DNP (doctor of nursing practice) vs. DO/MD

[contessa54]

Hello! I'm a post-bac student w/ a Master's in health promotion and a couple of years of hospital work. I decided I want to go to medical school and have been taking the pre-reqs. I've learned a lot about the growing filed of advanced practice nursing and of direct-entry doctoral programs in which one does not need an RN/BSN to be admitted and can earn an MSN and DNP. Can anyone give me more information about the different roles NP's (nurse practitioners) have compared to MD/DOs, their level of autonomy (more/less flexible), salaries, and what their collaboration is like with other healthcare professionals?

Thanks!!

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[deleted6669]

the doctorate degree as an np does not grant any additional rights beyond what one has as an ms level np. despite the doctorate a dnp is still a midlevel provider and can not call themselves dr xyz in a clinical situation or have dr xyz on their name tags.some states allow np's(regardless of degree) to open their own practice. many in medicine (including current np's) consider the move to a dnp to simply be a way for nursing programs to charge more tuition by giving in to the degree creep currently making rounds in all allied health fields(mine included).

 

[njbmd]

Moving to Other Health Professions forum.

 

[fab4fan]

Hello! I'm a post-bac student w/ a Master's in health promotion and a couple of years of hospital work. I decided I want to go to medical school and have been taking the pre-reqs. I've learned a lot about the growing filed of advanced practice nursing and of direct-entry doctoral programs in which one does not need an RN/BSN to be admitted and can earn an MSN and DNP. Can anyone give me more information about the different roles NP's (nurse practitioners) have compared to MD/DOs, their level of autonomy (more/less flexible), salaries, and what their collaboration is like with other healthcare professionals?

Thanks!!

You probably would do better to direct your question to the NP forum at www.allnurses.com.

 

[50960]

FYI, DNP folks can and will call themselves doctor. There is no regulation barring that. I agree it is misleading and wrong, but will happen.

 

[deleted87716]

"Are you a real doctor, or a doctor like Dr. Pepper's a doctor?"

 

[deleted6669]

FYI, DNP folks can and will call themselves doctor. There is no regulation barring that. I agree it is misleading and wrong, but will happen.

most states have laws that in a clinical situation only an md/do/dds/dpm can call themselves dr. a phd psychologist can if he makes it clear that he is not a physician.
I know in my state for example that midlevels have to have
physician assistant or
nurse practitioner
displayed prominently on i.d.
I know midlevels with phd's who have been threatened with loss of job or worse for introducing themselves as dr smith

 

[fab4fan]

FYI, DNP folks can and will call themselves doctor. There is no regulation barring that. I agree it is misleading and wrong, but will happen.

Are you equally outraged at psychologists who use the title "Doctor"?

 

[deleted6669]

Are you equally outraged at psychologists who use the title "Doctor"?

personally if someone says
I'm dr smith the podiatrist or
dr smith the dentist or
dr smith the psychologist or
dr smith the nurse practitoner
dr smith the pa
I don't have a problem with it. it's when one of these folks shows up at the scene of an accident or in the er and says"i'm dr smith", push the tpa" that it becomes a problem. folks need to know when they are talking to a physician and when they are not. to introduce yourself as "dr" in a clinical situation is misleading and inappropriate if you are not a physician.
a dpm in his office can call himself dr smith as folks know they are at a podiatry office. ditto dentist or phd psychologist.

 

[50960]

Of course I do not have a problem with psychologists calling themselves Dr. It would be stupid to think otherwise. We have real doctorates. Emedpa, what states have such laws? I know there are no such laws in Ca or Co.

 

[Chronic Student]

I know that Texas statutes specifically state that I must wear a name badge which identifies me as a PA. As for someone other than an MD calling themselves a doctor in a clinical situation in Texas, I am unsure.

-Mike

 

[fab4fan]

Of course I do not have a problem with psychologists calling themselves Dr. It would be stupid to think otherwise. We have real doctorates. Emedpa, what states have such laws? I know there are no such laws in Ca or Co.

And someone who graduates with a doctoral degree in nursing is no different. It's just in your mind, nurses are inferiors, subservients.

Who made you the arbiter of what is a real doctoral degree or not? Are you ready to go to every university that offers doctoral degrees in nursing and tell the faculty that those degrees aren't real? Get a grip on reality, for a change. You may not like it, but that's how it is.

For once I find myself agreeing with emedpa. The Apocalypse cannot be far behind.

 

[deleted6669]

Of course I do not have a problem with psychologists calling themselves Dr. It would be stupid to think otherwise. We have real doctorates. Emedpa, what states have such laws? I know there are no such laws in Ca or Co.

my state has a law that says a pa may not represent themselves as an md....
check the pa regs in co and ca, I bet they have them too.

 

[fab4fan]

FWIW, I do not agree with NPs using the title "doctor" in the clinical setting. It's too confusing for pts. Truth be told, I'm not sure how I feel about mid-level providers (NP/PA) in general.

That said, I will not allow someone like psisci, who is uninformed and biased, to just blather away about my profession and not call him on it.

 

[fab4fan]

Deleted; double post.

 

[50960]

People who have a doctorate in a doctorate level profession can call themselves Dr...this is so silly to have to explain... A doctorate in nursing is like a doctorate in PT, OT, SLP...etc, an additional academic quality that has nothing to do with a license to practice. A physician, a psychologist, a dentist a podiatrist all require a doctoral training to get a license, that is why they are refeered to as doctors, clinically, legally, professionally etc. It is as simple as that.

 

[50960]

emedpa, I would much rather an NP, PA, DPM, or DDS show up at an accident saying they are Dr. so and so...no argument there.

 

[lawguil]

People who have a doctorate in a doctorate level profession can call themselves Dr...this is so silly to have to explain... A doctorate in nursing is like a doctorate in PT, OT, SLP...etc, an additional academic quality that has nothing to do with a license to practice. A physician, a psychologist, a dentist a podiatrist all require a doctoral training to get a license, that is why they are refeered to as doctors, clinically, legally, professionally etc. It is as simple as that.

A doctorate is an academic degree of the highest level. Traditionally, the award of a doctorate implies recognition of the candidate as an equal by the university faculty under which he or she has studied. There are essentially three types of doctorates: research, first-professional (USA only), and honorary. Research doctorates are nearly always awarded in recognition of academic research that is of a publishable standard (even if not actually published) and represents at least a modest contribution to human knowledge. It is usually assessed by submission and defense of a doctoral thesis or dissertation, though in some cases a coherent body of published literature can be accepted instead. Honorary doctorates are awarded for a substantial contribution to a field but this need not be academic in character. In the UK, Australia, and some other Commonwealth countries, a distinction is made among research doctorates into junior doctorates (generally awarded after a course of 3-5 years postgraduate research and study and submission of a thesis), and higher doctorates -- awarded on the basis of ~10 years outstanding research, judged through examination of publications. These higher doctorates are also used as honorary doctorates, but those awarded on the basis of academic research are non-honorary.

General information
USA only: First-professional doctoral degrees are first degrees in a given field and include: Chiropractic, Dentistry, Law, Medicine, Optometry, Osteopathy, Pharmacy, Podiatry, Psychology and Veterinary medicine. There are many others. First-professional doctoral degrees such as the M.D. and J.D. do not require completion of a thesis/dissertation or publication of a coherent body of literature. The normal minimum term for a first-professional doctorate can be as little as 4 years past secondary education. These "first-professional" doctoral degrees therefore lack the status of the research doctorates. Actual practice within the field requires that the degree holder become licensed by the appropriate body (an organization not affiliated with the schools granting the degrees) and registration can require a certain amount of work experience.

Source: http://dictionary.laborlawtalk.com/doctorate

Noun 1. Doctor of Medicine - a doctor''s degree in medicine
Synonyms: MD
The M.D. in Canada and the United States is not a doctorate level degree. The M.D. is an undergraduate degree but mistaken to be a doctorate level degree due to the title. It is a professional degree much like the J.D. ( juris doctor ) is. All programs require a previous undergraduate degree or some undergraduate coursework to be completed before acceptance into a medical school.

In the United States most physicians have earned a M.D., although some may instead hold a D.O.. See the Flexner Report.

In the United Kingdom and in countries that follow its tradition, medical doctors instead graduate as Bachelors of Medicine and Surgery, usually abbreviated as 'MB BS' or 'BM BCh'. The Doctor of Medicine and Master of Surgery are higher doctorates reserved for those who have contributed significantly to the academic study of medicine and surgery respectively. (It follows that the title of "Dr." is technically honorary for the majority of practising physicians in the UK.)

Source: http://dictionary.laborlawtalk.com/Doctor_of_Medicine


For somebody with a "doctorate", you seem to have a jaded view of what a "doctorate" really is!

 

[DogFaceMedic]

DNP "sounds" better than PA, but that is an attempt at academic prestige/legitimacy. If I have a choice between a newly minted PA or DNP (both without prior experience), I'm going with the PA. As I said on the other post, a CCRN who goes DNP or PA is the best. I know a CCRN going PA, and will be well-ahead of any DNP/NP that I've ever met -- and better than many of the internists who shot-gun labs all day long without reason. But, that's another story.

Academic rank inflation is another of my pet-peeves: MPA is appropriate, DNP has little market or clinical value added above NP.

 

[DocWagner]

People do realize (I HOPE)the DNP is part of an "agenda". The ANA and NP societies are not exactly "pro physician" nor are they "pro PA". They see this academic "title progression" as an attempt to legitimise the nursing profession as a "seperate but equal" profession. This is not an attempt to add quality, but rather eventually create competition. Similar to how the DPT vs DC fued has progressed. Practice acts do not change, but titles and PERCEPTION does. Ask any nurse or NP what they are taught about physicians, PA, or resident training...you will hear the undertones of resentment.

 

[rn29306]

And don't anyone start in on the DNP and CRNAs. We put out our position statement on this - we don't want or need this.

This is all on the hopes and prayers of the NPs. They are dragging us kicking and screaming.

Its ridiculus.

 

[deleted87716]

emedpa, I would much rather an NP, PA, DPM, or DDS show up at an accident saying they are Dr. so and so...no argument there.

As a former EMT, I can attest to the fact that pretty much any doctor at the scene of an accident is, at best, useless, and at worst, dangerous. The exception would be an emergency physician, and they usually know better than to stop at accident scenes.

 

[fab4fan]

Lol!

 

[group_theory]

This is the regulation for CRNP for Pennsylvania

http://www.pacode.com/secure/data/049/chapter21/subchapCtoc.html


§ 21.286. Identification of the CRNP.
(a) A patient shall be informed at the time of making an appointment that the patient will be seen by a CRNP.

(b) A CRNP shall wear a name tag that clearly identifies the CRNP with the title ‘‘certified registered nurse practitioner.’’

(c) A CRNP who holds a doctorate should take appropriate steps to inform patients that the CRNP is not a doctor of medicine or doctor of osteopathic medicine.


Authority

The provisions of this § 21.286 issued under section 15(b) of the Medical Practice Act of 1985 (63 P. S. § 422.15(b)).

Source

The provisions of this § 21.286 adopted November 17, 2000, effective November 18, 2000, 30 Pa.B. 5943.

 

[50960]

Jaded, No. I was trained in the UK and am well aware of their system, but being as we are in the USA I was referring to that system. What hospital allows people in clinical setting to call themselves Dr. who did not need a doctorate for their license? None, that I have seen except for some PharmD's

 

[deleted6669]

Jaded, No. I was trained in the UK and am well aware of their system, but being as we are in the USA I was referring to that system. What hospital allows people in clinical setting to call themselves Dr. who did not need a doctorate for their license? None, that I have seen except for some PharmD's

a pharmd is a doctorate of pharmacy. that's the d after pharm.....

 

[50960]

Yes, I know ...... however they have not and do not in many places need this degree for their license.
Can we get a clue before we respond please??

 

[core0]

my state has a law that says a pa may not represent themselves as an md....
check the pa regs in co and ca, I bet they have them too.

Here is the Colorado law:
Nameplate. While performing acts defined as the practice of medicine, a physician assistant shall wear a nameplate with the non-abbreviated title “physician assistant” clearly visible.

It is generally a good idea to introduce yourself as Joe Blank Physician Assistant.

The nurse practice has this to say:
A nurse who is included in the advanced practice registry has the right to use the title "advanced practice nurse" or, if authorized by the board, to use the title "certified nurse midwife", "clinical nurse specialist", "certified registered nurse anesthetist", or "nurse practitioner". These titles may be abbreviated as "A.P.N.", "C.N.M.", "C.N.S.", "C.R.N.A.", or "N.P.", respectively. It is unlawful for any person to use any of the titles or abbreviations listed in this subsection (3) unless included in the registry and authorized by the board to do so.

While not prohibited, "Doctor" is not a title allowed for use by the Nurse Practice Act.

The medical practice act does have this to say:

(d) Using the title M.D., D.O., physician, surgeon, or any word or abbreviation to indicate or induce others to believe that one is licensed to practice medicine in this state and engaged in the diagnosis or treatment of persons afflicted with disease, injury, or defect of body or mind, except as otherwise expressly permitted by the laws of this state enacted relating to the practice of any limited field of the healing arts;

It has generally been interpreted that to use the term Doctor in a medical setting is misrepresenting yourself as one who is licensed to practice medicine. Since NP's practice nursing, they are not allowed to represent themselves as practicing medicine.

The reality would be weird since the BOM has no authority to regulate nursing. However, they have been very rigorous in protecting the use of titles for both PA's and Physicians. If this came to their attention they could move forward and charge an NP just as they could charge any non-physician with representing oneself as practicing medicine. I doubt someone is willing to risk a felony for a title.

David Carpenter, PA-C

 

[MacGyver]

The reality would be weird since the BOM has no authority to regulate nursing. However, they have been very rigorous in protecting the use of titles for both PA's and Physicians. If this came to their attention they could move forward and charge an NP just as they could charge any non-physician with representing oneself as practicing medicine. I doubt someone is willing to risk a felony for a title.

David Carpenter, PA-C

Nurses have nothing to fear from doctors. Loopholes in state law allow the state nursing boards to define whatever they want as "nursing" and as soon as they do that the docs cant touch them.

A state nursing board could define surgery as the practice of "nursing" and there's not a damn thing any state medical board could do about it.

My prediction is that the first step after DNP will be DNP residency programs, tremendously weak watered down versions of what real doctors go thru. After that, you will see them start expanding the nursing scope laws. In less than 20 years, we will see at least one state nursing board write surgery into their scope of practice, defining it as "nursing" practice and ergo immune from any medical board interference.

PAs are in a different boat. They are regulated by state medical boards. In order to escape that, they would have to convince state legislatures that they dont practice medicine, but instead practice something else.

 

[50960]

Perhaps, but to practice at most hospitals one must be on the medical staff. Bylaws changes to prohibit DNP parity with physicians would last a long time, and bring this movement to a screetching halt. The real reason this has not happened, and will not happen is that midlevels make physicians jobs easier...simple as that. So one day we will be seeing Dr. Nurse because it will decrease the amount of double booked complex patients on a physican's schedule that day. Will this be worse or better?? I do not know.

 

[deleted6669]

Perhaps, but to practice at most hospitals one must be on the medical staff. Bylaws changes to prohibit DNP parity with physicians would last a long time, and bring this movement to a screetching halt. The real reason this has not happened, and will not happen is that midlevels make physicians jobs easier...simple as that. So one day we will be seeing Dr. Nurse because it will decrease the amount of double booked complex patients on a physican's schedule that day. Will this be worse or better?? I do not know.

apparently grads of the np program at columbia are already following their own medical inpatients at nyc hospitals.....
http://www.capna.com/

 

[Beau Geste]

For somebody with a "doctorate", you seem to have a jaded view of what a "doctorate" really is!

In the US, we know what it means, so when arguing doctorate, it's probably best to stick with the US versions of "doctor" (e.g. one who completes a doctoral program, whatever the emphasis).

And you forgot to post this from the website you qouted which pertains to the argument:

"The title of Doctor is used both by and of those holding research doctorates or some professional (usually medical) degrees, but according to convention is not used by or of those holding honorary doctorates. Additionally, in the United States while a person with a research doctorate would use the title "Doctor" in an academic or research/development setting, and in publication, he would generally not use the title if working in a corporate setting."

Presumably because it is confusing to the patient, whom we are all there to serve, regardless of our egos.

 

[jwk]

Yes, I know ...... however they have not and do not in many places need this degree for their license.
Can we get a clue before we respond please??

So much for moderators and subtlety.

DNP's do not need this degree for their license.

DPT's do not need this degree for their license.

CRNA's and CNM's and NP's with a doctorate degree do not need this degree for their license.

Does that stop some of them from referring to themselves as "Doctor"? Nope. There's the problem.

Wasn't this topic debated ad nauseum a few weeks ago?

 

[Beau Geste]

Wasn't this topic debated ad nauseum a few weeks ago?

Yes!!!!!!!!!!!!!!!

 

[chimichanga]

So much for moderators and subtlety.

how did he get to be a mod anyway...he continually slams non PhDs...I guess we're not worthy...

 

[Beau Geste]

If you have an issue with a mod, please notify Lee.

 

[matt1234321]

I'm not sure if it is true or not, but i heard that student midlevel nurse providers will have to complete a mandatory dnp after 2015. Is this true?

 

[lawguil]

In the US, we know what it means, so when arguing doctorate, it's probably best to stick with the US versions of "doctor" (e.g. one who completes a doctoral program, whatever the emphasis).

And you forgot to post this from the website you qouted which pertains to the argument:

"The title of Doctor is used both by and of those holding research doctorates or some professional (usually medical) degrees, but according to convention is not used by or of those holding honorary doctorates. Additionally, in the United States while a person with a research doctorate would use the title "Doctor" in an academic or research/development setting, and in publication, he would generally not use the title if working in a corporate setting."

Presumably because it is confusing to the patient, whom we are all there to serve, regardless of our egos.

Professional doctorate degrees are not "doctorate" level degrees EVEN IN THE USA. The USA degree model is broken! It has been broken by accrediting agencies who mandate what degree is awarded. Remember, the administrators at our IVY leagues didn't sit around and decide that medicine, physical therapy, pharmacy or whatever (insert medical profession) were doctorate level degrees. As far as I know, they have never been recognized as anything more than a professional degree in the academic setting. Literally, they are not academic or graduate level degrees, they are vocational or first professional degree's the equivalent of a bachelor’s degree.
LABORLAW.COM
Noun 1. Doctor of Medicine - a doctor''s degree in medicine
Synonyms: MD
The M.D. in Canada and the United States is not a doctorate level degree. The M.D. is an undergraduate degree but mistaken to be a doctorate level degree due to the title. It is a professional degree much like the J.D. ( juris doctor ).

Procede to argue your ignorance, L.

 

[Beau Geste]

Procede to argue your ignorance, L.

This quote shows you are not open to any other opinion about this and really not being very gracious in your argument.

At any rate, why is the US "broken" for considering physicians to hold "doctorates"? No one ever said we had to use the same classification as the British system! The term "doctorate" is legitimate for graduates of a post-graduate doctoral program. There may not be a thesis written with a professional doctorate, but that doesn't make it any less valid.

It sounds like you are being ignorant by inferring that physicians are less of a "doctor" than someone who holds a Ph.D., when in fact it's apples and oranges. You can argue this fact until you're blue in the face, but governing bodies in this country will tell you different, and they make the rules, not you.

 

[lawguil]

This quote shows you are not open to any other opinion about this and really not being very gracious in your argument.

At any rate, why is the US "broken" for considering physicians to hold "doctorates"? No one ever said we had to use the same classification as the British system! The term "doctorate" is legitimate for graduates of a post-graduate doctoral program. There may not be a thesis written with a professional doctorate, but that doesn't make it any less valid.

It sounds like you are being ignorant by inferring that physicians are less of a "doctor" than someone who holds a Ph.D., when in fact it's apples and oranges. You can argue this fact until you're blue in the face, but governing bodies in this country will tell you different, and they make the rules, not you.

Professional organizations mandate what the entry level degree will be, not the university. This does not mean that it is a doctorate level degree because the professional organization wants to advance its agenda or because somebody already has bachelors and then goes back to school. Medical school could be taught as a bachelors program. A PhD couldn't. Do you get it? It's the same reason why the nursing organization can mandate that entry-level be a DNP or the Physical therapy organization can mandate that entry level be a DPT. They are not recognized as doctorate level degrees. It's merely the equivalent of a second bachelors or certificate program. My intent is not to marginalize medical school or any other professional program. It simply isn't doctorate level education!
It's obvious you really don't understand our educational system. US students are so vulnerable to the big business called education. Welcome aboard!

 

[50960]

Actually it is state-law that defines entry level degree requirements, usually called the Health and Safety Code or the like. If NP's want to change entry requirements they will have to change state law.

 

[lawguil]

Actually it is state-law that defines entry level degree requirements, usually called the Health and Safety Code or the like. If NP's want to change entry requirements they will have to change state law.

No! The bottom line is the professional organization decides what educational programs exist and what degree must be awarded for accreditation. Sure you can find a handful of states that require master's degree's for PA's or the like, but there is usually some type of exclusion criteria for folks who are already licensed. Further, most state practice acts require graduation from an accredited program, not xyz degree.
Example: for the PT program to be accredited where I work, we must award master's degrees. The state requires applicants graduate from accredited programs for licensure. Because of accreditation, the professional organizations have all the power and because education is a business, the universities go along with it. The fact is the degree's are inflated!

 

[lawguil]

double entry

 

[lawguil]

If NP's want to change entry requirements they will have to change state law.

Again, NP's don't have to change state law. All they have to do is require "professional doctorate degee's" for accreditation. This in effect changes entry level for all new practitioners. Medicine did this years ago!

 

[lawguil]

Or should I say degree dilution.

 

[Beau Geste]

Do you get it? Welcome aboard!

Why do you have to be so rude when posting? Maybe I might be inclined to read any more of your posts, but for now, I think I'll skip over them. Anything useful you have to say is completely marred by you acting so conceited.

 

[smugtroll]

FYI, DNP folks can and will call themselves doctor. There is no regulation barring that. I agree it is misleading and wrong, but will happen.

Actually your wrong. According to their proposal they'll still be called NP or whatever; I agree with your thoughts on it.

 

[jhaynesky]

Introducing the Doctor of Nursing Practice

• In many institutions, advanced practice registered nurses (APRNs), including Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse Mid-Wives, and Certified Nurse Anesthetists, are prepared in master's-degree programs that often carry a credit load equivalent to doctoral degrees in the other health professions. AACN's position statement calls for educating APRNs and nurses seeking top systems/organizational roles in DNP programs.
• The DNP is designed for nurses seeking a terminal degree in nursing practice and offers an alternative to research-focused doctoral programs. DNP-prepared nurses are well-equipped to fully implement the science developed by nurse researchers prepared in PhD, DNSc, and other research-focused nursing doctorates.

• In a 2005 report titled Advancing the Nation's Health Needs: NIH Research Training Programs, the National Academy of Sciences called for nursing to develop a non-research clinical doctorate to prepare expert practitioners who can also serve as clinical faculty. AACN's work to advance the DNP is consistent with this call to action.

• Nursing is moving in the direction of other health professions in the transition to the DNP. Medicine (MD), Dentistry (DDS), Pharmacy (PharmD), Psychology (PsyD), Physical Therapy (DPT), and Audiology (AudD) all offer practice doctorates.

 

[Therapist4Chnge]

1st post bumps a nearly 3 year old thread......

 

[Paseo Del Norte]

http://forums.studentdoctor.net/showthread.php?t=635613