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

bajasauce07 · Feb 24, 2010

I think you missed a majority of my post. Congratulations, you win. May your sunshine and happy thoughts independent clinic bring you many profits. But do me a favor and learn the Zebra's because if you don't know it's out there you will not recognize it. You can't prove to me that NP's that practice independently are not missing zebra's, but I can most definitely prove to you that most of them can't spell the "zebra's" must less recognize them which means very likely many would be missed. You say I'm incompetent if I can't explain something, which I in fact do. I say the definition of incompetent is not recognizing anything beyond "primary care" as I think you are defining it. There's a hole in your argument of not wanting to pay for certain things but having patients come to you so they can be referred to someone who know's more than just your definition of "primary care." Added referrals means aded costs. The rest of your replies are rather feeble attempts to dismiss my points without truly addressing them.

As far as how can patient satisfaction be important but not relevant? We are talking about patient OUTCOMES not who explains things better. Seriously, I am very worried about your definition of good healthcare!

mbreaz1 · Feb 24, 2010

I think you missed a majority of my post. Congratulations, you win. May your sunshine and happy thoughts independent clinic bring you many profits. But do me a favor and learn the Zebra's because if you don't know it's out there you will not recognize it. You can't prove to me that NP's that practice independently are not missing zebra's, but I can most definitely prove to you that most of them can't spell the "zebra's" must less recognize them which means very likely many would be missed. You say I'm incompetent if I can't explain something, which I in fact do. I say the definition of incompetent is not recognizing anything beyond "primary care" as I think you are defining it. There's a hole in your argument of not wanting to pay for certain things but having patients come to you so they can be referred to someone who know's more than just your definition of "primary care." Added referrals means aded costs. The rest of your replies are rather feeble attempts to dismiss my points without truly addressing them.
As far as how can patient satisfaction be important but not relevant? We are talking about patient OUTCOMES not who explains things better. Seriously, I am very worried about your definition of good healthcare!

So just explain so that everyone can hear why you don't want to face competition? Is it maybe because you have a terrible fear that you will lose out to it? If you provide so much more value, then why won't your patients see that and still come to you instead of going to the independently practicing nurse practitioner? If that were the case in my profession, I surely wouldn't battle so vehemently against it. I would welcome it so that I could defeat it and prove my point to everyone. If you truly believe all that you say, then wouldn't all of the independent nurse practitioners be out of business within weeks of opening the doors, whether they fell prey to the ultimately more valuable physicians or to the attorneys that would take the shirts off their backs for failing to recognize zebras?

bajasauce07 · Feb 24, 2010

ah but there's the rub, it generally takes years to kill someone in "primary care" none would be the wiser to the damage. And buddy, I'm a midlevel, I think you have me mistaken for an MD. I'm all for NP's and PA's in all areas of medicine. We serve an incredible role to the community and to healthcare in general. I wouldn't be an MD if you paid me, but that's the point. We didn't want to sacrifice that much. It still stands that if you want to practice independently, become a doctor, not some watered down nursing school with 600 clinical hours or a PA school which is, at best, 60%-75% of medical school with 1/4 the clinical hours (about 2300-3500 hrs worth of training). I'm not afraid of competition, I only stand to gain financially with what you propose. I'm worried about the disservice to a public who doesn't know the difference between a respiratory therapist and a doc, much less an DNP and an MD. The damage will be done over years and you seem to forget that we deal daily with human lives, not an easier paycheck.

mbreaz1 · Feb 24, 2010

ah but there's the rub, it generally takes years to kill someone in "primary care" none would be the wiser to the damage. And buddy, I'm a midlevel, I think you have me mistaken for an MD. I'm all for NP's and PA's in all areas of medicine. We serve an incredible role to the community and to healthcare in general. I wouldn't be an MD if you paid me, but that's the point. We didn't want to sacrifice that much. It still stands that if you want to practice independently, become a doctor, not some watered down nursing school with 600 clinical hours or a PA school which is, at best, 60%-75% of medical school with 1/4 the clinical hours (about 2300-3500 hrs worth of training). I'm not afraid of competition, I only stand to gain financially with what you propose. I'm worried about the disservice to a public who doesn't know the difference between a respiratory therapist and a doc, much less an DNP and an MD. The damage will be done over years and you seem to forget that we deal daily with human lives, not an easier paycheck.

So now we have identified your real problem with all of this. You don't want NPs to have the right to practice independently while PAs will never get that right. So you really don't stand to gain financially. The real point is that this has been working in a number of states for years already and it will eventually work in all 50. You needn't worry yourself about a public disservice. There is an important legal doctrine that you apparently aren't aware of that affects every transaction that occurs in our country, caveat emptor. As long as the difference is disclosed, people have the freedom to contract for themselves with whomever they choose. And spare me the garbage about "we deal with human lives" and "it could compromise the quality of care". What a load.

wowza · Feb 24, 2010

How can patient satisfaction be important, but irrelevant at the same time? If you work solely in inpatient medicine, then why are you trying to act as if your experiences have any relevance in the primary care arena? I have only discussed independent practice for nurse practitioners in the primary care arena.

Patient satisfaction is important to keeping your patients happy and coming back. It is completely irrelevant to the quality of care you deliver. That's how.

mbreaz1 · Feb 24, 2010

Patient satisfaction is important to keeping your patients happy and coming back. It is completely irrelevant to the quality of care you deliver. That's how.

So what you are saying is that you can do a terrible job and still deliver good service? I don't think so. You can't separate the two in any business. If you didn't satisfy the customer, you didn't do your job. You just made the most ludicrous statement I have ever heard in my life. You might want to think about things before you post so that you don't sounds like a complete idiot next time.

wowza · Feb 24, 2010

So just explain so that everyone can hear why you don't want to face competition? Is it maybe because you have a terrible fear that you will lose out to it? If you provide so much more value, then why won't your patients see that and still come to you instead of going to the independently practicing nurse practitioner? If that were the case in my profession, I surely wouldn't battle so vehemently against it. I would welcome it so that I could defeat it and prove my point to everyone. If you truly believe all that you say, then wouldn't all of the independent nurse practitioners be out of business within weeks of opening the doors, whether they fell prey to the ultimately more valuable physicians or to the attorneys that would take the shirts off their backs for failing to recognize zebras?

It has absolutely nothing to do with competition. There will always be plenty of patients for doctors. Most doctors will also never compete with DNPs or NPs. The entire issue is that the training of the DNP is not equivalent to a doctor's training. Acting like it is as good is irresponsible. See the earlier posts in this thread for the obvious details on the difference between the two, the 50% fail rate of the watered down step 3 with the lower minimum passing score, the fluff courses that take the place of real pathophysiology, pharmacology and the like and the other things that have been talked about.

Medicine is getting more complex everyday. Acting like PCPs should get less training instead of more is utterly ridiculous. That is the reason why family practice docs increased the length of their residency recently. There was just too much to get done in the shorter time frame. If you don't want that long of training, great. But you shouldn't have abreviated training without someone looking over your shoulder.

So now we have identified your real problem with all of this. You [bajasauce] doesn't want NPs to have the right to practice independently while PAs will never get that right.
You needn't worry yourself about a public disservice. There is an important legal doctrine that you apparently aren't aware of that affects every transaction that occurs in our country, caveat emptor. As long as the difference is disclosed, people have the freedom to contract for themselves with whomever they choose. And spare me the garbage about "we deal with human lives" and "it could compromise the quality of care". What a load.

You realize that if NPs get independent practice rights, PAs will get the exact same thing soon after. Baja knows that and apparently knows and respects his/her limitations of training. The most dangerous thing possible in medicine is someone who does not understand just how much they don't know.

The eye can't see what the mind doesn't know. You don't even acknowledge that your training is inferior to an MDs. When someone is ignorant of how much they don;t know, people can get hurt. I hope that never happens to you but with that attitude you are likely to get burned.

And the difference is not disclosed but is rather covered up by the nursing leadership who claim that the education is the exact same.

bajasauce07 · Feb 24, 2010

Ah, so you've discovered the plot have you? No sir, my profession nearly followed in the same foolish footsteps with the whole doctoral degree. Luckily wiser heads prevailed and it has not become mainstream as of yet. No, my profession seems to closely follow yours just to keep up with the joneses if for nothing else. I actually would stand to gain from the situation even if not immediately so. I neither want or desire independency, only autonomy under a physician. I simply am of the opinion that so many of your own colleagues share. Don't let your hubris harm your profession or your patients.

as far as this statement:

"So what you are saying is that you can do a terrible job and still deliver good service? I don't think so. You can't separate the two in any business. If you didn't satisfy the customer, you didn't do your job. You just made the most ludicrous statement I have ever heard in my life. You might want to think about things before you post so that you don't sounds like a complete idiot next time."

You're right, one of us does sound that way....

The problem is that I can guarantee I know more than you. hands down, a medical knowledge bowl etc. And even then I don't foolishly think I could do it on my own. That's not what my degree is for, neither is yours. you want to play doctor? BECOME ONE

wowza · Feb 24, 2010

So what you are saying is that you can do a terrible job and still deliver good service? I don't think so. You can't separate the two in any business. If you didn't satisfy the customer, you didn't do your job. You just made the most ludicrous statement I have ever heard in my life. You might want to think about things before you post so that you don't sounds like a complete idiot next time.

That is a strawman argument. Service is not directly measured by patient satisfaction!

But yes, you can have happy patients and still deliver terrible care. Conversely, you can deliver excellent care and have your patients hate you because of bedside manner. So patient satisfaction is a terrible metric of quality of care because it is unrelated to quality.

They are neither mutually exclusive nor mutually inclusive.

dgenthusiast · Feb 24, 2010

So what you are saying is that you can do a terrible job and still deliver good service? I don't think so. You can't separate the two in any business. If you didn't satisfy the customer, you didn't do your job. You just made the most ludicrous statement I have ever heard in my life. You might want to think about things before you post so that you don't sounds like a complete idiot next time.

Unfortunately a hospital is not a hotel. The primary goal of physicians is to make a sick person better, not cater to their every needs in hopes that their customer satisfaction rating is high. And I don't think wowza's the one who sounds like an idiot either.

You fail to understand that satisfaction has nothing to do with outcomes. If you're incredibly nice to the patient, cater to his every need, but do a poor job in actually treating him, he'll still likely think you're the greatest doctor in the world. Just because you listened to him (because you know, all the other docs that don't listen are just meanies). It doesn't matter whether you actually fixed the problem or not.

That's the problem with using patient satisfaction surveys to assess medical competency. They're completely unrelated. Maybe now you finally understand? And maybe now you can finally stop using patient satisfaction as an indication of NP/DNP competency?

mbreaz1 · Feb 24, 2010

It has absolutely nothing to do with competition. There will always be plenty of patients for doctors. Most doctors will also never compete with DNPs or NPs. The entire issue is that the training of the DNP is not equivalent to a doctor's training. Acting like it is as good is irresponsible. See the earlier posts in this thread for the obvious details on the difference between the two, the 50% fail rate of the watered down step 3 with the lower minimum passing score, the fluff courses that take the place of real pathophysiology, pharmacology and the like and the other things that have been talked about.
Medicine is getting more complex everyday. Acting like PCPs should get less training instead of more is utterly ridiculous. That is the reason why family practice docs increased the length of their residency recently. There was just too much to get done in the shorter time frame. If you don't want that long of training, great. But you shouldn't have abreviated training without someone looking over your shoulder.
The issue with training is that physicians are overtrained and overpaid to provide primary care. We need look no further for evidence of this than to see that nurse practitioners do the job just as good as physicians. That is why we have doctors falling all over themselves to close down retail clinics and keep them from advertising their prices. There is no way to explain why someone would want to unfairly restrict trade. Every profession gets more complex everyday, that's why you have continuing professional education. The only reason that family practice docs increased their length of residency is because they think it will mean that they get the pay increases they keep clamoring for.
You realize that if NPs get independent practice rights, PAs will get the exact same thing soon after. Baja knows that and apparently knows and respects his/her limitations of training. The most dangerous thing possible in medicine is someone who does not understand just how much they don't know.
Nothing of this sort is true. Won't happen because their training is so far inferior to that of NPs.
The eye can't see what the mind doesn't know. You don't even acknowledge that your training is inferior to an MDs. When someone is ignorant of how much they don;t know, people can get hurt. I hope that never happens to you but with that attitude you are likely to get burned.
And the difference is not disclosed but is rather covered up by the nursing leadership who claim that the education is the exact same.

You think physician training is superior, when actually it is just excessive. Nobody in the nursing leadership claims it is the same, only that it is more than adequate and not excessive. What they claim it to be is efficient, something physicians can't seem to comprehend.

mbreaz1 · Feb 24, 2010

Ah, so you've discovered the plot have you? No sir, my profession nearly followed in the same foolish footsteps with the whole doctoral degree. Luckily wiser heads prevailed and it has not become mainstream as of yet. No, my profession seems to closely follow yours just to keep up with the joneses if for nothing else. I actually would stand to gain from the situation even if not immediately so. I neither want or desire independency, only autonomy under a physician. I simply am of the opinion that so many of your own colleagues share. Don't let your hubris harm your profession or your patients.
Explain to my why exactly it is that you think only nurse practitioners are in favor of independent practice?
as far as this statement:
"So what you are saying is that you can do a terrible job and still deliver good service? I don't think so. You can't separate the two in any business. If you didn't satisfy the customer, you didn't do your job. You just made the most ludicrous statement I have ever heard in my life. You might want to think about things before you post so that you don't sounds like a complete idiot next time."
You're right, one of us does sound that way....
The problem is that I can guarantee I know more than you. hands down, a medical knowledge bowl etc. And even then I don't foolishly think I could do it on my own. That's not what my degree is for, neither is yours. you want to play doctor? BECOME ONE

You have no idea what my degree is for, I told you earlier about assuming.