AAFP to NBME: Don't Renege on 'Dr. Nurse' Exam Promise

The AAFP is asking the National Board of Medical Examiners, or NBME, to make good on its promise that the board would do all in its power to ensure that a certification examination it offers to graduates of doctor of nursing practice, or DNP, programs would in no way be construed as being equivalent to physician licensing exams.

In a Feb. 19 letter to Donald Melnick, M.D., president and CEO of the NBME in Philadelphia, AAFP President Ted Epperly, M.D., of Boise, Idaho, said he is concerned about the way the Council for the Advancement of Comprehensive Care, or CACC, and the American Board of Comprehensive Care, or ABCC, are communicating about the certification in comprehensive care examination for graduates of DNP programs. The exam was administered in November.

In his letter, Epperly pointed to a statement posted on the ABCC Web site regarding the 50 percent pass rate for the first cohort of candidates who took the examination. The statement says that the exam "was comparable in content, similar in format and measured the same set of competencies and applied similar performance standards as Step 3 of the United States Medical Licensing Examination, which is administered to physicians as one component of qualifying for licensure."

In fact, Epperly said in the letter, the examination "does not test the same set of competencies. Further, if the CACC examination uses a lower 'pass' score than is applied to the USMLE Step 3, the CACC examination does not apply a similar performance standard."

"We think the CACC's recent actions both mislead the public and raise substantial patient safety concerns," Epperly said in the letter.

Epperly referred to a September 2008 meeting with the NBME that he attended with other Academy leaders and with representatives from the AMA, the American College of Osteopathic Family Physicians and the American Osteopathic Association.

He said that at that time, the NBME agreed to request from the CACC an attestation statement for any person taking the certification exam. The attestation statement would make clear that the DNP certification exam is not equivalent to the process involved in physician certification.

In his letter, Epperly says the AAFP is requesting that the NBME take the following actions: