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Apr 07, 2008 -- New nursing program will alleviate healthcare crunch
Economics have forced medical students to abandon primary care. The costs of medical school and the current health insurance system mean that everyone wants to be a specialist. Clark believes that nurse practitioners and physician assistants are the answer to the shortage of primary care doctors -- and the looming shortage of pediatricians. Clark recently read in the Personal Journal about a new program called Doctor of Nursing Practice that's being offered at 200 schools. This doctoral-level program requires nurses to take the same qualifying exam as a doctor. Clark loves that the marketplace is developing an answer to the primary care crunch.
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What others are saying
PA Education
I'm a PA student and I have just have to comment on the jab made a PA education.
First off, I graduated Cum Laude from a state university with a Bachelor's of Science in Cellular Biology. I shadowed several physicians and PAs prior to my decision to go into PA school. I am no in school, working on my Master of Medical Science and being taught medicine under the same medical model than physicians are taught. Most PA programs are 27 months, with the first 13 being entirely classroom oriented and the last 14 months doing clinical rounds with medical residents in all major clinical specialties of medicine.
NPs do not have any clinical rotations included in their education, and they're education in described as "Advanced Nursing"- they do not actively practice medicine. They can practice independently, but often don't as they are inexperienced with broad medical pictures.
Personally, PAs are more educated in the physiology of disease and how treatment works on the organ/tissue level.
I feel NPs lack the core science necessary to make up for their experience.
If you never learn your multiplication tables, advanced Calculus will never make sense.
Doctor of Nursing
One final addition to my last post. I read the Wall Street Journal article referenced below. It appears that either the journal or Clark (in the comment on the website misspoke). The Doctors of Nursing will not be taking the same exam as medical doctors. They will take an exam which is based on, but narrower than the test given to doctors. This raises the interesting question of whether or not a "narrower" education will be any problem to patients. The difficulty with studying this is that the major study to date (sited in the journal article) has been done in an academic center and has involved relatively healthy patients, who may show no statistically significant difference in outcomes, even if they don't see a healthcare provider at all. They have also involved only Ivy League trained elite practitioners. Finally the case sited in the Journal article referenced in one of the postings seems to discuss a case of temporal arteritis, a common cause of headaches. I believe that most patients with this common disorder would be diagnosed and treated by a primary care physician. The patient in the journal article was referred to and treated by a neurologist. Once again, don't get me wrong. The Doctor of Nursing may end up being a great boon. But again, the market will have to determine that. My suspicion, based on personal observation and some preliminary published data, will be that Doctors of Nursing will be highly satisfying providers to patients without measurable detriments in outcome, but may actually increase the cost of healthcare by seeing fewer patients per day (this may be beneficial to patients, especially if they have higher smoking quit rates, etc.), ordering more tests and subspecialty referrals and increasing the already critical nursing shortage and, thereby, salaries. I believe that the best solution would be to increase the reimbursement for cognitive (nonprocedural) medical services for docs and NP/Doctor of Nurses so that good docs don't abandon primary care.
Nurse Practioner
I am a primary care practitioner who left the field for hospital medicine. I'll say right off that I work with nurse practioners, respect them and even testified before the Georgia Assembly in favor of prescription rights. I believe that nurse practioners will help to ease the primary care crisis. However, the real problem is the undervaluing of primary care and medical care that doesn't involve procedures in general. The following problems are likely to ensue from the above. First, while most nurse practitioners had many years in practice in the past prior to entering NP school (which was rare) and there were only a few such schools, many NP's now graduate with few, if any years of actual previous nursing experience, thanks to dozens of new NP programs. NP's, except for their nursing experience, which may be extensive or not,recieve nothing like the internship and residency program physicians go through. Second, some preliminary research shows that NP's order more tests and call subspecialists more, which in the end in these studies, actually increased costs. Finally, large numbers of nurse practitioners will continue to exacerbate the nursing shortage, which is probably worse than the primary care shortage. In summary, while I respect nurse practitioners, I don't think that it will be a cure all. The real problem with primary care and nursing is the undervaluing of so called "cognitive services" as opposed to procedural services which forces up the overall cost of medicine by increasing the volume of procedures done and makes primary care not worth it. Would you triple your salary by studying for 9 years instead of 7?
NP vs PA
"Who would you rather have write your prescription, a PA with less than 3 years of education, including their clinical rotations, or a NP with 25 years of clinical practice?"
You are not required to have 25 years experience to be an np. Actually you could have as little as two years of nursing experience and be an np. Also, a nurse with 25 years experience could actually go into a PA program if they wanted too. I detect a little jealousy.
Same qualifying exam?
I wasn't aware of this. It's my understanding that the NBME (the exam people) developed a new test just for DNP's. While the level of similarity between that test and the ones for medical students (ie, those wanting an MD) remains to be seen, they are definitely different tests. A subtle yet distinct difference. http://online.wsj.com/article/SB120710036831882059.html?mod=todays_us_personal_journal
Nurse Practitioner
I am a Nurse Practitioner with 25 years of experience in critical care. I can vouch that a NP can absolutely assist with easing the primary care physician shortage. Many NPs do critical care and have the nursing instinct of looking at a whole patient and making very accurate diagnoses, both due to their education but also due to the experience level. I also know, despite the shortage, many MDs will not take this "encroachment" lightly. Here in Georgia, though the law for NPs to have independent prescriptive authority was written some time ago, the language of the law is still being debated, with the physicians of the GMA having a very difficult time relinquishing their control to professionals who have high levels of education and experience, such as NPs. PAs, however, graduate with prescriptive authority, with less than 3 years of education, though it is highly intensive. Who would you rather have write your prescription, a PA with less than 3 years of education, including their clinical rotations, or a NP with 25 years of clinical practice?
The nurse doctoral program-around $92k, eh?
There is a good article highlighted below from *The Wall St. Journal* on this same topic, from the Apr. 2, 2008 copy, with much detail about this fairly new program. Take a look!
Clark should point out that due to high income categories in other speciaties, like the derm MDs in the $390k+, and radiology in the $330k+ range, this income level far outweighs to some incomes in the pediatric and the primary care MD/DO fields, in that $120-150k range.
Still, the missing criteria of a good consumer experience has yet to be implemented in relation to ranking medical services/products in terms of quality and price levels. What do others think?
