What is the difference between NP and DNP?

dgenthusiast · Mar 16, 2010

They obviously must teach some strange brand of lobbying or rhetoric in the medical schools. Sounds like when you become a part of the fraternity they teach you to cry about student loans, whine about how low your pay is, and then beg society to give you more money.

You mean just like they teach you in NP/DNP school how to be a pretend physician? If anything, it's the nursing community that's greedy. You're not happy with what you have, so you want more. You have an inferiority complex and so, keep pushing more and more into the realm of medicine while calling it "advance practice nursing." Hah! It's not a good thing when primary care (which is one of the hardest "specialties" due to the sheer depth and breadth of knowledge you must have) is being taken over by nurses who have maybe 1/3 of the knowledge/training physicians have, at most. Giving patients more access to people with an inferior training is going to put them at risk...I suggest that we do some longitudinal studies and I would bet that there would be a pretty significant difference between physician and midlevel outcomes (since, you know, a lot of what you see in the primary care office will manifest in the future if you miss it).

Also, I can start to see why you guys have soooo many (useless) stats courses in the NP/DNP curricula. Are you really telling me that the all studies out there right now are well designed? Haha, nice. You guys have cited several studies that several of us "anti-NP/DNPers" (as you think of us) have thoroughly discredited. They don't just have minor flaws, they have huge ones like measuring useless values, using patient satisfaction as an indication of outcome rather than the actual medical outcome (I still can't wrap my head around this silly measure), etc. I recommend you add even more stats courses to the curricula since this is such a difficult concept.

And funny you say what medical students think is irrelevant. They have far more basic science and clinical training than NPs/DNPs receive. They're also the future leaders of medical teams and ticking them off is not going to do you any good. There are already several medical boards (in various states) talking out against the NP/DNP independence movement and last I heard, they're even taking them to the courts. Be careful what you wish for. If you push physicians hard enough, they will fight back tooth and nail. And considering how weak the NP/DNP training is, there's a good chance medicine will win.

wowza · Mar 16, 2010

there are plenty of publications with very solid methods that prove the point that np's have similar outcomes to physicians in the primary care arena. why do you insist on throwing in something about "complex" patients? you talk about conflicts of interest? i suppose you would like to see a study designed by physicians and administered by physicians and you would try to tell us that it had no conflicts?

i guess that shouldn't be a surprise as physicians have been used to pulling this type of trickery on the public for years. they try to claim that unless a physician leads medical research, it has no validity. they even lead and do research that they have inherent conflicts of interest with and then think that they can disclaim their own conflicts by disclosing them. if you really think that studies showing np's have similar outcomes are flawed because np's designed the study, then you are basically saying that there are no valid physician studies either and they should all be thrown out the window.

please post any one of these studies you think has solid methods.

in terms of conflicts, i would like to see any study from someone who does not have a major interest in either side. that is the idea of non-biased studies. mary mundinger created almost every study in your repertiore. this is the same lady who created the dnp, pushed for the nbme to create a certification exam and who has been a main lobbying force in the np movement. i cannot think of anyone who could possibly be more biased.

that is a wonderful thing. that means that patients can get greater access to more affordable care without a massive side of arrogance.

explain exactly how nps allow patients to get more affordable care. each patient pays the same deductible whether they see the doctor or np.

if you were talking about overall costs, provider pay makes up a miniscule portion of healthcare costs. so the small difference between physician reimbursement and np reimbursement doesn't create more affordable care. furthermore, it has been shown in numerous studies that nps order more tests than physicians upping their costs and taking away that difference in reimbursement. so that affordable care "bit" that people keep posting, is a myth.

dqbanrn · Mar 16, 2010

as i understand it, the difference in cost between an NP and and MD refers more to the cost of training. Specifically federal dollars which are used to fund many of the residency programs. Further, Medical school tends to cost more.

Even if someone believes studies showing nurse practitioners provide equal or better care are biased, I am unaware of any study showing NPs provide inferior care.

One strength of nursing education over the medical model is that nurses actually touch patients early on. Typically, most NP students have been involved in patient care for 4 years or more when they begin their NP education.

countryboy · Mar 16, 2010

One strength of nursing education over the medical model is that nurses actually touch patients early on. Typically, most NP students have been involved in patient care for 4 years or more when they begin their NP education.

I'm sure the 18,000+ clinical hours a physician has before he/she is independent is plenty of time around pts

Jstand · Mar 16, 2010

I'm sure the 18,000+ clinical hours a physician has before he/she is independent is plenty of time around pts

18,000? How exactly do you come up with that number?

prairienp · Mar 16, 2010

please post any one of these studies you think has solid methods.
furthermore, it has been shown in numerous studies that nps order more tests than physicians upping their costs and taking away that difference in reimbursement. so that affordable care "bit" that people keep posting, is a myth.

please do as you have recommended, provide reference(s) that nps order more tests. i will do my review as i recall an insomnia study in the mid 90s that compared mds to nps done by a md that concluded mds not only ordered more tests, but spent less time with the patients and ordered pharmacotherapy more frequently as compared to the nps.

here is the reference i was thinking of http://linkinghub.elsevier.com/retrieve/pii/000293439090349i

Jstand · Mar 16, 2010

please post any one of these studies you think has solid methods.
in terms of conflicts, i would like to see any study from someone who does not have a major interest in either side. that is the idea of non-biased studies. mary mundinger created almost every study in your repertiore. this is the same lady who created the dnp, pushed for the nbme to create a certification exam and who has been a main lobbying force in the np movement. i cannot think of anyone who could possibly be more biased.
if mundinger's studies are so flawed, then why isn't someone offerring up studies with conflicting results on the other side? there seem to be none at all that would even begin to say that her studies aren't correct. it seems to me that if they were that bad that at least someone would have designed a study to refute it, don't you think? maybe since you are so unbiased, you should design your own study to refute it.
explain exactly how nps allow patients to get more affordable care. each patient pays the same deductible whether they see the doctor or np.
if you were talking about overall costs, provider pay makes up a miniscule portion of healthcare costs. so the small difference between physician reimbursement and np reimbursement doesn't create more affordable care. furthermore, it has been shown in numerous studies that nps order more tests than physicians upping their costs and taking away that difference in reimbursement. so that affordable care "bit" that people keep posting, is a myth.

how about showing some of the studies you refer to regarding nps ordering more tests. i am sure that they are unbiased. as far as the costs go, nps are cheaper to train and if they practice independently they are free from a physician surcharge and cost less for all patients. it is no myth that nps can provide more cost effective care. you can simply look to the states where they practice independently and already see it happening there.

what are you talking about each patient paying the same "deductible"? what in the world does that mean? do you live in the us? and you are telling us you have some basic working knowledge of healthcare economics? provider pay makes up a much more significant portion of overall healthcare costs than malpractice costs do, and i dare say you wouldn't tell us that those were miniscule or insignificant.

wowza · Mar 16, 2010

18,000? How exactly do you come up with that number?

Yeah I think 18,000 may be a touch high. It is closer to 15,000 or 16,000. I have already posted on this thread that the minimum for 3rd/4th year is about 4200 hours at my school (most actually log closer to 5000). You can go back to earlier if you want to look it up. It's on page 7.

Add to that, residency which is 80 hours a week (mandated by law to be no more) for 49 weeks a year, for 3 years.

That comes out to be just over 16,000 hours.

Jstand · Mar 16, 2010

Yeah I think 18,000 may be a touch high. It is closer to 15,000 or 16,000. I have already posted on this thread that the minimum for 3rd/4th year is about 4200 hours at my school (most actually log closer to 5000). You can go back to earlier if you want to look it up. It's on page 7.
Add to that, residency which is 80 hours a week (mandated by law to be no more) for 49 weeks a year, for 3 years.
That comes out to be just over 16,000 hours.

I think you are still largely overestimating the number of hours a resident works. For starters, just because 80 hours a week is the maximum doesn't mean that all residents will "average" that many. It means that the average is obviously somewhere south of 80. Also, there are numerous studies that would suggest that any hours over 65 a week would be largely unproductive due to fatigue, so I would hardly call those hours quality educational time spent. It is hard to learn anything or to do a good job when you are fatigued. Perhaps if you really want to count all of the hours spent, you should do more years in residency in order to make sure that they are quality hours. The point is that the model used to train resident physicians with its long hours is counterproductive and there are diminishing returns. So the model is inherently flawed and basically stupid. Quoting the average number of hours spent doing something doesn't prove a thing other than that someone was present. It doesn't mean that the training is higher quality because someone was standing there half asleep for 20 extra hours a week.

wowza · Mar 16, 2010

please do as you have recommended, provide reference(s) that nps order more tests. i will do my review as i recall an insomnia study in the mid 90s that compared mds to nps done by a md that concluded mds not only ordered more tests, but spent less time with the patients and ordered pharmacotherapy more frequently as compared to the nps.
here is the reference i was thinking of http://linkinghub.elsevier.com/retrieve/pii/000293439090349i

an interesting study no doubt but with some massive flaws.

first and foremost this study did not study how each provider takes care of actual patients, instead they interviewed the provider and asked how they would take care of patients (ie not how they actually did take care of patients). what people say they would do, and what they do in real life are 2 very separate things. this is an example of response bias

i could create a study that asked people what they would do if they were walking down a street and they saw a neonazi beating up a black kid. i guarantee many would say they'd help the kid out compared to reality. this is why it is always better to measure a real variable, than ask someone about it.

the next problem is that all the subjects knew they were being studied which is a major source of bias. again, response bias, non-blinding, non-random sampling. the list goes on.

the study also just measured the number of questions asked by each provider, not whether or not they were the right questions to ask. there was also no physical exam could be done to rule in or out secondary causes of insomnia.

btw that study said nothing about ordering more tests

wowza · Mar 16, 2010

I think you are still largely overestimating the number of hours a resident works. For starters, just because 80 hours a week is the maximum doesn't mean that all residents will "average" that many. It means that the average is obviously somewhere south of 80. Also, there are numerous studies that would suggest that any hours over 65 a week would be largely unproductive due to fatigue, so I would hardly call those hours quality educational time spent. It is hard to learn anything or to do a good job when you are fatigued. Perhaps if you really want to count all of the hours spent, you should do more years in residency in order to make sure that they are quality hours. The point is that the model used to train resident physicians with its long hours is counterproductive and there are diminishing returns. So the model is inherently flawed and basically stupid. Quoting the average number of hours spent doing something doesn't prove a thing other than that someone was present. It doesn't mean that the training is higher quality because someone was standing there half asleep for 20 extra hours a week.

Fine, let's use 65 hours a week. That still puts it right around 14,000 clinical hours.

Jstand · Mar 16, 2010

If you were talking about overall costs, provider pay makes up a miniscule portion of healthcare costs. so the small difference between physician reimbursement and NP reimbursement doesn't create more affordable care. Furthermore, it has been shown in numerous studies that NPs order more tests than physicians upping their costs and taking away that difference in reimbursement. So that affordable care "bit" that people keep posting, is a myth.

So all you can do is pick apart the studies provided to you. WHERE is your evidence to support the bolded statement above?? Don't sit back and tell us how the studies provided are flawed if you have absolutely NO evidence to support the statements that you make.