Thursday, August 27, 2009

Turf War Smackdown: The AMA and MDs vs. DNPs

CHICAGO TRIBUNE -- The University of Michigan-Flint is launching an online doctoral program in nursing this fall. The university says the nurse practitioners it trains will be able to assess and manage medical and nursing problems in a variety of specialties and settings. It says the new degree program is a response to a looming shortage of nurses and doctors. The four-year Doctor of Nursing Practice (DNP) program is aimed at skills needed for advanced nursing practice in primary health care.

And what does the AMA think about the DNP alternative to a "looming shortage of nurses and doctors?"

Delegates at the recent annual meeting of the AMA left little room for doubt when it came to their views on the appropriate role of nurses in patients' medical care. Although nurses -- including those with a terminal degree in nursing -- are welcomed as part of the medical team, physicians still need to take the lead.

Despite strongly worded opposition from national nursing organization representatives who attended the meeting, the delegates adopted a resolution that called for new AMA policy stipulating that doctors of nursing practice, or DNPs, "must practice as part of a medical team under the supervision of a licensed physician who has final authority and responsibility for the patient." The delegates further directed the AMA to oppose a recent move by the National Board of Medical Examiners, or NBME, which earlier this spring announced it would develop and administer a certification exam for graduates of DNP programs.

Originally posted at Carpe Diem.


At 8/27/2009 11:06 AM, Blogger Peter said...

An online doctoral program for registered nurses, and an end result being equivalence with a physician who has 4 years of pre-medical education, 4 years of medical school, and 3-7 years of residency training and possibly an additional 1-3 years of fellowship training?

Who would want to be a patient of someone who did their medical education online along with 10% the number of clinical hours as a residency/fellowship-trained physician?

I am not degrading the education and value of nurses in healthcare. The solution to a shortage of doctors is an increase in the number of doctors with residency training, and the first place to start is for the government (through Medicare) to increase the number of residency slots for MDs. Nurses should be nurses, and physicians should be physicians, both with their respective critical duties.

At 8/27/2009 12:14 PM, Blogger LoneSnark said...

I don't need "4 years of pre-medical education, 4 years of medical school, and 3-7 years of residency training and possibly an additional 1-3 years of fellowship training" to diagnose a sprained ankle. The healthcare system needs to have tiered service just like every other industry: the underlings which handle 90% of interactions with the public, and the over-educated to handle those rare House M.D. cases where the antibiotics didn't work and the ankle got infected.

At 8/27/2009 2:19 PM, Blogger Peter said...


The scope of a physician's practice is immense and covers the entire spectrum of human disease. If you do not learn everything about the human body, how can you expect to know what is a true sprained ankle and what could be a more serious issue? What if the problematic ankle is a manifestation of some other disease pathology?

At 8/27/2009 2:53 PM, Blogger The Happy Hospitalist said...

Perhaps the solution to exploding education costs are teachers aids who hold community college degrees. Spend 90% of the time teaching students from a text book. Bring in the professor 10% of the time for the difficult concepts.

I'm sure, I as a physician could certainly teach economics to a bunch of undergrads who would only not care since their tutition was cheaper. The value of their education. Well of course it's the same. We all learn from the same books.

Perhaps we should also bring in the paralegal as your legal counsel for your tax evasion. They can read the same books as a barded lawyer. Have the paralegal spend 90% of the time with the defendant (or plaintiff for that matter) and only bring in the big dogs for the really hard questions at hand.

I am in internist trained hospitalist. I spent fours year, after undergraduate work in medical school and over 12,000 hours over 3 years of intense supervised training to be able to do what I do.

The assumption that an NP can be "equal" and there for practice independently with in a scope undifferentiated from mine is like getting a paralegal or a teachers aid to do 90% of your easy stuff.

And by the way, you don't need an NP or and MD to diagnose a sprain.

There is a lot of stuff you don't need any health care contact to manage. Paying an NP to care for the "easy" stuff is like paying a lawyer to fill out your taxes on turbo tax. You're wasting your money either way.

At 8/27/2009 6:54 PM, Anonymous Dr. T said...

Please remember that fewer than one-fourth of practicing physicians belong to the AMA. Many of us favor increased patient use of "physician extenders": physician assistants and nurse practitioners. I've encountered both good and bad PAs and NPs, but I also can say the same about MDs.

I do agree with Peter's critique of the new program. Clinical medicine needs more than online training. These programs should heavily emphasize hands-on experience with patients in clinic and office settings. There also should be some time for hospital rotations so the students can see more serious diseases. ("This is what happens if you miss an early infection" type of lessons.) The described four-year program for an unheard of degree seems fishy. UM-Flint will rake in big bucks for little work, and will end up with a disaster if a qualifying exam is developed and most students fail.

Disclaimer: In a previous job, I taught pathology and pathophysiology to physician assistant students, some of whom were better than the medical students I taught.

At 8/27/2009 9:19 PM, Blogger save_the_rustbelt said...

I work with a lot of terrific FNPs (RN,MS usually), and there is no way in hell anyone can earn a clinical degree on-line.

Same for PAs.

And why would a FNP need a doctoral degree?

(Lonesnark - you are truly clueless)

At 8/27/2009 10:11 PM, Blogger QT said...


Save the insults. One need not be disagreeable to disagree.


Most medical problems (nor as ornate as episodes of House) are not as simple as a sprain and most of us have the common sense to just buy a tensor bandage from the drugstore rather than wasting 2-4 hrs. in Emergency or 1 hr to go to a walk-in clinic.

A DNP has a very limited ability to prescribe medication. Nurses certainly have a very important role but they cannot replace a physician.

The same is true of psychologists. They can provide theraputic counselling but they cannot prescribe anti-depressant medication. Patients have to make an appointment with their family doctor or a psychiatrist to obtain anti-depressants, etc.

At 11/14/2009 12:01 AM, Anonymous Anonymous said...

In my view NP'S can do a much better job than some of the MD's. I would choose a NP as my primary care provider over a MD without any question. NP's have a very strong clinical and educational background. I know my NP has a undergraduate degree in nursing and Biochemistry with distinctions, master's degree in nursing, post master's NP certification (as FNP and ACNP), and doctorate in nursing. She has 15 years of solid critical care/CVICU experience prior to NP program, thousands of clinical hours of critical thinking and hand on care. How can you compare this to a MD who is totally new to the medical field. I was a patient of a third year medical resident who always consulted his fellow NP before making a clinical decision. I highly regard NP profession. Health care system will crash without NPs support, NPs' contribution to the medical field is priceless.

At 12/05/2009 1:46 AM, Anonymous Anonymous said...

I can only speak from my experience so here's my 2 cents. I'm an internal medicine physician with 9 years’ post residency under my belt. I work for a fairly large multispecialty group. In my clinic alone we have 3 NP's. Now, I've seen some pretty dumb things that NP's have done. Once, when my partner was out on vacation his practice was being "managed" by "his" NP. One NP kept a guy with declining renal function (CR 5) on his ACE. I just happened to be on call one night when his labs came back and I reviewed the case. I admitted the patient stopped his ACEi and worked him up for ARF.

Another one of our NP's has serious mental health issues and had a psychotic break requiring a 6week hospitalization. I happen to know that she was seeing patients just before she was hospitalized. I had one patient tell me when he saw her a few days before her she was admitted she sat on her stool shaking her head looking at his chart. She said to this patient that his heart was very bad and not much could be done for him. This was not at all the case. The poor guy was scared to death for a couple of weeks before his appointment with me.

Our third NP is perhaps the most dangerous of the bunch. She has a HUGE chip on her shoulder and thinks everyone at the clinic including the MD's are stupid. She "steals" patients, bad mouths other providers to the patients and in general undermines the cohesiveness of the clinic.

Based on my 9 years experience I am not at all impressed with NP's.

I feel we as a medical community has opened Pandora's Box by letting non physicians practice medicine as if they were M.D.'s. It's a slippery slope to say the least.

At 1/01/2010 8:36 PM, Anonymous Anonymous said...

I am a Advanced Practice Nurse Practitioner completing a DNP. I am fortunate to be part of a program that is the first Nationally Accredited DNP program, a damn good program. I, however; do not agree with any online clinical degree. I would not be comfortable with any colleague that obtained a degree onine. Lastly, I am fortunatel enough to work in one of the top ten Children's Hospitals in the Nation, with world renowned physicians that consult me, and some tell me that I am better than some of their colleagues. You do the Math.


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