The Doctor of Nurse Practitioner Program Will ROCK the Physician Assistant Profession

[heme-onc]

Nurse practitioner educational programs are starting to migrate from the master’s level to the doctoral level, leading to the “Doctor of Nurse Practitioner” degree. Right now, the DNP is officially geared toward nurse practitioners in “leadership roles,” but—reading between the lines—I believe the AACN credentialing body is likely seeking the DNP for the majority of future practitioners.

 

See this info from the American Association of the Colleges of Nursing: http://www.aacn.nche.edu/DNP/dnpfaq.htm

 

Meanwhile, physician assistant programs remain at the M.S. or even B.S. levels.

 

In the future, many NPs might be addressed as “Dr. So-and-So,” while PAs will be addressed as “hey you,” and be perceived as lower down the professional totem pole.

 

I understand the DNP development is because, like everyone, NPs want to be perceived as professional as possible and have as much training as possible.

 

But a major reason to grow the PA and NP professions—rather than to educate more MDs—is to add a LESS-expensive form of care to an elephant-sized health care system that is already straining the economy. If increasing numbers of NPs get doctorates, they will be saddled with enormous educational loans; this means their salaries will have to rise to pay for this debt. DNP salaries will soon rival that of MDs, but without medical school training. This translates into much higher health care costs, especially if trends continue and nurse practitioners grow hugely in number.

 

If a large number of NPs embrace the DNP approach, this will drain health care dollars—and it will also put PAs in a precarious situation. My question is: will PAs be forced to likewise embrace doctoral programs? If PAs don’t embrace these programs, how will their roles change vis-à-vis the more highly-credentialed future DNPs? Or, if PAs do embrace PhD-level programs, then what will be the practical difference between a DPA (Doctorate of Physician Assistant) and an MD? One prediction I’ve personally come up with: once the DNP degree gains ground in five to 15 years, bridging programs may spring up like mad to convert PAs into MDs. This could cause the PA profession to actually shrink while the NP profession grows. Conversely, many RNs can’t afford a four to six year long DNP program costing 200k+, and so you might see a surprising number of experienced RNs flooding PA educational programs.

 

I think the new DNP focus will have a HUGE impact on PAs.

 

What do you think?

[Hemegroup]

The group I work for (like many) prefers PAs. This is likely because they're familiar with the difference in training.

 

PAs are trained in the medical model the same as Medical Doctors (real ones), and PA program accreditation is overseen in part by the American Medical Association, American College of Surgeons, and American Academy of Family Physicians (to name a few). NP/DNP program accrediation is overseen by Nursing boards. The amount of difference in training is significant.

 

PAs go through more clinical training than NPs (NPs do not rotate in surgery, for example), and the didactic coursework is more rigorous.

 

As well, if you look at recent salary reports, PA salaries are typically higher ... this is but one representation of the differences in training.

 

When patients call me "Doctor" (many do), I correct them ... I'm a PA, and I'm very proud of my profession. I have no egotistical issues which serve me with a false sense of satisfaction when referred to as something which I am not.

 

Incidentally, welcome from the SDN forum, where you were banned numerous times in the last few days. I hope you fare better here, but I'm doubtful.

[coloradopa]

Nurse practitioner educational programs are starting to migrate from the master’s level to the doctoral level, leading to the “Doctor of Nurse Practitioner” degree. Right now, the DNP is officially geared toward nurse practitioners in “leadership roles,” but—reading between the lines—I believe the AACN credentialing body is likely seeking the DNP for the majority of future practitioners.

 

See this info from the American Association of the Colleges of Nursing: http://www.aacn.nche.edu/DNP/dnpfaq.htm

 

Meanwhile, physician assistant programs remain at the M.S. or even B.S. levels.

 

In the future, many NPs might be addressed as “Dr. So-and-So,” while PAs will be addressed as “hey you,” and be perceived as lower down the professional totem pole.

 

I understand the DNP development is because, like everyone, NPs want to be perceived as professional as possible and have as much training as possible.

 

But a major reason to grow the PA and NP professions—rather than to educate more MDs—is to add a LESS-expensive form of care to an elephant-sized health care system that is already straining the economy. If increasing numbers of NPs get doctorates, they will be saddled with enormous educational loans; this means their salaries will have to rise to pay for this debt. DNP salaries will soon rival that of MDs, but without medical school training. This translates into much higher health care costs, especially if trends continue and nurse practitioners grow hugely in number.

 

If a large number of NPs embrace the DNP approach, this will drain health care dollars—and it will also put PAs in a precarious situation. My question is: will PAs be forced to likewise embrace doctoral programs? If PAs don’t embrace these programs, how will their roles change vis-à-vis the more highly-credentialed future DNPs? Or, if PAs do embrace PhD-level programs, then what will be the practical difference between a DPA (Doctorate of Physician Assistant) and an MD? One prediction I’ve personally come up with: once the DNP degree gains ground in five to 15 years, bridging programs may spring up like mad to convert PAs into MDs. This could cause the PA profession to actually shrink while the NP profession grows. Conversely, many RNs can’t afford a four to six year long DNP program costing 200k+, and so you might see a surprising number of experienced RNs flooding PA educational programs.

 

I think the new DNP focus will have a HUGE impact on PAs.

 

What do you think?

I agree with you. It will have a huge impact on the PA profession. Its the best thing to ever happen to the PA profession.

 

1. Current graduation rates for NPs are already abysmal. Adding two years to those programs (especially the distance learning programs) will cut that rate even more.

2. The DNP adds almost no clinical value to the NP. Most of the course work is in policy and nursing theory (unlike the original white paper which mandated an additional 1000 clinical hours for the DNP).

3. Most NPs are employed by physician practices (like PAs). The physicians do not consider the DNP an equivalent to the MD and dislike the claim of equivalence. Preference to PA.

4. The DNP makes the NP more specialized when we need less specialization. Preference to PA.

5. The DNP adds to the cost of NP education when as you pointed out we need to make healthcare education less expensive. It adds no clinical value. PA school becomes the equivalent or cheaper (even when considering income loss to go to full time PA school).

 

Anectdotally both local PA programs doubled the number of RNs going into the program. Why go 4-6 years to get the same salary as a PA and have less scope of practice. I think that ultimately the DNP will result in the marginalization of the NP. The real goal is to get lots of "doctorally prepared" RNs so they can turn out more MSNs to teach more BSNs so they can get rid of the ADN (the real ANA goal IMO). Remember the DNP is not driven by NPs as a whole. Instead its a political construct by the NONPF and ANA.

[heme-onc]

Colorado PA—

You make some really good points. Two things to mull over:

1.) Whatever you feel about the DNP’s curriculum, much of what matters in the end is public perception. So if the public knows to call a DNP “doctor,” but knows to call another mid-level provider “Jim” or “Sue,” then that creates a difference in perception for many patients. Same thing goes if the public knows that particular DNP has earned a “doctorate” rather than a BSN or an MSN.

 

2.) The DNP will give nurse practitioners a new incentive to practice independently from physicians. It could also put more pressure on state licensing agencies to give NPs additional autonomy. Again, focusing on perceptions: if you were a patient, would you be more likely to see an independent DNP or an independent master’s-educated NP? Though you're right the doctoral program could be a failure, it's also possible we could wind-up seeing DNPs compete directly with MDs in much larger numbers than is currently the case.

P. S. – HemeGroup: I never joined or even heard of the "SDN forum." So thanks, but this is my first time contributing.

[SocialMedicine]

Degree creep is not always a positive thing. Physical therapy is soon becoming (or perhaps already?) entry level doctorate. Nurse Pract will be soon enough. It costs more, and doesnt equal more salary, respect, nor is there data to support improved clinical capacity DNP vs MNP. It will happen regardless and may put the PAs in an awkward position. After all thenurse practitioner is DOCTORAL level education and the PA is in some cases "just a certificate". I understand a degree level is not alwasy directly linked with clinical acumen or intellect BUT to some people (especially those ignorant of healthcare) it will.

[marilynpac]

Nurse practitioner educational programs are starting to migrate from the master’s level to the doctoral level, leading to the “Doctor of Nurse Practitioner” degree. Right now, the DNP is officially geared toward nurse practitioners in “leadership roles,” but—reading between the lines—I believe the AACN credentialing body is likely seeking the DNP for the majority of future practitioners.

 

See this info from the American Association of the Colleges of Nursing: http://www.aacn.nche.edu/DNP/dnpfaq.htm

 

Meanwhile, physician assistant programs remain at the M.S. or even B.S. levels.

 

In the future, many NPs might be addressed as “Dr. So-and-So,” while PAs will be addressed as “hey you,” and be perceived as lower down the professional totem pole.

 

I understand the DNP development is because, like everyone, NPs want to be perceived as professional as possible and have as much training as possible.

 

But a major reason to grow the PA and NP professions—rather than to educate more MDs—is to add a LESS-expensive form of care to an elephant-sized health care system that is already straining the economy. If increasing numbers of NPs get doctorates, they will be saddled with enormous educational loans; this means their salaries will have to rise to pay for this debt. DNP salaries will soon rival that of MDs, but without medical school training. This translates into much higher health care costs, especially if trends continue and nurse practitioners grow hugely in number.

 

If a large number of NPs embrace the DNP approach, this will drain health care dollars—and it will also put PAs in a precarious situation. My question is: will PAs be forced to likewise embrace doctoral programs? If PAs don’t embrace these programs, how will their roles change vis-à-vis the more highly-credentialed future DNPs? Or, if PAs do embrace PhD-level programs, then what will be the practical difference between a DPA (Doctorate of Physician Assistant) and an MD? One prediction I’ve personally come up with: once the DNP degree gains ground in five to 15 years, bridging programs may spring up like mad to convert PAs into MDs. This could cause the PA profession to actually shrink while the NP profession grows. Conversely, many RNs can’t afford a four to six year long DNP program costing 200k+, and so you might see a surprising number of experienced RNs flooding PA educational programs.

 

I think the new DNP focus will have a HUGE impact on PAs.

 

What do you think?

 

 

Of course our profession is shrinking. When we move to all masters I see class size smaller. It already is now at my Alma Mater. I predicted this quite a while ago....BTW, in many states and many more to come the NPs have already made a HUGE impact. As for working with a group that prefers PAs..that's good for now but in the future there won't be a choice. Many medical practices are getting bought out, when that happens there are more rules to follow. Whether the doc or group prefers one over the other isn't going to be considered, fiscal responsibility is. Money shouts volumes.

[rsandoval79]

Nurse practitioner educational programs are starting to migrate from the masters level to the doctoral level, leading to the Doctor of Nurse Practitioner degree. Right now, the DNP is officially geared toward nurse practitioners in leadership roles, butreading between the linesI believe the AACN credentialing body is likely seeking the DNP for the majority of future practitioners.

 

See this info from the American Association of the Colleges of Nursing: http://www.aacn.nche.edu/DNP/dnpfaq.htm

 

Meanwhile, physician assistant programs remain at the M.S. or even B.S. levels.

 

In the future, many NPs might be addressed as Dr. So-and-So, while PAs will be addressed as hey you, and be perceived as lower down the professional totem pole.

 

I understand the DNP development is because, like everyone, NPs want to be perceived as professional as possible and have as much training as possible.

 

But a major reason to grow the PA and NP professionsrather than to educate more MDsis to add a LESS-expensive form of care to an elephant-sized health care system that is already straining the economy. If increasing numbers of NPs get doctorates, they will be saddled with enormous educational loans; this means their salaries will have to rise to pay for this debt. DNP salaries will soon rival that of MDs, but without medical school training. This translates into much higher health care costs, especially if trends continue and nurse practitioners grow hugely in number.

 

If a large number of NPs embrace the DNP approach, this will drain health care dollarsand it will also put PAs in a precarious situation. My question is: will PAs be forced to likewise embrace doctoral programs? If PAs dont embrace these programs, how will their roles change vis-à-vis the more highly-credentialed future DNPs? Or, if PAs do embrace PhD-level programs, then what will be the practical difference between a DPA (Doctorate of Physician Assistant) and an MD? One prediction Ive personally come up with: once the DNP degree gains ground in five to 15 years, bridging programs may spring up like mad to convert PAs into MDs. This could cause the PA profession to actually shrink while the NP profession grows. Conversely, many RNs cant afford a four to six year long DNP program costing 200k+, and so you might see a surprising number of experienced RNs flooding PA educational programs.

 

I think the new DNP focus will have a HUGE impact on PAs.

 

What do you think?

 

I still think DNP should still be called nurses, because they aren't medical doctors. I'm just saying, I mean cmon I can get a PHD and be a physician assistant, and it still shouldn't give you the right to be called the doctor in a medical setting. In an educational setting it would be appropriate.

[rsandoval79]

I agree with you. It will have a huge impact on the PA profession. Its the best thing to ever happen to the PA profession.

 

1. Current graduation rates for NPs are already abysmal. Adding two years to those programs (especially the distance learning programs) will cut that rate even more.

2. The DNP adds almost no clinical value to the NP. Most of the course work is in policy and nursing theory (unlike the original white paper which mandated an additional 1000 clinical hours for the DNP).

3. Most NPs are employed by physician practices (like PAs). The physicians do not consider the DNP an equivalent to the MD and dislike the claim of equivalence. Preference to PA.

4. The DNP makes the NP more specialized when we need less specialization. Preference to PA.

5. The DNP adds to the cost of NP education when as you pointed out we need to make healthcare education less expensive. It adds no clinical value. PA school becomes the equivalent or cheaper (even when considering income loss to go to full time PA school).

 

Anectdotally both local PA programs doubled the number of RNs going into the program. Why go 4-6 years to get the same salary as a PA and have less scope of practice. I think that ultimately the DNP will result in the marginalization of the NP. The real goal is to get lots of "doctorally prepared" RNs so they can turn out more MSNs to teach more BSNs so they can get rid of the ADN (the real ANA goal IMO). Remember the DNP is not driven by NPs as a whole. Instead its a political construct by the NONPF and ANA.

 

Hey I agree with you, and thanks for this post. I agree that it will help the PA profession. Alot if nurses I know will not go for NP because they don't get paid much more for the 2year education, and they definitely won't do it if it's 4years.

[bradtPA]

I can only say from my SPs perspective, he prefers PAs. He actively participates in PA and MD training by being a clinical rotation site. He trained me, then hired me. In my 2.5 years of working here, not one NP has ever asked to train here, and no NP has been hired, only PAs. The DNP in NC is not affecting me at all.

[andersenpa]

Of course our profession is shrinking. When we move to all masters I see class size smaller.

 

The number of programs and total national seats is growing.

[andersenpa]

If a large number of NPs embrace the DNP approach, this will drain health care dollars—and it will also put PAs in a precarious situation. My question is: will PAs be forced to likewise embrace doctoral programs? If PAs don’t embrace these programs, how will their roles change vis-à-vis the more highly-credentialed future DNPs? Or, if PAs do embrace PhD-level programs, then what will be the practical difference between a DPA (Doctorate of Physician Assistant) and an MD? One prediction I’ve personally come up with: once the DNP degree gains ground in five to 15 years, bridging programs may spring up like mad to convert PAs into MDs. This could cause the PA profession to actually shrink while the NP profession grows. Conversely, many RNs can’t afford a four to six year long DNP program costing 200k+, and so you might see a surprising number of experienced RNs flooding PA educational programs.

 

Right now PA leadership and (anecdotally) PAs don't embrace the doctorate credential as entry level; they do strongly support it as an elective avenue for those PAs for whom it is useful. Other than those select few it is a major barrier to practice and a resource drain.

 

The DNP may be more "highly credentialed" but when looking at other real world factors such as clinical ability, experience, practice philosophy, etc all influence how we work with physician teams. As a recruiter you may have some experience with this. As a PA who has hired other PAs in the past, their degree (cert/BS/MS/etc) is low on the list of priorities. Other nonclinical people who hire may see differently and rely on degree, but we can;t really know how those two groups are distributed. The major barrier would be facilities/practices which restrict to a doctorate level non physician provider. With the shortage of providers in many areas, I find it hard to believe that would be a significant amount.

 

Based on the very health care finance problems you mentioned, it would be unlikely that "bridge programs will spring up like mad". People will want to employ PAs or not. If they do, there will be plenty of competent PAs and damn near most of them will have a masters. If they want docs, they'll just take traditionally trained MD/DOs not create a new track for PAs which won't shave much time off what it currently takes to train a physician.

 

For many specialties including surgery, even the almighty DNP will have trouble making an impact given their more limited clinical training and paucity of necessary surgical background.

 

I don't see how anyone can look at the current health care landscape (and recent trends) and think the PA profession is going to shrink. (???????)

[marilynpac]

The number of programs and total national seats is growing.

 

Not at the rate NPs are...In my class the BMS had over 60 students, the Masters about 25. Now that it's all MMS the count is down to 40.

[EMEDPA]

when I went to pa school their were 52 programs. now there are 150. sure class size may be shrinking but # of programs and grads is rapidly expanding...residencies are also being accredited at a faster rate than ever. there are 3-4 new accredited em pa residencies just this yr.

[andersenpa]

Not at the rate NPs are...In my class the BMS had over 60 students, the Masters about 25. Now that it's all MMS the count is down to 40.

 

This is basic stats and math- relative vs absolute change. To say our profession is "shrinking" in any way is a gross error.

[coloradopa]

Colorado PA—

 

You make some really good points. Two things to mull over:

 

1.) Whatever you feel about the DNP’s curriculum, much of what matters in the end is public perception. So if the public knows to call a DNP “doctor,” but knows to call another mid-level provider “Jim” or “Sue,” then that creates a difference in perception for many patients. Same thing goes if the public knows that particular DNP has earned a “doctorate” rather than a BSN or an MSN.

There are a couple of issues here. There is a lot of debate over the use of "Doctor" in a medical setting. A number of states and hospitals prohibit non-physicians from using the term without the appropriate qualifier. For a lot of physicians (people who have significant input into hiring) its a huge aggravator. On the Med Mal boards a number of attorneys have been discussing whether this is potentially deception. "Ie they introduced themselves as a doctor so I assumed they were a physician." I don't think that its everything that its cracked up to be.

2.) The DNP will give nurse practitioners a new incentive to practice independently from physicians. It could also put more pressure on state licensing agencies to give NPs additional autonomy. Again, focusing on perceptions: if you were a patient, would you be more likely to see an independent DNP or an independent master’s-educated NP? Though you're right the doctoral program could be a failure, it's also possible we could wind-up seeing DNPs compete directly with MDs in much larger numbers than is currently the case.

 

P. S. – HemeGroup: I never joined or even heard of the "SDN forum." So thanks, but this is my first time contributing.

Autonomy in medicine is a political process. Additional non-clinical training is unlikely to impress anyone. The opt out for CRNAs has turned the ASA from a relatively small PAC to the largest PAC in medicine. This is starting to happen to NPs with physician organizations. If NPs think that calling themselves doctors will give them all the privileges of physicians they need to study politics more. For example despite moving to a doctorate PT and pharmacy have made few gains in the ability to bill independently. Pharmacists have made some gains in the ability to prescribe but its been very limited and at great cost.

 

Bottom line there are 10 times the number of physicians as NPs. They dominate the health care market. They have the ability to substantially influence healthcare policy and referral patterns. Changing degrees doesn't change that.

[coloradopa]

Not at the rate NPs are...In my class the BMS had over 60 students, the Masters about 25. Now that it's all MMS the count is down to 40.

You didn't give comparators for NPs. Even if you did the way that they count students makes it apples to oranges. If you look at a given PA class of 40 then in two years or so you can expect around 39 of them to graduate (national attrition rate is 5%). Total student population would be 80 or so for the two years.

 

If you look at a given NP class they may claim to have 100 students. However, some will be full time, some part time. A number of them will drop out. On the average about 60-70% of those that start will graduate in 2-6 years.

 

If you look at all the data, despite the claims of 160,000 NPs the 80,000 or so PAs seem to be doing almost as much work and seeing almost as many patients. All of the same forces that cause the NP workforce to shrink (NPs not working in role, NPs not working in nursing ect) will continue to be in effect. The degree does not change things. If anything it drives the best toward either PA or medical cool while increasing the number of those that drop out before completing their training.

[heme-onc]

AndersenPA—

 

I think you’re right: surgical PAs are largely immune to the effects of the DNP. From what I’ve seen, PAs rule the roost in surgical assisting. In fact, if anyone has stats comparing the number of surgical PAs v. NPs v. RNFAs, that would be insightful.

 

Regarding your comments about “shrinkage”—or, to much more accurately reflect my thoughts, the supposition that many PAs could leave the profession to become MDs through bridge programs—you’re looking at the current landscape, rather than possible future trends. I’m extrapolating out a decade or two, when PAs and NPs are practicing in far greater numbers than today and the growth rates have likely slowed; when the DNP focus could possibly produce large number of NPs who are publicly perceived to be nearly on par with physicians; when health care budgets are potentially under severe financial constraints due to demographics and other trends; and when corporate policy and public policy each increasingly serve to redirect the hiring of providers.

 

Don’t get me wrong: I definitely feel the PA profession has an incredibly positive future. I’m just surprised that a contingent of the nursing leadership can not only alter the face of the NP profession, but also, potentially, greatly impact the PA profession—as well as lead to significant changes in future health care costs. For the sake of physician assistants, I’m hoping some of the PA profession’s capable academic researchers will investigate, analyze, and debate the future impact of the DNP program on PAs and on society. This will become urgent should the DNP really take off.

 

Ciao.

[browndog]

Okay, from an NP perspective.

 

The DNP degree is worthless from a clinical standpoint. Personally, I have zero intention of slogging through the mindless parade of courses that form the fabric of most DNP programs.

 

And, yes, I agree 110%. PAs enjoy a better educational model...absolutely.

 

The only thing that I wonder about is this. After a bit of real world practice... say 1-3 years....most NPs and PAs that I have met seem to perform at a similar level of competency. Under such an assumption would the higher degree (although agreed worthless degree) provide an advantage from either a perceived or legistlative standpoint?

[Hemegroup]

Not at the rate NPs are...In my class the BMS had over 60 students, the Masters about 25. Now that it's all MMS the count is down to 40.

 

interesting ... my program is a masters program and regularly seats 80-90 per class

[marilynpac]

I can only speculate as to why they did this. There are many PA programs in the Chicago area and the fight is over rotations spots. I know that MWU has some excellent rotations now, compared to when I was there. But there are only so many preceptors and the school doesn't want to lose those spots or have to look outside of Chicago for anymore.

[andersenpa]

 

this is the major assumption that your theory hangs on and I don't see it happening. This is a physician-centric society. DNPs may gain a niche market but the majority in physician led practices will still be under that umbrella.

[just_me]

Of course our profession is shrinking. When we move to all masters I see class size smaller. It already is now at my Alma Mater. I predicted this quite a while ago....BTW, in many states and many more to come the NPs have already made a HUGE impact. As for working with a group that prefers PAs..that's good for now but in the future there won't be a choice. Many medical practices are getting bought out, when that happens there are more rules to follow. Whether the doc or group prefers one over the other isn't going to be considered, fiscal responsibility is. Money shouts volumes.

 

This I dont get...when researching it seemed to me that MS programs had more seats compared to other degree types

[Hemegroup]

i love seeing 'PA Student' under just_me's name :D

[LESH]

i love seeing 'PA Student' under just_me's name :D

just like seeing PA after yours...

[just_me]

You and me both lol

 

PA-C still beats PA-S though ;)

 

Congrats on the -C :D

i love seeing 'PA Student' under just_me's name :D