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NPs, GPs, and the Health Sector
Linda Goin
  
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Are you old enough to remember a time when doctors made house visits? I remember when our family doctor, who was a general practitioner, came to our house to check up on my siblings and me when we were sick. It was a comforting gesture, but those visits stopped when my doctor retired, and that was about one-half century ago. In the past fifty years, much has happened to change the face of health care. The most dramatic change has occurred within the past five years, with the advent of the doctoral degree for nurse practice (DNP).

The DNP is a controversial degree. All you need to do is follow that link to the article about new DNP programs and read the comments after that article to understand the controversy. To explain briefly, anyone who earns a doctoral degree earns the title of “Dr.” However, since the DNP is within the health care field, that title has ruffled some physicians’ feathers. How dare a nurse take on the title of “Doctor” when a physician puts in more time and money into training? From that article:

By the time MDs and DOs start family practice, they have completed about 11 years of rigorous training – both academic and residency, clocking in between 20,000 and just over 21,000 hours dedicated to the study and practice of medicine. By comparison, DNPs education lasts, on average, between 7.5 and 9 years over 3,500 to 6,000 hours.  In other words, physicians routinely receive 15,000 to 17,000 more training hours than DNPs.

The best way to determine a situation is to look at both sides of the coin. According to the Bureau of Labor Statistics, a general practitioner earns $173,860 in average annual income. But, that salary can be deceptive. According to a recent article that dissects the physician’s income, the bottom line is that an internal medicine physician earns about $34.46 per hour. I know graphic designers who earn more.

I would hope that any student who wishes to become a doctor these days would leave behind the general practitioner goal. Why spend that much time and money to do what can be accomplished with a DNP? Or, the medical student can specialize, earning a title as surgeon, researcher, or specialist. Incomes for specializing can easily double that of a GP, with some general surgeons earning as much as $520,000 annually.

The Bureau of Labor Statistics doesn’t have financial figures for nurses with doctoral degrees, since this is such a new development; however, an RN with a master’s degree can become a nurse practitioner. Salaries for nurse practitioners average about $85,200 per year, or about half the salary of a GP. But, what can a nurse with a master’s degree accomplish?

A nurse practitioner (NP) can perform routine caretaking tasks, diagnose, and treat a wide range of ailments, and can also prescribe medication without consulting an MD in some states. They have served in rural areas for years, where no GP would dare to tread because the pay is so low. You can find NPs  serving in clinics, doctor’s offices, and in other health environments where specialists and surgeons are not required. And, with the rising cost of health care in hospital environments, you may find them there as well – they are, after all, less expensive than the GP.

It is very possible that the NP with a doctoral degree will replace what we’ve known in the past as the general practitioner. Overcoming the confusion between an NP with a GP can represent a hurdle; but, there is one way to distinguish the NP from the GP, and that is in the style of practice. This difference in style also has a great deal with how you might view the health sector stocks in your portfolio, too.

  • The GP operates from the medical model, which means that traditional doctors diagnose and make prognoses with or without treatment once a complaint is lodged by a potential patient.
  • The NP, on the other hand, operates from the nursing model [PDF], which emphasizes preventive care and a more holistic perspective on illness and recovery, including education.

This change in how people are treated at the grassroots level can also alter how patients use medical equipment, health options, and medications. Imagine this scenario: In less than five years, when the first waves of NPs with doctoral degrees hit health care centers around the country and encourage people to live healthy lives through education and by watching diets and exercising, there may be a change in how people view their participation in healthy living. Some folks may be able to stop taking high blood pressure meds, other people might avoid heart attacks, and other individuals may avoid seeing a surgeon unless involved in an accident. While this sea change is happening at the tail end of the Baby Boom, it still bodes well for an entirely new way of thinking about personal health care.

At this point, I’m wondering why the term, “Doctor,” has become so important. I think most of us are smart enough to understand that a DNP is not an MD. When that first wave of DNP grads start to work, it will be interesting to see the impact they might make on the health field.

I can’t predict the future, but I can watch trends and imagine what might change in services and products over the next decade or two. While it’s doubtful that NPs will resume home visitation practice like the GP of yore, it seems that a relationship with a nursing professional might be more personal than a relationship with a surgeon. Partnering with professionals to stay healthy is a novel concept, and it may just alter health care investments as well.

Until Later,
Linda Goin

 


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