Is There a Doctor in the House?

Recently I read something about the new program that has begun in nursing where a nurse practicioner has the opportunity to become a doctor.

What? A nurse who is also a doctor? How could this be?

I'll tell you. Nurse Practicioners in some areas now have the opportunity to pursue a degree known as a Doctor of Nurse Practicioning.

Maybe some of you are thinking: This is great! Another possible option for nurses to pursue. No longer are they forced to adhere to the constraints of what it means to be a traditional nurse, e.g. being involved in every aspect of patient care.

I'm not of that opinion. And here's why:

Here's a blurb from the University of Tennesse, Memphis:

"The DNP curriculum is Web-mediated including opportunities for synchronous and asynchronous learning. Students are only required to be on campus 4 times a year (July, December, January, & April) for 5 to 7 days each session. With faculty approval, clinical courses can be completed in the student's state of residence."

What is this, the University of Phoenix? Other reports I've heard have stated that nurses need only complete 1000 hours in order to complete the program. It's absolutely ridiculous on a number of fronts.

First, the amount of experience that a medical doctor gets is at least ten-fold higher the experience that a DNP candidate would have to gain.

Second, what does it mean to be a nurse anyway. What is so wrong about being called a nurse. Personally I think that nursing is one of the most selfless, noble professions that one can pursue. Why is it suddenly necessary that we need nurses proscribing medications and being addressed as doctors.

Third, there was such a righteous fervor over the inventer of the artificial heart (Jarvik) who is a Ph.D "doctor" that was supporting a certain medication on the internet. Where is the fervor now. We're going to see a day where someone with 1000 hours of experience is seeing a patient that has no idea about the difference between a DNP and an MD "doctor." It's disgusting, and I think the biggest reason is because the current doctors of America couldn't care less.

Where were the doctors when malpractice lawsuits have got out of control? Where were doctors when people saw the subtle signs that medicine in the US was going downhill? Where are the doctors now when an exer increasing number of "physician extenders" encroach on what it means to be a doctor? Sadly, the pay is still good, the hours aren't terrible--so the majority of doctors could care less what state the health care system is in when it is handed off to the next generation.

Instead they'd rather complain about duty-hour restrictions, and how medical student today "just aren't as driven as they used to be."

Edmund Burke once said, "The only thing necessary for the triumph [of evil] is for good men to do nothing."

Is what is going on in the medical system evil? I don't think so. But the only thing necessary for it to continue in its downhill trend is for enough of today's doctors to do nothing.

The debate over the validity of having Doctors of Nurse Practicion is sadly going to become a debate over whether the still male dominated doctors are just trying to keep the female dominated nurses down. And at its root I think many people will view it as a gender equality issue. But it isn't. The question is not whether a nurse could be as knowledgeable/valuable as an MD doctor, because I can tell you right now, there are some nurses that are smarter/more adept than some doctors. The question is what would be best for patients

The root of the question is this: What does it mean to be a doctor, and what does it mean to be a nurse? Are there roles that a doctor should fill that a someone trained as a nurse shouldn't be filling? In the same token, are there roles that are better filled by a nurse? I think that the answer to the last two questions are both yes. But if the DNP program (among others) continues, we'll continue to dilute the respect that the average person has for someone who is known as a "doctor" until we're all just "health professionals," despite our vastly different training.

4/48/04 Update: Today in class we had a family of acondroplastic dwarfs come and speak to our class as part of a genetics patient panel. Here is a phrase that the father used, I'll try to reproduce it verbatim.

"When we were at this conference in Dearborn one of the nurse practicioners / doctors got up to tell everyone a story..."

The person he was referencing turned out to be a nurse practicioner and not a doctor. I don't for one second think that John Smith patient has any idea what the difference between a nurse practicioner and a doctor is, and I think they would know even less about what the difference between someone who has NP-C and MD on their coat (if they even looked).

It's misleading to patients and those who keep pushing to expand the role of nurses are exploiting it.