Is There a Doctor in the House?
Professions periodically assess themselves in terms of their status, how they are perceived, the services they offer, and the value they bring to the public.
Outside of healthcare this often translates to a simple name change. For example the legal profession in many countries made a conscious decision to swap their LLB (bachelor of laws) degree for a JD (Juris Doctor). Course content changed little, if at all. But it certainly is more prestigious to have a doctorate rather than a bachelor's degree. Right? Both are first professional degrees, but the JD allows greater recognition, more uniformity and also allows for international mobility.
Physical therapists a few years ago decided that the scope of knowledge of their profession was wide enough to warrant a doctorate. They also argued that their patient assessment, development of plan of care and individualized therapy were independent enough to warrant a doctorate in physical therapy (DPT). There is a bridge program to the doctorate for those PTs who currently hold a bachelors or master's degree. However, all physical therapy schools will offer the DPT by 2015.
Pharmacy is probably the best known example of a well timed professional doctorate.They chose to phase out the bachelor's degree and opt for a first professional doctorate degree (PharmD).
Again there were only very minor changes in curriculum. Pharmacists also decided to go all out and expand their role in clinical settings to become advisors, consultants and the experts on "all things medication." They now routinely monitor aspects of therapeutic drug regimen, order lab tests and adjust dosages based on protocol. They are the "other" doctors in most hospitals, HMOs, and health centers. Other countries have quickly adopted this attractive model as well.
Physicians and patients have accepted this expanded role without complaint and some even welcome it.
Nurses have offered programs in what they term "advanced practice" for years. These nurse specialists assume a physician-extender role, work alongside physicians and in some situations even work independently. They include nurse anesthetists, nurse practitioners, nurse midwives and the like. The nursing profession has generally made the requisite advance certification very accessible and attainable.
They have also made the route to advanced practice very clearcut and uncomplicated: RN who takes advanced courses and passes a certification examination. In some cases there is a separate license. But note there are no silly round about routes like a biology degree plus experience ( are you listening MLS???)
This past week, I received a brochure from Loyola University offering a BSN- to- DNP (bachelor of nursing to doctor of nursing practice) degree.
This will be a 3 year program, with coursework completed completely online. In three years graduates will be called "doctor" and will additionally be eligible for certification as nurse practitioners. This direct leap of bachelor to doctor/advance practice is designed to address the provider shortage and to anticipate the additional number of patients coming into the healthcare system under health care reform.
We have had talks of a clinical laboratory science doctorate (DCLS) for almost 20 long years with not very much progress. I do not recall getting a survey from physical therapists or pharmacists or nurses about the wisdom of molding their profession. They saw a need to change their image, to offer expanded services, to better serve patients; and they found a way to do it, easily, efficiently and without too much burden on current practitioners. Healthcare administrators and patients saw the extra value and have embraced them.
But we continue to survey others and mutter among ourselves. Why is the Medical Laboratory Science profession so hesitant?