What is the difference between NP and DNP?

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I was looking into future possibilities through Arizona State University and noticed that all their NP programs are "DNP". Does this mean you get the title of Dr. once you get this degree vs the NP degrees?

I have a long ways to go, but I can't find the answer to this anywhere and it's confusing.

Thanks,

Amber

Specializes in ACNP, ICU.

so all those 16000 plus hours produces a practitioner that cost way more to educate, way longer to train, and yet yields outcomes similar to an NP.

Show me a study, unbiased or otherwise, where outcomes for an MD are better than that for an NP

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How about showing some of the studies you refer to regarding NPs ordering more tests. I am sure that they are unbiased. As far as the costs go, NPs are cheaper to train and if they practice independently they are free from a physician surcharge and cost less for all patients. It is no myth that NPs can provide more cost effective care. You can simply look to the states where they practice independently and already see it happening there.

1) http://www.acponline.org/clinical_information/journals_publications/ecp/novdec99/hemani.htm

Results. Resource utilization for patients assigned to a nurse practitioner was higher than that for patients assigned to a resident in 14 of 17 utilization measures and higher in 10 of 17 measures when compared with patients assigned to an attending physician. None of the utilization measures for patients in the nurse practitioner group was significantly lower than those for either physician group.

NP had much higher rates of ordering expensive tests including ultrasounds, MRIs, CTs, Medical consults, surgical consults, optho consults (all consults measured), ED visits and hospital admissions (ie all the expensive measures in the study NPs ordered much more of).

The things that showed no major differences were the things that didn't cost much (UAs, XOL, TFTs, PSA, BUN/Cr)

2) http://www.ncbi.nlm.nih.gov/pubmed/11934775

Nurse practitioners ordered more tests with an odds ratio of about 1.25

What are you talking about each patient paying the same "deductible"? What in the world does that mean? Do you live in the US? And you are telling us you have some basic working knowledge of healthcare economics? Provider pay makes up a much more significant portion of overall healthcare costs than malpractice costs do, and I dare say you wouldn't tell us that those were miniscule or insignificant.

For the cost to the patient- what the patient actually pays to see the provider is the same- (ie their deductible is the same) to see a nurse practitioner or a doctor.

Now for the overall costs. Provider reimbursement makes up less than 10% of heath care costs. The expensive part of heath care are expensive tests, drugs, medical equipment and ED costs. So while one provider may get paid less than another, ordering more tests makes the care of that provider more expensive...

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an interesting study no doubt but with some massive flaws.

first and foremost this study did not study how each provider takes care of actual patients, instead they interviewed the provider and asked how they would take care of patients (ie not how they actually did take care of patients). what people say they would do, and what they do in real life are 2 very separate things. this is an example of response bias

i could create a study that asked people what they would do if they were walking down a street and they saw a neonazi beating up a black kid. i guarantee many would say they'd help the kid out compared to reality. this is why it is always better to measure a real variable, than ask someone about it.

the next problem is that all the subjects knew they were being studied which is a major source of bias. again, response bias, non-blinding, non-random sampling. the list goes on.

the study also just measured the number of questions asked by each provider, not whether or not they were the right questions to ask. there was also no physical exam could be done to rule in or out secondary causes of insomnia.

btw that study said nothing about ordering more tests

agree, the abstract didn't mention lab tests. sorry, i had not read the article in 20 years, didn't recall all the specifics. what about the number of medications ordered, is that also a massive flaw? so the mds knew they were being studied so they asked less questions and ordered more medications so they could spend less time with patients. where the nps who also knew they were being studied asked more questions and ordered less medications? no pe to evaluate possible causes of insomnia and yet md more likely to have treated with medication? help me understand why this research design resulted in these findings. also let us know about these two mds bias and how this medical journal messed up in accepting such a poorly done study.

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1) http://www.acponline.org/clinical_information/journals_publications/ecp/novdec99/hemani.htm

results. resource utilization for patients assigned to a nurse practitioner was higher than that for patients assigned to a resident in 14 of 17 utilization measures and higher in 10 of 17 measures when compared with patients assigned to an attending physician. none of the utilization measures for patients in the nurse practitioner group was significantly lower than those for either physician group.

np had much higher rates of ordering expensive tests including ultrasounds, mris, cts, medical consults, surgical consults, optho consults (all consults measured), ed visits and hospital admissions (ie all the expensive measures in the study nps ordered much more of).

the things that showed no major differences were the things that didn't cost much (uas, xol, tfts, psa, bun/cr)

did you actually read the whole article? the part about the authors not being able to determine who ordered the tests, rather only if the test was ordered for the patients. the np patients had higher rates of mris, cts ... , but these tests could be ordered by specialists who also saw the patient. thus, no way of knowing if the np ordered extra tests, or are you making an assumption?

you also fail to note that only 3 criteria were statistically significant, the comment suggests 14 of 17. when you read the discussion section, did you find the information unbiased?

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1) http://www.acponline.org/clinical_information/journals_publications/ecp/novdec99/hemani.htm

Results. Resource utilization for patients assigned to a nurse practitioner was higher than that for patients assigned to a resident in 14 of 17 utilization measures and higher in 10 of 17 measures when compared with patients assigned to an attending physician. None of the utilization measures for patients in the nurse practitioner group was significantly lower than those for either physician group.

NP had much higher rates of ordering expensive tests including ultrasounds, MRIs, CTs, Medical consults, surgical consults, optho consults (all consults measured), ED visits and hospital admissions (ie all the expensive measures in the study NPs ordered much more of).

The things that showed no major differences were the things that didn't cost much (UAs, XOL, TFTs, PSA, BUN/Cr)

.

Talk about massive flaws. I will point you to the conclusion for starters. I think you changed one key word that we need to examine to begin with. You changed the wording in the conclusion from MAY to WAS. The second thing I notice about this is the bias of the researchers. Did you not pick up on that? Don't tell us that this study is unbiased if you want to say that any of Mundinger's studies are biased. The next flaw in this study is that it is not large enough to be statistically significant, and it does nothing to determine whether the tests were even warranted. This study is a complete joke. You need to come up with something far better than this if you want to give a shred of credibility to your argument.

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1)

2) http://www.ncbi.nlm.nih.gov/pubmed/11934775

Nurse practitioners ordered more tests with an odds ratio of about 1.25

Not sure what your point is here. The study suggests that nurse practitioners provide better care. Is that the point you were trying to get across to us?

For the cost to the patient- what the patient actually pays to see the provider is the same- (ie their deductible is the same) to see a nurse practitioner or a doctor.

I think you must be referring to a copay. That is largely irrelevant in overall costs. You want to disect the issue when it suits your purpose, and then try to look at overall costs when that suits your argument. It can't work both ways, sorry.

Now for the overall costs. Provider reimbursement makes up less than 10% of heath care costs. The expensive part of heath care are expensive tests, drugs, medical equipment and ED costs. So while one provider may get paid less than another, ordering more tests makes the care of that provider more expensive...

Ten percent gets pretty significant when we look at it in terms of what the overall costs are. We are talking about a multi-trillion dollar market. I know you would love for us to think that 10% is a small amount, but it simply isn't. Billions could be saved by lowering provider compensation. You also have proven nothing about ordering more tests.

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Hey wowza,

Maybe you need to take a few more of those statistics courses so that you can actually interpret the so-called "science" to which you are such a big subscriber of studying. I can't imagine they don't teach you any logic at all in medical school either. Surely they would teach you the difference in the meaning of the word MAY and WAS, wouldn't they?

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did you actually read the whole article? the part about the authors not being able to determine who ordered the tests, rather only if the test was ordered for the patients. the np patients had higher rates of mris, cts ... , but these tests could be ordered by specialists who also saw the patient. thus, no way of knowing if the np ordered extra tests, or are you making an assumption?

you also fail to note that only 3 criteria were statistically significant, the comment suggests 14 of 17. when you read the discussion section, did you find the information unbiased?

i couldnt find where in the article it says that the authors couldn't determine who ordered the tests (especially since you can tell who ordered what on the va system). however, i will agree that the discussion infers it. they do not outright say if they did or did not look at who ordered the tests. whether or not the np ordered the test, it was either them, or someone they refered the patient to. thus seeing an np caused increased costs (whether from the np ordering more test or from the np ordering a consult which lead to more testing)

the second thing i notice about this is the bias of the researchers. did you not pick up on that? don't tell us that this study is unbiased if you want to say that any of mundinger's studies are biased. the next flaw in this study is that it is not large enough to be statistically significant, and it does nothing to determine whether the tests were even warranted. this study is a complete joke. you need to come up with something far better than this if you want to give a shred of credibility to your argument.

tell me why you think the authors are biased? you realize one is a nurse practitioner. it's not like they lobby for the exact thing the article finds (you know like mundinger does).

i agree that the study is not large enough to have power for every measure. nonetheless 3 points are statistically significant including the most expensive tests (mri & ct, ultrasound, & consults for ophtho). the others are very close to statistical significance that the difference cannot be ignored (ie overall consult rate has a p value of 0.12).

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Hey wowza,

Maybe you need to take a few more of those statistics courses so that you can actually interpret the so-called "science" to which you are such a big subscriber of studying. I can't imagine they don't teach you any logic at all in medical school either. Surely they would teach you the difference in the meaning of the word MAY and WAS, wouldn't they?

Do you notice it is only the "pro-DNP" people who are using adhominems and attacking individuals posting rather than attacking the education or the articles.

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I couldnt find where in the article it says that the authors couldn't determine who ordered the tests (especially since you can tell who ordered what on the VA system). However, I will agree that the discussion infers it. They do not outright say if they did or did not look at who ordered the tests. Whether or not the NP ordered the test, it was either them, or someone they refered the patient to. Thus seeing an NP caused increased costs (whether from the NP ordering more test or from the NP ordering a consult which lead to more testing)

Tell me why you think the authors are biased? You realize one is a nurse practitioner. It's not like they lobby for the exact thing the article finds (you know like mundinger does).

I agree that the study is not large enough to have power for every measure. Nonetheless 3 points ARE statistically significant including the most expensive tests (MRI & CT, ultrasound, & consults for ophtho). The others are very close to statistical significance that the difference cannot be ignored (ie overall consult rate has a p value of 0.12).

Not large enough to have power for every measure, but three points are statistically significant? You see, this is my point, you have absolutely no understanding of statistics. You have clue what you are even talking about. This study had 9 nurse practitioners in it and you want to try to draw conclusions about all nurse practitioners from it? That is the weakest thing I ever heard of. How can you honestly tell me that you know a thing about statistics and call anything that came out of that study "statistically significant? That is the most flawed piece of garbage I have ever read in my life.

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Do you notice it is only the "pro-DNP" people who are using adhominems and attacking individuals posting rather than attacking the education or the articles.

Do you notice the med students can't admit when they are wrong? You spew all of this argument about how people shouldn't study statistics, and then I prove to you that you can't interperet the science without them. I am attacking the education. Your training is obviously inferior to that of NPs if you can't figure out that the study you posted is simply garbage.

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Not large enough to have power for every measure, but three points are statistically significant? You see, this is my point, you have absolutely no understanding of statistics. You have clue what you are even talking about.

Power (1- beta) is an indirect measure of the number of subjects. Not having enough power for every measure means that there were differences approaching statistical significance (like the p=0.12), but there were not enough subjects. Had they enrolled more subjects, it would have been statistically significant. Even in this small study the power was sufficient on 3 measures to indicate statistical significance.

The implication is that despite the fact that NPs claim to save money for the system by having lower reimbursements, there are hidden costs there from shifting the burden onto a specialist doc or by ordering more tests.

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