Why DNP and not MD?

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I'm really curious about why the AACN wants all NPs to become DNPs. I understand the notion of "advancing nursing practice" but I think that there's going be a backlash towards this because (1)if you get the additional education, it doesn't mean you actually have the stature of and MD (2) what is it that you actually study? (3)if it requires you to get the same amount of schooling, why not just go for your MD?

Why is it illogical? I'm an RN trying to decide if I want to go for an advanced degree that allows me to become a provider. But if I have to spend just about as much time doing it, why stop short of being an MD, with, sorry, a lot more stature and scope of practice than a DNP? It's about effort/money/time vs. Outcome

Someone made a post kinda similar to this thread in the FNP forum. The difference is that he is an NP who wants to go to back to school to become a physician. You are wondering if you should do NP-DNP or go to med school. There's quite a bit more to the differences between them than just the titles and scope of practice. DNP degree doesn't cost about the same as medical school , and it certainly doesn't take anywhere near the same amount of time (well, it might...if you drag it out and take time off). According to your handle, you are an ADN. You could do an Accelerated BSN in a year or so. And the masters to DNP combo might take another 4 or so years if you do it full-time. Depending on the school you go to, it might cost anywhere from $60k to maybe $110k to do the whole thing. Most universities no longer offer the stand along master's degree for NPs, and some schools are a lot more expensive than others.

Medical schools will not accept your RN science credits towards the matriculation requirements. So, you will have to do the entire pre-med core: BIO 1, BIO 2, CHEM 1, CHEM 2, ORGO 1, ORGO 2, PHYS 1, PHYS 2. You may already know that you have to do these classes in a particular sequence. You will not be able to take organic chemistry until after you have completed general chemistry, and you will not be able to take physics unless you have at least trigonometry or calculus. And you can't take trig or calculus unless you've completed college algebra. Some colleges may allow you to register for certain science courses if you don't have the prequisite course IF you co-register in both classes, but if you withdraw from one for any reason they will automatically withdraw you from the other. Remember that all of these science classes have labs, and you need to pass everything with A's and Bs. This is something that takes time. Even the 100 level general chemistry and biology classes are much more challenging than the ones required by most nursing schools. Working full-time while taking these classes is another consideration because you need a LOT of time for all the studying that you're going to have to do.

Let's say you take 2 of these classes per semester and you don't take summers off and you finish the whole pre med thing in say about 2 to 3 years. Then you take a few months to prep for the MCAT and you get a pretty good score. And you get into medical school. You're going to be there for about 4 1/2 years. After that there's a internship year, then residency which is about 3 to 4 years at a minimum, and much longer for surgical specialties.

Now, most nurses who are pursuing APN/doctoral degrees can continue working throughout their program and they can juggle both because of how the nursing programs are structured. Having a job during med school is certainly not encouraged, and some schools actually forbid it because of the vastness and complexity of material that you have to study. Also, the average tuition costs for med school is $50k per year. That is the tuition only. Most people also need to take out loans to cover their living expenses, food, transportation, etc. for the entire time that they are in med school. This can add up to about $350k or more. Many people don't even think about these loans because they imagine that, as physicians, they will be earning more than enough money to pay them off over the course of their careers. They also have many more opportunities to participate in loan repayment programs than NPs as long---as they are willing to take jobs in certain types of areas. Many new docs find though that those loans consume a huge portion of their paychecks---in an environment of smaller reimbursements. You definitely have seriously think about the pros and cons of both, and definitely talk to some MDs to get their perspective. But if you decided that being a physician is what you REALLY want then you should go to medical school. And do it while you're young and have time on your side. If you make any other choice or let too many years go by you will regret it later.

Oh, and never mind nurses who eat their young (not that I believe that most of us do). If you go to med school you're going to meet some very interesting personalities. You can get a preview over at the student doctor forum.

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Specializes in Emergency.

Sailornurse, LOL. If someone puts their views on an online discussion board, it's called a discussion for good reason.

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Of course everyone will be fascinated by your great penmanship and mediocre diagnostic skills when you complete your DNP.

Although I agree that the DNP program could be structured better I disagree with this slight of DNPs in general. The DNP was initially proposed as a clinical doctorate-- at least, so claimed the people at Columbia university who were among its pioneers. It ended up being something different but that doesn't mean that the graduates are mediocre clinicians.

A lot of what one learns depends on the school that one goes to. I did not go to an online school. The didactic courses were tough and my clinicals weren't easy either. I did most of my rotations with some very bright physicians who were constantly picking my brain. It takes time to develop these skills to expert level---even for medical students who are in their residency.

The CRNA-DNP programs are not better than the other dnp programs. Beyond the master's level coursework (the CRNA core) the rest of it is the same. The only real difference is that the CRNA programs have prequisites that make them a bit more challenging to get into. Nothing that is taught at the doctoral level in the CRNA-DNP program is actually relevant to the practice of nurse anesthesia. CRNA-DNP clinicals don't really teach anything new. The students are in the same OR, using the same equipment, and sedating patients the same as always.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.
Invitale, why so hateful?

It's relative effort vs. Outcome.

No hate. It's disbelief. Like, are you for real?

There's a troll on these boards who likes to bash NPs and has several accounts.

If you're really an RN, you should understand why an RN would choose the DNP over the MD. It's a no brainer.

I think you're full of poppycock. But I don't hate you.

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Specializes in Emergency.

Thanks all. Moving on.

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Although I agree that the DNP program could be structured better I disagree with this slight of DNPs in general. The DNP was initially proposed as a clinical doctorate-- at least, so claimed the people at Columbia university who were among its pioneers. It ended up being something different but that doesn't mean that the graduates are mediocre clinicians.

A lot of what one learns depends on the school that one goes to. I did not go to an online school. The didactic courses were tough and my clinicals weren't easy either. I did most of my rotations with some very bright physicians who were constantly picking my brain. It takes time to develop these skills to expert level---even for medical students who are in their residency.

The CRNA-DNP programs are not better than the other DNP programs. Beyond the master's level coursework (the CRNA core) the rest of it is the same. The only real difference is that the CRNA programs have prequisites that make them a bit more challenging to get into. Nothing that is taught at the doctoral level in the CRNA-DNP program is actually relevant to the practice of nurse anesthesia. CRNA-DNP clinicals don't really teach anything new. The students are in the same OR, using the same equipment, and sedating patients the same as always.

I just last week interviewed at The Mayo Clinics CRNA-DNP program. It was an 8 hour process that included touring the campus and OR's, meeting the faculty and learning about the courses and structure of the program. The program is 3.5 years in length. The first year is hybrid and is the "DNP" type material front loaded with leadership, research and ethics type courses. Although they do add in an element of usefulness clinically to that first year. You are required to complete 3 clinical days in the OR each month even during this first year. This may seem like a small step but when you've done this for a full year it will make a big difference in knowledge and comfort in the OR when you enter your second year. The last two and a half years is 5 days a week around 60 hours a week time commitment with didactic and heavy clinical rotations. The program director said that year to year they alter and grow the CRNA-DNP program to make it as robust and useful not only academically but also clinically.

They stated that by the end of the program you should be prepared and have the opportunity to be published in a national healthcare journal and present a research project on a national level. You also will be clinically skilled enough to perform any type of anesthesia/intubate independently, insert a Swann-Ganz catheter, perform spinal blocks and insert CVL's.

Do the CRNP programs offer that level of specialty mastery when completed? That's a rhetorical question, I have probably 5 friends who have recently finished their CRNP program, I know the answer.

They did get very good at doing online course work, reading their textbook, writing papers and finding local doctors and setting up their own clinical experiences. I have quite a few friends who have said that they didn't feel at all prepared to practice when they finished CRNP school. They usually need 3 or more years after graduation to finally feel comfortable with their role after relying closely on an MD to teach them.

I'm sure you might find a rare CRNP program that is almost all on campus and schedules structured clinical experiences for 3+ years and graduate students who feel confident in independent practice but let's be honest, that is not 90% of programs.

This is just my opinion of course and life experiences of a travel nurse who has worked with CRNP's from east coast to west.

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Out of curiosity:

Other than for teaching or working with anesthesia: Why pursue a DNP when a NP/MSN would suffice?

and

Other than for surgery or not being limiting when it comes to prescribing certain medications: Why pursue a MD when a NP/MSN would suffice?

-More of a med folks question, I know, but, maybe someone here could answer it.

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Specializes in Nurse Leader specializing in Labor & Delivery.
Other than for teaching or working with anesthesia: Why pursue a DNP when a NP/MSN would suffice?

Because some of us are academic geeks at heart, and crave the challenge that a doctoral level program would provide. Because we might want it for our own intrinsic goals.

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I see. I now understand that the objective of certain posts in this thread isn't about sharing information at all but, yet again, about bashing NPs. So sad that some of us spend so much energy hating on, putting down, and being envious of others.

But that just life, I suppose...

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I see. I now understand that the objective of certain posts in this thread isn't about sharing information at all but, yet again, about bashing NPs. So sad that some of us spend so much energy hating on, putting down, and being envious of others.

But that just life, I suppose...

I hope you're not referring to myself when you mention no real discussion but just bashing of NP's. I did mention that I have many personal friends who are NP's and some of my favorite prescribers are NP's. If we put blinders on and refuse to address the lacking nature of the majority of these MSN/DNP CRNP programs there will never be any positive change.

I have a friend who got her ADN at a local small community college. She worked in Med/Surg passing meds for two years while she wrote some papers online and paid tuition for her online BSN. Now she is in a CRNP program that is less than 2 years and she just writes more papers and studies on her own very similar to the BSN online program. She goes to campus one day every 6 weeks or so for a test. She is hand picking her own clinical teachers, which of course are the ones she is comfortable with and match a work schedule that fits her lifestyle. They teach her as they go of course but they're busy and working and I don't believe are getting any payment for this, so it's half hearted. She will graduate soon with a masters degree and the ability to diagnose, treat and prescribe medication even independently in some states and the last didactic and structured clinical education she received was her ADN. As long as that is a reality you will always have animosity between the MD's and the newcomer CRNP. If the ANA is publicly stating that CRNP's are equal prescribers able to manage family practice care independently then these programs need to change.

Many people I've spoken to about going back to school to get a MSN/DNP say they'll probably just do CRNP because CRNA is too hard, takes too much time and too many prereq's. CRNP shouldn't be the fast and easy option for any RN who doesn't want to do bedside anymore. They shouldn't accept any student with a BSN and a pulse.

I listed the program structure of the CRNA just to show you that the CRNP could do a very similar structure. The numerous requirements and years of prep that the CRNA program has should be mirrored with the CRNP programs, at least some of it.

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Personally, I wish the NP programs would be like the MD programs in terms of providing preceptors.

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Specializes in Nurse Leader specializing in Labor & Delivery.
Personally, I wish the NP programs would be like the MD programs in terms of providing preceptors.

Not sure what you mean. MD programs do not have preceptorships. Are you referring to the residency match?

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