NPs practicing as DRs

[SkiBumNP]

This has been a heated discussion between some of my friends and I, so I thought I would bring it to the forum.

Should people who are going through a DNP programs and taking the SAME test we all took for our MSN - NP for national certification think their education 'doctorate" is a clinical doctorate?

Until there is a national standard and an elevation of the test (think along the USMLE) then I think anyone who thinks their DNP is a clinical doctorate is a joke.

your thoughts. . . . .?

[PMFB-RN, RN]

True - and if advanced practice nursing moves fully in the DNP direction, you would likely have many more people completing the DNP early in their careers.

I think if this ridiculous march to DNP requirement for advanced practice continues it is more likely that many nurses will simply opt for the shorter & cheaper PA school. The jobs are often so similar that they are advertised as PA or NP wanted" and pay is close. Besides PA would eliminate all the issues NPs have with scope of practice.

[myelin]

I think if this ridiculous march to DNP requirement for advanced practice continues it is more likely that many nurses will simply opt for the shorter & cheaper PA school. The jobs are often so similar that they are advertised as PA or NP wanted" and pay is close. Besides PA would eliminate all the issues NPs have with scope of practice.

Yeah but being a PA has its own limitations... NPs typically have a lot more independence. This depends on the state, of course. Also, if you're interested in a specialty it's pretty much all on the job training for PA, whereas an NP can dedicate all their clinical hours and training to that specialty (WHNPS, psych NPs, CNMs, etc.) Of course, that limits their scope of practice. There are pluses and minuses to both professions.

[unplannedRN]

This has been a heated discussion between some of my friends and I, so I thought I would bring it to the forum.

Should people who are going through a DNP programs and taking the SAME test we all took for our MSN - NP for national certification think their education 'doctorate" is a clinical doctorate?

Until there is a national standard and an elevation of the test (think along the USMLE) then I think anyone who thinks their DNP is a clinical doctorate is a joke.

your thoughts. . . . .?

You know, back in the days when "Doctors of Osteopathy" were part chiropractor, part allopathic physician, part naturopathic physician, allopathic MDs didn't worry much about them. They were seen almost as chiropractors. They were low in numbers, the schools didn't compete with medical schools, and they tended to expect much less money and prestige. It was coincidence their markets overlapped, mostly. They typically did the rural health care few MDs wanted., though, and their schools cost them less.

Then things evolved, and now DOs can practice in any specialty an MD can, and sadly, many of them do NOTHING "osteopathic" once they leave school. Far fewer of them do rural care, and they expect the same money and power MDs have. While MDs sometimes look down on them as people who "couldn't get into medical school", frankly some insecure MDs say that about foreign grads, podiatrists, dentists, PAs, chiropractors, and of course NPs. In other words, just about everyone whose training and work overlap MDs to any extent.

But even back in those days, DOs were "Doctor", too, even when it might have been quite confusing. And all along, there have been Doctors of Optometry (OD), and as a diabetes educator I can vouch that few patients understand the difference between DO, OD, and MD. Yet we don't worry our patients will be confused.

We have Doctors of Psychology, Podiatry, Dentistry, etc., and few complain that they shouldn't use the title doctor, even when there might be a dentist and medical doctor in the same clinic. Or psychiatrist and psychologist, who very often work side-by-side, have overlapping duties and share patients, who often don't now the difference if they're not taking medicine.

The modern APN is no longer single faceted. We are branching in many directions, so we are as as different as podiatrists and dentists. Just as in medicine, you have the teaching/research huge area, and then everything else. (There are PHD doctors of medicine who are not qualified to practice in the field.)

Primary Care NPs will be one area, and I believe many of these will take over the gap left by DOs, caring for under-served and rural populations, because we, too, have that same culture. We will continue to grow in complexity, and scope of practice just as DOs did. (I pray we don't dump the philosophy that makes us unique as some DOs do. Those ARE MD wanna-bes.)

I firmly believe that MOST Primary Care Practitioners will be NPs in 20 years, because doctors can't bear the time pressure, the control from the insurance plans, etc. The pay doesn't suit them, either, with med school costing as it does. These things must happen, too, because NP school is getting expensive, and if we need 8 or more years to enter practice, then we need a way to pay for school, too.

I for one think the goal in clarifying the NP role and title is to proudly wear and use the "Doctor" an eight-year education deserves, embrace the practice guidelines that demand a doctorate...and wear a NAME TAG that SPELLS OUT the entire title.

Patients will ask, pamphlets will be printed, discussions will ensue, TV commercials and movies can be used as they are now to educate the public.

Nursing is not and never will be "medical doctoring". Like the "real Osteopaths" once did, we have our own holistic approach, and caring for the body is and has been only a modest part of that, for decades now. We have the right to evolve and expand, and to have a unique style of practice that now, yes, very much includes some diagnosing and prescribing and treating as part of a new type of practice.

Making it clear that, yes, unfortunately for doctors we're competing for some of the same business market, but no, we have no interest or intention of "trying to be equal" "trying to be MDs", "usurping the MD role", etc. Suggesting that we are is a red herring, a tactic used to avoid territory encroachment. They are worried because a person can now have different kinds of primary care.

What is the difference after all, in having a gynecologist as one's PCP, when he/she is going to refer you out for almost anything but a sore throat, or an NP who is broader and can do the holistic person-centered care best of any profession, but who will also refer you out to an MD or DO for more serious medical problems? They are 2 different types or primary providers, with different foci and skill sets. But this isn't news, except to doctors.

That can't be helped...but the territory is patient care of populations, not medical care nor a particular role. Advanced practice NURSING care is a whole new profession, not demi-"doctoring". There's just a new type of practitioner in town, and giving us our independence is the only way to go for all concerned.

And with that independence must come a burial of the phobic taboo written into State Practice Acts saying, "Under no circumstances does a nurse diagnose or prescribe..." meant to remind a nurse she is not a doctor. We need to stand and say, "Enough already!"

As long as we define ourselves EVER so carefully as what we are not--no, as what we allegedly want to be but DARE not be--then we will only be able to go as far as "not quite a medical doctor". Which is why we are stupidly arguing over that word in the title now. And as long as we act as though only fear is keeping us fromn admitting we diagnose and prescribe, etc., ironically medical doctors will have reason to think only fear is keeping us from snatching their jobs entirely.

We need to let them know it's not what we're after. We want to be recognized, trained, compensated, respected and allowed to practice independently what we and only we do the way we do it. We're really not dying to take on more and more of the doctoring functions. Is a dentist any more or less a doctor than a medical doctor? No.

Yes. you do have a "professional degree", DNPs. It's a doctoral degree. You are "Dr. So-and-so, the Advanced-Practice Professional Nurse", a specialty the public really knows very little about. There's no excuse in practicing nurses not understanding and getting the word out. Hiding your name tag will only muddy the waters when some do and some don't!

If you have to go to school 8 years to be something that earns half the money--at the most--a doctor does for similar work, but you went that route anyway, a doctor is less likely to think you wanted his job that, but didn't want the 2 extra years of residency, nor to earn the extra 50% pay...So the DNP requirement may help settle that old confusion.

..and about the DNP as the new standard (sigh....here we go again...)

I should add that I am an older nurse planning to enter an N program, and dread the extra DNP years, which I will add on after getting the last-minute (pre-2015) NP under the MSN. I have reason to hope I will be very good at what I do, long before I work on a DNP.

At this point most DNP programs are flimsy rush jobs, trying to be the first and grab the market share of new NP students, and their programs reflect that with a lot of stuffy and stale "filler" courses, rehashing research models, nursing theory, and healthcare policy without adding anything substantive or relevant to primary care. (There are some exceptions, and the current quality of a school's DNP track certainly doesn't seem to be tied to "Big name" vs. modest schools!)

So, to those excellent Master's-prepared NPs out there, let me make it crystal clear that I know your new DNP NP peers-in-practice really won't be ahead of you. It's why taking all those fluff courses will be torture for me--boring and a sham--unless I can afford one of the good programs. Frankly, since you had to pioneer in your area of nursing, and have been the cutting edge, you should be grandfathered in as DNPs, not just allowed to keep your NP practices!

One of the most brilliant women I know is a hematology NP who (I believe) got her MSN after she started her NP practice. (Yes, JC, that's you!)There will be tons of infighting and screaming over the DNP vs MSN-NP competence over the next few years, and all for nothing. The DNP in these early days won't be an upgrade.

But even if I never get a DNP because I can't afford it, etc., embracing it for the future of the profession helps upgrade nursing as a profession now, and it's worth doing just for that.

The DNP programs will evolve. However, I notice that generally, when other professions increase their pre-practice requirements, they don't just condescendingly allow previously-licensed practitioners to hang on, "grandfathering in" their credentials but regarding them as the relics of a time when nursing was less evolved. We do!

Instead, they tend to regard them as revered founding fathers who represent the pinnacle of their time and a STANDARD to which all others coming after must aspire. We should do the same for our founding mothers at EVERY turning point, not just with the very first nurses. That would go a long way to help nursing "self-esteem".

Footnote re "profession": When I say "new profession", I mean so only in the sense of "doctoral-degreed profession", which is the meaning it has when you fill out a form asking you if you have a "professional degree". I mention this because RNs are professional nurses, period, in the broader sense.

[wowza]

I believe there has been about a 50% pass rate. I think part of the reason for this is that it *is* similar in nature to the USMLE Step 3, which MDs would normally take after their first year of residency. Most of the people taking the DCC have been practicing as NPs for many years - how many MDs who have been practicing for years as psychiatrists or neurosurgeons do you think could pass the USMLE Step 3 if they had to take it today? Not many, I'd bet. Anyway...)

Actually I bet almost all of them would pass. Of course, we'll never have data to show one way or the other but for us, Step 3 of the USMLE is a really easy exam- by far the easiest of the 3 steps. Most interns don't even study for it much at all because of time constraints of internship, yet there is still a 95% pass rate.

Do we think that pharmacists, physical therapists, psychologists, dentists, optometrists, (etc.) are all afraid to refer to themselves as doctor?

I have never seen a pharmacist or physcial therapist refer to themselves as doctors in the hospital and we work in very close multidisciplinary rounds. Dentist I don't have a problem with at all. Very often they are dual DMD/MDs and do Facialplastics or OMF. They really are the experts in the face/mouth so have earned the doctor titile.Optometrists really don't practice in hospitals so it's less of an issue. It is a bit misleading though in the clinic.Psychologists... again, I don't really care but have some minor issues with it.

I've not seen this at all. Why is it suddenly so controversial when it happens in nursing?Specifically in reference to the DNP, I hesitate to earn one. At this point it doesn't seem like the degree is standardized and what kind of advantages regarding employment, salary, etc. it may confer appear to be up in the air.

I think you touched on some of the issues. In my opinion, unlike every other practice/clincal doctorate there is no standardization of education. The other thing, it really hasn't stepped up the coursework, which it seems like many students are asking for. Finally, the title doctor in my opinion, should be reserved for the person with the most education in a given field.As above, this is why I think dentists deserve the designation- no other provider knows as much about the face and mouth. Same thing with pharmacists, podiatrists. This is also why I think optometrists probably shouldn't use the title- ophthalmologists have far more training. Similar to psychologists and psychiatrists. With regard to DNP and title of doctor- what the DNP is supposed to be the most knowledgable of and what the doctor is supposed to be the most knowledgable about are the exact same and I think everyone is on board with the differences in training. So, by this logic, it is misleading for a DNP to call themselves a doctor in a clinical setting. Outside, it makes no difference to me... although I think anyone who introduces themselves as Doctor X in any non-clinical setting is a bit of a tool.

[wowza]

You know, back in the days when "Doctors of Osteopathy" were part chiropractor, part allopathic physician, part naturopathic physician... Then things evolved, and now DOs can practice in any specialty an MD can, and sadly, many of them do NOTHING "osteopathic" once they leave school.

First, wow, that was a very long post. Thank you for taking so much time to post your views. The difference here is that osteopathic education changed so that it now is IDENTICAL to allopathic education. They both have 2 years of basic science education, 2 years of clinical education and the exact same residencies. The improvement in education is why they are considered identical. It is not that MDs relaxed what they expected. It is that DO's stepped up their education.

Just as in medicine, you have the teaching/research huge area, and then everything else. (There are PHD doctors of medicine who are not qualified to practice in the field.)

PhD's do not have a doctorate of medicine. They have doctorates in biology, biochemistry, or genetics or molecular engineering... well you get the idea. It is not a doctorate of medicine. There is no overlap there between MD and PhD. One is clinical, one is research based.

Is a dentist any more or less a doctor than a medical doctor? No.

Not to be snide but the dentist is the most knowledgable about the pathology of the mouth. MDs know much less about the mouth. What is the DNP the most knowlegable about? This is a serious question.

[nomadcrna, DNP, CRNA, NP]

PA never has independent practice so I'm not sure what you mean by issues with scope of practice. We have it much, much better than PAs.

[nomadcrna, DNP, CRNA, NP]

WOW, kudos to unplannedRN.

Absolutely outstanding post. I can only dream of articulating as you do. You are a credit to our profession and will be a huge assest as an NP.

[zoidberg, BSN, RN]

scope of practice is different than MD involvement. PA's have it better in some cases in regards to what procedures they can do, meds they prescribe, and types of patients they can see. it is usually similar but in some cases PA's have a better situation. no argument about PA's not having it so good with autonomy of practicing.

[nomadcrna, DNP, CRNA, NP]

what procedure can a pa do legally that i cannot as a np?

what meds can they prescribe that i cannot as a np?

what types of patients can they see that i cannot as a np?

i have full admit privileges, pas must have a physician "co-manage" the inpatient.

the vast majority of states nps have the same or better practice environment than pas.

look at the dea schedule list. 8 states nps have the ability to prescribe more than pas while pas are better in 2 states.

i support pas having the same scope of practice as we have. there really is not much difference. i'm not running down pas, i just want to make that clear.

btw, i'm an fnp and have worked solo er in 4 different states. i saw your other post where you state that fnps must stay in primary care. i'm amazed at someone with such hard and fast opinions and passing out incorrect information is not even and rn yet, much less an np.

i'm not trying to be a jerk but many people will read this information and believe it.

jan 29 by

benm93 your welcome! ha you would think i was going to pa school... but i am accelerated bsn student with plans to go to grad school... so to be honest that is a fine plan too. i went this route because my undergrad bio gpa was not that great i was in no mood to retake classes and be a cna for a year, so this seemed like a good option

[myelin]

I agree that PAs can have it better, depending on the circumstances. NPs can also have it better. It really depends on your specialty, what state you plan on practicing in, etc. Since I'm interested in psych, NP was a no-brainer choice.

[RNTwin]

I'm about to graduate from my MSN-FPMHNP program in May... I've reviewed curricula from several schools and really see no benefit from the DNP as it stands now. There's nothing directly "clinical" about the majority of the coursework for this "clinical doctorate." Seems more like the boring bastard child of a second-rate MPH degree and nursing systems or health policy program.

I'm willing to bet the DNP offers more of the same ridiculous busy work that plagues my MSN program. Endless hours of eye-glazing, mind-numbing "cultural competency" lectures/workshops/assignments. 20 page APA-formatted, referenced papers on the history of dryer lint.

Oh, and the icing on the cake... huge, unnecessary debt with no rhyme, no reason, no payoff.

I'll pass.

finishing my ACNP this May, feel the same way

[traumaRUs, MSN, APRN]

Yep - me too....