discussion regarding education of NP (DNP) and PA compared to MD/DO

MikeTexas82 · Jul 26, 2008

I agree w/ you JDCitizen, all the kinks should have been worked out. From the start, there should have been a standardization from BSN to DNP.

eugenie98 · Jul 28, 2008

Becoming a primary care physician requires a 4 year undergraduate degree, completing the premed curriculum (inorganic chem, organic chem, physics, calculus, bio I and II), 1.5-2 years of didactics, and 5 years of clinicals (1.5-2 years sciences in med school, MS 3 and 4 clinical rotations, PGY1-3 of residency).

Becoming a PA generally requires a 4 year undergraduate degree, completing the premed curriculum, 1000 hours of patient care in some capacity (EMT, respiratory therapist, tech, etc..), 1 year of didactics, 1 year of clinicals

Becoming an NP generally requires completing the prenursing curriculum (A&P I and II, psych, microbiology, chem I), a BSN which includes 1 year of nursing didactics (600 hours) and 1 year of clinicals (600 hours), and an MSN which includes 1 year of nursing didactics (600 hours) and 1 year of clinicals (600 hours).

So, I'd venture that PA's are better prepared didactically speaking, NP's are better prepared clinically speaking. Perhaps each program type could learn from the other, the clinical element perhaps could use enhancement on the PA side since they're coming from a tech or EMT background, MSN NP programs could use some more stringent science requirements, maybe a semester of orgo, since NP's can, after all, prescribe meds...

enoRN · Aug 8, 2008

How many here plan on obtaining their DNP?
Why?

I do.

Because i want to see what nursing is all about. To know what something is all about, u have to get to its root.

ffsparky26 · Nov 13, 2008

How many here plan on obtaining their DNP?
Why?

I am trying to get into the mid level medical practiconer game before the DNP becomes required and a doctorate level educational ******* match starts. I wonder if the PA programs will go to a doctorate program next?

It seems to counter act one of the benifits of a mid level practiconer in that it adds more time to the educational pipeline, and it adds it in the area of research and not medicene.

Dr. Tammy, FNP/GNP-C · Nov 13, 2008

I am trying to get into the mid level medical practiconer game before the DNP becomes required and a doctorate level educational ******* match starts. I wonder if the PA programs will go to a doctorate program next?
It seems to counter act one of the benifits of a mid level practiconer in that it adds more time to the educational pipeline, and it adds it in the area of research and not medicene.

I'm not sure I understand. How can doctorate prepared NP's with terminal degrees in the very discipline and profession in which they practice be considered mid levels?

zenman · Nov 13, 2008

But we are also trained to practice evidence based medicine. We don't just make decision based on what we "feel" is right-- we base it on what the science says.

I've seen physicians do what they "feel" is right even when all the labs and other diagnostic tests say otherwise. One did so recently with my wife and it turns out he was correct. Many older physicians have no trouble with this also, especially back in the days when they had no choice and their diagnostic skills were more finely honed than they are today.

greygooseuria · Nov 22, 2008

Not to bash on MDs but...

when I was in the ER in September, the ER MD said I just had a pulled muscle and gave me some pain meds and sent me on my way. My PA the next day saw my labs and did some tests and it turns out I had an infection that had spread to my spine and would have killed me if she hadn't intervened. So uhh...yeah, MD isn't always the best.

I prefer seeing an NP/PA for primary care. They're generally easier to talk to and more understanding and have much better bedside manner and if it's a routine physical exam then I am 100% confident they'll know what they're doing since I, as a nursing student, have to know how to give one too and know where it deviates from the norm. Also, my primary care MD put me on an antidepressant that actually made me worse because he didn't listen to any of my symptoms. Who got it right? A Psych NP.

And my primary care MD has been an MD for over 35 years.

belairnp · Dec 16, 2008

I realize that I am VERY late in joining this forum discussion and perhaps my comments will have already been stated and addressed. That being said....

I have been licensed as an RN for 20 yrs, the past 10 of which have been as an FNP.

My circuitous journey included enrollment and attendance at one of the country's first BS PA programs, a change to pre-med, and eventually completion of a BSN program (after enrolling and dropping out of a different BSN program several years earlier). After practicing as an RN for 7 yrs and being extremely disillusioned and disappointed in the nursing profession, I examined graduate school options (specifically MD vs DO vs NP). Again, to my regret today, I chose what appeared to be "the easier, softer way"....an MS and certification as an NP. Hindsight being 20-20, I would have chosen MD or DO, if I knew then what I know and have experienced now.

This has been a journey of youth, with impulsive decisions and high idealism.

IMHO the following specific real-world practice differences exist:

MD/DO programs and residencies: the primary focus of learning and care delivery is in the acute care setting, though rotations include various subspecialties, very little time is actually spent within the realm of primary care. (As an aside: As a new NP graduate in 1999, I worked in a Family Practice where the full-time MD mentored 3rd year IM residents during their 3-day primary care experience. One day, the MD that was the then Chief Resident of the large urban medical center was there for his primary care experience and said the following to me after spending 45 minutes with his head in textbook while I saw 3 patients "If someone comes to me with an acute MI, drug overdose, or a gun shot wound, I know what to do for them, but I have no idea how to treat sinusitis or an ear infection".

I realize this example only represents an IM resident and personally think that an MD/DO in a Family Practice Residency program would receive considerably more primary care/ambulatory care experiences.

PA: most programs mirror MD/DO programs, only on shortened time scale. They have subspecialty rotations and what is probably more exposure and training within the primary care field during those experiences.

MSN NP program: These programs have clinical experiences based entirely within the area of concentration. For primary care specialties (FNP, ANP, PNP, GNP) the clinicals can occur in all settings where primary care is delivered to their respective pt populations.

Acute care NP: these programs, obviously, have clinical experiences that occur in the acute care setting NOT in the primary care arena.

Therefore, it has been my experience that a Master's prepared primary care NP is better educated and equipped to provide primary care. I believe that MD/DO would be MUCH more able and proficient, due to their training and education, to provide complex care of patients as a specialist/subspecialist, which would make better use of their credentials. A PA has the background education and training to be quite versatile in many arenas.

Now...my thoughts on DNP... It's about time. We are late to jump on this band wagon and I believe that this should have been the entry credential for NP's since the beginning. (Not that I will go back and get one, however, when this does nothing for me professionally or financially).

On a different note:

My experience has been that MD/DO are MUCH more accepting of NP's as primary care providers and peers than Nurses.

Nurses are the reason that I cannot STAND my profession.

MikeTexas82 · Dec 16, 2008

Let me see if I'm getting you correctly... You would have become an MD/DO because you don't like your fellow nurses? What is your reasoning behind this?

belairnp · Dec 17, 2008

Mike,

No..they are not the reason. As I stated in my post, my reasons for not continuing the journey to MD/DO were related to youthful impulsivity and short-term orientation vs long range vision.

The fact that I generally do not like nurses is a separate statement based on separate experiences.

Though, as an aside, I have generally noticed that most nurses do not accept NP's as PROVIDERS as often as MD/DO's or PA's do.

If you want, we could start a separate posting and discussion on why I don't like nurses. Suffice it to say that the statement "a little knowledge is a dangerous thing" comes to mind.

JDCitizen · Dec 23, 2008

OK another few thoughts to add to the discussion regarding education of NP, PA and DNP compared to MD/DO...

I believe there will be a grandfather clause but I digress from my intention of the posting...

So anyway about the DNP:

The invention of DNP is an attempt to garner more acceptance of NPs in the health field industry.
It's focused at shifting us further from the comparison with PAs (no insult intended).
The shift in title also has some connotations in reference to MDs/DOs...
It has higher financial incentives for the actual educational centers doing the training.
The higher up front costs will mean higher reimbursement expectations down the road.

What happens:

If there is no more acceptance than what we have now? If the goals of DNP fizzle; what next?
Will DNP change practice or practice laws?
Will DNP just mean advanced training will be out of range of more nurses due to expense/time?

menetopali · Feb 5, 2009

1) The fizzle of the DNP is a real possibility (DNSc, DNS, ND come to mind) and those of us in the first programs have a responsibility to make sure that it is seen as a distinct degree and not a 'PhD light' even though academia has made that a difficult thing given the course profile.

2) If the DNP standardizes then over time practice laws will hopefully standardize with compact agreements, the combined statement on the DNP should help that along slowly but surely.

3) expense as a barrier is an issue each individual must determine on their own.