21: THE DNP CERTIFICATION EXAMINATION ■ 469further assert that evaluation reflecting national standards of practice is the only mecha-
nism that can ensure safe and high- quality patient care.
According to proponents of the DNP examination, the line between physician
and DNP practice is very clear, because the context and scope of the examination
are different from those of the three- step USMLE examination for physician certifica-
tion (NBME, 2009). Unlike the physician USMLE examination, the DNP certification
examination is a shorter examination, which does not require prior formal clinical
skills assessment and prior fundamental scientific knowledge, as required by physi-
cian certification candidates. Because the DNP certification examination should reflect
the same level of clinical acumen as primary care physicians, proponents also defend
the choice of the NBME as the developer of the examination (Kane, 2009; Mundinger,
2007).
In contrast to physician certification, proponents also argue that the DNP exami-
nation more comprehensively evaluates the training of DNPs in patient care coordina-
tion to facilitate access to care and meet health care disparities (NBME, 2009). Unlike
physicians, DNPs represent a new generation of primary care providers who not only
manage complex illnesses in hospitals, emergency departments, and outpatient offices,
but also coordinate care among various health care providers and health care settings,
and provide preventive services that encompass contextual components such as social
and family support and cost- effective health care (Kane, 2009; Landro, 2008). Rather
than replicating the physician USMLE examination, the DNP examination contains
different dimensions of the USMLE Step 3 that reflect advanced nursing practice.
Mundinger (2009) argues that opposition to the examination may be fueled in part
from physicians who worry that competition from DNP diplomates may lower their
income and prestige.
Proponents of the DNP examination assert that concerns about physician regu-
lation of APRN practice are unfounded (Mundinger, 2008a, 2008b; NBME, 2009).
Justification for this position is based on the fact that the DNP examination is only one
component of the certification process. In order to receive a diplomate status, DNPs
must also possess national certification as an APRN, graduate from an accredited DNP
program, and be recognized or licensed by a state board of nursing as an APRN, all of
which are governed almost exclusively by nursing associations (with the exception of
the CNM, which is governed by the American College of Nurse-Midwives [ACNM]).
In addition, the DNP examination may actually assist in better defining the boundaries
between doctoral advanced practice nursing and medicine.
The DNP examination represents expert input from both nursing and medicine
professionals; these both support a multidisciplinary health care team approach that
better serves the needs of primary care patients. According to the NBME and the CACC,
future health care will require the collaboration of multidisciplinary health care teams
whose individual members possess a variety of educational backgrounds and clinical
expertise to meet the health care gaps created by an increasing shortage of primary
care providers (Mundinger, Starck, Hathaway, Shaver, & Woods, 2009). Nonphysician
primary care providers such as DNPs are vital to reduce the fragmentation and ineffi-
ciency of patient care, especially among the medically underserved. Without a sufficient
pool of primary care providers, proponents of the DNP examination assert that there
will be increased cost, decreased quality of care, and decreased patient satisfaction.
They further argue that the increased use of DNPs will require additional assurance
that DNPs have met national standards of care expected of all primary care disciplines.
Each primary care discipline, however, will need to define its boundaries and standards
in patient- care management. With the ultimate goals of patient safety and excellent
health care, the NBME and CACC promoted the development of the DNP examination