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Who Will Be Your Doctor?
Mary O' Neil Mundinger 11.28.07, 6:00 AM ET
A quietly emerging trend in health care is likely to have a major effect on
who will diagnose and treat your illness in the coming years. Rather than a
physician, that comprehensive-care provider may very well be a nurse--who
also happens to be a doctor.
As more physicians move toward specialties and away from general care, there
is a troubling lack of providers in this critical health-care sector. The
need is even more urgent in light of the growing number of Americans who are
suffering from chronic illnesses such as asthma, diabetes and hypertension
and require long-term disease treatment and coordination of care. Many
others who survive extraordinary medical interventions or trauma need
sustaining care for the rest of their lives.
The doctor of nursing practice (DNP) is a new level of clinical practice
that is attracting a rapidly growing number of nursing professionals. This
doctoral degree enables advanced-practice nurses to gain the knowledge and
skills necessary to practice independently in every clinical setting.
In Pictures: Innovative Health-Care Solutions
DNPs are the ideal candidates to fill the primary-care void and deliver a
new, more comprehensive brand of care that starts with but goes well beyond
conventional medical practice. In addition to expert diagnosis and
treatment, DNP training places an emphasis on preventive care, risk
reduction and promoting good health practices. These clinicians are peerless
prevention specialists and coordinators of complex care. In other words, as
a patient, you get the medical knowledge of a physician, with the added
skills of a nursing professional.
Truly comprehensive care requires both medical and nursing skills, and
nurses with a clinical doctorate have that complement of abilities. Skilled
at identifying nuanced changes of condition, and intervening early in a
patient's illness, these clinicians are also expert at utilizing community
and family resources, and incorporating patient values into a
family-centered model of care.
Once patients move beyond the common bias that only doctors of medicine can
provide top-flight care, they typically come to appreciate these added
benefits. Most important, research has demonstrated that DNPs, with their
eight years of education and extensive clinical experience, can achieve
clinical outcomes comparable to those of primary-care physicians.
As more advanced-practice nurses pursue this new level of clinical training,
we are working to create a board certification to establish a consistent
standard of competence. To that end, we are working to enable DNPs to take
standardized exams similar in content and format to the test that physicians
must pass to earn their M.D. degrees. By allowing DNPs to take this test,
the medical establishment will give patients definitive evidence that these
skilled clinicians have the ability to provide comprehensive care
indistinguishable from physicians.
Along with a doctorate and the title of "doctor," the fact that a nurse
practitioner has fulfilled this certification requirement will instill
confidence in patients that DNPs have the expertise to serve as their
health-care provider of choice.
Nurse practitioners are reimbursed by Medicare and Medicaid in every state,
but only variably by commercial insurance carriers. That is certain to
change soon, as these DNP graduates prove they are the logical choice to
become the new comprehensive-care clinicians.
As this valuable new resource grows and becomes fully established, the
health-care system's ability to meet the nation's desire for accessible,
high-quality care will be greatly improved, yielding better health for all.
Medical specialists are in short supply; patients increasingly need their
care. With the advent of the DNP clinicians, we can have both dedicated,
brilliant specialists and effective health management. It is the future we
all need and want.
In Pictures: Innovative Health-Care Solutions
Mary O' Neil Mundinger, Dr.P.H., is the Dean of the Columbia University
School of Nursing, which was the first to pioneer the DNP concept.
