Get ready for Dr. Nurse, who will call himself/herself “Doctor,” but who, after 4 year bachelor’s degree in nursing, has gone to the Doctor of Nursing school for two years with a one year internship — that’s compared to the 4 years of college, 4 years of medical school, followed by at least 3 years of residency that Family Physicians, Pediatricians and Internal Medicine docs devote to training..
The Wall Street Journal reports (please let me know if you can’t access this page) that the National Board of Medical Examiners will begin testing these “DrNP” candidates this fall.
From the Wall Street Journal:
As doctors face shrinking insurance reimbursements and rising malpractice-insurance costs, more medical students are forsaking primary care for specialty practices with higher incomes and more predictable hours. As a result, there could be a shortfall ranging from 85,000 to 200,000 primary-care physicians by 2020, according to various estimates.
So,the supposed reasoning behind the new doctorate is this shortage of primary care doctors. That shortage has been artificially encouraged by all sorts of federal interventions. For some reason, no one’s considered paying Family Doctors more!
Instead, there are schemes to divide and re-divide the Medicare “Pie.” There are the rural health clinics, which are paid more by Medicare and Medicaid than your local family doctor, pediatrician or internal medicine doc for seeing the same patients. In order to qualify, the clinic — get the distinction, there, not the doctor, but who ever it is that owns the clinic and contracts with doctors and hires the rest of the staff – must hire at least one “mid level practitioner” to see patients. They can’t hire a doctor to do the same work and/or for the same money — they must hire a Physician Assistant or Nurse Practitioner.
As the article notes, the main reason for the loss of primary care physicians, however, is the low pay for the thinking part of what we do, compared to the procedures of specialists, such as all the varieties of surgeons, urologists, gynecologists and gastroenterologists. We analyze, examine and determine treatment or treatment change, resulting in “Evaluation and Management” visits. Rather than the codes used for procedures, the E&M visits are divided into levels of payment based on a set of check lists and diagnoses. The money from Medicare – followed closely by the insurance companies – has consistently shifted from the office visits toward the procedures.
Needless to say, the smart medical students — or at least the ones more interested in money than in your family history, living arrangements and whether Junior ate his peas and carrots will become interventional sub-specialists, not a Family Physician or Pediatrician.
A few years ago, Medicare payments increased for home health agencies, which encouraged RN’s and LVN’s to leave the hospital. Medicare quit paying your family doc to “scrub in” with the general surgeon or orthopedist as an assistant during your gall bladder surgery, colon resection or hip replacement. But, they did pay the surgeon enough to justify the hiring of a nurse practitioner or physician assistant. And studies said there was no difference or even better outcomes, since the “team” worked better in the Operating room and the peri-surgery procedure became more efficient.
(Of course, the NP or PA won’t be available to your wife or kids for questions next week, and won’t watch the effect of your new level of activity on your blood pressure or diabetes. And your family doctor may no longer even know that she should, since she won’t even find out about the surgery until your next visit or hospitalization. But that has nothing to do with the outcome of the surgery, right?)
The increase of Federal funding for Nurse Practitioners has exacerbated the loss of good RN’s and LVN’s – leading to more of the Federal pie going to nursing schools. And the DrNP will probably have the same effect. The WSJ article mentions the lack of faculty in the nursing schools. The funding will have to come out of the Medicare and Federal “pie.”
However, what patients need to consider is whether the DrNP training can truly accomplish the same training in 3 years that our Medical Schools can do in 5 to 7 years. Some have said that mid levels can handle 80% of what doctors do.
It’s that 20% that is the difference between knowing what you don’t know and planning for the 2 AM crisis.
LifeEthics 
The hardest thing for me to understand after nursing for years is why there is so many nurses in management. Is there even a need for a FNP, since Medical Doctors have PAs. I am starting to think every time I heare nursing shortage is the nursing profession seems to do it to themselves.Would it not make more since for nurses to do the job they were intended to do in the hospital.After working in nursing and seeing many FNPs, the thought process is not the same. Even simple procedures take longer with FNPs compared to a MD. Time wasted on the patients part and the nurse assisting.I have also seen many good nurses go on the medical school and some go to be FNPs. There is just things that doctors need to attend to and there are some things nurses should do.
Posted by Anonymous | November 11, 2009, 1:47 amThanks, November 11 Anon. It does seem as though every government funding program concerning health care contains some way of encouraging nurses to move away from nursing care. And then, like the home health care push, they pull the rug out from under the business by removing the money.
Posted by LifeEthics.org | November 11, 2009, 5:21 pmI recently graduated from one of the top nursing schools in the country and I completely fell in love with nursing over the past four years. I want to give my patients the best nursing care possible. If that means going to school for an additional 4 years to earn a DNP then I'm going to do it. If I had to go to school for an additional 20 years I'd do that too. In no way do I want to take the place of a doctor…medical theory is just as important in a health care environment as nursing theory. I feel that it is my duty to provide my patients with the best nursing care possible and a part of that is receiving as much education as I can.
Posted by Anonymous | December 22, 2009, 7:10 pmMost nurses would see the comment of "Why don't you just be a doctor?" as insulting. There is a huge difference in what we do. We spend more time with patients-actively listening, assessing and observing. We know them. We care about what happens to them. They are not just a DX or a procedure to us. Can most doctors say the same? I think not. I, as well, have encountered the same issues with not only residents but physicians with years of experience. No one is infalible. No, really. MD's are not GOD, as much as they seem to think so. Nurses are not 2nd class citizens. In fact, some of us actually have a decent knowledge base. And, sometimes (said w/ much sarcasm) we catch the physicians mistakes.I am an MSN student with over 15 years experience (ER). Oh and btw, most DNPs are obtaining their MSN prior to DNP. So, add another 2-3 yrs to your equation and most programs will not accept you unless you have completed a role option in an advanced PRACTICE setting-thus clinical practice in your specialty. The idea is not Doctor but Doctor of NURSING PRACTICE. It means that they have gotten to the highest point in the profession of nursing. I honestly think disgruntled doctors are teaching the new ones and are perpetuating this BS.I believe there needs to be education about nurses-by nurses for physicians. I read a survey tonight that stated that 96% of nurses interviewed have heard a physician yell at or abuse another nurse. And, we wonder why nurses are racing out the door of the hospitals. How about some recognition and respect for what we do? Yes, we carry out orders. But, our work is difficult and laborious but it is the most rewarding thing I have ever done. I do not do it for the $…as most likely the reason that half the physicians are in their profession. I do it because I care and I make a difference by being a nurse. Research proves that good care by a nurse can be quite beneficial to patients. And, no…I would never want to be a doctor. I hold nurses in much higher esteem as does most of the country. In fact, another study revealed that while nurses are still held in high regards, that going to see an MD was considered lower than going to supermarket or a mechanic.
Posted by Coleen | April 24, 2010, 8:04 amColleen, You are assuming a lot: about motives ($), listening/not listening, aggression against others. I can line up Family Physicians and Internal Medicine doctors that meet all your criteria. I only know about troubles communicating between doctors and NP, which seem philosophical rather than language or years of experience, the rate of referrals to sub-specialists compared to Family Physicians, and the problem that NP's are no more likely to move to underserved areas than physicians, are less likely to provide for 'round the clock call coverage for the patients seen in the office and that quite a few of them subspecialize and work for subspecialists.If it takes as long, and the training is equivalent, why the two degrees, why the two State Boards?
Posted by LifeEthics.org | April 25, 2010, 4:39 amFrom “Anonymous” on November 15, 2010 to the old website:
LifeEthics forgive me but I think you are ignorant. I am currently in nursing school while also getting my pre-reqs for medical school. The reason I decided to go to nursing school and then medical school is because I want the nursing perspective as a MD. Please notice that I said MD and NOT Doctor. A doctoral degree is simply a terminal degree in any field whether it is Philosophy, Music, Medicine, or Nursing. Please do not be mistaken in thinking that the field of nursing is just a simplified version of medicine, it is not. Medicine focuses on the treatment of disease processes and symptoms whereas nursing focuses on patient care. There is a huge difference. Medicine is about healing when nursing is about wellness in the holistic view of physical, spiritual, and mental parts of a person and how they fit into their familial system. While it is true that Family Practice and Internists tend to be more relational with their patients it is also undeniable that a MD may spend 5 minutes at the bedside and 10 minutes with the chart apart from procedures in the hospital setting when nurses spend a 12 hour shift constantly interacting with patients and their families. Nurses also serve as patient advocates watching for drug interactions and coordination of care when there are multiple MDs caring for one patient. All that to be said, a DNP is not trying to take a shortcut to becoming a MD. A DNP is the terminal degree for nursing practice. DNPs do not have the same role in healthcare as MDs and do not want it or they would have gone to medical school. I hope this has cleared a little of the fog for you and given you a little insight into why nurses are offended by your statements.
If DNP’s are going to have independent practice that involves diagnosis and treatment – and from al reports, that is what they are asking for – that sounds like medicine.
There certainly is a lot of projection going on in the comments. No one has more respect for nurses than I do. I listen and ask advice and give credit where it’s due.
Posted by Beverly Nuckols, MD | November 15, 2010, 11:47 pm