Monday, February 9, 2009

DNP title...

OKEY DOKEY. I like NP's, I consider them colleagues, but I think that they have gone off the deep end with this one. First, mandating that all NP education is awarded a doctorate by 2015 is foolish. This will decrease enrollment of many potential RN's, and especially those that might be likely to practice in rural and underserved areas, where we have the greatest need. The added expenses of completing a doctoral degree will ensure that DNP graduates will seek out better paying opportunities in more attractive locales in order to pay down student loan debt.

My other concern is the use of the title, "Doctor". It is true that pharmacists, PT's, and others have moved to a doctoral degree. BUT, none of those professions outside of a psychologist, use the title "Doctor" when treating patients.....why you might ask?

Simple, it is confusing to the layperson, and downright fraudulent, especially when you consider how closely a PA/NP's duties are to a physicians. I am a firm believer that the title "Doctor" should be reserved for MD's, DO's, DPM's, DDS's, and PhD psychologists. I have several PA colleagues who have PhD degrees, which despite some beliefs, is certainly more difficult than completing a DNP degree from what I have gathered. Not a single one of them will use the title "doctor" in the clinical setting. It is simply not worth the potential confusion. I get called "Doctor" all day long as it is, and I politely remind the patients that I am a PA, not an MD. They usually reply, "Okay, thanks doctor".....but to DELIBERATELY call yourself a doctor is potentially misleading. Trust me, when I complete my doctorate in about 3 years, the title doctor, will not be used in the clinical setting.

A recent article I read in Advance for NP's suggested that 47% of current NP's or NP students PLAN ON USING THE TERM DOCTOR UPON completion of their degree. This is a potential legal minefield, and I would urge the NP community to tread lightly with this. Everything will be fine as long as no bad outcomes occur.......unfortunately, BAD OUTCOMES do occur, and they will happen to everyone that practices medicine at some time. It is a simple statistical reality. When that happens, I can already see a case of fraud, or misidentity being brought easily.

Here's a snippet and link from an article on ADVANCE for NP's...

Using the Title 'Doctor'
One of the greatest hurdles NPs with DNPs will face is opposition to use of the title "doctor" in professional practice. Historically, the term "doctor" has been an academic title.

In the past century, physicians have used the title "doctor" to identify themselves as medical practitioners. However, many professions, including pharmacy, physical therapy, clinical psychiatry and naturopathy, have already or soon will transition to a doctorate degree for entry to practice. In 2008, the AMA passed resolutions to restrict professional use of the title to physicians, osteopaths and podiatrists. These resolutions do not have the force of law.

In response, seven national nurse practitioner groups convened to craft a position statement. In the document, the American Academy of Nurse Practitioners, the American College of Nurse Practitioners, the Association of Faculties of Pediatric Nurse Practitioners, the National Association of Nurse Practitioners in Women's Health, the National Association of Pediatric Nurse Practitioners, the National Conference of Gerontological Nurse Practitioners (now the Gerontological Advanced Practice Nurses Association) and NONPF addressed three important issues: the DNP, NP certification and use of the title "doctor."

"The DNP degree more accurately reflects current clinical competencies and includes preparation for the changing health care system," the groups wrote. The document also stated that the NP groups do not support a National Board of Medical Examiners (NBME) certification for DNPs, and that the title "doctor" is earned by many and should not be reserved for physicians alone.

"Physicians have nothing to fear in the long run and would probably do well to embrace the possibilities of partnering with these advanced practice nurses as it would be of benefit to all involved - especially the patient," O'Dell notes.

Laura K. Melaro, NP, has been an NP for 20 years. Sheearned a DNP from the University of Tennessee in Memphis in 2008.

Melaro has already had to address the use of her new title. "I have found myself minimizing my accomplishments by going out of my way to assure that people are aware that my degree is in nursing, not medicine. I have always proudly identified myself as a nurse." She sees the AMA's actions as excessive, "considering that all health care providers are required to display their licenses, degrees and credentials in their practice settings."

"Most of my peers and patients have been very positive, and they often comment that they are proud that I am being recognized for the level of work that I do," Melaro says. "I am often chastised for not using my title. I have only recently started using my credentials professionally and allowing people to call me 'doctor.'"

No matter what degree they earn, NPs must follow their state laws as to how they may identify themselves in practice. Seven states prohibit NPs from using the title "doctor" in professional settings.4


Why Get a DNP Degree?
Many NPs with master's degrees wonder what the DNP will add to their everyday practice. Nurse practitioners who have earned the DNP say that it's hard to grasp what is to be gained from the degree "until you've already earned one."

O'Dell says the DNP is a symbol of having earned the highest level of practice ability in the nursing discipline. "If an NP is going to grow professionally and contribute as the professional that I believe us to be, then a terminal degree is the next logical step in demonstrating skills in our discipline."



http://nurse-practitioners.advanceweb.com/editorial/content/editorial.aspx?cc=191346&CP=3

57 comments:

jeff said...

Amen brother. Fellow ER PA.
J

ladyk73 said...

All clinicians, while in a clinical role should not call themselves doctor unless they are a physician. We had a NP with a Phd who was a big academic at the local Nursing school. She had attitude...but still refered to herself as an NP to the patients. A pharmD referes to himself as a pharmacist, a Doctorate PT, as a physical therapist.

What is wrong with refering to yourself as a nurse practioner to the patient?

My brother is a big fancy scientist with a Phd. He generally gets ticked off if a doctor calls him by his first name and refers to himself as a Dr. so and so. But he has issues.

Contrasted to SW with doctorate I know. He usually intoduce himself as Dr. Joe Blow, clinical social worker, but you can call me Joe.

physasst said...

ladyk...

YOU ARE SO correct, unfortunately, the NP profession feels otherwise. Here's a snippet from a converstaion I was having on a nursing forum....

"Rightfully so as the PhD credential is not a clinical-based doctorate like the DNP or MD degree. Holding oneself out as a clinical doctor in a clinical setting with a research-based credential would be misleading, fraudulent and dangerous."

and my reply...

"Are you honestly trying to compare a DNP degree to an MD degree? Really?

That is the height of blatant arrogance. A DNP is NOT a clinical doctor, despite their feelings to the contrary.

I'll tell you what, if you are willing to take the physician board exams for whichever specialty you choose to practice in, and are willing to complete a 3-5 year residency, than perhaps I will change my mind. If you are willing to RE-board in those specialties, and are willing to be licensed by the state medical board, perhaps I will change my mind.

Until then, you have taken a very vaulable asset, the rural NP, and taken the profession down a VERY dangerous road."

MLP said...

I would agree that clinicians that have the doctorate degree in PA or NP professions should not use the title "doctor" in their clinical setting. The idea of a doctorate degree is controversial in general and this certainly does not help their cause.

Anonymous said...

Enjoy the blog, but the clashing colors of a black background and white font makes it almost impossible to read. You have to respect those with diverse monitors and this color scheme is tough on the eyes.

Anonymous said...

History lesson: Professors (PhD's) are the true, original doctors.

Physicians in early times had very little respect and were seen as quacks or body snatchers. In order to overcome that stigma, physicians began to refer to themselves as "Doctors" in the hopes of garnering some of the respect accorded to professors.

That PR move has been so successful that most people in the U.S. now think that "doctor" refers mainly to physicians and that PhD's are "fake" doctors.

Anonymous said...

In that practice of medicine, unlike many other disciplines inthe pure sciences, the term doctor has a distinct meaning. As a fellow clinician (military and occ med PA), I agree that this will be very misleading to patients. As one who is sometimes referred to as doctor by patients who simply assume (even after introducing myself as a PA), it is our obligation to delineate our position while providing equal care. Entering into a room and introducing ones self to a patient as "doctor" and practicing medicine (non-PT, podiatry, chiro, dental) will almost always be misconstrued. I read another artice about this on www.zulumedica.com.

PS. I read in a state board disciplinary action about a MD who allowed her doctor husband to perform a few pelvic exams on a few of her patients. It was later discovered that her husband was a PhD (sociology or other). the patients did not question his credentals..only heard "I am doctor_____."

Anonymous said...

DNP degree is appropriate for the ARNP NPs, considering their clinical responsibilties and training. I don't believe it is their intention to called themselves "Doctor" in the clinical setting but to allow themselves more autonoumous practice.

Anonymous said...

The negative discussions in this column about ARNP's raising their educational requirements to doctoral level is ludicrous. The Physician Assistant is exactly that, an assistant. There is very little need for them to raise their current educational requirements since they do not practice without direct supervision from a Physician, unlike ARNP NPs.

Anonymous said...

The term "Doctor" is not nor has it ever been the the sole "possession" of the medical community. It applies to independant practitioners such as Dentist, Podiatrist, Optometrist, Psychologist and Advanced Practice Nurse Practitioners who have trained at the Doctoral level. A PhD is not considered a practice doctorate but a research and/or teaching degree. PAs can earn a DHSc degree but it is a "post professional" degree with not much application to clinical health care practice or reality.

Anonymous said...

There is no real comparison between Nurse Practitioners and PAs. The Nurse Practitioner is an Masters prepared *independent (*key word) practitioner with advance clinical training in his/hers specialty beyond his/her 4 year BSN/BS. Where as a PA could have been a labortory technician with no health education or training before being accapted into general science PA program. If I am incorrect, please correct me.

Anonymous said...

I thought this might help:

http://www.txwes.edu/DNAP/

http://www.aacn.nche.edu/dnp/DNPProgramList.htm

Anonymous said...

As a ARNP,MSN,NP, I have seen very little discussions in our forums concerning PAs. Reason, we don't feel they compete with us directly. PAs have very specific duties outlined by their Physician supervisor which, unlike an ARNP, are usually standard orders. Secondly, professional "bad mouthing" isn't, well.... professional.

Anonymous said...

phyasst, you are incorrect about DNP degree being offered as comparable to MD degree it is not. As the degree states it is a Doctor of Nursing Practice,i.e., it is a Professional Nursing degree of clinical practice not medicine. That would seems fairly clear to any reasonable and unbias person, one would think. Secondly, your declaration that only a "Medical Doctor" can call themselves Doctor seems counter intuitive. Are you suggesting that Dentist, Podiatrist, Optometrist, Psychologist, and others are being deceptive with their patients?

Anonymous said...

Doctorate of Physician Assisting...ah..err..??? You're right, a PA shouldn't present himself as a physician.

Anonymous said...

Simply stated, health care consists of three foundations: medicine, nursing and dentistry. All other areas are adjuncts to them. I don't believe I see PA-ology is one of those foundations.

Mick, RN, MS, ACNS, CCNS/P, FNP said...

It is very interesting to me that people are getting in an uproar about the DNP degree. As an Advance Practice Nurse, I have worked very hard to obtain the knowledge I possess. Completing my BSN gave me a solid base to start caring for real patients and diseases. The conditions and treatments I had to be knowledgeable about were the same conditions and situations that MDs, PAs and ARNPs learn about. The difference is that RNs learn the information on a broad scope. This occurs over a 2 year time span. I do believe that most PA programs do the same. Then upon graduation the RN goes to work in the hospital or clinics with patients and are mentored by more knowledgeable RNs in order to refine and strengthen the knowledge that they obtained in the BSN program. This sounds a lot like the 3rd and 4th year of medical school. Then comes graduate school. Once in graduate school the RN (most with 2+ years of on the job experience) builds further on their knowledge. We go more indepth into physiology, psychology, pathology, assessment and physical diagnosing, pharmacotherapuetics and pharmacokenetics, health promotion and disease prevention, and more. If this is a master's program then the practitioner has another 2.5-3years of education and clinical experience. The difference is that our training is focused on the special that we desire certification. If a nurse wants to be a FNP then they focus their training in caring for the entire family in primary care, or if the nurse desires acute care or emergency medicine then they do clinical rotations and focused in class training in that specialty. This sure sounds a lot like internship and residency. By this time in our career we have at least 7 years of experience and 7 years of education. If the practitioner wants to obtain a DNP degree then they are looking at more didactic and clinical training in the specialty they are boarded in as an ARNP. This brings the grand total of educational and clinical experience years to 10-11. If I am not mistaken a family practice doctor has the same amount of education in regards to years spent in school and clinical experience.

One other thought, how many months do PA's get in focused training in family practice before becoming certified as a PA? Now I'm not talking about over clinical training, but focused training in family practice, emergency medicine, or or acute care/hospital medicine.

Mick

p.s. All of the DNPs I know only use the title for the academic setting. They usually initially tell patients that they are nurse practitioners. They all pursued their DNP to better care for patients.

Mick,RN, MS, ACNS, CCNS/P, FNP said...

One other comment that pertains to what I said. I have worked with PA's in their 2000-2600 hours of training and in many cases they are just standing in a corner observing. Most do this in teaching institutions where med students and residents get first dibs on cases and patients. Furthermore, the PA has to learn basic patient interaction skills and direct patient care skills for the first time. This takes time. I know, I've been there. During the RN program is were ARNPs get that training. Then in the real world we better ways to communicate with patients in order to get to the root of the problem without wasting a lot of time. By the time we enter NP school we should have around 6000 hours of clinical experience and training. That is a lot of clinical hours. In my CNS program I had to do over 1500 hours of clinicals to work in acute care. My FNP I only did about 600 hours, but I already had about 26,000 hours of experience and training. This does not include didactic.

Mick

p.s. Thank you for your blog. it has been very interesting and educational.

Anonymous said...

Mick, thank you very stating facts and differences concerning ARNP NP versus the PA. The PA cirriculum is really an entry level health care education, usually 12 to 18 months, of basic health education/amatomy/physiolgy. They have minimal clinical hours versus total ARNP NP. This is like comparing apples to oranges. The PA is a supervised health care worker, the ARNP NP is a independent health care professional . Again we appreciate them and they "extend" the Physicians care. The PA program is terminal education, whereas, the NP reaches a Practice Doctrate for his/her independent practice.

Anonymous said...

please forgive the quick typing of my comments and lack of spell of above.

Anonymous said...

After reading the comments from physasst in other areas in his blog site, I have concluded that he tends to over inflate his education and qualifications. He does seem well informed on his "medical model" of education (I've never seen that used to describe PA school) he attended. His lack of understanding of the clinical doctorate that independent practitioners have i.e., Dentist, Psychologist, Optometrist and DNP is a bit perplexing. I would suggest he get out the ER more and visit the real world, if he gets premission.

physasst said...

Anon,

PA school is modeled on the "medical model", meaning one year didactic, and ONE year full time clinical.

I do not know of a single PA program that is only "12-18" months, please enlighten me.

Most are 24-27 months, and one is actually 3 years.

They are all accredited BY ONE single body, the ARC-PA. Every student recieves the SAME education, whether they go to school in Washington, or New York, it doesn't matter. We all take ONE SINGLE exam the NCCPA board exam, WHICH btw, we have to re-take every six years.

The only nursing programs with similar accrediting processes are the CNM and CRNA programs. The NP process is nothing like it.

Oh yeah, and since many PA schools are AT medical schools, and the PA's often take combined courses with the medical students, I would hardly call it "basic" training.

Does that mean they get the same education as the medical students, for some classes Yes, overall, No.

You should really educate yourself a little more before coming here and spouting half truths, and incorrect information.

I'm happy to educate you.

Anonymous said...

phyasst, I think you made everyone's point here. PA school takes about 24 to 27 months. That NOT much education for an inexperienced entry student. Well, 1 year diadatic and 1 year clinical is entry level at best.

Anonymous said...

Conerning your medical model, please go to http://www.ncbi.nlm.nih.gov/pubmed/8194936

physasst said...

Anon,

And how long is NP school?

The point is this. We are both colleagues. I would like to see NP's and PA's work collaboratively.

Do I have concerns about NP education. YEP. Do I have concerns about the progressive lack of HCE that I am seeing among PA students...YEP.

I equal concerns about BOTH professions. PA education to me is not much different than NP education. OH WAIT...we don't take nursing theory courses.

Anonymous said...

phyasst, most of the PA programs are at Community Colleges not medical schools. I also agree with the last commentor that PA initial education is very basic and comparable to two year RN ADN programs, Respiratory Therapist and ect.

Anonymous said...

Again, you've missed the critical point that differentiates ARNP's education from PA. NPs DO NOT start at the entry level as PA do. They have BSN\BS degrees and usually 2 to 4 years clinical experience BEFORE entering into advanced practice clinical education not basic health education. An its at a GRADUATE level education within a University or college not community college. Your remarks about not having nursing theory is exactly what differentiates RNs and ARNP Nurse Practitioners from other health care "workers". As of 2015, all ARNP education will be at the Practice Doctrate level (DNP), regardless of any concerns that you may have, LOL.

physasst said...

Anon,

Over 85% of PA programs are now Master's degree credentialed. Most are offered at Universities. In fact....you should really educate yourself before you speak. PA programs USED to be primarily at community level colleges but this has changed dramatically over the past 20 years.

OF the 142 programs, ONLY 3 are community colleges. But nice non sequiter.

We also have programs at Yale, Wake Forest, Baylor, etc.

Almost ALL programs require prior HCE, and most require a prior degree in healthcare.

My class had an average age of 34, and we had 5 RN's in my class, respiratory therapists, several ex-military medics like myself, and about 8 paramedics.

But look for yourself.

http://www.aapa.org/PAPgms111407.pdf

"ACCREDITED PA PROGRAMS — 142. Programs are accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA, Web site, http://www.arc-pa.org; John McCarty, 770/476-1224. The ARC-PA is recognized by the Council for Higher Education Accreditation (CHEA).

The typical PA program is 24-32 months long and requires at least four years of college and some health care experience prior to admission. The majority of students have a BA/BS degree and prior health care experience before admission to a PA program.

While all programs recognize the professional component of PA education with a document of completion for the professional credential (PA), 80 percent of the programs also award a master’s degree. [113 award master’s degrees, 21 award bachelor’s degree, 3 award associate degrees, and 5 award certificates.]

PA Program Directory - The Physician Assistant Programs Directory is available on-line through http://www.paeaonline.org at $35 for one year’s unlimited access."

You can try and belittle us all you want. But it doesn't make it true.

Anonymous said...

I'll repeat my point, NPs DO NOT enter their programs at an entry level(see above) as PA do. That is a fact that you can not change.

Please take a moment to visit the listing of DNP programs. Pay particular attention to admission criteria.
http://www.aacn.nche.edu/dnp/DNPProgramList.htm
I hope this helps educate you to the significant difference between us.
Thank you

physasst said...

Ahh, but they do.

The simple fact is, you cannot twist prior experience in nursing to equal to practicing medicine.

And despite all the BS that the NP profession tries to state about "practicing nursing", you are practicing medicine when you begin to diagnose, treat, and manage illnesses.

I have yet to speak to one NP who states that what they did as a nurse is equivalent to what they do as an NP..

SO how exactly is it not entry level?

It still is, both schoolings are entry level.

You can twist it any way you want, but at the end of the day, those are the facts.

And those are the facts that I write about, and speak about at policy meetings.

physasst said...

Oh, and if you want to continue to discuss this, I just posted a WHOLE new post about my views on both PA's AND NP's, and you can reply to that, cause to be honest, I'm not going to keep coming back to a thread that I posted almost three months ago.

physasst said...

Lastly,

Mick,

Thank you for a polite, well thought post. It was refreshing.

BTW, I share your concern about PA students today. When I went to PA school, I had 12000 hours of prior hands on patient care experience between the military and working as a medic after.

At least here at Mayo, We encourage PA students to get involved. I was just showing one how to do an LP the other day.

Thanks again, and I just posted a new post that may clear up some misconceptions about where I am coming from.

Iain said...

Your not a doctor you are a nurse practitioner, so what if you have a DNP? You still treat sore throats like any other middle level provider.

Whey are nurses so darn hung up on their overly bloated self-absorbed titles anyways?

It is unfair to the patient, only a MD/DO/Podiatrist/Dentist/ or chiropractor can be called doctor with any real meaning.

Joe Shmoe, RN, MSN, OSPPA, FNP, CNAIII, PhD, LPN, Blah, blah, Zzzzzzzzzzzzzzzzzzzzzzzzzzz

Iain said...

Some of you guys are about as informed as a goldfish.

PA=
4 years undergrad (BA/BS degree)
+ 29 months of graduate level PA school.
+ many have years experience as a RT, RN, EMT, etc. = about 7 years of college plus in many cases at least 5 years in the medical field and don't forget the training too as RT, RN, EMT etc...

NP=
4 years BSN
2 Years Clinical RN experience (some don't even require that, you can go from BSN to NP school w/o clinical experience=disturbing).
Less hard science classes as PA, I find it amazing that most NP do not teach Gross Anatomy, Histology, or Biochemsitry. Just lots of fluff Holistic nursing theory classes and I also find it interesting that many nurses I know can continue to work full time in NP school while most PA students can't even work part time due to how gruelling it is.

Learn your facts goldfishes.

Anonymous said...

The anon NP that thinks that NP programs only admit experienced BSNs needs to educate themself. There are several direct entry NP programs that award an MSN NP degree for people with absolutely no experience besides an bachelors in anything. They do an accelerated RN program with minimal clinical experience and then do two years masters work for the NP, again, with much less clincal exposure than a PA program.
I have worked with several NPs that have graduated from a direct entry program. Some of them are fantastic clinicians. However, there were also several that I wouldn't trust to take my BP.
Anon should really do their homework before saying that NP programs are not "entry level".

Anonymous said...

You're grossly uninformed. You cannot received a RN degree without clinical practicums/experience. Entry level PA student can have NO clinical experience and a BS to be "determined" to be appropriate by his/her program. That is the problem that there are no standards for entry into PA programs. I have met PAs that were competent and others that were AWOL clinically. Thats where Physician supervision is important with PAs.

Anonymous said...

lain, why are you so concerned with ARNPs receiving a DNP Clinical Doctorate as there practice degree?
You seem very informed and knowledgable about ARNP education although its only partially correct. I have noticed that every new posting keeps increasing the PA educational requirements, length of program, cirriculum and clinical hours. I see your a fisherman, your fish story about the "Big One" that got away must be fascinating to the uninformed.

physasst said...

Anon 3:13

You are wrong here, yes, standards for PA school admissions vary, but the school curriculum's do not.

By way of comparison, NP school curriculums vary considerably. Not saying that it is right or wrong, just the way it is.

As far as RN experience. It does not matter, unless you were practicing medicine as an RN, the experience is only minimally helpful. Your duties as an ARNP, compared to your duties as an RN are vastly different.

BOTH PA and NP are ENTRY level degrees. No amount of spin, or bullshitology can change that.

I could care less personally if you guys go to a DNP, it'll be better for us.

Iain said...

You need a BA/BS for every PA program, and if it is "to be determined" as you say, then with the competition being so fierce to get into PA school, the vast majority of PA students have their undergraduate degrees and several to many years clinical experience.

There are some NP programs that admit NP students with a BSN but without any clinical experience, in other words, they take new grad BSN students. With no clinical experience.

NP programs do not have the hard science classes as PA programs and PAs are trained in the medical model often alongside med students in many classes. NP can do a lot of it on-line, continue to work, and do not have the hard science classes. They are not trained under the medical model like PAs.

Now I have seen some new grad NPs who are clueless and have seen less new grad PAs who are less clueless, could it be the training under the medical model? I think so.

Just try, just try to get admitted to PA school without a BA/BS degree and some medical experience, I guarantee you won't get in, you won't even get an interview, Esp. w/o an undergraduate degree. Good luck without one...

Anonymous said...

All NP programs require BSN/BS degrees or better for entry. There is NO program that will accept a NP student without prior significant clinical experience. Yes, NP cirriculum does vary because the specialty that is being study dictates that. My prerequisite undergraduate subjects were required: chemistry, biochemistry,statistics,anatomy,physiology,calculus. I took those classes along side pre-med and pre-dental students. After finishing my BSN, took national boards and received my RN license to practice. After 3 years as a CCU\ICU experience I apply to an anesthesia program that accepted 4 student per cycle. I was accepted and completed a very rigorous 30 month program along side Anesthesiology Residents. The program had all the hard sciences and long, long hours of clinical. I graduated with a MSNA, took my National board to practice anesthesia, passed an received my CRNA. I will most likely continue on to complete a DNAP. I currently practice as the sole anesthetist in a rural hospital and enjoy every moment of it. There is a primary care PA that I call a friend and a colleague. We provide outstand care to patients as we were trained to do. After reading some of the comments in your blog, it is very apparent that there is some "misunderstanding" among NPs and PAs which is totally not necessary. I agree with PHYASST that it would be better to support and encourage each other so our professions would progress and flourish. As professions, we are at a crucial moment in health care that could give our professions more importance in the developing health care arena but working together is key.
Thank you PHYASST for this open forum to our express ideas.
Ed G, MSNA, CRNA

physasst said...

Ed,

Thank you for a very well reasoned post. You serve your profession honorably.

But there are combined RN/NP programs. Applicants do not ever work as RN's, they complete the RN portion and then go STRAIGHT into the NP program. This is concerning to me. Just as the lack of prior HCE among some PA schools concerns me as well.

Also, there are online NP programs. Now, I am completing a doctoral degree in policy online. But that is an academic credential, not a clinical one. I simply cannot support a clinical degree being taught online. If there are or were PA programs that are online, than I feel the same exact way about them. It is simply not acceptable when patient care hangs in the balance.

Iain said...

The bottom line:

PA and NP both do exactly the same thing for about the same pay. Both work together well and respect each other. Both are midlevel providers.

The main difference:

1) NP can set up shop on their own, they don't need a doctor to supervise. But in reality, how many can afford to do that? Most are employees of a hospital/group just like PAs.

2) PAs have more lateral mobility and can change specialties with more ease.

That's it, end of story.

Anonymous said...

Yes, I certainly agree, Lain. WE have more commonalities than real differences. We all recognize that we will have some disagreements from time to time but our core values and goals are the same. I believe any "misunderstanding" that arose in this blog was from a perceived lack of respect from each party. I think its clear that we have all worked hard to achieve our education and professional goals. In my practice I have had the pleasure to work with several excellent Physician Assistants that are a credit to their profession. Thanks to PHYASST for this blog.
Jean M,CRNA,ARNP,MSNA

physasst said...

Jean, thank you so much for a thoughtful and considerate post.

My deepest respects.

Anonymous said...

Ah, I love it! Someone who is completely rude and arrogant to nurses starts spouting off about the law. It truly is my day!

So, what is this "legal minefield" of which you speak? Please, do tell us what claim a disgruntled patient can bring against a DNP for introducing herself by the title an accredited university and recognized professional body bestowed upon her after completing the prescribed education and training requirements? Doesn't sound like fraud or misrepresentation to me. But what do I know? I'm only a lawyer. Do you have any idea what you are talking about or is that just a fine example of ipse dixit?

Physicians do not have a monopoly on the "doctor" title. As a previous poster pointed out, it merely means teacher in Latin. In fact, it's the height of arrogance and pomposity that most doctors insist that their patients call them "Doctor ____" but then refer to their patients by their first names. If one is going to demand such formality than they should give it in return.

Every time physicians feel their toes getting step on they throw up the illusory argument that is is all about "patient care." Yeah right. Honestly, how many problems would it really cause? I think a reasonably intelligent person can easily grasp the difference. Furthermore, weight the damage of a few confused patients against the benefit of having more DNPs and NPs bring low cost/high quality medical care to under served populations. Seems to be more than a fair trade off.

The real issue here is pretentious physicians and insecure PAs getting their fragile egos hurt and wanting to preserve their profitable monopoly on rendering medical services. But that is something they are going to have to get over, because change is coming. People are sick of paying $150 for a fifteen minute visit.

But after reading this blog I now see why there is a nursing shortage. Who would want to work with such self-aggrandizing co-workers?

Mick said...

I find it interesting that the PA's focus on the 80% of their programs are at the Masters level. I find it scary that 21 award bachelor’s degree, 3 award associate degrees, and 5 award certificates, and are out prescribing med and diagnosing. That makes up 20% of the graduates from PA education are practiting without much education or experience.

On the not about PA admission criteria. It is not true that PA programs require health care experience prior to admission. The University of Oklahoma HSC PA program does not require health care experirence. If you are a Male applicant it is encourage, but not required. A BS degree is not required, but strongly suggested.

To be certified as an NP all certification programs require a masters or higher to be eligible to take the NP exam. The post masters certificate is accepted, but the nurse must already have a masters in nursing and take an extra 12 to 24 months of training.

http://www.nursecredentialing.org/Eligibility/FamilyNPEligibility.aspx

It is true that some NP programs will admit students directly out of their BSN programs, but many of those students where AD nurses or LPN's prior to entering RN school. They are also very bright students with high GRE scores. The DNP programs are even more critical of applicants.

Hey physasst, tell me this: What did you master in your PA program? Don't tell me ER, or surgery or even primary care. You get the gunshot approach to medicine and medical education. FNP master primary care. ANP master caring for the adult. ACNP master caring for patients in the acute care setting. GNP master caring for the geriatric patients. PNP master pediatrics. psych/mental health NP master psychiatric disorders and counseling those in need. We (NPs)all master compassion and how to care for the person and not just the disease. That is the reason behind NURSING theory.

Hope this helps clear up some things for you.

Anonymous said...

very interesting blog. More interesting are the responses from representatives in each field. Through experience I have found NP's to think higher of themselves than PA's do. Ultimately, it does not matter. The fact is that PA programs are more competitive from an academic and testing perspective. Ask any MD or DO which program he feels is more comprehensive and complete.... I guarantee that they will overwhelmingly pick PA.

Anonymous said...

If one looks at all physician office practices you would see the MAJORITY hire ARNP NPs for their practice. PA are usually hospital employees.

Anonymous said...

As a soon to graduate medical student with both DNP, MSN, and PA programs out our school (DO) I can unquivocally state that I will always hire a PA based on my observations. Equating the 'training' a NP gets to a Board Certified family physician is ludicrous. Yes you do serve a role but respect it. You DO NOT work 80-100 hours a week in residency, take three board certification exams or have 1000s of hours of didactic instruction in the hard sciences (i.e biochem, pathophysiology, pharmacology, microbiology and immunology). We each have a role to play. Respect yours. BTW DNP degrees as well as NP are very top heavy in nursing theory and other vaguely named classes.

Doctor/Nurse said...

Anyone who can read will know a DNP is a nurse.Some of your information "anonymous"is erroneous and inaccurate.you should not blog abour roles you have no knowledge about unless you have been a nurse for 20 years.you sound very uninformed.

John said...

I've been a nurse for 12yr and a NP for the last 5yr and the DNP is a ridiculous degree. It adds nothing more than light research to a degree that works just fine. No hard sciences that are needed! The NP curriculum should be more like the PA curr. We are midlevel providers not doctors and there is no reason to use the title in clinical settings.

Ryan said...

I would have to respectfully disagree that the nursing profession has “gone off the deep-end.” There are few losers in this and the winners are the patients that we treat. I find it traitorous to jump on the boat with medical disciplines such as the PA and MD and leave the profession that licensed you and trained you hanging out to dry. The nurse practitioner has been studied in comparison to other provider disciplines and found to be preferable in many of those studies because the approach used by the nurse practitioner when providing care. Listening to the patients and allotting more time than physicians is common-place in the NP practice. Patients need quality primary care, especially now that the recent legislation has been passed. The doctor of nursing practice (DNP) is an expansion on the unique and quality care that is provided by the NP. The term doctor is okay to be used by a clinical psychologist who has no prescriptive authority, but not the DNP who has prescriptive authority? That statement deserves rethinking. Most all DNP schools are extremely particular when it comes to educating their students on the proper methods of introduction. “Hello, I am Dr. Doe. I am a doctor in nursing practice (provide further details as indicated).” The AMA and everyone talks of confusion patients may experience. I do not think confusion would be an issue with DNPs (NPs do an excellent job of ensuring patients understand treatment plans. A title wouldn’t be too difficult). Physicians are increasingly avoiding primary care at startling rates. The collaboration between NPs and physicians in primary care is not as simple because the primary care physicians are disappearing (retiring, specializing, etc). The lack of collaboration with physicians, an increased number of elderly individuals, and a comprehensive decline in the health status of individuals are some of the many issues that necessitate an increased educational basis of nurse health care providers. The dollar seems to be driving the medical field into specialties and the gap that remains is filled by NPs who are concerned for the health wellness of individuals in this country. The monetary incentive for a DNP should not be the reason for entry because it is not likely to be substantially more than a NP if we evaluate the salary differences between associate-prepared nurses and bachelor-prepared nurses (little if any difference). Nurses in advanced practice roles are ready to “step-up” and in order to be qualified for this the DNP was created. I think it is fair for the APN to be recognized for his/her accomplishments even though historically there has been little nurse recognition credential, monetary, or otherwise. Support your profession!

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Who You Calling Cupcake? said...

This blog is a good read, interesting positions.

I am a C-FNP and am currently pursing my DNP. I chose to do this, not because I wanted to be a doctor, but because I want to have a terminal degree in my field. I want to be the best NP possible, and for me, this means having the highest degree possible in my field.

As for the title, I will use the title Dr. in the university setting when I am teaching undergraduate and masters level nursing. I find it appropriate for academia. In my clinical practice setting, I will still use the title NP. I would never want anyone to assume I was a physician (although half of my rural health patients think I am). If I had wanted to me a medical doctor I would have went to medical school. I love being a nurse, and and NP.

Verbatim said...

Here's a link to the most comprehensive review of the DNP degree I could find:

http://www.studentdoctor.net/2011/04/sdn-reports-the-dnp-degree/

It's somewhat biased, but the AMA's concerns are justified. Over half of patients believe DNPs are physicians or are uncertain.

I doubt non standardized curricula with online courses (often on non clinical topics) will lead to improved patient outcomes both the confusion of patients and the expense of NPs paying tuition for this degree.

Verbatim said...

Here's a link to the most comprehensive review I've found:

http://www.studentdoctor.net/2011/04/sdn-reports-the-dnp-degree/

It appears the AMAs concerns are justified. More than half of patients think either a DNP is a physician or are unsure.

Also, I suspect online non standardized course work on often non clinical topics will do little to enhance the NP degree. In my opinion, this degree at many institutions will add unnecessary expenses to education with few gains.

ed8ecaae-0725-11e1-935a-000bcdca4d7a said...

physasst said: "But there are combined RN/NP programs. Applicants do not ever work as RN's, they complete the RN portion and then go STRAIGHT into the NP program. This is concerning to me. Just as the lack of prior HCE among some PA schools concerns me as well. "

Lack of prior HCE? Don't you know that the "RN portion" always includes clinical experience? And so what if there are BSN-MSN/DNP programs? **Students get accepted into MD programs all the time who have ZERO HCE. You can be accepted into an MD program with a BA in Art History as long as you take all the pre-req courses for medical school.** Idiot. BSN programs provide students with extensive, mandatory clinical experience that prepares them for a career as a registered nurse.

How can you be so against NP programs when you clearly have no clue how nursing education works?

Fool.