25: TODAY, TOMORROW, AND IN THE FUTURE ■ 557a department chair managing a DNP program at the time, I was convinced that my own
graduates were absolutely positioning themselves to be this new kind of expert, non-
physician, primary care provider he was applauding. So at least the Harvard Business
School was sympathetic to the work product of NPs and other advanced practice
clinicians; however, we dislike the use of physician extender as we see nurse practi-
tioners as more than an extension of physician’s practice. Indeed, even if their oppo-
sition has decreased down some, they continue to oppose, in particular, the practice
of the DNP graduate and their use of the title Doctor (Moore, Judge, & Angelini, 2013;
Schreiner, 2014). Furthermore, the stances taken by the AMA in its 2009 policy paper
warning about the spread and encroachment of nonphysician primary care providers,
is still being proliferated by The Physician’s Foundation in its white paper Accept No
Substitute: A Report on Scope of Practice (Isaacs & Jellenik, 2012). However, one must not
assume all physicians are against doctorally prepared advanced practice nurses, and we
cannot view medicine as “the enemy.” From our perspective, the AMA (at least institu-
tionally), perceives the DNP graduate and practitioner who will call themselves doctor
to be a threat to their sphere of influence and to their power and authority as experts on
health care, and also, most certainly, as a financial threat.
We continue to be uncertain of the future of the Diplomat in Comprehensive
Care examination (the DNP examination or the “ABCC examination” as some prefer).
Although we believe it will help better differentiate the clinically oriented DNP grad-
uate from the DNP graduate who pursues a nonclinical or leadership- focused DNP,
the numbers of individuals who have passed this examination since its founding in
2008 remains small. The examination does not appear to have made a critical impact on
DNP education. Moreover, there was broad opposition to it within the profession at its
inception, including the then- president of the American College of Nurse Practitioners
(ACNP), Dr. Julie Stanik- Hutt (2008). Initially, some of the opposition came from PhD-
prepared NPs who likely felt left out because, without a DNP degree, they could not
take the examination. That remains a fair argument, but in the end, a PhD is a research-
intensive degree, and its aim has never been to improve the clinical skills of master’s-
prepared advanced practice nurses. It remains to be seen whether patients and payers
will recognize that this subset of DNP graduates (Diplomates of Comprehensive Care)
are the “clinical experts of choice” as former Dean Mary Mundinger and the Columbia
University School of Nursing faculty suggests (“Ten Years of Progress,” 2010, p. 25).
We think it is more prudent for DAPRNs to work from a positive frame of refer-
ence and to find ways to explore collaboration with physicians, particularly with those
who do respect the practice of highly educated advanced practice nurses. We encourage
you to seek out these sympathetic physician partners and to work with them and to
establish successful partnerships. One of the first Drexel DNP graduates runs a primary
care practice with an MD colleague, and she is a full partner in the joint practice. She did
not have that kind of practice arrangement prior to having her DrNP degree. This is clear
indication of the kind of leverage the new DAPRN may exert today and perhaps more
commonly in the future. It is the expert role modeling of today’s practice DNP gradu-
ates and their demonstration of advanced knowledge, skill, expertise, and ability that
will go a long way toward paving the way for future graduates who may themselves
secure full partnership primary practice positions with physicians and other health care
providers.
Finally, we envision primary care primary practices comprised completely of DNP
prepared practitioners. It is not hard to imagine a practice being set up with full part-
ners (founders and highly experienced DAPN) and employing new associate partners
as new graduates are hired with an expanding practice. We envision new associate part-
ners working their way up the ladder to full partner and then enjoying the benefits of