Doctors and Nurses - Doctor Nurses

The U.S. is now 30% short of primary care doctors and nurses. As the shortage intensifies, two schools of thought about doctor nurse relationships are becoming evident, as expressed in a series of letters to the editor in the Wall Street Journal onApril 6, 2008.


1. Doctors and nurses complement and should work together as a team. Sherri Osborne, a nurse practitioner in Kernersville, North Carolina, expressed this view in a recent WSJ letter to the editor, “Each profession has a lot to learn from the other, and the problem of access to health care needs to be addressed by the physician and nursing professions working together as a team.”
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3. Doctors and nurses can co-exist competing, independent professions with equal treating and admitting privileges. Carla Millis, Nurse Practitioner and president of Maverick Health in Naples, Florida, says it this way, “I fully respect the skills doctors posses, as well as their education and training. However, as a nurse practitioner, I, too, have skills, experiences, and expertise doctors don’t possess. Within my scope of practice, studies have shown my care is equal to or superior to physician care.”


4. Doctors and nurses have different backgrounds and their roles as “doctors” should not be confused. Says Edward Langston, MD, Chair of the AMA Board of Trustees. “I have the deepest respect for nurses. However, it’s an undeniable fact that a nurse with a graduate degree doesn’t have the same education as a doctor who has completed medical school and residency.”


What set off this debate? An article in the April 2 WSJ “Making Room for ‘Dr.Nurse’” The article, by Laura Landro, reports that 200 nursing schools have launched doctorates in nursing programs to produce nurse with skills “equivalent to primary care physicians.” These new doctor nurses will have two years of additional training and a year of residency beyond their nurse practitioner training.


Mary Mundinger, PhD, dean of the Columbia School of Nursing and a not-for-profit organization, the Advancement of Comprehensive Care, staunchly back the doctor nurse concept. Furthermore, the National Board of Medical Examiners is developing a voluntary Doctor of Nurse Practitioner (DNP) certificate test, similar to that given to primary care physicians, to quality, doctor nurses to practice.


It is proposed that these new nurse doctors will.

1. Have RN and NP licenses with DNP certification.

2. Be capable of managing complex diseases in hospital, ER, and office settings.

3. Concentrate on preventive and coordinating care.

4. Prescribe medications.

5. Refer to other doctors

6. Qualify for admission to medical staffs.

Whether “doctor nurses” should be considered the “equivalent of primary care physicians” is an issue that should be met head on It represents a sea change in doctor nurse relationships. There are now 125,000 nurse practitioners. Many of these could soon qualify as “doctor nurses,” as will as thousands more as nursing schools ramp up to produce more of nurses functioning as doctors.

As physicians, what are your attitudes towards this development? A good or bad thing? A potential solution to the primary care shortage? A threat to the medical professional? Please comment.