Wednesday, April 2, 2008
Nurses as Doctors
The Wall Street Journal wrote today that more than 200 nursing schools will launch a doctorate of nursing program so "Nurse-doctors" will graduate with the "skills equivalent to primary-care physicians."
Whoa there, Kimosabe. By whose standards is a two year program that includes a one-year residency, equivalent to the rigors of four years of medical school followed by three -plus years of internship and residency? How is a voluntary (yes, voluntary) certification exam the same as the multiple and ongoing certification exams that physicians are subject to?
We already have advanced nurse practitioners who work under the supervision of physicians and are able to write prescriptions and practice within specific guidelines. They are valued members of treatment teams and serve a vital role in health care. So what is the purpose of allowing a nurse to use "Doctor" before his/her name? We already have PhD in Nursing along with EdD and DNSc degrees that cover nurse educators and researchers. Believe me, just putting "Doctor" before your name does not qualify you to diagnose or treat anything.
It is clear the goal is to allow nurses to bill independently for Medicare and insurance services without needing to go to the trouble, time and expense of medical school. According the to article, these Nurse-doctors will handle complex diagnosis, treatment and management of patients in hospitals, emergency departments and medical offices. All this from nursing school. Hmmmmmm!
There is no doubt we are facing a primary care shortage in this country that will reach crisis proportions. We have devalued primary care to the extent that we will now put it in the hands of nursing...call them doctors (without medical school training), pay them lousy primary care rates and get what we pay for. There is no doubt that referrals to specialists will increase and care will become increasingly more fragmented and expensive overall.
As a last aside, I truly value and work well with both Advanced Nurse Practitioners and Physician Assistants. Some of them have amazing skills but they don't have my training and they don't do what I do.
(Hat tip to J.S. for alerting me to the article in WSJ)
Posted by Toni Brayer, MD at 10:52 PM