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When is a Doctor not a Doctor?

When I graduated from law school with my J.D. (Juris Doctor) degree, I remember getting a call from one of my smart-aleck brothers. We had another brother with a doctorate in theology, so Mr. Smart Aleck said, “Now we have two doctors in the family and neither one of you is worth a damn.” That might be a debatable point when he needs a lawyer, but he was reflecting a commonly held belief, maybe a bit old-fashioned now, that the only REAL doctors are M.D.s. But these days a whole array of health care providers attain doctorate degrees – most of which (like my J.D.) are non-research professional doctorates. So, physical therapists, pharmacists, and dentists are all “doctors.” But, especially in the field of nursing, the question of who can call themselves doctors has become an even hotter topic.

In my home state of Florida – where you can always count on the most extreme ideas to come from our state legislature – bills have been introduced that would force health care providers with doctorate degrees to explain to patients and the public that they are "not medical doctors" or face felony charges. Yes, that’s right – felony charges!!

The AMA has had a “Truth in Advertising” campaign for several years now. They have data that indicates there is a lot of confusion among consumers of health care as to who the various practitioners are. We in allied health know that this is a problem – everyone who has direct contact with patients is perceived by most patients as either a doctor or a nurse.

So, the AMA’s “model legislation” calls for all health care practitioners who come in contact with patients to wear a name tag “that clearly identifies the type of license held…” This is certainly not a bad thing and it would help promote the visibility of professions like medical assisting. The AMA’s material notes that the model bill “does not provide for criminal penalties.” But it goes on to say, “although a state may wish to pursue that course.” Really? Do we really want to further clog up our criminal courts with felony charges against a nurse practitioner who fails to clearly identify him or herself as NOT a doctor?? Will prosecutors, who are ever sensitive to political concerns, be lobbied to throw these “not real doctors” in the slammer?

For more information on the AMA’s campaign, here is the document I have cited:

http://www.ama-assn.org/resources/doc/arc/tia-campaign-resources.pdf. The AMA says this is not a “turf battle” but others disagree. Here’s an interesting article from Bloomberg that offers another perspective: http://www.bloomberg.com/news/2013-03-04/nurses-spar-with-doctors-as-30-million-insured-seek-care.html

State of the Education Union

Education and accreditation leaders were not shocked when, in his State of the Union address, President Obama said this about higher education: “Taxpayers cannot continue to subsidize higher and higher and higher costs of higher education. Colleges must do their part to keep their costs down, and it’s our job to make sure they do.” This is a theme we have been hearing repeatedly from the Administration.

But the “supplemental document,” released after the speech, did contain a very big surprise for the accreditation community. In that document the White House said: “The President will call on Congress to consider value, affordability, and student outcomes in making determinations about which colleges and universities receive access to federal student aid, either by incorporating measures of value and affordability into the existing accreditation system; or by establishing a new, alternative system of accreditation that would provide pathways for higher education models and colleges to receive federal student aid based on performance and results.”

Right now, in order for their students to receive federal financial aid, a college must have institutional accreditation from an agency recognized by the US Department of Education.  (This is different from program accreditation which is what CAAHEP does). The main purpose of the recognition by the Department is to assure that the accreditors are serving as “gatekeepers” for that federal aid. But with rising default rates on student loans and ever-escalating costs for a college degree, the Administration clearly believes that those institutional accreditors are somehow failing in their duty as gatekeepers.

There has been a lot of debate in recent years in the accreditation community about how we should balance our roles as the cop who assures certain outcomes versus promoter of quality and quality improvement. That debate will no doubt continue.

But what is of particular interest to me is that the underlying philosophy in the Administration’s position seems to be that federal money should be used only to train students for jobs. If you want to spend $40,000 on a liberal arts degree that won’t prepare you for a profession, you have that right. But not at taxpayers’ expense.

Many of us in the “Boomer” generation started out with English or philosophy degrees before we ultimately settled into a profession. But given high unemployment rates and the fear of the looming crises over student loan defaults, this would appear in the minds of many to be a “luxury” we can no longer afford.

Just So You Know..."State Authorization" Has Not Gone Away

There was a lot of publicity recently when the U.S. Department of Education announced that it would no longer enforce a requirement that had been placed in their regulations that distance education programs would have to obtain permission to operate in every state in which they enroll at least one student.

While the Department's decision was good news, the issue did not go away. In fact, it moved to the forefront in many states. As one observer said, "the genie is out of the bottle." Many states already had laws on the books that required registration or some other form of authorization but had never enforced them, while a couple of states saw a revenue opportunity and swiftly passed such laws. Most states simply do not have the manpower to enforce the laws and with the threat of federal enforcement now gone, many colleges will simply wait to get caught rather than paying the registration fees or going through whatever process the state has set up.

There is another troubling aspect to this controversy - some of the state laws also say that placing even one student in a clinical or externship site also triggers a "physical presence" in the state and requires authorization.

Just so you know, CAAHEP has assembled a chart that provides a "thumbnail" sketch of what the various states require in terms of both distance education and clinical placements.  Proceed at your own risk! 

Déjà Vu All Over Again!

It has been more than a year since I posted a blog and what’s even more remarkable than how quickly that time has passed is the fact that my topic continues to be a variation on the same theme as previous entries: unethical or questionable practices by some colleges, most of them for-profit entities.

But while there have been lots of allegations about aggressive recruiting practices, misrepresentation of job placement rates and misleading information about accreditation status, today’s topic may be the most reprehensible yet, not because the behaviors are new but, rather, because of the population being targeted: veterans and active-duty military personnel.

Most of the abuse stems from something called the “90-10” rule which requires that no more than 90% of a school’s revenue can come from federal financial aid. But for some reason, revenue from veteran’s benefits is considered “other” income and is not counted in the 90% limit. Congress has debated ways to get at this problem but no consensus has been reached on legislation. So, on June 12th, President Obama signed an executive order that will force schools to disclose more information about topics like financial aid and graduation rates. It also requires DOD to set rules for recruiting at military installations.

In addition, the order sets up a complaint system for reporting suspected institutional fraud or abuse of veterans’ benefits, and it requires institutions to abide by the same rules as schools that receive financial aid from the Education Department.

In an effort to get out ahead of the story, the Association of Private Sector Colleges and Universities (the organization that represents for-profit institutions) issued a statement on June 11th outlining “Five Tenets of Veteran Education.” Needless to say, APSCU disagrees with many elements of the Executive Order and the battles will no doubt continue.

What Are The Pharmacist Education Requirements?

Pharmacy is very sought after profession. It is high paying with many perks that other professions don't offer. It is considered to be one of the best health care professions these days. Working as a health care professional can be messy at times, considering the blood or body fluids, and not everybody can handle that. So if you are a person who can't handle the messy part but still want to be in health care, pharmacy can be the right thing for you.

Pharmacist education requirements are not difficult at all. You can join a pharmacy school right after graduating from high school. If you have decided that early, meaning that you made the decision while still in high school, it will be wise to opt for math and science courses while you are still in high school. But even after that, during college or later, you can join a pharmacy school anytime.

The basic pharmacist education requirements to pursue a degree in this filed will be to clear the PCAT (Pharmacy College Admission Test) but all colleges listed by PharmaCAS do not require a test. The interview, application and letter of recommendation are all part of the process.

The prerequisites are an important part of the pharmacist education requirements. If you are joining a pharmacy school right after high school you can join a joint undergraduate and Pharm. D program. This way you will be completing your prerequisite courses in two years and the actual pharmacy education in the next three to four years.

But if you are a bachelor's degree student than the courses you are taking can make a lot of difference. Science and life science subjects will give you a greater advantage over arts subjects. You can always get the most accurate information from the websites of the particular schools you are interested in. By getting that information you can be sure about the pharmacist education requirements and the admission process will become easier for you.

The bachelor's degree for pharmacy has been phased out. You will very rarely hear about a registered pharmacist meaning a pharmacist who is only a BS. It has become essential to obtain a Pharm. D Degree before you become a licensed practicing pharmacist. Another important thing to note is that the doctor in Pharmacy is different than both PhD and MS in pharmacy.

Being in a pharmacy school is as demanding and as hard as being in a medical school. There is extensive study and practical work involved. But once you have completed your years at a pharmacy school the road ahead is comparatively easier. To begin with, you will not have to go through years and years of residency. At the most the residency will be one to two years and that also only if you want to.

You can get straight to practicing without the residency. It is important to get a license from the state before you start practicing. You don't necessarily have to work at a drug store. Pharmacy is exciting and diverse. You can work alongside doctors as part of a medical team or choose to work in the lab for further research. Once you obtain your degree it is up to you to decide what you want to do with it.