NP & MD equivalency

as i understand the debate rages on over the equivalency between physicians and np's, especially in the sense that soon we will all possess clinical doctorates-physician and apn alike. many have stated that physicians and np's are not "equivalent." although i believe that most are stating this in the context of comparing medical school training and np training, i am starting to get a sense, however, that this is transcending into a different area--that is from a training point of view to a product/professional standpoint. this concerns me.

to that end, i think we can all agree that medical school is not the same as np school, just like md school is not the same as podiatry or optometry school. from a license structure, md's and anp's are quite different. apn's are no more licensed to practice medicine than physicians are licensed to practice nursing. the danger lies, i feel, when we start on a path describing discrepancies and disparities in the form of inequalities in the form of equivalencies between the two separate disciplines from a training and licensure standpoint to that of a profession and product.

the oxford english dictionary, the gold standard for defining and initiating concept analysis provides the following definition for "equivalent":

1. of persons or things: equal in power, rank, authority, or excellence.

with the contemporary power structure there is much evidence to support the notion that physicians have superior power, rank and authority in comparison to np's (for now) in the health care industry. this is evidenced by the medical communities power in attempting to suppress nursings utility of clinical doctorate titles in the health care setting, while at the same time, supporting the use of other clinical-based" doctor" titles for other disciplines, such as dentistry and podiatry. this clearly sets the tone, as just one example, especially if supported by apn's that physicians truly do have more power, or i should say the power apn's allow them to have.

i'm curious, though with regards to "excellence" in the definition. how many np's out there feel that the excellence they demonstrate through caring, practice and leadership are less than that of a physician?

2. equal in value, significance, or meaning.

how many np's out there feel that their value, significance or meaning to themselves, clients, the profession or intuitions are less than the physician?

3. that is virtually the same thing; having the same effect.

for those np's who consider themselves as practicing medicine: is the medicine you practice of any lesser quality than the medicine practiced by the physician? if not, does adhering to the same standard of care yield the same results--that is provide the same effect? for those who consider their apn practice as nursing and only nursing--that is functions of advanced nursing overlap with other disciplines (e.g. medicine) are the outcomes of your clients inferior to that of the outcomes effected by the physician?

4. having the same relative position or function

think about the term, concept and practice of "primary health care." how many np's feel they cannot perform primary care functions to the same standard and yield equivalent outcomes for their clients as the physician? do you take care of clients knowing they would have received better care and consequently a better outcome if they would have been seen by the physician?

5. something equal in value or worth.

how many np's out there feel they have less value or worth than that of a physician?

to sum it up, when apn's state that md's and np's are "not equivalent" i am hopeful this is only in the context of training and licensure and not practice, outcome or product-based.

in this context for anyone to claim that apn's and md's are not equivalent, they would have to subscribe to the following system of beliefs:

1) apn's do not demonstrate the same excellence in care and practice as the physician,

2) apn's are insignificant; of lesser value and ultimately mean less to themselves, their clients, their profession and the institutions in which they are employed.

3) clients have less than a positive outcome when treated by apn's as compared to those who are treated by physicians.

4) apn's provide primary health care services to clients in an inferior manner as compared to the physician.

5) apn's have lesser of a value than physicians.

i hope, in this context, that i will not be the only one on this board who believes apn's are equivalent to physicians.

i do not know you started a new thread to discuss virtually the same issue?

i do not think that np's pa's and or dnp's do not have value,

i do think that they are not equivalent to md and do's

i think that np's, pa's and dnp's do and should have a level of autonomy just not complete.

residents who are doctors do not have 100% autonomy, not until they are finished and in private practice, and even then they are held to the standard of care.

i think the nursing philosophy has great worth, these are people we care for not diseases,

i think the nursing take on team is good too (just that the md or the do is the team captain)

we need pa's and np's and dnp's

my take is not as replacements of physicians but to work with physicians

Then you would agree that DNP's and MD's are equivalent, or are you suggesting that DNP's have less value to the consumer in the context of primary care services than a MD?

The word equivalent encompasses so much more than just value. It encompasses utility plus power, authority, training, knowledge base and a slew of other things. So no DNPs are not equivalent to MDs.

And this is exactly why DNP's are of equivalent value to the consumer. There is much for APN's to bring to the table.

So your argument is that because something has worth, it makes it equivalent. Using that logic, an RN is equivalent to the doctor because both have equal value to the patient. An RN is in no way equivalent to a doctor just like a doctor is not equivalent to a DPT or a dentist or any other non-physician.

A hot dog has the value of $1 but one dollar and a hot dog are not equivalent.

I do not know you started a new thread to discuss virtually the same issue?

I do not think that NP's PA's and or DNP's do not have value,

I do think that they are not equivalent to MD and DO's...

Yep used to know a lot of MD's that thought DOs were nuts..

I think that NP's, PA's and DNP's do and should have a level of autonomy just not complete.

Residents who are Doctors do not have 100% Autonomy, not until they are finished and in private practice, and even then they are held to the standard of care. Whose standard?

I think the Nursing philosophy has great worth, these are people we care for not diseases,

I think the Nursing take on Team is good too (Just that the MD or the DO is the team Captain)

We Need PA's and NP's and DNP's

My take is not as replacements of Physicians but to work with Physicians

My take is we all work together to take care of the patient.

I have a good analogy. Think back of World War 1 or World War 2. Take no offense please. The German's had the regular army "grenadier" infantry (supposedly NP's) and the Strumtroopen or Stormtroopers who were elite troops to take on any tasks (Supposedly physicians). They both had the task of taking on the allies (tough diseases, cancers, etc). The German armies had a difficult time taking on the Americans (regular infantry) at certain battles. No matter if the German infantry was regular or elite, the elite thought they had more power and could overrun the allies which they were wrong. Watch the movie "The lost battalion" of WW1 and band of brothers bastonge. In bastonge, the elite panzer division had "elite" training but couldn't take on the allies even though the allies had nearly no food, water, and ammo.

My point is, NP's may do things similar to what a doctor does clincally. Its that MD's have more schooling/training that allows them to be more politically powerful in my opinion. MD's may have more training and all, but they may be equal with NP's in working with the patient. Therefore, the practice, outcome, product-based may be the same. Education is different, more training for MD's, both treating a patient, may have same clinical outcomes. If the patient has a very difficult to treat disease, both NP and MD may have the same difficulty in treating that same patient. Ultimately, both may even fail at keeping the person disease free or alive even though they one had more training that the other.

I think it's a game of semantics to say that NPs are equivalent to MD/DOs.

You don't see people arguing that DPT or DPharm is equivalent to MD/DO even though there is definitely some scope overlap there and both possess clinical doctorates.

In strict terms NP is not equivalent to MD/DO, because the training, licensure, and scopes of practice are not equivalent.

Now equivalency has nothing to do with value, need, or anything else. I don't value apples over oranges. They're both fruits, but I don't think anybody would argue that an apple is the equivalent of an orange.

If the situation is difficult. Both the NP and MD may have the same difficulty in treating that difficult patient, even though the MD had more training. I repeat words too much.

MD equivalency...

Does anyone in nursing really want to equivalent to an MD? Just imagine what that means. I/we bring advanced Nursing care, principles, diagnostic and treatment capabilities to the table. I/we treat the patient and the disease/condition (often times the family is included). After 25 years of health care and working with 1000s of doctors have seen I would have to lower some of my standards.

Granted for the doctors or soon to be doctors that are on the site the above statement isn't 100% towards all doctors..

Comments like that are just antagonistic and unnecessary. We (docs and nurses) are a healthcare TEAM and need to put aside our egos and just work together for good outcomes. The patient doesn't care about our initials.

Antagonistic? This whole topic can be considered antagonistic..

A team works together.. I have seen too many instances of "it my way or the highway" Over the years the patient/family/legal community has continued to hold nurses up to higher and higher standards. While the hospital / medical (i.e. doctor) has been doing just the opposite. In school nurses are taught to be patient advocates,try that too many times in the real world. There is no small numbers of doctors and administrators that would like nurse to go back to the days of handmaidens the time when nurses had to stand-up give up their chair and leave the nurses station when the doctor arrived.

And yes there are a lot of times the patients do care about initials.... If a patient wants to see a MD and not me thats their right. If a patient wants to see an NP and not the MD that should be their right also. In the hospital when a patient requested to have a female nurse and not a male nurse that was/is that patients' right.. Provider choice is a patients right.

I do agree we could all put aside our egos........

Does not mean that I don't have other standards that need changing or increasing.

By the way "...lower some of my standards". Does not mean that I don't have other standards that need changing or increasing.

I feel that it is primarily a difference of philosophy.

MD/DOs concentrate on evidence-based treatments to take care of their patients. Med school pays little attention to the bueracracy of medicine and the hospital... instead, it assumes that the physician may be practicing "in a vacuum" and encourages its students to be fully aware of medical problems in every field, from primary care to surgery to OB/GYN. The student's efforts are directed to scientific fields such as biochemistry, pharmacology and pathology. The student undergoes a rigorous and standardized series of brutal exams to become a physician, tests that examine the student's grasp of the science of medicine. Any lessons to be learned about how the hospital runs "in real life" are learned only informally during the student's third year of med school, and are not really tested. Medicine remains an elite profession with high compensation and requires top-notch qualifications and dedication from its applicants. Between school and the 3+ years of required residency, medicine demands many long hours of clinical experience before the physician may practice.

By contrast, the NP model makes the primary care provider as a "medical manager." The medical manager's primary purpose is to guide the patient through the vast, complex network of the medical system and oversee his/her interactions with specialists. Primary care consists of protocol-driven medicine, such as with the Minute Clinics, where individual deviation from the system is not allowed. This model takes note of the fact that difficult medical cases are handled by specialists. Considerable classwork is directed toward liberal-arts-type leadership-theory and systems-based practices as opposed to the hard sciences. Also, the qualifications necessary to enter NP school are much lower, and the coursework is far less demanding, in order to take account of the fact that NP students lead busy lives with jobs and children. NP school also requires very little in the way of clinical hours before the NP may practice.

So take it as you will. The schools are not the same... they just follow different philosophies.