DNP required soon?

stanman1968 · Feb 5, 2011

Now let me get this strait, when the title doctor is used the patient thinks they are speaking to physician, dentist, podiatrist, or optometrist. You realize three of these are non physicans and have limits on their practice right? It is the educational degree that they are addressing which is by the way the point we have been making, thanks for acknowldging it.

As for appropriate it is not for physicans to decide who can use this academic term, matter of fact it is totally innappropriate but somehow this escapes you.

allnurses Guide · Feb 5, 2011

In a health care setting, it's not so simple. Patients have certain expectations when they hear the word "doctor". When they hear that word, they assume they're going to be treated by a physician, dentist, podiatrist, or optometrist. Anyone else using that title is deviating from patient expectations, and as a result, there is too much opportunity for confusion to arise.
Physicians aren't worried about patient safety or confusion of patients they are worried about their egos and the lack respect they think they could lose.
So, let me put this into a realistic scenario. Let us say that I was a medical lay person. I bring my five year-old daughter to the hospital for lethargy and neurological changes. Someone walks into the room to evaluate her and direct treatment. This person introduces himself as "Dr. Smith". I'm going to assume that this person is a physician. If I found out later that "Dr. Smith" was a nurse, I would be very upset. It would be patently inappropriate for anyone to allow the kind of situation where a patient could be treated by someone other than what they were expecting, and without their knowledge to boot.
Well if the person introduced themselves correctly, Dr. Smith your nurse, then there would be no issue. Most patients aren't going to care who the person is in that situation as long as the child is taken care of appropriately. How would the parent feel if it was an intern that came out to assess the patient for the senior resident or staff and totally missed some key findings that delayed treatment causing permanent harm to the patient (not that that has ever happened before). I am sure that degree on the wall is really going to make the parents feel really good.
So completing medical school doesn't deserve any respect?
No, it doesn't as far as I am concerned. Medical school is only the start of a physicians training, and I have worked with enough medical students, interns, and residents to know that the degree on the wall isn't what gains you respect.
It's not an issue of "most" or "some". It's an issue of what is appropriate and inappropriate. I think it's inappropriate for nurses to be introducing themselves as "doctor", as they are not in a profession that is known by the public as a profession of doctors.

Appropriate or inappropriate doesn't even come into play that is purely opinion.

SuperSixEightMD · Feb 6, 2011

Now let me get this strait, when the title doctor is used the patient thinks they are speaking to physician, dentist, podiatrist, or optometrist. You realize three of these are non physicans and have limits on their practice right? It is the educational degree that they are addressing which is by the way the point we have been making, thanks for acknowldging it.

Dentists and podiatrists are experts in their respective fields -- akin to physicians having expert status in medicine. As such, a dentist has no 'limit' on his/her practice of dentistry.

As for appropriate it is not for physicans to decide who can use this academic term, matter of fact it is totally innappropriate but somehow this escapes you.

Why do you keep saying that physicians are the ones who are trying to make the decision? It's the public that does so. We are simply saying that, by calling yourself "doctor", you are effectively hiding from the patient the fact that you are a nurse.

Unlike dentists and podiatrists whose professions are quite distinct from the practice of medicine, it is the DNPs intent to practice medicine (under the guise of nursing). When a DNP enters the room to address a patient's diabetes or blood pressure or diagnose the cause of a non-healing ulcer or diagnose the cause of chest pain, and introduces themselves as "Dr. Smith", how is the patient going to know, realistically, that he is about to be treated by a nurse rather than a physician? Most patients are going to assume that they are being treated by a physician.

The "buyer beware" and "read the fine print" doesn't apply to health care. Patients should not be charged with the responsibility of identifying the credentials of their health care provider. Rather, they should be readily identifiable to the patient. And the biggest way that we make them readily identifiable is verbally, by calling ourselves "doctor" or "nurse". Most patients don't even read the writing on our white coats or our ID badges. And certainly a patient isn't going to know what the hell "DNP" means.

So don't complain to physicians about who should use the title of "doctor". Complain to the public for thinking that doctors are physicians, dentists, podiatrist, and optometrists, but not nurses.

SuperSixEightMD · Feb 6, 2011

No, it doesn't as far as I am concerned. Medical school is only the start of a physicians training, and I have worked with enough medical students, interns, and residents to know that the degree on the wall isn't what gains you respect.

Spoken like someone who's never been to medical school! Honestly, Wtb, have you ever stopped to wonder what it is we learn in medical school? Have you ever wondered why it's so hard to get into medical school, or why medical school is notorious for being insanely difficult? Have you ever stopped to wonder why completing medical school earns one the title of "Doctor of Medicine", and what the term "Doctor of Medicine" means?

Just FYI, Wtb, medical school is not "only the start" of a physician's training. Medical school is the physician's training. Residency is for specialization. An internist is an expert in internal medicine. A pediatrician in pediatric medicine. A plastic surgeon in plastic surgery. An anesthesiologist in anesthesiology.

But if you want to consider medical school "only the start", well then, you have to admit, it's one hell of a better "start" than you or any other CRNA or DNP has, now isn't it!

stanman1968 · Feb 6, 2011

CRNA's are experts in their field, therefore by your logic I can call myself Doctor after completing my doctorate. It has nothing to do with the practice of medicine, dentists, podiatrists, optometrists, audiologists and pharmacists do not practice medicine, and neither do I anesthesia delivered by a nurse was ruled the practice of nursing in 1926. These are FACTS not opinion.

This movement is one that is completely motivated by both parties one attempting to advance their profession and one trying desperately to impose their will on the other.

Why do I say physicians are the ones dictating the use of this term, well their is no PUBLIC movement over this issue but certainly one by physicians, check out the AMA resolution 303.

allnurses Guide · Feb 7, 2011

Spoken like someone who's never been to medical school! Honestly, Wtb, have you ever stopped to wonder what it is we learn in medical school? Have you ever wondered why it's so hard to get into medical school, or why medical school is notorious for being insanely difficult? Have you ever stopped to wonder why completing medical school earns one the title of "Doctor of Medicine", and what the term "Doctor of Medicine" means?
Just FYI, Wtb, medical school is not "only the start" of a physician's training. Medical school is the physician's training. Residency is for specialization. An internist is an expert in internal medicine. A pediatrician in pediatric medicine. A plastic surgeon in plastic surgery. An anesthesiologist in anesthesiology.
But if you want to consider medical school "only the start", well then, you have to admit, it's one hell of a better "start" than you or any other CRNA or DNP has, now isn't it!

I have shared classes with medical students and trained medical students during their anesthesia rotations. I have fair understanding of what med students or fresh interns bring to the table. I stand by my statement that medical school is only the start of a physician's training. Medical school gives physicians the bare understanding of how to take care of a patient, if it wasn't then they should only need a 6-12 max since apparently according to you medical school teaches you so much about being an

anesthesiologist. Brand new physicians are dangerous, and have several more years of practical training before they aren't a danger to the public and no longer need mentorship and supervision.

No, I don't think medical is a better start than nurse anesthesia school. Medical students get very minimal training in anesthesia and most are a walking cluster during their anesthesia rotations just like everyone else when they start doing anesthesia.

I have met many physicians that thought just because they were a physician they knew more than every other nonphysician, especially nurses, they usually end up killing someone due to their ego. Your posts sound just like those physicians.

allnurses Guide · Feb 7, 2011

My last post should have said 6-12 months max.

JacobSZ · Mar 13, 2011

"have you ever wondered why it's so hard to get into medical school, or why medical school is notorious for being insanely difficult?"

i've often wondered how hard it is to get into medical school, and i'm currently experiencing how hard it is to get in to crna school right now.

i know this is not entirely relavent to the debate but...

...39,108 applicants to us medical schools, according to the aamc (association of american medical colleges).

in contrast, 17,370 folks graduated from medical that same year and a grand total of 69,167 people were enrolled in medical school.

if you assume these are all 4-year programs, that means the average enrollment of an individual class (ie. the "class of 2010") would be 17,291, fairly close to how many graduated that year.

in other words, of the 39k who apply, 21k (or 53%) don't get in. your odds are very roughly 1 in 2.

http://www.aamc.org/data/facts/2006/state-re-app2006.htm

and this is from wikipedia...

in 2006, the average gpa and mcat for osteopathic matriculants was 3.46 and 24.6 respectively, and 3.64 and 30.4 for md matriculants.[4][5] in 2010, 42,742 people applied to medical schools in the united states through the american medical college application service. 18,665 of them matriculated into a medical school for a success rate of 44%.[6]

and now for nursing anesthesia...

aana j. 1995 jun;63(3):244-8.

nurse anesthesia admission qualifications.

this study describes criteria used by graduate nurse anesthesia educational programs (gnaeps) in selecting students for admission. the investigators prepared and distributed a 15-item questionnaire to 71 gnaeps as listed by the council on accreditation of nurse anesthesia eduational programs for december 1992. thirty-eight of 71 (54%) of gnaeps participated in this study. upon examination of standardized test scores, mean graduate record exam scores were: analytical 533, quantitative 512, verbal 510, and cumulative 1,552. the mean millers analogy test score was 47. the mean overall grade point average (gpa) was 3.32 and the mean science gpa was 3.20. experience in critical care nursing averaged 5 years, with 54% of students coming from surgical intensive care units and 81% advanced cardiac life support certified. the most commonly identified prerequisite course was organic/biochemistry. all programs required references, 97% required interviews, and 68% required essays. program directors ranked overall gpa, interview, and science gpa among the factors considered most in the selection process. the sample revealed an acceptance rate of 22% for those applying to gnaeps.

so as you can see both becoming a physician and becoming a dnap nurse anesthetist are equally difficult if not favoring the greater degree of difficulty to that of the nurse anesthetist since their is only a 22% acceptancece rate for anesthesia school and considering you are competing against 2.9 million nurses in the united states where experience and age count for you as opposed to against you as with medical school. most 1st year medical students are from what i can research 24 years of age, where most srna's are 28 or above with an average of 5 years working experience in critical care. so with most students now finishing their bachelors in 5 years, most incoming medical students are fresh out of school with no medical experience what so ever, where srna's not only have direct nursing/health science education, but also have 5 additional years of critical care experience working along side physicians. if you really look at it for what it requires, not what the title tells, you can see just how difficult and time consuming it is to become a nurse anesthetist, let alone dnap.

so supersixeightmd is it wrong for a optometrist to refer to himself as "doctor" at the bedside of a family member in the icu, in front of the dnap who just brought them back from the or?

i respect physicians with all my heart and admire what they do, but i also feel the same for nurse anesthetists, other advanced practice doctorate prepared nursing specialist and anyone for that matter who holds a doctorate degree for that matter. they've earned the title, no one should take that away from them, especially in the eye's of the public. how else will we educate them if we don't address their misconceptions?

there was a time when being a physician was a predominantly male profession, but over time and through educating the public women became accepted too as doctors while in a hospital setting wearing a white lab coat, and not automatically assumed to be nurses. not to mention not too long ago when do's were paid less then their md counterparts, which also raises questions about physicians being veiwed and treated as equals, even amoungst their peers. so you can see how public/patient misconceptions, and professional inequalities and standards can be corrected over time, with the help of determined individuals who feel the need to do so.

but then again, that's only if people feel it worth while... i know i do.

here's where i'm coming from with my background and experience

age: 29

gender: male

rn/bsn/as, 6.5 years experience (5 er, 1.5 icu, 6 phrn/emt-p, 10 emt) er charge rn (adult and peds specific) volume 57,000 pts/yr, level ii trauma. currently in icu, 44 beds. level i trauma, staff rn, now orienting to open hearts. firefighter paramedic, suburban town 70,000 pop., 6,000 calls a year, 4,200 ems)

currently i work as a firefighter/paramedic (24/48), nights in the icu (24+hrs/wk), and 16-24hrs/month er.

certifications: rn/bsn, acls, pals, bls, ccrn, cen, abls, atls(non-physician provider), nrp, ecrn, tns, ccemtp, enpc

gpa 3.65(4 scale), gre 1175/4.5

and i'm still trying to become a nurse anesthetist after an entire year of applying, but if it doesn't work out i've been told by the physicians i work with i would make a great doctor... but i think they mean physician. who knowns, either way health care is all i've ever wanted to do with my life and i will continue to do so, respectfully.

take care.

BCRNA · Mar 15, 2011

I don't know what it is like to be a medical student, but I have taken many of the same classes as medical students. My physiology and gross anatomy classes was mixed with physicians, dentists, anesthetists, and optometrists. What exactly did they get out of the classes that I did not?

Super six, do you really think patients are so stupid that it would be impossible for them to learn the differences in education? It is as simple as you saying your a physician after introducing yourself. As far as your trying to say they wouldn't know the difference, those people who would continue to think we are physicians after explanation would do so anyway. Whether we introduced ourselves as Dr. SoAndSo your nurse anesthetist or just introduced ourelves as nurse anesthetists those people would think we are doctors. I would not introduce myself as Dr. SoAndSo, but I still get called doctor anyway. When I correctly state I am not a physician, the response is always "ok doctor." In those situations all that matters is that I correctly stated who I am and my role, and did not try to deceive the patient. Most patients understand the difference, those who do not comprehend the difference would not be able to no matter how the situation was handled. I am very proud of my accomplishments and do not want to be a physician. I feel I should not have to bend over backwards to explain I am not a physician just to protect the feelings of physicians. I am actually proud of not being a physician. Especially the ones who come into the room and look at the patient for thirty seconds, and come to the completely wrong conclusion on what needs to be done just because they spent no time with the patient.

I personally feel DNP's have much more of a right to use the title doctor then chiropractors. Especially after having it explained to me by a chiropractor that asthma and diabetes is caused by spinal cord compression. Why do physicians not complain more about chiropractors when they are the ones throwing pseudoscience at patients, and effectively putting the patient at risk? Especially since their practice is justifed by only case studies, there are no clinical studies proving the effectiveness of their interventions. All advanced nursing practice specialties are backed by clinical studies. Chiropractors on the other hand prove their worth by case studies: patient X had cancer, I did a manipulation, they are now cancer free, therefore I cured them. My point with this is just that if physicians were concerned about patient safety because of the use of the title doctor, this would be a much more appropriate topic for them to attack. Most chiropractors are quick to refer patients to physicians and are exremely safe; I just wanted to point out that chiropractors have not proven themselves with true clinical studies. The only clinical studies I have found dealt only with pain management of chronic back pain. No studies have proven the manipulations they do help with anything else besides pain.

I have heard many pharmicists--and a few audiologists and physical therapists--introduce themsleves as doctors. Only the pharmicist further explained they were pharmacist. The other two just used the title doctor with no amendment.

Many physicians may not like the change, but they are going to have to introduce themselves as physicians and not just doctors. There is about to be a flood of nurse practitioners and anesthetists who are going to have doctoral educations. We are not trying to replace physicians by any means. Nurse practitioners will not be able to fill the advanced specialties outside of primary care. At least not without some huge education overhauls. Patients with multiple severe disease processes will need to be handled by physicians. But for primary care and health promotion/prevention for most people, NP's will function just as well as physicians. They will even spend much more time with the patient. And anesthetists can already function completely independant of anesthesiologists. Even though we do exactly the same thing and have the exact same outcomes anesthetists practice nursing and physicians practice medicine. I understand the legal reasoning behind this; but this is alot like having two baseball teams but calling each one a different sport while playing the same game.

swift125 · Mar 23, 2011

with all due respect to nurses/crna; at my hospital, only physicians will introduce themselves as "doctor"....doctor in a hospital setting means physician, pure and simple.

stanman1968 · Mar 24, 2011

I trust any poditrists, phamacists, audiologists PT will fall under this same restriction?

allnurses Guide · Mar 24, 2011

with all due respect to nurses/crna; at my hospital, only physicians will introduce themselves as "doctor"....doctor in a hospital setting means physician, pure and simple.

So unless you are calling dentists and podiatrists physicians I would bet those professionals are called doctor at your hospital everytime they are there. No, "doctor" in a hospital setting doesn't equate to physician and physicians haven't been the only ones in the hospital using the title doctor for decades, but it sure becomes an issue when even one nurse talks about using the academic title.