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)

15 comments:

Anonymous said...

What is the differance in education and training between a DO and an MD which are both seen as primary care physicians? Does a DO have less training?

Anonymous said...

I have seen three NP's two for primary care. One gave an incorrect diagnosis on a gyn problem, so I had to go to an MD who specialized in gyn to get it tested for cancer and a correct diagnosis.
I saw the second NP for a physical which was not as complete or extensive as the reagular primary care doctor I go to and didn't set up a plan of treatment for a problem so, now I need to see an MD to get it taken care of and the physical with LESS TREATMENT (not covered by ins.) cost the same as if I had gone to an actual primary care physician. The third NP specializing in gyn was excellently trainrd, skilled and personaly interested, found a lump that needed to be removed and refered to a breast surgeon.

For a primary care physician I would prefer,chose and feel more confident with an MD for serious emergencies, especialy if having to be admitted to the hospital. I hope the hospitalists are all MD's.
Sad to have a smaller selection of excellent,interested, quality, highly trained and educated MD's as many retire, go into a speciality or become conceraige.

walden said...

I am a Physician Assistant who provides care in a rural community. I'm fortunate to have the support of an excellent supervising physician, and I'd like to think that as a team we provide high quality care. Unfortunately, nurse practicioners don't seem to value that relationship, nor the more extensive training that MD's and DO's go through. For some strange reason they feel that nursing assessment is appropriate for complex medical conditions. I strongly question this. Additionally, few people realize that NPs are not held to the same practice standards and ethical standards as DO's, MD's and PA's. Sad to say, I believe most are interested in cash incentives rather than providing optimal care. Another issue I have is with NPs providing specialty services without a collaborating specialist. The bottom line for me, is if you want to be a doctor, go to medical school.

Vance said...

There is no substitute for training and experience. There are no shortcuts. You get what you pay for.

All cliches, but all true, especially when it comes to your health.

Jonathan said...

I’m concerned as a patient about nurses being able to use the usual and customary honorific doctor for a DNP in a hands-on capacity in the medical field. As a patient I’d like to keep my doctors of medicine separate in my mind from my doctors of nursing.

Titles are a method society uses to confer expertise, and while I have the education to delineate the training differences between a DNP and an MD, I’m not sure the less well educated will enjoy the same level of understanding and hence will not necessarily receive the benefit of the additional training of the MD.

Rich said...

Just another step in the direction of outsourcing. Need more doctors? we'll create some, less the medical school, who needs that???

Maribeth cnm said...

Wait a minute. Methinks someone (probably the WSJ) misunderstood this. Yes, they receive doctorates, but no, they are not CLINICAL practitioners on par with physicians. DNPs are like PhDs - they work in research, or education. I've been a nurse for 16 years, and an (advanced practice) nurse-midwife for 7, and I've never heard anyone refer to them as clinical providers.

That said, APNs are HUGELY important in our health care system, and presently both undervalued and underutilized. It threatens some physicians, but it's true.

Toni Brayer MD said...

maribeth cnm: I agree with you about the value of advanced nurse practitioners and PAs. I work with both as colleagues and have a great deal of respect for them. There is also a need for more nurse educators. That said, the planned expansion of DNPs is likely an answer to the primary care shortage crisis. Rather than do the hard work of fixing a broken system, they are substituting a different training and skill level for doctors. This is not a good use for DNPs and society will not be better off without primary care physicians.

Maribeth cnm said...

Clearly we need: more primary care docs, more nurse practitioners, health care for all, and more urgent care clinics (to respite the ERs). Have you discussed "walmart" type clinics on your blog? And, is there any momentum in medicine right now to curb the tendency of up and coming docs towards specialization? Because that's hurting both the nation, and the doctors.

Butte Munch said...

These doctor nurses, the minute care clinics and all the like are just going through a brief and lucky fantasy period before the ugly realities of our medical-legal system kick in. Does anyone think it a coincidence that currently the vast majority of medical malpractice is against MDs??

I look forward to the day very soon when the "chickens come home to roost", the lawyers wisen up and there are a flood of medical malpractice suits against all the current medical para - professionals. Jurys will hang these poor folks out to dry without any supervising MD's to take the fall. Only then will the Nursing Boards go running for cover and beg someone else to take the liability once again for patient care.

It wasn't long ago that OB/GYN's thought they could read mammograms on there own and make a few extra bucks. A few missed cancers and several multi million dollar lawsuits later there governing boards quickly scrapped that idea.

Good luck and enjoy it while it lasts Dr. Nurse.

Anonymous said...

NUrse practitioners are trained in advanced nursing and medicine. Before an NP becomes an NP, the training and education was vast, rigorous and most NP's were already experienced in handling acute and chronic conditions. If I would be asked which one to see. I'll ask for an NP...why..they are compassionate...they give you extra time...they are nurses they "care" and at the same time they"cure".. Their assessments are far more detailed and complete...I know this because it is a fact and I've seen it.

Anonymous said...

Let's not confused ourselves about the DNP (Doctor in Nursing Practice)..it's not a prfession to replace doctors. By 2015 all nurses who wants to be NP's must have the DNP. Doctors have wide knowldege on treating diseases but NP's are wide knowledge too. Together they are a team who can practice medicine to help patients. NP's are widely respected in the medical society. Most physicians that I know have NP's in their practice. Why...knowledge and experience..pluc their compassionate touch.

Anonymous said...

If a person wants to direct care and manage complex patients, they should go to medical school and then complete a residency. Anything less demanding will harm patients in the long run.
The reason for primary care shortages is poor compensation. Adding lower quality health care providers willing to work for less is a terrible solution. Primary care is the front line, and having well trained diagnosticians keeping people healthy is the only acceptable method for improving this country's health.

Look up the curriculum for this Doctorate in Nursing and compare it to the rigors of medical school/residency and tell me if you still feel as confident with your DNP as you are with an MD...

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according to a friend of mine, she is nurse, she told that the medical training to be nurse and to be doctor, is technically the same, for the unique difference in operation process knowledge.

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