Thursday, April 10, 2008

Say Hello to "Dr. Nurse"

This seems to have made a small furry at my school. It makes for a lively discussion! You should read the article first.

Mr. A wrote:
If any of you haven't seen or heard about this, you should give it look. Anyone know what the AMA's position is on this? http://online.wsj.com/article/SB120710036831882059.html?mod=todays_us_personal_journal

Mr. B replied:
Doesn't really matter what the AMA's position is. They (the AMA) have been letting physician autonomy slip for year's now. They're more concerned with universalization of healthcare than preserving the scope of physician practice. I'm not sure what year you are in your studies, but welcome to the real world...the more you learn the "better" it gets. Doctor of Physical TherapyDoctor of PharmacyDoctor of Nurse PractioningDoctor DoolittleDoctor Octopusetc. The title is becoming watered down. Just wait till you get your first patient telling you that a Nurse practitioner is the same as a Doctor:D Getting angry and arguing will only make you look bitter.You're (short) white coat will no longer garner respect, you'll have to earn it...All this from a person who still really really wants to be a "doctor."Good luck!

Mr. C says:
I love how this guy asks, "Does anyone know what the AMA's position is on this?" It is basically just the facts of where things are going. Third party payers basically think that doctors are too expensive for primary care. I.e. they don't feel like all this training is necessary to do basic primary care. So primary care doctors have been getting paid less and less, and so less med students go into primary care fields. This creates a void in primary care. Someone has to fill that void. So nurses say that they are willing to do the job for less. Patients are happy because they are able to be seen by someone that can right them a prescription and third party payers are happy because they can spend less on their customers' primary care needs. This really isn't rocket science. The problem is that everyone else views medicine as a business and as physicians we try to view it differently. I'm not saying I think this is a good way for it to be or how it should be or that it will even continue to be this way, but right now, that is the fact of the matter and the way it is right now. Too bad for me that I actually like primary care...

Mr. B wrote again:
You are absolutely right. I think you should fwd this as a reply (to temper my "tough love" response). I was actually speaking to a NP about this earlier today. We agreed that there will probably always be a way to carve out a niche as a M.D. in primary care...however, it will not be in the traditional role. The economics will force MDs into more of an administrative role and the actual routine delivery of patient care will be handed down to midlevels (RNs, NPs, DNPs, etc.). I believe there will continue to be primary care docs that maintain/build successful (primary care) practices, however, the difference will be that these individuals evolve with the economics of healtcare and posses as much business savvy as they do clinical acumen. The health care model is shifting to a "team approach." For a long time physicians monopolized patient care (and reimbursement), for better or worse. Instead of being the "star quarterback" on the high school football team, we're now more akin to the "team captain" on the intramural volleyball team.If I was going to give advice to someone in undergrad wanting to become a primary care doc I would suggest they take a long hard look at the Doctor of Nursing Practice program, with special consideration of the DEBT BURDEN upon graduation ($130,000 vs. $30,000). Would you pay 30 grand for an education in a field that pays 35 grand? Now multiply by 4, and we're roughly in the same ball park as physician salaries.Maybe the curiculum should emphasize this "real world" information at least as much as, for example, the pathways of purine degradation....Because I care,The "New"moccocal Warrior.

Mr. D can't leave things alone and writes:
Why do people get so hung up on the word “doctor”? It’s not as if physicians own this title. As a matter of fact, doctoral degrees pre-date the specific profession of medical doctors by years and years; doctors of medicine started out as a specialized sub-set of these degree holders. The simple truth is that if someone does the graduate level work required to achieve a doctoral degree, they are entitled to said degree, whether they be a doctor of medicine, a doctor of philosophy, J.D, PharmD., etc… Bickering about whether or not people are entitled to be called doctor only makes us appear bitter & resentful.The real issue at hand is far bigger and more important. The positions these nurse-doctors will be filling are vacant in the first place for valid reasons. Why are there so few primary care physicians? Reimbursement for services rendered is most assuredly a factor. Why does it seem that insurance companies own our profession these days? Could it be that our government basically GIVES them this power? Considering how few people know or care anything about who is elected into office or what they do while in their elected positions, that’s not a surprising outcome.The other issue involved concerns the AMA. If, in a healthcare setting, it is deemed to be confusing to patients for so many people of various backgrounds to be called doctor, why is the AMA not fighting to limit the use of that title in healthcare settings to M.D.s only? Is the AMA not in existence to serve the medical profession? Who is elected to run the organization? Do we as (future) physicians pay enough attention to and demand enough service and representation from the AMA? Are we involved enough and actively informed enough to hold the AMA to the line so that the needs of physicians, and thereby their patients, are met? Or do we just pay dues each year and assume that “someone’s going to take care of things”?Ultimately, these are multi-faceted problems that require a lot of time and effort to tackle. They aren’t impossible to deal with, but doing so will be far from easy. Right now, our (future) patients face having to either potentially accept a lower standard of care from healthcare workers with the same title (doctor) as M.D.s but far less training, or sort through all the plaques and certificates on a wall to see exactly what kind of degree this “doctor” has before being treated. But that being said, when someone’s baby has cancer, or when someone’s dad has parkinson’s disease, do you really think they will be sitting at home thinking, “I need to find a good nurse for my child/father.” I doubt it. I think they will come searching for us. What will continue to separate M.D.s from all the other healthcare professionals is the level of care that only we can provide based on the depth and breadth of our education. Maintaining our position in the hearts and minds of our patients (the people we are here to serve and whose desire for our care keeps us in business) only requires that we perform at that superior level to which we, and only we, are capable of performing. I’m afraid, however, that maintaining our position in the healthcare society is going to require a great deal more effort on our part.

Mr. A didn't realize he caused such a stir and says:
Whoa guys and gals. Just wanted to give you all some info I ran across on SDN. My question about the AMA was not a rhetorical one, or meant to provoke. I just simply wondered if anyone knew if the AMA had a position on this, and if so what it is. I don"t have an opinion one way or another yet. Was simply asking for more info. Maybe it's a good thing, maybe not. We should be concerned enough to be involved though, as stated earlier.No need to bash each other when we are all part of the same team. Relax.....you just may live happier and longer.

Mr. D didn't get to have the last word so:
No bashing at all! Just healthy, career oriented conversation/debate. :) :)

Finally, Mr. E sums up how we all feel:
I'm running out of room in my inbox for this conversation about Dr. Nurse.

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