discussion regarding education of NP (DNP) and PA compared to MD/DO

JDCitizen · Jul 10, 2008

OK I did get "Sassy" myself. I really did not mean to create an online fight, SO I apologize too
heated debate sure pass the popcorn.
As far as this debate I will come back and check but I posted what I wanted.
I think this does need to be discussed, Maybe you can change my mind?

My education was not like the one I received for my BSN and I dare not compare it to what many of my friends went through for medical school. Over the years I advanced my training and changed fields. I became a RN worked my way through hospital nursing than added to and advanced my education/training as a nurse to become a Nurse Practitioner..

I still say the days of nurses being subservient are long gone. A lot of it has to do with advances of technology and the sicker and sicker populations being served as well as litigation potential.

From my early days in the hospital were one doctor took a patient to surgery, did OB/GYN as well as neonatal to geriatrics, ER duty all in one day is long gone. Some of them didn't like us paramedics because we were making decisions in the field that they were supposed to make. So now I am a nurse making some of those same decisions in a hospital/office environment and they would be more than perturbed. Now today we have ER doctors and that is all they do. We have office doctors who don't admit anymore but give their admissions to hospitalist. We have hospitalist who don't stay in the hospital because they have an office?!?!?

Nope I am not here to replace any doctor but like I said on the other post: Medicare / Medicaid and serving the underserved in rural communities where doctors refuse I am more than happy to step up to bat and I do everyday I go to work. My education does not equal a doctors but I do have 4+ years of biology and chemistry as well as psychology in my portfolio.. I have a background in how it works and why it works.

Have I stopped nope I am still looking for more school time because even in the 5 years I have been out things have changed.

We all bring something different to the table and I hope we can all focus on what's important: The Patient.

DaisyRN, ACNP · Jul 10, 2008

i moved this from the other thread...

i apologize if i started this whole dnp "debate," but that is exactly why i said i was not here to argue the dnp issue in my post. however, others ran with it... so just to clarify for all, i was not saying that the dnp and the md are equals, thus creating a hierarchy of professionals in healthcare. i was saying that generally speaking, the time frame for any doctoral degree is roughly the same. i am not saying the quality or content of the programs are the same... at all. that was "assumed," i suppose. i actually do not recall anyone on this thread claiming that they are "equals."

and this "i'm a doctor," claim by non-physician providers is not something i support... simply because the public associates "doctor" with "physician," when the term "doctor" by definition, also refers to someone prepared doctorally (think dentist, pharmd, vet, phd).

as for replacing mds/dos... i do not think that is the intent, at all. we are all in this together to improve access to healthcare for our patients. it's a team effort... and its unreasonable to think that nonphysician providers are trying to replace mds/dos.

as much as people will debate the issues we've brought up, one thing remains the same... i believe nonphysician providers are "midlevels" even when someone acquires the terminal np degree such as the dnp because that is where we fall in the hierarchy of healthcare professionals. :)

i would be happy to clarify anything else i have said in pms...

SteveNNP, MSN, NP · Jul 10, 2008

I also don't know who you're trying to argue with, or impress. We all had the choice to go to medical school.

Not a single person on this board believes for one second that NPs are the equivalent of a physician. The talking heads are soiling their pants over it on SDN. They don't get it either.

The DNP works for NPs who want to add to their clinical expertise. There's no argument here. The DNP was never intended to match 4 years of medical school.

djc1981 · Jul 10, 2008

Yes, no one here is arguing the equivalency of the DNP to a physician. The OP seems to have a huge chip on his/her shoulder -- bordering on being a big ole' troll. Any more passive agressiveness should lead to banning the hairy thing under the bridge. :cool:

wowza · Jul 10, 2008

That said, I'm happy that alternative teaching strategies such as online classes are offered.

While online classes fit nicely into a tight schedule it also leaves the door open for inconsistent didactics and shoddy quality. Were there some sort of tight regulation, like the LCME, I would have less of a problem with it but as it stands it is troubling that many degrees can be obtained online without some stringent overarching quality control measures.

There is nothing inherent in the medical model that forces it to be soul-destroying. There are plenty of other fields with equally difficult if not more difficult content to master which do not place the same stresses on oneself.

I agree, but unfortunately with the volume of material to master and the time constraints to do so(most impt), stress is inherent in the job. This gets at the heart of the DNP/MD/DO debate. The medical model has condensed the necessary information into as little time as possible. The DNP model circumvents much of this information and then passes itself off as a primary provider. This is what many find troubling.

Yes, no one here is arguing the equivalency of the DNP to a physician. The OP seems to have a huge chip on his/her shoulder -- bordering on being a big ole' troll. Any more passive agressiveness should lead to banning the hairy thing under the bridge.

I think the OP was reacting to the nursing body's decision to lobby to get full practice rights for the DNP degree. Most of you openly assert that the DNP is not equal to the MD/DO. If this is the case then you should join OP and try to keep your leadership from lobbying for autonomous practice rights. To do otherwise is hypocritical.

djc1981 · Jul 10, 2008

while online classes fit nicely into a tight schedule it also leaves the door open for inconsistent didactics and shoddy quality. were there some sort of tight regulation, like the lcme, i would have less of a problem with it but as it stands it is troubling that many degrees can be obtained online without some stringent overarching quality control measures.
i agree, but unfortunately with the volume of material to master and the time constraints to do so(most impt), stress is inherent in the job. this gets at the heart of the dnp/md/do debate. the medical model has condensed the necessary information into as little time as possible. the dnp model circumvents much of this information and then passes itself off as a primary provider. this is what many find troubling.
i think the op was reacting to the nursing body's decision to lobby to get full practice rights for the dnp degree. most of you openly assert that the dnp is not equal to the md/do. if this is the case then you should join op and try to keep your leadership from lobbying for autonomous practice rights. to do otherwise is hypocritical.

nps are already autonomous in many states, and have autonomous prescriptive authority in most states. there looks to only be more autonomy coming in other states due to physician shortages. the genie is out of the bottle in that respect. sorry to disappoint ya, bro.

SteveNNP, MSN, NP · Jul 10, 2008

I think the OP was reacting to the nursing body's decision to lobby to get full practice rights for the DNP degree. Most of you openly assert that the DNP is not equal to the MD/DO. If this is the case then you should join OP and try to keep your leadership from lobbying for autonomous practice rights. To do otherwise is hypocritical.

The OP gave no indication of why he posted that information. Maybe he'll come back and enlighten us. Assuming he posted it as a reaction to lobbying is a mental stretch....

Like we said. We already have been proven safe caregivers with autonomous practice rights..... water under the bridge.

JDCitizen · Jul 10, 2008

Well something is going on: The Medical College of Georgia has multiple programs and it covers MDs / PAs / NP's (others):

Allied Health Sciences

Undergraduate Programs:

Biomedical and Radiological Technologies

Graduate Programs:

Advanced MHE and MS Degrees

Dentistry

DMD Program

Oral Biology Dual Degree Program

Residency Training Programs:

Advanced Education in General Dentistry

General Practice

Endodontics

Oral and Maxillofacial Surgery

Residency Training Programs

Clinical Nurse Leader Program

So in a medical school/hospital that does research as well develop new medical doctors what do you call the PhD who is not an MD but is teaching doing research in said school/hospital: Doctor.

I for one never said my training is that of a medical doctor. But wow down here in the South in Georgia there is a medical school that trains different "styles" of providers basically under one roof.

:eek: :banghead: :yawn:

Music in My Heart · Jul 10, 2008

1) I agree that a DNP and an MD are not of the same length nor rigor.

2) Many common health problems don't require the breadth and depth -- and the resultant cost -- of a medical doctor's education and training. They can be adequately treated by folks with no knowledge of surgery, no knowledge of OB, etc.

3) I'm personally of the opinion that many or most (perhaps even all) family practice and pediatric physicians are grossly overtrained for vast majority of the work they actually do.

As an example, my kid has had more health issues than most. The pediatrician is wonderful but largely serves as a point of contact to the various specialties. Besides all the referrals, all she's really done is write out a few antibiotic prescriptions and provide well-child exams. The *real* work has been done by the cardiologist, pulmonologist, ophthalmologist, and neurosurgeon.

I think the future of medicine will see more and more NP/PA folks filling the primary care roles and the MDs will exclusively be specialists. It would surely be a more cost-effective approach. Does it really take 4 years of med school and 3 years of residency to diagnose and write out a scrip for strep throat?

4) In response to whatever I read above about the MD being the pinnacle of academic rigor (to paraphrase) I would assert that most folks with the intellectual firepower to earn masters degrees in physics or engineering have the firepower to earn a medical degree; the converse is not at all evident to me.

I grow weary of that group of physicians who seem to believe that they are just a whole lot smarter and more sophisticated than everybody else. I know many without that attitude but it still seems predominant to me.

Advanced Practice Columnist / Guide · Jul 10, 2008

While online classes fit nicely into a tight schedule it also leaves the door open for inconsistent didactics and shoddy quality. Were there some sort of tight regulation, like the LCME, I would have less of a problem with it but as it stands it is troubling that many degrees can be obtained online without some stringent overarching quality control measures.

There are two accrediting bodies that oversee all types of nursing education programs similar to LCME. I understand that the Liason Committee on Medical Education is sponsored by the Association of American Medical Colleges and the American Medical Association. Similarly, the Commission on Collegiate Nursing Education or CCNE is an autonomous accrediting body sponsored by the American Association of Colleges of Nursing. This entity has been accrediting master's degree programs including NP programs across the US. They were also given the task to accredit DNP programs and is endorsed by the National Organization of Nurse Practitioner Faculties.

The National League of Nursing Accrediting Commission (NLNAC) is the other agency that grants accreditation to a larger variety of nursing programs from the associate's degree level all the way to the practice doctorate. You are welcome to check their websites and read the criteria these agencies use in ensuring that NP education across the US meets national standards. You see, nursing has been around for a long time and we have established our own mechanism to ensure quality in the training of our ranks from entry level RN's all the way to nurses desiring a terminal degree.

I feel that this is sufficient as we are all nurses and should be accredited by a nursing agency. Some may feel otherwise just because an agency that is not "attached" to medicine is accrediting NP programs. I strongly disagree with that.

I agree, but unfortunately with the volume of material to master and the time constraints to do so(most impt), stress is inherent in the job. This gets at the heart of the DNP/MD/DO debate. The medical model has condensed the necessary information into as little time as possible. The DNP model circumvents much of this information and then passes itself off as a primary provider. This is what many find troubling.

Prior to the advent of the DNP, NP's have already been training at the master's degree level and were already providing safe, cost-effective, and quality care to all types of patients. Primary care NP's have been able to practice with little physician involvement in rural and underserved areas of the country. There is approximately 1% of NP's who are independent but this number is likely inaccurate.

The DNP/MD/DO debate became heated when the Wallstreet Journal Article came about quoting Dr. Mundinger from Columbia University. I will tell you this though, that article has further clouded other professionals' perception of the DNP and the intention behind the new terminal degree for APN's. I have offered a link to the FAQ's on the DNP from the American Association of Colleges of Nursing in my previous post in this thread. Reading all the answers to the questions posted in that FAQ will give one a clear idea of why nursing chose to develop this degree and what it's about. I personally refer to this FAQ in addition to a similar FAQ by the National Organization of Nurse Practitioner Faculties as the only definitive information on the DNP (http://www.nonpf.org/NONPF2005/PracticeDoctorateResourceCenter/PDfaqs.htm).

Also for you own information, Dr. Mundinger's views are not shared by most NP groups as evidenced by a unified statement by a variety of national NP organizations in this link from the National Organization of Nurse Practitioner Faculties website: http://www.nonpf.org/DNPStatement0608.pdf. Though the statements made in this release does not clarify whether DNP's are seeking an expanded scope, it did not endorse Dr. Mundinger's proposed certification program developed by the NBMS.

I think the OP was reacting to the nursing body's decision to lobby to get full practice rights for the DNP degree. Most of you openly assert that the DNP is not equal to the MD/DO. If this is the case then you should join OP and try to keep your leadership from lobbying for autonomous practice rights. To do otherwise is hypocritical.

So can you tell me again which nursing organization is lobbying to get full practice rights for the DNP degree? Nurse practice acts that regulate the practice of NP's are bound by how they are defined by each state of jurisdiction. Change happens on a state by state level. If I were you, I would check with my own state and see what our NP's are up to. Chances are they are just minding their own business and taking care of their patients as usual.

wowza · Jul 10, 2008

So in a medical school/hospital that does research as well develop new medical doctors what do you call the PhD who is not an MD but is teaching doing research in said school/hospital: Doctor.
I for one never said my training is that of a medical doctor. But wow down here in the South in Georgia there is a medical school that trains different "styles" of providers basically under one roof.

There are a lot of things that are 'doctorates' and I have no problem calling any of them Dr X in an academic setting outside of the hospital. But, in a clinical setting, since the layman equates doctor with physician, I think the term doctor should only be used for MD, DO and DPM so that we dont confuse patients.

Technically an MD isnt really a doctorate since it is a first professional degree (and neither are anything else on that list except the PhD). Patients have no idea that recently pharmacy, physical therapy, nursing and a host of other programs created doctorates.

RN to Medschool · Jul 10, 2008

Long before the DNP became public, nurse practitioners have been providing primary care to many patients. The nurse practice acts of each state have provisions that allow this to happen. Physician involvement varies but that does not in any way discredit the fact that NP's have been providing primary care.

I feel there are two points, sure there have been states where NP's have a lot of autonomy, but where are the studies that show Care for patients has exceeded care by a Doctor? Patients satisfaction surveys are not even close to the right kind of study, we are talking about life and death here.

I want to see that the NP's are catching Diseases and properly treating and referring people, by themselves.

The Model I think is best is the Collaboration model, this is where a MD or DO is consulted on the cases, not all the routine but all the unusual and complicated. Why are so many Nurses and NP's against simple collaboration? Are not to work together? NP's are not licensed to practice Medicine.