Why do I ask? Because recently, as noted in the Wall Street Journal (link) and Forbes (link) magazine, there is a new movement among nursing educators to make a clinical doctorate the standard for nurse practitioners (DNP = Doctor of Nursing Practice).
So, what is the big deal?
If you read the articles, this degree is designed to enable nurse practitioners to become independent practitioners
Lack of training:
In general, physicians (MD or DO) undergo 4 years of undergraduate training, then 4 years of medical school, followed by at least 3 years of on-the-job training referred to as "residency."
In medical school, the first 2 years are filled with lectures (156 credit hours - comes to 39 hours a semester, when 12 per semester is considered full time in undergraduate study!!) on anatomy, physiology, embryology, pathophysiology, microbiology, histology, cell biology, genetics, neurology, psychology, and many more subjects.
Years 3 and 4 are full time clinics and hospital rotations in Internal medicine, Family medicine, Pediatrics, OB/Gyn, Surgery, Emergency medicine, Psychiatry, and various subspecialties. Hours are generally AT LEAST 35-40 per week for the less time-intensive rotations (Family medicine and psychiatry) and may be more like 80-100 hours per week for the more time intensive - Internal medicine, surgery, OB/Gyn. Emergency medicine usually has pretty good hours (part of the reason I chose to train in it).
After medical school (remember, 4 years there) is residency, which is from 3-7 years in length, depending on the field of training. Most primary care residencies (Internal medicine, Family medicine, Pediatrics) are 3 years in length, Emergency medicine is 3 or 4 years, most surgical specialties are 5 or greater.
In the past, residents actually lived at the hospital (hence, the name "residency") and were always available for patient problems and emergencies. Over time, the value of personal time was noted and hours were decreased, but were typically still over 100 hours per week. In the past few years, however, studies on patient and resident safety have shown that the longer a resident is on duty, the more likely s/he is to make a mistake, so current work hour regulations are that a resident cannot work for more than 30 hours consecutively and no more than 80 hours a week, averaged over a 4 week period. What does this mean? We still work more than full time and up to 30 hours in a row, up to every 4th or 5th day. All in all, we put in probably 3000-4000 hours per year. Multiply that by 3 years = 9000-12000 hours of on the job training, not counting the 2 years in medical school of clinical clerkships. So, we are probably above 15000 hours of clinical training, just for a 3 year residency. When you look at a surgical specialty (minimum of 5 years = 15-20k hours of training) or fellowships (another 2-4 years on top of residency), that is a huge amount of training we receive, just to be able to care for you and your family/loved ones, etc.
Now, let's look at the DNP program training, in comparison:
According to the University of Columbia website for the DNP degree, their curriculum includes:
Support Core (19 credit hours)
Translation and Synthesis of Evidence for Optimal Outcomes
Quantitative Research Methods
Epidemiology and Environmental Health
Legal and Ethical Issues
Clinical Genomics Advanced Seminar
Practice Management
Informatics
Clinical Core (11 credit hours)
Doctor of Nursing Practice I and II
Chronic Illness Management
Residency/Seminar (10 credit hours) = 1000 hours over 1 year
Total credits (40 credit hours)
How can one say this is even close to preparing a DNP for any kind of medical practice, much less independent practice, without any physician oversight?
They argue that they already have a Masters degree, so let's look at that curriculum as well:
Family Nurse practitioner (FNP) curriculum:
Core (10 credit hours)
Health and Social Policy: Context for Practice and Research (4)
Assessing Clinical Evidence (4)
Interpersonal Violence & Abuse (1)
Management in Advanced Practice (1)
Sciences (12 credit hours)
Advanced Physiology (3)
Pathophysiology of the Adult (3)
Advanced Pharmacology (3)
Incorporating Genetics into Advanced Nursing Practice (3)
Specialty (27 credit hours)
Family Primary Care Nursing I (2)
Advanced Clinical Assessment (3)
Advanced Assessment Practicum (2)
Diagnosis and Management of Illness: Family I (4)
Family Primary Care Nursing II (1)
Family Primary Care Practicum I (4)
Diagnosis and Management of Illness: Family II (3)
Family Primary Care Nursing III (1)
Advanced Practicum in Family Primary Care (4)
Family Theory (3)
Total Credits 49
So, for a total of 89 credits, including practical time, they want independent practice rights and to claim their practice is equal to that of a fully trained primary care physician? Even looking at ALL the Master's level nursing programs, the most hours they require are 52 (look here for yourself if you don't believe me). Including clinical time, this just a few more hours than 1 year of medical school. The DNP "residency" is slated to be 1000 hours in length, or 25 weeks at full-time (40 hours per week) - just barely 6 months in time.
So, what is the big deal?
If you read the articles, this degree is designed to enable nurse practitioners to become independent practitioners
Lack of training:
In general, physicians (MD or DO) undergo 4 years of undergraduate training, then 4 years of medical school, followed by at least 3 years of on-the-job training referred to as "residency."
In medical school, the first 2 years are filled with lectures (156 credit hours - comes to 39 hours a semester, when 12 per semester is considered full time in undergraduate study!!) on anatomy, physiology, embryology, pathophysiology, microbiology, histology, cell biology, genetics, neurology, psychology, and many more subjects.
Years 3 and 4 are full time clinics and hospital rotations in Internal medicine, Family medicine, Pediatrics, OB/Gyn, Surgery, Emergency medicine, Psychiatry, and various subspecialties. Hours are generally AT LEAST 35-40 per week for the less time-intensive rotations (Family medicine and psychiatry) and may be more like 80-100 hours per week for the more time intensive - Internal medicine, surgery, OB/Gyn. Emergency medicine usually has pretty good hours (part of the reason I chose to train in it).
After medical school (remember, 4 years there) is residency, which is from 3-7 years in length, depending on the field of training. Most primary care residencies (Internal medicine, Family medicine, Pediatrics) are 3 years in length, Emergency medicine is 3 or 4 years, most surgical specialties are 5 or greater.
In the past, residents actually lived at the hospital (hence, the name "residency") and were always available for patient problems and emergencies. Over time, the value of personal time was noted and hours were decreased, but were typically still over 100 hours per week. In the past few years, however, studies on patient and resident safety have shown that the longer a resident is on duty, the more likely s/he is to make a mistake, so current work hour regulations are that a resident cannot work for more than 30 hours consecutively and no more than 80 hours a week, averaged over a 4 week period. What does this mean? We still work more than full time and up to 30 hours in a row, up to every 4th or 5th day. All in all, we put in probably 3000-4000 hours per year. Multiply that by 3 years = 9000-12000 hours of on the job training, not counting the 2 years in medical school of clinical clerkships. So, we are probably above 15000 hours of clinical training, just for a 3 year residency. When you look at a surgical specialty (minimum of 5 years = 15-20k hours of training) or fellowships (another 2-4 years on top of residency), that is a huge amount of training we receive, just to be able to care for you and your family/loved ones, etc.
Now, let's look at the DNP program training, in comparison:
According to the University of Columbia website for the DNP degree, their curriculum includes:
Support Core (19 credit hours)
Translation and Synthesis of Evidence for Optimal Outcomes
Quantitative Research Methods
Epidemiology and Environmental Health
Legal and Ethical Issues
Clinical Genomics Advanced Seminar
Practice Management
Informatics
Clinical Core (11 credit hours)
Doctor of Nursing Practice I and II
Chronic Illness Management
Residency/Seminar (10 credit hours) = 1000 hours over 1 year
Total credits (40 credit hours)
How can one say this is even close to preparing a DNP for any kind of medical practice, much less independent practice, without any physician oversight?
They argue that they already have a Masters degree, so let's look at that curriculum as well:
Family Nurse practitioner (FNP) curriculum:
Core (10 credit hours)
Health and Social Policy: Context for Practice and Research (4)
Assessing Clinical Evidence (4)
Interpersonal Violence & Abuse (1)
Management in Advanced Practice (1)
Sciences (12 credit hours)
Advanced Physiology (3)
Pathophysiology of the Adult (3)
Advanced Pharmacology (3)
Incorporating Genetics into Advanced Nursing Practice (3)
Specialty (27 credit hours)
Family Primary Care Nursing I (2)
Advanced Clinical Assessment (3)
Advanced Assessment Practicum (2)
Diagnosis and Management of Illness: Family I (4)
Family Primary Care Nursing II (1)
Family Primary Care Practicum I (4)
Diagnosis and Management of Illness: Family II (3)
Family Primary Care Nursing III (1)
Advanced Practicum in Family Primary Care (4)
Family Theory (3)
Total Credits 49
So, for a total of 89 credits, including practical time, they want independent practice rights and to claim their practice is equal to that of a fully trained primary care physician? Even looking at ALL the Master's level nursing programs, the most hours they require are 52 (look here for yourself if you don't believe me). Including clinical time, this just a few more hours than 1 year of medical school. The DNP "residency" is slated to be 1000 hours in length, or 25 weeks at full-time (40 hours per week) - just barely 6 months in time.
All this for a "doctorate!"
To kick it all off, much of the didactic portion (lectures, etc) can be taken ONLINE!!!
Is this the type of training we want for the person taking care of our loved ones and making potentially life and death decisions? Or would you rather have a fully trained physician who has had THOUSANDS of hours of training making these decisions with you? I know my choice.
Part 2 upcoming...
Part 2 upcoming...
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