Nurses are Not Doctors

[Brian]

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

[klone, MSN, RN]

Do we know that a Bachelor's degree in China or Pakistan is equivalent to a Bachelor's degree in the US? Are we actually comparing apples to apples here? It's hard for me to imagine that a state would approve an MD license to a physician who only has the US equivalent of a Bachelor's degree. ANd regardless of a person's education in other countries, they still need to obtain a state license to practice medicine in the U.S.

[klone, MSN, RN]

Regular physicians you probably work with every day.

And nope, all the docs/residents I work with were trained here in the U.S. and have doctorates. Which is why they're called doctor.

[toomuchbaloney]

Alaska is one of the states that allows autonomy for APNs.

It works well here.

The doctors are not threatened by this autonomy.

[wtbcrna, MSN, DNP, CRNA]

If nurse practitioners want total independence, then their malpractice policies should reflect that; their fees for insurance should be on par with physicians. Perhaps this is the case now, but in the past, they paid less for malpractice insurance.

I'm not an NP basher, but I do think a patient is served better when there is collaboration. NPs tout the time they spend with patients as something that makes them superior to physicians, but if they work independently, there is no way they'll be able to sustain longer patient visits and survive financially. Before long it will be the same as a doctor's office: "Move 'em in, roll 'em out..."

Malpractice fees are based on your professions average liability risks. Independent CRNAs have had lower liability rates for years compared to anesthesiologists while doing the exact same cases. http://www.aana.com/aboutus/Documents/quality_nap.pdf This is the same as for independent NPs.

NPs and CRNAs have all shown they can give equal or greater care to their respective physician counterparts for years. Every argument that is being used against NP independent practice has already been used in the CRNA independent practice arguments with the only difference is that for CRNAs these arguments, legal/political battles go back to the early 1900s.

Mandatory collaboration does not help patient care. It is up to every health care provider to know when they need extra help/to refer and no provider works in vacuum of care.

APNs are not looking to provide care they are not trained to do or deceive the public by providing independent care. APNs are simply trying to work to highest level of their training and remove unnecessary barriers to care that have no proven benefit.

[wtbcrna, MSN, DNP, CRNA]

FYI: Doctor does not equal physician. A Doctorate is just a degree that many APNs, like myself, have already earned.

[klone, MSN, RN]

FYI: Doctor does not equal physician. A Doctorate is just a degree that many APNs, like myself, have already earned.

I think most of us understand that. The question that someone brought up is, does physician equal doctor. I am skeptical that there are actually physicians practicing here in the US that do not have the equivalent of a doctorate.

This person stated that we are working among physicians who only have bachelors degrees, and are not MDs or DOs

[wtbcrna, MSN, DNP, CRNA]

I think most of us understand that. The question that someone brought up is, does physician equal doctor. I am skeptical that there are actually physicians practicing here in the US that do not have the equivalent of a doctorate.

This person stated that we are working among physicians who only have bachelors degrees, and are not MDs or DOs

I read through the whole thread and I do understand that most people understand this, but the title of the thread is that "Nurses are Not Doctors". This is also a common misconception among laypeople.

Some physicians and medical groups in their many political ploys to maintain the status quo have done everything they can to equate Doctor=physician with the ever changing health care environment that just is not true. There even many nurses that think only physicians should be called doctor.

We nurses need to be as proficient in advocating for our own profession just as much as physicians advocate for their own profession. Nurses do not need to hide behind unproven myths that physician groups use to belittle nurses, but need to utilize research and EBP to empower our profession.

[TU RN, DNP, CRNA]

Would you choose a career path if you knew you were going to be deep in debt and have difficulty managing after graduation?

I think you need to learn more about the issues going on in primary care for physicians before you continue to cast stones.

And, FYI, it's "OCNRN," as in "Oncology Certified Registered Nurse."

If I was offered the opportunity to become a physician in a family practice I would absolutely drop my life and aptly take on $200,000+ in student loan debt additional to my current student loan debt if that's what you're asking, Oncology Certified Registered Nurse. Despite the debt, I would look forward to acting as a business manager, physician, and trusted, well-respected member of society with a firm understanding that I won't be swimming in cash like all my med school buddies who went on to be placed into surgery or anesthesiology. With that expectation in mind I might not be so bitter as to reject NP autonomy.

And since money seems to be so important to you, the BLS still seems to report that on average physicians in family practices still make about double that of NPs in most work environments ($207,111 physician versus $94,320 NP, you can look those up at U.S. Bureau of Labor Statistics). Considering the median family income of the United States - approximately $50,000-52,000 per household, not individual that is - I'd say even the latter is still an excellent living. Shoot if I spent a third of my income on malpractice as a family practice physician, which is unrealistic, I would still be doubling that average American family's income.

[PMFB-RN, RN]

Do we know that a Bachelor's degree in China or Pakistan is equivalent to a Bachelor's degree in the US? Are we actually comparing apples to apples here? It's hard for me to imagine that a state would approve an MD license to a physician who only has the US equivalent of a Bachelor's degree. ANd regardless of a person's education in other countries, they still need to obtain a state license to practice medicine in the U.S.

If you read the Wiki link I provided you would see that they are not equivelent at all. The bachelor of medicine is a professional degree. Who is making comparisons between a bachelors degree in the USA and the BMBS bachelors degrees in those countries?

I know many physicans who practice in the USA with a BMBS degree they earned in other countries, usually in 5 years of college after graduating from secondary school. I work in a teaching hospital with physicans trained in many different countries. Many of them are Americans who went to medical school abroad.

We see this with nursing degrees in the USA all the time. ADNs are often refered to as "two year RNs", when for the majority it actually takes 3-4 years to earn and ADN.

[PMFB-RN, RN]

This person stated that we are working among physicians who only have bachelors degrees, and are not MDs or DOs

You may not be, but many of us are. I would guess that every nurse here who works in a taching hospital where they get a lot of residents trained abroad does. I certainly do. They may not even know it since their name badge usually says "MD" even when they don't actually hold an MD.

[Nola009]

Sooo... are they gonna be "death panel" facilitators??

[PMFB-RN, RN]

It's hard for me to imagine that a state would approve an MD license to a physician who only has the US equivalent of a Bachelor's degree.

I have to wonder if you even read the post you are addressing. It doesn't appear that you did. Who stated that any physician got a license with a "US equivalent" bachelors degree?