The Doctor of Nursing Practice, or DNP, is the newest proposal by nursing educators to offset the growing shortage of primary care physicians across the United States. This new breed of advanced practice nurse would receive more training and assume greater responsibilities than a Nurse Practitioner. Even as physician groups argue that patients will be confused by this new "hybrid" provider, it is acknowledged that a lack of primary care physicians is nearing the point of a nationwide crisis. 

 

A shortage of Primary Care Physicians in the United States is causing many nursing schools to consider offering doctoral nursing programs that will produce a new breed of primary care provider. According to a recent Wall Street Journal article entitled “Making Room for Dr. Nurse ”, several hundred nursing schools are offering---or are planning to offer---a doctoral-level nursing degree resulting in “hybrid” practitioners with more training and education than nurse practitioners. DNPs, or Doctors of Nursing Practice, will undergo a rigorous two-year course of study with a one-year residency.

These new providers would use the initials DrNP after their name, and would be allowed to use “Dr.” as a title.  DNPs would have hospital admitting privileges and the ability to coordinate care among multiple specialists. While Nurse Practitioners have long been eligible for reimbursement under Medicare and Medicaid, DNPs will most likely be additionally eligible for third-party reimbursement from private insurers. 

Apparently, a push to make doctoral training the standard for all advanced practice nurses is being strongly considered for as soon as 2015. According to an article in The Chronicle of Higher Education , the nonprofit Council for the Advancement of Comprehensive Care is ready to announce that the National Board of Medical Examiners will be developing a comprehensive certification exam for DNPs in the near future.
In terms of requiring all advanced practice nurses to pursue doctoral studies, some within the nursing field itself worry that costly doctoral degrees may drive some NPs out of the field altogether, further eroding the quality of care for thousands of patients in need of primary care, and weakening nursing as a whole at a time of nationwide shortages at all levels of care.

The Wall Street Journal article adds that some physician groups are worried that blurring the lines between nurse and doctor can be potentially confusing to patients, although similar fears voiced when Nurse Practitioners first entered the healthcare fray were largely unfounded. Most sources agree that study after study shows that advanced practice nurses provide excellent care to millions of patients with comparable outcomes to doctors at considerably lower cost.

As an article in USA Today elucidates, many physicians are being driven from primary care due to increased costs and decreasing reimbursements from third-party insurers, including Medicaid and Medicare. Data also demonstrate that medical students and medical residents are showing diminishing interest in primary care or ambulatory medicine as areas of study, especially as the costs of a medical education increase and the financial viability of a career as a primary care physician evaporates.

Therefore, even as physician groups argue that the DrNP designation may confuse patients as to who is qualified to care for them, physicians are leaving primary care in droves. As the USA Today article points out, “the first wave” of 76 million Baby Boomers will become eligible for Medicare beginning in the next few years. All of those Boomers will indeed be looking for primary care providers. Thus, if doctors are leaving the halls of primary care for greener pastures, why not allow DNPs to fill this ever-widening gap? Perhaps it would behoove us all to allow them to do so.

 

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NurseKeith is a nurse, consultant, writer and blogger. Feel free to visit his blog, Digital Doorway .  

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