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An E.D. Doctor Who’s Not an M.D.

Posted on Mon, Jan 14, 2013

An EmCare-Affiliated Doctor of Nursing Practice Provides Insight into Her Growing Field
 

DR. KATHY MILEY, D.N.P.

mileypic.jpg“Hi. My name is Dr. Miley, I’m one of the Nurse Practitioners. What brings you to the ER?” That’s how I start most of my conversations with patients. Most patients are there for medical care and don’t think much about the introduction, but some ask “What does that mean?”

It’s a great conversation that I enjoy having. I am one of a growing number of nurse practitioners who holds a Doctorate of Nursing Practice (D.N.P.) degree. The D.N.P. is widely considered the penultimate training for clinical nursing education. After graduating with my master’s degree as a Family Nurse Practitioner, I felt like there was more to learn. I wanted more knowledge. I admit I should have probably gone to medical school, but my opportunities for a medical degree seemed limited.

My first degree program was in pre-pharmacy. I really thought I wanted to be a pharmacist. However, I was swept off my feet and married. I didn’t just pick an “Average Joe,” I married an Air Force Airman.

I always enjoyed the adventure the military offered. I got a new house every few years. I got to decorate, unpack, settle our four kids in school and, oh yeah, find a new job. My pre-pharmacy degree was not much help. So after we moved to Georgia, I decided the kids were old enough and I needed to go back to school. During my first semester, though, I found out child number five was on his way with his expected arrival during my schooling. Despite this unexpected (but welcomed) arrival, my husband remained supportive and somehow I made it through nursing school. I graduated with my associate degree in nursing.

This degree offered lots of flexibility. I no longer had to worry about what career I would work in. Nurses remain in great demand.

Even though I was working and raising children, a friend convinced me I should join her in earning a bachelor’s degree. The next year I graduated with my Bachelors in Science-Nursing.

But still, I felt the need to do more. While working in Interventional Radiology, I began to notice the nurse practitioners (N.P.s) with whom I worked. I noted that one N.P. in particular was able to insert central lines, work on clotted dialysis ports, complete biopsies, and perform various other procedures. He worked independently and was able to care for some of the more critical patients.

I decided to go back to school for my Master in Science Nursing-Family Nurse Practitioner degree. One big difference between working as a physician assistant and nurse practitioner is the degree that is required. I stayed in the emergency department as a nurse practitioner. After all, the majority of my nursing experiences were based in the emergency department. The E.D. just feels like home to me: total managed chaos. There is something about the excitement that starts and ends just as quickly that keeps me in the emergency room.

When asked to be in the inaugural class of my alma mater’s Doctoral of Nursing Practice (D.N.P.), I was thrilled. More knowledge, more information, more understanding in the medical field, and better resources - all good things to have in this ever-changing field of medicine. When asked what I wanted to complete as a capstone project, I knew it had to be something emergency-room based. I studied “chest pain in the young adult (under age 40) who presents to the emergency room.” My study has been accepted and is pending publication in the Journal of Emergency Nurses.

In today’s clinical environments, where the rapid expansion of scientific knowledge is only outpaced by the demand for health care services, it is imperative that clinical practice experts master additional competencies,” says Dr. Susan Eley, chair of the Department of Advanced Practiced Nursing at Indiana State University.

I have earned a doctorate much like those in business, pharmacy and education can earn. There is this misunderstanding that I wanted to complete the degree so I could use the doctor title. Quite frankly, you can call me Kathy for the rest of my life - it has worked for the first 38 years and I will still answer to it without hesitation. Truth be told, I am sometimes caught off guard and don’t answer when I hear “Dr. Miley.”

I continue to assist with bedside and clinical care. Of course, I’ve been approached to teach and I do this in my spare time (limited to one or two classes a semester). But my passion is still bedside care. I still find it rewarding to help others despite all of the changes and difficulties in health care. Nurse practitioners often work side by side with a team of medical providers in the emergency rooms. Each hospital is set up differently in terms of the types of patients I see, but no matter what I enjoy what I do. Having the doctorate degree only offers me more knowledge and a personal sense of accomplishment.

“The expectation of the D.N.P. prepared nurse practitioner is congruent with other professions and demonstrates additional and expanded knowledge and skills consistent with those of other clinical based professions, such as podiatrists, optometrists, pharmacists, and physical therapists,” says Dr. Eley. “No longer can the advanced practice nurse remain in the mid-level role. Nurse practitioners’ skills and knowledge place them in a role of top performers and the attainment of the Doctor of Nursing Practice degree reflects those qualifications.”

Emergency rooms are often considered a “catch all” for the underinsured or uninsured and they continue to be the point of entrance for access to medical care. Physicians are vital in this environment. However, for those times when the physician line is large and wait times for non-critical patients (those without life-threatening conditions, the physician extender can assist.

“Extenders ‘extend’ a physician’s ability to see each patient as need without sacrificing the level of quality and attention given to them,” says Chris Loman, M.D., Medical Director of Emergency Medicine at Major Hospital in Shelbyville, Ind.

If patients don’t hear my introduction, it is easily visible on my name tag: Dr. Kathryn Miley, Family Nurse Practitioner. I’m not here to mislead anyone. I’m here to help alleviate the congestion in the emergency room.

A Board-certified nurse practitioner can perform both routine and acute care, including ordering lab work, wound care and diagnostic workups. This specialized care affords patients a number of benefits including shorter wait times, attentive treatment and management, great coordination of care, continuous access to a medical professional, and accurate diagnosing with necessary treatment(s) or referral to appropriate medical care.

“Extenders are a key resource within the E.D. at Major Hospital, both for physicians and patients,” Dr. Loman says. “Simply put, they fill a role to deliver health care more quickly, efficiently and compassionately than can be done by physicians alone.”

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Comments
Womp
Te English usage of the term doctor comes from Canterbury times and refers to a physician. It's a separate usage from the academic title or the priest title. The physicians did not hijack the original And common English usage of doctor. This is why even in England where physicians do not earn doctorates, they are still called doctors.
7/2/2014 10:26:28 AM

pgy-1
Funny claims about a degree that can be obtained via community college (99.99%) + online (99.99%) being comparable to that of university (various) + medical school (<13%) + residency (EM: <.5%)

(acceptance rates)
7/2/2014 10:26:03 AM

A. RealMD
Also, I find the authors focus on her academic title very interesting.

I don't usually refer myself as Dr. Real Doctor, M.D as this seems rather redundant.

Usually it is either Real Doctor, M.D. or Dr. Real Doctor.

Many of my patients actually call me by my first name as what is important is how I practice medicine, not what they call me.
7/2/2014 10:25:17 AM

A. RealMD
Lots of comments so far.

I will say I have worked with some very nice NPs and PAs. In the right setting and with appropriate backup and supervision there is certainly a place for them to practice nursing or as a PA within the scope of their license.

I can see the point of commentators who note that "doctor" is an academic degree, but it must be completely obvious to any reasonable person that to call yourself "doctor" in any sort of health care setting is misleading.

Especially considering the extremely low level of health literacy in the US.

As an aside, it would be interesting to actually do a survey of people treated by both MDs and Dr. DNP to see if people truly understood the difference. I cannot tell you how many times I have had someone show up in my office where the previous "doctor" was really an NP.

500 hours of additional clinical training plus some (often online) courses on epidemiology, health care economics, ethics or quality does not equal the training of a fully trained physician. This isn't hubris, its just fact.

In fact, the watered down version of USMLE step 3 for physicians (absolutely required for licensure) was only passed by 50% of DNPs!!! Think about that, 100% for licensed MDs have to pass a more rigorous version of this test to practice versus only 50% DNPs passed a less comprehensive test.

Again, DNPs have a place in healthcare, but to call them doctor outside of a lecture hall, or to imply equivalence to physician training is just incorrect.
7/2/2014 10:24:42 AM

Philip White, MD
"The D.N.P. is widely considered the penultimate training for clinical nursing education."

penultimate = next to last

So what is the ultimate "training for clinical nursing education?"
7/2/2014 10:24:05 AM

Sarah
Earning a doctorate is earning a doctorate and no, physicians do not hold a monopoly on the word doctor. But the world-wide perception in the clinical setting is that doctor means physician. Every culture that I have ever read about has a special word for "doctor" and they aren't talking about academic professors. When someone keels over in a restaurant and people shout "Is there a doctor in the house?" they aren't looking for a PhD, even a genius Harvard educated one with 30 years of experience being excellent at something else. Doctors of astrophysics, Spanish literature, robotics, geology, or whatever should NOT be walking into patient rooms and introducing themselves as doctor. Neither should DNPs.





And if the title doctor is so UNimportant to nurses, then why do you insist on having the title? And why so much vitriol and jealousy about it? --> @SP



I am also alarmed by the physician commenters who seem to think this problem "will go away" if ignored. That laissez-faire attitude is precisely why we are in this predicament. We are allowing people without our depth of knowledge or training to do our jobs for us. We think its to our benefit because (for now) we get paid for their work. But look at the evolution: We hired assistants to help us get things done faster. Then they moved to doing things for us. Now they are doing things instead of us.



"Extenders" now practice medicine without real supervision (blindly signing off a stack of PA/NP charts at the end of the week is not supervision). They can diagnose, treat, even prescribe scheduled narcotics independently. They can run codes, place central lines, and the whole 9 yards as long as there's a doctor next to a phone somewhere. The next step is complete autonomy. Believe me it will happen, probably within the next few years.





What do you think your average state congressman is going to say when the nursing lobby proposes a bill to completely free them from physician supervision? The state legislatures ultimately govern everyone's scope of practice. The state legislatures are mostly lay people. When a lobbyist tells them there's no difference between an MD and a DNP and shows them data that they can do the same job, with the same outcomes, with lower costs, and happier patients what do you think will happen? They'll say they shouldn't be shackled by physician supervision at all. It may not actually be true, but that won't matter. That's how it works. How do you think chiropractors won the right to be called doctors? Now we have nurse-doctors, next will be PA-doctors, then maybe physical therapy-doctors, or whatever other group would like the title.



What do you think it does to our job market?



Physicians will be replaced by cheaper labor. No one will hire a physician when they can hire a Nurse-doctor for less money. Eventually it won't be "cheaper labor" though, because the pay scales will equilibrate. After all, why should one "doctor" be paid less than another doctor for the same work?



What do you think that does to our profession?

It dumbs-down the degree. And the number of fully trained physicians will actually wane. Why go to medical school when you can have the same title, privileges, prestige, and income potential with zero competition, for a fraction of the cost, and a fraction of the effort? Real physicians (except maybe surgeons) will have to become super-specialized to remain relevant and offer something the Noctors can't.





Wake up guys & gals. This will NOT go away. These programs are recruiting and enrolling like gangbusters. There will be a flood of new "doctors" applying for your job soon.

In the words of Dr. Eley. “No longer can the advanced practice nurse remain in the mid-level role. Nurse practitioners’ skills and knowledge place them in a role of top performers…"



PS - I would be completely silent on this subject and have no qualms whatsoever about any nurse practitioner being called doctor if their training were indeed physician-equivalent. If you studied like physicians study, met rigorous testing standards like physicians do, trained the same long grueling years that physicians train, maintained the same continuing education standards, and carried the full weight of medical-legal responsibilities and liabilities that physicians do I'm sure we'd all be happy to call you doctors. Oh wait, there's already a system in place to allow you to do exactly that….. Its called medical school and residency.
7/2/2014 10:23:33 AM

Kish mein touchkis D.O
There is NO DOWNSIDE and plenty of upside for all NPs to run every plan by physicians. Period.
7/2/2014 10:21:53 AM

PA-Doctoral student
I am glad to hear that PA posted the idea on moving our current medical system forward by indicating the terms "clinical officer" for PA/NP and/or perhaps, "medical officer" for the MD/DO. There are countries and organization, like the UK, Canada, and the Peace Corp who use similar terms.

By training, I am a PA. I am aware of the education and training differences between PA (perhaps NP) and MD/DO. I acknowledge the demands of medical school, their training and residency requirements that PA's do similarly, but not exactly. This is by no means in any form states that physicians are better clinicians that PAs/NPs. From my own personal experience, there are many PAs and NPs out there in clinical practice who are just as good as their physician colleagues; many of them earned their respect from their physician cohorts.

For individuals who choose to pursue a doctoral degree, he/she should be recognized and granted the use of their title accordingly, evening in a clinical setting as long as the clinician's roles and functions are clearly defined and the public is not confused that the medical service rendering clinician is a PA/NP and not an MD/DO.

What may work better is if the current medical system and/or medical organizations decide to use the terms of "medical officer" and "clinical officer". The doctorate title would be more appropriate to use without the fear of confusing the public, because the public would know that medical and clinical relate to rendering a medical service; the terms maintain the hierarchical system that MD/DO want; it also defines the clinician's role better internally in any given organization (my own personal thought).

I am currently in a doctoral program myself to advance my education to be a leader in the arena of organizational behaviors and development. I strongly support Dr. Miley's decision to use her title, if she so chooses to do so.

I think, we as a medical team of physicians and MLP should work together to solve our current healthcare shortage we are facing. We should maximize the use of all clinically trained personnel, not fighting over who should have the biggest piece of the pie in this title/hierarchical game. If a clinician (PA/NP/MD/DO) is in clinical practice long enough, he/she will ultimately gain the appropriate experience and knowledge to treat even the most complex cases.
7/2/2014 10:20:07 AM

The White Coat Investor
"It is unconstitutional to deny any doctor their title once earned."

I'm pretty sure that's not in the constitution.

I don't have a problem with adequately supervised mid-levels. I have worked with many very good ones. If they want to get a doctorate, that's fine too. Introducing themselves as "Doctor" in any kind of a medical setting is not appropriate.

The independent practice of medicine by mid-levels is a worrisome trend. All those years docs spend in med school and residency are not useless. They add a great deal of value. Discount that value at your own peril.
7/2/2014 10:17:57 AM

PA
As a physician assistant who has been practicing for several years both in the states and abroad, I too have trouble with DNP's referring to themselves as "doctor". Colloquially, in any clinical setting, a "doctor" should refer to an MD or DO or a DDS. Beyond this, it confuses the patient.

A patient can receive excellent care from a mid-level provider. And in many cases, equivalent care. Not every patient encounter needs House MD. Without mid-levels, physicians would be overwhelmed with the volume of patients.

While working in Africa, I worked with a health professional known as a clinical officer. They were independent, and knowledgable. However, it was widely known that they are not doctors. Essentially, clinical officers (CO) did all the primary care. If a patient was complex or needed specialist care, they were sent to see a physician.

I propose we adopt a similar model. All mid-levels (including "doctor" nuses) should have an opportunity to take an exam after several years of practice. This exam would be rigorous, and would qualify the practitioner to adopt a new title. The new title (clinical officer, advanced practitioner, take your pick) would also come with independence to practice independently. There would be no confusion that these practitioners are not physicians, and don't claim the title doctor, but they provide near equal care and refer out when needed.

In so doing, this would hopefully fix the physician shortage, and allow for better coordination of card, de-stress ER waiting rooms, and appease everyone.

Any thoughts?
7/2/2014 10:16:20 AM

MedStud
forums.studentdoctor.net/showthread.php?t=981881

There's nothing wrong with being a nurse. If you want to call yourself a doctor and not lie to your patients, go to medical school. End of story.
7/2/2014 10:15:40 AM

Stacey
The article posted in my local newspaper once I received my DNP was in the top 5 most blogged for the year! Doctor is an academic title. It does not belong to any one profession. It is unconstitutional to deny any doctor their title once earned. I am always careful (and proud) to state that I am the Nurse Practitioner who will be caring for them in the ER today. We should be proud of all the doctors in health care! NPs, MDs, DOs, PTs, OTs, DDSs, etc, etc, etc.
7/2/2014 10:15:11 AM

West Texas Intermediate Crude
PA: It's a fact that you are licensed by the state to practice medicine under the supervision of a physician. The degree of supervision varies by state, but in no state does a PA practice medicine without supervision.
You shouldn't be braggin' like that.
To answer Random MS4, DNPs and other extenders are liable for their actions, but their supervising physicians share that liability, and the docs' malpractice policies generally specify by name the extenders that they are supervising. In Texas, the medical board also specifies
7/2/2014 10:13:55 AM

Norman Mok
So are DNPs doctors (ie: independent practitioners) or extenders? the article isn't clear, and seems to straddle the fence. also, go to an NP or DNP and ask them for a differential of prolonged QT or hoarse voice and see what they come up with. the commenters who compare their years of clinical nursing experience vs. clinical experience of young doctors making them better 'doctors' is laughable (fine if she meant, young doctors as in interns, ill give you that) Years of putting in IVs, giving meds, reassessing vitals/clinical status doesnt equal working up undifferentiated complaints. (I do see a great value to NPs as extenders in the ER though - but what does an NP offer over a PA?)
7/2/2014 10:13:30 AM

scenic
Guys, guys. Save your breath. The noctor's inferiority complex can not be a dressed by rational arguments. It is comforting to know that most nurses are happy being nurses and don't try to be docs. There are always bad apples. Ignore her, she'll go away.
7/2/2014 10:09:23 AM

Dr Nancy Sampson, BS, MS, PHD, DNP, ACSE, LOL, WTF
I am a doctor, as you can see behind my name with my MANY illustrious credentials! I have a doctorate from Harvard. I spent over 20 years accumulating all of my ILLUSTRIOUS degrees from all over the world at top institutions! You WILL respect my authority as a nurse AND a doctor AND a physician! I am the best of all worlds! I own you insolent peons with all the letters after my name! How DARE you question my nurse credentials!
7/2/2014 10:08:54 AM

West Texas Intermediate Crude
PA: It's a fact that you are licensed by the state to practice medicine under the supervision of a physician. The degree of supervision varies by state, but in no state does a PA practice medicine without supervision.
You shouldn't be braggin' like that.
To answer Random MS4, DNPs and other extenders are liable for their actions, but their supervising physicians share that liability, and the docs' malpractice policies generally specify by name the extenders whom they are supervising. In Texas, the medical board also specifies who are the supervising physicians for the extenders. If the extender practices without appropriate supervision by a specified physician, she is in violation of the state Medical Practice Act and will likely have her license suspended or worse.
7/2/2014 10:08:02 AM

BL PA-C
Truth be told, the NP Masters degree can be obtained online, as can most of the doctorate, while mantaining a full-time job. I shudder at what an ER MD must think about a DNP who claims a comparable "residence"....MD's must pass their boards... PA and NP recert boards simply don't compare. The government think MD's are more qualified, that's why they get paid more/reimbursed at higher rates. MD's remain liable for their PA/NP (and DNP) extenders who work UNDER their licenses. MD's work harder and take heavier academic loads in Pre-med Bachelor programs... PA/NP don't have to take the MCATS, Boards...Poo-Poo that all you want, but those exams just lend to better "breeding" then most any PA or MD....That a PA/NP shines and does well speaks volumes to their ability, but it isn't really the same...I could go on, but the points have been made already...
7/2/2014 10:07:35 AM

bwNP
I am shocked by the hateful comments from some of the MDs on this site. I sure hope, and don't believe that any of the docs I work with feel this way.
First of all, Ms. Miley has earned a doctorate degree. She has a right to be called "doctor" just like any other profession that has earned a doctorate degree. And no, physicians are not the only group of people that are called "doctor". Ms. Miley clearly states to her patients when introducing herself, that she is a nurse practitioner.
As like any medical provider, I am sure Ms. Miley practices within her scope of expertise. The ER is one place were we all collaborate and consult. Not doing so, could have dire consequences.
I don't know where everyone works, but in our ER, us NPs and PAs see many patients independently and collaboratively and are an important part of the team. As a team, we do not belittle each other's training. I feel my 20 year experience as a NP are respected by the MDs and DOs and not ridiculed like some of the comments above.
Perhaps if some of the MDs above had some nursing training, they might have some better people skills.
7/2/2014 10:06:50 AM

random MS4
Do these DNPs assume all liability and carry their own malpractice insurance policies?
7/2/2014 10:06:03 AM

PA
To clarify the comment above- PAs practice medicine. We are licensed by the state to do so.
So to paraphrase, it aint braggin', because it's a fact.
7/2/2014 10:05:45 AM

Sarah
So should someone with a PhD in literature who volunteers in a hospital address himself as Doctor in the Hospital? He earned the title too right?

And what if there were a certificate that gave you the title 'Nurse" without going to nursing school. Would it not be confusing to say "I'm Nurse Jones, ED technician?" You could not have a degree called "Pilot" with different training than a pilot and work at an airline calling yourself Pilot. Highly trained and deeply experienced legal clerks cannot call themselves lawyers. Really smart and well educated people with degrees in criminal justice and years of experience cannot call themselves Policemen unless they go to a police academy.

Why don't people just admit what's really going on: You want to be physicians without going to medical school. Simple as that. You covet the title, the autonomy, the prestige, and the pay of doctors but you don't want to go to medical school to earn the actual degree of MEDICAL DOCTOR. Medical school is more expensive. Medical school is more competitive. Medical school is more disruptive to your lifestyle. Medical school is a LOT harder. Physician residency is a LOT LOT harder. Those are the reasons for choosing the DNP instead of going to medical school. So be honest about it. Why go the tougher route when you can get the same title an easier way? Especially when your unions and lobbyists are winning at tearing down the practice boundaries and expanding your scope of practice?

You have successfully circumvented the system due to the country's demand for cheaper labor and you've been extremely politically savvy about it. So now you can get an easier degree (yes, easier), work as a nurse making tons of money while take classes in your spare time and come out at the end able to call yourself Doctor.

Maybe after seeing "new physicians" going through their training you realized that they're no smarter than you, and maybe it bugged you that they had more authority than you. But 25 years of clinical experience as a nurse doesn't qualify you to be a physician even if you "know more than any new physician you've ever met". If that were the case then medical schools would confer the degree to every seasoned nurse.

Calling yourself Doctor is blatantly deceptive and you know it. If it weren't there would be no point in writing this article.

Across the globe the accepted understanding the word Doctor in the medical setting is physician. You did not "just want to learn more", you aspired to be a physician. You chose your path, then changed the rules, and now you're trying to change perception.
7/2/2014 10:05:24 AM

Paul-Moreau Bossous
I read all the comments and agree with most. Some are out of line like calling " green doctors" etc.
Calling yourself doctor in a Health Care setting is indeed confusing, that is why she further explained she is a nurse practitioner. But, " Doctor" is not a Trademark. Anyone who hold a PhD or now DNP can use... Just like in the VA system we call PharmD, DNP, etc.
Nurse practitioner do not practice medicine only physician do. Yes! any PA/NP/DNP can be as good a clinician as a Physician.. . To an extend even an RN or LPN.
I'm currently in my third and last year of residency in internal medicine. If God permits in 5 months I will be able to practice medicine on my own after 7 years of medical school and 3 years of residency. All full time. This after 4 differents USMLE exams and ABIM awaiting in August. I agree any good test taker can pass those exam PA/NP/DNP included, as a matter of fact some DO also take them if they want to be apply in Osteopathic programs. Just like I can and will pass any NCLEX exam if I study for it. But, passing them will never make me an RN, the training and schooling will. Of course we cannot teach compassion, empathy etc ... You either have it or not. Last but not least please please please do not spent your time and money on any NP to MD you will not be able to practice anywhere. ( ECFMG will do certify you if you have less than 4 years of medical school or if any class was taken during nursing school) Do not take any short cut, you will regret it. My advise is if you want to practice medicine you have only one choice but go to medical school you will not regret it. If you want to practice nursing you can pick and choose LPN, RN (ASRN, diploma RN, BSN) APN. And if you want to be called Doctor while practicing nursing go for DNP. I hope this help.
7/2/2014 10:03:53 AM

TechDoc
I work as an ED Tech but I have a PhD in English so I introduce myself to patients as doctor. I've been in a bit of trouble lately for running around putting in central lines and intubating people (like I knew she was just there for a sprained ankle), but I worked quite hard for my degree so I deserve to be seen as a doctor too. Thanks for standing uo for folks like me!! PS - went and checked the course requirements for some of those online DNP degrees.... whewee, that is some rough stuff!!
7/2/2014 10:03:06 AM

Mike
Is this article a satire?

Surely she can't be serious in comparing her education/training to a physician. EM + IM training in 2 years? What!?! That people in the American public are being led to believe that DNP in any way, shape or form even resembles a fraction of a physician is a travesty. You can get a DNP online!!!!! Online!!!!
7/2/2014 10:01:59 AM

PM by EM doc
Honestly,

I find this new trend a bit alarming. The rigors of a medical school education, residency and fellowship are vastly more rigorous versus any level of "advanced" nursing. In fact, the difference is laughable. DNPs as "top performers"...please. Nurses serve a phenomenal role in medicine. However, trying to somehow parlay their training/role to be on level ground as physicians (or anywhere close for that matter) is an incredible load of misinformation. Ultimately, it will be the patients who pay the ultimate price.
7/2/2014 10:01:31 AM

a physician
Jennifer,

That is amazing that you were able to pack in both an internal medicine and an emergency medicine residency into 2 years. It took me four ass-kicking years just to get through just my emergency residency, and I still feel like there was stuff I didn't see.

So that 2 years, was it after 2 years of DNP school? so is it 2 years in the classroom and 2 years in residency?

How are you able to jam in everything that a doctor needs to know in half ther time? Is DNP just that much more rigorous? Medical school seemed pretty damn hard.
7/2/2014 10:00:57 AM

West Texas Intermediate Crude
SP: Please stop, you are beclowning yourself.
You lose the argument when you start calling those who disagree with you names such as "arrogant."
This discussion is about the implications of a title and certificate. You are free to ignore or disrespect the years of study and hard work that are requires to earn the MD and board certification. I recognize and respect what Kathy Miley has done to earn her degree. I do not believe that, even with a 2 year residency, that RN+APN+APN=BS+MD+residency of 3-5 years.
No one will dispute that there are practicing MD physicians who are, to put it kindly, idiots and dopes, and that there are nurses at every level, including LPNs, whose training and experience make them valuable in caring for even the sickest patient. That said, it cannot be disputed that the minimum training needed to practice as an MD is roughly equivalent to the maximum training available to the nursing profession.
This is not a criticism of the nursing profession, it is a fact.
You state that a PA/NP/DNP could "of course" pass the tests that MDs take if they studied for it. It ain't braggin' if it's true, and in my case, it's true (and I have recertified twice in my specialty). In your case, it's just braggin'.
If you have been practicing medicine for 16 years, and do not have a medical licence in your state, you better keep quiet- these laws tend to be enforced quite strictly.
7/2/2014 9:59:49 AM

SP
I have a solution for you "real doctor". This individual has went to school and passed all required boards to earn the title DNP. So instead of insisting that she not use her title, that she earned, why don't all "real doctors" simple introduce themselves as Doctor of Medicine instead of insisting that someone else not use their title at all. As to your remark about a "lower level of care" afforded by mid-levels I think you need to be educated. I have been practicing medicine for 16 years and no one is going to convince me that some green doctor, who earned their degree from some caribbean island, practices a higher level of care than I do. Besides, if you are basing level of care on reimbursement it is well known physicians are reimbursed around 23 cents on the dollar. So tell me, what level of care should one expect based on 23 cents?
7/2/2014 9:58:17 AM

A "Real" Doctor
As I read through these comments, I see that several others have also made my point.
In a Health Care setting, anyone being referred to as "Doctor" will be assumed to be a Physician - MD or DO or anyone who is licensed to practice Medicine - by patients.
For example, Medical Students are often called "My Doctor" by patients - as are APNs working in Clinics.

This is misleading. Patients are receiving a lower level of care - as reflected by the less stringent requirements for and lower reimbursement of Non-Physicians giving health care - and the patients don't know it.

DNPs have a Nursing Degree. As long as they are required to make patients understand that they are Nurses, that they have a Nursing Doctorate, and a Nursing License, then they can be called "Doctor."

Otherwise the term "Doctor" should be reserved for Physicians in the HealthCare setting. Just as the PharmDs do not call themselves "Doctor."
7/2/2014 9:57:03 AM

SP
Are all physicians truly as arrogant as those who have commented on this site? But of course they are. Some how or another going to medical school and taking a series of test makes MD's the most brilliant people in the world...LOL. The above comment as tho whether or not a DNP/NP/PA could pass the National Board of Medical Examiners Test; of course they could if they put the effort into studying for it. Do you truly believe that just because you past a few test that makes you more intelligent than someone else? That's absurd. Midlevel practitioners are just as intelligent as many physicians. In fact I know of several physicians who I would not allow to do anything to me. And when it comes to passing boards, whatever that means to you, I can guarantee you there are many physicians practicing today who could not pass those boards again without a significant amount of studying. Some not even then. It's silly to believe that passing a test makes someone a good practitioner/physician. Test are certainly needed to prove one's proficiency but do these test guarantee one's dedication to the profession? Does passing a test somehow automatically give someone compassion, love, dedication, and commitment to their patients. Absolutely not. Practicing medicine is much more than being able to pass a test. There are many physicians practicing in these small towns who are still practicing the same medicine they were 20 years ago. As for me, if I had to choose between that "Dr (MD)" or a midlevel practitioner in a inner-city hospital the choice is easy. The problem with MD's is they still want the clout and respect that they had 50-60 years ago when everyone bowed to them. Well welcome to the 21st century. Those days are long gone. And just wait until we have a national publicly funded heath care system. These MD's will be reduced in the public eye to what teachers are today. It's time for physicians to come off their high horse and focus on bringing all heath care providers together to practice good medicine and stop belittling NP/PA's in order to protect their own self made ego.
7/2/2014 9:55:46 AM

West Texas Intermediate Crude
This is unfortunate.
Patients in an ED or any other health care setting know what a doctor is- a person who has gone to medical school, passed a series of tests, and has completed a residency in a specialty. In most of the better hospitals in the USA, the doctor must be certified by a specialty board, or be on track to accomplish this. This requires 3-8 years of training beyond the MD.
The holder of the DNP certificate has done none of these things. While your skills and training are certainly more applicable and useful in the ED than a person who has earned a doctorate degree in English or physics, when you refer to yourself as Doctor in the health care setting, your patients have certain expectations of your background that are not correct. A Ph.D. in English has earned the degree and is correctly referred to as Doctor in the academic setting, but would not call herself Doctor in your ED, or, if she did, would not be treated as one.
Do you really think that you could pass Parts I, II, and II of the National Board of Medical Examiners Tests and the certifying exam of any medical specialty board? That's what Doctors do.
I have 2 children, but I would never go into a Catholic seminary and refer to myself as "Father Vince."
You started out as an entry level nurse, and have worked your way up to the highest levels of your profession. You are very proud of that, and you should be. I would be happy to have you as part of my team. I have extenders who work with me and they are quick to correct anyone who mistakenly refers to them as Doctor.
You should do the same.
7/2/2014 9:54:57 AM

Carl
I'm a physician and don't feel DNPs should be called doctor in the healthcare setting. Let's face it, NPs/PAs chose their profession because school was much less difficult and shorter. If you want the title then go to medical school, take all those test, do the residency, etc. "You don't know what you don't know."
7/2/2014 9:53:41 AM

sdkmd
Penultimate means 1 below ultimate or second best. What would be the NP ultimate achievement?
7/2/2014 9:52:36 AM

Peter
I'm a little irritated by the title as well.

What about the D.O. ER doc?

And I do think there is a difference between someone who has spent 4 years beyond college in medical school and 4 more years in internship and residency, and someone who has spent less time studying in less demanding academic programs.

I don't think there is anything magical about the word "doctor", but this is indeed misleading the patient.
7/2/2014 9:51:03 AM

Richard Garrison,MD
I congratulate anyone who seeks further expertise and education. The field of APN's has been embraced by our group and feel they are essential. The points to note that nursing has not outlined a national standard of training to a standard in general. The term "Doctor " again raises many questions not only in the professional sense but in the patient's mind. In short it blurs the of the hierarchy of practitioners . This is not an ego thing but the plain fact is that medical training ,both undergraduate an post graduate is defined and has certain expectations denoted by the layman term Dr. That should not be tampered with.
7/2/2014 9:49:43 AM

Heath
The term "doctor" is derived from the Latin word "doceō" which means I teach. It has been used since medieval times to denote one who has earned the authorization to teach. Of course the meaning of the word has changed though time, but somehow along the way physicians have hijacked the term (excepting its use in academia).
You have earned the title just like many other non-physicians before you. The fact that you are a nurse does not exclude you from using the title.
Dr. Miley, thanks for your thought provoking post.
7/2/2014 9:49:08 AM

Leila
Nicely said RD, I am definitely not a physician, by choice. My degree is not a PhD (research-based) but is rather a clinical degree. I can practice independently, have prescriptive authority, determine medical diagnoses and treatments, and provide valuable patient education. Whatever it is that NPs are practicing, I think the outcomes and patient satisfaction with our care speak for themselves.
7/2/2014 9:46:48 AM

A "Real" Doctor
The proper title for this piece should be "An ED Doctor Who's Not a Physician."

Calling themselves "Doctor" is proper for DNPs but it will never make them Physicians.

Nurses practice Nursing not Medicine.
They have Nursing degrees and training - not Medical degrees and training.

Nurse practitioners, no matter if they are PhD level or not are not Physicians and do not Practice Medicine.

A long as DNPs remember that and don't mislead patients and the public, then they can call themselves whatever they want.
7/2/2014 9:44:55 AM

Kathryn Miley
Jennifer--thanks for the feedback of your opinion. If you read the article I always introduce myself as "nurse practitioner" (my chosen career), my title is Dr Miley (my chosen degree). To only use the title in the academic setting is ridiculous. Education is the key, thus my article. I also have MDs that call me Dr Miley (despite me saying Kathy is good).

Almost every career field has the opportunity to obtain a doctorate degree, so is it not appropriate for any of them to use it? I've even seen the doctorate degree for athletic trainers! I call my neighbor Dr Cupp (PhD in education). I call my dentist Dr Stradley (not an MD). I think you should re-consider using your appropriate title--and continue to love your career: Nurse Practitioner.

(PS There are NP to MD program) :-)

Krystal: have you seen the DNP website?? You can network with many DNPs!! and students are welcome http://doctorsofnursingpractice.ning.com/
7/2/2014 9:44:20 AM

Diane Keahey, APRN, FNP-BC, DNP
I have been a FNP for 10 years now and received my DNP almost 5 years ago. I no longer work in the emergency room setting as I saw a need in our community and opened my own family practice clinic. I too answer better to my first name better than Doctor! I too thought being doctor nurse practitioner was to confusing for my patients however the majority of people understand after a little information. When a patient or a family member first call me Doctor I advise them that I am a nurse practitioner with a doctorate degree. I make sure they understand I am a nurse practitioner. If needed I explain it is briefly as I can. I often ask if they understand what I am saying. A person with a very low IQ said yes I understand; you are a nurse who doctors on me so that makes you my doctor! What a wonderful understanding! If someone with such a simple way of thinking sums it up so nicely why is it the population with the average or above average IQ has such a hard time understanding we are nurse practitioners with doctorate degrees!
7/2/2014 9:43:46 AM

Dr Linda Hall Rothery
I agree with Dr Miley! I too am a DNP in ED for 25 years as LPN, RN BSN MSN and finally DNP. Why would any one who earned the title be too intimated to use it? One doesn't complete this degree and work in an ED who is not a strong leader in this field. My suggestion is step up to the plate and be proud of the professional you are, a doctor of nursing. It's your call.
7/2/2014 9:43:16 AM

Leila McKinney
Jennifer,
I completely disagree. I'm not sure about you but my DNP included a full two year residency in internal and emergency medicine. Combined with my prior nursing experience I had much more hands on clinical experience than any new physician i've ever met. I tell my patients I am a nurse practitioner, but also call myself a doctor because that's what I am. My physician colleagues respect me and if it rubs others the wrong way that isn't really my concern. Patients need to be educated about practitioner alternatives and I applaud DR Miley for her approach!
7/2/2014 9:40:54 AM

Krystal Baggett
Hello to both of you. First off, I would like to say congratulations on your accompishment of gaining your DNP. It is such an honor to know that you guys are providing care at the
most advanced level of nursing for individuals and communities that your serve. I am also an ER nurse practitioner. I am currently in school for my DNP and was wondering if either of you mind sharing your email address. I would love to discuss some current health care issues as well as current legistative changes with you. Thanks in advance.
7/2/2014 9:31:40 AM

Jennifer Palermo
Dr. Miley,
I too have earned a DNP and work in the ER, however, I don't address myself as "doctor" as I don't think it is appropriate in a non-academic setting. It is just too confusing for the patients. Not that I am not proud of my accomplishment, but it seems to do more harm then good and can rub the real "MDs" the wrong way because calling me "doctor" in the medical setting is really false advertising. I do have DNP after my name on my name tag and will explain this if a patient asks. Until they have an NP to MD academic program, I'll stick with addressing myself as a nurse practitioner
7/2/2014 9:31:12 AM