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)?
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.
I don't think I'm equal to a physician. However, I know that I can take care of the majority of healthcare problems that present on a day to day basis and I know when I can't. I refer to a "higher level of care" for complex issues that I'm unable to treat. I've been doing it for 5 years now. I "shared" an internal medicine practice with a physician - I saw the patients 3 days a week and she saw them the other 2 days. This arrangement worked out well for both of us.
Doctors have monopolized the health care field long enough - we can all see how that has turned out. In NM, psychologists and optometrists are able to prescribe medication within their scope of education/training - you can bet THAT ruffled some feathers. In OK, optometrists are able to perform LASIX surgery and that has brought down the cost of that procedure so more people can afford it. In fact, the TMA and TX Medical Board have filed a lawsuit against the TX Chiropractic Board over yet another "turf" issue. Make NO mistake about it, this is all about money!
If physicians were so concerned about patient care, then why did they try to get legislation passed in 2009 that would have enabled them to supervise up to 8 midlevels in TX? Now, just how on earth is that humanly possible? As long as the doctor is on site, they can bill at the DOCTOR RATE for those midlevel visits, even though they never see the patient nor review the chart. You don't think this is about money??
If physicians were so concerned about patient care, then why did they try to get legislation passed in 2009 that would have enabled them to supervise up to 8 midlevels in TX? Now, just how on earth is that humanly possible? As long as the doctor is on site, they can bill at the DOCTOR RATE for those midlevel visits, even though they never see the patient nor review the chart. You don't think this is about money??
And if midlevels were really concerned about patient care, they would make their education more in line with physician training. Instead, what it really is about is money- not patients. You can house it in whatever light you want to but it really is about money. Midlevels want the money that being a doctor entails withouth having to go through the training, the time, the effort or spend the money associated with the duration of education.
And if midlevels were really concerned about patient care, they would make their education more in line with physician training. Instead, what it really is about is money- not patients. You can house it in whatever light you want to but it really is about money. Midlevels want the money that being a doctor entails withouth having to go through the training, the time, the effort or spend the money associated with the duration of education.
I actually only want to take what is useful from physician training. I certainly don't want to put the biomedical, clinical point of view over all others. In my area, psych, relief from drugs has not been realized. In fact, people with schizophrenia for example, do better in third world countries where there is a better social network. Social interaction can change gene expression. So, yes I'm concerned about patient care so I don't want my education more in line with physician training.
And if midlevels were really concerned about patient care, they would make their education more in line with physician training. Instead, what it really is about is money- not patients. You can house it in whatever light you want to but it really is about money. Midlevels want the money that being a doctor entails withouth having to go through the training, the time, the effort or spend the money associated with the duration of education.
They don't need physician education to do their job for starters. They can provide more cost effective care without it. If physicians weren't so greedy, they would agree and stop opposing it. If the money is so good that midlevels would aspire to it, then why do physicians cry and moan about how bad the reimbursement is? Can you explain that to me? It wouldn't make a whole lot of sense now would it?
They don't need physician education to do their job for starters. They can provide more cost effective care without it. If physicians weren't so greedy, they would agree and stop opposing it. If the money is so good that midlevels would aspire to it, then why do physicians cry and moan about how bad the reimbursement is? Can you explain that to me? It wouldn't make a whole lot of sense now would it?
So explain how it is more cost effective.
Here are the facts:
1) the patient pays the exact same co-pay- so it's not cheaper for them
2) midlevels get paid what, 80-85% of what physicians get paid
3) provider pay has been shown to be ~10% of helath care cost. Costs are more associated with tests/meds- so the tiny difference is 1% of costs.
4) it has been shown in various studies that midlevels order more tests which makes up the tiny difference that pay difference makes
5) we all know midlevels continually push for the same pay as physicians. Midwives are currently paid what physicians are.
So in the end, we have less trained providers, yet it costs the system almost the same, possibly more. When midlevels finally get paid what physicians do, we will have providers who are less trained, cost the system more than physicians do and cannot do the same things that a physician can... that makes sense
1) the patient pays the exact same co-pay- so it's not cheaper for them
2) midlevels get paid what, 80-85% of what physicians get paid
3) provider pay has been shown to be ~10% of helath care cost. Costs are more associated with tests/meds- so the tiny difference is 1% of costs.
4) it has been shown in various studies that midlevels order more tests which makes up the tiny difference that pay difference makes
5) we all know midlevels continually push for the same pay as physicians. Midwives are currently paid what physicians are.
So in the end, we have less trained providers, yet it costs the system almost the same, possibly more. When midlevels finally get paid what physicians do, we will have providers who are less trained, cost the system more than physicians do and cannot do the same things that a physician can... that makes sense
None of what you said makes any sense whatsoever, it isn't even consistent with your own previous arguments. It is ridiculous. You need to go back to school and learn a thing or two before you try to tangle with me on this.
1) the patient pays the exact same co-pay- so it's not cheaper for them
2) midlevels get paid what, 80-85% of what physicians get paid
3) provider pay has been shown to be ~10% of helath care cost. Costs are more associated with tests/meds- so the tiny difference is 1% of costs.
4) it has been shown in various studies that midlevels order more tests which makes up the tiny difference that pay difference makes
5) we all know midlevels continually push for the same pay as physicians. Midwives are currently paid what physicians are.
So in the end, we have less trained providers, yet it costs the system almost the same, possibly more. When midlevels finally get paid what physicians do, we will have providers who are less trained, cost the system more than physicians do and cannot do the same things that a physician can... that makes sense
Let's just start with the first fallacy in your argument then. You say that midlevel providers cannot do the same things that physicians can. Please show some shred of proof for that statement. If you can prove that, then we will attack the rest of your argument. Otherwise, it isn't even worth discussing.
Whew - after 7 pages this issue hasn't been resolved.
Maybe we just need to agree to disagree on this topic and decide that we need to do what is best for the pt: in those underserved areas where (apparently) physicians don't want to practice, have mid-levels. And...for those areas (either a particular specialty or a particular part of the country) where there is a glut of physicians, let the physicians fight it out.
Thank god for NPs like viral2010. It gives me hope.
But you ask why so many physicians are hostile to DNPs? It's exactly because of the attitudes of those like ANPFNPGNP, and even those who are more militant for expanded scope, no supervision and claims of equivalence. Unfortunately that is now the public face of the DNP movement (and many extend that to all NPs, unfortunately, because a large majority is silent).
You ask if its just students who are becoming increasingly hostile? I can tell you for a fact it is NOT -> many senior residents and young attendings, the future generation of doctors are very, very angry due to some of the reasons stated above.
I for one respect so many NPs who provide such good care for so many patients. The problem is there is a vocal minority of DNPs who DON'T KNOW WHAT THEY DON'T KNOW. ANPFNPGNP blindly cites these studies which are so horrendously designed they are useless, as pointed out above. It makes me wonder if he/she has any formal education in reading articles and deciding if they are valid. The truth is, we don't know if midlevel care is equivalent in outcome to physician care. But it's very very clear there are propaganda studies that some people buy hook line and sinker.
In regards to the rural/underserved argument for no supervision, unfortunately the number of NPs/DNPs that go to rural areas doesn't really exceed the percentiles of physicians doing the same. I could understand if maybe it was required or if 50% were going to these areas but that's just not the case. Instead the trend has been NP/DNP going into specialty care where we do not need them...
Anyway, I agree it will be interesting to see how this will play out.
Thank god for NPs like viral2010. It gives me hope.
But you ask why so many physicians are hostile to DNPs? It's exactly because of the attitudes of those like ANPFNPGNP, and even those who are more militant for expanded scope, no supervision and claims of equivalence. Unfortunately that is now the public face of the DNP movement (and many extend that to all NPs, unfortunately, because a large majority is silent).
You ask if its just students who are becoming increasingly hostile? I can tell you for a fact it is NOT -> many senior residents and young attendings, the future generation of doctors are very, very angry due to some of the reasons stated above.
I for one respect so many NPs who provide such good care for so many patients. The problem is there is a vocal minority of DNPs who DON'T KNOW WHAT THEY DON'T KNOW. ANPFNPGNP blindly cites these studies which are so horrendously designed they are useless, as pointed out above. It makes me wonder if he/she has any formal education in reading articles and deciding if they are valid. The truth is, we don't know if midlevel care is equivalent in outcome to physician care. But it's very very clear there are propaganda studies that some people buy hook line and sinker.
In regards to the rural/underserved argument for no supervision, unfortunately the number of NPs/DNPs that go to rural areas doesn't really exceed the percentiles of physicians doing the same. I could understand if maybe it was required or if 50% were going to these areas but that's just not the case. Instead the trend has been NP/DNP going into specialty care where we do not need them...
Anyway, I agree it will be interesting to see how this will play out.
viral2010 should have remained an RN if she had no desire for professional autonomy. The problem here is not with NPs, but with physicians. They would like to think that their education makes them the RIGHT provider for every situation simply because they go to school longer. They certainly aren't more efficient simply by virtue of the fact that they study longer. In case you haven't noticed, it isn't just NP's, or DNP's for that matter who are interested in independent practice. Their patients are asking for it too. That should tell you something. What it tells you is that all of those senior residents and young attendings, the future generation of doctors should be angry at themselves and their own profession for not doing a better job of being the professionals that they claim to be.
In regards to the rural matters, it simply doesn't matter. Why would NPs be licensed to practice independently "but only in rural areas"? That would be ridiculous. No state that has authorized independent practice has restricted it to low population density areas to my knowledge. I'm not sure why they would want to cut the urban citizens out of the benefit of having an independent nurse practitioner at their disposal either.
I do continually find it comical when you medical students get on this board and run down any study that might make a nurse practitioner sound competent and then fail to ever produce a shred of evidence proving otherwise. You say "the verdict is still out" while ignoring the fact that there are several hundred thousand NPs out there providing care everyday and doing so successfully. Your arguments against this are so ridiculous that I don't believe that they come from the mouth of someone who has any education at all. You really expect someone to believe that you have a superior education when you make arguments like this?
ANPFNPGNP
685 Posts
I don't think I'm equal to a physician. However, I know that I can take care of the majority of healthcare problems that present on a day to day basis and I know when I can't. I refer to a "higher level of care" for complex issues that I'm unable to treat. I've been doing it for 5 years now. I "shared" an internal medicine practice with a physician - I saw the patients 3 days a week and she saw them the other 2 days. This arrangement worked out well for both of us.
Doctors have monopolized the health care field long enough - we can all see how that has turned out. In NM, psychologists and optometrists are able to prescribe medication within their scope of education/training - you can bet THAT ruffled some feathers. In OK, optometrists are able to perform LASIX surgery and that has brought down the cost of that procedure so more people can afford it. In fact, the TMA and TX Medical Board have filed a lawsuit against the TX Chiropractic Board over yet another "turf" issue. Make NO mistake about it, this is all about money!
If physicians were so concerned about patient care, then why did they try to get legislation passed in 2009 that would have enabled them to supervise up to 8 midlevels in TX? Now, just how on earth is that humanly possible? As long as the doctor is on site, they can bill at the DOCTOR RATE for those midlevel visits, even though they never see the patient nor review the chart. You don't think this is about money??