I remembered reading an old post awhile ago where an NP (who got her DNP) was told by Human Resources that she couldn't use the title "Doctor" at the hospital, because it would mislead the patients.
I am wondering if anyone has seen or heard anything similar where they work (you personally or someone else).
If hospitals are "all about introductions", I see nothing wrong with telling a patient, "Hi, I'm Dr. Smith, I'm a Nurse Practioner"...I see no difference between that and saying, "Hi, I'm Dr. Jones and I'm your Cardiologist".
To me, that would be a HUGE slap in the fact to someone who has worked hard for that degree, because they are entitled to use that title.
WHy shouldn't we group NPs and PAs together? We all provide the same service with different educations and are all midlevel providers.
PICUNP what exactly you do in the middle? in between? What do you call an optometrist? A physical therapist? Who is below you? What services do you provide that are in the middle?
PICUNP what exactly you do in the middle? in between? What do you call an optometrist? A physical therapist? Who is below you? What services do you provide that are in the middle?
You're not the highest level of authority in medicine. That responsibility is in the hands of the attending physicians. Not residents, not med students, not NPs/DNPs/PAs, but the person with the greatest fund of knowledge and experience: the attending.
So you have someone higher up in the heirarchy than you and since some of you seem to consider PAs beneath you (not entirely sure why since PAs are very well qualified to practice medicine and they're not arrogant enough to assume they're equivalent to physicians), you appear to be in the middle. Where would you place yourself? Do you think you're the highest authority in delivering care? I'm not asking in a sarcastic way; I truly want to know where you guys think you're placed in the heirarchy if you refuse to be called midlevels.
dgenthusiast, you weren't asking me, but I'll give my response anyway. I don't "refuse" to be called a midlievel and speaking only for myself, it doesn't offend me at all (actually I'd love to be called one right now, lol, I'm only a FNP student). However, I do think it would be better across the board to just refer to all individual professionals as what they actually are. Nurse practitioners are nurse practitioners, PAs are PAs, physicians are physicians (though often a specialty designation is appropriate, i.e. "cardiologist," etc). Very straight forward and clear; that's the way I like things. "Midlevels" is just an unnecessarily vague term that fails to offer any clarity or identification except in the most general sense. Frankly, it is almost useless, but I just can't muster up any offense. If being vague and unclear is how some people like to communicate, it's no skin off my nose. If they use the term "midlevel" because they know full well that some PAs and NPs do bristle and it is their intention to "put them in their place," well that says enough about that person that I don't much care what they opine about anything I guess, lol.
Now, some of the professionals I mentioned above are going to have different titles. All physicians will continued to be called "Doctor," of course. If PAs or NPs earn a degree that entitles them to use that term, then so be it. Consistently refering to them by their specific role, i.e., "Dr. Jones, the nurse practitioner in the 'ABC Total Health' practice on 34th Street....." "Dr. Smith, the internal medicine physician at the 'ABC Total Health' practice..." just seems to me to be the most logical approach.
I admit, I don't have an emotional stake in it b/c I am neither a MD nor a DNP, but the vitriol on both sides is confounding. I happen to think the whole Dr. Nurse brou ha ha is a moot point anyway. I have never met or heard of a single NP that asks to be called by anything other than their first name, and I don't think that is going to change, regardless of what the degree on the wall says.
That said, I will completely agree that if Joe Blow, DNP gives his name to the matiredee (sp?) at Sardis as "Dr Blow" just to try to get a better table or impress the onlookers, he's an ass. I would also think that of the psychologist, nobel laurette physicist, English professor and MD that does the same bonehead thing.
WHy shouldn't we group NPs and PAs together? We all provide the same service with different educations and are all midlevel providers.
NP's and PA's can't be grouped together, because we're separate professions. We (NP's) consider ourselves independently licensed practitioners and not under the supervision of another profession. We're trying to be recognized as such by our legislators.
PA's will always be under the supervision of physicians, it's just the way it is. This makes it difficult to lump us together as some kind of "midlevel," whatever that is. I suppose I can see where a PA would be considered a "mid" level...like they're always lingering in the first year of residency. However, this isn't the case with our profession.
This isn't the thread to get started on PA vs NP education and duties. Suffice to say that I believe that NPs should be grouped in with PAs as we all do the same job. They function in all areas that NPs do and more. The fact that we have independent practice as NPs is due only to a strong nursing lobby. PAs do have a better education than any Np. We could only hope for the type pf education that PAs receive. Yes, I have worked with PAs in the PICU.
You're not the highest level of authority in medicine. That responsibility is in the hands of the attending physicians. Not residents, not med students, not NPs/DNPs/PAs, but the person with the greatest fund of knowledge and experience: the attending.
So you have someone higher up in the heirarchy than you and since some of you seem to consider PAs beneath you (not entirely sure why since PAs are very well qualified to practice medicine and they're not arrogant enough to assume they're equivalent to physicians), you appear to be in the middle. Where would you place yourself? Do you think you're the highest authority in delivering care? I'm not asking in a sarcastic way; I truly want to know where you guys think you're placed in the heirarchy if you refuse to be called midlevels.
Sorry, never suggested I was the highest level. I am asking who do you think is in the middle? Never said PAs were beneath NPs. Why do I appear to be in the middle? What am I in the middle of? I place myself on the health care team, I collaborate with the health care team. Thus, is the OD a midlevel? is a DC? Just yes or know questions with a rationale is fine. No need to change the subject, just tell us what we are in the middle of? If the attending is on top who is on the bottom? When I am in the clinic seeing patients (no MD present) who is on top? Am I in trouble because I have not discussed patient care with a MD in the past 6 months? Do you think my patients view me as in the middle?
A DNP wanting to be called "doctor" just really isn't gonna' happen much. Though technically they have a doctorate, they still are an NP. I don't see why people have to get caught up in technicalities. If an NP provides competent and effective care, who cares what title they carry.
All this foofera about mid-levels is pretty stupid. An NP and PA have similar roles, and when it comes down to it, most jobs advertising for PA's are also willing to accept NP's and vice versa. There is the difference that NP's can work on their own as independent providers, but I'd wager to say that most NP's would like to have an attending physician around for their first few years of practice to help them learn. I think that prescribing and operating completely independent would pretty daunting for the first few years.
Another thing people ought to consider when calling NP's "unprepared" to fulfill an independent practitioner role is that an MD or DO has 3-4 years of residency. They have plenty of time to practice under supervision of the attendings. So naturally a fresh NP grad isn't going to perform with complete confidence on their own. But I imaging that given 3 or so years, like an MD resident, they would be pretty much able to hack it on their own.
Arguing about which mid-level is better and all this doesn't ultimately matter. It all depends on the individual and the experience level.
Sorry, never suggested I was the highest level. I am asking who do you think is in the middle? Never said PAs were beneath NPs. Why do I appear to be in the middle? What am I in the middle of? I place myself on the health care team, I collaborate with the health care team. Thus, is the OD a midlevel? is a DC? Just yes or know questions with a rationale is fine. No need to change the subject, just tell us what we are in the middle of? If the attending is on top who is on the bottom? When I am in the clinic seeing patients (no MD present) who is on top? Am I in trouble because I have not discussed patient care with a MD in the past 6 months? Do you think my patients view me as in the middle?
thanks
Lower levels- nurses
Midlevels- PAs, NPs and DNPs
Upper levels- MD/DOs
ODs and DCs and pharmacists and DPTs should not be grouped with the above as they do very different things than the above. At least with nurses, PAs and NPs you could make the argument that they provide general medical care rather than doing eye exams, cracking backs, giving recs on drugs or improving mobility.
Another thing people ought to consider when calling NP's "unprepared" to fulfill an independent practitioner role is that an MD or DO has 3-4 years of residency. They have plenty of time to practice under supervision of the attendings. So naturally a fresh NP grad isn't going to perform with complete confidence on their own. But I imaging that given 3 or so years, like an MD resident, they would be pretty much able to hack it on their own.
I'll agree that you shouldnt use the example of a fresh NP... It takes a while to just get used to the system. That said, using your logic, an NP with 3 years experience should have a similar fund of knowledge as the attending. Even after 20 years that is far from the case.
So what if someone has "a doctorate"? In a clinical setting, only a physician should be called doctor because they are the only ones who have the highest level of education. Let's be honest, when you compare normal NP and the DNP curriucula, it becomes obvious that the DNP is not really a doctoral program. It is a masters program with some lipstick on it. Making it a doctorate was completely a political move.
Wowza, right on the money. If you wanted to be called a doctor, you should have gone to medical school. If you didn't, just be happy being called whatever you're called, and accept the limitations of your scope of practice. Be the best that you can be.
And if it bugs a person too much, why don't you just go back to med school?
ODs and DCs and pharmacists and DPTs should not be grouped with the above as they do very different things than the above. At least with nurses, PAs and NPs you could make the argument that they provide general medical care rather than doing eye exams, cracking backs, giving recs on drugs or improving mobility.
I'll agree that you shouldnt use the example of a fresh NP... It takes a while to just get used to the system. That said, using your logic, an NP with 3 years experience should have a similar fund of knowledge as the attending. Even after 20 years that is far from the case.
So what if someone has "a doctorate"? In a clinical setting, only a physician should be called doctor because they are the only ones who have the highest level of education. Let's be honest, when you compare normal NP and the DNP curriucula, it becomes obvious that the DNP is not really a doctoral program. It is a masters program with some lipstick on it. Making it a doctorate was completely a political move.
Good luck with calling RNs lower level, I for one have far too much respect for my roots to think of RNs or nurses as lower level. What do you consider nurse aids or medical assistants, I mean how much lower is low?
Have you ever reviewed what a DC considers as part of their practice? They are reimbursed for otitis media, UTI and other health problems, they commonly refer to themselves as "Dr." Have you been following what the Pharmacist are seeking? They call it "cerebral reimbursement" , when they consult with you and your medication that want the consultation fee, they are on the verge of providing/administering immunizations, regulating DM and HTN medications in the pharmacy and they are all Pharm D, are they in the middle?
Please tell the DNP students about the "lipstick", walk in their shoes and see if they think the course work is "lipstick". Graduate school and the scholarly activities associated with completion are not often considered lipstick. Do you consider the Pharm D a "lipstick" degree? Which "Dr" curriculum is the most rigorous ? DNP-DC-Pharm D-OD ? Based on your posts I suspect you feel the DNP is the least rigorous?
wowza, right on the money. if you wanted to be called a doctor, you should have gone to medical school. if you didn't, just be happy being called whatever you're called, and accept the limitations of your scope of practice. be the best that you can be.
and if it bugs a person too much, why don't you just go back to med school?
tell dr. allan greenspan who was on "meet the press" sunday he should have gone to medical school if he wants to be called a dr. how silly, the argument of who is or is not called a dr. is just plain dumb. i have been called a dr. in the office for 25+ years, i constantly tell patients i am a np not a dr. , but i am their dr. i gave up correcting my established patients years ago. reality is very very few of our np dnp or phd colleagues are going to refer to themselves as a "dr" in the clinical setting. the vast majority are not into the need to be recognized as a dr, they want to be known as great healthcare provider.
PICUPNP
269 Posts
WHy shouldn't we group NPs and PAs together? We all provide the same service with different educations and are all midlevel providers.