AAFP prevails in efforts to clarify difference between physicians and ‘Dr. Nurse’

By Barbara Bein

A recent meeting between the AAFP and members of the National Board of Medical Examiners, or NBME, resulted in acknowledgment from the NBME that a new certification examination for candidates for the doctorate of nursing practice, or DNP, degree—the so-called “Dr. Nurse”—is in no way equivalent to exams for physician licensure.

Academy leaders and representatives from the AMA, the American College of Osteopathic Family Physicians and the American Osteopathic Association met with NBME Sept. 25 in Philadelphia to discuss concerns about the potential for patient misinterpretation of what the DNP represents.

During the meeting, AAFP President Ted Epperly, M.D., of Boise, Idaho, expressed appreciation for the value of nurses in health care delivery, but said he is concerned that the DNP is creating confusion among the public regarding scope and quality of practice. He pointed out that this confusion could adversely affect the U.S. health care workforce by confusing medical students interested in practicing primary care.

“At a critical time like this, we cannot afford to have the public or medical students confused about what a primary care doctor is or who it is. If DNPs are legitimized as being equivalent to real primary care doctors, the potential impact on medical students choosing primary care physician roles could be deeply affected,” Epperly told AAFP News Now.

The issue arises from an announcement from the NBME last spring that it would work with the Council for the Advancement of Comprehensive Care, or CACC, to develop and administer the first certification examination for DNP graduates. According to the NBME, the exam will be “comparable in content, similar in format and will measure similar competencies and apply similar performance standards as Step 3 of the (United States Medical Licensure Examination) USMLE.” Step 3 of the USMLE examinations provides a final assessment of physicians assuming independent responsibility for delivering general care.

During the meeting with NBME, Epperly made several requests, and the two sides agreed that:

• the NBME will ask the CACC to ensure that individuals who take the DNP certification exam attest that they understand the test is not equivalent to the USMLE Step 3;
• the NBME will ask the CACC to make a public attestation that the DNP exam is not equivalent to physician licensure or USMLE exams; and
• if efforts to expand nurses’ scope of practice occur, the NBME will “step up” and clarify that the DNP exam does not prove (or even remotely suggest) physician equivalency.