There is a huge difference in nurse practitioner and osteopathic (and allopathic) physician training.

Physicians complete 4 years of college, 4 years of undergraduate medical training (allopathic or osteopathic - which includes over 150 hours of didactic training and at least 2000-3000 hours of clinical training), then between 3 and 6 years of residency training, which incorporates > 12000 more hours of clinical training as well as formal didactics.

Nurse practitioners complete 4 years of nursing school, then 2-3 years of didactic and clinical training. Nurse practitioner school is typically a masters degree, the majority of which may be pursued online and part time, includes about 50 didactic hours and an undisclosed number of clinical training hours. The doctor of nursing practice, which is a relatively new degree, includes an extra 40 hours of didactic training and 1000 hours of clinical training - again, much of which can be performed online.

So, as you see, there is a HUGE difference in the training. In addition, the didactic training in medical school is in hard sciences (biochemistry, cell biology, genetics, pharmacology, pathophysiology, as well as training in the individual fields - cardiology, neurology, pulmonology, etc), while nurse practitioner didactics are a lot of nursing theory, practice management and is fairly light on hard science.

FNP responds: While I agree that the DO and MD have more years of education and clinical experience, please disregard the uninformed information provided about the NP education. My master's curriculum was more along the lines of the doctoral program comparable with physical therapists, occupational therapists and other health science field doctorates. Between the 4 years undergrad and 3 years masters, I completed approx. 1500 clinical hours (which were entirely on-site). All undergraduate clinical hours are on-location, NOT online. All graduate CLINICAL hours must be completed with a vetted MD, DO, or NP. Performance is routinely critiqued and rated. As a DNP student now, yes, I can complete some research courses online, but all my clinical courses will still be onsite. All RN clinical is ONSITE, all MSN clinical is ONSITE.

My undergrad curriculum was right along side the pre-med candidates - the same chemistry, biology, physiology, pathology, pathophysiology, calculus, statistics, microbiology. . . As I progressed to the master's level, this was expanded to advanced pathophysiology, advanced statistics and research, advanced pharmacology + others, ALONG with the "nursing theory and practice management". Depending on the specialty chosen, other courses can be included (e.g. cardiology, neurology), otherwise those courses are more of recognizing "normals" and "abnormals", assessment skills, red flags, and practical application.

What is also different with nursing versus the medical programs is the amount of social sciences that are ALSO included in the nursing curriculum, since from the beginning, we are trained to view the "patient" as a whole being, not just a diagnosis. So, we've studied psychology, sociology, ethics, religion, and other "soft sciences". As a family nurse practitioner, I spent my clinical rotations in the pediatric setting, internal medicine setting, orthopedics, emergency room, state psychiatric facility, community health (health department and in-home care), newborn nursery, labor and delivery, and medical-surgical rotations. As the NP chooses the specialty, the "residency" will be in the chosen area - so for me, working in a family practice clinic for my final rotation. I also was interested in orthopedics, so completed a sports medicine rotation. This is where there isn't as structured "total clinical time" as it can vary depending on the program.

As the MD has to take a credentialing exam to be considered a "MD" - which is the basic, generalist MD and shows a "basic" medical knowledge and practical ability, the NP must take a credentialing exam to show the "basic" knowledge as well. As the MD specializes further, other credentials are added, while at this point, as the NP progresses with specializing, acquiring more education, knowledge, etc., there are not necessarily "more credentials" that are added. This may change in the future and there is current debate whether the new entrance level for NPs (which will be the DNP level in 2015 as a generalist NP) should finish with taking the same USMLE (or very similar) Step 3 exam as do the medical students. In my opinion, this may be acceptable for basic clinical knowledge, but doesn't include the specialized nursing knowledge and won't distinguish the two professions. It may make some physicians and patients more comfortable with the NP education, but our purpose is NOT to be physicians, so personally, I don't agree with the final certification being the USMLE.

I will never claim that the NP (master's level) has as much education or training as a DO or general practitioner MD. There have been multiple studies that show that the certified FNP can "do" 85-95% of the same job that the MD does (general practice, not specialty). Now, that other "5-15%" is very important and I recognize when I need to consult, and what I don't know. I do collaborate with physicians. Currently I work in a subspecialty clinic and have general practitioners refer their patients to me, because I have more experience in this given field (neuropsychiatry), but I still don't have as much knowledge or as much "medical" training as the psychiatrist I collaborate with (except in the counseling arena, where I have more training.)

Even when I achieve my DNP, it will not place me on the same level as the psychiatrist regarding that specialized knowledge; but just as the PsyD psychologist or PhD pharmacist, my degree will be a doctoral degree and should be respected as such. This DNP program is focused on systems theory and holism, integrating individual nursing practice into the healthcare arena with the plan of utilizing multiple fields to provide the best care for the patient - integrated. This means transitioning healthcare into the family, community, between specialties AND utilizing all these for the benefit of the patient - not claiming NURSING only is best.

The best physicians I knew started out as nurses (or nursing assistants) and had that rounded knowledge of body-mind-spirit incorporated into their medical practice. I believe that the new medical graduates are now experiencing some of this "holistic" training as many programs are now requiring rotations with a clergy/religious representative for the hospital setting.

Please don't devalue my training or those of other NPs who have chosen to specialize and also receive extra clinical and didactic training (as do the medical specialists). There is also nothing wrong with a student who decides to work through a program on a part-time basis. Whether it is a part-time program or a full-time program is irrelevant, as the same knowledge and clinical experience must be completed in a set amount of time.

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