Nurses are Not Doctors

Nurses General Nursing

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An article appeared today in the New York Times as a followup to a bill passed in New York granting nurse practitioners the right to provide primary care without the oversight of a physician. The authors of the bill state "mandatory collaboration with a physician no longer serves a clinical purpose and reduces much-needed access to primary care". The need for more primary care providers is due to the shortage of primary-care physicians, the aging boomer population, and the Affordable Care Act.

Although the president of the American Association of Nurse Practitioners feels that the current "hierarchical, physician-centric structure" is not necessary, many physicians disagree citing that the clinical importance of the physician's expertise is being underestimated and that the cost-effectiveness of nurse practitioners is being over-estimated.

Many physicians also feel that "nurse practitioners are worthy professionals and are absolutely essential to patient care. But they are not doctors."

What are your thoughts on this? Where do nurse practitioners fit into the healthcare hierarchy?

For the complete article go to Nurses are Not Doctors

Specializes in Pain, critical care, administration, med.
Wha?? I feel like I'm in an alternate reality here, some of the things I'm reading in this thread. Please explain to me how an RN has a higher level of academic education then [sic] most MDs. An RN can practice with an Associate's degree. An MD requires a doctorate.

MD's do not have doctorates in the academic sense. The have a undergraduate degree. The rest is their medical school program.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Wha?? I feel like I'm in an alternate reality here, some of the things I'm reading in this thread.

Hmm, I thought what has been posted here is pretty common sense.

Please explain to me how an RN has a higher level of academic education then [sic] most MDs.

I am not the one who said that but what I assumed they meant was non medical specific education. In that case it is easy to see how at least many nurses would have a higher level of non medical education than physicians. Even though many (most) physicians may have an undergrad degree it isn't usually required and both medical school in my state admit students without a bachelors degree, though of course they have certain requirements. These can usually be fulfilled in two to three years of college.

Also consider that there are plenty of physicians who do not hold a doctorate degree and spend a total of 5-6 years in college after secondary school (high school). These people likely have less general education than the typical BSN grad.

An RN can practice with an Associate's degree.

Yes, just like Physician Assistants!

An MD requires a doctorate.

True! However a physician does not require a doctorate to be a physician.

No kidding. Even the MD that I work with regularly has an entire passel of MDs that she consults with on more complicated cases.

You mention this like it's a bad thing. Medicine is a team sport, always has been and always should be. Quality and safety improve when we (nursing, medicine, all other healthcare fields) work together. Any person that argues NPs, particularly NPs with years of experience, don't have a seat at that table then they are sadly mistaken. I think where we disagree is what seat it should be. By "taking the jobs of PCPs" it increases the adversary relationship between physicians and nurses/NPs and DECREASES collaboration. Without standardization and credentialing that emphasizes your ability to diagnose and treat (the focus of medical school not nursing) you hurt your argument.

Yes, well...they'll all get a rude awakening during their intern year and a nurse saves their ass.

Again no one would argue that nurses and APNs dont know a lot but if you want to continue to insist on comparing yourself to interns and residents it looks really silly. Of course you are going to save the ass of an intern. It's their first year out of medical school. Residency is where you learn to be a real doctor, medical school is all the knowledge. I'm sure that intern would make a first year nurse look like an idiot as well. As a resident I get a good laugh when my medical students make mistakes or says something dumb but I can't honestly compare myself to them. It's like night and day. Same goes for comparing a nurse with experience to an intern... But if it makes you feel good inside...

MD's do not have doctorates in the academic sense. The have a undergraduate degree. The rest is their medical school program.

um what? Do you know what the MD is? Medical school is not just a program, it's a doctorate program. This shouldn't need explaining... No doctors do not just have bachelors degrees. They have doctorates in medicine.

Specializes in Adult Internal Medicine.
You mention this like it's a bad thing. Medicine is a team sport, always has been and always should be. Quality and safety improve when we (nursing, medicine, all other healthcare fields) work together. Any person that argues NPs, particularly NPs with years of experience, don't have a seat at that table then they are sadly mistaken. I think where we disagree is what seat it should be. By "taking the jobs of PCPs" it increases the adversary relationship between physicians and nurses/NPs and DECREASES collaboration. Without standardization and credentialing that emphasizes your ability to diagnose and treat (the focus of medical school not nursing) you hurt your argument.

Taking the jobs of PCPs increases the adversary relationship? So MD/DOs have a right to that job because they had it first? Set aside the fact that what minute percentage of medical students want a PCP job?

I spent graduate school learned how to diagnose and treat, and I have done that in practice since I graduated and passed standardized national certification boards. More over, the evidence had demonstrated that NPs can diagnose and treat with comparable outcomes to physicians.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
You mention this like it's a bad thing. .

Then you completely mischaracterized my words. Collaboration is never a bad thing. Physicians collaborate with other physicians. Midwives collaborate with more experienced midwives, as well as physicians. Heck, the midwives often collaborate with ME, and I'm "just" an RN.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Again no one would argue that nurses and APNs dont know a lot but if you want to continue to insist on comparing yourself to interns and residents it looks really silly.

I haven't compared myself to residents. You will see, if you actually have read my words, that I've repeatedly supported and defended the education of physicians in this thread. The words you quoted above were ONLY in response to the person who said that the med students at that other site were completely bashing nurses. And I simply stated that they won't be bashing nurses when a nurse saves their hiney someday.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

And can I ask, honestly. Why are you here?

Hmm, I thought what has been posted here is pretty common sense.

I am not the one who said that but what I assumed they meant was non medical specific education. In that case it is easy to see how at least many nurses would have a higher level of non medical education than physicians. Even though many (most) physicians may have an undergrad degree it isn't usually required and both medical school in my state admit students without a bachelors degree, though of course they have certain requirements. These can usually be fulfilled in two to three years of college.

Also consider that there are plenty of physicians who do not hold a doctorate degree and spend a total of 5-6 years in college after secondary school (high school). These people likely have less general education than the typical BSN grad.

True! However a physician does not require a doctorate to be a physician.

This is just wrong. In every sense, I'm sorry. In order to get into American medical school, an MD or DO program, you need a bachelors degree. The course requirements you see are contingent upon completing a bachelors degree. You can't apply with just those courses and no bachelors degree. Please find any medical school (a real one, MD) that doesn't require a bachelors and I will shut up and disappear forever. That won't happen because it doesn't exist. There are some programs that have linkages where you can do a combined bachelors and medical degree in 7 years instead of 8... But this person still graduates from college with a bachelors and graduates from medical school with an MD. And they are rare. Maybe you are referring to foreign medical grads that have the MBBS but they are not as common in the average hospital (unless you are working in a community hospital that is kind of desperate and just takes all foreign docs) but the MBBS is the equivalent to a medical doctorate in that country. It takes 6-7 years to get so it's clearly not just a bachelors.

even if this was true, who cares about how much non-medical education you have? You could become a medical assistant with a doctorate in literature... Does that mean the medical assistant is smarter than you? Maybe. Better at doing that job? Not even close.

Lastly, as I stated in the last post, EVERY physician (MD/DO) has a doctorate degree. The MD is a doctorate. If you don't believe me here's trusty Wikipedia: Doctor of Medicine - Wikipedia, the free encyclopedia. This means, for those keeping score, an MD has 4 yrs undergrad + 4 yrs medical doctorate and then 3-7 yrs of postgrad training aka residency. We spend on average 8 yrs in school post secondary, which is 4 more than the typical BSN.

Feel free reed to disparage physicians, it doesn't bother me in the slightest, but at least have it based on opinion not completely erroneous facts.

And can I ask, honestly. Why are you here?

Same reason as you I presume.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Same reason as you I presume.

No. I'm a nurse. You are in med school.

I ask again, why exactly are you here? I'm not saying you're necessarily unwelcome, I'm just trying to understand what exactly you get out of being here.

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