Nurse Doctors to be paid same as traditional doctors...

[Laker]

http://www.msnbc.msn.com/id/36472308...h-health_care/

"CHICAGO - A nurse may soon be your doctor.

With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called "Doctor.""

Thoughts?

[Cumberland]

If insurance starts reimbursing NPs at the same rate as MDs, why should they make less? If they earned a doctorate, why shouldnt they be called Dr?

[MarissaNicole]

My first thought was why even go to medical school if you can go to school to become a NP in less time... but then I noticed that the article said that the NP went to 4 years undergrad, 3 years grad and 3 years residency which is just one year less than an MD. Wow, I had no idea that NP's go through just as much school!

We definitely have a need for more primary care providers.

[SuzySunshine]

Not all NP's go through that much school. Just like most degrees there are levels. My sister got her BSN and then her Masters to become an NP. I'm not sure what she would have to do to get a doctorate, its an interesting question that I will have to ask her.

My question wouldn't be the amount of training it would be the roundness of the training, are they getting the complete array of exposure that MD's get in med school before they specialize? There are some things I don't mind seeing a nurse or NP for but there are definitely some things that I'd much rather see a doctor for.

I don't really see this affecting specialties like neurosurgery but I could see how it would take some work away from and some pressure off of family practice docs.

[Laker]

actually the article said she did 4 years undergrad then 3 years of additional schooling...7 years vs. 11 of the medicine doc/family/peds doc.

[DCJenn]

I think we're ultimately moving to the point where general medicine will be done by NPs and PAs and specialty medicine will be done by MDs. Whether that's good or not, I don't know. I have had one general practioner MD in 10 years (of my socialist military medicine). She's great, I love her, I hope she stays here. BUT, does she to anything more or more special than my previous 9 years of NP care. Nope.

For my infertility examinations- ordered by a doc, conducted by nurses and NPs. My messed up knee after my marathon? Tx Ordered by the PA. My physical therapy issue? Ordered by the NP, and conducted by the PT. My uterine ablation- ordered by the doc, completed by the ob/gyn resident. (the anesthesiologist was a resident as well.)

Is this bad? I don't know.

Jenn

[SoonerTexan]

he AMA argues the title "Dr." creates confusion. Nurse practitioners say patients aren't confused by veterinarians calling themselves "Dr." Or chiropractors. Or dentists. So why, they ask, would patients be confused by a nurse using the title?

It may not be a bad thing, but I don't agree with the quote above. That IS confusing.

Maybe I should talk DF into becoming an NP while there's still time...

[peggyfromwastate]

On their white coat, it should say PhD not MD so the Doctor title is not a huge deal. I don't really care about if they call themselves doctor as long as they've actually earned a doctorate. Pretty much all the pharmacists have doctorates- doctor of Pharmacy. I dont' know if they are called *Doctor* by patients, but I think everyone gets the drift. Savvy patients who are concerned ask their doctor where they went to medical school. Some patients refuse to be treated by non-MD providers, and that's OK- they just have to wait a long time.

I think the good thing about this (for the MDs of the word-- not necessarily for the patients or for the malpractice lawyers) is that it appears the doctors (MDs) wouldn't be responsible for the decisions the NPs do. Not sure if they'd have to review the NPs charts so much, but it seems like it adds authority to the NP to make medical decision, and possibly the NPs malpractice would have to be the end of the road for lawsuits.

FWIW, my dad employs mostly NPs and a couple of PAs in his 3 clinics and they generally do a great job. He has more trouble with his 2 MD *employees* b/c of the ego issue. I think you would consider my dad's field primary care-- (worker injuries, workers comp stuff).

I have had excellent care from NPs and PAs. I don't see a huge problem with this in primary care. THere is going to be a HUGE shortage in primary care. Just astronomical.

I'm not sure if this adds an additional layer of wait time if you need specialty care or if the NP will be allowed to refer you. I bet the NP would have to refer you to the MD who then would have to duke it out with insurance/government to let you see the specialist. That would be a pain for the patients.

[MarissaNicole]

actually the article said she did 4 years undergrad then 3 years of additional schooling...7 years vs. 11 of the medicine doc/family/peds doc.

You're right, hmmmm.... I could have sworn it said that she did 4,3, and then 3 years of a nursing residency. They either edited/updated the article or I was seeing things!

[Thirteen]

DH, as a PCP, has suggested a pay raise for PCPs. If there isn't any incentive, who would want to go into primary care, knowing you'll have med school and training debt (and that someone else could do the job)?

The shortage for PCPs will continue.

[peggyfromwastate]

My dad's NPs make more than a starting PCP in our hometown-- he starts them at around 70K with bonus incentives available for productivity. One of his NPs makes over 100K. I would agree there is no financial incentive to go into PCP as an MD.

[Thirteen]

This is DH's biggest regret. He thinks/feels responsible for med school debt that will be "difficult" to pay back. Additionally, I think the prestige (or ego) associated with being a doctor, for him and possibly other PCPs, is now tarnished. He feels and acts betrayed. It's sad.
I told him that once I'm finished with school, he can "retire at 40 and be my house husband."
Law school, here I come.