mbreaz1

My point is not that you are right under normal circumstances, just that when a provider acts in an unethical manner and lies to their patient, yes you can conceal the truth about what type of care you are providing. The provider lied when they told the patient that the kidney disease was just a part of being diabetic instead of disclosing the fact that they made a mistake. It is easy to make someone think you are doing a good job if you lie to them. So what you are saying is that all NPs will lie to their patients in order to make them think they are doing a good job and thus have patient satisfaction? What is your degree? This isn't a basic premise in medicine, you are trying to make an argument about someone lying to their patient and thus it makes your example completely ridiculous. It doesn't prove your point at all.

Not really such a good point. Some Caribbean med schools are accredited, and most of them do cost less. How do you make the determination that the AOA is less anti-competitive in its accreditation policies? Also, nobody ever said that the AMA was to blame for high med school tuition. Furthermore, just because new schools are opening doesn't mean that supply is outpacing demand.

They are still self governed accreditation processes that are designed to limit availablility and have been from the very start. I will direct you to my points on the Flexner report. Haven't heard any rebuttals to the inconsistencies there yet.

I think that the medical profession places a lot of importance on titles. Most other professions have dropped the use of mister as a title. The medical profession still seems to perpetuate this sort of weird paternal requirement for respect of someone's education and wisdom. I find it rather strange that someone would still introduce themselves as "Dr. X" or that they would require anyone to call them that. This tends to only happen with old men or people in formal settings such as courtrooms and political assemblies. Any doctor/patient or doctor/nurse or other health professional relationship doesn't require such formality. It seems to me that the practice has just been kept up to stroke the physician's egos. It is really a silly and antiquated practice. I would never dream of calling any doctor that I went to or worked with by Dr. surname, regardless of what they wanted to be called. As a result, I don't see why there is a rub with an NP getting a doctorate degree. What is wrong with introducing yourself as James Madison, your physician? I think it must be that physicians would be offended by the fact that the NP could call themselves doctor while having a different education. The letters after the name are what lets people know the difference, so what is the big controversy the two letters that precede the name? If people are smart enough to know their alphabet, I think they can determine that there is a definitive difference between MD and DNP.

Let's just examine your initial argument. You said that there is an accreditation process for medical schools. I agreed but said that it is an anticompetitive process. You implied that there was no accreditation process for nurse practitioner programs, which I asked you to prove. YOU DID NOT. Then you said that the AMA was not anticompetitive, to which I offerred one of the many items of proof that they are indeed anticompetitive. You had no response to that. Now you are trying to tell me that because medical schools don't care where you went to school, and because they rank medical school reputation as the 9th most important criteria for choosing a resident that they are of higher quality than any DNP program? You also think that allowing physicians to artificially limit the number of medical schools and the entrants to the programs doesn't drive up costs? That sounds a little delusional to me. By the way, the second link is a survey. I believe that at least one of you or your PA colleagues on here has told me that surveys don't constitute scientific evidence and are completely irrelevant. So what exactly is it that you think you have proven with this post? I thought you were in favor of "evidence based posting". Isn't that what you guys call it?

Here is the key to your whole argument, the PCP in your scenario lied to their patient and acted unethically. Are you saying that primary care physicians routinely lie to their patients about their mistakes? If that is the case, you are correct, patients can't get a good idea of what quality of care they are getting because physicians are basically defrauding them. If the scenarios are endless, it seems to me that what you are saying is that a great deal of lying is going on out there and the only way to deminish the lying is to open the physicians up to competition so that more transparency is provided to the patient. We are definitely not talking about "lowering" standards for accreditation. What we are talking about here is a redistribution of the power to make the judgement calls on what the standards should be and how they should be applied. When the power is in the hands of a few who deem themselves to be acting in the best interest of the public, they have the power to do things that are in their own self interest under the guise of that action. Typically, they do act in their own self interest because that is human nature. When they are allowed to do so with no oversight on that power, they can become a tyrant and completely forget about the interests of the public. "This and no other is the root from which a tyrant springs; when he first appears he is a protector." -Plato

What you wrote is that the case had nothing to do with competition and consumer choice when in fact that is all it is about. The fact is that you don't ever really debunk anything. You simply say that it is untrue because it is contrary to your own opinion. You don't ever analyze anything. You obviously didn't analyze that case. Here is what you said: "Once again, nothing about letting consumers choose their provider. Most people would realize that "consumers" who don't know much about what they're buying (ie. medical care) would probably choose poorly." Now you are backpedaling and saying that isn't what you said. So I did READ your post and I did CRITICALLY ANALYZE it. You said that most people would tell you that they are too stupid to choose their own provider. That is what everyone who posts on here seems to contend. They think that everyone outside of the healthcare realm is too much of a fool to be able to understand the difference between a physician and a nurse practitioner and to be able to choose between the two. That is the whole premise of your argument. People do this in the use of a number of other professionals. There is no reason that it can't work in medicine. I guess the person doesn't know whether every little detail of their treatment is absolutely perfect or not, but "good care" is a subjective term by it's very nature. What that means is that what you consider to be good care, might even be different from another provider's opinion. Medicine is truly more of an art than it is a science. So why should you be able to push your values about what you think is "good care" onto another person's body. What this is all about is choice and competition, and you don't want either of them because it doesn't advance your position. DO you understand what I am saying now? Can you hear me? You have never offerred a shred of true evidence. I am the only one who ever did that. You sit back and ask people to provide evidence so that you can discount it by simply saying that it isn't true, is poorly designed, or doesn't prove anything. What I have proven here is that the federal courts have agreed that the AMA is an anti-comptitive organization, to which I have heard absolutely no rebuttal. I stand behind the fact that there needs to be no further research to prove that NPs can and should practice independently. That is all that I said about there needing to be no research.

I did read the lawsuit. The ruling wasthat the AMA violated the Sherman Antitrust Act, which means they were GUILTY of unlawful restraint of trade.QUOTE FROM THE OPINION:]] This conduct constituted a conspiracy among the AMA and its members and an unreasonable restraint of trade in violation of Section I of the Sherman Act. It is all about letting consumers choose for themselves what provider to go to. Why is it that everytime someone posts a study or comment that is contrary to your opinion, you never produce any evidence to counter it, you just simply say that is a poorly designed study and doesn't constitute evidence, or that their comment is incorrect? You made absolutely no point in your above post other than the fact that you don't understand the law and you were displeased with the outcome of the case, so you thought you would cry about it like the physicians probably did. Listen to yourself on this stuff about consumers. You are saying that most people realize that they are too stupid to choose a medical provider that is right for them? I don't think that more than 50% of the population would tell you that if you polled them. Do you really think that every poor soul who walks the earth who isn't a physician is a complete moron? I'm guessing that would include you since you claim you are not a physician. Are you actually suggesting that educated people can't understand what primary care provider is right for them?

Sure, they would agree accreditation is necessary, but not to the extent that the medical profession does it to limit competition. The AMA is the most anti-competitive group in the country. I don't know what you are talking about that my argument doesn't hold water. Plenty of people agree, including federal courts: in Wilk v. American Medical Association (1990), a federal court concluded that it was anticompetitive for the AMA to pass an "accreditation rule" that forced hospitals to exclude chiropractors from access to medical facilities. The AMA claimed the exclusion was necessary because the chiropractors were not using proven methods of health care. However, the court decided that this choice should be made by consumers themselves and not through coerced exclusion of chiropractors from the market.

Simple law of supply and demand. If there are fewer, it costs more.

The truth is that these accreditation procedures for medical schools are specifically designed to limit competition and have done so since their inception. That could be one reason that the poor physicians graduate with so much student loan debt. But you certainly guessed wrong about the accreditation process for an NP program. Maybe you should complete your research and not try to be so one sided in your argument.

What?

I really don't think there need to be any changes in the current curriculum for nurse practitioners other than to simply make it more uniform across programs. I also would agree that requiring a doctoral degree doesn't add anything in terms of value to nurse practitioners. I think their education and training levels are fine for them to be independent providers within their scope of practice. I think that people in medical professions get very hung up on titles. It is actually worse than politicians are about it. I think it is silly to go around calling yourself doctor or to expect other people to call you that. It is condescending. Titles are antiquated. The healthcare industry needs to get over itself on a lot of antiquated notions.

What you all fail to acknowledge is that patients are never happy if you don't provide good care. Those two are definitely mutually exclusive. You can't do a poor job and make a patient happy.