By Andrew Villegas and Mary Agnes Carey
KHN Staff Writers
Provided by Kaiser Health News
OCT 05, 2010
A new report released today may give nurses with advanced degrees a potent weapon in their perennial battle to get the authority to practice without a doctor’s oversight.
The Institute of Medicine report says nurses should take on a larger and more independent role in providing health care in America, something many doctors have repeatedly opposed, citing potential safety concerns.
It calls for states and the federal government to remove barriers that restrict what care advanced practice nurses — those with a master’s degree — provide and includes many examples of nurses taking on bigger responsibilities. “A qualified health care professional is a terrible thing to waste,” Cheryll Jones, a pediatric nurse practitioner in Ottumwa, Iowa, told the authors.
The report calls for elimination of “regulatory and institutional obstacles” including limits on nurses “scope of practice” — which are state rules about what care people who are not physicians can provide.
The findings come from the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, a collaboration among nurses, doctors, health care business leaders and academics that studied the issue for two years. While the report addresses an ongoing battle being played across state legislatures, it’s not clear if the new report will have any impact on those battles. The panel is planning a meeting next month to discuss ways to implement its recommendations.
The new federal health care law provides more funding for nursing education and nurse-led clinics, but this study could also propel the nurses’ argument for more authority to deliver care independently from physicians.
“We cannot get significant improvements in the quality of health care or coverage unless nurses are front and center in the health care system — in leadership, in education and training, and in the design of the new health care system,” said Donna Shalala, a former Health and Human Services secretary and chair of the IOM’s committee on the future of nursing. “We can’t be fighting with each other if we really are going to have a high quality system that we can afford.”
For years advanced practice nurses — as well as a host of other caregivers such as chiropractors and physical therapists —have butted heads with doctors over “scope of practice” considerations. Doctors maintain that even with an advanced degree, these nurses do not have the same education that physicians get in medical school and residency programs and that patient safety could be compromised. They are also wary that their practices could see significant patient losses if the nurses were allowed to practice more independently.
In a statement responding to the report, Dr. Rebecca J. Patchin, a former nurse who is now an anesthesiologist and member of the American Medical Association’s Board of Trustees, said, “A physician-led team approach to care – with each member of the team playing the role they are educated and trained to play – helps ensure patients get high quality care and value for their health care spending. … Physicians have seven or more years of postgraduate education and more than 10,000 hours of clinical experience, most nurse practitioners have just two-to-three years of postgraduate education and less clinical experience than is obtained in the first year of a three year medical residency. These additional years of physician education and training are vital to optimal patient care.”
In its recommendations, the committee said Medicare and Medicaid should reimburse advanced practice nurses the same as a physician for providing the same care. “When you do the same job you ought to be paid the same,” Shalala said.
Also, the report calls for nurses to be allowed to admit patients to the hospital or to a hospice and for the Federal Trade Commission and the Department of Justice to review existing scope of practice provisions for “anticompetitive” practices.
The Obama administration has signaled its commitment to increasing the number of primary care providers, including nurses. Late last month the Department of Health and Human Services announced $320 million in grants to strengthen the health care workforce. The grants include $31 million to 26 nursing schools to increase full-time enrollment in primary care nurse practitioner and nurse midwife programs and $14.8 million for nurse-managed health clinics. In addition, Peter Buerhaus, a registered nurse, heads the newly formed National Health Care Workforce Commission, which was set up under the new law to advise lawmakers on how to change the health care workforce to better fit America’s needs.
Experts predict that more physicians, nurses and other medical professionals will be needed to care for the 32 million additional Americans who will get coverage beginning in 2014 under the sweeping health care law. Nurses’ groups say that they can help ease a physician shortage. Last week, the Association of American Medical Colleges said in a report that in 2015, there will be a shortage of nearly 63,000 doctors across all specialties in America.
The battle is being waged across the country. Colorado, for instance, recently became the 16th state to allow nurse anesthetists to work without a doctor’s oversight. In Michigan, nurses are pushing for legislators there to allow advanced practice nurses to prescribe drugs. Other fights over scope of practice for registered nurses loom in Kentucky, North Carolina, Iowa and Minnesota.
But, Dr. Alexander Hannenberg, president of the American Society of Anesthesiologists, said the clashes between nurses and doctors scare the public. “It’s exactly what people worry about when they worry about what health reform will bring,” he said. “Patients and voters say ‘If you’re talking about taking the docs out of my health care, I want no part of it.’”
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
Is this the tidal wave that is going to drown medicine as we know it? Why go to medical school when you can just become a “doctor” of nursing…
Doctor’s have had plenty of time to fix the American Health Care system, but they did not. Other groups are fixing it for them.
Its not up to doctor to fix health care system. Its our politicians and strong lobbying from Insurance companies that has ruined it.
The two professions have different perspectives on medicine. That’s why.
This is complete and utter bullsh it.
Working in a hospital with both MD’s and NP’s I do not see how this could ever be possible. While the NP’s I work with are excellent at their job, they are constantly going to the physicians with questions over things such as something they found during an assessment, or abnormal lab results. I will say that NP’s are absolutely necessary to modern healthcare. They help alleviate much of the pressures felt by overwhelmed doctors. The bottom line they are just not trained to take on the role of physician.
Scary
Purely politics
What about physician assistants who have more training than nurse practitioners
This is obviously very biased
DNP/NP programs – 60 credits in length; overseen by nursing boards, 500-600 hours of clinical training. The DPT averages 85 credits in length with 800 hours of clinical training…completed part-time over 2 years. Pre-requisites = an RN qualification and BS degree. Trained using a nursing model with nursing theory courses eating up the minimal number of credits in their education
PA programs average 125 credits in length and average 2-2.5 years; overseen by the medical boards; 2000+ hours of clinical training, rigorious pre-requisites required for acceptance similar to medical school. Requires …and they welcome MD supervision. Trained in the medical model of education
MD/DO programs are 200+ credits in length; 4 years of medical school followed by 3 years of residency training; over 10000 hours of clinical training.
There is no comparison. What are people thinking by letting nurses practice medicine. NP’s are fine caring for simple patients who don’t need the help of those trained with an advanced degree
So let the nurses take over Primary Care Physicians and see what happens. They want all the power and non of the responsibility.
Yeap, let them. Once nurses start getting sued, watch their mal-practice insurance going sky high unless they work with a physician, it will come back to normal.
This seems more like an attempt to gain power of decision and prestige than to address the problems we face in healthcare. I am all for NP’s playing a crucial role in the delivery of healthcare, however to place them at the same level of responsibility and status as physicians is ludicrous and comes off as a lame attempt at a quick-fix, at best. I am assuming (and hoping) this attempt made by the nursing profession to hijack the role of physicians will be met with much resistance from the AMA, AOA, and legislation. Don’t get me wrong; nurses are extremely valuable and very much needed, as much as doctors. But lets not get it twisted. They are NOT doctors, nor should they have the right to assume the role of one.
As a patient with years of shitty experiences in clinics which supposedly “cut the cost of healthcare,” I have never ONCE had a satisfactory experience with an NP or PA. After dozens and dozens of appointments they have never even come remotely close to diagnosing any of my problems (which I had to have later diagnosed by an actual physician). However incompetent, in my experience NPs and PAs are universally ego-maniacal and think that they have all of the knowledge and expertise of a doctor even when they fall desperately short. Not one of them ever deigned to refer me to a physician when it was obvious that they were not able to meet my medical needs, instead dismissing me and acting arrogant, as if it was MY fault as the patient that they couldn’t figure out how to treat me. How much do NP’s cut the cost of care if they don’t do their job effectively and the patient eventually ends up having to go see a real doctor anyway? Then they’re paying for the NP AND the doctor. In the short term, it may seem cost effective, but in the long term it’s devastatingly costly. The only thing a NP can be relied on is for diagnosing sniffles and bellyaches. But I could have done that myself and I’m not even a health care professional.
I have t agree with you. Twice I have almost been killed by a NP. The first one diagnosed a bad cold, gave me no meds and told me to “tough it out” for a few weeks. That same evening I was in the ER with a 105 degree temp and a simple x-ray revealed pneumonia. The second time I was prescribed the wrong medication and almost bled to death. I appreciate the hard work of nurses and applaud their use in primary care but only in addition to, not in place of, a real physician.
Completely biased opinion here, but I have never had an NP diagnose me correctly. One actually told me I had shingles once and that it did not require any medical attention. She said shingles goes away on its own in time… I told her I politely disagreed with the diagnoses, so she brought in another NP who said “I’ve never heard of shingles before, so I couldn’t tell you.”
1) it did not look anything like shingles
2) shingles is nothing to worry about it will go away on its own?
::sigh::
I have nothing against nurses, my best friend is one, but you’ve gotta draw the line somewhere. If I could be a gp just by going to nursing school + a little extra, why am I wasting a decade of my life with med school and residency?
Just a lot of talking. At the end of the day, not a lot will change. Doctors have a hard time letting other doctors take responsibility for their patients so no tell what kind of fight is in store for nurses trying to practice outside their role.
Nurses are important but they aren’t physicians. If they want more responsibility then apply to medical school.
Well, then the answer is not to go to these NPs etc. And if you get one in the hospital, just demand for an MD/DO – I’ve done it many times. The nurses’ demands are ridiculous when taking into account the disparity of training b/w them and physicians.
I was examined by an NP last year, and had pain in my hip for repetitive motions. He diagnosed me with arthritis. Needless to say, I want to a pain management PHYSICIAN who actually assumes a role of a physician rather than “substituting” for one. He gave me a correct diagnoses, and it wasn’t arthritis. I also felt insulted by the NP as well. I refuse to see anyone but a PHYSICIAN and who want to medical school, and who have MD and DO on their tag.
If NP or PA have the same power as MD/OD then why do people even go to MD school for? Our standard of care in USA will be decline if this is true. Even though there are shortage of MDs but NP/PA cannot take the same role. The best solution is to open more medical schools or matriculation more students to relief the shortage.
Please don’t include PA’s in this nursing manifesto. I have worked with many many PA’s and felt confident in their abilities. In fact I have worked with some amazing PA’s. Never have I worked with an NP who new what they were doing….seriously undertrained. PA’s know their limits and are just different in my opinion. As soon as I finish my fellowship year…i’m going to make sure I have a PA to work with….never an NP unless I’m forced.
Just my opinion and experience. Just don’t lump PA’s into this nursing manifesto. They are overseen by the medical boards in my state and are held to their standards.
MD fellow
This is a horrible idea. Despite their need to feel special, nurses have nowhere near the amount of training and knowledge that physicians have. I hate to quote Scrubs, but a nurse really is “just a nurse.”
If you think now is bad, wait until Obamacare takes effect. You will have to wait for weeks or months – just to see an Np/PA.
Brother, you asked for it!
Doctors maintain that even with an advanced degree, these nurses do not have the same education that physicians get in medical school and residency programs
lol, maintain? Replace with the truth is…
This is absolute bull*&%^. How do people figure. I could see a PA stepping up to the plate, but they are content with being supervised…and they have far better training than an NP. Autonomy has to be based on entry level standards….and NP’s are seriously lacking in entry level standards. Scary stuff.
If a shortage is truly an issue, why not take PA’s who are trained like the physicians of WWII and based on the medical model and offer them an abbreviated program to become a physician. They essentially have a masters degre in medicine….lets make a path to the MD and let them match for primary care spots. NP’s are a joke. They don’t have the pre-reqs, they don’t have the didactic education, they don’t have the clinical education…..but they sure know their politics.
I am against this idea.. this could lead to the death of medical practice as we know it. It would render the M.D. or M.B.B.S. or M.B.ch.B medical qualifications useless!! This is a bad step, its trying to politicize something that has been around longer than democracy! I SAY LET THE NURSES NURSE,and THE DOCTOR HEAL!
Nothing against nurses here, but I would like to mention that I have had one encounter with a PA in my life, at an urgent care clinic after hours. He was entirely professional and correctly diagnosed a somewhat rare tick transmitted illness from history and physical symptoms, ordered tests to confirm, and prescribed meds to fight it off.
I don’t have a problem with the idea of nurses eventually becoming higher level providers, but before they do, they need a higher level of education. On the job they spend a lot of their time focusing on the aspect of clinical care of patients rather than diagnosis, and their training reflects this. Doctors spend 2 years just learning anatomy, physiology, pathology, histology…essentially everything about how the human body and disease works, and then they move on to clinical aspects of care. Nurses are the backbone of our care system here and are vitally important, but they are not doctors.
As a NURSE….and also a pre-med student…
let me say this….
Nurses DO NOT welcome this proposal WHATSOEVER.
We are overworked and constantly being pushed by our management/hospital to perform great “customer service” (as healthcare is a money-making business).
I have 7 years ER, medical/surgical and pediatric care under my belt. I know what I am talking about.
And although we dont have the education of an MD…there are many MDs that do not even know the patient, yet make “textbook” decisions. This is not a clear-cut issue.
We need more doctors AND more nurses….NOT more blurring the boundaries of either scope of practice.
Either professions cannot exist independently.
If you want to be considered my equal then take all the steps of the USMLE followed by my specialty board exam written and oral with passing scores. Then we can talk about it.
Ultimately the patients (consumers) will decide. These institutes, boards, which are full of people that talk and don’t practice will not change anything other than the laws. As long as patients can choose, NP vs PA vs MD competition will play out, I think we know who the smart patients will choose when they really need care.
This is F—- disgusting.. I want these idiots who are for the nurse agenda to send their sick kids mothers and fathers to see the NP..If that’s the case why have admission process to get into medical school.. nurses and others do not have the intelligence to carry out the health care that is needed.. if they did, they wouldn’t go to nursing school, they would be in medical school..
@My choice: I’ve heard that argument before and it’s true for those patients that can afford the choice, know the difference, or even care. It’s a Pollyanna vision that supports inaction rather than fighting this dangerous effort by nurses.
Remember, nurses are looking to call themselves doctors, or even physicians as noted here: http://allnurses.com/nurse-practitioners-np/md-do-np-65769.html
Unless national legislation can be passed that requires clear and public designation that cannot be easily obfuscated by nurses, I suspect that in many cases patients won’t even know they’re not being treated by a residency trained, board-certified physician. Instead they’ll be seeing a ‘Dr. Nurse’ that potentially got their ‘doctorate’ from an online course.
After a while, if this follows historical trends (as HMOs use of PCPs through the 80s and 90s) you may see insurance companies mandate use of NPs and DNPs before a patient can see an MD or DO. So, even if you want to see a doctor, you’ll need to get authorization through your DNP’s office (or go to the ER).
This is the most unbelievable professional land-grab which is being rolled straight through under the banner of ‘healthcare reform’ thanks to lots and lots of nurse lobbyists.
Pharmaceutical companies have proven time and again (Vioxx, etc) that profits take precedence over patients’ lives — there is no reason to think that when presented with the opportunity to make more filthy lucre nurses will respond any differently. Plain and simple, nurses want more money, even if common sense doesn’t support patient safety when using nurses in place of physicians.
Student doctors… support those professional medical organizations that are arguing against this poorly conceived effort. Push for more medical schools and primary care residency funding so that we can do the right thing and train more primary care physicians rather than plugging the gap with inferiorly trained ‘nurse doctors.’
The lawyers will love this one… “Were you treated by an NP? We are here to help!” Honestly, I find this attempt to hijack the role of the physician disrespectful to patients and what they deserve in service.
As an NP to went to medical school, I can tell you there is a huge difference in education. You can’t even compare the two. An NP who thinks they’re capable of primary care on their own is truly ignorent. I know I was…..I went to medical school for the authority and ended up with a real medical education and completely new perspective of my previous abilities. A nurse is a very poor substitute for medical training.
@mychoice, putting aside what Tony B said, with which I agree100%, that choice is not going to be yours forever. Under Obamacare you will be unable to choose your doctor, that choice will be mandated by beaurocratic process. Since there will be so much more patients coming in to every practice, the number of NPs and the NP/MD ratio will be much higher, it’s more likely that you will see an NP than an MD, unless the gov’t decides you qualify for an MD/DO appointment. When the free market is tampered with, be so optimistic about your right and ability to choose.
I work with mid levels every day. I have met PA’s I don’t like, but none that are BAD at their job. On the other hand depending on where they were educated I have met great to TERRIBLE NP’s. I had to tell a Dr. NP what BiPAP was. She didnt feel like learning and she told me to write up what ever vent orders I wanted and she would sign them. One call to the ICU director and she was off the case. Why did she become a fake doctor just to let me write here orders for her? The difference in the quality of NP’s is scary.
Midlevel’s need physician oversight or a bridge program to let the ones who want to learn more to get a DO or MD while letting them continue to work and have families.
@ Francisco… I can’t choose my doctor NOW – which physician I see, and if my situation qualifies me to see a specialist, is decided by my health insurance provider. That’s not something that might happen in the future under new health care legislation, it’s already a reality. I’m not sure where you’re getting your information from, but the new healthcare legislation doesn’t even address the issue.
I just want to thank the Physicians and Physicians-in-training for their support towards PAs. Unfortunately, most hospitals in my area have several openings for NPs although PAs are severely looked down apon because of a strong nursing lobby in my area. My local university has both a PA and an NP program and the differences in educations between them are astonishing. While I spent a total of 3 years (full-time) and over 3000 clinical hours learning medicine, the NPs took all their classes online, and only clocked in 550 clinical hours! After all this, I consider myself a physician-extender, but the NPs trying to replace primary care physicians, it doesn’t make sense. It’s sad, but they are making up for an inadequate education by intense heavy lobbying.
Just like physicians, PAs have seen quite a boisterous push from the Nursing Lobby. The AAPA isn’t influential enough to limit NPs, although I have complete confidence on the AMA and it’s associated organizations.
This makes absolutely no sense. NP’s cannot fill the shoes of a doctor. I would much rather see PA’s have more autonomy than NP’s who earn their degrees online. Just get rid of the cosigniture requirements for PA’s and let them have more of a role in primary care…although still supervised….DNP’s are simply undertrained and their education is very inconsistant. This would be horrible for healthcare. The physician model of education can’t be substituted.
Well, it truly is wonderful to hear the well-formed opinions the medical students and doctors here have of the nursing profession. I find it hard to believe that the majority of people writing in here have never had a positive experience with a nurse practitioner or a negative experience with a doctor or PA. Yes, our programs may require less clinical hours. However, we log clinical hours as RNs, generally in the ER, PACU, or ICU before enrolling MSN and DNP programs. Yes, we are not schooled in the “medical model.” We are schooled in the nursing model, which is neither inferior nor superior to the medical model, despite your personal opinions. It’s just plain different. As a nurse practitioner, I, in no way, want to take the place of physicians. I know my place as a mid-level practitioner. Please don’t let a few bad apples color your perception of our entire profession. Some of the attitudes expressed in the above comments are downright apalling. Perhaps some of you should consider the effect your attitudes towards nurses and nurse practitioners are having on your ability to participate on interprofessional teams. When a resident (or even attending) asks me a question pertaining to a medicine or a procedure or what I think the diagnosis is, I don’t run to the computer and talk about how incompetent doctors are. As NPs and doctors, we are members of a TEAM of healthcare professionals. So, I’d recommend that some of you stop making broad generalizations. After all, prejudice is ignorance and aren’t you supposed to be oh-so-much-more intelligent than we are?
Look at the “class” of 2009 for IOM. Way too many non-MDs in there. I wonder why such a conclusion came into being. So what to do?
1. Put money into the PACs. Residents only need to give 20 bucks a year.
2. Live modestly. Pay the loans off.
3. Plan to retire to an emerging market country so you can get a doc to treat you versus some nurse here.
4. Tell every undergrad student to avoid med school (if the already high tuition amounts have not discouraged them).
Welcome to the start of the end. Why do you need a bomb to ruin the US? We’ll do it ourselves via our so-called social progress.
Reply to “just a nurse”:
1). The dichotomy set up by the nursing profession between
“medical model” and “nursing model” is PURE NONSENSE.
This line of fraud is propaganda put out by the Nurse lobby
to justify and rationalize the production of the new, phony
“DNP” degree (some of which, like the best DIPLOMA MILL
frauds) are ON-LINE.
2). The TRUTH is that there is ONLY the application of SCIENCE and
SCIENTIFIC METHODS for the rational approach to the treatment and
cure of disease. This fact in no way minimizes the need for emotional
and caring support of the patient while scientific methods are applied.
And when cure cannot be effected and pain and suffering are maximally
relieved, emotional support is vital.
BUT there is NO FALSE DICHOTOMY of “nursing model” vs. “medical model.”
3). You have not earned the right to a full license to practice medicine and
surgery because you know virtually NO medical science at all compared with
the physicians.
4). Long ago, in ancient days, when Socrates in Athens made preparations
in a jail to take his leave of his friends by a cup of hemlock, he made
ONE REQUEST of his fellow Athenians:
He bade his friends that if ever his sons PRETENDED TO BE MORE THAN
THEY REALLY WERE, the Athenians should SEVERELY rebuke them.
For Socrates knew that intellectual self-honesty was the very key
to wisdom.
In this vein, your appeal to a “nursing model” is the very essence of
fraud and deceit. In reality, there are only sick patients and the
application of scientific methods to attempt both the cure and relief of
suffering.
To the above nurse:
Most of the comments here are not putting down nurses; many are just concerned that their years of effort and money will be watered down by those who spent much less. Not for anything, but it much much MUCH more difficult to get into med school than nursing school… regardless of the level of nursing. Students dedicate years just to get to the point where they will even be considered a candidate for med school. And that is just the beginning. How many nurses finish all of their degrees with over a quarter million in loans? Not many if any.
Nurses play an essential role on health care team, without a doubt. Without them, the system will fail. However, they are not the captains of the ship, nor should they make an attempt at such a mutiny. There is a hierarchy of responsibility and authority whether one likes it or not, and it is EARNED! You want to be captain? Ok… finish a bachelors along with all the biology, chemistry, organic chemistry, and physics… score well on the MCAT… jump through the hoops and over the hurdles of the admissions process… finish the grueling 4 years of medical school… nail all 3 steps of the USMLE… get beat up by at least 3 years of underpaid work as a resident… and you are just getting started. Until then, you are a valued member of the team, performing the role you were trained for, that being a nurse… a Mate to the Captain of the ship. Anything other that, is just plain unfair and for the most part… dangerous!
Also, a side note: I have seen these NPs who have PhD’s who walk around introducing themselves as “doctor” and being that they are in a white coat this can be very misleading as well. That’s wrong! I was visiting my step-mom at Sloan-Kettering and one of these individuals did this. I was able to sneak a peak at their ID and saw the NP. When they left, my Dad said “I like that doctor.” I told him that they are not doctors, but nurses. Now, my question is, why not identify yourself? Why masquerade as a physician? That left a bad taste in my mouth… because these 2 NPs were around for a whole week without once saying their title. The average individual will assume they are doctors. NOT COOL.
“just a nurse,”
please scroll up and read NP-to-DO’s post again. You don’t know what you don’t know.
To GaryP and SkepticalInternist: very well spoken…
I also dont get why NP & PA compare themselves. The PA education is far superior to the NP education. I have trained both and honestly, NP students aren’t even in the same class as PA students. The PA students I train have a very similar workload as the medical students.
When it comes to midlevels, Physician Assistants dominate Nurse Practitioners in education. Only thing nurses have to their favor is a behemoth lobbying organization that is only second only to the AMA in Healthcare.
Maybe if I knew this would be the future, I maybe would have chosen nursing school over medical school. I went through a lot to get to where I am, seeing a NP take it away doesn’t bode well with me.
PAs with more authority would work, but still they should still be supervised. I went through a 5 year residency for a reason…
I vote for them PAs; Scrap these NPs
Primary Care medicine requires the most broad knowledge base of all medical fields. The idea of someone practicing primary care medicine, unsupervised, without basic science medical education and extensive residency training is OUTRAGEOUS. Why do you think so many of the above posts are from individuals who were horrendously mismanaged by NPs?
Once the nurses start billing CMS for their services they’ll see what a headache it is. It is practically or almost impossible to get compensated the same. They do NOT do the same workload. In terms of admits, they only admit one then go home for the day shunting it off to the resident. In terms of surgery, the concept of a surgical nurse is NOT the surgery itself and of course every so often they get their breaks while the surgeon has to continue with the 6-hour case while the CRNA is there tiddling away on his iPhone (I’ve seen it).
Then if something should go wrong, it always falls back on the physician who has high malpractice and ends up paying for it on both ends (incompetence on one end and the patient suing MDs on the other). The argument that Advanced nurses (and PAs) help with the healthcare disparities in the rural setting is true to an extend, but they use that as an argument for independence (for instance Colorado opting out). Once they get independence it doesn’t alleviate the rural problem. That just means MORE OPPORTUNITIES in the urban setting for a majority of them, hence competing with Docs. Also, since CO is opting out of anesthesia billing for Medicare/Medicated to allow CRNAs to practice in rural setting, think what that means. They don’t have to deal with the billing headaches of CMS AND they get paid the same if not more as anesthesiologists from private insurance and cash.
Finally, look at this giant coalition lobby of nurses. Why can’t physicians muster enough courage to take back medicine and form our own coalition? The AMA’s response to the new healthcare legislation was a tepid “we’ll take whatever we get” without asking for more! In the end Pharma got theirs, hospitals go theirs, and it seems nurses got theirs! I thought it was called the Institute of Medicine, not the Institute of Nursing. What gripes me is that on the one hand the IOM virtually mandates that nurses get broader scope of practice and more independence and yet in the same breath are dictating that residency work hours are reduced to (yay) 60 hour work weeks. That just means RESIDENCIES WILL BE LONGER as residency PDs seek to maintain the same levels of training as before. How can we be stabbed in the back by the very institute of medicine which we are subject to? Why didn’t the Healthcare Bill mandate changes to medical education and post-medical residency training to address the physician shortage? Nurses get a BSN (BACHELORS of Nursing) and get to see patients. MD graduates HAVE TO GO INTO RESIDENCY to see patients. What can we learn about this dispairity? Also no medical liability reform either. Everyone says, Doctors have it easy but really we don’t and it’s irritating how people assume Docs will get well compensated. So do AC repairment and plumbers but they don’t have kind of headaches we deal with. It’s about principles of why I’m so upset. I’m doing 4 years of med school, at least 3 years of residency (getting paid less than a PA might I add during those three years and doing the same if not more than a starting PA) and still getting hosed as medicine is changing right under my nose and I am a slave to the system.
I come from a very rural state in the southeast US. The family practice physicians tend to get overrun with patient load. I know of one group (excellent physicans BTW)that are so overloaded they just cannot get to every single patient in a timely manner. In turn, that ususally results in a large influx (and overload) at our ER’s. Many of the groups began hiring NP’s and a few PA’s. It has helped immensely in getting patients seen in a more timely manner. Not to mention, some of the patients really enjoy their mid-level practicioner. And, yes, there are some of the mid-levels that are much better than others. This group in particular (because now they have the time in their schedule)regularly rotates all of their practitoners thru the ER for increased experience (the chief of the group mandated it). Seems to be working pretty well.
Another issue in the state is ER coverage at many of the small rural hospitals. Some cannot afford 24/7 physician coverage and will place a mid-level on for coverage (I have many NP friends that serve in this role). I can say (as a flight nurse) that not all of the experiences are great (have had issues with some physicians also – definitely not as often, but some for sure).
My last point (sorry this is so long)is that so far (in my experience – which is limited) most of these mid-levels know their limitations and when to seek help (or a second opinion). I have rarely seen the case where one just went rogue on their own, over their head and compromised patient care/safety. They do understand where their training/experience/knowledge ends and how the physician bridges that gap and takes it further. So, not every mid-level is out to eradicate a physician specialty. Where I am from, without them lots of patients would have to wait much longer for care and/or travel much further to get it. Also, I have yet to know of any of them “masquerading” as a physician. Most worked pretty hard to get where they are and are proud of that.
There are places where the system works like it should. It’s not all chicken little with the sky falling.
If you made it this far…thanks for taking the time to read and allowing me to have my opinion and relatively narrow experience heard.
Well, Another Nurse….I can tell that your experience is a little on the narrow side as you clearly admit that. I have no problem with physician extenders (NP and PA) working in underserved regions or regions that have adequate healthcare human resources. The problem is that these folks are simply not qualified to practice independently on their own. Nurse practitioners are particularly undertrained and they seem to be doing nothing to address this issue other than to funnel funds into PAC’s (politics) to win more autonomy. They are not residency trained (very dynamic, intense multidisciplinary training, designed to protect patients while at the same time prepare new doctors (physicians) for independent practice….all supervised by an attending). You obviously have a slant towards nursing (note I was a nurse and NP before going to medical school) and I can tell you first hand that I trust the training of PA’s far more than I can the training of an NP. NP’s lack the quantitative reasoning that is learned through science based study and hard, full-time, medical training. PA’s are a true mid-level provider and receive this type of education, although a bit shorter than a physician and typically not residency trained. I realize now that nurse practitioners are still a nurse and should be at the bedside alongside RN’s providing care, albeit with a bit more knowledge than an RN. As a nurse practitioner, I had to go back to school to obtain the pre-reqs for medical school (which are the same for PA school). I learned a lot during this process. I was severely undertrained as a Nurse “Practitioner” as both a scientist and provider and I learned that through my training to become a physician. There was so much that I just didn’t understand when examining patients..how to think..differentials..ect..and it scares me now realizing I was so poorly prepared as a nurse practitioner. In medical school, I had to learn the basics which I was exposed to in the core rotations and further developed in my residency training to become a general practitioner. In residency, I had to round throughout the hospital, in emergency medicine, derm, psych, on athletic fields, inpatient/outpatient, …ect. You name it. Seeing and being held accountable for this very objective and supervised training is what made me an independent practitioner and qualified to practice medicine. All 17000+ hours of MS3/4 and residency training…all the exams….all the pimping….the thousands of patients I had to examine….the zebras I had an opportunity to see…..only which can be learned at an academic center where these patients are referred for care. Many of which you may never see again, but you will never forget. You just don’t get it as a nurse practitioner and you will never understand that (setting up your own clinical). As an NP, you focus in one area of medicine, complete 500-800 hours of training in that area…but you never get a comprehensive education in general medicine even if that is your focus. You just don’t understand how much primary care medicine is learned in your derm rotation, surgery rotation, emergency medicine rotation, OB/GYN rotation, ect….that is what makes the independent practitioner. If you want to practice holistically, you must have a holistic and complete education….there is no substitute, Ms. Nightingale. I do have respect for the profession, but can honestly say that I would support PA’s taking a more independent role as physician extenders, but nurse practitioners have more autonomy than their education can warrant….Sorry
You don’t have to apologize to me. Yes, I lean towards nursing (because I am one), but I am also a paramedic and flight nurse with some semblance of autonomy in that specific arena. I have dealt with many NP’s. I completely agree with you about the education – it is entirely too inconsistent and highly dependent on one’s previous experience before starting their program. Also, the online junk is horrendous. But, nonetheless, some very good practicioners come about. The only way I see any justification in any further advances for NP’s independence is enforcement of more strict experience requirements,strictly enforced admission standards, and much more invasive clinical training (getting rid of most online training and direct entry programs would be a great start).
My main point was that when implemented as it should be, mid-levels are quite effective. I can only hope that some do not equate “independence” as “I don’t ever need another opinion or help”. Which I guess is true of any healthcare specialty involving direct patient care. While my experience with PA’s is limited, I have been impressed with most, and there are some that are downright scary. This can be said of everyone though. But, to lump every NP in the same boat because of one experience is quite insulting to some. Many do their job quite well.
However this pans out, I hope that many do not lose site of their own limitations (clinical or didactic). Anyway, starting to feel like I am preaching to the choir. Thanks for reading.
July 21, 2006
A Clinical Look at Clinical Doctorates
By WILLIAM L. SILER and DIANE SMITH RANDOLPH
Universities complain about clinical doctorates, arguing that degrees like doctor of pharmacy represent little more than degree creep and are not equivalent to, say, the Ph.D. or M.D. But few institutions have done much more than complain, instead coming to rely on the revenues clinical programs bring them — especially given that many students in those programs pay tuition over a longer period than do students earning bachelor’s or master’s degrees in the same fields. And clinical doctorates have become increasingly established over time.
The doctor-of-pharmacy degree, created in 1950, has served as a model for clinical doctorates in other fields. The American Council on Education began its justification for the new degree with the fact that the body of pharmacological knowledge was expanding, and mastering it required enough credit hours to merit a doctorate. The ACE also noted that pharmacists were practicing in new settings such as retail chains like Walgreens, and dealing with new diagnoses and new drugs. Finally, the council argued that pharmacology’s status among other health-care professions required that its practitioners be called “Doctor.”
Since 1950 other professions have created or considered clinical doctorates, such as doctors of audiology, nursing, occupational therapy, and physical therapy. Most of the professions use arguments like those for the pharmacists, with some recent additions: that the clinical doctorate will help practitioners work without requiring referrals by physicians, and it will allow them to charge more for their services.
Those new arguments are intriguing because they suggest that it is the degree, rather than the profession, that commands respect and recognition. In fact, clinical doctorates have so far had little effect on status, compensation, or reimbursement. There is even mounting evidence that the pharmacy doctorate, for example, has led to growing job dissatisfaction as the expectations of new practitioners clash with the realities of American health care — like the fact that insurance companies pay for the kind of service provided, rather than the educational level of the provider.
Some professional organizations have pushed for clinical doctorates even though their members oppose the degrees, on the basis that the doctorates are good for the professions. Established practitioners with only a bachelor’s degree may oppose the introduction of a clinical doctorate because they feel their experience makes them more qualified than a new graduate with a higher degree.
One response to objections from practitioners is a transitional degree, which awards them a doctorate for taking a few courses after having worked in the field with the required bachelor’s or master’s degree. Because transitional degrees are given to people who are already licensed professionals, accrediting bodies generally feel that reviewing the degrees is outside their scope; thus the degrees are seldom evaluated.
On the other hand, professions typically try to ensure the quality of new professionals by requiring them to pass a licensing exam, and by allowing only graduates of accredited programs to take the exam. Many universities have been willing to offer clinical doctorates, in spite of their reservations about the degrees’ academic credibility, because they fear if they do not, students in the field will attend other universities that do.
Employers who hire new practitioners often oppose clinical doctorates. The professions frequently explain that position away as a result of corporate greed, claiming that industry is willing to place corporate profits above the quality of patients’ care. But employers point out that they are reimbursed for clinical services, not according to the degrees held by their clinicians. Employers also argue that if new holders of clinical doctorates do make more money than graduates a few years ago with lower degrees, that is not because of their increased education, but because of the growing shortage of clinicians — which is being exacerbated by the increased length of time it takes to earn a clinical degree.
So far, few people have investigated the clinical doctorates’ implications for the public health of Americans, but it is easy to argue that the degrees could have unintended adverse effects.
First, the explosion of those doctorates threatens research, which is particularly important today with the growing emphasis on evidence-based medicine. The doctorate programs require minimal research from their students, unlike Ph.D. programs, and as colleges and universities scramble to maintain their share of the student market, they push professors’ research activities further down on the list of the programs’ priorities.
The programs also find themselves scrambling to get many of their faculty members a doctoral degree — any doctoral degree — as quickly as possible. Professors who themselves lack Ph.D.’s and who choose to get clinical doctorates learn little in the process about conducting research or advising students who seek research opportunities.
Second, because clinical doctorates require more time and thus tuition than a bachelor’s or master’s degree, doctorate programs may reduce the number of new graduates at a time when health-care workers are in increasingly short supply. The market may respond by using assistants and technicians to provide more clinical services, deploying people with higher credentials as supervisors and administrators. That has already begun to happen in the field of pharmacology, and job satisfaction and morale are declining because practitioners have less chance to use their clinical expertise and interact with patients.
Third, the increased time and cost involved may also exacerbate health-care disparities in our society. Few health-care professionals now come from minority populations, whose members are much better represented at the level of technician or aide, and students from those groups may be less able to afford the longer educational programs than are students from more-advantaged populations. If minority students see assistant positions as good employment opportunities that are easier and cheaper to get, we may reinforce the pattern of having minority assistants provide the actual services to patients, while supervisors come from more-privileged backgrounds. And given that students from underserved areas are more likely to return to practice in those areas, decreasing the number of minority students could make health care even less available there.
Professional organizations want to raise the status of their professions; universities want their enrollments to increase, or at least not to decline. Neither side can objectively evaluate clinical doctorates.
At the turn of the last century, the medical profession had the vision and integrity to ask the Carnegie Foundation for the Advancement of Teaching to study medical education, with the goal of strengthening it. The result was the landmark report of the Flexner Commission, which recommended standardization of medical-school programs. It’s time to have a similar external study of clinical doctorates, to establish uniform criteria for them and for the professions that offer them.
BSN to DNP program at Duke university = 81 credits in length with 816 clinical hours. Prerequisites: RN degree. Program completed online part-time over two/three years. Practice oversight regulated by each states respective nursing boards. One year of nursing experience preferred, but not required at Duke University Program. 812 hours of clinical training required for the program. Prerequisites for the typical RN degree = A&P and statistics and sometimes a survey course in microbiology. Education is degree based versus competency based. Nursing programs call their clinical training in school “residency”, which can create confusion because it is not post -graduate residency training as it would be known in the medical model of education, rather it is clinical training that is part of the educational program similar to a rotation as it is referred to in medical or PA school. NPs are not residency trained. http://nursing.duke.edu/modules/son_academic/index.php?id=191
PA (physician assistant): 126 credits average length; full time study; average program 28 months in length. Regulated by the state medical boards, Upon graduation, physician assistants take a national certification examination developed by the National Commission on Certification of PAs in conjunction with the National Board of Medical Examiners. To maintain their national certification, PAs must log 100 hours of continuing medical education every two years and sit for a re-certification every six years. Pre-requisites for PA school are similar to medical school less physics. The average PA student has an average of 4 years of experience in paid patient care, although some programs admit students with high GPA’s and minimal healthcare experience. PA school is competency based education and not degree based and modeled after medical school. PA’s complete over 2000 hours of clinical rotations (minimum) as part of their program – including family practice, surgery, internal medicine, emergency medicine, OB/GYN, pediatrics and other electives. Residency programs are optional, but not required
Physicians (MD/DO) 4 years of full-time study followed by a minimum 3 year residency program. Additionally, many physicians complete fellowship training. Medical school provides a broad based education in the basic sciences and clinical medicine. Primary care doc will have over 17000 hrs of clinical training…more for specialists. Physicians receive a very structured and broad based education in all aspects of basic medicine before specializing. A post graduate residency is required for board certification. Prerequisites for medical school include a minimum of 1 year of biology, 1 year of physics, 1 year of chem, 1 year of org chem, and some programs require biochemistry. In residency, physicians round throughout the hospital, in emergency medicine, derm, psych, on athletic fields, inpatient/outpatient, …ect to become a primary care physician. You must complete rotations in all areas or medicine to become a competent provider in your specialty and practice holistically. Seeing and being held accountable for this very objective and supervised training is what makes physicians independent practitioners and qualified to practice medicine independently. All 17000+ hours of MS3/4 and residency training…all the exams….all the pimping….the thousands of patients examine during this training….the zebras you have an opportunity to see…..only which can be learned at an academic center where these patients are referred for care. Many of which you may never see again, but you will never forget. You don’t get this training as a nurse practitioner.
Nurse practitioners have the least amount of training of all healthcare providers, yet want to call themselves doctor and practice without physician supervision. They compare themselves to physicians, but as a matter of fact have significantly less training and education than a PA.
Above poster thank you for that only slightly relevant article pasting. I just wasted 3 minutes of my life reading it.
Nurses are not good practitioners as a whole. Surely you can state the exception to the rule, but they are undertrained, arrogant, and their academic history is a little on the light side. I wouldn’t want one making important decisions about my health and well being with such little training. Nurses take orders from physicians and PA’s. They shouldn’t be allowed to practice with such an education that is lacking in the sciences and clinically. They are down right scary, but powerful because there is 25 nurses for every physician. That equals lots of money and power. I have no respect for their motivations which are not in the publics best interest. This is just another example of how america is Fu&*ed UP
There should be a study done to see how many lawmakers have a NP or PA as their Primary Care Physician. It’s interesting how lawmakers pass those laws to help “the people” to address the physician shortage that is looming. I believe everybody should serve one year in the military when they turn 18. Serving in the military for one year would make you eligible to receive medical care at the VA for life….this would solve the universal health care issue because every adult citizen will have health insurance through the government….oooops….is that Socialized medicine????
I understand that America is in need of primary care professionals, but to give under-qualified professionals the ability to practice with no supervision is preposterous. I have no problem with advanced practice nurses, currently my fiancee is obtaining her masters to work as an adult nurse practitioner so I know exactly what their education entails. Her entire “master’s” program is online, save the clinicals–which may as well be online. Maybe it is just me, but to grant someone the power to take full responsibility for a patient who has gone through less than 2 years of online courses to become who they are is absurd. The reason we have state laws defining a scope of practice for advanced practice nurses is to prevent deaths. I don’t even understand how they would feel comfortable caring for someone on their own with their level of education. I have basically taken their “advanced” “medical” physiology class and pharmacology class and it is a complete joke. Don’t get me wrong, there are certainly roles that NP’s can fulfill–and they do a wonderful job–but being the sole overseer of a patient’s care should not be one of these. Furthermore, the whole Doctor of Nursing Practice is even more of a farce. With this “research” intensive curriculum, we are giving people a false sense of accomplishment and granting doctoral degrees for theses in “best finger placement for IV removal–a research based approach,” and “do patients like their doctor standing or sitting when addressing them?” Is this really the direction the United States is heading? Are we really going to drop the bar on medical standards this far? For the sake of the future of healthcare, we cannot be this ignorant. The next thing we will see are accelerated 1 year baccalaureate degrees for cardiothroacic surgery. Open your eyes people…please, there is no sense in creating a healthcare system with under-qualified professionals to combat the increasing need for practitioners. The funding that has been spent on these nursing degrees would be better allocated to help family practice physicians who really do need the aid.
More undereducated nurses
and the IOM supports them now…go figure
I should have gone into nursing I guess
Iabatyd:
It will continue and it will worsen because of
the demands for universal healthcare, the baby boomer
retirements, and most disgustingly of all because of
America’s sick love affair with political correctness.
In PC America, all people and all professions MUST
be equal. Men and women of true accomplishment
must not be distinguished in licensing responsibilities and
privileges from the pseudo-doctors and pretenders
and the revolting phonies and frauds, such as the DNPs
and their supposed equivalence to real doctors.
The DNP is a political degree-to gain a full license for
medical practice [EVEN if that practice must be relabeled
NURSING and brought under the nursing boards of the states].
The DNP is virtually worthless for scientific and medical
education and will be given ZERO credence, like all phony,
cheap diploma mill degrees, by the overwhelming majority of
physicians and scientists in the United States.
The Nursing profession should be utterly ashamed for its
cheap mimicry and phony attempt at producing a degree
that it now touts as equivalent to real medical degrees.
But the United States now has the standards of a banana republic
(with nukes).
For the insane conceit of our politically correct ways, for the
lowering and destruction of our scientific and medical standards,
for our utter failure to safeguard our rights, liberties and freedoms,
this country will pay a huge price: bankruptcy, ruin and decline
in our contribution to the drama of the human story.
What a scam
As a nurse I know I don’t get the education of an MD/DO
I’m ashamed on my profession
Time to go back to school
Anyone consider that it is quite likely that the IOM was bribed? it’s not the first one AANA did such a thing…
Hmm! This is wrong. Doctors must endure rigorous training in order to be qualified to treat people. If a nurse wants to be a physician, then he/she should have went to medical school- not nursing school. These people are jeopardizing the well being of human beings simply for monetary purposes. If you want to be a doctor, then go to medical school! Just because you have learned a few things by watching a doctor, do not think that you are automatically ready to run the show!
All of the contributors to the IOM report were nurses. There is not an MD listed on the contributor page. Why IOM let such obvious propaganda be released without any validation is beyond me.
This is the kind of climate I’m about to enter after 11 years of medical school and residency??? There really are no words to express how wrong it is that a midlevel ANYTHING is as qualified to begin practice independently! Does a nurse after 30 years of NP do an adequate job in primary care realm? Perhaps… does a NEW nurse function as safely or as competently as a NEW attending after his/her many years of aggressive training?? Absolutely NOT! What is our AMA or AOA even doing for us?!?! This is completely absurd.
Commenting here won’t do ANYTHING. Write to your local Medical Association. Write to your representatives. I wrote to my state medical association and you’d be surprised at how much you can get done by just having your voice heard. They want to help you (us), but they just need a push. Be that person to provide that push.
The AANA has launched a full-frontal attack against us. IOM report was all nurses, why are they representing medicine?! Do what you can, but for the 50 comments above me, if 50 letters or emails were written to representatives/associations, it would be much more helpful then posting on SDN.
-FM resident
“A qualified health care professional is a terrible thing to waste,” Cheryll Jones, a pediatric nurse practitioner in Ottumwa, Iowa
-You’re not being wasted, Cheryll? Take their blood pressure, give them their pills, and wipe their a**. Its what you were trained to do and you”re getting paid for it.
NPs do have advanced training….in nursing. I agree that a qualified health care professional is a terrible thing to waste. Everyone has a role. I just wish nurses would stop trying to take over the role of the physician and work within the scope of their training. You shouldn’t be able to go through nursing training and then say you have the same training as a physician. That’s ridiculous.
Nice Ads, Google.
“Earn a nursing degree now! Accelerated online BSN!”
“Be a nurse practitioner! Earn your degree in 20 months!”
Where do I sign??!
My dream for the response to this debate would be to say screw the oath that we as physicians take and do what all the other allied health professionals have done: strike! If only every REAL physician out there would agree to do this to show this country what they will be missing with lack of knowledge, training, and judgement at the bedside… but of course, we as physicians unfortunately actually do get brought up on malpractice charges and abandonment…something the mid-levels would truly know nothing about as it’s not their license on the line (not without the MD at least). So how about it everyone? STRIKE! lol… if only.
I am from another country than US but maybe my input can give things at another perspective.
As far as I know there is a shortage of MDs in the US. How to overcome this shortage? Increasing access to medical school? As I have heard geting a slot at medical school is more competitive in the US as in other countries, despite the high student loans associated. A bit surprising why there are so few slots.
Although it is relative easy obtaining an MD in international schools in the caribean, in panama, poland or romania, gradauates from such schools face a shortage of slots for residency training back in the US.
My strong impression is that AMA keeps MDs in high demand, securing high salaries and prestige to their profession.
While this is understandable, its not possible to finance health care with this system future. A huge part of medical costs are physiscians salary and that outcompensates their school loans by far. However, I believe that producing more MDs may not automatically reduce their salaries and costs, instead it may even increase the costs.
The best solution, giving more rights to the cheaper allied health care professions such as nurses and pharmacists, and even I would suggest to include some PhD grade clinical scientists in patient care, although the last would be another story.
That’s not actually the AMA’s fault. Residency slots are federally financed, and despite the shortage of care professionals they’ve been cutting funding instead of raising it.
Pass the MCAT? says:
October 22, 2010 at 12:56 am
“A qualified health care professional is a terrible thing to waste,” Cheryll Jones, a pediatric nurse practitioner in Ottumwa, Iowa
-You’re not being wasted, Cheryll? Take their blood pressure, give them their pills, and wipe their a**. Its what you were trained to do and you”re getting paid for it.
I dare you to tell me that.
jadedfinalyearresident says:
October 20, 2010 at 1:08 pm
This is the kind of climate I’m about to enter after 11 years of medical school and residency??? There really are no words to express how wrong it is that a midlevel ANYTHING is as qualified to begin practice independently! Does a nurse after 30 years of NP do an adequate job in primary care realm? Perhaps… does a NEW nurse function as safely or as competently as a NEW attending after his/her many years of aggressive training?? Absolutely NOT! What is our AMA or AOA even doing for us?!?! This is completely absurd.
does a 1st year resident do an adequate job as opposed to a 30 yr nurse? I THINK NOT…..you guys screwed the pooch more many times than I can count. you want to bash …we can bash
STUDENT DOCTORs bashing nurses, this is nonsense.
you guys need to start treating nurses as colleagues and stop acting like elitist swine.
“TX.RN said:
does a 1st year resident do an adequate job as opposed to a 30 yr nurse? I THINK NOT…..you guys screwed the pooch more many times than I can count. you want to bash …we can bash”
And that is why a first year resident is practicing UNDER SUPERVISION of the senior resident, fellow and attending physician for 3 years +, with 80 hours of work every week for most of the first and second years.
Your training is not even close to that of a resident, and you know it.
Ok, though I’m not in med school I’ve read a few things on this post that make me feel that some people don’t know what they are talking about.
First, CNA’s wipe a**. I did that for 2 years. LPN, RN, NP’s ect don’t do that unless they need to, to help out the CNA’s, maybe because of a staffing issue. So what I’m getting at is.. Know the people that work for you, and really what they do if you plan on being the head guy / gal making decisions.
I read a lot of .. In med school this, in med school that, you didn’t learn “X” in med school. Whatever, we get it, you’re going to be a bada** doctor.. Excuse me. One thing I’ve learned while currently being assigned to an Air Commando unit is, Training means shi* compared to combat. SO, though you might not have the same schooling.. a lot of people learn a lot on the job, fixing doctor F-ups, trial by fire, etc. So, though they don’t have the same schooling, they might have been seasoned enough to do the job correctly. What is correctly? That’s not for me to decide but for licensing officials. So because doctors are in such sort supply, this is the current, corrective action. If you really have a problem with it , do something about it. Help your friends get into med school, petition schools about standards / residency, do something besides *itch about something you’re doing nothing to solve. So right now NP’s/ PA’s (with that doctor hanging out somewhere) are the interim corrective action. Congradz.
I’m sorry but the whole on the job experience thing is pure BS. Doctors get on the job experience, it’s called residency, and it lasts for 3-7 years, not even going to mention fellowship training. In each of those years it’s approximately 80 hrs a week, for EVERY specialty, and that’s only what is advertised, most will break those hours, ACGME rules non-withstanding. To compare any nurse’s “on-the-job” experience is ludicrous and insulting to anyone that has had to sacrifice as much as we do. APN would like the same respect and renumeration for less work, I don’t necessarily think it’s 50% of work, but anything short of 100% of what we do does not qualify someone as “equivalent” to a physician.
I don’t care if they want to be called doctors, etc. whatever, there are plenty of people with the title doctor out there, go ahead, but to continually claim that they are equivalent is again, nothing short of insulting. I’m not saying APNs are dumber, many I have worked with are quite intelligent, and could have done well in med school. However, what is at issue here is APNs would like to have something that took years of toil and sacrifice to achieve by MDs.
And the old excuses of time and money are not ok, I am of immigrant dissent, my parents came here with literally $90 dollars, there are people in med school who started pregnant, with 7 kids, working a night job etc. APNs are basically advertising “hey, want people to think you’re a doctor without actually working hard to be one, become an APN.” As I sit on call, not going to my kids’ social activities, not being with my wife, while the APN stops taking pts at 330 and then considers us equals, is again a complete insult and marginalization of what I have worked hard to achieve.
I, and probably all physicians who have a problem with this, do not regret the sacrifices, this is what we signed up for; nor do we begrudge APNs working with us, but to complete less training, to sacrifice less, cheapens our experience. There is no short-cut to being a doctor, on-the-job training is only useful if you have a good foundation to rest it on.
And I’d like to add, that paging a doc in the middle of the night or when they are post-call, b/c they’re discharge orders are incorrect, hardly consits of “fixing our f’ups”. Doctors f’up to be sure, but nurses aren’t the ones that fix it.
RE: PO’d MD…
AMEN brotha!
To all the nurses wanting to play doctor for Halloween… if I weren’t such a humanitarian, I’d love to see you take over for all the physicians out there. My suggestion? Better beef up the malpractice insurance.
P.S. As a former nurse who practiced NURSING for 10 years, I can and will contend nurses do not know the first thing about practicing effective and SAFE MEDICINE.
Its me again.
I believe the underlying essence of the original article is not whether nurses or MDs are doing their job better, the main point is that nurses are doing it cheaper which reduce the costs for the health care insurances. Since americas new government plans to transform the health care system to make it more social, the costs need to be reduced. As I have stated earlier, the salary of US doctors is very high and significantly contributes to the total costs of health care.
The question is, do simple medical treatments such as the surgical treatment of an ingrown nail under local anesthetic requires the presence of an MD? The nurse may apply the anesthetic in a wrong way, there may happen an unexpected reaction to the anesthetic, but what is the probability that such complications are happening? The probability of a complication needs to be compared with the money saved when doctors supervision is not required.
Such calculations on the economic costs of safety measures for human life play a role in many areas. Also in the health care system such calculations need to be done to improve the access of all social classes to the health care.
the only way to combat these militant nurses is to increase the role of Physician Assistants, who are much better educated then these so called “advanced practice nurses” in patient care.
They are regulated by the Board of Medicine and are happy to work with Physicians
Don’t hire NP/CRNA/CNM…Hire PA/AA’s … This has been said for years and now is the time to take it SERIOUSLY!
if nothing is done about this issue now, nurses will take over!
Nurse Practitioner trained in surgery = Nursing’s future.
Wouldn’t it be great to train a NP to perform surgery? I’m fascinated just thinking of the possibilities an advanced nurse can attain. Orthopedic Surgery, General Surgery, Cardiovascular Surgery, etc. Certainly a model could be developed to address the training curriculum. As patient needs grow, the need for advanced nurse grows as well. From nurse anesthetists to NP and beyond….. The surgery aspect of nursing needs to be explored. What would the term be called? Surgical Nurse Doctor? Here’s a cool little thought. Physician Assistants can help Surgical Physicians during surgery right? Well the advanced Nurse Practitioner should be given the same opportunity. On the horizon the advanced nurse must take her/his place to ensure patient quality just like the Physician does. Ohh, and to answer the posts above…The NP is a doctor, given the right to write prescriptions in most states. If you can write it, then you are a doctor…period
@ Travis Williams
NP’s cant do surgery because they are not adequately prepared to do it. Not like they are adequately prepared for anything other then being physician-extenders, but certainly not surgery. Not even as a first assist. I have a PA as a first assist and he is amazing; because they are TRAINED in surgery, unlike nurses.
I’m sure your just some murse trying to be a noctor.
Travis Williams:
The Nurse profession’s current arrogance is truly boundless,
along with its ignorance.
The Surgeons will NOT accept you in order to train you,
lacking in even basic medical science to understand A&P
of surgery and wound healing.
Just because the powerful Nurse lobby gets the rights to
practice medicine by POLITICAL instead of educational means
does NOT make you a doctor. And you will NOT be accepted as
one by the real docs.
You are a “NOCTOR” or a “Nurse-doctor”.
But “NOCTOR” should simultaneously stand for:
“NOCTOR”= “NOT (A) REAL DOCTOR”.
That should be the unofficial response of the medical profession:
“NOCTOR”=Nurse “Doctor”= “NOT-A-REAL-DOCTOR”.
May all of you enjoy living and working under false pretenses and
with phony, bloated and absurd credentials. Living and working as
frauds, fakes, and pretenders, whether you admit it or not. Claiming titles
you KNOW you have never earned the way real doctors did, regardless
of what disgusting politicians and legislatures do.
During my undergraduate years I suffered for 4 years earning my Biochemistry degree, while the most advanced science class which my nursing colleagues took during their undergraduate years were basic inorganic chemistry and biology both of which were watered down (high school level) and different than even the first year chemistry and biology courses which first semester freshman premeds have to take. Along side that, I did not have any summer as I spent any time off doing research and studying for the mcat, all of this just to GET to medical school. If our nursing colleagues want equal rights than there is a simple solution, they should also have to pass the same certification exams that physicians are required to pass in order to practice. STARTING with the mcat, then the “advanced nursing degree” individuals should take the step I, step II, step III, then state certification. Should they pass all of these, then they should be given the right to practice along side and be paid equally to their physician counterparts. Also, sorry I am not exactly aware, but does anyone know if nurse practitioners have ever been versed in basic gross anatomy, pharmacology, biochemistry, genetics, etc. let alone systems? You must learn how to walk before you can run!
Simple solution:
The answer to your question is NO! They are NOT versed in
physiology/pharmacology or gross or neuroanatomy in anywhere
NEAR the depth of medical (MD/DO) school.
They take coursework which is an incredibly watered down
version of the real work done by medical students-essentially the
mirroring the same pattern you noted in the University. Like you,
I was a double major in Chemistry/Biochemistry and even did the
first year of graduate P.Chem before applying to med school.
The Nurses know WHAT is routinely done in medicine, BUT NOT
WHY. They do NOT have the scientific background to understand the
limits of (nor the analytic reasoning surrounding) the techniques and
methods used in medical practice. Thus, they work from lists-
practice recommendations established by committees and other types
of “check-list” operations. They are NOT trained to critically evaluate
medical cases and thus understand when a patient CANNOT be treated
by referring to a cookbook practice guideline.
They have advanced their cause via POLITICAL agendas and by
that unique process of social acceptance (with accompanying verbiage)
which we all recognize as the disease of “political correctness.”
A side effect of the current push for the DNP degree is the
weakening of medicine and the requirements for practice from a
scientific standpoint: Medicine is already not scientific enough
(in the chemistry/physics sense) and the “Noctors” would set
Medicine back as a scientific endeavor by generations.
Review for yourself any DNP on-line curricula at any major
University, obtain a nauseated feeling, and then post your
observations and conclusions.
Dear Tx. RN,
I tell every one of my new interns to take nursing input into consideration. Nurses are a great resource. I also tell them they are not being trained to be nurses. They are being trained to be surgeons.
A month or so into my own internship many years ago, I was getting yelled at by an older nurse about her 20 years of experience, which I acknowledged. But I asked her how many years of experience did she have being a doctor. As she was now silent, I told her I was two months ahead of her in that regard, but if she’d like to hold my pager for the next 24 hours I’d be happy to share.
Everyone has a role. Know yours and be good at it. If you want to manage patients and take on the responsibility, take the MCAT, go to medical school, take the USMLE Steps 1-3, complete a residency that requires 80-100 a week of work often 6 days, go into debt and endure the bile from junior college trained nurses who are well versed in hindsight.
Now Travis Williams….good luck with that. It’s nurses like you who ruin the team approach to medicine and surgery. I’m sorry but all you seem to want to do is take a short cut to the OR. Stop being antagonizing, and learn to work WITH the team rather than clamoring to be the leader. Without paying dues. NP does not equal doctor/physician/surgeon. Not to say you aren’t intelligent. It’s just that you don’t have the training. You want to cut? Go to medical school. You want to assist and hold retractors and not go to med school? Go to PA school. But for godssake quit pretending that your training is equivalent. It’s not. We know it, and you know it. I don’t care how many contact hours you have. Our training is measured in years, not hours.
Well said PO’d MD.
@AnnoyedSurgeon
Well said. Just wanted to add that PAs do much more as a first-assist then “hold retractors”
well said annoyedsurgeon, I’m so going to use that line from now on when a nurse tells me about their “experience”
Reading this just makes me want to laugh. I have a lot of respect for Nurses and what they do, but not only as a pre-med student, but as a patient as well, I don’t want an NP to treat me. I trust you to aid the physician, not try and fill his shoes. If you want to treat, diagnose and be considered a Primary Care Physician, go to school. I personally switched my degree from Nursing to Pre-med for this exact reason; I knew what I wanted out of my career, and Nursing couldn’t provide it. If you want the easy way to a decent pay check, that’s fine, but don’t come crying to the public when you’re told that you don’t have enough training to become equal to a physician.
This reminds us of the subprime crisis of mortgage. The whole country was bought down into an economic disaster. This nurse practioner is akin to the Bernie Madoff Ponzie scheme, which opens a small hole for untrained people to sneak into the forted practice of medicine. I think now a days qualification to practice medicine is based on the ability to hang a steth on the neck, wear a white coat and sweet talk to the patient. There is no need for anatomical dissection, didatic physiology, biochemistry, histopathology, microbiology or even the OBG, surgical and medicine. So the NP’S think physicians are fools who are overtrained. The sad part is that the medical school association, ACGME which safeguards residency standard, ABMS, ABIM, ABFP and all associations do not even raise concern, which is dangerous and shameful.The hospitals, and some lazy doctors like it as they think make hay when the sun shines.
I love how they say that the “future of medicine” is a nurse. WTH ?!
Oh Lord, Where is the Common Sense?
Increase residency slots for primary care & increase the role of Physician Assistants. PA’s openly welcome us and can greatly integrate in a Health-Care Team. They are regulated by the board of medicine and not to mention they get THREE TIMES the clinical hours these DNP’s have.
PA>DNP, it’s sad how I don’t hear about PAs on the news or anywhere.
As a future DNP student myself, I am writing this in response to the nurses that have posted on here as well as the misinformed MD/MD students. First of all, this article was written from a biased perspective and is making DNP’s/NP’s out to be bad guys trying to dominate the medical field. As a nurse myself, I know that DNP’s will never be able to take a physician’s place. You are right when you say that your medical training far exceeds ours. However, what you fail to see is that nursing is its own separate field in the health care team. Nursing focuses on holistic care rather than just all stoic science, science, science. Where doctors fail and nurses succeed is seeing the patient as more than a disease. DNP’s can not take your job just like MDs can not do a nurses job. You are not trained as a nurse and we are not trained as doctors. I’ll say it again…no one is trying to steal your jobs! People that say we are, are not aware of what we do. The only area where NPs/DNPs maybe take patients are in Primary Care. PCPs just do not have the increased specialties like surgeons do (for example) therefore, if an NP has prescriptive authority, well that’s all PCPs do basically.
Another point, there is such a shortage of adequately trained health care providers in rural areas of this country, why wouldn’t you want other providers to provide cheaper care for people who can not afford to pay for services? So, yes there are areas where a DNP could never work, but there are areas where a DNP with experience can provide high quality care alongside a physician. The DNP programs are more than just providing basic training and slapping a “doctor” title to anyone who wants it. Many DNP programs and hospitals make their graduates/new hires complete a residency, thus giving more training and hours before they are “turned loose”. There goes your “Well I have 100,000 hours as a student doctor.” DNP programs are refining their curriculum and are advancing their students’ training everyday. These schools are also around 3-5 years on top of having 2-3 years of intensive care experience with remarkable undergraduate degree gpa (not any nurse can just waltz in off the street).
All in all, we as nurses are not trying to bring down the hierarchy or steal jobs or dominate health care. We are advancing our field in order to provide better patient care (in our field not better than MDs). There is no need to fear us, but please do embrace us because DNPs do provide better care than advanced practice master’s degree nurses. Help us help you and let’s all work to save lives and improve the health of our nation. (cue patriotic music)!
DNP – Sorry, you don’t know what you don’t know.
My pre-med classes were harder than most of the required nursing classes. Nurses do a wonderful service, but why increase their influence? It is fine how it is. To the post suggesting nurse-surgeons, you frighten me. Considering my future in surgery, and in the unlikely event that I will ever need surgery, I’d say sleep on that idea.
Reply to Future DNP/analysis:
>”the only area where NP/DNP take patients are in Primary Care”
-then why is there a DNP dermatology “residency” at USF in Florida?
>”many DNP programs and hospitals make their graduates/new hires
complete a ‘residency’ “
-Indeed, and is this “residency” of comparable length, rigor or
quality with physician (MD/DO) residencies, such that its graduates
should be able to become Board Eligible/Board Certified by the
American Board of Medical Specialties? Yes or No? If Yes, then
face the exam. If NO, then are you not really falsely claiming
equivalent training WITHOUT the hours, CALL, and RIGOR of
becoming Board Certified JUST BY YOUR THEFT OF THE MONIKER
“RESIDENCY”. Fraud by any other name is STILL FRAUD.
>”if an NP has prescriptive authority, well that is all PCPs do basically”
-Revealed here is the very basis of my earlier statements: Nurses know
WHAT is done in medicine, but DO NOT have the minimal science
training to know WHY it is done- thus they know what is done
routinely, but not the limits of the methods docs use- and thus
they are not even in a position to appreciate that prescribing is the
MINIMUM that PCP physicians do-their actual job is DIAGNOSIS,
followed by the exercise of medical JUDGEMENT.
As Osler explained long ago, common conditions sometimes present in
unusual ways and the SUM over all the rare entities in Medicine that
CAN present in a patient makes the aggregate probability of an
atypical presentation or rare condition fairly likely in a LARGE volume
of patients. THAT is why the ABIM certifying exam is fairly rigorous,
and that is why IM residency is three years in length of graduated,
progressively greater responsibility.
Clearly, future DNP understands medicine not at all. Which leads
him/her to the ubiquitous “false dichotomy” argument as follows:
> “you are not trained as Nurse, we are not trained as Doctors”
Having recognized that they do NOT know medicine, the future
DNP adopts the fall-back position that “well, we are really training
to be the most advanced level of nurses.”
However, future DNP, you CALL YOURSELF DOCTOR with the DNP
degree and you label your post-graduate experience “residency.”
In other words, future DNP would have us believe that anything
they claim without any critical analysis- MORE is LESS, UP is DOWN,
and so it goes: any Orwellian notion will fly.
I can hardly believe that such self-deception made manifest and
projected (nay splattered) all over a credulous public audience
does not engender a deep sense of shame in the Nursing
profession for such bald-faced chicanery as what I have noted
above.
Bottom Line: an aggressive element in the Nurse profession, that
hates MDs and has always hated them is taking
advantage of the current crisis in medicine and the
prospect of “universal” healthcare to undermine
primary care docs and just attempt to steal elements of
their profession under the totally mistaken notion that
“primary care”=”simple care” that ANYONE can do.
If Osler were still with us, he himself, I believe, would
instruct us all on just how wrong and silly that notion is.
Nurses are getting pit of control. They knew what they were getting into. It’s like podiatrist. For years, the wanted to change their degree to MD. The fact remains that nurses are just that: NURSES!
Unfortunately, hospitals are greedy. They are now forth anesthesiologist sine they’re a third the price. Nurse have tried to say that their safety record is equal to mds. How can they make a statement like that when its the supervising anesthesiologist saves the case?
No way to crnas
A lot of routine cases that are simple to treat can well be competently done by the nurses while the doctors can deal with the more complicated cases!
Its acually a brilliant idea, because it involves the nurses much more in managing patient care, which gives them more self-esteem and control. Doctors should stop thinking they know it all and integrate other healthcare professionals into managing patient care.
FutureDNP says: “Nursing focuses on holistic care rather than just all stoic science, science, science. Where doctors fail and nurses succeed is seeing the patient as more than a disease.”
Though your comment was well crafted and less acerbic than many here, the above is simply nonsense. Oft quoted, but still nonsense. And, at bottom, a very skillful propaganda ploy – simplistically categorizing the individuals in a contending arena or discipline. I am a tertiary specialist, that is, I see patients referred usually by other specialists (and PCPs). As far removed from the world you imagine that you describe for yourself as any physician could be. You are, in a word, wrong. Contrary to your statement, not only I, but most of my hard-working colleagues are every bit as cognizant of the “patient as more than a disease” as you claim to be. My compassion and concern for the overall personal context of the patient’s disease, I doubt is exceeded by any nurse. This holds true for most of my colleagues.
This is not to bash nurses. I depend on them and hold them in high esteem. The ones I work with grasp well their own important role in health care.
All this weasel word nonsense about keeping health care costs down, etc. is also balderdash. If you want prescribing authority, if you want hospital admitting privileges, if you want unsupervised diagnosis and treatment authority, get the qualifications. And assume the responsibility. All of it.
If this is to be dealt with fairly by regulatory agencies, you must meet the same criteria I do. The prerequisite basic sciences. The medical school discipline and training. Passing of equivalent state, national or other board exams. All of it. Once you demonstrate equal competence, then by all means welcome to the discipline. And the liability. All the liability. And the 24/7/365/entire career responsibility.
Anything else is weasel words and self serving (Isn’t that what all of this is about anyway? This whole discussion is about vested self interest, which is not necessarily an invalid topic.)
Equal qualifications – equal authority – equal responsibility – equal liability. All the fine slicing and dicing of who is qualified to do what, in separately licensed and regulated disciplines only confuses, muddies and creates more energy waste that benefit. Again all and only for vested interest. On the broader scale, concern for patients doesn’t enter into it and never has. The only time patient concern arises is on and individual doctor-patient basis, not in a statewide or nationwide agenda. There, it is all and only about self interest.
Meanwhile I have no doubt that the arena will continue to get more and more cloudy and ill defined as special interests keep pushing a weak and ever more unqualified, politics-driven regulatory system toward whatever it is each discipline’s skillful PR and lobbying agencies sell them.
Per Jai’s comment: This has nothing to do with the well respected team approach between doctors and nurses, working together to efficiently do the work.
The error is in thinking that nurses don’t already carry out many lower risk patient care issues. The greater error is in again categorizing doctors across the board as having a know-it-all attitude. Gimme a break. Maybe you haven’t worked with a solid, on-the-ball group of nurses in a while. We have excellent regard for each other and the contributions of each other.
This is about nurses who are dissatisfied with the scope of their work. The advice of most career counselors is “change your job” if it is that non gratifying.
Increase the role of PA’s who welcome supervision and are better trained in medicine. SCREW NPs
I do not think that NPs are trying to take over a physicians job at all. Even with a DNP they will be functioning essentially as mid levels. No one says that NPs have the same clinical experience or expertise as a doctor. Who thinks that?
I do not think NPs know more than Doctors at all whatsoever, but as it takes 7-8 years of schooling, plus at least 1-2 years working experience in between…it takes a decade to become an NP that deserves some respect…..
Less than 2% of medical students are going into primary care – there is a hole that can be filled as an NP that physicians obviously dont want to do.. because there is no money in it.
Nurses do take a lot of the same science classes as pre-med, are in the same room with them. It isnt watered down versions in a BSN program.
Physicians assistants DO not have the same clinical experience as NPs. PA’s get get any degree in basket weaving, fashion design or whatever and get 2 years of schooling and you think they would do better than a BSN prepared nurse, who obviously worked in the hospital before graduate school.. then became an NP? or DNP? You just like the PA’s because they work under you. P.S- NPs often do not work under physicians, have prescriptive rights in many states.
I am a nurse. I am an excellent nurse. I did not go to med school. It is a future plan; but until then I am not a MD or DO. You cannot practice medicine without completing medical school. Period, end of story.
Why does it seem that so many NPs and even RNs are of the opinion that PAs have “any [undergraduate] degree in basket weaving, fashion design or whatever” before beginning their training and little to no prior health care experience? You don’t need to break out any rulers or urine sample cups.
The field was conceived to utilize well-trained, battle-tested field medics after further education and in conjunction with physicians to improve the delivery of medical care. I have a BS Biology (minor in Psych) and was a firefighter/paramedic in an outlying area that is part of a VERY progressive EMS system. I did this for nearly a decade before deciding to go to PA school; I feel honored to have received so many compliments from the physicians under whose licenses I’ve practiced, nurses who receive my patients in the ED, and from my patients. So as I view the field from this perspective, it seems I am a very good fit for this model and I look forward to integrating in the health care TEAM quite well. I also feel confident that when the time comes, I will be able to use my education, past experiences, resources, and SP to provide outstanding patient care at a higher level than I have in the past.
I don’t feel that I am unique in this respect. Many of my classmates are medics, laboratory scientists, and various types of medical techs. We each bring a unique perspective and excellent experience to our class, along with rockin’ GPAs and fun personalities… As I must be especially thick this morning – can you please explain how it is that we are (in your myopic view) ‘substandard’ to BSNs, even after completing our competency-based, Master’s degree-level training? Even as a paramedic, I found myself teaching nurses about reading EKGs, RSI and intubation (especially in the field), and drug selection to treat various problems. I was also happy to be on the receiving end of what they were able to teach me.
I guess you’ll just have to break it down for me, because I thought we were supposed to be a TEAM that works COOPERATIVELY. And, just FYI, teams have just a select few leaders…
I am a NP and my best friend is a MD. I think the NP programs could integrate medical courses and practice hours. I think that some of the medical courses are not needed and its so much that at-least 1/2 is forgotten. Medical school is so tough to get into it scares people off. Just thinking of 10 years of school is mind blowing! If it were me I would incorporate the medical component for NP with training during grad school and not residency and for the regular MD/DO degree the way it is make it mandatory for specialty. I dont care for pushing drugs because in every drug book there are at-least 10 side effects and adverse effect for the cure of the problem. What about natural medicine? Drug companies are making big bucks on pills for what a leaf in the woods could cure. What were people doing before pills??? I get that we have made advances with many medications but the public seems to think you go to the physicians to get a pill and your cured! Or what about if you get a cold…why does everyone think they need ATB? If physicians study medicine why not include herbs and other natural therapies instead of making it a specialty. The public needs education but doctors are stretched so thin that they dont have time to teach. I know nurses are not trying to claim equality with Physicians. I also think that the title Doctor is used for those who have earned a doctorates degree. DOCTOR is Latin for teach. The title can be used for veterinarians, dentists, scientists, and nurses. The true term to use for MD/DO is PHYSICIAN or Surgeon. Look it up in you medical dictionary. The phenomena of calling a person a doctor was used to put a positive connotation on the practice. It has lead to a title defining the person and arrogance. I commend physicians for there dedication. I was going to be a MD but had a child and no support so I put my child first and continued in the nursing field because I wanted to help care for people. I have volunteered for more clinical hours and taken excessive science and other medical related courses to supplement my education so that I can give great care. I was not fortunate enough to go to medical school but I would love if some of those classes be incorporated into NP/DNP curriculum to help us better preform or change the medical requirements so that people who only want to do a specialty can do that only. US have very high standards on physician. I spoke with a physician who came from over seas and she told me that her curriculum was different from the US. Less schooling and residency but some can get into the US to practice and some cant. Well, If I did not have my child I would go to med school but family first. My goal is prevention and teaching. Too bad they pay public health professionals soooooo little because the US population is suffering for lack of knowledge.
the reasoning that medical school is so long and hard it scares people out of it and that is the reason for the shortage of physicians and that’s why NP/PA is a good option is not well thought out. The national acceptance rate for medical schools in 2008 is 46% (AAMC) and has been between 46-52% since at least 2002 (I don’t feel like doing further research for an anonymous post, but I suspect the rate was always around there are even lower). Therefore there is no shortage of qualified applicants, I do know several people who did not match into an MD school, and are now NPs advocating for independent practice claiming equivalency. So how can people that couldn’t cut the criteria to get into med school be equivalent. Are there NPs who could do well in med school? absolutely, did some of them go the other route because of life circumstances preventing them from the very intense, long training? yes. It’s the former group, the ones that didn’t cut it to get into med school (even if they were high achievers, it was high enough to meet the stringent requirements of medical school (MD or DO)) that are screaming for equivalency. The latter group is quite content working with physicians or for them, but not independently, which is what these programs are for. Not to create pseudo-doctors.
As far as the term doctor meaning teacher that is absolutely true, however NPs will not use that term as a title, but as a descriptor of their job, i.e. hi i’m so and so, i will be your doctor. For some reason these people need an ego boost, if there is any question look at their white coats, one a “senior clinical nurse” had RN, BSN, MBA (who puts MBA on their coat?) and then underneath something about sickle cell disease. Mine and my colleagues coats just have our name and MD,DO.
Thanks.
I am disappointed by the lack of understanding surrounding the education that nurses currently receive. The profession and the required training has evolved in the past 50 years to the point where advanced practice nurses are qualified to perform a wide range of services that were once the exclusive realm of physicians. There are many well-designed studies supporting the fact that advanced practice nurses do as well, or better, than physicans in their respective areas of practice. I am excited by the prospect that health care will become more accessible and nurses will be better utilized in the near future.
The problem with the “more accessible” argument is that the vast majority of NPs “D”NPS etc, would like to work in the same highly desirable areas as doctors and because they would like to claim “equivalency” they also demand the same reimbursement. So they are essentially creating an inferior product for the same cost and the same accessability as a well trained physician.
Let me assure you that I have absolutely no problem with NPs and PAs as physician EXTENDORS, not physician equivalents or replacements. In the physician extendor role they are worth their weight in diamonds, a competent one can save hours off a days work and make things go smoothly. On the other hand an incompetent NP could create more work for the physician, could cause a patient much anxiety by ordering any number of unnecessary tests, or worse could lead to a poor outcome.
Once again we see the endless repetition of the
argument that “many well designed studies” show that
nurses do as well or better than physicians, etc.
These studies demonstrate nothing of this kind because they:
1). Examine only NPs treating the most common of disorders,
such as HTN and diabetes(HbA1C) and, hence, cannot and
do not compare NPs to physicians for the broad scope of
general medical practice and
2). Flagrantly refuse to acknowledge that NPs always refer to
physicians for diagnostic and treatment conundrums. That is,
“equivalence” is only demonstrated if NPs can refer to physicians
at all- thus, the “studies” are hardly evidence of readiness for
independent and full-rights medical practice.
But the NP movement nevertheless draws the unwarranted conclusions,
in exactly the same political language as in the post of “B” above.
I find this deliberately misleading and reflective of the naked political
ambition obviously manifesting itself among the NPs.
In my opinion, the NPs have earned the deep distrust of many in
the medical profession through the actions and statements of those
NPs who are so obviously pursuing a political agenda against the
primary care docs under the guise of “greater access” to care
(by legislating a right to medical practice without the requirement
to go to medical school).
here’s a perfect example of why NPs should not be practicing independently. This just happened a few days ago, not going to go into specifics due to HIPAA, but sufice it to say the patient presented with classic signs of distal colorectal carcinoma, abd. pain, narrow caliber stools, progressing to constipation, also with hx of known cancer at another site. Went to see NP when MD was not available, was diagnosed with sciatica by NP, given percocet (to a patient with constipation) and told to f/up in 4-6 months. Came to ER a few weeks later with obstipation….I’m sure each and every MD in every specialty could come up with at least one such scenario in the past month where patient care was severely compromised
I sense a great deal of fear and ignorance in these comments.
When I complete my DNP degree I will not only have had an education that entails the following; 2 years of prerequisites + 2 years associates degree nursing school = ADN, 2 additional years of education = BSN (Summa Cum Laude), 12 years of emergency and critical care nursing (CCRN certified) + 4.25 years of graduate school = Doctorate of Nursing Practice degree. After graduation, I will be in a residency that is not funded by taxpayers (Medicare), rather an employer will provide me with one to two years of supervised practice before I am considered fully prepared to independently perform.
In addition, I possess a formal degree in Orthopedic Technology and worked in that field for four years prior to admission to nursing school (despite my 4.4 GPA, work experience was required for admission to my associates degree program).
So please make an attempt to understand the milieu to which you speak. These types of divisive, narcissistic, and ultimately ignorant comments do not move the science of health care forward.
re Jpayne:
while I commend your dedication and having worked with many CC nurses realize that you work hard. but your experiences hardly qualify you for independent practice as was evidenced by my example above. The NP who was involved had similar training to your with exclusion of the orthopedic technology experience. An associates degree in nursing and experience in intensive care nursing again does not make you qualified for dealing with complaints like the one the patient presented with above. NP/PA make excellent physician extenders but poor physicians. I think all of you provide an invaluable service with the caveat that it is a service to the physician. It is not even an issue of willing to take on malpractice if practicing solo, etc. but there is a major difference in training paradigms between nursing and medicine, as attested to by many MDs who were nurses and even NPs previously. I for one would not be comfortable going to or referring to an NP or PA who practices independently with no physician supervision.
Note to Colleagues.
RE: JPayne
Note how, regardless of the evidence or of data,
that the NPs/DNP individuals refer to the docs as
“fearful” and “ignorant” and “divisive” and “narcissistic”
As all of you are aware, this is trivially the “argument ad hominem”,
abusive variant, so common in political discourse.
To wit: if the docs do NOT agree with our self-presumed equals and
colleagues that, of course , these equals must be fit to practice medicine
independently, then we MUST be just protecting our “turf” and
are ignorant, fearful retrograde throwbacks, etc, etc, the list goes on
endlessly.
Here are two objective pieces of data and evidence that demonstrate
that NPs/DNPs do NOT have anywhere near the medical science knowledge that
physicians virtually universally have:
1). DNP performance on USMLE part 3- the simpler, shorter and “dumbed
down” version of the exam has a pass rate (set by the NURSES themselves)
that is only 1/2 the rate at which real physicians pass this easiest of
licensing exams. Even DNP cherry-picking and cherry-grading their
exams demonstrates precisely the opposite of what they claim.
Of course, DNPs will not even attempt STEP I in all its glory- they
know they have not REALLY gone to medical school, don’t they.
2). See the recent IOWA court decision preventing NPs from arrogantly
presuming the qualifications to supervise fluoroscopy and other
radiologic procedures in radiology departments in that state- the
attachments appended by the Judge in the Court speak enormous
volumes about the arrogance and political ambition of the nurses-
and as we all well know, nursing programs require NO University
Physics- let alone study or knowledge of the ODEs and PDEs of
Maxwell’s Field equations that are really needed to understand
radiation and its effects on matter. Of course, the Nurses will tell
you that matters not at all. Thank god for the Judge in Iowa who
saw right through the baloney and prevented injury to Iowa patients
and citizens.
In the Iowa District for Polk County. Consolidated Case # CV8252
3. All of us are full well aware that 2-year and 4-year Nursing degrees
just have very little hard core science basis in them, compared to
real undergrad degrees in Physics, Chemistry, Biochemistry and Biology
that so many docs do before medical school.
And a review of the “DNP” degree curriculum demonstrates a ‘doctorate”
in social and political correctness attempting to pass itself off as a
scientific “practice” degree.
Any legitimacy accorded to the DNP is both a lowering of standards and
will result in making medicine LESS scientific, not more – and medicine
is already far behind Chemistry and Physics as a Science- and I say
this with degrees in BOTH Chemistry and Medicine.
4. We cannot convince the DNPs and NPs of the clear chicanery of their
position in this discussion- theirs’ is a POLITICAL movement, not a
search for truth.
What we can do is to aggressively develop PA programs, which are
actually based on medical SCIENCE, not Healthcare Political Correctness.
I propose that the best way to maintain high standards of practice and
sound, rigorous scientific training is to aggressively partner with PAs to
give the best medical care possible to the greatest fraction of the
US population that we can.
I appreciate nurses’ contributions and capabilities in some areas. I am an RN going to an osteopathic medical school. I chose medical school because I know that my patient’s outcomes would not have been the same as if I had gone to the DNP program (that I was accepted at the previous cycle).
DNP programs lack the basic science aspect and basically skips to pathophysiology. In my estimation, DNP programs basically do the 2nd year of medical school in an abbreviated format followed by what is something like a 4th year of medical school, then perhaps a somewhat accelerated training year akin to a PGY2 before practicing effectively on their own. The other 2 years of the DNP program were not really based on practice at all, it was almost entirely research and was much more like clinical nurse specialist (read, education or research depending on school orientation) which has only minimal relevancy to patient care.
If you think that what I just described is equal to four years of medical school plus a minimum of 3 years residency, you’re kidding yourself. Sure, the worst physicians and the best NPs probably cross on capability, but on whole, your typical physician will be better at medical practice than your typical NP. It’s not the 99% of patients you take care of well that’s the issue, it’s the 1% you missed. That is were the problem lies.
I have to agree with the statement from AMA that we are all specially trained in our respective fields and that collaboration gives the patient the best care available. I am a final year pharmacy student, and although I’ve heard alot about our field moving towards a push for a bigger role in general medicine, we as pharmacists are taught to recognize out limitations. MD’s are diagnosticians and having that single, capable decision maker ensures medical treatments and decisions are appropriately executed and followed up upon. That being said, I do believe that pharmacists being medication experts should have a role in determining treatment regimens. Our 4 yr graduate curriculum mirrors the medical school model.. we are taught the basics of pathophysiology, the disease state.. but we shine when it comes to the depth we go into when it comes to pharmacology (how drugs work), pharmacokinetics (the effect of the body on drug absorption, distribution, elimination and excretion) and drug treatment (all evidenced based, according to guidelines or primary literature sources). Why then does it not make sense that a phyician would defer to a pharmacist, once the patient has been diagnosed, for treatment.. the best, evidenced based treatment and not just medicine according to what the last sales rep “educated” them on or anecdotal medicine (ie going with that’s always worked in the past)? I respect the NP’s plight for an expanded role in general medicine, and if MD’s cannot or will not end the inhouse bickering about pay being a deterrent to doing a residency in family practice medicine, someone has to step up to the plate, and so I applaud NP’s for their wanting to fill that gap.
Darrell M you are absolutely correct with regards to pharamcists. You possess knowledge depth that we as physicians do not in regards to pharamocology and all that goes along with it. In my training I have absolutely loved having pharmacists on rounds with us, especially in the ICUs, but also on the floors. In fact if I was ever on a team without a pharmacist I would routinely go search one out after rounds for questions regarding treatment regimens. Unlike pharmacists NPs do not provide complimentery knowledge to a MD/DO. Does a CRNA know more about anesthetia than a family doc, sure; but not more than an anesthesiologist. Does a FNP know the differential and presentations for hypertension in a child as well as a family doc or pediatrician? Highly unlikely, the depth of training in NP education with regards to clinical medicine is not the same as it is for pharamacists with regards to pharmacology. I would go as far to say as the amount of pharmacologic knowledge an MD possesses relative to a PharmD is about the same as the amount of knowledge an NP has about clinical medicine relative to an MD/DO.
“I would go as far to say as the amount of pharmacologic knowledge an MD possesses relative to a PharmD is about the same as the amount of knowledge an NP has about clinical medicine relative to an MD/DO.”
I would not go that far. Yes PharmDs are great to have, particularly when you likely interactions. (and personally having been an ICU RN and a chemist, I believe that I understand non-exotic medications as well or better than most.)
You under estimate NP’s clinical skills by a huge margin. I believe this is where they are strongest amongst their skill set they do have. The issue they lack consistency due to the high variability of experience prior to graduate work. What they are not strong with is the what to do next. This is where I think having a solid DO/MD benefits everyone.
I am extremely skeptical of nonphysician healthcare workers doing independent work. One thing I have realized what American healthcare will realize in a few years in how the nonphysician healthcare workers have driven the number of imaging studies to a skyrocketing high because they don’t have the knowledge and clinical skills to assess patients. They would order lab tests and CTs and MRs on routine base follow ups : I have seen a Oncology NP order annual knee MRIs for AVNs without any clinical note ! Without any clinical history ! I have fought with a orthopedic NP who refused to believe me when I told him that his 25 year old patient had osteomyelitis after fracture ! The patient ended up in OR in a week I have seen another pediatric orthopedic NP order spine MR on a patient he had never seen , who turned out to have hydrocolpos on MR spine as it covered pelvis. I have innumerable examples and it is really bothering me where all this is going ! All the proponents of the nonphysician healthcare workers above have too much confidence in their entire rank and file and while I agree that there are some doctors that are as clinically incompetent as above, my experience as a radiologist with nonphysician healthcare providers is very poor. Extreme caution is the word !! None of them should be ordering these high end expensive tests without seeing a physician for one.
Let’s be honest, a nurse’s role is different from that of a physician’s role-so why exactly are we pushing for DNP? I’m sorry but what exact does it mean to get a Doctorate in Nursing Practice…? I understand MD, DDS, DMD, PharmD, because there is an actual science to which is being studied.
Tom please go talk to a veteran pharmacist…I’ll put money on it that they will know more than you. Actually go talk to a PhD in pharmaceutical sciences they will know more than you (trust me talking from experience a family member of mine has a PhD in pharmacokinetics)
Let the nurses be nurses and doctors be doctors.
JUST an FYI: http://www.truthaboutnursing.org/faq/aprn_md.html
Apparently they consider themselves better than physicians…..right.
Very good discourse here. But let me bring up one point. It is easy to make anecdotal statments about anyones realm of practice. NP MD whatever, the comment let me tell you about the NP missing this diagnosis, can be said of any practitioner of any discription.
If you. only want to look at data that supports or augments your argument then you argue away the data of anothers published study.
The only way to move forward and provide quality care in an environment that does not take away every dollar available in the American economic machine is to include and use every available provider to thier fullest extent.
No one can argue that most of this discourse has at it’s root the threat of loss of income to one party or another. The problem is we are all loosing money in a health system that needs to be adjusted , the historical training and presemed roles are not working. Something has to change. Argue if you will but lets use real facts real data etc.. not anecdotal statement of “well let me tell you about this person or practitioner or that one . ” because that is not a debate that is in fact political mudslinging.
>”no one can argue that most of this discourse has at its roots the
threat of loss of income”<
This is an argument repeatedly thrown in the face of physicians
who actually care about the standards and quality of the medical
care that is given in the United States.
Many, if not most, physicians believe that the practice of medicine
is both a privilege that must be earned and a responsibility to both
the individual and to society, each of which grants that physician a certain
trust in carrying out their responsibilities.
Nurses playing doctor, prescribing psychologists, and all the rest of
it remain the practice of medicine under lesser and inferior standards
of training and intensity and degree of learning, especially scientific, than
the standards that physicians are held to. Plain and simple.
Shortages of physicians, claims that physician level training are not needed
(by NPs and pyschologists), and, of course, money considerations by
administrator bureaucrats and MBAs and RN CEOs and, of course,
by all divisions of government, are the EXCUSES used for justifying
the lowering of the standards required to practice medicine.
Here is the point: Failure to maintain high standards in every area of
human activity comes with its inevitable cost: in banking oversight,
in business regulation (Enron/Worldcom), in fiscal responsibility
in government, in engineering, AND IN MEDICINE.
Prediction: "Someone else" will maintain that this debate is all about lost
income for certain groups as long as the health care is about someone
else and someone else's family.
But when serious illness is missed in him or herself or in those he/she
loves, all of a sudden, in my humble opinion, I will bet that the above
poster will feel that the services of a fully trained
physician are needed.
Unfortunately, the current emphasis on lowering standards for medical
practice may mean that fewer resources will be available for training and
teaching more primary care physicians.
Thus, those physicians may not be there when "someone else" decides
they are really needed after all.
You guys are a bunch of idiots.
Of course AMA pushes for additional PA schools. Why? A person to call their assistant and control. Independent NP = loss of control for AMA.
I am all for NPs, but the reason for their existence, like PAs, is to increase access and decrease costs. By lowering the standards we increase the supply of providers to meet increasing demands in primary care. By paying them less we decrease costs and make health care more affordable. By having them under the supervision of a physician we decrease the chances of misdiagnosis and harm to the public.
Now, if NPs want the same pay and practicing rights as Docs. I propose they develop a program with the nursing model in mind that is as rigorous as medical school. Especially with clinical hours and training in preventing and treating illness are concerned.
I am in no way fearful of the niche MD/DOs have. The public will soon shun these doctors of nursing when they begin to hurt people. As long as the free market is free there will be no place for DNP in medicine. Especially, if they are getting paid the same as MD/DOs. Who would pay the same price for a high school teacher when you can get a post-doc for the same price?
This is absolutely absurd…. if you want to be doctors and treat patients on your own go to medical school. you have no possible idea the rigors it entails unless you do it yourself. A few individuals in my class were formerly nurses and they did the right thing by becoming doctors, not trying to shortcut their way into making a bigger paycheck without making the sacrifices we as physicians make. If this becomes a reality why even go to medical school if you want to go into FP? I cant even read this garbage any longer. Nurses are essential to health care, i agree… but you are NURSE… not a doctor.
NPs that did it the right way — they got their BS, worked as an RN for a long time, then went back and did a legit masters program and post-grad training in a particular specialty — are wonderful resources and important members of the team… which should be led by physicians. I’ve worked with absolutely fantastic NPs that have been in the biz for decades and got their education the traditional way, not by some fast track crap that’s sprouting up all over, and they STILL consulted with the physicians on a daily basis. Every single day, multiple times per day, they were running ideas by the docs, asking questions, etc. And as far as I’m concerned, these were the best of the best when it comes to NPs. And they KNEW that’s the way it should be, because they were smart enough to understand they didn’t have the same education as physicians and shouldn’t be responsible for knowing the same information or having the same decision-making capabilities.
When you compare the education and clinical training that NPs have relative to MD/DOs, it’s not even close. NOT EVEN CLOSE.
The US standard for practicing as a physician has been established. If NPs want to practice like physicians, they should have to pass the same test that allows physicians to practice as physicians. If they don’t pass the USMLE, they don’t get independent practice rights. That’s the way I think it should be.
There is the presumptive opinion here by many comments that physicians always make the correct diagnosis and if one sees a physician that they can be assured a correct diagnosis.
Simply not fact. Facts are physicans fill an important role in todays health care, always have. They will continue to do so. Fact there is change coming to how healthcare is accessed and consumed. There is room and necessity and efficacy in utilizing all members of the health care team. RN’s , NP’s MD, DO etc… again, going to physican does not assure a complete and correct diagnosis the anecdotal “well I heard of an NP who did this or that.” can easily be filled in with ” I know an MD who did this or that ” as well.
My wife is a NP and she is awesome, but even she readilly concedes she is far from being a Doctor. It doesn’t take a rocket scientist to see the training is vastly superior there is no comparison at all….anyone can see that.
I agree something has to be done giving nurses more power isn’t it. I personally would take a IMG over a NP/DNP any day of the week.
For prescription refills, sniffles, coughs, and fevers I’m fine with it after that I WANT A DOCTOR not a nurse. Remember I was there through all of the classes my wife took, all of the theory, the didactic bologna that frustrates almost every nursing student especially at the graduate level.
NP/DNP do and will play a critical role their scope of practice needs to stay the same. UNDER A DOCTORS SUPERVISON!!
Response for “someone else”:
1). What you say in your last post is completely correct.
Physicians will miss a diagnosis, and error like anyone else.
To error is human.
2). Your point, while correct, is completely irrelevant.
NP “equivalency” to physician care is “established”
(in a NON-independent manner), only for the simplest and
most common of medical disorders.
3). The Power of studies needed to demonstrate that (real) doctors
know more medicine, and can better determine when/if a
presentation is a “zebra” instead of a horse … those studies are
of such a large power that they have NOT been done (they would
have to include the enormous sweep of all of medicine).
NPs are arguing that because they can treat diabetes, asthma and
high blood pressure as well as real doctors, therefore they are
equivalent to real doctors and deserve the same title and pay
compensation. Their “studies” (on asthma, diabetes, and hypertension)
“PROVE” they are correct.
4). NPs who turn around and actually GO to medical (MD/DO) school
invariably say that the NPs do not even realize how much they do
NOT know and understand about medicine. USMLE part III results
back up these statements-let alone the medical science part of the
exams-which NPs do NOT take.
5). The obvious fallacy and fraud by many of the leaders of the NP
movement is blatantly obvious- not to mention the title and
status-grabbing and other self-serving behavior, which is also
blatantly apparent.
They seek to exploit the exponentially increasing demands for
medical care in our bankrupt United States by LOWERING the
standards that all real doctors had to meet to practice
medicine.
6). I cannot imagine how ANY physician, who sacrificed blood, sweat,
and tears, and took on tremendous debt to become a (real) doctor
could have anything but absolute contempt for the behavior
that the NP “movement” is currently demonstrating.
This is especially true of those (real) doctors who heeded their
country’s call to go into primary care medicine to meet the
nations’ needs- so loudly and stridently proclaimed by pundits over
many years.
7). Sorry is the state of this nation today, when political correctness
rules the World, and a spade may not be called a spade.
“Sic Semper Tyrannis”
People who want to be a doctor should go to medical school. Not nursing school. Not PA school. Not whatever else that pops up. If you go to nursing school, you’re going to become a nurse, not a doctor. If you want to prescribe, manage patient care, perform surgery, etc, then you want to be a doctor, not a nurse, not a PA, not a so called medical psychologist. As a corollary, if you want to be a psychologist, get a degree in psychology, NOT social work. Nurses simply don’t go through the didactic training that a doctor goes through. I know quite a few nurses who later went to medical school. They ALL got a big surprise about how much they didn’t know that they thought they knew about medicine.
I say let them have independent practice and all that that entails: malpractice, absolutely no physician oversight (reviewing 5% of the charts is hardly oversight anyway), and make them take care of the same patients we take care of, let the CRNAs do the transplant and cardiac cases, let FNPs deal with young people with adrenal HTN and pheos who present for a well visit, let inpatient NPs take care of (at least) the same number and type of patient that we take care of (not just the 31 year old with no pmhx and gallstone pancreatitis).
If they want to play doctor, lets let them play doctor. In my hospital NPs make around 100k, while residents make 50k, and we care for more complicated patients and their cap is 4 our cap 12. So in my opinion if we give them what they want, they will quickly realize that they are not competent and grossly undereducated to deal with the issues we deal with, patients will soon realize this as well, and hospitals will get sick of covering the lawsuits.
I hardly think it is a fair scenario that they want to make as much, and practice with little to no oversight, but any mistake they make falls under some physician’s license and that poor bastard will be the one that gets taken down if they screw up.
I’m switching careers into medicine, and I still haven’t chosen which path to take yet. This is not a question of knowledge or even experience; it’s a question of economics.
Presumably, most individuals are comfortable with the concept of Nurse (nowadays an LVN) and Doctor (nowadays, MD/DO/NP/PA). The conceptual roles will always exist, regardless of their title: someone’s got to be held accountable for choices over a patient’s care, and someone has to clean up/check up on the patient with hands-on care.
The problem with a competitive environment for medicine (MD vs DO vs NP vs PA) is that it drives up cost. Normally competition drives cost down, but we don’t tolerate the loss of patients as easily as capital loss or material loss, a byproduct of that process. The problem is, we want to regulate to prevent loss of life but not regulate to control cost. Healthcare becomes too expensive for many, so seeing an NP or PA is simply cheaper or more available.
This issue isn’t going to be resolved by arguing the merits of
each training process. Every patient wants to get the best care that’s both available and affordable. If the medical industry wants to standardize care, and patients want standardized care, it may require standardizing cost. Then training and titles is worth arguing over.
To the author of the above comment. How about you try commenting about this when you actually have w client about medicine. There is much more going on than simple business models. The bottom line is that someone wants to be a doctor they should become one instead of taking a path that is ultimately easier and quicker. Anyhow, if you really want to PRACTICE medicine EARN IT! Don’t take some Backdoor entrance. Become an NP or PA with the intention to provide a service to help patients, but please do not confuse this with the art, science, and practice of medicine. This is the work of a well trained Physician.
Have a clue I meant. (Phone typing edit).
I know I’m late to the party but a major part of the problem we are facing is the unions. Nurses are part of a massive union that lobbies for them. There is no way this issue would have even come up if it weren’t for the progressive union that represents them. Union mentality is mob mentality. They take, pressure, and extort out in Washington. Union bosses that don’t know anything about medicine negotiating with politicians that don’t know anything about medicine. All they know is the union bosses walk away happy and the politicians walk away happy. The progressive nature of their union embraces the wealth distribution and everyone should be equal ideals. But not everyone is equal when it comes to training and academic attainment (and I don’t just mean the letters after your name). Nurse does not equal doctor in any equation. This progressive union needs to be stopped. Let the nurses do the job they are trained to do and the doctors do theirs. If you want doctor privileges and doctor pay, then go to doctor school.
Why don’t the doctors just form a union and then we’d have some pull around this place? It’s illegal and you will be arrested for it. For some reason it is ok for nurses to have unions to stick up for themselves, their hours, etc… but doctors can not. When did they finally get residencies to decrease to 80 hours per week? Was it when the residents and interns went on strike? No. It was when the literature started showing decreases in patient outcomes and not until then. Show me the non-nurse non-physician funded study that shows that nurses and doctors have the same abilities and then let’s have a chat. I guarantee you won’t see an unbiased study with those results.
Unions only work one way. They decrease the amount of work their members have to do and drive up the pay and benefits. They are a one way street. When does a union say, he we realize that compensation is decreasing so we are going to decrease what we are asking for in terms of compensation? Do you think the nursing union will ever say to their members, ‘oh actually you guys aren’t qualified to be full fledged doctors. Try going to get a full medical degree and you will have what you want’. No. They push and push and push to bring the world home for their members. If doctors can’t unionize then down with the nursing unions.
@Smash: You make a good point about the nursing unions. I don’t think anyone realizes how harmful these are until the profession is harmed so much from the union that it turns into a mockery of itself. I understand how it is nice to have pay and benefits increased. But eventually that well will be so dried out, that everyone will feel the pain. I always think of people in unions as being the worst of the worst in their professions.
This must be a joke! Nurses have no qualifications whatsoever to take on responsibility like doctors…. these nurses need to realize that their education level is a joke compare to what a doctor has. They just want more and more things that they don’t deserved!! If you want more responsibilities and power than go to fu cking med school! Your lazy ass want to do 2-4 years of nursing and has a equal role of someone like doctor who has over 10+ years of education? This is the biggest joke i’ve ever seen!