Article exploring the idea that full autonomy for NPs may not be a good idea.

[corpsman89]

Its not everyday I come across an anti-full-autonomy-NP article, so I figured I would post this.

I do get a little frustrated seeing constant Facebook ads for more and more completely online DNP/NP programs that do not require experience. It is a bit scary knowing the nation seems to be moving in this direction.

I really wish the AAPA would put more effort into an advertising campaign highlighting PAs strengths. Things like, rigorousness of education,  quality of education, standardized education, medical model, collaboration with physicians, and while we have it, re-examination ever 10years. They could get ads out through Facebook, the radio, and even TV and we could see a turning of opinion in the public.

Seems that PAs may be moving in the best direction with OTP. Kinda the best of both worlds? More autonomy, full responsibility, and better patient care with collaborating physicians.

Now if we could just get that name changed.

http://www.houstonpress.com/news/nurse-practitioners-in-texas-want-to-work-without-doctor-supervision-9569688

[DizzyJ]

Interesting read.  I sent the author a little email to correct her apostrophe S and clarify PAs don't require on-site supervision.  Also, my disagreement about the NP introducing herself as doctor so-an-so, without clarification she was an NP.

[camoman1234]

I emailed the author as well.

[GetMeOuttaThisMess]

Similar story advocating IP in Dallas News a couple months back. Agenda being pushed in Texas apparently.

[camoman1234]

This is the email I received from the author today:

 

Thank you for reading and for reaching out in such a nice manner about your concerns. I knew I had to differentiate between PAs and NPs and from all of my research I found that I could have written a thousand words with ease delineating the differences. However, from what I understand in Texas this was the one clear cut difference in how the regulations in Texas work. I know it's more complicated and that the rules change depending on where you are practicing but I opted to keep it down to this one differentiation in Texas since that was the easiest way to simply and quickly explain that PAs were not the same as NPs and move on quickly. I debated how to refer to PAs and decided to use the "s" since that seems to be the most common usage. However, you have an excellent point and going forward I will not use the s since it does imply ownership. 

 

Again, thank you for reading and for the kind words and I hope you have a lovely Monday!

 

Sincerely, 

-Dianna Wray

[MedicinePower]

"Nurse practitioners, unlike physician’s assistants, are allowed to treat patients without a doctor’s on-site supervision."

 

I posted a comment with corrections for the name and on-site statements but it may be helpful for others to do the same.

[Houstonian]

Livy (or her mother) apparently made an appointment with someone she thought was a neurologist...but was not.  Either she did not know that the "doctor" was a nurse practitioner or she did in fact have an appointment with a neurologist...who then did not see the patient, preferring to delegate that task to the NP without the permission of the patient or her daughter.  Either way, it sounds like deceptive manipulation was used at some point.  I would say if that was the case, then a complaint to the Texas Medical Board would be justified.  Could be the fault of the office appointment scheduler, but still needs to be dealt with.  Perhaps the neurologist's schedule was already full, so he told the appointment scheduler to have the NP see the patient.  Scheduler says,  "Dr. A can't see you tomorrow, but would like you to see Dr. B" instead of saying more appropriately "Dr. A can't see you tomorrow, but would like you to come in and see his nurse practitioner".  

 

[DizzyJ]

11 hours ago, Houstonian said:

Livy (or her mother) apparently made an appointment with someone she thought was a neurologist...but was not.  Either she did not know that the "doctor" was a nurse practitioner or she did in fact have an appointment with a neurologist...who then did not see the patient, preferring to delegate that task to the NP without the permission of the patient or her daughter.  Either way, it sounds like deceptive manipulation was used at some point.  I would say if that was the case, then a complaint to the Texas Medical Board would be justified.  Could be the fault of the office appointment scheduler, but still needs to be dealt with.  Perhaps the neurologist's schedule was already full, so he told the appointment scheduler to have the NP see the patient.  Scheduler says,  "Dr. A can't see you tomorrow, but would like you to see Dr. B" instead of saying more appropriately "Dr. A can't see you tomorrow, but would like you to come in and see his nurse practitioner".  

 

Or perhaps...family was instructed on the phone who their appointment was with and they weren't listening.  An important key would be exactly how the office states the credentials of the NP when scheduling.  I worked private practice and am certain staff always told patients they were seeing PA DizzyJon when scheduling appointments.  Yet, I'd have a patient every couple months saying "Oh, I thought I was seeing the doctor".

[popopopop]

I made the mistake of reading the comments, which were unanimously negative.

[jb5158]

4 hours ago, dizzyjon said:

Or perhaps...family was instructed on the phone who their appointment was with and they weren't listening.  An important key would be exactly how the office states the credentials of the NP when scheduling.  I worked private practice and am certain staff always told patients they were seeing PA DizzyJon when scheduling appointments.  Yet, I'd have a patient every couple months saying "Oh, I thought I was seeing the doctor".

More likely this. I'm a PA in a neurology office and I hear the front desk referring to me as the physician assistant so I know it is said clearly. I also know if someone asks what that is, they explain it (not in the best way always, but they differentiate me from the doctor). I have a completely different schedule than my SP, so the appointment is with ME specifically. When I walk into the room and introduce myself, I introduce myself as "J----, the PA in the office."  Yet despite all of this, we still have patients who will call me doctor or say they thought they were seeing the doctor. I really think people just don't listen.

 It's way worse if it's an NP with a doctorate that refers to themselves as Dr. so and so. That's just misleading. I worked with great NPs, but if I'm seeing a health care provider, I want to know their credentials and not feel intentionally misled. 

[sas5814]

The Texas Medical Society is rabidly anti anyone-who-isn't-a-physician. and it is their agenda that is being pushed. We also have several physicians in the legislature who carry TMAs water. For as many years as I can remember one of the pillars of their legislative agenda has been to stop the expansion of privileges by any non physician. Doesn't matter if it is NP, PA, psychology, PT you name it. They aren't interested in health care or patients just in maintaining their complete control over the turf, power, and money.

[Kaepora]

I hate to be the dissenter in this thread (besides sas5814) but come on.  All of the negative anecdotes were from anonymous sources.  No factual data was presented.  I fully admit that there are quite a few terrible, god awful NP programs out there.  So why, then, only tell unprovable stories?

Articles like this were paid for by the state medical society.  No question about it.  Why in the world would that make PAs so happy?  Like it or not, by the general public, you are lumped in with NPs.  Any negative press about NPs is negative press for PAs.  It's a physician vs "other" debate here, not a PA and MD vs NP issue.

Texas is a difficult state for both PAs and NPs.  Celebrating a trash article is only supporting the notion that MDs>>>>>>>>>>>PA/NP.  It's absolutely about money and control.

Also, even as an RN, I introduce myself to the patient and say, "good morning Mr. so-and-so, my name is ACNPstudent, one of the nurses in the department, and I'm going to get you ready for your procedure today." And they smile and nod their head or say "ok" and after I've prepped them the physician walks over to consent and they say, "But I thought he was my doctor??"

[DizzyJ]

14 hours ago, ACNPstudent said:

I hate to be the dissenter in this thread (besides sas5814) but come on.  All of the negative anecdotes were from anonymous sources.  No factual data was presented.  I fully admit that there are quite a few terrible, god awful NP programs out there.  So why, then, only tell unprovable stories?

Articles like this were paid for by the state medical society.  No question about it.  Why in the world would that make PAs so happy?  Like it or not, by the general public, you are lumped in with NPs.  Any negative press about NPs is negative press for PAs.  It's a physician vs "other" debate here, not a PA and MD vs NP issue.

Texas is a difficult state for both PAs and NPs.  Celebrating a trash article is only supporting the notion that MDs>>>>>>>>>>>PA/NP.  It's absolutely about money and control.

Also, even as an RN, I introduce myself to the patient and say, "good morning Mr. so-and-so, my name is ACNPstudent, one of the nurses in the department, and I'm going to get you ready for your procedure today." And they smile and nod their head or say "ok" and after I've prepped them the physician walks over to consent and they say, "But I thought he was my doctor??"

I don't think anyone is "celebrating" this article.  I agree that this could have a negative reflection on both NP and PA profession as we do have an association.  And as I stated, I think it is very possible that the family member/patient was instructed they were seeing an NP, but had selective hearing.  Based on discussions I've read about DNP NPs, I don't think it is actually the norm that DNPs are introducing themselves as doctor in the clinical setting. 

[mgriffiths]

3 hours ago, dizzyjon said:

I don't think it is actually the norm that DNPs are introducing themselves as doctor in the clinical setting. 

In my experience this is not true - not questioning yours, just stating mine.  I have yet to meet a DNP that did not introduce him or herself as Dr. John/Jane Doe.  Actually had a coworker fired for this just recently because she was told to stop introducing herself this way and she refused and ignored the directive - there was more to it as well.  Again, not saying that all NPs are bad, good, indifferent, just my experience with titles.

[EMEDPA]

There are both PAs and NPs with a doctorate who inappropriately introduce themselves in a clinical setting as Dr Jane doe and leave it at that.

not a fan of the concept and don't do it myself.

I have

Emedpa, PA, DHSc

Emergency Medicine PA

on my IDs. if anyone asks about the DHSc I explain it is an academic doctoral degree in health science specializing in global health. I don't use assistant on anything.

 

[GetMeOuttaThisMess]

This is how Texas has/continues to get around this dilemma; you are still required to have a name badge specifying name and "physician assistant" below.

[Reality Check 2]

Where I am - almost every NP who has a DNP is introducing themselves as "doctor X" - some get so confusing and say "doctor X nurse practitioner". A few MD/DOs I know have countered them publicly stating it is not appropriate. Some of the DNPs are pretty militant in refusing to use their proper clinical title. 

I find it very misleading.

I have also worked with PAs who have PhDs in whatever and try to be called Dr in the clinic. I don't let the patients be fooled - "He is a PA just like me. He got a doctorate in something. It doesn't make him a doctor in this medical clinic". One guy is super snotty about it. Had to go to admin to get him to quit calling himself Doctor.

I think this behavior alienates us further from the docs we are supposed to work WITH. Especially when the doctorate obtained really has nothing to do with clinical skills in a lot of cases and doesn't change one's bill coding. Patients need clarification and understanding. 

Where I am - I don't see horribly successful NP only offices and they certainly don't garner much respect from others in the community when they are stand offish and not real communicative. Particularly Psych NPs right now.

No good solutions here except that I still support that PAs with XX number of years experience in the primary care fields and EM should be given the opportunity to practice without a doc as the SP but rather a collaboration. I still wouldn't call myself Doc or let patients think that. 

As per Popeye - I am what I am

 

[sas5814]

2 hours ago, EMEDPA said:

There are both PAs and NPs with a doctorate who inappropriately introduce themselves in a clinical setting as Dr Jane doe and leave it at that.

not a fan of the concept and don't do it myself.

I have

Emedpa, PA, DHSc

Emergency Medicine PA

on my IDs. if anyone asks about the DHSc I explain it is an academic doctoral degree in health science specializing in global health. I don't use assistant on anything.

 

I have been asked by potential employers if I refer to myself as Dr when at work and I say "never. It just creates unnecessary confusion." This has always been asked because they have had issues with the NPs and the use of the title.

[DizzyJ]

18 hours ago, EMEDPA said:

There are both PAs and NPs with a doctorate who inappropriately introduce themselves in a clinical setting as Dr Jane doe and leave it at that.

not a fan of the concept and don't do it myself.

I have

Emedpa, PA, DHSc

Emergency Medicine PA

on my IDs. if anyone asks about the DHSc I explain it is an academic doctoral degree in health science specializing in global health. I don't use assistant on anything.

 

Same here.  I have the DHSc on my ID and scrubs, but don't bring it up unless someone asks. 

[DizzyJ]

On ‎7‎/‎13‎/‎2017 at 10:42 AM, mgriffiths said:

In my experience this is not true - not questioning yours, just stating mine.  I have yet to meet a DNP that did not introduce him or herself as Dr. John/Jane Doe.  Actually had a coworker fired for this just recently because she was told to stop introducing herself this way and she refused and ignored the directive - there was more to it as well.  Again, not saying that all NPs are bad, good, indifferent, just my experience with titles.

Now I kind of want to purposely book an appointment with a DNP and see what they say.  I don't personally know any DNPs and haven't worked with any.  As a PA student I did an ER rotation with an RN who had one of the first doctorates for nurses and it was an ND (nursing doctorate).  They had to change the degree title because the "ND" was already in use by naturopathic doctors.  He still kept "ND" on his lab coat/ID badge.  He introduced himself as Dr Doe to patients without any modifier that he was an NP.  Well...I would evaluate patients prior to him and he would over hear me saying that John, the nurse practitioner would be in shortly.  He asked me why I kept referring to him by first name and NP and that he is a doctor.  I took a risk being a student and shut him down stating it was not appropriate in the clinical setting to call himself doctor and not stating his NP title to patients. 

[runforhotdogs]

9 hours ago, dizzyjon said:

Now I kind of want to purposely book an appointment with a DNP and see what they say.  I don't personally know any DNPs and haven't worked with any.  As a PA student I did an ER rotation with an RN who had one of the first doctorates for nurses and it was an ND (nursing doctorate).  They had to change the degree title because the "ND" was already in use by naturopathic doctors.  He still kept "ND" on his lab coat/ID badge.  He introduced himself as Dr Doe to patients without any modifier that he was an NP.  Well...I would evaluate patients prior to him and he would over hear me saying that John, the nurse practitioner would be in shortly.  He asked me why I kept referring to him by first name and NP and that he is a doctor.  I took a risk being a student and shut him down stating it was not appropriate in the clinical setting to call himself doctor and not stating his NP title to patients. 

No offense to you but seriously that statement just sounds childish. To even entertain making an appointment to see what someone calls themselves is absurd. How much does coat initial inspectors make exactly? Keep this in mind, when was the last time you called your pharmacist or lawyer friend, doctor? They have a PharmD and a JD. If they practice within their boundaries, is it anything more than an ego boost? It wasn't that long ago when DOs went around with the Pinocchio phrase of "I am a real doctor" gosh darn it.

[DizzyJ]

On ‎7‎/‎14‎/‎2017 at 4:21 PM, runforhotdogs said:

No offense to you but seriously that statement just sounds childish. To even entertain making an appointment to see what someone calls themselves is absurd. How much does coat initial inspectors make exactly? Keep this in mind, when was the last time you called your pharmacist or lawyer friend, doctor? They have a PharmD and a JD. If they practice within their boundaries, is it anything more than an ego boost? It wasn't that long ago when DOs went around with the Pinocchio phrase of "I am a real doctor" gosh darn it.

Haha...it was a joke.  I would never do such a thing.  I should have added an "lol" to clarify sarcasm.  I do however always request to see a PA/NP over an MD if given the option as I want to support our professions.