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

mbreaz1 · Feb 26, 2010

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.

I think that the medical profession places a lot of importance on titles. Most other professions have dropped the use of mister as a title. The medical profession still seems to perpetuate this sort of weird paternal requirement for respect of someone's education and wisdom. I find it rather strange that someone would still introduce themselves as "Dr. X" or that they would require anyone to call them that. This tends to only happen with old men or people in formal settings such as courtrooms and political assemblies. Any doctor/patient or doctor/nurse or other health professional relationship doesn't require such formality. It seems to me that the practice has just been kept up to stroke the physician's egos. It is really a silly and antiquated practice. I would never dream of calling any doctor that I went to or worked with by Dr. surname, regardless of what they wanted to be called. As a result, I don't see why there is a rub with an NP getting a doctorate degree. What is wrong with introducing yourself as James Madison, your physician? I think it must be that physicians would be offended by the fact that the NP could call themselves doctor while having a different education. The letters after the name are what lets people know the difference, so what is the big controversy the two letters that precede the name? If people are smart enough to know their alphabet, I think they can determine that there is a definitive difference between MD and DNP.

mbreaz1 · Feb 26, 2010

Actually my point that you keep creating strawman arguments is very valid. Especially since you have done it a few times since I posted my "tirade" about the inconsistencies of your arguments.
Your post above is again a strawman argument. I made no claim that the AMA was or was not against competition. What I said was this argument is not about DNPs competing against doctors because there are enough patients to go around. What it is about (as I said in the post you are referring to) is that it is about lowering standards. Stop misquoting me and please stop using Strawman arguments.
I'll strawman you all that I please and I didn't misquote you, but I'm glad you agree that the AMA is anticompetitive. What a relief to hear that. I'll ask you to stop posting tirades as well. There are absolutely no inconsistencies in my arguments. You are the one who is being inconsistent and hostile.
Yet again a strawman argument.
What he said was that, residencies do not care what medical school an applicant went to because the education is standardized at a high quality. It was in support of my claim that it doesn't really matter if you go to harvard or a "low tier" school because the education will be just as good. It was also in support of the strict LCME accredidation standards.
And for the record, the accredidation process is not anticompetitive. It will allow anyone to create a school as long as they meet the required standards of the LCME. If you want to set up a school. Great. You can. You just need to meet the appropriate standards. If you are really worried about it, you can still open up a medical school in the US that will be unaccredited.
The point is that none of this proves that medical education is of a higher quality than NP education, it simply proves that there are quantity differences that result in overkill.
Good point.
Note that osteopathic schools have been expanding rapidly. The osteopathic students take the exact same courses as MD students (but add a manipulation technique called OMM) and have the same hours in rotations.

They are still self governed accreditation processes that are designed to limit availablility and have been from the very start. I will direct you to my points on the Flexner report. Haven't heard any rebuttals to the inconsistencies there yet.

mbreaz1 · Feb 26, 2010

Osteopathic medical schools have, on average, higher tuitions than LCME schools despite being regulated by the AOA. And the AOA is certainly less anti-competitive in its accredidation policies; the number of osteopathic seats has rapidly outpaced that of allopathic school, with new schools and expansion branch campuses opening practically every year. They have even allowed the accredidation of a private for-profit school (RVU in Colorado). I would also add that most offshore/Caribbean med schools have similar tuitions despite also not being under LCME regulation.
I can't see clear evidence that the restrictive monopolistic accredidation tactics of the "AMA" are to blame for high med school tuition given that most non-LCME schools (ie, those in direct competition for students with the LCME schools) have even higher costs.

Not really such a good point. Some Caribbean med schools are accredited, and most of them do cost less. How do you make the determination that the AOA is less anti-competitive in its accreditation policies? Also, nobody ever said that the AMA was to blame for high med school tuition. Furthermore, just because new schools are opening doesn't mean that supply is outpacing demand.

bajasauce07 · Feb 26, 2010

MBREAZ I call strawman on my post, The provider in my example was not lying, I said his actions were not malicious, perhaps he did not know, or he forgot for that patient to start appropriate therapy, Either way, you prove my point you admitted that the patient would have no Idea if the provider was lying, still be happy with the care/provider and continue about his way. I believe with your admission that I am right I am done with this thread. It's like banging my head against a brick wall, only without any of the pleasure of the exercise. I bid you all adieu.

mbreaz1 · Feb 26, 2010

MBREAZ I call strawman on my post, The provider in my example was not lying, I said his actions were not malicious, perhaps he did not know, or he forgot for that patient to start appropriate therapy, Either way, you prove my point you admitted that the patient would have no Idea if the provider was lying, still be happy with the care/provider and continue about his way. What is your degree? It is obvious you have difficulty with the most basic practices and premises of medicine. I believe with your admission that I am right I am done with this thread. It's like banging my head against a brick wall, only without any of the pleasure of the exercise. I bid you all adieu.

My point is not that you are right under normal circumstances, just that when a provider acts in an unethical manner and lies to their patient, yes you can conceal the truth about what type of care you are providing. The provider lied when they told the patient that the kidney disease was just a part of being diabetic instead of disclosing the fact that they made a mistake. It is easy to make someone think you are doing a good job if you lie to them. So what you are saying is that all NPs will lie to their patients in order to make them think they are doing a good job and thus have patient satisfaction? What is your degree? This isn't a basic premise in medicine, you are trying to make an argument about someone lying to their patient and thus it makes your example completely ridiculous. It doesn't prove your point at all.

Ranier · Feb 26, 2010

I'm not sure what you mean when you state that some Caribbean schools are accredited. Neither the LCME nor the AOA accredit offshore schools, and given that these are the accreditation bodies under discussion here, your statement is not true. If you are instead conflating the issue and referring to other international accrediting agencies or to the four schools that have a handful of state-specific approvals, then the point is just irrelevent.

As for tuition in the Caribbean, it's impossible to keep track of all schools as they are constantly opening/closing, gaining/losing WHO listing status, etc. but I do know that all of the Big 4 (Ross, SGU, AUC and Saba) have tuition on par with US schools, ranging from the mid-20's to low-30's annually.

As for who is claiming that the AMA was to blame for high med school tuition, any reasonable reader should infer that to be the intent of your post (319), as you wrote it in direct response to a poster discussing LCME accredidation. Perhaps you were just unclear. You also suggested that med schools sustain high tuition by keeping numbers down, which is revealed to be a flimsy claim given the rich example of the AOA and osteopathic schools. They are expanding seats rapidly, literally quadrupling their enrollments in the last two decades and opening dozens of new schools, and yet their tuitions are not falling and in fact have increased to an even greater level than the LCME schools. DO expansion is a remarkable phenomemom, incidentally. Right now about 5-8% of physicians in the US are DO's, but today 20% of med students are in DO programs and that figure will reach 25% in the next decade. Anyway, clearly the high tuition at DO schools is not resultant of keeping seats limited. Rapid expansion and low(er) admission standards have not made AOA or Big 4 Caribbean schools any cheaper.

How do I make the determination that the AOA is "less anti-competitive" in its accredidation policies? Well, first I use the term anti-competitive in the spirit with which is has been used in numerous prior posts- that is, to mean harboring policies which intentionally limit the number of seats in medical schools for the purposes of maintaining artificially low supplies in exchange for among other things the ability to charge higher tuition to students. Obviously there are other, more accurate, interpretations of the word. But the AOA is clearly willing to allow greater (practically out of control, given the limited osteopathic residency slots) expansion and to relax its accredidation standards to the point of approving for-profit status schools (something that the LCME strictly forbids) and so on those two points I find them to be less anti-competitive

Ranier · Feb 27, 2010

A simple example of providing poor care to a happy patient who remains oblivious to the consequnces of that poor care: prescribing antibiotics inappropriately. A lot of patients still believe that antibiotics cure colds. These people are happier with the providers who "do something" rather than telling them to wait it out and it will go away on its own. They've been known to doctor-shop or bounce around walk-in clinics until they find a provider who gives them what they want. God, we see these people daily in the ED. Of course, by the time they finish that ten-day amoxicillin prescription, their self-limited viral URI will have run its natural course and gone away on its own, but they will attribute the recovery to the abx and be grateful to the provider who really took their symptoms seriously and did something to help them. Same thing could apply even with some bacterial infections like otitis media in young children. Some people really don't like it when they present with a sore throat or N/V/D and walk out with just a test order for a culture. Its the standard of care, but they just want their drugs. Will it harm anyone in the long run to take an antibiotic for the viral pharyngitis or gastroenteritis that's on its way to getting better in a few days anyway? Of course, but not directly enough that they are likely to recognize the effects anytime soon.

Editorial Team / Admin · Feb 27, 2010

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