So basically this DNP degree is a cheaper, easier to complete, less experienced version of an MD?By Helena Bachmann
This spring, the University of Rhode Island in Providence is starting the registration process for the state's first Doctor of Nursing Practice (DNP) degree. Scheduled to commence in the fall, it will join the ranks of 153 other DNP programs presently operating in the United States; some 106 new ones are currently under development.
(Information courtesy of American Association of Colleges of Nursing, http://www.aacn.nche.edu/Media/pdf/Docprograms.pdf)
As this degree is gaining ground, it continues to stir intense debate and conflict within the health care community.
On one hand are the proponents, who argue that the doctoral-level degree focused on the clinical practice (as opposed to a PhD, which prepares nurse researchers/scientists), gives nurses enhanced knowledge and skills to treat patients, especially in places where there are no other primary care providers. On the other side are the critics, claiming that the "doctor" prefix confuses and misleads patients into believing they are being treated by a Doctor of Medicine (MD) or a Doctor of Osteopathy (DO), the two professional doctoral degrees for physicians in the US. Just as importantly, many medical organizations say, is the quality of patient care provided, since DNPs receive far less training than MDs and DOs do.
DNP's Evolution
The Commission on Collegiate Nursing Education (CCNE), the leading accrediting agency for Bachelor's and graduate degree nursing programs in the United States, began the process of accrediting DNP programs in 2008.
While leaving the specifics of the DNP curriculum up to individual academic institutions, the American Association of Colleges of Nursing (AACN) explains on its website that the degree's focus is on "providing leadership for evidence-based practice." Furthermore, AACN states, "It is believed that enhanced educational preparation will lead to degree parity with other health care professions and assist graduates to assume leadership roles in clinical practice, clinical teaching, and policy development."
AACN, the voice for the country's nursing education programs, notes in its position statement that more doctoral-level nurses are needed to meet the changing demands of the nation's health care system. An estimated 32 million additional Americans will gain coverage as of 2014 under the recent health care law, so a larger number of health providers will be needed to care for these patients. For this reason, AACN has suggested moving the level of preparation necessary for advanced nursing practice from the master's to the doctorate degree by 2015.
Butting Heads Over DNP's Role
The idea is that DNPs would fill some of the gap left by the on-going shortage of primary care physicians needed to treat not only the newly insured, but also the growing aging population. If predictions are accurate, the demand for health services will outstrip the supply: The Association of American Medical Colleges says that, at current graduation and training rates, the U.S. could face a shortage of up to 150,000 physicians in the next 15 years.
These present and future trends and challenges have prompted the Institute of Medicine (IOM), the nonprofit arm of the National Academy of Sciences, to issue a report at the end of 2010 urging increased training and autonomy for nurses. The most contentious part of this report is a call for the so-called "scope of practice" – the authority nurses would have to order tests, prescribe drugs, as well as perform other medical services.
According to Kaiser Health News (KHN), an independent news organization providing coverage of health care policies and trends, the report "calls for states and the federal government to remove barriers that restrict what care advanced practice nurses provide and includes many examples of nurses taking on bigger responsibilities."
Some states have already started this process, while others are on the way. KHN notes that Colorado "recently became the 16th state to allow nurse anesthetists to work without a doctor's oversight. In Michigan, nurses are pushing for legislators there to allow advanced practice nurses to prescribe drugs. Other fights over scope of practice for registered nurses loom in Kentucky, North Carolina, Iowa and Minnesota."
But as increasing numbers of DNPs are being trained and getting ready to assume more responsibility for patient care, many physician groups are concerned about the implications of these measures.
The Level of Training
One of the main arguments advanced by organizations such as the American Academy of Family Physicians (AAFP) and American Medical Association (AMA) against giving DNPs autonomy to care for patients is the lower level of education and clinical experience as compared to training MDs and DOs receive.
AAFP's president Roland Goertz, MD, MBA, tells SDN that the educational requirements for DNPs "focus more on topics such as concepts in nursing, health policy, illness management, drug therapy, epidemiology, and health assessment. In general, the DNP does not have residency training, and the only clinical requirement is that candidates for this degree receive at least 1,000 hours of supervised clinical experience."
By comparison, Goertz points out that family physicians spend nearly 6,000 hours in lectures, clinical study, lab and direct patient care as medical students. They then go on to three years of residency training, in which they complete an additional 9,000 to 10,000 hours of clinical training.
Eventually I think America should just outsource everything and constantly search for cheaper substitutes regardless of effectiveness.
In a few decades the US health care system will be saturated with union loving Noctors.
How in the world does a degree like this get created? I guess the artificial capping of residencies and what not hasn't really protected the field of medicine like everyone says. Soon we will have tons of specialist Noctors.
