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Nursing schools at UW-Madison and Edgewood College are planning to replace their master's degree programs for specialty nurses with doctorate degrees. It is part of a national trend requiring professional doctorates as part of certification for nurse practitioners, other specialty nurses and some other health-care workers.
The move, orchestrated by professional associations, will better prepare students for the increasingly complex health-care system and could curb staff shortages in nursing and other fields, proponents say.
But opponents, including UW-Madison's leader, say a plethora of professional doctorates will confuse patients and cheapen the prestige of academic doctorates, or Ph.D.s. Universities should not be forced to dole out doctorates to students doing master's level work, as is happening with nursing, said Chancellor John Wiley.
"Just as customers don't dictate to General Motors what they name their cars, I don't think it's right for external constituencies to tell us what to call our degrees," said Wiley, an engineer. "It confuses our product array. "
Katharyn May, dean of the UW-Madison School of Nursing, said the university couldn't afford to avoid the shift because nursing schools around the country, including those in neighboring states, are moving to doctorates.
"The competitive pressures were more than we were prepared to accept," May said. "If we didn't do it," she said, prospective students "would look elsewhere. "...
Bill Boissonnault, an associate professor of physical therapy at the university, said physical therapy and the other fields have joined disciplines that made the shift long ago, such as dentistry, podiatry and optometry.
"Our credit load is on very similar grounds with these other doctoring professionals," he said.
Medical testing board to introduce doctor of nursing certification
AMNews are reporting: Medical testing board to introduce doctor of nursing certification
Physicians are concerned that the move will lead to scope-of-practice expansions.
Starting this fall, doctor of nursing practice graduates will be able to take a certification test that proponents say will set a national standard for DNPs and add to the profession's credibility.
The voluntary test, being created by the National Board of Medical Examiners, is based on the medical licensing exam. It will be offered at a time of growing momentum in the DNP movement: About 200 nursing schools are expected to offer the two-year DNP degree by 2015 -- more than double the programs available today.
Test proponents said the DNPs, called "doctor nurses" by some in the nursing profession, are comparable with primary care physicians in their diagnostic and disease-management skills.
But physicians expressed concerns that DNPs will use the test as leverage to seek scope-of-practice expansions that cross into medical practice.
"Why would they get a DNP unless they want to do things that are currently not in the nursing scope of practice in most states?" asked AMA Board of Trustees Secretary William A. Hazel Jr., MD. "It makes sense they will want to change their scope."
The AMA and the American Academy of Family Physicians said they support advances in nursing education but emphasized that nurses should operate as part of a health care team under physician supervision. Dr. Hazel said there are important distinctions between DNPs and physicians that the public should understand.
"I do not want to be construed as attacking nurses, but there are concerns," Dr. Hazel said. "There's a difference in training that should not be overlooked."
In April, the nonprofit Council for the Advancement of Comprehensive Care contracted with the NBME to create the exam, which is expected to be offered in November.
Mary Mundinger, DrPH, speaking for the council, said the goal is for a national standard that distinguishes DNPs who have an advanced clinical knowledge from those who have an emphasis in research, administration or systems management.
"While a primary care physician went to medical school and did residency, a nurse practitioner with a DNP has achieved many of the same competencies but through nursing education," said Mundinger, who also is dean of Columbia University School of Nursing in New York City. "They have the same skills in identifying a disease state and treating it, but it's a different hybrid of care."
AMANews are reporting: AMA meeting: Physicians demand greater oversight of doctors of nursing
Citing patient safety concerns, members of the AMA House of Delegates protested the unregulated expansion of doctors of nursing practice and urged organized medicine to ensure transparency in and supervision of their role in medical care.
The outcry comes amid concerns about a shortage of primary care physicians and a surge in DNP programs.
The National Board of Medical Examiners this fall plans to offer a voluntary DNP certification test based on the medical licensing exam. In addition, many nursing schools and other health care professional training programs have incorporated doctorate degrees and used the titles "resident" and "doctor" despite their nonphysician status.
Delegates said patients could wind up confused and have their treatment compromised because DNPs and other advanced practice professionals do not share the same level of knowledge and training as licensed physicians. Delegates also worried the movement could lead to other scope-of-practice expansions.
In response, delegates at the AMA Annual Meeting in June passed a resolution calling on the Association to advocate that professionals in a clinical setting clearly identify their qualifications and degrees to patients. Delegates directed the AMA to develop model state legislation to that effect and to support other state legislative efforts to make it a felony for nonphysician health care professionals to misrepresent themselves as physicians.
"This is not to impugn [nurses'] training and important contributions to the care team. But in an era of transparency, we have to insist on complete openness in the qualifications and licensure of all caregivers," said AMA Board of Trustees member Steven J. Stack, MD. "Patients have a right to know."
The house also adopted policy that DNPs must practice under physician supervision and as part of a coordinated medical team. Delegates voted to oppose the NBME's participation in any DNP exam and directed the AMA to refrain from producing test questions.
Anyone ever notice that when one profession wants to try and restrict the activities or scope of another, they always cite patient safety concern. Why don't they just be honest and say that its all about not wanting the competition?