A HISTORY OF THE SHAM SH%T DNP DEGREE AND SCOPE CREEP
For those who may not know, the nurse practitioner scope creep matter has been an issue for decades–it simply was not publicized like it is now. Mary Mundinger, DrPH, is the recognized mother of the nurse practitioner(NP) independent practice movement(aka full practice authority or scope creep or the unsupervised practice of medicine) and a hack for United Health Group(UHG). In my opinion, her goal was for nurses who possessed master’s degrees(NPs) to be promoted as analogous to medical doctors for two reasons: so nurse practitioners(NPs) would get the same prestige and respect as physicians and more importantly, the same reimbursement for supposedly possessing “expertise” in medicine. But she could not make that exact statement because NPs are nurses, not physicians. They are experts in nursing, not medicine. She could however emphasize their competence in “comprehensive care”, a vague concept which one can arbitrarily assume is comparable to medicine. Known also as advanced practice registered nurses(APRNs), the focus would then be on the term “advanced”, further embellishing the conflation. Brilliant marketing strategy and effective spin. The screenshot below describes her vision. To her credit, she made a lot of this happen. But she could not have done it alone. But first, she needed to “validate” the sham s**t Doctor of Nursing Practice(DNP) degree.
Enter the National Board of Medical Examiners(NBME), the board responsible for developing the United States Medical Licensing Exam(USMLE). All they have done since they originated in 1915 is create assessment tools for those in the House of Medicine. In other words, they are proficient at developing exams. So the Council for the Advancement of Comprehensive Care(CACC), of which Dr. Mundinger was president, joined forces with the NBME to create an exam for DNP recipients who, if they performed well, could be sold as “being as good as” physicians. The exam, which was fashioned after the USMLE exam Part 3, was administered for five years at Columbia University(Dr. Mundinger’s alma mater and where she was former dean of the nursing school). It was an abject failure. Their performance on the exam was abysmal.
When one administers a medical competency exam to people uneducated and untrained in the practice of medicine, what the f**k else would one expect to happen? Academic excellence? As an aside, the CACC also established a “board” for the DNPs who passed the exam with success–the American Board of Comprehensive Care(ABCC). Hmmm…no conflict of interest there. Sponsors included the federal government and the Robert Wood Johnson Foundation, well known for its enthusiastic support of the unsupervised practice of medicine by NPs. Yeah, both the CACC and ABCC are now defunct.
“The ABCC and its programs are supported by grants from foundations and universities, as well as examination fees, and revenues from certification-related activities. ABCC sponsors have included: the federal government, New York State, the Josiah Macy Foundation, the Robert Wood Johnson Foundation, the W.K. Kellogg Foundation, the Teagle Foundation, the Commonwealth Foundation, the Arthur Vining Davis Foundations, the Stavros Niarchos Foundation, and many other private donations. For more information about the ABCC, go to http://www.abcc.dnpcert.org(link is external and opens in a new window).”
Second, the DNP was to be a clinical degree, which would presumably add credibility to their academic pedigree. That failed also. The NPs that took the modified NBME exam had completed the clinical version of the DNP; however, 85% of the DNP degrees today are NON-CLINICAL, making the clinical degree no longer relevant. Turns out clinical programs are rigorous and require a lot of work and funding to develop. NPs seeking these degrees don’t want to work, they want s**t quick, fast and in a hurry. The non-clinical DNP enables them to do just that. Nothing worth having ever comes easy folks. But you can’t tell them that. But I digress…
The third step was to get docs on board with this nonsense–to advocate for “nurse-doctors”. Dr. Mundinger found some traitor trash sellouts at the Institute of Medicine(now known as the National Academy of Medicine) who wrote the 2010 white paper on the “Future of Nursing”. IOM attempted to get some physician organizations on board with this preposterous idea, which would strengthen their case. Yeah…No. They said f**k off, including the AMA.
Unwilling to be undone, the fourth strategy was to convince anyone who would listen that NPs could practice primary care–by implying it was easy. Internal Medicine, Family Medicine, Psychiatry and Pediatrics are the most difficult specialties in medicine due to them requiring a significant amount of cognitive, comprehensive knowledge of medicine. The umbrella term “Primary care” makes the s**t sound simple. Some smart docs in 2009 saw this coming…
Last, but not least, when the attempts to academically authenticate “nurse-doctors” failed, these agenda-driven NPs hustled their a**es on over to the simp-and-pimp legislators, their final resort. They batted their eyelashes, whined that they were being bullied by the big bad physicians who were protecting their turf(we were–from charlatans), which the NPs felt they had an inherent right to trample on, and brought with them the obligatory Benjamins to seal the deal. That worked better than a blow job. They currently have unsupervised practice in 27 states. Mind you, at no time during these extensive activities did Dr. Mundinger, or anyone else who believed that ARNPs had “broad” medical knowledge(see screenshot below), ever provide an explanation as to how they had acquired the expansive knowledge that has taken physicians over a decade to learn. Therefore, I must surmise it was by osmosis. By simply being in sheer proximity to physicians.
It is now 2023 and the unsupervised practice movement is in full swing. NPs were willing to spend many years attempting to become “doctors”, first by manipulation of degrees/tests, then by legislation. They could have gone to medical school and become experts in the art and science of medicine like other nurse practitioners have, if they were actually serious about learning medicine. But they are not serious, they are grifters. Quality takes time…and effort. They cheated and took the easy way–by legislation and not education. Hmmph. No one respects a cheater.
No matter how small the dishonest deed is, at the end of the day, cheating is cheating.–Mohammad Amir
Once the “independent” N.P.’s get sued right and left for malpractice when they “don’t” have a doc to fallback on and shift blame, that will kill this movement pure and simple. If they want to stand on their own two feet then they can take all the blame for their f#$k ups. Their malpractice insurance will go to the moon. I worked with N.P.’s who knew their limits and would grab me in the office when they had a difficult case. When Debbie or Karen got to me for a question, I knew I had to put my thinking cap on. Many times led to a legitimate direct admit under my care. Our N.P.’s didn’t have an independent practice per se and worked with an M.D. Didn’t have hospital privileges either. If someone was really sick in the office, Deb would present the case to me, I’d see the patient and 100% of the time it was a legitimate direct admit under my M.D. name. Shoot it was like having a “real smart” resident doc working with you.
Turns out a docs day was devoid of “easy stuff” we could relax on and we got all the “hard stuff” to work on that took more time. Actually income went down a bit, though at the time we supervising docs got a “cut” of the N.P. production. That made it easier to swallow. If that’s totally illegal now, makes no sense to work with an N.P. if can’t get a modest cut of their production. Heck that’s what might be the reason they want to be independent so they can “get all the money”!
Back then our practice got overall better Medicare and Public Aid reimbursements if we used “physician extenders” ie. N.P.’s in our practice. Even the docs got paid a little extra to see regular patients if we had N.P.’s in the practice. It was a “Gubbermint thing”. Hence that’s why our multi-specialty practice allowed/voted for them. Surgeons loved them as the N.P.’s were H & P dogs. If the patient had some significant medical problems, they’d send’em back to the primary care doc to do the surgical clearance. (Which was likely a good idea.)
I’m retired 2 years but back in the day, the N.P. thing was good for our practice. They knew their limits and grabbed a doc when they needed them 100% of the time. Kurt
“They could have gone to medical school and become experts in the art and science of medicine like other nurse practitioners have, if they were actually serious about learning medicine. But they are not serious, they are grifters.”
Perfectly stated!! It’s all about $$$ with these people. They don’t want to really learn and practice medicine competently. It’s all about reimbursement (grifting).
Ludicrous article and ludicrous comments from very insecure and grossly jealous people. What a shame that this has become ALL ABOUT YOUR WEAK EGO and not patient care. I suppose that is why an APP is preferred over an MD by so very many patients. I work with many, both MD and NP. Actually have family at UCLA, Vanderbilt, and Neurosurgery law in 36 states. You ALL have completely MISSED the mark on the purpose of care. It’s so easy to work together; MD, NP, PA, and RN – such a shame Natalie, you are a weak pious insecure woman. If you have so much knowledge, START a fellowship program to help these sub-professional basic RN’S with extra letters. DO SOMETHING ABOUT THE KNOWLEDGE GAP YOU BITCH ANOUT SO OPENLY. Such a weak woman, small small mind, and truly a disappointment to the field of medicine.
I will let this go through for now. I will let Dr. Newman respond but obviously you have read nothing and are a militant NP. If the rest of the militant NPs jump in then I just delete all their comments so don’t waste your time.
Ludicrous….except that nothing I have stated is incorrect. If you actually paid attention to what I have written(multiple articles), you would understand that the unsupervised practice of medicine doesn’t have s**t to do with “team”. It’s the antithesis of team and the reason I vehemently oppose it and will continue to do so. Try taking your uninformed opinion over the AANP whose stance divides the medical team, fragments care, endorses substandard NP education and is deceptive to the public. Perhaps they will give a shit about your opinion. Because you have no influence over here.
There is nothing more egotistical than nurses practicing medicine without a medical license. And seeking to do so by legislation rather than the appropriate education. Especially those who obtain their “advanced” education online. Not particularly interested in your ad hominems–just indicates that you have no legitimate response to my factual statements. Ad hominems are the last bastion of the intellectually bereft….You have a good day.
This is called a mic drop.
The profit machine asks, “If a rabbi baptizes a pig, can you sell it as kosher or halal?” There’s a question for the MBA’s!
I love the “play” on words. Primary care…….like simple care. WE know that a malady can be something simple….and we have also been exposed to worst possible case scenarios…..that is why our training takes so many years, and we see thousands of patients before we are set loose. In my field, every red eye is called a “pink eye”. What a joke! We have a continuous turf battle with the optometrists who can be fine “eye doctors” when there is nothing wrong (other than the ethical transgressions of selling people glasses when they do not need them, forcing vision therapy on unsuspecting parents who are worried about their child’s performance at school, selling unnecessary proprietary eye vitamins to most anyone, and needless high tech eye tests as part of routine exams, etc.)
Getting back to your post, I have been practicing in a rural area for almost 40 years, and all the old timer MD’s are dying off or retiring. Many of the remaining docs are using NP’s as extenders (cheap labor vs unable to recruit real docs). And then of course the hospital system is using NP’s virtually as doctor replacements- they run about 1/2 price and we all know how important that bottom line is! So few of my patients remain under the care of a real MD, and it continues to worsen. I do worry about my own health as I fear I will outlive my own internist. And I will never go to the ER unless I am on death’s door and do not want to make a mess at home. Not sure how I would react to an NP hospitalist doing rounds on me. I will probably need to use my own antiquated medical education for my own and my family’s personal needs. So I am preparing to keep my licensure until it is pried from my cold dead hands. I will keep the overpriced DEA license too, but I can skip the malpractice.
Nothing unusual as most all of our world is going to pot (literally/figuratively).
“Disruptive innovation” is mirrored by extinction. Every skill lost to a rule is a step into the Dark Age of tomorrow. “I dunno” is the only diagnosis needed for ICD-12