Doctoral degree to become an NP???

physasst · Mar 8, 2009

ANA is not as strong an entity as the AMA. the DNP is being pushed by AACN, NONPF, AANP, ACNP et al (they put out a joint statement this past summer on the issue). perhaps if the ANA or any other single organization represented nures as a single lobbying group, we would get a bit farther. that's just my humble opinion on the issue.

Yep, my mom is a nurse. I grew up around nurses all the time. And she was right. She used to say all the time, that "If only nurses could ever unite on ANYTHING, we could change medicine completely".....she was usually pretty frustrated by all the infighting and bickering.

menetopali · Mar 8, 2009

Right, and the language that is being re-worded is primarily being done to assuage those groups. As far as the IOM, well, I'd like to see a link to a statement that they do not consider physician care to be the standard of care. The new language of the bill that we will likely see this year will allow for DC's, DPM's, OD's, and PsyD's to retain their title of doctor, but will prevent others from following suit. The AMA has conceded that point, else they know that their is virtually no possibility of the bill passing without having those other groups neutrality at the very least.

a "gold standard" implies the best available and the standard to measure other interventions against. The IOM quality series discusses at length how the curent system fails to provide the recomended intervention or performs interventions that are inappropriate. they recomend the standard to be measured against as a set of criteria including: safety, efficacy, patient-centered, timely, efficient, and equitable (Crossing the Quality Chasm, 2001). i pointed out that the services provided by most physicians does not meet these standards and the IOM has pointed this out in several of their reports on qualty of care. For example: "In its current form, habits, and environment, American health care is incapable of providing the public with the quality health care it expects and deserves." hardly "gold standard" care. you are mixing oranges and cadillacs - my response was to: "The care that they provide is still considered the "Gold Standard"..." as the care provided is not in fact the proverbial "gold standard" and the current system (endorsed by the AMA and AAFP of 'the physician is in charge') falls far short of that standard.

menetopali · Mar 8, 2009

Yep, my mom is a nurse. I grew up around nurses all the time. And she was right. She used to say all the time, that "If only nurses could ever unite on ANYTHING, we could change medicine completely".....she was usually pretty frustrated by all the infighting and bickering.

i feel her pain..., boy do i feel her pain... :crying2:

physasst · Mar 8, 2009

a "gold standard" implies the best available and the standard to measure other interventions against. The IOM quality series discusses at length how the curent system fails to provide the recomended intervention or performs interventions that are inappropriate. they recomend the standard to be measured against as a set of criteria including: safety, efficacy, patient-centered, timely, efficient, and equitable (Crossing the Quality Chasm, 2001). i pointed out that the services provided by most physicians does not meet these standards and the IOM has pointed this out in several of their reports on qualty of care. For example: “In its current form, habits, and environment, American health care is incapable of providing the public with the quality health care it expects and deserves.” hardly "gold standard" care. you are mixing oranges and cadillacs - my response was to: "The care that they provide is still considered the "Gold Standard"..." as the care provided is not in fact the proverbial "gold standard" and the current system (endorsed by the AMA and AAFP of 'the physician is in charge') falls far short of that standard.

The "Gold Standard" comment, it was meant more from a medical legal perspective. Our standard of care will be held up next to a physicians. IF, a midlevel is being sued for malpractice, say a family practice PA, than the first thing the they will do (lawyers) is see if the PA's care matched the same standards of practice of a family physician. I don't necessarily always agree with that. But that's our system currently.

Dr. Tammy, FNP/GNP-C · Mar 8, 2009

Ahhh, you have no real conception of how things work in DC do you?

I know the difference between a law and a dead bill.

I misrepresented NOTHING.

You have misrepresented nothing except the facts. Like the bill you said that would soon pass is dead, and if the dead bill would have passed, it would have been "illegal" for DNPs to refer to themselves as "Doctor"--both of which are complete fabrications.

Several of the largest healthcare institutions in the country are already crafting rules that will not allow DNP's to call themselves "doctor".

Great, more unsubstantiated claims. Perhaps you would scare us more if you held up a flash light to your face and said, "boogey man gonna get you"

You can scoff all you want, one of us will be proven right.

Uh, yeah. I think one of us has. Let me know if you need further schooling between the truth and what you have claimed previously--It's only a copy and paste command away if you need more help.

There is discussion in the PA community, as the Baylor EM residency now offers a doctoral of PA studies to it's graduates, as to whether or not this would be a good idea to pursue further.

That's pretty clever--I like it. So will PA's be known as Doctor-Doctor Assistants or Physician Doctor-Prepared Assistants or Doctor Assistant to the Physician or Physician Doctor Assistants? I know you are pretty high in the medical and PA world--which one gets your vote?

physasst · Mar 8, 2009

i feel her pain..., boy do i feel her pain...

Yeah, she finally gave up. She has like 7 years left until she can retire, and she is counting the days. She basically hates nursing now.

Mayo does have a policy regarding nonphysician use of the title "doctor". It is restricted to DPM's, PsyD's, and OD's. We don't have any DC's working here. No one else can use that title in the clinical setting. It was just passed in October. I was at the meeting. Cleveland Clinic and Hopkins, according to our physician leadership are considering similar rules. Although I do not know if they have implemented them.

Anyway, I'm bored, and tired after a long shift in the ED, time for some sleep, so I can do it all again tomorrow.

menetopali · Mar 9, 2009

The "Gold Standard" comment, it was meant more from a medical legal perspective. Our standard of care will be held up next to a physicians. IF, a midlevel is being sued for malpractice, say a family practice PA, than the first thing the they will do (lawyers) is see if the PA's care matched the same standards of practice of a family physician. I don't necessarily always agree with that. But that's our system currently.

It is certainly true that the standard all providers are held to in a legal sense is currently set by medicine (good, bad, or indifferent - it is the case) and APRNs are currently held to that standard; I would never refer to that standard as the "gold standard" in any policy or quality sense though. Several CRNA cases have come down to whether the services provided are consistent with the standards of others who provide a similar service - this has opened up some hospitals to CRNAs as anestesia providers (they meet the same standards for performance) and has been used in litigation against individual CRNAs who did not meet that standard (as it is used against individual dentists and anestesiologists who fail to meet the standard of care for all providers). for NPs practicing independently it is the same question if they are sued for malpractice, unfortunately NPs are too fragmented to raise the issue of restraint of trade as effectively as CRNAs have.

Unlike the PA which is required to work under the license of a physician in all 50 states and who therefore shares risk with the 'supervising' physician for any errors or omissions, NPs in many states do not share that risk with their "collaborating" or "supervising" physician. The result is being held to an equal standard by the courts, recieving lower payments from third-party payers, and having to 'hire a name' that collects a fee, has no appreciable risk, and provides no value to the patient or provider. The courts have already decided that the "collaborating physician" is not responsible for the actions or inactions of the NP beyond respondent superior in cases where the NP is employed by the physician. In cases where there is no employment relationship (ie independent contractors, independent NPs who refer a case out, or independent NPs who hire a physician for chart review or billing purposes) no doctrine of respondent superior exists. in any case the oft mentioned "captain of the ship" doctrine has been thrown out by the courts many times over, not just with regard to NPs but with regard to RNs who are not employed by the physician in question.

:twocents:

menetopali · Mar 9, 2009

Yeah, she finally gave up. She has like 7 years left until she can retire, and she is counting the days. She basically hates nursing now.
Mayo does have a policy regarding nonphysician use of the title "doctor". It is restricted to DPM's, PsyD's, and OD's. We don't have any DC's working here. No one else can use that title in the clinical setting. It was just passed in October. I was at the meeting. Cleveland Clinic and Hopkins, according to our physician leadership are considering similar rules. Although I do not know if they have implemented them.
Anyway, I'm bored, and tired after a long shift in the ED, time for some sleep, so I can do it all again tomorrow.

it is disapointing that Mayo has taken such an anti-nurse and physician-centric position. they had a reputation for being prro-nurse here in Arizona and even have an NP residency program. i wonder if that is going to out the window as the NP community raises objections to such an arbitrary and caprious move as to "allow" certain non-physicians to use the title while "disallowing" other non-physicians to use the title as if to endorse the backward position that "doctor" implies one is a "physcian" even though clearly it is not the case even in their own policy. sad, sad, sad.

have fun in the ED. i'm just wrapping up a day in our little 3 bed ED in podunk Arizona.

physasst · Mar 9, 2009

it is disapointing that Mayo has taken such an anti-nurse and physician-centric position. they had a reputation for being prro-nurse here in Arizona and even have an NP residency program. i wonder if that is going to out the window as the NP community raises objections to such an arbitrary and caprious move as to "allow" certain non-physicians to use the title while "disallowing" other non-physicians to use the title as if to endorse the backward position that "doctor" implies one is a "physcian" even though clearly it is not the case even in their own policy. sad, sad, sad.
have fun in the ED. i'm just wrapping up a day in our little 3 bed ED in podunk Arizona.

Well, Mayo has always been a physician centric institution, and there was considerable concern amongst the physicians that allowing other providers to use the title would create significant confusion among patients, and as a physician led institution, they decided to take that position.

Today, today was bad...I was used. 32 patients and counting. :banghead:

JDCitizen · Mar 9, 2009

Now when it gets down to brass tacks who should and who should not be called "doctor" in a medical institution? Who does the patient think they are talking to when the only term that is mentioned is Doctor So-and-So...

menetopali · Mar 12, 2009

Now when it gets down to brass tacks who should and who should not be called "doctor" in a medical institution? Who does the patient think they are talking to when the only term that is mentioned is Doctor So-and-So...

first, i have said (and will say again) that all members of the health care team should identify themselves by profession and role. "I'm Doctor So-and-So" doesn't do either as "Dr" is an academic title, not a profession or role. The same problem exists in health care institutions when MAs & CNAs don't identify themselves (mistaken for nurses), male nurses don't identify themselves (mistaken for providers - sexist but true), female providers don't identify themselves (mistaken for nurses - worse with those who introduce themselves by first name - sexist but true), anyone in scrubs other than surgical who don't identify themselves (mistaken for nurses), anyone in a white coat who don't identify themselves (mistaken for any of the number of other people in a white coat including nurse manager, PA, NP, physician, diabetic educator, nutritionists, et al).

the key is identifying yourself and your profession/role. nurses, physical therapists, psychologists, social workers, or a myriad of other health care team members have no objection to identifying themselves - it is physicians who object.

the confusion claim was a red herring when it was used against the psychologists & optometrists at the turn of the century, against the DO until the 1960s, against the podiatrists into the 1980s, and now against the DNPs. It is nothing but an ego trip and a vain attempt to claim authority over an academic title and to continue the charade of the physician as the "captain of the ship" (a long outdated belief with no place in reality or in modern collaborative health care).

yalienne · Mar 12, 2009

What if dnp programs follow a curriculum identical to that of the medical school curriculum and nurses are allowed to do residency??? I wonder what excuses MD's will come up with then?? I think that is a possibility in the future.