Nursing schools make room for Dr. Nurse

The Wall Street Journal
http://www.dailyherald.com

As the shortage of primary-care physicians mounts, the nursing profession is offering a possible solution: the “doctor nurse.”

More than 200 nursing schools have established or plan to launch doctorate of nursing practice programs to equip graduates with skills the schools say are equivalent to primary-care physicians.

The two-year programs, including a one-year residency, create a “hybrid practitioner” with more skills, knowledge and training than a nurse practitioner with a master’s degree, says Mary Mundinger, dean of New York’s Columbia University School of Nursing. She says DNPs are being trained to have more focus than doctors on coordinating care among many specialists and health-care settings.

To establish a national standard for doctors of nursing practice, the nonprofit Council for the Advancement of Comprehensive Care plans to announce that the National Board of Medical Examiners has agreed to develop a voluntary DNP certification exam based on the same test physicians take to qualify for a medical license. The board will begin administering the exam this fall. By 2015, the American Association of Colleges of Nursing aims to make the doctoral degree the standard for all new advanced practice nurses, including nurse practitioners.

But some physician groups warn that blurring the line between doctors and nurses will confuse patients and jeopardize care. Nurses with doctorates use DrNP after their name, and can also use the designation Dr. as a title. Physician groups want DNPs to be required to clearly state to patients that they are not medical doctors.

“Nurses with an advanced degree are not the same as doctors who have been to medical school,” says Roger Moore, incoming president of the American Society of Anesthesiologists.

Although there are no precise statistics on the number of nurses with doctorates because the programs are relatively new, there are about 1,874 DNP students currently enrolled in programs nationwide, up from 862 students in 2006, according to the American Association of Colleges of Nursing.

A study led by Columbia’s Mundinger and published in the Journal of the American Medical Association in 2000 showed comparable patient outcomes in patients randomly assigned to nurse practitioners and primary-care physicians.

Mundinger, of Columbia, says the primary aim of the DNP is not to usurp the role of the physician, but to deal with the fact that there simply won’t be enough of them. 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 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.

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