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What if the pt has Sheehan's Syndrome? Then a low TSH means a malfunctioning pituitary and low T3/T4 levels.

The level to pass was also set lower. That's something to consider if this test is mandated for all DNP's. What if the medical groups force the real USMLE step 3 on us?

Take a look at this http://blogs.wsj.com/health/2009/03/10/cvs-shutters-90-retail-clinics-for-the-season/

Look at any state law. "Physician" will be defined as someone who holds either an MD or DO. Ever heard of the phrase, "It is illegal to impersonate a physician"? You can go to jail for that. I guess NP's could amend the state laws so that they are included among "physicians", but then they would be forced to be regulated by the boards of medicine because the state laws also specify that. Discussion done.

Physician is a protected legal term. Discussion done.

It's called supply and demand. Nursing education can be done quickly, therefore supply is higher than demand and hence lower salaries.

Doesn't Texas have thousands of physicians waiting to get into the state to practice? Since tort reform, Texas has been a very popular destination for physicians. In fact, they had to expand the medical licensing department to handle all the paperwork. It's kinda hard to make the "physician shortage" argument now.

If more states license AA's, more AA schools open, and more CRNA schools open in response, yes we will hit a saturation point very quickly. It may happen sooner than most of you think. One day it's all great, and then next month the market goes off a cliff. Isn't that how most bubbles end?

You guys are forgetting something. At least 40 successful surgeries (at the time of the writing) have been performed so far with this McSleepy system. I read that the inventors want to do a 1000 surgeries. Kinks will have to be worked out. OR designs have to be worked out to take full advantage of the system. Don't mistake the financial incentive to implement something like this. At $140k per year for a CRNA and each room requiring one, can you imagine how much money hospitals can save by implementing such systems? Do you know how much a company like GE can make by selling these systems? You guys can rationalize all you want about why this or why that won't work. If you guys don't anticipate and embrace the future, you'll end up like the carriage makers when the automobile came out.

But you assume that an automated system would use the same room setup we have today. What if we have better room design that would accomodate such a system? Imagine if you will a spoke and hub design. The spokes outline the OR's and the hub is central anesthesia control room. From the hub, the staff can peer into any room. From the hub, the staff can be in any room within 5 seconds. With such a setup, it would be feasible to have an automated system. There is plenty of financial incentive for hospitals to explore different ideas to take advantage of technology. Don't think that anesthesia 50 years from now will look like anything today.

But what percentage of the operation involves "intubate, extubate, bag-mask, provide MAC, insert regionals, invasive lines"? Very little. Most of the time, the anesthesia is uneventful and can easily be handled by an automated system. You will still need people for the take off and landing, but it can be autopilot rest of the time.

Sometime nexty year, Tammy will create a thread called, "Why aren't the physicians treating me like equals when I have an online NP degree" :chuckle

For every good NP who comes out of one of these online NP programs, how many make the profession look bad? Maybe even you know of an NP who you said probably shouldn't be in this profession. That's the problem with these programs. Too many questionable graduates. If you talk to physicians, many can relate bad experiences with poorly trained NP's. Look at it this way. If online NP programs were so successful and strong, why do we have so many NP's who can't find work? You can find several threads on this forum from NP's who have been looking for work for many months. I have no doubt it is because of the perception and experience of physicians with prior bad NP's. The true test of the quality of the NP's coming out of programs is the demand for them. If we as a profession want to improve our image with the physicians and public, we have to tighten the quality of the product we produce. That means rigorously testing students to make sure they know their stuff, ensuring students receive quality clinical training at reputable sites, etc. There are too many holes in online training that someone of questionable moral and intellectual abilities can slip through.

FNP2009, It sounds like you got a great experience from your well-structured program. However, the arguments that people are making here is that there is no mechanism in place to guarantee that all online NP programs are of high standard. Too many of them are substandard and the grads of these programs are giving NP's everywhere a bad name. There needs to be tighter quality control of NP programs nationwide so that a consistent, high quality product is produced at each and every program.

I'll say it again. There are no accredited online US MD or DO medical schools. In fact, if online coursework was the mainstay of your medical training even during the pre-clinical years if you're from a foreign medical school, I don't know of one state that will license you.

this still doesn't address the central question. who do physicians prefer to hire? traditional or online np's? if you're so proud of your online pedigree, make sure you repeatedly point this out again and again during your interviews and see how they receive it.

no accredited us medical school is mostly online. they may have some online components here and there like any modern educational institution, but the vast majority of the time in the classroom. in fact, you will not get a license in many states even if your pre-clinical years were mostly online. why is this point important? because some carib md programs tried this and their grads are not able to get us licenses.

The goal of any NP degree, whether online or traditional, is employment. Because physicians are the primary employers of NP's, I think that it is more important to consider their opinion on degree format. Do most physicians have favorable views of online NP degrees or traditional ones? Since there are no online MD degrees and most physicians know that learning medicine requires clinical time and experience with a knowledgeable and competent preceptor, I would argue that most physicians would not look at online degrees favorably. Don't believe me? Why don't the online degree supporters ask the physicians over on SDN for their opinions? They are, after all, most likely the future employers for NP's and PA's.

You are employed at-will. An employer can let you go or you can quit at any point in time. You can't force an employer to keep you on and pay you for another 2 weeks or month. They could use that money instead to hire and train your replacement. I highly doubt that you have a case.

However, to get that residency at Mass Gen or JHU or to get into derm, plastics, etc, it sure helps you a lot if you go to Harvard Med or JHU Med. To get into Harvard Med, it helps if you went to an Ivy for college. Not saying it's impossible to get into a great residency from State U Med, but it's a lot more difficult.

I think what ANPFNPGNP is trying to point out is that among docs the school that other docs went to is very important to them. Graduating from Harvard Med is different in the eyes of many docs than graduating from State U Med. So why are people surprised when they use this same yardstick when it comes to APN's? In theory, if docs are presented with two APN's, one from an elite school and one from unknown school, which one would they pick? 9/10 times, it will be the elite school. However, this rarely happens. Docs probably will pick among individuals from schools they have only vague idea about.

but for who's benefit? for the universities who will collect more tuition money from me? if i don't see an increase in pay or scope, how do i benefit? i'll be forced to compete with pa's for the same salary but i have to spend twice as long and much on my education.

I doubt it. If PA's are smart, they will stay master's. I've been saying this over and over again. We're shooting ourselves in the foot with the DNP. DNP is longer to complete than a PA but there's no benefit in terms of scope or pay. The DNP does not give us an edge when it comes to finding jobs. If you're an MD, who would you rather hire? A PA who is asking for 70k or a DNP asking for 100k but they both do the same job?

So how can anyone here argue that APN's shouldn't at least be regulated by both BON's and BOM's as they do in some states? Many of you are saying is that you do both. If you do both, then doesn't it make sense that both regulate APN's then? APN's are clearly practicing medicine. Remember that the DO's decades ago pretty much preached the same thing about looking at the patient as a "whole", etc. They even tried to create their own state boards. Look at what has happened. DO training today is nearly indistinguishable from an MD's. Besides Mundinger's study which hardly holds any water, there aren't much data out there comparing NP's and MD's. What if the MD's start to get serious and start to do real studies? How confident are the people here that the studies will unequivocally show that NP's are just as good as MD's, even in all areas of primary care? This is what people don't get. We have it good today. All we need to do is go to NP school for 2 years. I fear, and with good reason, that if the MD's start to really scrutinize the DNP and training we get, the training will get longer and harder. There will be more regulations, more cert exams, re-cert, etc. The same BS that MD's have to go through to practice. Is that the kind of regulation NP's want? Why do you think that the MD training got so long? Because it's heavily scrutinized field. A few people screw up and they tack on one more year of training for everyone. Something like that will happen to NP's if we allow these ivory-tower figures like Mundinger to lead us off the cliff.

Are APN's practicing nursing? Even Mundinger herself said that DNP's will have the knowledge of a physician and to play it safe Mundinger keeps the DNP's toes in the nursing pool. I've asked this before and I'll ask again. How many of you think that NP's could argue in court successfully that they are practicing nursing and not in fact medicine? If your best argument is to point to me statements from the ANA, AANP, AANA, etc where they claim that they are practicing nursing, then I've got a bridge to sell you. Judges aren't stupid. They look at the facts and they aren't swayed by some proclamations from nursing groups. Take a look at how the CRNA's in Louisiana were barred from doing pain medicine. They lost every single legal challenge even though the ANA and AANA supported them. Something like this could happen to NP's where judges officially rule that NP's needed to be supervised by the boards of medicine. * The practice of interventional pain management is not the scope of practice of a nurse anesthetist. * The practice of interventional pain management is solely the practice of medicine. Taking on the AMA is not like the AANA taking on the ASA. We're dealing with the entire enchilada. If it goes badly, at least we'll know who to blame. Mundinger.