Nursing excluded as 'professional' degree by Department of Education | Hacker News Reader

Nursing excluded as 'professional' degree by Department of Education

nurse.org

145 pointsourmandave95 comments

This applying to graduate degrees really does seem like the result of AMA lobbying to keep Nurse Practitioner numbers down. It is state and program dependent, but in some states NPs have prescribing authority, which cuts into the domain of MD/DO practice in the US. There are of course merits to the argument about NP training vs MD/DO training in Pharmacology, but overall this limits patient access in America to prescribed medicine.

Congress, at the behest of AMA lobbying, had kept the number of Medicare funded residency slots capped at the same number since 1997 until the Consolidated Appropriations Act of 2021 which added 1000 new residence slots[0]. Starting in FY 2023 (October 1 2022) no more than 200 new positions would be added each FY meaning the full 1000 could be created no sooner than FY 2028 (October 1 2027). Given the medical school timeline of 7-10 years training (school, residency, fellowship) we won't see any meaningful impact from that until the mid 2030s.

The US already has a much lower physician to patient ratio than Nordic countries (as a comparison between wealthy, western countries). The us has 2.97 active physicians per 1000 population, of which 2.52 are actual direct patient care physicians[2]. For comparison Sweden is ~5 per 1,000, Norway 4.5 per 1,000, Denmark 4.45 per 1,000, and Finland at 3.8 per 1000. Extra Bonus (Russian Federation reports 4.0 per 1,000)[3]. Note these numbers are as of 2020.

In America, most people interface with doctors in order to get tests run and medicine prescribed. Reducing the incentive for RNs to move into NP by removing it's professional degree status will likely lower the amount of prescribing individuals a patient can interface with, increasing bottleneck and time to care.

[0] - https://www.sgu.edu/news-and-events/new-residency-slots-appr... [1] - https://pmc.ncbi.nlm.nih.gov/articles/PMC8370355/ [2] - https://www.aamc.org/data-reports/data/2023-key-findings-and... [3] - https://www.worldatlas.com/articles/countries-with-the-most-...

I haven’t seen a MD in years. I’ve only seen nurse practitioners, at least 5 years now. Health care in the US is deadly, expensive joke. But Fox and friends tell us how great it is compared to socialist countries! Yay!

My current working theory is that US systems are in general great, if you're smart and educated enough to not get scammed. There's a high level of knowledge you need to just exist in society without being preyed upon by some entity.

Unfortunately, healthcare is probably the most glaring example of this. It's already K-shaped based on the insurance you have (or don't have). In addition, most americans just aren't educated enough about their own bodies and medicine to accurately convey their problems to their care team, and that's before how likely they are to believe you.

I have a great PPO plan and spend a large amount of time each year researching care for longevity and curating a care team, or cash-only practices for things. If i lost that, then i'd be hosed. I can't imagine how people on HMO or medicare plans work.

NPs fulfil a very useful niche, even if that niche is "you tested positive for strep, here's your antibiotics" keeping physcians and PAs able to care on more severe persons.

> In America, most people interface with doctors in order to get tests run and medicine prescribed.

In my experience, NPs already carry a lot of this load, especially in non medical speciality cases (i.e., what a GP or PCP would do).

Another example of self-harm to protect a wealthy segment of the population (doctors) at the expense of those who need medical care. It's not just time to care that's the problem. Scarcity drives up prices as well.

Regressive. Divinity on the list, but not nursing and advance nursing degrees.

chiropractors also have an origin in pseudoscience, they have sort of evolved into scientific studies in many ways but part of the quackery remains.

Chiropractic was taught to its founder by a ghost

So you're saying it belongs under divinity?

The ghost wasn't holy

It was some regular dead dude’s ghost not god

That’s funny.

But when Ramanujan says 1 + 2 + 3 + … = -1/12 because god told him we accept that as a reasonable explanation.

>But when Ramanujan says 1 + 2 + 3 + … = -1/12 because god told him we accept that as a reasonable explanation.

What community accepts that as reasonable explanation?

I think Ramanujan’s results attained acclaim and notoriety long before rigorous proofs were discovered.

They came to him from God. So apparently divine inspiration can indeed be valuable. Who is to say a Holy Ghost couldn’t divulge secrets of medicine to an anointed prophet.

If you believe in God, it’s blasphemous to suggest the chiropractic ghost was divine or holy. It was the ghost of a regular man.

1 + 2 + 3 + … = -1/12 in the sense that you can factor out the divergence in a well-defined way, and the remainder is -1/12, not 0. Anybody glossing over that divergence is just baiting you, usually for advertising revenue.

In what way are they anything but quacks?

They have more scope to experiment, in my case it was a way for me to access PRP injections before wider adoption. They are paid rather orthography to treatment, they can treat other things while also giving you regular spinal adjustments - similar to the idea that researchers should be paid to teach as paying them to research will pollute the research. We need a way to continue paying dentists so they can stop finding ‘soft spots’ that don’t exist.

I dislike the quackery but traditional science isn’t free from it either. I wish everyone was rational, evidence based and disinterested (as in not having a particular interest on biasing an outcome). But the world we live in is far from that. Consider the percentage of ‘normal’ medical doctors in Germany who believe in homeopathy. A large part of that is due to the terrain school of thought in medicine which lost out to germ theory. An artifact of history rather than rational people and rational study. I’m still looking for a better way the phrase it; but it seems to me that the belief in the belief of science far exceeds the actual belief in science.

If doctors / medical researchers really were so good at research they wouldn’t have taken so long to rediscover the ancient practice of prolotherapy.

> in my case it was a way for me to access PRP injections before wider adoption

So they are not only quacks, but also grifters? The evidence for PRP is basically non-existent. It doesn't hold up in RCTs: https://www.jwatch.org/na54355/2021/12/27/evidence-against-p...

(To be fair, chiros are not unique in grifting PRP -- I've seen traditional doctors selling it too.)

> Consider the percentage of ‘normal’ medical doctors in Germany who believe in homeopathy.

I hadn't heard of this, but, yeah, that's also quackery. Wild. 32% of German GPs report "using" homeopathy once a week. The US medical system may have some problems, but at least believing in homeopathy isn't one of them.

I had a limp from an injury that persisted for 8 years before PRP cleared it up in 3 months. I would have gotten the French sucrose injections earlier but France was a far way off and I couldn’t afford it at the time. I put it in the bucket of prolotherapy not in the bucket of stem cells and on that basis it absolutely works. Being a substance derived from the patient allows it to skip over regulatory hurdles, as mentioned I would have taken sucrose but that wasn’t on offer. The evidence for prolotherapy working is extensive, far exceeding a single study.

In studying actual science along with the fake stuff, mostly. Nowadays they have anatomy, physical therapy classes, etc.

Some of their techniques are also proven to be useful-ish for short term pain management (not for the reasons they claim, it’s similar to acupuncture). So someone who actually tells the patient that the treatment is exclusively for physical therapy and only short time benefits might be useful.

Few are that honest, but for some people that kind of short term help is vital.

It might be what gets you through the wait for a long term procedure, or what lets you rest and sleep to improve actual recovery, for example. Pain management is a need for some people.

Meanwhile when seeking treatment for pain with western medicine:

* first see a GP, no real diagnosis.

* get an ultrasound - everyone already knows it won’t show anything of use but insurance companies require this escalation path

* get an xray - same as above

* maybe if you insist get an MRI.

* regardless the treatment is the same: go to a PT’s office.

That's an artifact of the health system (as an economic/insurance system), not of medicine itself. Chiropractors are different, the problem with them isn't the bureaucracy of insurance.

Conflating medicine with how health systems work in some countries is a serious error.

physical therapist != chiropractor

The professions are traditionally divinity (https://en.wikipedia.org/wiki/Divinity_(academic_discipline)), medicine, and law, so I don't see how you could remove divinity from the list. When you argue for including nursing as a "professional degree", what you're arguing is that it belongs to the category exemplified by those three instances.

Edit: please see https://en.wikipedia.org/wiki/Profession for the current undestanding of that category.

[flagged]

Without the 13th-century POV in question, the distinction becomes meaningless.

Why? Can we not define what a professional degree is without the historical baggage?

You could make up a new category and call it by the same name as the old category, if what you wanted was to confuse people and make clear thinking more difficult. If you want to define a category without historical baggage, I would prefer that you used a different term so that it was clear that you weren't talking about the concept laden with that baggage.

I don't think many associate the term with the historical baggage here, so its you who are confusing others by using it that way rather than the opposite.

They may not be consciously aware of it, but that makes them more likely to be influenced by it, not less. Having unexamined opinions generally means having self-contradictory opinions, which makes you easy to manipulate.

Moreover, the Department of Education is clearly using the term in the sense I am describing, about whose further historical development you can read more in https://en.wikipedia.org/wiki/Profession.

> Moreover, the Department of Education is clearly using the term in the sense I am describing

But that change will confuse people since it has been a professional degree for a long time now. Using ancient definitions causes confusion, it doesn't resolve it.

I'm talking about divinity, not nursing.

Words evolve in meaning all the time. What's included in "science" now is very different from what was included 500 years ago. Doesn't mean we should create a new term for it each time a new discipline is added.

maybe we should include alchemy in the list then

Ever heard of Chemistry?

Chemistry is not alchemy and astronomy is not astrology and philosophy is not divinity.

Alchemy and astrology were the precursors to modern chemistry and astronomy.

Alchemy was a subfield of natural philosophy, not a profession. Its European practicioners had typically studied medicine or theology.

Is this sarcasm?

And people say the humanities aren't important....

Absolutely

Adore your handle

What is divinity?

Edited into parent.

A masters level degree in Christian theology. Traditional Christian denominations require it to be a priest or pastor.

Is the US government preferring one religion over others?

Is nursing not medicine?

It is.

Wtf does tradition have to do with it?

Why the hell does a large portion of this country give a rats ass about tradition, but also larp as caring about progress and effectiveness. These two are logically inconsistent.

If anything we should be removing more traditions than ever.

Word meanings are determined purely by tradition. There isn't an objective reality about what words do or don't mean apart from how people use them. If you make up your own definitions for words instead of using the traditional ones, you sacrifice the possibility of communication with people who don't know your definitions. That's glory for you!

Words change meaning and definitions drift all the time. Language isn't static and adapts to modern times.

Besides, this bizarre tangent about tradition ignores that this has some very practical downsides for nurses, it's not just about preserving tradition or whatnot.

You're equivocating. Rejecting the relevance of a centuries-old traditional definition does not mean that all words have suddenly lost all meaning.

The problem is the "traditionally" part. What merit does tradition have? None.

Of course tradition has no real merit on its own, but studying the same linguistic tradition is what enables two people to communicate by using language. Unless you manage to complete John Wilkins's project, perhaps, and eliminate the arbitrariness of Wilkins's decisions.

However, in this conversation, we are speaking English, whose words owe their meaning entirely to tradition.

> However, in this conversation, we are speaking English, whose words owe their meaning entirely to tradition.

The meaning of words change over time, so you are wrong, words meaning are not entirely from tradition or else their meaning would not change.

Or if you agree that traditions can change, then what the word meant year 1300 doesn't matter, things has changed since then.

And the word "word" used to mean "to speak", as in make a sound. The word "merit" likely meant "to assign". Current day meaning matters a lot more than what something used to be.

Yes I profess that these antiquated terms are deeply disturbed

> Regressive. Divinity on the list, but not nursing and advance nursing degrees.

The list on the site has Theology, not Divinity (which is a bit ironic, because Divinity is traditionally the professional degree and Theology the academic one.)

Just to note, this is probably American Medical Association lobby change since it impacts graduate nurse programs so not RNs but Physician Assistants/Nurse Practitioners and like.

Graduate programs in some domains tend to be a relatively affordable way to insure against opportunity risks (nursing, not divinity)

The context is some interpretations of Baumol effect, as discussed here for the very parallel case of childcare

https://news.ycombinator.com/item?id=45956525

Excluding nurse practitioners & physical therapists but including osteopaths, theologian & chiropractics is insane.

It seems like there has probably been a lot of scope creep in the nursing role due to the artificially induced doctor shortage. Wonder if the de jure/de facto gap there plays a role in this decision and how it’s perceived.

A nurse anesthetist median income in the U.S. is 223210 USD. They administer medicine throughout surgery, e.g. brain surgery, open heart surgery, etc.

They make more than I do with over 25 years as a software engineer. If that’s not professional, what is?

Seems fairly regressive to health care costs for everyone.

…so tracks for America.

I heard they are getting rid of the Department of Education anyway.

This is all about student loans, and destroying the academia, with a nice dose of quackery and anti-intellectualism thrown in for amusement. While it does not impact me at all to know my degrees are no longer 'professional', it really impacts folks trying to get loans to pay for college. Having less nurses and teachers out there is going to create many problems in the coming years, that is if we actually care about we the people.

Why is there medicine and then like 8 kinds of medicine? Does this mean something like anesthesiology is also not 'professional?' Or why is podiatry singled out but not the others?

They are different degrees based on different curricula. Anesthesiology is a specialization you can choose after finishing MD in "generic" medicine.

Class warfare

Theology is a professional degree, while Nursing is not. Dumbfounding. Handmaid's Tale may turn out not to be fiction after all.

Well if you know your theology you should know

>Women should remain silent in the churches, They are not allowed to speak, but must be in submission, as the law says. If they want to inquire about something, they should ask their own husbands at home; for it is disgraceful for a woman to speak in the church (St Paul, https://en.wikipedia.org/wiki/Paul_the_Apostle_and_women)

though I think that stuff is a bit outdated even if it's in the Bible.

> a bit outdated

"a bit"? like 2000 years outdated

> even if it's in the Bible

the Bible also says you get stoned to death for adultery; we bring that back, starting with Trump and all rich bozos who cheat on their wives, and then we can talk about women keeping silent in the church

(not to mention that stoning is a very slow and painful death)

Anything to give the for profit medical and insurance industry an excuse to cut nurse's wages. So transparent.

As I've explained to my NP colleagues (ones that have already completed school), this actually helps them (the impending oversupply threatens NP wages, as some of them are already having trouble finding the job they want since the 45 different APP degree offerings create an unrestricted supply). And while this might discourage some people from entering nursing, that will again only decrease the supply, which will increase the wages since you cannot replace nurses. But that would be a bad thing, as hospitals are already in a crunch trying to find nurses and pay them fairly (a large and different discussion).

On the physician side, there's definitely big changes coming, and I'm banking on a move to up-front APPs and a few remote physicians overseeing things. But I'm actually also seeing a number of entities that hired a bunch of APPs and are now moving back to physicians only and saving money doing do (think urgent care, ED, inpatient), though some specialties work very efficiently with a primary APP or co-management model, particularly the procedural ones.

> impending oversupply

Why? As you said, hospitals have a hard time finding nurses (undersupply), so more nurses would be better for patients and hospitals. An influx of more nurses could ease the undersupply, but I don't see why it would necessary overcome it completely and even lead to the impeding oversupply.

I'm talking about an oversupply of APPs (most NPs and related degrees), not nurses. Nurses are currently in short supply (hence the travel nurse phenomenon where some of them are paid more than physicians).

Let me help with that APP: The acronym APP in the context of a nurse practitioner stands for Advanced Practice Provider

Is there really an oversupply of APPs? That's certainly not the case in my state which has long wait times to see a doctor or NP.

Good grief.

Incredible things happening in America these days.

there's been nursing shortage for my whole life, what the hell is wrong with people? why can't we take care of each other

Because if there us a nursing shortage there is opportunity to 'supplement' existing nurses with AI and thus transfer more wealth to the very richest among us

This doesn't make much sense to me. As the previous commenter mentioned, this shortage has been ongoing for decades, it's certainly not new in the last two years. Additionally, nursing is one of the jobs least replaceable by AI.

There's a nursing shortage because the work is brutal, under appreciated, and under compensated aside from travel nursing gigs, for those who can maintain that sort of lifestyle. Nurses are a cost center, so management is constantly running floors understaffed. It's to the point that they receive bonuses for running the floor as thin as possible, despite the worsening of patient outcomes and nurses' sanity.

Don't get me wrong, there are some good gigs for sure, but there are lots of terrible ones.

It's possible you've been lied to. Every single industry always says "there's a shortage" so they can justify expanding the labor pool to drive salary costs down.

Perhaps! though this doesn't change the sentiment

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