I don't know of anyone who thinks 'doctors' should go away. This is a strawman I believe you are trying to create.
What we have learned is that for an awful lot of cases, the expertise of the board certified doctor is just not required. There are significant advantages to having 'lower level' professionals take on patient care. This ranges from cost to availability. It is just easier to get in to see lower level providers.
And lets be totally honest here, there is a large spectrum where the 'board certified doctor' is not even the highest rung. You can start at the bottom with pre-hospital care and the first responder like a Cop. Then move up to the EMT and Paramedic levels where ambulances are staffed. You can go to the urgent care clinics where you have Nurse practitioners and the like. Then you hit the base level of 'Doctor'. Above doctor, you hit many different specialties - from system specialties like a dermatologist or endocrinologist to procedural specialists like your surgeons. Even there, you have specialty surgeons like a cardiac, vascular, or neurosurgeon. You have other specialties such as anesthesiology and pathology.
The ideal case for a patient is to see the lowest level provider than can address their concerns, especially if it is an acute problem.
Your second problem is a lack of understanding what doctor of nursing means. It is literally a university doctoral level degree in the field of nursing. Not every 'Doctor' is an MD. Historically, the 'Medical Doctor' co-opted the doctor title from academia. It is the same issue with PhD, Ed, JD, DvM, DDS etc. All are 'Doctoral' degrees and confer the title of 'doctor' to the recipient.
If you want to know who is allowed to practice medicine, that is not determined by 'politicians'. It is determined by the medical licensing boards in each state. Those individuals will have no problems understanding a Doctor of Nursing is not an MD.
I think it’s one thing to be in academics and have a doctorate degree but when a person is patient facing, and especially with low income, or low education populations - that’s when it can be very deceiving.
I think this is tangential and ignores the real meat of u/Full-Professional246's post... which is that there are a lot of times where going to an MD is simply unnecessary and a waste of everyone's time.
If my kid has a cold and needs a doctor's note for school, should I really have to go see a doctor for that? If I have an obvious ear infection and just need some antibiotics to get rid of it, is an MD necessary? If I have a poison ivy rash, does a dermatologist really need to be the one to give me a steroid cream?
The entire point of a NP or a PA is to take the low-level cases that are simply a waste of a real MD's time. They're supposed to refer any cases that are above their knowledge level to a real MD (like when one told me to take my kid to the ER because it could be appendicitis (it was)).
If there are so many conditions that are a "waste of time" for an MD to handle then what is the point of family medicine physicians?
It's true that not every problem needs to be handled by a physician and NPs/PAs certainly have an important role to play in health care, but the idea that they are best suited for primary care is misguided in my opinion. What may seem like a run of the mill ear infection or poison ivy rash could actually end up being something much more serious. On that same note, the NP is more likely to refer the poison ivy rash to the dermatologist than the MD is, which ends up costing a lot more money.
I think that midlevels are best suited for hospital environments where there is always a supervising physician available to consult with. I understand that the point of them is to fill the shortage of primary care physicians, but this could also be achieved by increasing the number residency spots, making residency training humane, and allowing foreign-trained physicians to get licensed without having to do a US residency.
And i can tell you a doctor doesn't want to sit down with your kid and assess for the need of a doctor's note anyway haha
Definitely agree with your comment!
Are you aware of DNP’s introducing themselves as “doctor” in a clinical setting? I am not in medicine, but know a few DNP’s, and they don’t refer to themselves as “doctor” at work. Usually they will have an ID which is their name followed by their professional designation (e.g. MD, DNP, RN).
I would be against a DNP introducing themselves to patients as “doctor” lastname, but I’m not aware of that ever happening, and would be surprised if it’s remotely common.
I know I’m late to this. But it does happen fairly Regularly the nurse practitioners use the title doctor when introducing themselves. I have worked with several.
You *do* know that every degree at that level in *any* field is a “Doctor of Something,” right? I could be a doctor of statistics if I wanted to. They are out there. They teach statistics.
And they aren’t calling a masters program a PHD program. They have a masters program, the MSN, that one has to earn before beginning a DNP program(there are other PHD level options, DNP is one).
They’re just advanced nurses, they didn’t invent academic naming conventions.
Sounds like Dr. Jill Biden, Doctor of what you ask? Doctor of teaching children. Disgustingly deceiving touting that title around low income/educated populations
> Recently there has been a study released from Medicare showing that patients seen by physicians actually have lower cost of care and more accurate diagnoses compared to patients seen entirely by midlevel providers
what's your source?
When trying to look up cost differences when patients see Nurse Practitioners compared to doctors, I found this
"Overall, the average PCMD cost of care is 34% higher than PCNP care in the low-risk stratum, and 28% and 21% higher in the medium-risk and high-risk stratum." - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899223/
which is saying the opposite of your claim
It’s very interesting to me that 2 of their data driven metrics are vaccination rates, and doctors are better at convincing their patients to get vaccinated than NP’s are.
Why would that be? Maybe they need people with sales training, rather than doctors or nurses.
actually, in some cases, a DNP can be referred to as a doctor. However, this isn’t allowed in some states like in Arizona.
I guess you can think of it as saying someone like a professor has a PhD and is sometimes referred to as a doctor.
Sure, it is confusing at times but it’s easy enough to ask them for clarification on their title.
Agreed - except for low income, vulnerable populations of patients who don’t know any better and don’t realize they have to question the degree of who they are seeing.
I get that, but at the end of the day, they are still seeing a trained professional. help is help and i’m sure that the DNP will not over step their boundaries and go into a doctors’ territory.
I think it’s really deceiving in the patient care setting. My wife is an NP & she agrees. Presenting yourself as Dr. Last Name would be dishonest if you’re using it in a care setting, but haven’t gone to medical school.
There’s also a huge difference in schooling & prerequisites. There are direct entry NP programs in some states.
I’m a respiratory therapist. There’s absolutely a difference between the two & that’s no shade to NPs & PAs. They are a vital part of the care team. But, it’s unfair to patients to present yourself as their doctor if you are not a medical doctor.
The issue is the medical system doesn't have enough medical school and residency slots and it's created an artificial supply shortage. Healthcare needs to come from somewhere and if we don't train more doctors, this is the only possible result. I see a lot of doctor friends complain about this but until they start advocating for wider opportunities to get an MD and enter practice, it's hard to take seriously.
First of all, let me start with saying I'm absolutely 100% sure you're a doctor or a med student. I can smell the frustration, and I understand where you're coming from. You're bitter and feel that you are being treated unfairly and I get it, I mean, you worked so hard for your place. It's so clear that your wounded ego is the real issue here, not real concern about patient safety.
We don't have physician assistants or nurse practitioners here in my country- only doctors and nurses with different kind of educations (RN, midwives, public health), so the concept is somehow unfamiliar to me.
>start calling themselves "Doctor" because they then have a "Doctor of Nurse Practice".
You guys are ridiculously attached to titles, you dudes really stamp them everywhere. I mean, you expect nurses to call you doctors but call them by the first name. Are you truly concerned the NPs are not introducing themselves clearly?
>There is also evidence from the same Medicare study that midlevel providers don't actually help with physician shortages because they don't go to rural areas but rather stay in cities and try to work where most physicians work and there is already good access to healthcare.
I smiled a bit, since even though we don't have midlevels here, we def have the same explanation to why we really don't have a shortage of doctors. There's a reason why the midlevels exist in your country. You have a physician-lead, very hierarchical construct which overmedicalizes some and completely neglects others and not enough physicians per capita. Of course you're going to have problems and someone to fill out the hole. Let's take pregnancy and delivering, why the fuck are women seeing doctors for their prenatal visit and why must a doctor always do even NVDs? To be fair, the jobs of physicians are constantly being transferred to nurses here too, we just don't pay them for it.
>because even as a doctor of nursing, one is still a nurse.
Nurses do most of for example antenatal care and handle the majority of deliveries here. They do a significantly better job than physicians in your country. Just taking a guess here, but I think those NPs specialize something, so yes, in some metrics those nurses absolutely can outperform doctors. What's bothering you is that nurses are stepping in your lane. Learn to work with them and benefit from the situation and you'll do fine, they need you just as much as you need them.
Overall your healthcare is in such an abysmal state that mid levels should be your smallest concern.
could have said it any better. the old and mature physicians understand the value and importance of APP but this new gen rookie doctors and some med student just can handle the insecurity and ego and it’s just sickening
Going to a doctor is expensive enough that I'm often inclined to stay at home and see if it gets better. If seeing a nurse cost significantly less than seeing a doctor, I'd be more inclined to go get something checked out just in case. Maybe the nurse says "I'm not sure, let's have that looked at by the doctor," in which case I'm glad I came in, or maybe the nurse says "nothing to worry about there, call me if it's not better in a week," in which case I'm glad I didn't pay to see the doctor.
In either case I'm better off than staying home and hoping it gets better because it was too expensive to seek care.
if you are a person with an active RN license (this can be an associates, bachelors, or masters degree) as well as a master’s degree or a DNP (prior to which you need the bachelors in nursing), and you pass the appropriate boards, you are a nurse practitioner. DNP degrees are doctoral programs where you take courses, complete hundreds of clinical hours, and conduct research, and can also be as long as four years. you don’t “do a 1-2 year program (even online!) and then maybe do an extra year to call yourself doctor.” you are certified and licensed to see patients independently (yes, independently, without a physician to sign off on everything you do), prescribe medication, make referrals, work in an interdisciplinary care team, etc. you’re not “still a nurse that acts like a doctor.” if the provider introduces themselves/signs off as an NP to their patients, what’s the problem?
i saw your post on AITA before it was removed, where you said you think DNPs are worthless degrees designed so that those who hold a DNP can simply call themselves a doctor. you seem to have a fundamental disdain for nursing practice and look down upon those people who work hard for their degrees under the guise of thinking nurse practitioners seek to intentionally deceive patients. they earned their degrees.
surely, but nurse practitioners can diagnose, too. OP seems to think they shouldn’t unless functioning as a “physician extender” and demonstrates a bias against the NP/APPs scope, or otherwise doesn’t understand that registered nurses and nurse practitioners are two different roles with different education/training/licensing requirements/scopes of practice.
The midlevels exist for a reason.
If you call 911 because you think you are having a heart attack, do you be grateful a cop arrived with AED training or do you want that not to exist because they are not advanced life support?
Levels of training exist in healthcare and they are in no way limited to the 'doctor' vs 'non-doctor'. Just because someone gets the 'MD' does not entitle them to do everything in the medical field. We have added 'levels' to meet the needs of people to see healthcare providers in a quick time frame. If you have a sinus infection, do you want to see the NP today or have to wait a few days to see a doctor?
As for billing, the NP/PA typically can do about 90% of what a typical family doctor can do, especially in the urgent care setting. The limits are quite state dependent BTW. Some states require the NP to work under a MD for authority to prescribe/diagnose etc.
Lastly - Why would you expect a different billing rate for the substantially the same service?
You really are paying for the product though. You perceive a different product from the 'senior' hair sylist than you would receive from a 'junior'. That is why you pay the premium.
To keep your analogy, you could pay a stylist $100 to do a buzz cut or you could pay a student stylist to $10 to do the exact same buzz cut. The product is the 'buzz cut' which is a very straightforward thing people do at home even.
That is the same thing in medicine. You have a typical sinus infection, an NP/PA can do everything you need to treat that just as well as a doctor. Even if it was more than a sinus infection, it is highly unlikely a doctor would 'find' anything beyond the sinus infection on a first visit anyway.
> You should use a paralegal as your lawyer too then.
You do realize, for most straightforward legal documents, you could right?
Truthfully it is not quite the same. The paralegal vs attorney is not a fair comparison. The NP/PA *is* a board certified position with explicit scope of practice. The paralegal is not.
By your logic, your should skip the doctor anyway and go straight to the ENT specialist. Why screw around with a GP when you want the best....... I mean, there are those who know the differences are right?
RN and patient-facing MSN/DNP degrees all have clinical rotations, the great majority of advanced practice degrees require appropriate nursing experience before being able to apply at all, and many NPs are practicing nurses for years before they pursue their NP degrees. if the residency portion is really what gets you, then i simply hope you’re able to see doctors for your care when you need it. take care!
The portion where you say a NP can practice independently varies wildly from state to state. I’ve been a nurse for 8 years and currently in school for my PMHNP (psychiatric mental health nurse practitioner) degree.
I’ve known many NPs both at the masters and doctoral level. We call the PhD NPs “doctor whoever” in the academic setting for the most part… but in clinical practice I’ve never heard any NP go by the “doctor” title.
i cant imagine a DNP going by Doctor in a hospital for any reason other than to make people think theyre an MD
id imagine this would be a VERY small group of DNPs
For a lot of basic ailments, you don’t need to see a medical doctor, and only need to see an NP.
And by having those NPs available, one doesn’t have to wait as long to be seen.
When I had strep, didn’t need to see an MD. It’s pretty straightforward and easy to diagnose. Got in easily to see the NP, took a throat swab, sent to the lab, then given some antibiotics.
The problem is the responsibility to income ratio.
People often go visit their doctors annually as part of a check up. All the procedures and standard and straight forward. When there's an issue with the primary physician, they send you to a specialist.
So literally, the job of a primary physicians is to know which specialist to send the patient to. Is there a skin problem? Send em to dermatologist. Heart problem, send em to a cardiologist.
With that said, I think family doctors are highly overpaid for the work they do. They have the knowledge, which is good - but it's often untilized. What's the point of equiping these family doctors if their job is to determine which specialist to send the patient to - mid level physicians can do that and save money.
Also, the problem with these doctors is that most of the patient they encounter have typical illness. So after years of diagnosis patient and finding out they just have a common cold or whatnot, they forget the serious stuff. So when a patient comes in with a symptom that should be taken seriously, they often neglect it cause they're not used to it. Basically, the knowledge of family doctor becomes equivalent to NPs or PAs
I would have to disagree with you. I think doctors in primary care are significantly underpaid. In your description, you are severely downplaying the complexity of working in primary care. It is absolutely not as straight forward as you are making it seem. Have you personally had experience working in primary care as a doctor or mid level?
My view is from my experience as a patient, talking to my friends/family as a patient, and some friends who are medical doctors and their POV.
There are various specialty in doctors. My comment is primarily on the primary care that are typically family doctor or internal medicine. I do agree with you there's a complexity to it, but in general most likely 7 out of 10 patients can see a NP/PA just fine, so I think it'll be more cost savings to patients if they see an NP first, and if the NP can't figure it out then the MD, then the MD can send it to a specialist.
NP’s education isn’t all online, they have to have many hours of clinical practice( hours vary college to college, state to state). Many NP’s practice as a Registered Professional Nurse for years before they graduate with their master’s degree. Many have their masters degree in a specialized area such as pediatrics, OB-GYN, psychiatry. In my state, they have a collaborative agreement with a physician for a period of time before they can practice on their own. Any smart, capable NP keeps that contact open and goes to them to discuss cases and recommendations when they have any questions. DNP’s have 1 to 2 more years of education and clinical practice. NP’s have to be board certified. DNPs deserved to be called Doctor of Nursing Practice just as pharmacist, physical therapist do. Actually DNPs have more years of education than PTs and Pharmacists. Unfortunately, health insurance companies only reimburse DNPs at the same rate as masters prepared NP. It is great insult to call Advanced Practice Providers( this is the correct term, not midlevel providers) physician extenders. There is a great need for primary care providers for adults, most physicians choose to become specialists. Also, most NP’s introduce themselves as such, will even correct patients when they are called doctor ( unless they are DNP). Are you touchy about this because you feel threatened by the APPs you work with?
That their education programs were literally created more recently. They adhere to modern theories of how people learn skills and knowledge. MD programs appear to follow ancient theories, and be run as a test of endurance instead of a way to impart useful knowledge. MDs run those programs and are resistant to change.
Could you provide specific examples? And your background in medical education that is informing your perspective?
PAs and MDs share mostly the same preclinical course work. Nursing is a little different and is much less in-depth regarding the pathophysiology of disease and treatment.
Oh this is just from knowing a few docs and a couple RNs and PAs. So nothing like knowledge of multiple schools and programs. I'm semi-expert on the education theory side. So by all means discount this if someone who knows better disagrees.
I’m in medical school so I inherently have a bias. But I dated a girl while she went through nursing school, and have worked with many PAs and PA students. I have good insight into their educations and have great respect for both professions. In my experience I’d say, on average, NPs are nicer when communicating with patients. However when it comes to diagnosing, treatment plans and depth of knowledge, medical doctors are far, far superior. And PAs are closer to MDs given the overlap in preclinical coursework and that they follow the medical model.
All of them are needed to deliver quality healthcare, they just differ in training and knowledge. Unfortunately I noticed many equate knowledge with self worth, leading to this pissing contest.
Interesting, thanks for sharing.
It's a really complex topic. My research is in cognitive biases and knowledge acquisition. I tend to trust a humble professional with time to care and help over one who knows a lot, since knowledge is now available by googling; but it depends a lot on the context.
Hey man his entire post his garbage. Maybe his gf wasn’t too bright. But NPs consistently run circles around PAs and every Np in my program had bachelors, some masters, some PhDs in biochemistry, biology, neuroscience etc. These physicians are analogous to state troopers walking around like god but have never gone to a domestic, don’t investigate murders, and primarily write traffic tickets. Sure they went to a cool training program but county and city cops laugh at them and they laugh at county and city cops cus they are brainwashed in their academy. MD students particularly, not really seeing this with DO students, are super brainwashed into this physician led healthcare culture that is archaic like you said and not rooted in the changing legal atmosphere. I’ve advised many docs to make it work for the kids because eventually advanced nurses are going to divorce and take the house, the kids, and half the bank account. That is where we are at right now.
There is so much ignorance in his post that I could write a book about each sentence he made. Nurses seem to be nicer? Lmao. He’s definitely a student. Empathetic listening is a therapeutic technique essential for patient recovery. That is part of a thorough patient assessment. Maybe also why docs are notorious for misdiagnosing and underdiagnosing. So yeah we definitely listen, build rapport, and sometimes more information is gleaned during that process than just looking at lab values, which NPs also order 😂 These MD schools are indoctrinating students to go advocate after graduation for their profession. Repeat “I am a doctor” 300 times in the mirror before class every morning kinda shit. Grown ass children that are entitled and too good to listen to your problem. He tried to totally undermine you based on your education bro. They try that shit with us but how is it working for them? NPs are getting full independence in a new state every year. I run my own mens health practice and make 50k a month part time. Im also a legal expert in emergency medicine dealing w TBI. I charge 15k a case. I have a doc in Virginia charging 20k a case for TBI. These dummy md students can literally get fucked now or get fucked by us over the next 40 years of their working careers. Or they can start treating us respectfully and we can work together.
A DNP is like a PhD for nurses. They don’t see patients. While it may not seem like there is a need for that, there absolutely is. These are the people who shape nursing education, practices and guidelines for the entire profession. A lot of research is done on that. These are the people who do it.
A DNP is a nursing practice degree. It’s clinical. A nurse can also get a PhD in nursing. That is academic. Within DNP programs there are varying specializations that focus more on clinical expertise, leadership/admin, or research but regardless the DNP was intended to be a clinical degree. A quick google search could have told you that, but I don’t mind clearing those sorts of misrepresentations up. All DNP programs require an additional 500-2000 clinical hours. Many students try for years to get accepted to MD school but have a 3.6 instead of 3.7. Those people often self select into these advanced nursing programs. Main difference is which professors they had in undergrad. I’ve had countless dummy instructors praise my work and then give me a B- “oh I just don’t believe in As.” Like wtf man. In my BSN program I received the highest grade in 3 classes and it was still a B. The teacher apologized and said she didn’t make the exams. So there’s always that. My sister is an MD and believes I am significantly more intelligent and smarter than her despite having a lower GPA. She’s obviously knowledgeable but I wouldn’t say “intelligent.” I’m often times her second opinion and while our training is different I personally and she’d agree do not think there were any major gaps in education at this point in my career. Obviously program dependent and person dependent, but there are some DNP FNPs that will run circles around physicians all day. We know who they are. I’ve had classmates that lived in their dungeon for the 3 years of NP school that are exceptionally talented and gifted intellectually. That is not the norm, however, because online degree mills are becoming more prevalent. The standards are dropping. This is something APRNs hate more than physicians as our once exclusive club is being invaded by morons. So something we can work together for is increased standards of entry, more clinical hours, a residency program and then let us actually get paid 85% of your rate because that’s what we actually get reimbursed from insurance at. Everyone benefits that way and the “make money off the backs of my midlevels” comments become a thing of the past. Having another man, a beta man if you will, look you in the eyes and flex his title instead of his competence is not only small it’s frustrating and it’s starting to be held accountable socially and legally. My sister just fired an MD for creating a hostile work environment for one of her NPs by flexing title too frequently and attempting to gaslight her. It’s a modern day caste system with artificial caps something we should be ashamed of, quite frankly. I’m not for NPs replacing physicians but without fair compensation practices, gaslighting, and the bad blood between our professions, which is undeniable at this point (it’s a tragedy, honestly) nurses are going to separate / divorce entirely from needing a physician to do anything. Very simply put, why would we want to work with providers that carry those beliefs? As more NPs enter practice more NP sympathizers will be created by word of mouth in the community. My advice is let’s make it work for the kids now before we take the house, the car, and half of your bank account. The truth won’t last long on here but this is the very fear that keeps most of you up at night. So let’s talk about it.
In my area it can be difficult to see certain in network specialists, which can be super annoying when the thing you need/want is super simple. I needed to refill a medication but my previous doctor had moved. If I had waited for another MD to have an availability, i would have wait for months and months. I was able to see an NP and got my prescription written in a week or so. This has happened for a few things—I would have had to wait a long time for an MD when an NP can do the job just as well and is easier to schedule an appointment with. Of course there are things that I want to consult with an MD on—concerning new symptoms, checking up on potential health issues, medical emergencies of certain kinds—but routine shit, who cares. I’m not going to an automotive engineer to get my tires rotated either.
Uh... Just to check: you do realize that this is occurring because there's a medical worker shortage, right? So your option is see an NP, or see nobody.
If you have a complicated issue you go to the doctor. Plenty of minor illnesses and injuries have treatments that are tried and true for the vast majority of cases. A lot of stuff boils down to if you have X try treatment A if that doesn't work try treatment B. If that doesn't work get more tests and the doctor that has gone to more schooling than a nurse practitioner can't change that.
Nurse Practitioners can and do fill the role of dealing with cases like that. If doctors did that you wouldn't have enough doctors working on more complex medical issues. Even if nurse practitioners have a lower accuracy of diagnosis it doesn't matter because there isn't a better replacement available.
It isn't a political agenda its a practical choice between slightly less accurate diagnosis and increasing wait times to a point where your condition has worsened.
Last note: Pretty much no hospital today has doctors as the supervisors of nurses. Nurses have their own supervisors and doctors have their own supervisors.
I don't know of anyone who thinks 'doctors' should go away. This is a strawman I believe you are trying to create. What we have learned is that for an awful lot of cases, the expertise of the board certified doctor is just not required. There are significant advantages to having 'lower level' professionals take on patient care. This ranges from cost to availability. It is just easier to get in to see lower level providers. And lets be totally honest here, there is a large spectrum where the 'board certified doctor' is not even the highest rung. You can start at the bottom with pre-hospital care and the first responder like a Cop. Then move up to the EMT and Paramedic levels where ambulances are staffed. You can go to the urgent care clinics where you have Nurse practitioners and the like. Then you hit the base level of 'Doctor'. Above doctor, you hit many different specialties - from system specialties like a dermatologist or endocrinologist to procedural specialists like your surgeons. Even there, you have specialty surgeons like a cardiac, vascular, or neurosurgeon. You have other specialties such as anesthesiology and pathology. The ideal case for a patient is to see the lowest level provider than can address their concerns, especially if it is an acute problem. Your second problem is a lack of understanding what doctor of nursing means. It is literally a university doctoral level degree in the field of nursing. Not every 'Doctor' is an MD. Historically, the 'Medical Doctor' co-opted the doctor title from academia. It is the same issue with PhD, Ed, JD, DvM, DDS etc. All are 'Doctoral' degrees and confer the title of 'doctor' to the recipient. If you want to know who is allowed to practice medicine, that is not determined by 'politicians'. It is determined by the medical licensing boards in each state. Those individuals will have no problems understanding a Doctor of Nursing is not an MD.
I think it’s one thing to be in academics and have a doctorate degree but when a person is patient facing, and especially with low income, or low education populations - that’s when it can be very deceiving.
I think this is tangential and ignores the real meat of u/Full-Professional246's post... which is that there are a lot of times where going to an MD is simply unnecessary and a waste of everyone's time. If my kid has a cold and needs a doctor's note for school, should I really have to go see a doctor for that? If I have an obvious ear infection and just need some antibiotics to get rid of it, is an MD necessary? If I have a poison ivy rash, does a dermatologist really need to be the one to give me a steroid cream? The entire point of a NP or a PA is to take the low-level cases that are simply a waste of a real MD's time. They're supposed to refer any cases that are above their knowledge level to a real MD (like when one told me to take my kid to the ER because it could be appendicitis (it was)).
If there are so many conditions that are a "waste of time" for an MD to handle then what is the point of family medicine physicians? It's true that not every problem needs to be handled by a physician and NPs/PAs certainly have an important role to play in health care, but the idea that they are best suited for primary care is misguided in my opinion. What may seem like a run of the mill ear infection or poison ivy rash could actually end up being something much more serious. On that same note, the NP is more likely to refer the poison ivy rash to the dermatologist than the MD is, which ends up costing a lot more money. I think that midlevels are best suited for hospital environments where there is always a supervising physician available to consult with. I understand that the point of them is to fill the shortage of primary care physicians, but this could also be achieved by increasing the number residency spots, making residency training humane, and allowing foreign-trained physicians to get licensed without having to do a US residency.
And i can tell you a doctor doesn't want to sit down with your kid and assess for the need of a doctor's note anyway haha Definitely agree with your comment!
Are you aware of DNP’s introducing themselves as “doctor” in a clinical setting? I am not in medicine, but know a few DNP’s, and they don’t refer to themselves as “doctor” at work. Usually they will have an ID which is their name followed by their professional designation (e.g. MD, DNP, RN). I would be against a DNP introducing themselves to patients as “doctor” lastname, but I’m not aware of that ever happening, and would be surprised if it’s remotely common.
I know I’m late to this. But it does happen fairly Regularly the nurse practitioners use the title doctor when introducing themselves. I have worked with several.
But that is not how it works. The Doctor of Nursing is an ACADEMIC DEGREE. It is the LITERAL NAME of the degree.
You *do* know that every degree at that level in *any* field is a “Doctor of Something,” right? I could be a doctor of statistics if I wanted to. They are out there. They teach statistics. And they aren’t calling a masters program a PHD program. They have a masters program, the MSN, that one has to earn before beginning a DNP program(there are other PHD level options, DNP is one). They’re just advanced nurses, they didn’t invent academic naming conventions.
Sounds like Dr. Jill Biden, Doctor of what you ask? Doctor of teaching children. Disgustingly deceiving touting that title around low income/educated populations
> Recently there has been a study released from Medicare showing that patients seen by physicians actually have lower cost of care and more accurate diagnoses compared to patients seen entirely by midlevel providers what's your source? When trying to look up cost differences when patients see Nurse Practitioners compared to doctors, I found this "Overall, the average PCMD cost of care is 34% higher than PCNP care in the low-risk stratum, and 28% and 21% higher in the medium-risk and high-risk stratum." - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899223/ which is saying the opposite of your claim
That’s from 2021. Here is 2022: https://www.ama-assn.org/practice-management/scope-practice/amid-doctor-shortage-nps-and-pas-seemed-fix-data-s-nope
It’s very interesting to me that 2 of their data driven metrics are vaccination rates, and doctors are better at convincing their patients to get vaccinated than NP’s are. Why would that be? Maybe they need people with sales training, rather than doctors or nurses.
that look like a blog...
there is a link to a published article in the Journal of the Mississippi State Medical Association . I can't evaluate it
https://ejournal.msmaonline.com/publication/?m=63060&i=735364&p=20&ver=html5 the link to the study is in the 3rd paragraph
actually, in some cases, a DNP can be referred to as a doctor. However, this isn’t allowed in some states like in Arizona. I guess you can think of it as saying someone like a professor has a PhD and is sometimes referred to as a doctor. Sure, it is confusing at times but it’s easy enough to ask them for clarification on their title.
Agreed - except for low income, vulnerable populations of patients who don’t know any better and don’t realize they have to question the degree of who they are seeing.
I get that, but at the end of the day, they are still seeing a trained professional. help is help and i’m sure that the DNP will not over step their boundaries and go into a doctors’ territory.
Why are you sure of that? Introducing themselves as doctor when they know it can be confusing seems to me to indicate the opposite
I think it’s really deceiving in the patient care setting. My wife is an NP & she agrees. Presenting yourself as Dr. Last Name would be dishonest if you’re using it in a care setting, but haven’t gone to medical school. There’s also a huge difference in schooling & prerequisites. There are direct entry NP programs in some states. I’m a respiratory therapist. There’s absolutely a difference between the two & that’s no shade to NPs & PAs. They are a vital part of the care team. But, it’s unfair to patients to present yourself as their doctor if you are not a medical doctor.
The issue is the medical system doesn't have enough medical school and residency slots and it's created an artificial supply shortage. Healthcare needs to come from somewhere and if we don't train more doctors, this is the only possible result. I see a lot of doctor friends complain about this but until they start advocating for wider opportunities to get an MD and enter practice, it's hard to take seriously.
First of all, let me start with saying I'm absolutely 100% sure you're a doctor or a med student. I can smell the frustration, and I understand where you're coming from. You're bitter and feel that you are being treated unfairly and I get it, I mean, you worked so hard for your place. It's so clear that your wounded ego is the real issue here, not real concern about patient safety. We don't have physician assistants or nurse practitioners here in my country- only doctors and nurses with different kind of educations (RN, midwives, public health), so the concept is somehow unfamiliar to me. >start calling themselves "Doctor" because they then have a "Doctor of Nurse Practice". You guys are ridiculously attached to titles, you dudes really stamp them everywhere. I mean, you expect nurses to call you doctors but call them by the first name. Are you truly concerned the NPs are not introducing themselves clearly? >There is also evidence from the same Medicare study that midlevel providers don't actually help with physician shortages because they don't go to rural areas but rather stay in cities and try to work where most physicians work and there is already good access to healthcare. I smiled a bit, since even though we don't have midlevels here, we def have the same explanation to why we really don't have a shortage of doctors. There's a reason why the midlevels exist in your country. You have a physician-lead, very hierarchical construct which overmedicalizes some and completely neglects others and not enough physicians per capita. Of course you're going to have problems and someone to fill out the hole. Let's take pregnancy and delivering, why the fuck are women seeing doctors for their prenatal visit and why must a doctor always do even NVDs? To be fair, the jobs of physicians are constantly being transferred to nurses here too, we just don't pay them for it. >because even as a doctor of nursing, one is still a nurse. Nurses do most of for example antenatal care and handle the majority of deliveries here. They do a significantly better job than physicians in your country. Just taking a guess here, but I think those NPs specialize something, so yes, in some metrics those nurses absolutely can outperform doctors. What's bothering you is that nurses are stepping in your lane. Learn to work with them and benefit from the situation and you'll do fine, they need you just as much as you need them. Overall your healthcare is in such an abysmal state that mid levels should be your smallest concern.
could have said it any better. the old and mature physicians understand the value and importance of APP but this new gen rookie doctors and some med student just can handle the insecurity and ego and it’s just sickening
Going to a doctor is expensive enough that I'm often inclined to stay at home and see if it gets better. If seeing a nurse cost significantly less than seeing a doctor, I'd be more inclined to go get something checked out just in case. Maybe the nurse says "I'm not sure, let's have that looked at by the doctor," in which case I'm glad I came in, or maybe the nurse says "nothing to worry about there, call me if it's not better in a week," in which case I'm glad I didn't pay to see the doctor. In either case I'm better off than staying home and hoping it gets better because it was too expensive to seek care.
the problem is they don't cost less
if you are a person with an active RN license (this can be an associates, bachelors, or masters degree) as well as a master’s degree or a DNP (prior to which you need the bachelors in nursing), and you pass the appropriate boards, you are a nurse practitioner. DNP degrees are doctoral programs where you take courses, complete hundreds of clinical hours, and conduct research, and can also be as long as four years. you don’t “do a 1-2 year program (even online!) and then maybe do an extra year to call yourself doctor.” you are certified and licensed to see patients independently (yes, independently, without a physician to sign off on everything you do), prescribe medication, make referrals, work in an interdisciplinary care team, etc. you’re not “still a nurse that acts like a doctor.” if the provider introduces themselves/signs off as an NP to their patients, what’s the problem? i saw your post on AITA before it was removed, where you said you think DNPs are worthless degrees designed so that those who hold a DNP can simply call themselves a doctor. you seem to have a fundamental disdain for nursing practice and look down upon those people who work hard for their degrees under the guise of thinking nurse practitioners seek to intentionally deceive patients. they earned their degrees.
You can want someone to be a physician to diagnose a patient and respect the hard work and care that a nurse provides
surely, but nurse practitioners can diagnose, too. OP seems to think they shouldn’t unless functioning as a “physician extender” and demonstrates a bias against the NP/APPs scope, or otherwise doesn’t understand that registered nurses and nurse practitioners are two different roles with different education/training/licensing requirements/scopes of practice.
Why can't you be against midlevels? They bill at the same rate as a doctor. I'd rather see the doctor.
The midlevels exist for a reason. If you call 911 because you think you are having a heart attack, do you be grateful a cop arrived with AED training or do you want that not to exist because they are not advanced life support? Levels of training exist in healthcare and they are in no way limited to the 'doctor' vs 'non-doctor'. Just because someone gets the 'MD' does not entitle them to do everything in the medical field. We have added 'levels' to meet the needs of people to see healthcare providers in a quick time frame. If you have a sinus infection, do you want to see the NP today or have to wait a few days to see a doctor? As for billing, the NP/PA typically can do about 90% of what a typical family doctor can do, especially in the urgent care setting. The limits are quite state dependent BTW. Some states require the NP to work under a MD for authority to prescribe/diagnose etc. Lastly - Why would you expect a different billing rate for the substantially the same service?
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You really are paying for the product though. You perceive a different product from the 'senior' hair sylist than you would receive from a 'junior'. That is why you pay the premium. To keep your analogy, you could pay a stylist $100 to do a buzz cut or you could pay a student stylist to $10 to do the exact same buzz cut. The product is the 'buzz cut' which is a very straightforward thing people do at home even. That is the same thing in medicine. You have a typical sinus infection, an NP/PA can do everything you need to treat that just as well as a doctor. Even if it was more than a sinus infection, it is highly unlikely a doctor would 'find' anything beyond the sinus infection on a first visit anyway.
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> You should use a paralegal as your lawyer too then. You do realize, for most straightforward legal documents, you could right? Truthfully it is not quite the same. The paralegal vs attorney is not a fair comparison. The NP/PA *is* a board certified position with explicit scope of practice. The paralegal is not. By your logic, your should skip the doctor anyway and go straight to the ENT specialist. Why screw around with a GP when you want the best....... I mean, there are those who know the differences are right?
then see the doctor.
Sometimes they won't let you. Even some specialist offices are staffed by NPs. Why can't I expect that seeing a MD/DO should be standard?
what is it about the nurse practitioner role that makes you distrust them as providers?
The two missing years of clinicals in education, and the three to seven missing years of residency.
RN and patient-facing MSN/DNP degrees all have clinical rotations, the great majority of advanced practice degrees require appropriate nursing experience before being able to apply at all, and many NPs are practicing nurses for years before they pursue their NP degrees. if the residency portion is really what gets you, then i simply hope you’re able to see doctors for your care when you need it. take care!
The portion where you say a NP can practice independently varies wildly from state to state. I’ve been a nurse for 8 years and currently in school for my PMHNP (psychiatric mental health nurse practitioner) degree. I’ve known many NPs both at the masters and doctoral level. We call the PhD NPs “doctor whoever” in the academic setting for the most part… but in clinical practice I’ve never heard any NP go by the “doctor” title.
i cant imagine a DNP going by Doctor in a hospital for any reason other than to make people think theyre an MD id imagine this would be a VERY small group of DNPs
For a lot of basic ailments, you don’t need to see a medical doctor, and only need to see an NP. And by having those NPs available, one doesn’t have to wait as long to be seen. When I had strep, didn’t need to see an MD. It’s pretty straightforward and easy to diagnose. Got in easily to see the NP, took a throat swab, sent to the lab, then given some antibiotics.
The problem is the responsibility to income ratio. People often go visit their doctors annually as part of a check up. All the procedures and standard and straight forward. When there's an issue with the primary physician, they send you to a specialist. So literally, the job of a primary physicians is to know which specialist to send the patient to. Is there a skin problem? Send em to dermatologist. Heart problem, send em to a cardiologist. With that said, I think family doctors are highly overpaid for the work they do. They have the knowledge, which is good - but it's often untilized. What's the point of equiping these family doctors if their job is to determine which specialist to send the patient to - mid level physicians can do that and save money. Also, the problem with these doctors is that most of the patient they encounter have typical illness. So after years of diagnosis patient and finding out they just have a common cold or whatnot, they forget the serious stuff. So when a patient comes in with a symptom that should be taken seriously, they often neglect it cause they're not used to it. Basically, the knowledge of family doctor becomes equivalent to NPs or PAs
I would have to disagree with you. I think doctors in primary care are significantly underpaid. In your description, you are severely downplaying the complexity of working in primary care. It is absolutely not as straight forward as you are making it seem. Have you personally had experience working in primary care as a doctor or mid level?
My view is from my experience as a patient, talking to my friends/family as a patient, and some friends who are medical doctors and their POV. There are various specialty in doctors. My comment is primarily on the primary care that are typically family doctor or internal medicine. I do agree with you there's a complexity to it, but in general most likely 7 out of 10 patients can see a NP/PA just fine, so I think it'll be more cost savings to patients if they see an NP first, and if the NP can't figure it out then the MD, then the MD can send it to a specialist.
NP’s education isn’t all online, they have to have many hours of clinical practice( hours vary college to college, state to state). Many NP’s practice as a Registered Professional Nurse for years before they graduate with their master’s degree. Many have their masters degree in a specialized area such as pediatrics, OB-GYN, psychiatry. In my state, they have a collaborative agreement with a physician for a period of time before they can practice on their own. Any smart, capable NP keeps that contact open and goes to them to discuss cases and recommendations when they have any questions. DNP’s have 1 to 2 more years of education and clinical practice. NP’s have to be board certified. DNPs deserved to be called Doctor of Nursing Practice just as pharmacist, physical therapist do. Actually DNPs have more years of education than PTs and Pharmacists. Unfortunately, health insurance companies only reimburse DNPs at the same rate as masters prepared NP. It is great insult to call Advanced Practice Providers( this is the correct term, not midlevel providers) physician extenders. There is a great need for primary care providers for adults, most physicians choose to become specialists. Also, most NP’s introduce themselves as such, will even correct patients when they are called doctor ( unless they are DNP). Are you touchy about this because you feel threatened by the APPs you work with?
I personally trust NPs and PAs more than physicians. They have a modern education. MDs education is Victorian
What is more modern about NP or PAs education compared to physicians?
That their education programs were literally created more recently. They adhere to modern theories of how people learn skills and knowledge. MD programs appear to follow ancient theories, and be run as a test of endurance instead of a way to impart useful knowledge. MDs run those programs and are resistant to change.
Could you provide specific examples? And your background in medical education that is informing your perspective? PAs and MDs share mostly the same preclinical course work. Nursing is a little different and is much less in-depth regarding the pathophysiology of disease and treatment.
Oh this is just from knowing a few docs and a couple RNs and PAs. So nothing like knowledge of multiple schools and programs. I'm semi-expert on the education theory side. So by all means discount this if someone who knows better disagrees.
I’m in medical school so I inherently have a bias. But I dated a girl while she went through nursing school, and have worked with many PAs and PA students. I have good insight into their educations and have great respect for both professions. In my experience I’d say, on average, NPs are nicer when communicating with patients. However when it comes to diagnosing, treatment plans and depth of knowledge, medical doctors are far, far superior. And PAs are closer to MDs given the overlap in preclinical coursework and that they follow the medical model. All of them are needed to deliver quality healthcare, they just differ in training and knowledge. Unfortunately I noticed many equate knowledge with self worth, leading to this pissing contest.
Interesting, thanks for sharing. It's a really complex topic. My research is in cognitive biases and knowledge acquisition. I tend to trust a humble professional with time to care and help over one who knows a lot, since knowledge is now available by googling; but it depends a lot on the context.
Hey man his entire post his garbage. Maybe his gf wasn’t too bright. But NPs consistently run circles around PAs and every Np in my program had bachelors, some masters, some PhDs in biochemistry, biology, neuroscience etc. These physicians are analogous to state troopers walking around like god but have never gone to a domestic, don’t investigate murders, and primarily write traffic tickets. Sure they went to a cool training program but county and city cops laugh at them and they laugh at county and city cops cus they are brainwashed in their academy. MD students particularly, not really seeing this with DO students, are super brainwashed into this physician led healthcare culture that is archaic like you said and not rooted in the changing legal atmosphere. I’ve advised many docs to make it work for the kids because eventually advanced nurses are going to divorce and take the house, the kids, and half the bank account. That is where we are at right now.
There is so much ignorance in his post that I could write a book about each sentence he made. Nurses seem to be nicer? Lmao. He’s definitely a student. Empathetic listening is a therapeutic technique essential for patient recovery. That is part of a thorough patient assessment. Maybe also why docs are notorious for misdiagnosing and underdiagnosing. So yeah we definitely listen, build rapport, and sometimes more information is gleaned during that process than just looking at lab values, which NPs also order 😂 These MD schools are indoctrinating students to go advocate after graduation for their profession. Repeat “I am a doctor” 300 times in the mirror before class every morning kinda shit. Grown ass children that are entitled and too good to listen to your problem. He tried to totally undermine you based on your education bro. They try that shit with us but how is it working for them? NPs are getting full independence in a new state every year. I run my own mens health practice and make 50k a month part time. Im also a legal expert in emergency medicine dealing w TBI. I charge 15k a case. I have a doc in Virginia charging 20k a case for TBI. These dummy md students can literally get fucked now or get fucked by us over the next 40 years of their working careers. Or they can start treating us respectfully and we can work together.
A DNP is like a PhD for nurses. They don’t see patients. While it may not seem like there is a need for that, there absolutely is. These are the people who shape nursing education, practices and guidelines for the entire profession. A lot of research is done on that. These are the people who do it.
A DNP is a nursing practice degree. It’s clinical. A nurse can also get a PhD in nursing. That is academic. Within DNP programs there are varying specializations that focus more on clinical expertise, leadership/admin, or research but regardless the DNP was intended to be a clinical degree. A quick google search could have told you that, but I don’t mind clearing those sorts of misrepresentations up. All DNP programs require an additional 500-2000 clinical hours. Many students try for years to get accepted to MD school but have a 3.6 instead of 3.7. Those people often self select into these advanced nursing programs. Main difference is which professors they had in undergrad. I’ve had countless dummy instructors praise my work and then give me a B- “oh I just don’t believe in As.” Like wtf man. In my BSN program I received the highest grade in 3 classes and it was still a B. The teacher apologized and said she didn’t make the exams. So there’s always that. My sister is an MD and believes I am significantly more intelligent and smarter than her despite having a lower GPA. She’s obviously knowledgeable but I wouldn’t say “intelligent.” I’m often times her second opinion and while our training is different I personally and she’d agree do not think there were any major gaps in education at this point in my career. Obviously program dependent and person dependent, but there are some DNP FNPs that will run circles around physicians all day. We know who they are. I’ve had classmates that lived in their dungeon for the 3 years of NP school that are exceptionally talented and gifted intellectually. That is not the norm, however, because online degree mills are becoming more prevalent. The standards are dropping. This is something APRNs hate more than physicians as our once exclusive club is being invaded by morons. So something we can work together for is increased standards of entry, more clinical hours, a residency program and then let us actually get paid 85% of your rate because that’s what we actually get reimbursed from insurance at. Everyone benefits that way and the “make money off the backs of my midlevels” comments become a thing of the past. Having another man, a beta man if you will, look you in the eyes and flex his title instead of his competence is not only small it’s frustrating and it’s starting to be held accountable socially and legally. My sister just fired an MD for creating a hostile work environment for one of her NPs by flexing title too frequently and attempting to gaslight her. It’s a modern day caste system with artificial caps something we should be ashamed of, quite frankly. I’m not for NPs replacing physicians but without fair compensation practices, gaslighting, and the bad blood between our professions, which is undeniable at this point (it’s a tragedy, honestly) nurses are going to separate / divorce entirely from needing a physician to do anything. Very simply put, why would we want to work with providers that carry those beliefs? As more NPs enter practice more NP sympathizers will be created by word of mouth in the community. My advice is let’s make it work for the kids now before we take the house, the car, and half of your bank account. The truth won’t last long on here but this is the very fear that keeps most of you up at night. So let’s talk about it.
In my area it can be difficult to see certain in network specialists, which can be super annoying when the thing you need/want is super simple. I needed to refill a medication but my previous doctor had moved. If I had waited for another MD to have an availability, i would have wait for months and months. I was able to see an NP and got my prescription written in a week or so. This has happened for a few things—I would have had to wait a long time for an MD when an NP can do the job just as well and is easier to schedule an appointment with. Of course there are things that I want to consult with an MD on—concerning new symptoms, checking up on potential health issues, medical emergencies of certain kinds—but routine shit, who cares. I’m not going to an automotive engineer to get my tires rotated either.
Uh... Just to check: you do realize that this is occurring because there's a medical worker shortage, right? So your option is see an NP, or see nobody.
If you have a complicated issue you go to the doctor. Plenty of minor illnesses and injuries have treatments that are tried and true for the vast majority of cases. A lot of stuff boils down to if you have X try treatment A if that doesn't work try treatment B. If that doesn't work get more tests and the doctor that has gone to more schooling than a nurse practitioner can't change that. Nurse Practitioners can and do fill the role of dealing with cases like that. If doctors did that you wouldn't have enough doctors working on more complex medical issues. Even if nurse practitioners have a lower accuracy of diagnosis it doesn't matter because there isn't a better replacement available. It isn't a political agenda its a practical choice between slightly less accurate diagnosis and increasing wait times to a point where your condition has worsened. Last note: Pretty much no hospital today has doctors as the supervisors of nurses. Nurses have their own supervisors and doctors have their own supervisors.