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The AMA, the DNP and so much misunderstanding between the lines June 15, 2009
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David Mittman, PA-C, DFAAPA About the Author
David Mittman, PA-C, DFAAPA

Clinician1Provided by Clinician1

This is one big ego war, so why not throw my large PA ego into it. Read the article above.
The NBME is mucking things up. This exam is not equivalent to the physician exam which has 3 parts. Part I deals with heavy anatomy, physiology, etc that we don’t “need” for primary care and that most physicians do not even remember, with muscle insertions and neuroanatomy that you still remember when you are coming right out of medical school. Those of us NPs and PAs who are very good could pass Part II and III in some significant levels. For the moment, lets say that this is a correct statement. Why even create an “eqivalent” test for the DNP which is not a clinical degree, (although I think only the NP graduates of the course can take this exam so the clinical background is there). Can midwives take the test if they are DNPs? So we have a clinical exm created for graduates of a non-clinical (for the most part) program. Talk about muddying the waters.

ON THE OTHER HAND, we have the physician world saying that in effect, “NO ONE SHOULD BE ABLE TO KNOW WHAT WE KNOW, OR DO WHAT WE DO” even if they can prove to us they can. WHAT AN UGLY STATEMENT AND ONE THAT SHOWS WHAT THIS IS ALL ABOUT. No one should have the ability to compare themselves to us, because it “confuses the public”. What nonsense. The fact that pharmacists, podiatists, chiropractors, PTs, OTs audiologists and many other professions do or will all use DOCTOR to describe themselves is not confusing enough, but if nurses or even heaven forbid, PAs were to do it, the public will have been fooled by these charlatans just trying to pass themselves off as physicians. AND BTW, the team MUST be physician lead and if you want to use the term DOCTOR go to medical school. They are angy that other professions use the words residency or fellowship too!!  Funny, they have not as been pissed about psychologists using fellowship or podiatrists or optometrists using residency. Just those damn advanced nurses who are trying to show they are able to provide care on their own. WILL SOMEONE TELL DR.CLEAVER (AMA President) TO TURN OUT THE LIGHTS ON THE SET, BECAUSE THE 50s HAVE ENDED.

I think it’s silly to argue over the test. Either have us take their test if we are ready to and good enough, or just go with the tests that we take now done by our own professions.Trying to show that “we” can pass their test just means they will change their test and say we can’t- the DNPs will lose credability.

I think the NBME has an agenda here and if it’s to show that DNP nurse practitioners can function at a particular level, then let’s just say that. Most of us know the DNP as designed today is not a clinical degree. Is it the doctorate that allows the person to take the test or their clinical knowledge? If primary care knowledge, put together a primary care test that’s “close” to the physician test and let all NPs and PAs with a Master’s take the test. Or how about all PAs that have gone to a formal postgraduate PA RESIDENCY (nice word) program along with all the DNP graduates. If its content and material are clinical, the training and experience that those PAs possess as a group will be more than fine. They will also do very well. After all let’s recognize all ability that clinicians possess. It’s time to stop hiding what we all know.
That would really show who has what knowledge and have all the medical and nursing powers that be who devised this test in a frenzy running for cover. After all, why discriminate? Let’s all show them what we can do.


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shea on 17 May 2012 at 6:30 pm

Kyle, PA-C you obviously know nothing about the NP role. A NP is educated to work as the primary healthcare provider, independent of a physician. Here is a quote about the nurse practitioner role “Nurse practitioners are licensed independent practioner”. (American Academy of Nurse Practitioners) Unlike the certified physician assistant, the nurse practitioner is built to practice autonomously. A PA is built to be an assistant to a physician. The NP has their own license to practice medicine (physicians aren’t the only ones who practice medicine obviously) that is issued in their name. The practice rights are state regulated, and in more states then not the DNP can call themselves doctor (in the medical setting), can have their own practice entirely independently, and prescribe medication include narcotics. To see the DNPs rights, check out this table

Like any other field, the nursing field has expanded into a terminal degree of a doctorate. Many other fields have done the same including physical therapy and pharmacy. If you earn the title you are entitled to the title. As for the PA, just as the name states, they will always be a physician assistant. If PAs ever move towards the doctor title, it will always sound ridiculous, “I\'m Dr. Assistant, the assistant to the other Dr.”

Kyle, PA-C (Iowa) on 30 Dec 2009 at 6:00 am

OK, as a former nurse and current PA, I want to give my 2 cents. I went to PA school to practice medicine with physician guidance at an on-campus program not a mail-order / online program that a lot of these NP programs indicate. I don't quite understand what the big to-do is with this DNP thing...Advance Practice Nurses are nurses and are licensed to practice nursing NOT medicine. The only people licensed to practice medicine are PHYSCIANS. The rest of us, are mid-level providers or whatever the current, politically correct term is, with some type of legislative permission to practice medicine or advanced nursing which, should ALWAYS be under the guidance of a physician!!! In my opinion, NPs should NOT have complete autonomy with diagnosing and treating MEDICAL conditions...Physicians are the only providers that should have that privilege. I went to PA school to learn a medical model that I could put to use in a practice setting with physician guidance...I did NOT go to medical school. I don't know why anyone would want the liability of practicing medicine without having the full benefit of completing medical school and residency!!! PA's and NP's both have places in today's healthcare crisis and I think we should be focusing on that instead of what type of degree someone has just to call themselves "DOCTOR"...remember, lawyers have JD's and are technically "DOCTORS."

Kelly (Columbia, MO) on 29 Jun 2009 at 1:29 pm

Here in Mid-Mo, PA's are the main stay. The NP's are abundant, but it appear the PA's get the job. But, let us all remember, it is not the initials behind the name, it is the name in front of the initials.

Bobby (Greenville, NC) on 29 Jun 2009 at 11:41 am

Having been both an RN and a PA I will speak to some of these nursing, there is a rather derogatory term called a " clipboard"..they are the ones, many times in that admin reason is they are no good at what they do with patient care ( seen it too many times) and get put into admin where they go on their power trips...and believe you me, they can impact how we as PA's ( they like to use the term ALP, advanced level providers) function by their paper pushing etc, and we have few, if any advocates in those settings....

As to the DNP.....what about the PHD program for PA's through the mention of that...also what about the PHD programs from the likes of NOVA, etc that have been in place prior to the DNP thing...granted it maybe an educational doctorate
still it has weight in this profession as an academic scientific calling....but what do I know...25 yrs of experience should count for the ability ( sorry guys no masters, just my cruddy ol BS in MED SCI) to set for their fact most of us PA's who have been in some form of primary care, ED, FAMILY MD, INT MED, etc, with over 10 yrs experience could probably pass the thing....but we wont be allowed any where near it...would destroy the validity of the test......that would be a problem

Angela (Texas) on 29 Jun 2009 at 8:41 am

I disagree wit you. It depends on where you graduate from with your DNP as to if your degree is clinical or not. UT Houston's program (the first in Texas) is a clinical program. These graduates are qualified to take the exam. I have always thought PAs and NPs should work together!

Edward, PA-C (SC) on 26 Jun 2009 at 7:16 am

Don't let it phase you, DNP, ANP, or BSN- all are really Practitioner's of Nursing world- nurses trying to beat the MD world, and trying to get respect, .....NOT!

Gregory P. Selasky, PA-C (WV) on 17 Jun 2009 at 11:33 am

AMEN Robert. We PA's need to be proactive instead of reactive. Until this happens PA's will only be considered second to NP's. President Obama proved it in his speech to the AMA when he omiited PA's.

Jared on 17 Jun 2009 at 7:55 am

sorry, that was meant to say the patient population far exceeds the provider population in 30 years.

Jared, PA (Vail, CO) on 17 Jun 2009 at 7:52 am

The RN is qualified for Dept Directors because of the purely administrative paper pushing part of the job.. In case you missed the news flash Robert, this country is in a health care shortage of MDs and should be relying on NP's and PA's to fill the void, hence creation of the positions back in the 60's when the FED realized our provider population would far exceed the patient population 30 years from then. Why would you, a seasoned PA, want to give up 80-90% of your patient care workload and replace with with a bunch of admin meetings and paper/policy making? I'd say your better off seeing patients for them and the organization. RN's can do admin jobs just as effectively as NP's and PA's with the input of NP's and PA;s on how the dept should run. Yet, they can not do the reverse.... guide patients on healthcare and treatment plans.

Robert Chavis (Ahoskie,NC) on 17 Jun 2009 at 7:03 am

One more thing to add, as a PA with 17 years ED, etc I am confused why any RN not even NP positions are advised as Director of Medical Departments. Not only am I a PA I have years of experience as a Senior Health Services Officer Commander/05. Now these hospitals etc stated they only can use an RN. There is not a Department in the health/hospital setting of which most of us could not run and run very efficient from the admin and medical standpoint. So what's up with the RNs obtaining all the jobs.

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