Actually, a lot of medical students/pre-med students as well.
I've been googling the subject DNP vs. MD and find little from nurses, but a slew of pure hatred for nurses and the DNP.
What gives? I understand the idea- the fear that the DNP will start to deprive the MD from practice, rather than work with the MD.
I found the threads interesting as at no point did any of the med students, not once, show concern that the quality of care provided might be lacking with a DNP.
The med students have this idea that from year 1 of undergrad through completion of a DNP program there are only 600-700 hours required in clinic, and that a DNP takes 2 years or less presuming one already has a BSN.
They also seem to rage in regards to nurses being able to work, and thus get paid, while attending school.
They call the DNP's "Dr. Fakey McNursey", and worse.
Where's the respect? What about the patients?
Why all the hostility? Why do MD's feel they're being pushed away? Is there a history of these new DNP's not providing quality care, or working with MD's? Is it just an ego issue? And why do so many existing NP's dislike the idea of the DNP (beyond what I've read- that additional education isn't apparently needed, some claim)?
As a NP in Texas, I absolutely will not support this bill! NPs are not physicians, have only a shred of their training, and should have physician oversight. If NPs want total autonomy, then go to medical school.
As far as not accepting medicare/medicaid, how are these individuals with an average of over $200,000 in student loans supposed to repay this money with reimbursement as it is now?
back in the mid 1990's i was a premed student and the physician who ran the per med seminar class i took talked about the issue of how much training a person needs to be a medical provider (medical meaning: np, pa, and md). his sense was that medical schools and residency programs were over training/over educating for providing care. he talked about medical schools that were considering taking a more nursing model-eg: doing specialty training from the beginning of school and not doing as much general medical education. its funny that nursing is feeling they need to go more medical model-more general education, then moving into specialty training. he also suggested that medical schools were still using a 19th century model for education which was probably useful in the 19th century, but with highly specialized medicine and biology we now have, at some point it seems there may need to be a shift in the education of physicians-as there may be just too much knowledge to learn, and specialization- as a necessity dt the amount of information to learn- would occur earlier in training.
in the field of education, it's called scope and sequence. the determination what previous knowledge is need to master advanced knowledge. i agree that your program director has a point. change is very slow in higher education.
Notice despite the fact that this lecture was 20 years ago, no medical school in the country has done this- for a reason. They never cut down the breadth or depth of medical school and many residencies (IM/FM/EM) are considering lengthening residency, quite frankly because the medical knowledge is so broad you could not have a competent practitioner without such extensive training. This is especially true for a generalist (IM, FM, Peds, EM). The fact that there are those who don't realize this, just proves how little those people actually know and have been exposed to. It shows ignorance to the sheer amount of medical knowledge out there. The further I get into my career, the more I realize how much there is to know and the more I realize that medical school was less than the tip of the iceberg. A cursory education does not help patients.
Viral2010 I respect your point of view. What do you propose as a solution?
As for physician supervision that's not a big deal, all doctors have someone to answer to:
-Interns report to residents
-Residents to attendings
-Jr attending to Sr Attendings
-Sr. report to Directors
-Private practice doctors answer to insurance companies and other doctors for paitents.
As for basic science knowledge learned in medical school. It not all that appears. Yes on paper, there is a lot more content (about 25-30 credit per semester) than a PA or NP program. But how much was learned and retained? Ask most doctors. They'll probably say it's 'Drinking water from a firehose.' They way the material is presented it's impossible to gain full content mastery of the subject. You wind studying to pass tests not to learn. It's just too fast paced. Both NP and MD programs have room for improvement.
As a NP in Texas, I absolutely will not support this bill! NPs are not physicians, have only a shred of their training, and should have physician oversight. If NPs want total autonomy, then go to medical school.
As far as not accepting medicare/medicaid, how are these individuals with an average of over $200,000 in student loans supposed to repay this money with reimbursement as it is now?
You are entitled to your opinion on independent practice, but I think you are very wrong. As far as how to repay their loans? That is their problem. Why don't you tell them to cut expenses like everyone else has to do?
As far as NP/DNP haters - I've encountered more than my fair share of this type of negativity to last a lifetime. I opened a minor emergency/primary care clinic in a medically underserved area of my city 4 months ago. It was featured in the local newspaper before it opened and that really ruffled some feathers. I offer low cash prices for the uninsured and under-insured, plus I accept Medicare, Tricare and Medicaid. I'm trying to help people who have limited access to medical care, yet several physicians have made negative comments to me about owning a clinic - they think only physicians should be allowed to own practices. I'm originally from NM, where we've had independence from physician oversight for almost 20 years, so this just amazes me. A lot of physicians in my area seem to think that advanced practice nurses are a new phenomenon, even though we've been around for over 40 years.
What's really amazing is the fact that many physicians in my city refuse to accept Medicare, Tricare or Medicaid, much less work in a medically underserved area. It's like they don't want to take care of those patients, but they don't want anyone else doing it either! This is just insane. Seriously, this needs to be about patient care and not a turf war.
It's interesting that you say that many physicians don't accept Medicare, Tricare, or Medicaid, but when I looked at the site you linked (presumably where you work), you seem to have a cash-only type of practice for the most part (with the exception of those 3 insurances). For example, you charge $60 for an office visit whereas Medicare pays about half of that and Medicaid pays even less. Not only that, it seems you guys treat (for the most part) minor things. I can't imagine those take up a majority of your time, so I would think you'd be seeing greater patient volumes than physicians who have to deal with everything from minor to very complex cases. Seems like you can easily make up for the loss of money due to patients with those 3 insurances from the patients who pay with cash/credit. I wonder how many of the physicians you're complaining about run primarily cash practices...Feel free to correct me if I'm wrong, of course.
Edit: Don't take what I said the wrong way. I'm genuinely curious about how your practice works. Thanks.
As a NP in Texas, I absolutely will not support this bill! NPs are not physicians, have only a shred of their training, and should have physician oversight. If NPs want total autonomy, then go to medical school.
As far as not accepting medicare/medicaid, how are these individuals with an average of over $200,000 in student loans supposed to repay this money with reimbursement as it is now?
NPs have been without physician oversight for almost 20 years in NM. We're also completely independent in at least 16 states and counting (including Washington, D.C.). Studies have CONSISTENTLY concluded that our patient outcomes are equivalent to those of physicians. So, tell me again WHY we shouldn't be independent?
Don't even get me started on how physicians are supposed to be more competent since they have more training. I can tell you stories that will shoot that theory down in a heartbeat.
NPs in Texas are leaving this state in droves due to the restrictions imposed on our profession. Texas can educate EIGHT NPs for the same cost as educating one physician. In case you've been living in a cave, there are not enough primary care physicians to take care of patients and therein lies the problem. We have already proven that we can provide excellent care. Leave primary care to NPs and we'll refer to doctors when necessary.
NPs have been without physician oversight for almost 20 years in NM. We're also completely independent in at least 16 states and counting (including Washington, D.C.). Studies have CONSISTENTLY concluded that our patient outcomes are equivalent to those of physicians. So, tell me again WHY we shouldn't be independent?
Unfortunately, there aren't any (yes I mean absolutely none) well-done studies that suggest that outcomes are equivalent beyond providing care for minor things that really don't require any training at all. There are many studies performed with flawed methods, looking at useless metrics such as patient satisfaction, etc, that are commonly cited on these forums. I urge you to read the studies yourself and to read them with a critical eye.
If someone can conduct a study that definitively shows equivalent outcomes, no matter what the complexity of the patient is, then I would be more than happy to publicly retract my statements. If it's obvious that outcomes are equal, as you say they are, you should be able to easily get IRB approval to conduct a prospective trial with patients randomized into physician and NP arms without regard to complexity (kind of like how you'd see patients in a clinic without physician oversight). Obviously, there would be no physician back-up for the midlevel arm. After about 2 years or so (because primary care requires long-term management of conditions, it'd be nearly impossible to notice difference in a time period shorter than 1-2 years), the data can be analyzed. Then, we can draw conclusions about whether NPs/DNPs should be allowed to practice independently.
Don't even get me started on how physicians are supposed to be more competent since they have more training. I can tell you stories that will shoot that theory down in a heartbeat.
Genuine questions, and I hope you don't take it the wrong way: Logically, if someone with a vast amount of training (ie. physicians) make some horrible mistakes, do you really think that others with a fraction of that training will make fewer/less horrendous mistakes? Please explain to me the logic behind that. I honestly cannot see how that works out. Surely you know something I don't and I would love it if you could reveal that secret to me. Thanks!
NPs in Texas are leaving this state in droves due to the restrictions imposed on our profession. Texas can educate EIGHT NPs for the same cost as educating one physician. In case you've been living in a cave, there are not enough primary care physicians to take care of patients and therein lies the problem. We have already proven that we can provide excellent care. Leave primary care to NPs and we'll refer to doctors when necessary.
Eh, for the proof part, please read what I wrote above.
To be honest, I wouldn't leave primary care to anyone but physicians. Primary care is one of the hardest medical specialties out there because of the sheer depth and breadth of knowledge one needs to have. I want to leave it to the people who have exactly that: the greatest amount of depth and breadth of knowledge out of all providers. As one wise attending told me, "it's easy to provide mediocre primary care; however, it's incredibly hard to provide good primary care."
Just because there aren't enough primary care physicians doesn't mean you replace them with individuals with a fraction of the training. What you have to do is provide incentives for med students to enter primary care. Obviously, giving equivalent scope of practice, etc, to midlevels would not entice many medical students into the field.
It's interesting that you say that many physicians don't accept Medicare, Tricare, or Medicaid, but when I looked at the site you linked (presumably where you work), you seem to have a cash-only type of practice for the most part (with the exception of those 3 insurances). For example, you charge $60 for an office visit whereas Medicare pays about half of that and Medicaid pays even less. Not only that, it seems you guys treat (for the most part) minor things. I can't imagine those take up a majority of your time, so I would think you'd be seeing greater patient volumes than physicians who have to deal with everything from minor to very complex cases. Seems like you can easily make up for the loss of money due to patients with those 3 insurances from the patients who pay with cash/credit. I wonder how many of the physicians you're complaining about run primarily cash practices...Feel free to correct me if I'm wrong, of course.
Edit: Don't take what I said the wrong way. I'm genuinely curious about how your practice works. Thanks.
I charge $60 for adults and $48 for children under 18 (including college students). I never planned on accepting any insurance plans, in fact the local paper wrote a story about my "cash only" practice before it opened, since that was somewhat of a new concept in my area. If you look on the first page of my website, there is a link to the article (off to the right of the screen). Also, take a look at my cash prices for services such as I&D's, suturing, injectables, etc. Do you know where you can get sutures for $100.00? That's a global charge and includes all supplies/injectables and follow ups. The other places I've worked charge $200 per 2.2 cm, $35 for a surgical tray, $10 for Betadine, $4 for gauze, $10 per ml for Lidocaine, $10 for packing strip...but that's still less than the ER!
When the clinic opened almost half the patients who came in had insurance, so I had no choice but to get credentialed with insurance companies. Currently, we accept Medicare, Tricare, BCBS and UHC. I'm in the process of getting credentialed to accept Medicaid and I've signed contracts with Humana and Aetna. The only reason I was able to get credentialed with Humana, Aetna and UHC was because my clinic is in an underserved area. My contracted rates are far less than what my physician friends get reimbursed for the exact same service.
I've worked at several minor emergency clinics and they charge $125+ for a cash visit, so I wanted to charge less than half that rate, so the hard working people without insurance could afford health care. I treat exactly the same things the other urgent care clinics treat, except I see more primary care patients (50/50). We're open until 9 pm weekdays and also on weekends, so people don't have to take off work to get health care.
The #1 most rewarding aspect of my practice has been treating people who knew they had DM or HTN, but couldn't afford the prices doctors are charging in this area, so they didn't seek treatment. I've also contracted with a lab that gives my cash pay patients a big discount - almost half what they would pay otherwise. So, now these patients can afford to see me, get labs and buy generic medications they can afford.
I charge $60 for adults and $48 for children under 18 (including college students). I never planned on accepting any insurance plans, in fact the local paper wrote a story about my "cash only" practice before it opened, since that was somewhat of a new concept in my area. If you look on the first page of my website, there is a link to the article (off to the right of the screen). Also, take a look at my cash prices for services such as I&D's, suturing, injectables, etc. Do you know where you can get sutures for $100.00? That's a global charge and includes all supplies/injectables and follow ups. The other places I've worked charge $200 per 2.2 cm, $35 for a surgical tray, $10 for Betadine, $4 for gauze, $10 per ml for Lidocaine, $10 for packing strip...but that's still less than the ER!
When the clinic opened almost half the patients who came in had insurance, so I had no choice but to get credentialed with insurance companies. Currently, we accept Medicare, Tricare, BCBS and UHC. I'm in the process of getting credentialed to accept Medicaid and I've signed contracts with Humana and Aetna. The only reason I was able to get credentialed with Humana, Aetna and UHC was because my clinic is in an underserved area. My contracted rates are far less than what my physician friends get reimbursed for the exact same service.
I've worked at several minor emergency clinics and they charge $125+ for a cash visit, so I wanted to charge less than half that rate, so the hard working people without insurance could afford health care. I treat exactly the same things the other urgent care clinics treat, except I see more primary care patients (50/50). We're open until 9 pm weekdays and also on weekends, so people don't have to take off work to get health care.
The #1 most rewarding aspect of my practice has been treating people who knew they had DM or HTN, but couldn't afford the prices doctors are charging in this area, so they didn't seek treatment. I've also contracted with a lab that gives my cash pay patients a big discount - almost half what they would pay otherwise. So, now these patients can afford to see me, get labs and buy generic medications they can afford.
NPs have been without physician oversight for almost 20 years in NM. We're also completely independent in at least 16 states and counting (including Washington, D.C.). Studies have CONSISTENTLY concluded that our patient outcomes are equivalent to those of physicians. So, tell me again WHY we shouldn't be independent?
Don't even get me started on how physicians are supposed to be more competent since they have more training. I can tell you stories that will shoot that theory down in a heartbeat.
NPs in Texas are leaving this state in droves due to the restrictions imposed on our profession. Texas can educate EIGHT NPs for the same cost as educating one physician. In case you've been living in a cave, there are not enough primary care physicians to take care of patients and therein lies the problem. We have already proven that we can provide excellent care. Leave primary care to NPs and we'll refer to doctors when necessary.
I would love to see the proof that NPs are leaving in droves. If they are leaving in droves to be independent, then that's their problem. I'm glad we NPs have the physician oversight requirement in Texas, it will help keep patients safe. The problem with NPs like you is that you think you're equal to a physician and that will do your patients a great disservice. Texas may be able to educate 8 NPs for every physician, but it wont be at a level of competency anywhere near that of a physician.
viral2010
74 Posts
As a NP in Texas, I absolutely will not support this bill! NPs are not physicians, have only a shred of their training, and should have physician oversight. If NPs want total autonomy, then go to medical school.
As far as not accepting medicare/medicaid, how are these individuals with an average of over $200,000 in student loans supposed to repay this money with reimbursement as it is now?