laypeople out there armed with only Google who can figure things out. How about this girl who just diangosed her own Crohn's?
Look, clearly Dr Mundinger is enthusiastic about the profession and wants to bring it forward. I am not particulary happy that she is not making any friends with the physican groups, but as she her herself has pointed out this stuff is in development and like I said before (in bold in fact) to me this whole testing thing indicates that NP training needs to be upgraded since DNP (a degree I am not even for) students are not passing an easier version of the test. What is it that you guys are not getting from my posts? I don't think you are reading them entirely, which is possible because I tend to write lengthy posts.
| | No. 52 |
Jun 11, 2009, 08:27 PM
Re: Medicine decries nurse doctorate exam being touted as equal to physician testing Originally Posted by NurseDiane  As a CRNA, I have lived the battle between physicians and nurses for 13 years. Never mind that nurses were the people who first administered anesthesia, and doctors caught on that anesthesia could be classified as a "specialty" and stepped in to be doctors in this area. Anesthesiologists are especially miffed with nurses at this point in time, because SO MANY anesthsia practices are hiring CRNA's as practitioners because we are much cheaper than an anesthesiologist is, and we do the exact same things. Shoot, in my opinion, if you are going to go on for higher education in nursing, why not go for something that increases your earning potential exponentially? NP's don't make s**t. I don't really know about Doctorates in Nursing----I have never really even heard of that. All I know is that doctors get their drawers in a knot when they feel threatened----if there was no threat, they couldn't care less. The problem is that doctors want to MAKE MONEY!! They feel that they will be reimbursed less money if there is someone else who can do their job and won't command the ridiculous amounts of money that the doctor wants and expects. If the docs weren't money hungry pigs then perhaps there wouldn't be such a "battle" between the initials. It all has to do with money............
I considered the CRNA route, got my ICU time in started the school search, but then my son came along and I really didn't want to miss out on the first 3 years. I chose the FNP route instead. The money will be adequate, and quite frankly I love the patient interaction.
I think you are right about the money. Here is a good read: http://www.huffingtonpost.com/dr-chr..._b_214318.html. I know, I know the Huffington post, liberal safehaven that it is, but there is truth in his letter.
| | No. 53 |
Jun 11, 2009, 08:36 PM
Updated
Jun 11, 2009 at 08:45 PM by dgenthusiast
Re: Medicine decries nurse doctorate exam being touted as equal to physician testing Originally Posted by ivanh3 dgenthusiast, I am starting to wonder why you evade the background question. Are you even a nurse? PA? Doctor? Medical student/intern/resident? Ranier, you too, whats your story? Not slamming you, it just helps to understand where you are coming from. You mentioned core0, a PA that posts here and brings a lot of valuable insight to this forum.
Good finds and good points guys, but you missed my point, or rather I wasn't clear. I am speaking of the training. MD 4 years undergrad, heavy sciences/patho, 4 years medical school, 10000 hours plus training NOT including clinical time during medical school. Compared to NPs who receive 4 years undergrad, light sciences, 2 years masters (plus 2 years or so for DNP, but not mandatory now) with 1000 hours give/take all total including undergrad. I still don't see where anyone has made the claim that NPs receive the same training as MD.
You guys are talking about patient outcomes, and there are plenty o' claims there. I am sure some of these studies are flawed as David (core0) has pointed out. That is almost statistically certain, eh? However, I am sure that not all of the studies are flawed. Here is one by the BMJ: http://www.bmj.com/cgi/content/full/324/7341/819
That study was a meta analysis and it looks pretty thorough and included many studies. It seems to indicate that NPs compare okay with family/GPs. NPs are not being compared to surgeons, specialist, etc. Why is this so hard to believe? Hell, there are laypeople out there armed with only Google who can figure things out. How about this girl who just diangosed her own Crohn's?
Look, clearly Dr Mundinger is enthusiastic about the profession and wants to bring it forward. I am not particulary happy that she is not making any friends with the physican groups, but as she her herself has pointed out this stuff is in development and like I said before (in bold in fact) to me this whole testing thing indicates that NP training needs to be upgraded since DNP (a degree I am not even for) students are not passing an easier version of the test. What is it that you guys are not getting from my posts? I don't think you are reading them entirely, which is possible because I tend to write lengthy posts.
Ivanh3, if it really makes you feel better knowing where I'm coming from, fine. I'm a premedical student just about to graduate. This doesn't necessarily disqualify anything I've said so far. The reason I didn't mention this earlier was because I was pretty sure people will jump on this fact and disregard what I was saying.
You mention that you're talking about training and not outcomes. However, how can one claim to have have the knowledge and skills of a profession without similar training? Wouldn't DNP = MD imply that the training is similar? If not, how can people claim they are equivalent? If the training is not similar, they aren't trained in the same things and thus, they cannot be the same. If I said I can play baseball at the level of an MLB athlete, did I do this by playing little league? No. It's implied that I trained similarly as an MLB athlete; otherwise, how can I claim to be as good as they are without any significant similarities in training? Do you see what I'm saying? By saying DNP = MD, Mundinger et al were implying that they have the same level of training as physicians do.
Thanks for the link to the study. I don't have time currently to look at it, but I will do it as soon as I find some free time.
Edit: You guys keep bringing up the money issue. There's no doubt money plays a role in why doctors are bothered by this, but it's not the only reason as some posts seem to imply. When doctors have spent a better part of a decade (at the minimum) receiving medical training and someone comes along with a significantly less amount of training and says they're equivalent, do you not agree that this would be annoying? This is especially true when NPs/DNPs are trying to set up private practices in order to practice independently. Can you understand why physicians would be miffed if someone with significantly less training is claiming to be equivalent to physicians and is taking potential patients (and thus reimbursement) away from physicians?
Edit2: To say that Mundinger is enthusiastic to bring the profession forward is an understatement. It's pretty clear that she wants DNP to equal MD and that she wants DNPs to be reimbursed at the same rate as MDs. If anything, this bit sounds greedy rather than doctors trying to protect the borders of their profession. In the article posted in the original post, there was a quote by Mundinger who was saying that DNPs should be reimbursed at the same level of physicians if they can pass a watered-down Step III. This sounds pretty suspicious.
| | No. 54 |
Jun 11, 2009, 08:52 PM
Re: Medicine decries nurse doctorate exam being touted as equal to physician testing Originally Posted by ivanh3 You guys are talking about patient outcomes, and there are plenty o' claims there. I am sure some of these studies are flawed as David (core0) has pointed out. That is almost statistically certain, eh? However, I am sure that not all of the studies are flawed. Here is one by the BMJ: http://www.bmj.com/cgi/content/full/324/7341/819
Actually, I just looked at the study quickly (I quickly skimmed through its important points but didn't spend a significant portion of time dissecting it) and it doesn't really look like that great of a study. Since you mentioned that core0 was a highly respected member, I'll quote his assessment of this study as well since it's likely to be considered more highly coming from him rather than me (who's new to this forum):
"...Please don't forget the really awful article in BMJ where they hopelessly mixed up NPs (and RNs) in the UK and the US who have completely different scopes of practice. http://www.bmj.com/cgi/content/full/324/7341/819" -core0 ( http://forums.studentdoctor.net/showthread.php?t=472176)
So you can't really say that's a well-designed study that shows similar outcomes between NPs and physicians in the US if they confuse the scope of practice of NPs in the US.
| | No. 55 |
Jun 11, 2009, 09:26 PM
Re: Medicine decries nurse doctorate exam being touted as equal to physician testing
I'm a nurse (ED) who is also the wife of an osteopathic physician (family practice). I'm also the daughter of an ICU nurse. I'm still in my 20's and considering whether to enter an APN program or apply to medical school in the next few years.
| | No. 56 |
Jun 12, 2009, 11:45 AM
Re: Medicine decries nurse doctorate exam being touted as equal to physician testing
Ranier---Why don't you consider going to a CRNA program? 3 years, money is great, lifestyle is great (after school is over, of course).
I, personally, do not think that the current state of medicine would make any nurse want to go to medical school. I know that my malpractice insurance as a CRNA is astronomical----my GYN has quit delivering babies, as she is married to an interventional radiologist and their combined malpractice insurance was about $350,000, more than what they made, they would have had to take a loan out to pay it. By the time you get out of medical school, you are at least $200,000 in the hole, then you face trying to get started in a pratice, on call every other night (unless you do something like Emergency Medicine or Derm)....maybe some would want to do it to fulfill their altruistic dreams, but if you think you're going to be raking money in hand over fist, those days are over, and it is only going to get worse as time goes on.
I'm sorry if I am trashing your dream----I don't mean to. If you want to go to med school, I wish you the best of luck. But, having been there, I think that nurse anesthesia is a great route to go is you want to go into advanced nursing practice. I suppose a lot of nurses go the NP route because they like the patient interaction. I enjoyed the CRNA route because I loved critical care, and it is the most challenging thing a nurse can do. You take care of one patient at a time, all the time. You have autonomy. You are respected. There are a TON of jobs now for CRNA's. And at the end of the day, I walk out of the OR and my job is done. When I was younger, I used to love the trauma, the cardiac surgery, the neurosurgery, big vascular cases.........now that I am old and gray, I prefer bread-and-butter cases, elective stuff with patients that aren't so sick. I paid my dues and had fun doing it---I just prefer to have my heart beating at a normal rate rather than being tachycardic while someone is bleeding out or herniating on the table!!! LOL!!! I make a great living, and I love it. I enjoy going to work every day (with the odd day that I work with the surgeon who plays symphony music at volume level 9 all day!!!), and the comraderie among surgeons, the anesthesia people and the OR nurses is great.
So, essentially, this post has nothing to do with a doctorate in nursing degree/MD disagreement. LOL.
| | No. 57 |
Jun 12, 2009, 12:15 PM
Re: Medicine decries nurse doctorate exam being touted as equal to physician testing
A DNP is not an MD, and so I find the "DNP = MD" question ridiculous. It's not the same degree, and I don't think that should be the issue.
The main question is, is a DNP qualified to function as a primary health care provider (like an MD)? The answer must be yes. PAs and NPs already function like MDs in primary health, so DNPs can too (in my state, an NP with her master's can even have her own practice!). Could a DNP be a neurosurgeon, like an MD? Of course not. We already have master's prepared nurses functioning as adult, acute care, pediatric, neonatal, etc. primary care health providers, and surely the doctorate-prepared nurse would be even more compentent.
There are plenty of advantages to going to medical school (over the DNP route). However, I also imagine there are certain benefits to being a DNP. The main one is evidenced by my primary care provider, an NP who recently earned her DNP. She is the most competent PCP I have ever had and was able to diagnose something 3 doctors before her missed; just as important, she also had a nurses' bedside manner and took the time to explain and teach me what was going on. She's not an MD and may not have the same competencies as one, but she has a great wealth of knowledge, many years of experience and the kindest heart (though DNPs may not have as many clinical hours of training as MDs, she is a new DNP and has decades more experience than a new MD). In my particular experience, she has given me the best combination of her medical and nursing knowledge and skills. Of course, if I had a heart defect I would go to a cardiac surgeon, or if I had cancer I would go to an oncologist. However, if I might use a certified nurse midwife to deliver my baby.
I guess what I'm trying to say is that health care providers some in so many shapes and specialties which require particular skill sets. So, if DNPs are qualified to perform the responsibilities given them, why debate if DNP = MD? MD from one program doesn't equal MD from another program and doesn't equal DO, either. There are vast differences between students/practionners, between programs and between degrees.
The second issue is what you CALL DNPs. Yes, they are doctors -- they have terminal degrees in nursing, just as someone with a PhD in English has a terminal degree or a PharmD has a terminal degree. In an age where people can graduate at 24 with a doctorate in Audiology or Pharmacy (3 years undergrad + 3 grad school = doctorate, which I find a little proposterous), I don't think it makes sense to argue that a DNP hasn't earned the doctoral right. It's confusing for lay people, though, to hear "Dr. Smith," when the person's a DNP. The DNP has earned the title "doctor" and the right to practice in the same capacity as a PCP MD, but a DNP is not what a lay person thinks of as "Doctor." I think it's probably just as well to leave that up to individual hospital and healthcare practice policy, however, rather than trying to a one-size-fits-all answer, don't you think?
| | No. 58 |
Jun 12, 2009, 01:01 PM
Re: Medicine decries nurse doctorate exam being touted as equal to physician testing Originally Posted by dgenthusiast Ivanh3, if it really makes you feel better knowing where I'm coming from, fine. I'm a premedical student just about to graduate. This doesn't necessarily disqualify anything I've said so far. The reason I didn't mention this earlier was because I was pretty sure people will jump on this fact and disregard what I was saying.
I think it gives you a different perspective which is what all dialogues need. No worries. DG doesn't stand for Denver General does it? Originally Posted by dgenthusiast You mention that you're talking about training and not outcomes. However, how can one claim to have have the knowledge and skills of a profession without similar training? Wouldn't DNP = MD imply that the training is similar? If not, how can people claim they are equivalent? If the training is not similar, they aren't trained in the same things and thus, they cannot be the same. If I said I can play baseball at the level of an MLB athlete, did I do this by playing little league? No. It's implied that I trained similarly as an MLB athlete; otherwise, how can I claim to be as good as they are without any significant similarities in training? Do you see what I'm saying? By saying DNP = MD, Mundinger et al were implying that they have the same level of training as physicians do.
I understand why you might think that, but that is not what she is saying. She is saying that the outcomes will be similar. Again no one is saying the training is the same. Here is something for you to consider. As you are graduating with your pre-med degree, I assume you have take your med school pre-req classes which usually at least include one year of physics and one year of organic. You will then go on to med school where I have no doubt that you will learn much and do quite well. Now here I am going to make an assumption: that you have no professional medical background like nurse, emt, paramedic, RT. I could be wrong, just going with the odds. You will pass all of your tests and then you will show up on your first day of your internship. Now I have a lot of experience working around interns and residents. I have met some really sharp ones too. What I have also learned, and please this is anecdotal at best, is that it is not rare for interns and residents to be completely clueless. It turns out that mastery of knowledge regarding that carbon ring might not help you assess a patient when the time comes. Now, don't get me wrong, residents/interns are no more clueless than a new grad NP or PA, probably less so. That is the nature of being new, and my opinion is this: as it is true in so many other fields, true learning really starts on the job. This is not to say by any means that training counts for nothing. I think training is critical, but I can't help but wonder sometimes if the whole point of training is just to survive it and those that do make through really start to put it together during residency/post graduation. I have had this discussion with quite a few physicians. I have asked just how much of the details do you remember from med school, and the answer is overwhelming very little. Well, they remember the pain  . This is exactly why people specialize. I am a PALS/ACLS instructor. When I have family practice physicians come through the class they can sometimes (not all the time) be kind of shaky. They are not dumb, it is just not what they do. My brother in law is a physician. There is a ton of stuff he doesn't know because it falls outside of his specialty.
How can you explain a resident getting their butt saved by an experienced RN? Man, I have seen this dozens of times. I know in my heart that the resident went on to become a great MD, but experience counts.
How does this apply NP/PA=MD? I firmly believe that as an FNP/PA begins to work they will learn the exact same things that physicians do. Remember, I am talking family practice here. Also for the record, I don't believe in independent NP practice until they have a certain amount of time under their belt. I would like to see a tiered system where independence is granted based on time/evidence of competency.
I think the BMJ study is solid. Yeah the practice varies, but so does practice here in the US. Each state is different. I respect core0, but I don't always agree with him. Let me ask you this: are you saying all these studies are completely worthless, and that there is nothing to be learned from them? I don't buy that.
Sure we keep bringing up the money. If we are doing the same thing why should we not get paid the same. Again (and again and again) we are talking about family practice. It is not like family practice MDs are raking in the dough either. Talk about jumping off of a sinking ship. When you get to med school, do a little informal poll and see how many of your peers are going to flock to family practice, then compare that to all of the recent studies. New physicians want to be specialists: there is more money, less paperwork, and it is more exciting. I have heard an MD say, "Last thing I want to do is deal with coughs/runny noses all day". It just simply comes to this: equal work, equal pay. How is that not fair if the work is competently done.
So if you physicians are not going to do it, who is? Is there or is there not a shortage of family practice providers right now? My primary provider is a DO who also has a PA in the office. If it is a non emergency, routine kind of thing I am looking at 4 weeks plus for an appointment. Now, if I am sick, he gets me in within a day or two, but still, a month?
In any case, all of your points are valid and need to be discussed, but I think you are missing the point in that midlevels are trying to elevate their status because there is good evidence that indicates we do well where we are properly trained and have experience.
Ivan
| | No. 59 |
Jun 12, 2009, 01:09 PM
Re: Medicine decries nurse doctorate exam being touted as equal to physician testing Originally Posted by Ranier I'm a nurse (ED) who is also the wife of an osteopathic physician (family practice). I'm also the daughter of an ICU nurse. I'm still in my 20's and considering whether to enter an APN program or apply to medical school in the next few years.
My wife is an ER nurse, and I was an ER nurse. There is a lot of thought that goes into that question. Getting into school, getting accepted into a residency, will that require a move, etc. I know of at least one husband/wife family practice team where there is an MD with an NP. Either way, I am sure you will do well.
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