Not all doctors are physicians

by | November 15, 2018

KevinMD.com

Ira Nash, MD | Physician | August 28, 2018

A colleague recently sent me a link to the American College of Cathopathic Physicians a new organization whose mission “is to protect the professional autonomy and advocate for a full, broad scope of practice for DNPs as a ‘cathopathic physician’ completely equal in every way to our MD and DO counterparts.”

I was, I admit, so stunned by the statement that I thought the whole thing might be an elaborate joke. It was only after spending some time exploring the site that I realized that it was for real, and a really bad idea.

Let’s start with the absurd circular “reasoning” that the group uses to justify labeling DNPs as “physicians.” According to the site (their quotations are unattributed):

A physician is commonly defined as a “doctor who practices medicine” which is “the art of healing” or “promoting, maintaining, or restoring health through the study, diagnosis, and treatment of disease”. Other organizations, such as the federal government, define a physician as a healthcare professional with “the authority to make independent judgments in the examination, diagnosis, treatment, prevention, and care of the human body.”

It then goes on to advocate for DNPs to have such authority, which in turn it believes would justify calling DNPs physicians. And of course, once you get to call yourself a physician, why wouldn’t you have full independent authority? After all, that’s what it means to be a physician, right? So, basically, if you call yourself a physician, then you are one.

Of course, the site does its best to completely obscure the very real differences in training and experience that distinguish true physicians from DNPs and other health professionals. It is so much easier to just assume the functional equivalency of “different” training paths than to recognize that those differences in training lead to differences in knowledge, understanding, and skills. In fact, the group bemoans the “burdens of the current medical educational model” as a barrier to entry, without acknowledging the obvious: becoming a physician is hard because being a physician is hard. The years of nursing experience that DNP candidates bring to their training are held as a false equivalent of medical training. They are, in fact, no more a substitute for medical training than years spent as a laboratory scientist, hospital administrator, radiology technologist or pharmacist.

To make matters worse, the curricula for DNP programs often have minimal, if any advanced clinical content. A quick scan of DNP programs across the country at institutions like Duke, Vanderbilt, and Hopkins shows that the degree can be earned without any advanced training in the understanding, evaluation, or treatment of human illness.

Finally, the message repeated throughout the site is that DNPs are needed to alleviate the “doctor shortage” that seems to continuously loom just over the horizon. I remain skeptical that the situation is as dire as predicted, but even it if were, the correct remedy is to leverage technology and the diverse skills of a variety of health professionals, including advanced practice nurses, into a more effective team, not to label nurses as physicians.

Ira Nash is a cardiologist who blogs at Auscultation.

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