Do you think NP's are "midlevels"?

hypocaffeinemia, BSN, RN · Jul 8, 2008

When you say "doctor" do you mean a doctor of nursing practice, or the other doctor that goes to school for the same period of time as a DNP (e.g. DNP=4 years BSN/2 years MSN/2 years DNP; MD=4 years of undergrad + 4 years of medical school)?

I don't think you want to compare length of programs with MD/DO.

The actual hours of MD/DO-- both didactic and clinical, far exceed DNP and that doesn't include their essentially mandatory 3+ year residencies.

I have nothing against DNPs in the least-- in fact, it's a path I plan to pursue over the next decade-- but it's dishonest to claim the programs take the same length of time to complete.

Dr. Tammy, FNP/GNP-C · Jul 8, 2008

I don't think you want to compare length of programs with MD/DO.

Actually, that was my intent. What is dishonest is not stating the facts. Please let me know of a pathway where one can obtain their DNP in under 8 years. I'd really like to know.

Oh, and as far as residencies-First not required for the MD degree-its actually for board certification after licensing, so you are comparing one thing against something totally different, two, residencies are also available for NP's, third, you forget to take into account that RN's have at least one year (and in my program-an average of 10 years) of experience before entering into an NP program where as there is no such requirement for medical school. Lastly, you need to take into account the fact that premed is nothing about clinical where as the BSN is all clinically focused.

I do agree that med school is completely different then that of the DNP and rightly so, but to suggest that one is inferior over the other related to straight time and end product is, well something I would expect to see on some student doctor forum.

DaisyRN, ACNP · Jul 8, 2008

whether or not someone prefers a physician over a mid-level is his or her decision to make. however, i think a great deal of hesitation to see a npp is due to a lack of understanding of the role or a previous bad experience or "horror" stories. i have encountered all of these issues in my new np role and just have to work with it. i will have patients regardless... and i have patients that only want to see me in the future. it goes both ways.

as for the time it takes to do the programs... a dnp and md *are* the same amount of time (a doctoral degree is a doctoral degree is a doctoral degree), without residency factored in which can account for 1-4 additional years. my stating this is absolutely not opening the door to arguing for or against the dnp degree. i am not discussing the dnp here... i just wanted to comment on the length of time it does take and clarify that the timeframe for most doctoral degrees, regardless of dnp vs md vs phd vs pharmd, is all the same.

also, let me encourage you to consider the educational background of the sources of conflicting information and realize that there is likely a learning curve. it all comes back to educating one another...

RN to Medschool · Jul 9, 2008

whether or not someone prefers a physician over a mid-level is his or her decision to make. however, i think a great deal of hesitation to see a npp is due to a lack of understanding of the role or a previous bad experience or "horror" stories. i have encountered all of these issues in my new np role and just have to work with it. i will have patients regardless... and i have patients that only want to see me in the future. it goes both ways.
as for the time it takes to do the programs... a dnp and md *are* the same amount of time (a doctoral degree is a doctoral degree is a doctoral degree), without residency factored in which can account for 1-4 additional years. my stating this is absolutely not opening the door to arguing for or against the dnp degree. i am not discussing the dnp here... i just wanted to comment on the length of time it does take and clarify that the timeframe for most doctoral degrees, regardless of dnp vs md vs phd vs pharmd, is all the same.
also, let me encourage you to consider the educational background of the sources of conflicting information and realize that there is likely a learning curve. it all comes back to educating one another...

hi, i'm new but been here before, you see i'm an rn for the past 20 years, and decided instead of np to go to medical school.

i'm in my 4th year now.

now to the above

here's the dnp program from university of md

university of maryland dnp program:
quote:
doctor of nursing practice
sample plan of full-time study
the program requires a minimum of 38 credits comprised of 19 credits of core courses, 15 credits of specialty electives, and 4 credits for a capstone project. full-time or part-time options are available.
first semester (fall) course title credits
ndnp 802 methods for evidence-based practice 3
ndnp 804 theoretical and philosophical foundations
of nursing practice 3
ndnp xxx specialty elective 3
ndnp 810 capstone project identification 1
total 10
second semester (spring) course title credits
ndnp 805 design and analysis for evidence-based practice 4
ndnp 807 information systems and technology for the
improvement and transformation of health care 3
ndnp xxx specialty elective 3
ndnp 811 capstone ii project development 1
total 11
third semester (summer) course title credits
ndnp xxx specialty elective 1
ndnp 809 complex healthcare systems 3
ndnp 812 capstone iii project implementation 1
total 5
fourth semester (fall) course title credits
ndnp 815 leadership and interprofessional collaboration 3
ndnp xxx specialty elective 8
ndnp 813 capstone iv project evaluation & dissemination 1
total 12
total credits total credits
total credits 38

how is this compared to medical school again? the courses are not even close to what i did, this is two years, medical school is 4, plus the 3 years of residency i have before me to be a family practitioner? you only do 2 years to come out and practice in the dnp program.

i'm sorry but they are in no way equal, not to mention there are some dnp programs all done over the internet. medical school cannot be done on the internet and by law in some state you will not be licensed.

look i'm not here to argue but this "i'm a doctor" just like a md scares me and is not lawful, you will not be licensed to practice medicine as a physician but be licensed as a nurse practitioner.

some states have already enacted laws that physicians are to be called "doctor" in the clinical setting to help with the confusion.

np's, pa's dnp's can be and are valuable care givers and are needed in the health care system but this should not be to replace physicians, it is not meant to do that, it is meant to deliver a higher level of care to the public, that scheme includes physcians not excludes them.

RN to Medschool · Jul 9, 2008

Oh, and as far as residencies-First not required for the MD degree-its actually for board certification after licensing, so you are comparing one thing against something totally different,

This is 100% wrong

US MD grads can be licensed after 1 year of residency true but cannot practice without finishing a residency, it is all specialties now, Family practice is 3 years, IM 4 years, you cannot just "Practice" you need the full license, if they are a FMG then they must complete a residency before License, at least 3 years.

No insurance company will pay for care without this anyway.

RN to Medschool · Jul 9, 2008

premed is nothing about clinical where as the BSN is all clinically focused.

As I said I'm an RN, for 20 years, Trauma, ICU, ED and Homecare.

Uh I have been to medical school and I gotta tell you, you are far from the truth here, Nursing is different then Medical School and did not prepare me well for it, it is not the same and the other Nurses and even 2 NP's who went to my school said the same thing. It proved to us that there are vast differences in what we are taught, how we are taught and what to focus on. Nursing focuses on more Psych social and care delivery issues, as well as prevention, Medicine focuses on Diagnosis and Treatment more, just the way it is.

and the amount of knowledge, heck I study all the time and just about never stop.

core0 · Jul 9, 2008

This is 100% wrong
US MD grads can be licensed after 1 year of residency true but cannot practice without finishing a residency, it is all specialties now, Family practice is 3 years, IM 4 years, you cannot just "Practice" you need the full license, if they are a FMG then they must complete a residency before License, at least 3 years.
No insurance company will pay for care without this anyway.

For someone that purports to be in medical school you certainly need to study more. First IM=3 years. Second you can practice in many states after finishing one year of residency (1-3 if an IMG). There are only a few states that you need to finish a residency to practice in. You are correct about being credentialled with insurance companies. So that would be a 33% mark on this post. For more information on licensing requirements please visit the FSMB here:

http://www.fsmb.org/usmle_eliinitial.html

Welcome to allnurses

David Carpenter, PA-C

RN to Medschool · Jul 9, 2008

Core0 You fullfill my expectations of a PA, LOL Insults are very mature......

IM is now 4 years in many progrems, there are a Few that are 3 Years, , I was speaking in general but when Nurses and PA's start to argue, emotions are used as facts. This is one reason why I'm becoming a Doctor verses staying an RN, just tired of the BS in the profession.

For someone that purports to be in medical school

Yea right as much as we are to believe you are a PA-C,

I will not prove my resume on the forum. But what has been posted here about Medical training is wrong, I'm in my 4th year of Medical School.

2 years of Basic science and 2 years of clinicals, then you are a MD but with a training License,

US grads can get a full License in many states after 1 yr Residency

FMG grads can get a Full License in 3 yrs Residency

Licensing is state by state not universal.

people tend to insult others on these forums when they are frustrated when faced with the facts posted.

MD's and DO's have years more training then a PA/NP/DNP in Medicine, it is a fact that undisputatble.

I do not consider my 20 years as an RN medical training and neither do the Medical Schools.

RN to Medschool · Jul 9, 2008

CORE0, it must frustrate you that DNP's, NP's and PA's will not by law be called Doctor in the clinical setting, if you want that there is Medical School.

As far as training for full License Here's Ga law for an example

Applicants must have official transcripts of all medical and premedical education
mailed directly to the Board from the school where such education was taken. If the
transcripts are in a foreign language, applicants must furnish a certified English
translation. Transcripts must include the dates the applicant attended the school and the
grades received in all courses taken to fulfill the requirements of the degree granted. In
the Board's discretion, the transcript requirement may be waived and the results of the
Federation of State Medical Boards (FSMB) verification service may be accepted if the
applicant adequately demonstrates that all diligent efforts have been made to secure
transcripts from the school. In such a case, the Board may require the applicant to appear
for a personal interview before the Board or the committee.
(d) Proof of post-graduate/residency training as follows:
1. This requirement does not apply to applicants who were licensed in another state on or
before July 1, 1967.
2. Graduates of United States medical schools must complete post-graduate year one in a
program approved by the Accreditation Council for Graduate Medical Education
(ACGME), the American Osteopathic Association (AOA) or the Royal College of
Physicians and Surgeons of Canada or the College of Family Physicians of Canada
(CFPC).
3. Graduates of Canadian medical schools must complete postgraduate year one in a
program approved by the Accreditation Council of Graduate Medical Education
(ACGME), the American Osteopathic Association (AOA), or the Royal College of
Physicians and Surgeons of Canada or the College of Family Physicians of Canada
(CFPC).
4. For graduates of all other foreign medical schools and Fifth Pathway applicants:
(i) Applicants who graduated from medical school on or before July 1, 1985 must
complete one year of post-graduate training in the United States in a program approved
by the Accreditation Council of Graduate Medical Education (ACGME) or the American
Osteopathic Association (AOA) or one year of post-graduate training in Canada in a
program approved by the Royal College of Physicians and Surgeons of Canada or the
College of Family Physicians of Canada (CFPC).
(ii) Applicants who graduated from medical school after July 1, 1985 must complete
three years of post-graduate training in the United States in a program approved by the
Accreditation Council of Graduate Medical Education (ACGME) or the American
Osteopathic Association (AOA) or three years of post-graduate training in Canada in a
program approved by the Royal College of Physicians and Surgeons of Canada or the
College of Family Physicians of Canada (CFPC). The Board may consider current
certification of any applicant by a member board of the American Board of Medical
Specialties as evidence that such applicant's postgraduate medical training has satisfied
the requirements of this paragraph.
(e) Graduates of foreign medical schools outside of Canada must provide proof of
certification by the Educational Commission for Foreign Medical Graduates (ECFMG)

I put in bold the 3 years.

This is typical of many states laws and should be the standard posted.

You see Medical Students do not pick the lowest standard as a rule we pick the highest.

Good Luck

RN to Medschool · Jul 9, 2008

PA's in GA are kept under close Physician supervision even in satellite offices:

360-5-.08 Remote Practice Sites. Amended.
(1) In addition to the requirements of licensure outlined elsewhere in these rules,
Physician’s Assistants applying for remote site approval shall be required to provide
appropriate documentation of one year of acceptable clinical experience or one year of
post-graduate training approved by the board.
(2) In addition to the documentation required to be submitted in connection with an
application for licensure as a Physician’s Assistant contained elsewhere in these rules, the
supervising physician shall submit a letter of intent to utilize a Physician’s Assistant in a
remote site, to be accompanied by a proposed utilization plan addressing the criteria
outlined in Rule 360-5-.08(3).
(3) The remote site must qualify as a principal office where the supervising physician(s)
regularly sees patients. For the purposes of this section principal offices shall mean an
office, clinic, or facility maintained by the supervising physician(s) for the purpose of
providing primary care services and at which the supervising physician( s) is physically
present for at least 25% of the time the site is open for patient care or calls. For purposes
of this Rule, a supervising physician may qualify no more than three offices or practice
settings as principal offices.
(a) To qualify as a “remote site”, it must be shown to the satisfaction of the Board that
there is a shortage and a maldistribution of health care services. The following factors
may be considered: (i) the physician-patient ratio in the area in question; (ii) the distance
between patients and existing physicians or other medical facilities; (iii) the
maldistribution of particular types of specialty care; (iv) whether the area is designated or
eligible for designation at the time of application by the Secretary of Health and Human
Services as a “Health Manpower Shortage Area” pursuant to 42 U.S.C. Sec. 254(e); (v)
any other factors which are indicative of shortage and maldistribution of health care
services or any other factors which are indicative of an absence of adequate physician
services in or reasonably accessible to the area in question.
(b) The Physician’s Assistant to be utilized in the remote site must meet the requirements
of Rule 360-5-.03(b).
© The supervising physician(s) must be available for supervision at the remote site as
needed and shall be immediately available to the physician’s assistant for consultation
and supervision either personally or via telecommunications. Provided, however, that the
supervising physician shall be physically present to review patient records and personally
provide patient care at the remote site as needed and at a minimum of at least twice
weekly and provided further that the supervising physician must provide patient medical
record review on a daily basis.
(d) Any patient seen on a regular basis by the Physician’s Assistant shall be scheduled to
be seen by the supervising physician at routine intervals as deemed necessary in the
particular setting and as outlined in the physician application and proposed job
description.
(e) A predetermined plan for the initial management and referral of emergencies must be
established for each individual site and submitted in the physician application and
proposed job description.
(f) All entries made by the Physician’s Assistant in patient medical records must be
co-signed by the supervising physician(s) within

In regular settings:

360-5-.04 Changes in Job Descriptions or Applying Physicians. Amended.
(1) When a physician applies to supervise a Physician’s Assistant who has previously
been certified by the Board, the Board may issue a written notice of temporary approval;
provided, however, that the Physician’s Assistant’s duties shall be limited to those
contained in the Basic Job Description.
(2) A Physician’s Assistant may only perform those tasks which are specified, and for the
physician(s), named, in his job description then currently on file with and approved by the
Board; provided, however, that tasks outside the job description may be performed by the
Physician’s Assistant under the direct supervision and in the presence of the physician(s)
utilizing him. Provided further, however, that the Board will not approve any task or
procedure in a Physician’s Assistant job description which is experimental or
investigational; for the purpose of this last proviso acupuncture is deemed by the Board to
be an experimental procedure.
(3) Requests for changes in the job description of the Physician’s Assistant, including
addition of specialized duties and tasks, shall be submitted by the supervising
physician(s) to the Board for prior approval.
(4) Termination of a Physician’s Assistant/Applying Physician(s) relationship.
Immediately upon termination of the physician/Physician’s Assistant’s relationship, the
Physician’s Assistant and the applying physician are required to give notice and date of
termination to the Board by certified mail. Failure to notify the Board immediately may
result in disciplinary action against the Physician’s Assistant and/or the applying
physician(s). Expiration of license and identification card by failure to renew will not be
considered an exception of the requirements of this paragraph.
Authority O.C.G.A. Secs. 43-1-25, 43-34-103, 43-34-108. History. Original Rule entitled “Changes in Job
Descriptions or Applying Physicians” adopted. F. Sept. 11, 1972; eff. Oct. 1, 1972. Amended: F. Sept. 16,
1974; eff. Oct. 6, 1974. Repealed: New Rule of same title adopted. F. Dec. 4, 1981; eff. Jan. 1, 1982, as
specified by the Agency. Amended: F. Apr. 8, 1985; eff. Apr. 28, 1985. Amended: F. Sept. 6, 1985; eff.
Sept. 26, 1985. Amended: F. July 15, 1988; eff. Aug. 4, 1988. Amended: F. Mar. 18, 1998; eff. Apr. 7,
1998.

If you are not practicing this way in GA ( as the other PA's ) then the law is being broken.

Not a good thing.

Dr. Tammy, FNP/GNP-C · Jul 9, 2008

I'm sorry but they are in no way equal

I agree and it sounds like you have experience to back that up since you have been through both DNP and MD training.

Medical school cannot be done on the internet and by law in some state you will not be Licensed.

Really? http://www.medscape.com/viewarticle/443292

Look I'm not here to argue but this "I'm a Doctor" Just like a MD scares me and is not lawful, you will not be Licensed to practice medicine as a physician but be licensed as a Nurse Practitioner.

It scares me, too. Thats why policy, regulation and statute has to be enacted to protect the consumer. All physicians should have to clearly state with each pt. encounter that they are not trained DNP's and that their doctorate degree is only in medicine and they have no training or license to practice nursing, either on a basic or advance level.

Some states have already enacted laws that Physicians are to be called "Doctor" in the clinical setting to help with the confusion.

To true. And at one time there were no states in which APN's could practice independently. Thank goodness wisdom, experience and common sense (coupled with consumer-support based on outcomes and evidence) continues to prevail which is why NP's can practice independently in 23 states.

NP's, PA's DNP's can be and are valuable care givers and are needed in the health care system but this should not be to replace Physicians, it is not meant to do that, it is meant to deliver a higher level of care to the public, that scheme includes Physcians not excludes them.

I agree, and I also feel that there is even room and a place for physicians too.

Dr. Tammy, FNP/GNP-C · Jul 9, 2008

As I said I'm an RN, for 20 years, Trauma, ICU, ED and Homecare.
Uh I have been to medical school and I gotta tell you, you are far from the truth here, Nursing is different then Medical School and did not prepare me well for it, it is not the same and the other Nurses and even 2 NP's who went to my school said the same thing.

Just curious, did you have to go through medical school after being a nurse for 20 years and consult with others to discover that the nursing and medicine are a bit different?

Nursing focuses on more Psych social and care delivery issues, as well as prevention, Medicine focuses on Diagnosis and Treatment more, just the way it is.
and the amount of knowledge, heck I study all the time and just about never stop.

And these fundamentals underscore the importance and popularity of NP's with the consumer. You see, some clients actually want more than a label and a pill.

and the amount of knowledge, heck I study all the time and just about never stop.

And its a good thing to study. I know you must have a very low opinion of NP's, especially in the context of your soon to be physician status which I believe we all can't wait, but you must consider that NP's too open a book from time to time.