Scope of Practice Partnership to Address 'Doctor-Nurse' Trend

When is a doctor not a physician? When the "doctor" is a nurse practitioner. And, since 2004 -- when a position statement by the American Association of Colleges of Nursing Task Force on the Practice Doctorate in Nursing recommended a doctorate of nursing practice, or D.N.P, as the required minimal education level for entry into advanced nursing practice -- the doctor-nurse title may become more frequent, confusing patients about the educational level and medical expertise of the person wearing the white coat.

"Our members work in teams with nurse practitioners, and they provide comprehensive care because of that team work," said AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif. "We have great concern about whether patients will understand that a nurse practitioner does have different education, training and skills from a physician when both are called doctor."

That concern will top the agenda of the recently formed Scope of Practice Partnership, a coalition of national medical specialty organizations and state medical societies established by the AMA. Frank is a member of the partnership's steering committee, which sets the group's agenda.

The partnership currently is developing a clearinghouse of information about nonphysician providers' educational preparation, licensure requirements, and state legislation and regulation regarding scope of practice. AAFP constituent chapters and other medical societies will have access to that information as they work to address scope of practice issues that may arise in their states, said Frank.

The database will include information on how different states or specialties have addressed scope of practice concerns. If a specific scope of practice concern -- such as physical therapists' efforts to gain the ability to diagnose patients with musculoskeletal complaints and prescribe physical therapy without physician oversight -- affects several states, the partnership likely would develop model legislation that can help resolve that concern.

"It will support the states," said Frank. "For family physicians, that's important because in many instances, we're involved in these debates" dealing with several nonphysician groups. . Once the clearinghouse is established, we will move on to individual issues such as the role of the doctor-nurse," she said.

The steering committee listed doctorally prepared nurse practitioners at the top of its agenda after Frank recommended this issue during the group's March meeting as one worthy of consideration.

"There's a movement in the nurse practitioner community to move to D.N.P. degrees rather than master's degrees," she said. "This would allow nurse practitioners to say they're doctors because the D.N.P. confers that honorific on them."

As of 2005, at least 10 schools of nursing had approved practice-focused doctoral programs, and another 40 were in the process of developing such programs, according to Elizabeth Lenz, Ph.D., R.N., dean of the Ohio State University College of Nursing, Columbus, in an article published in the September 30, 2005, Online Journal of Issues in Nursing.