Saturday, September 01, 2007

What do you call a nurse practitioner?

Codeblog recently posted on the dilemma of whether a nurse should call a physician by his first name. I frequently encounter a similar problem in my sleep practice: how to address a nurse practitioner in a letter.
For example, suppose a Certified Family Nurse Practitioner named Jane Doe has referred me a patient and I am sending her a consult note. Is it more proper to say "Dear Mrs. Doe", "Dear Ms. Doe", "Dear Nurse Doe", "Dear Nurse Practitioner Doe", or "Dear Jane Doe, CFNP"??

This is how I usually address the letter:

Jane Doe, CFNP
123 Maple Street
Jackson MS 39323

Dear Jane Doe, CFNP

Thank you for referring Mr. Smith for...

If I know the Nurse Practitioner's supervising physician's name, I will usually cc him at the bottom of the letter, esp on Medicare patients. This helps to justify billing the patient as a consult rather than a new patient.

39 comments:

Nurse Practitioners Save Lives said...

I think that you are doing it exactly how I would expect it to be done. My patients call me by my first name most of the time but some call me Mrs. So and So.. Either way is fine. I do like to get the "credit" when I refer patients to other MDs for testing but I suspect that my nurse is just saying that the consult is from "the office". I like the other MDs know that I think enough of their professional expertise to refer my patients to them.

Myriam said...

I am a graduate student and receive services from the university's health services where they have a lot of nurse practitioners. One thing that bugs me a lot is that they call them doctors. "You will have an appointment with Dr. So and So" or " Dr. So and So will see you in a moment" Is it OK for them to say that? I think it seems deceiving. If I'm seeing a nurse practitioner tell me so- don't say I'm seeing a doctor! However, if this is a correct term then I guess I'm wrong. Anybody knows if calling a nurse practitioner doctor is correct?

Anonymous said...

No, it is not okay for them to call use MD. I love NPs and think they are necessary, but they are not doctors! They didn't go to medical school and they do not have carte blanche to practice medicine by themselves.

Anonymous said...

Some Nurse Practitioners have a PhD in Nursing and in that case you can call them Dr. because they have a PhD. Also, that is incorrect, they do have the ability to practice on their own. Nurse practitioners can work without physicians. It is physicians assistants that are trained to work for/with a physician.

Anonymous said...

The title "doctor" is not reserved for physicians. I understand it may be confusing to some patients to refer to a nurse practitioner as a doctor if he/she is doctorally prepared. In that case an explanation of roles is warranted. Nurse practitioners with a PhD, DNS, or DNP are academically doctors and if certified are able to independently practice medicine. They are not "medical doctors" but still can provide excellent medical care.

Anonymous said...

The issue first and foremost should be disclosure to the patient. As a doctorally prepared non-physician provider, I feel strongly that a patient should know they are seeing a non-physician. There is NO substitute for physician training and experience. I can say that medicine, despite what you might hear can only be practiced independently by a physician. The practice acts of the other non-physicians play games with wording in the laws to give the look and feel of independence.

Anonymous said...

I find this discussion interesting. I do agree with disclosure to patients but this is the 21st century and the card blanche you have referred to by other health clinicians who hide behind " wordy" laws is a complete confabulation. By the way, you have seen the proven studies in JAMA where NP's consistantly excell with patient outcomes as opposed to physicans and where those very NP's have admitted patients to hospitals and are reimbursed at the same rates as doctors. The last time I checked there was nothing about bedpans on my NP state licensure test. In addition to your comments, I am very sorry to tell you but the last time I checked there was a CAPNA office on Madison avenue nesteled in NYC with MD's 12 inches away. In fact it was news worthy of the Wall Stree Journal. I am pretty sure they don't circulate erroneous information such as that. Patients prefer to go to the Nurse Practioner but because were "Caring" but b/c for years nurses have been preforming 80% of services that MD's bill for. Furthermore, the ignornace in your statement is that you can no longer stand on your soap box claiming that you went to medical school and we didn't. Are education may be staggered but the last time I checked 20 years in Critical Care, Occupational health, OR, Ortho, Cardiac Cath, ER and Obgyn gave me more than enough credit to stand head and shoulders above any MD that wants to defer to us as junior docs who bow to the all knowing physician.

Anonymous said...

As noted previously, the term "Doctor" is not reserved for MDs and DOs. In fact, the term "doctor" means scholar or teacher. As such, MDs/DOs are not real doctors in any historical or fundamental sense. It is the PhD who is the real doctor, and deserves to be called "doctor" more so than a mere MD/DO. While MDs/DOs may refer to themselves as "doctor," the MD/DO degree is actually an inferior degree (like a Master's degree), and is academically inferior to the PhD degree.

Anonymous said...

It is not acceptable if the patient that is being treated is misled OR believes that the NP is in fact a medical doctor.

Anonymous said...

An MD degree is NOT academically inferior to a PhD... From Wikipedia: The naming of degrees eventually became linked with the subjects studied. Scholars in the faculties of arts or grammar became known as "masters", but those in theology, medicine, and law were known as "doctor". As study in the arts or in grammar was a necessary prerequisite to study in subjects such as theology, medicine and law, the degree of doctor assumed a higher status than the master's degree. This led to the modern hierarchy in which the Doctor of Philosophy (Ph.D.), which in its present form as a degree based on research and dissertation is a development from 18th and 19th Century German universities, is a more advanced degree than the Master of Arts (M.A.). The practice of using the term doctor for all advanced degrees developed within German universities and spread across the academic world.

An M.D.

Anonymous said...

If you have a PhD you are Dr. Joe, which a smart individual such as yourself, should know. DR. IS NOT JUST FOR PHYSICIANS!!! HELLO!!!
If you are so inclined to make sure you are known as the physician, maybe you should call yourself Physician Joe - you know, just like Plumber Joe......

Anonymous said...

Jees- I just wanted to know how to properly/professionally address a letter!
They all deserve our respect regardless of their title!
Just a grammar question for me.

Anonymous said...

I'm sorry, but who (with any advanced education/degree) cites Wikipedia...are you serious? Anyway, great dialogue.

Anonymous said...

I am sorry, but this kind of petty bickering is what irritates me most about the issue of MD's and NP's. The NP role was created as a result of the lack of patient access to primary care as a result of too few MD's interested in pursuing it. The fact is there is not as much money in primary care as specialty care, which is sort of telling of the lack of motivation to pursue it. Therefore, nurses were the obvious choice given a long history of providing a variety of care giver services for considerably less compensation. This again may enlighten those of you reading this to their motivation.

Being an NP and having worked with supportive and empathetic physicians and nurse practitioners, I can tell you that those of us who are focused on delivering you great care will not quibble over what they or their counterparts are called.

Personally speaking I like my patients to call me by my first name......thats how I started as a nurse and if I were an MD I would choose the same. Let's all be professional, some of these postings do nothing but make each other look foolish and small minded.

Lester said...

What if the practitioner has a doctorate degree in alternative medicine and also is a nurse practitioer? what would be acceptable then? He/she does have a doctorate degree, yes? Of course disclosure is proper to patients, however, if you take any practicing NP, MD, DC, DO, etc and ask them to sit down and pass their own liscensing exam after being in practice 5-10 years, they propbably will fail. I bet that a practicing MD cannot pass a nurse practitioners liscensing exam that covers the MD scope of practice! All this rhetoric is about posturing for ego. Most primary trained health care practitioers of any kind are capable of recognizing the latest pharmaceutical interventions and prescribing them as well as what tests need to be run and when to refer to a specialist. The rest is ego. Most patients will be competetnly handled in our managed care cookie cutter healthcare system whomever or whatever the credentals may be.

Anonymous said...

My husband received his doctorate in nursing (ND) from CWRU twenty-four years ago, as well as an MSN from Case. He's been a university professor for the past 22 years and has always been call doctor by his students. Five years ago, he acquired his post-doctoral certificate as a family nurse practitioner and became a certified FNP. When he started collaborating with a local physician (part-time in addition to his full-time work as a professor), the physician's staff, NOT the physician, insisted that the patients be told to call him by his first name and not call him doctor. They said they were concerned about misrepresentation, etc. During the first few years some of the same staff members made derogatory remarks about his educational credentials, and were always quick to "correct" patients who called him doctor. None of these staff members even had a four-year college degree, yet my husband has a full 11 years of higher education under his belt--BS, MSN, MBA, NP Cert., & ND. The whole situation would have been comical if it hadn't been so absurd. My husband was very patient with them. Since that time all of the negative members of the original staff have left the practice. And my husband has proven himself as an outstanding practitioner with an excellent reputation as a diagnostician. A percentage of the previously-established patients in the practice even prefer to be seen by him on a regular basis rather than be seen by the physician. He has also brought many patients to the practice and has established his own new-patient population. Many of these patients are associated in some way with the university at which he teaches and these patients prefer to call him doctor. The current staff, however, discourages this by referring to him by his first name in front of the patients, even going so far as to tell patients, "We call him ....... so that patients won't be confused and think he's a doctor." --But if there's anyone who knows he's an ND and not an MD/DO, it's these patients from the university community. I think it's unfortunate, because he has more than earned the right to be called doctor, can't accurately be called mister; and having patients call him by his first name is inappropriate because it doesn't afford him the respect he is due for all of his hard work, knowledge, credentials, and responsibility he takes on in seeing, diagnosing, treating, and prescribing for his patients. (A very popular local chiropractor, who does not have prescribing rights, is always referred to by the title doctor by the same patient population.) I strongly believe all of the patients should call my husband doctor, and that this would appropriately increase the level of confidence and trust they have in him.

Anonymous said...

People with a DNP clinical doctorate are technically "doctors" in the academic sense of the word. To a class of students or around the university, it's appropriate to call them doctor. Generally in the clinical setting, however, only allopathic or osteopathic physicians with a medical degree are properly addressed as "Doctor." At least that's the way it was with every hospital and practice I've ever worked at.

Anonymous said...

Professors with doctorates working with students in the clinical setting ARE called doctor. In the clinical setting chiropractors ARE called doctor, optometrists are called doctor, dentists are called doctor, podiatrists are called doctor--none of whom are MD's--in addition to the MD-prepared psychiatrists, ophthalmologists, cardiologists, and regular old physicians, etc. who are called doctor--because ALL of these individuals have earned a doctorate and are treating their own patients. (In other words, it is not appropriate to refer to any of these doctors as Ms., Mrs., or Mr., since training has resulted in a doctorate.) A nurse practitioner with or without a doctorate treats his/her own patients, prescribes medications, orders procedures, monitors patient progress, makes referrals, and more. Some also perform minor surgical procedures (e.g. lesion removal, stitching). Furthermore, I would like to assure Myriam (see above) that any NP that asks to be called doctor or refers to him/herself as doctor is, indeed, a doctor, and not simply a master's-prepared certified NP but someone with additional education and training who's earned an ND or a DNP and deserves the respect of being called doctor. I would also like to point out that the NP’s role in the clinical setting (hospital or doctor’s office) is more closely linked to the traditional role of the physician as a primary care provider than that of any of the other non-MD/DO prepared types of doctors listed above. Also, doctorally prepared NP's always make it clear that they are ND's and not MD's. In my state, they are legally required to wear name badges listing their credentials. Optometrists also are legally required to make it clear that they are not MD's--and I have never met one who corrected me or had a staff member correct me when, out of respect, I called him/her doctor. And I've been wearing glasses for more than 30 years.

Anonymous said...

Honestly, that is total crap. Nurse Practitioner's now have to get their PhD in nursing. New law as of 2015. They are doctors, and they earned the title. No they didn't go to medical school, which is almost the same amount of time. Medical school is 11 years, getting your PHD in nursing is about 8-9. Get off your peddle stool, they know about medicine just about as much as you do, if not more. Not to mention they are better with patient care. And specialized nurses are now making a higher salary. A test shouldn't differentiate between a nurse with their PHD and a physician. Actually, I myself have met a lot of doctors that shouldn't be practicing medicine.

john said...

@ Anonymous 10:45 PM:
First off, it's "pedestal", not "peddle stool".

Your point about nurse practitioners with doctorate degrees having to go to school nearly as long as doctors is garbage. The length of time spent in school is not necessarily indicative of your capability as a health care provider, it's all about what was being taught in that time period. A nurse with a doctorate is still a nurse and simply will not have been exposed to the same information a doctor has.
As important as nurses and nurse practitioners are for supplementing physicians, they simply do not have the knowledge base to replace the care of a trained doctor.

Anonymous said...

Call them "Nurse SoandSo." If you know marital status, you can write Mrs. or Miss SoandSo instead. It should be fine. But never call them doctor. Even if they have a DNP. The DNP is just a degree creep. They added a few fluff classes and decided to call it a doctorate. DNP's are Nurses, and Nurses rule! No shame in being called a nurse. I think it is more shameful to misrepresent.

Anonymous said...

Nurses with a Doctor of Nursing Practice are indeed Doctors, as the title indicates. Same as a PsyD, PharmD, DPT, all have earned the title of doctor, and deserve the recognition. If you look at the history of the term "Doctor" in American culture it is Lawyers who were first called Doctors, as they received the Juris Doctorate. More commonly they are called Councilor now in a court of law, and Attorney's by the public. After this, physicians became known to the public as "Doctors". I believe this was a push in early days of medicine to distinguish those that actually went to school for their training.

Interestingly, outside the US, physicians are not referred to as "Doctors" but rather Mr. or Mrs. Most other countries reserve the title of Doctor for those that have earned a Ph.D or US equivalent.

Currently in the DNP program I am attending only those with Ph.D's are referred to as "Doctor" when an introduction is made in a formal setting. But have also noted that of my professor's which mostly consist of Ph.D, some DNP, and a few MD's, they are all called by their first names, as they have requested such.

I have heard so many sides of this story, lay person, physicians, even nurse practitioners on both sides of the spectrum. From how its not a real doctorate degree, to how it can be confusing to the public. The bottom line... nobody wants to accept change.

Having completed my first year of three, I recall many times I had wished I had found a Masters Degree program. I would have been half done by now. All the extra course work in research, evidence based practice, Biostatistics, Informatics, and other "fluff" as some might put it is preparing me to be a real ..... well scientist. I see it as nothing but preparing me to be an outstanding clinician and consumer of credible scientific research for the best outcomes.

So when I graduate, do I expect to be called "Doctor"? Only if the public recognizes that the title "Doctor" is an educational recognition that addresses numerous fields. Otherwise, I'll continue to go by my first, and last name as I have for 13 years as a nurse. Im somewhat proud of my experience, my education, and not to sound rude....but I dont want to be referred to as a "Doctor" if anyone would ever think it means I am a physician.

vladi p said...

Many people call other people doctors. Yet the circumstances are different. In clinical testing only M.D/ D.O should be referred as doctors. Nps with Phd can be called professors but not doc. Any other way is misleading. Because on a surface everyone looks or dresses the same. But the differences lies in level of education. Doctors get 4 plus year med school, 3 plus years residency, plus many examinations. This is not fun training this is hardcore. No else studies as much. Expirience counts but education level is just as important. You wouldn't want cops rescuing you from fire. And they might recieve similar training and gamy years expierience on the force. They may even hold fire fighting certificate. They are not however fire fighters! Let doctors be doctors, let nurses be nurses.

Anonymous said...

1. Patient outcomes are often more positive with NP's because NP's are not allowed to see critical cases. Rightfully so, they lack the expertise.

2. When in a hospital, if a patient says "I want to see a doctor" do you think he/she will be satisfied if I bring in a PhD in history. "Well doctor what do you think is it cancer?" "Hmm I don't know anything about cancer, I do however know about the civil war. Well it all started when..." Don't be ridiculous. DOCTOR means Medical Doctor in a hospital. Just like Doctor means dentist in a dentist's office.

Anonymous said...

According to the Merriam-Webster Dictionary the term "doctor" is defined as the following:

1) a person who has earned one of the highest academic degrees (as a PhD) conferred by a university
2) a person awarded an honorary doctorate by a college or university
3) a person skilled or specializing in healing arts; especially : one (as a physician, dentist, or veterinarian) who holds an advanced degree and is licensed to practice

I would say that if Medical Physicians are concerned about confusion then they should pursue legislation that only allows them to utilize the term "doctor". I don't think this is something they are willing to do nor do I think anyone would allow this. This is simply a case of tradition. Historically we have called Medical Physicians "doctor's" and that has become the common representation but by definition this is not an all inclusive title to be used only for Physicians. I am not sure as to the credibility of MedicineNet but their definition is as follows:
Doctor: In a medical context, any medical professional with an MD, a PhD, or any other doctoral degree. The term doctor is quite nonspecific. A doctor may, for example, be a physician, psychologist, biomedical scientist, dentist, or veterinarian. In a nonmedical context, a professor of history might be addressed as doctor, an eminent theologian might be named a doctor of a church, and a person awarded an honorary doctorate by a college or university might also be called a doctor.

The word "doctor" comes from the Latin "docere" meaning to teach. A doctor was a teacher, especially a learned or authoritative one.

Anonymous said...

This is such a lively conversation with little merit though. I am an NP and I have a Doctorate in Nursing Practice. So I am Dr. bla bla bla NP. No problem. I have a doctorate and do not say I'm a physician. Physicians do not hold the patent on the word doctor... it's a educational designation. If I can't use doctor, let MDs drop it too and call themselves Physician so and so. It's the same thing!

Anonymous said...

Additionally, NPs have a lot more education than you think getting their NP and doctorate. MDs spend their first 4 college years doing whatever. NPs spent their first 4 years in college doing nursing. Then two years for a Masters, then an addition 3-5 completing the doctorate. All in patient care. NONE in basket weaving. Ask those who see NPs about the level of care they receive. Education is different but not inferior.

Anonymous said...

When someone is in need of medical attention they never call for a nurse they call for a doctor! This goes to all of you trying to put down doctors. I am married to a physician and I can tell you that medical school and residency and fellowship and now board certifications every ten years or so is a lot harder than most PhDs to the exception of a PhD in Chemistry. Do not take away from what physicians do and know.
I am very good at diagnosing and maybe prescribing but it takes a lot more knowledge about anatomy and physiology to be a physician.
That being said I was reading the postings because I wanted to know the proper way to address the nurse practitioner I see. They are wonderful, they do a great job and I want to give them all the respect they deserve but I do not think calling them doctors is it.

Anonymous said...

MDs spend their four years of college learning biology. They learn about human life at the molecular and cellular level which is very important in order to know what happens when you get sick. I always here people talking about the human body thinking they know more than physicians including my dad and when you talk like that all of us know that you do not know what you are talking about. I have taken my fair share of anatomy, physiology, biology, chemistry etc to know how little I know compared to physicians. People know your limitations ...

Anonymous said...

Nurses spend 2 years of undergrad doing "nursing stuff," 2 years for a masters, and ~ 2 years for a doctorate. 2+2+2=6 yrs compare that to ~11 years to become a board certified physician.

Anonymous said...

I have hiv and I've not seen an MD in 3 yrs. Instead, I get PAs and NPs and they want to act like they are doctors, but when I ask them intelligent questions about research they think that I am undermining them because they are taught to follow a very strict flowchart / decision tree on care and my questions scare them outside of their safety box.

I think one thing being an MD gives you is the confidence and wisdom to use your intelligence, knowledge of biology, biochemistry, biostatistics and reality to make an informed, smart reply. I think PAs and NPs I've encountered don't do this, but they want the respect and they will not get it from me.

They can't remember what happened last time, can't remember my name, manufacture mythologies about my diet based on how I look (ie: they say, "stop the fast food..." so i'm overweight from meds but no, I must be eating fast food...yet I eat only an organic vegetarian diet!).

I'm never calling these people doctor. Having a phD in English doesn't compel me to call you DR unless I'm in your class. Likewise, having a phD in nursing will not compel me to call you DR especially in the context of treatment/care, but I would I were in your nursing class.

Calling a nurse a DR is like calling the guy who washes the space rockets an astronaut.

Anonymous said...

I call them trash, because that's what they are. They put you through a process that feels like you are getting an oil change. And if only it were so, if I could go through a machine that read everything, I'd be happy. But in addition to a clumsy oil change, you get human judgment, criticism and then a big bill, for basically doing nothing.

Anonymous said...

Let's call anybody that has contact with the patient, "Dr."

That would make everybody happy. After all, the only difference between MD, NP, NP-PHD, PA, LPN, RN, and MA, and office staff, is the amount of school, and clinical training right? Years of experience more than makes up for the educational differences right? So its all a shade of gray? No winners, no losers? everybody is equal?

Then if patient is mis-diagnosed, or becomes acutely sick, and heaven forbid, dies...Doctor? Where are you, all you doctors? Or, The practice has a couple of slow months, and can't meet debt obligations, and payroll. More and more capital is needed to survive and employ ten or twelve people... Now who is a doctor? Doctor? Who can chip in another 50k? Do some of you Docotrs mind going and mortgaging your homes and getting a loan to keep the practice going? Hello Doctors? Anybody there?

If a person wants to be called Doctor, go to school, and become a physician. It's a free country. For the bright, and persistent,MD can follow your name. You will make alot of money. You will also pay out alot of money in insurance, payroll, rent or mortgages, insurance processing, equipment leases, utilities, taxes, more taxes, more insurance, professional dues and licenses, supplies, and a hundred other gotchas.

Nice to meet you Doctor!

Anonymous said...

Physician = occupation

Nurse Practitioner = occupation

Doctor = doctorate college level degree in anything.

Get the picture?

Anonymous said...

Hello. I am a doctor. I studied hard. I got top grades while young. I went throuh med school while young. It was concentrated, tough, unbelievable demanding, often totally unreasonable. I call myself doctor in a clinical context because I am. I earned it. I have huge respect and admiration for my nursing colleagues. But they don't pretend they can do my job. To be a doctor is amazing just as it is damaging to the lives of those who do it. The brutal truth is that being a doctor is to choose a path of sacrifice. I'm glad I've done it. But please don't compare me to someone who gradually, bit by bit, picked up moree qualifications here and there and now pretends. Pretends they have taken my path, have sacriciced all I have, have contributed as much as I have. Please, all you wannabe doctors, why do you bring such decietful disgrace on your perfectly valid paths. You know full well you are engaged in misrepresemtation. Your arrogance, deciet and jealousy are sad. AS has been said before: If you want to be a 'doctor' in a medical context then lay down the same sacrifices as medical doctors do and go to med school. You disgust me. If I met you in clinical practice I would smile at you. Don't be taken in by that - I smile and nod add I dont have the time to swim against your torrent of self serving, self deceiving BS. Yours faithfully. A 'doctor'. Thats right excelled from an early age, completed a gruelling curse in a concentrted fashion while young and has all the clinical experience you tack your flimsy argumants together with. So....the word 'doctor'. You know what that means now. Its clear now I hope. If not then you can do another 'doctorate' in your much vaunted 'common sense'. Also then nice, trusting patients won't be taken in and thing you are capable of what I have proven. Accept your lot in life or change it with honesty.

Anonymous said...

Haha, I love this:

"It was concentrated, tough, unbelievable demanding, often totally unreasonable."

...

"But please don't compare me to someone who gradually, bit by bit, picked up moree qualifications here and there and now pretends. Pretends they have taken my path, have sacriciced all I have, have contributed as much as I have"

-----------

As a generalization, doctors are the second most deluded and brainwashed professionals -- behind pharmacists -- as to their value to society. The chief argument they cite for being able to provide better care and diagnostics is that they went through more education, that they passed more useless tests and stayed up longer nights goose-stepping their way through as much rote memorization as the AMA posits they could take, slaved away as indentured servants to their masters for token pay, etc. etc.

Then these tools swipe in to see me for a quick sec, check my reported symptoms against their computer (read webMD) and either tell me what I already know from webMD, or have someone else run the tests to round out the data needed for the webMD checklist. And then, when there is something complex at issue, they just pass the buck on to the specialist because they can't be counted on to be 'expert' webMD browsers at everything!

So, when an MD general practitioner insists on being recognized as superior to anyone I just laugh -- out loud. What they are insisting on is to be called a chump. They are insisting on being recognized for jumping through more hoops than anyone, being a pliant little puppet to the interests of their trade association, all for the privilege to add no value at all to the health of their patients above and beyond what their staff does.

And these tools punch the clock right at 5 every day (sorry if you were 10 minutes late for your appointment) in a mad rush to get home and catch the latest E.R. or House episode so they can reassure themselves of their superiority. "Oh look, here comes the doctor! He/She's so brilliant! They're going to get the Nobel prize for solving this complex riddle of biophysics that are this chap's symptoms! What a genius hero, saving lives at every turn!" Cue humble, frumpy, incompetent nurses and staff lining the halls clapping adoringly for the hero Doctor! "No petty nurse could do this with their 9 years of training, geez, isn't it obvious that 11 years of being a complete tool are required in order to solve problems and think independently?" Yes, of course it's obvious, the doctor reassures himself.

I for one prefer to see NPs, no matter what my situation, because the fact that they ARE NOT a doctor means they might actually have some critical thinking skills.

Enjoy your marginal social prestige while it lasts, Doctor. The AMA can only protect your ego and your salary from the reality of your unassuming role in modern medicine for so long.

Anonymous said...

1. I am an NP in pulm/cc. I see critical care patients.

2. I see them independently and bill and get reimbursed for my services

3. My collaborating physician who has been practicing for over 25 years says that I am as smart as any PCP and most pulmonologists that he knows.

4. I am not a phsycian nor do I pretend to be one. I love what I do. And I get get paid WELL to do it. no overhead, no massive medical school bills..... who is smarter?

Galen said...

"...throuh med school..."
"...unbelievable demanding..."
"...moree qualifications..."
"...have sacriciced..."
"...in misrepresemtation..."
"...deciet..."
"...add I dont..."
"...concentrted..."
"...flimsy argumants..."
"...and thing you..."

Med school graduate - CHECK
Board-certified - CHECK
High-school level English skills - hmmm...

Way to prove your point, Doctor.

Anonymous said...

Let's simplify everything. Everyone (nurses, doctors, staff, clients) should call an MD or DO doctor; again, everyone (nurses, doctors, staff and clients) should call an NP "Master"

I'm less than one year from being "Master"