As medicine has grown more complex and sophisticated, so have the skills needed to practice it. Pharmacists don't just dispense pills any longer; they develop medication regimens and counsel patients on how to follow them. And nurse practitioners are now for many people the main source of primary care, the experts who diagnose those aches and pains and then write the prescriptions that relieve them.
Given the ballooning of their clinical duties, it's no surprise that the education required of many health pros is expanding, too.
As of January 2012, students who want to be certified as audiologists must have a doctoral degree. New advanced practice nurses—nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists, who work with other nurses to improve patients' health outcomes in a range of specialties—can anticipate needing or being strongly encouraged to get a doctor of nursing practice (D.N.P.) degree beginning in about 2015. Physical therapy grads are looking at stiffer requirements starting in 2018.
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Those who are already practicing when the time comes generally won't have to meet the new standards as long as they keep their licenses up to date, experts say. And not all health professions are moving in this direction. There are no plans at this time to add requirements for physician assistants or speech-language pathologists, for example.
Unlike doctor of philosophy programs that emphasize academic research, the clinical doctoral programs that are becoming de rigueur in the health fields emphasize skills and knowledge students will need to practice their profession at its highest level. Advanced practice nurses who diagnose and treat patients need not just to know the necessary medicine but also to be familiar with "systems of care, and understand issues around quality and safety measurement and leadership to be able to fully utilize their capabilities," says Kathleen Potempa, president of the American Association of Colleges of Nursing.
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Two tracks typically lead to a clinical doctoral degree: one for practicing professionals who may already have a master's, and another for students just getting started in the field. Someone coming out of college wanting a doctor of physical therapy degree, for example, can enter the three-year program with any undergraduate major as long as he or she has completed some prerequisites. That's true for the four-year audiology program, too.
To enter a doctor of nursing practice program as a new grad, on the other hand, you have to have a bachelor's in nursing and an RN license. Pharmacy students must complete at least two years of targeted undergraduate coursework before beginning a four-year clinical doctoral program.
Even if credentialing requirements won't change for a while, many students who are entering these fields today aren't waiting. Indeed, some programs are designed to allow the very early committers to earn both a bachelor's and doctoral degree in one academic swoop.
"I knew I'd save money from tuition, room, and board for a whole year, and you don't have to take the GRE" entrance exam, says Samantha Letizio, 24; she will graduate with a doctor of physical therapy degree (D.P.T.) from Simmons College in Boston in August. Letizio began her studies there as a freshman in 2006 in the school's "three plus three" program, so she could pack seven years of study into six.
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Of 210 accredited physical therapy programs nationwide, all but four offer D.P.T. programs. Most of these three-year programs, including those at Washington University in St. Louis, the University of Southern California, and Columbia University, are aimed at students who already have their bachelor's degree. Thirty-five schools, including the University of Hartford, Indiana University, and Ithaca College in New York as well as Simmons, also offer the "three plus three" combined programs.
Unlike physical therapy doctoral students, who graduate with a generalist degree, advanced practice nurses specialize in one of a number of areas, such as nurse practitioner/family practice, nurse midwifery, and health management and policy. There are currently 182 accredited doctor of nursing practice programs in 42 states plus the District of Columbia. Thanks to the impressive and growing demand for advanced practice nurses, an additional 101 programs are in the planning stages, says Potempa.
Many D.N.P. programs now are conducted at least in part online; indeed, some require only occasional visits to campus. This can be a boon, especially for working students who live in states that don't have a D.N.P. program. According to a 2011 survey by the American Association of Colleges of Nursing, 32 D.N.P. programs were offered completely online, while 78 offered at least half of their program that way.
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Many D.N.P. programs incorporate online coursework even for students who live near campus. That's what Allison Bruner discovered when she enrolled at the University of Florida's program in Gainesville in 2009 after getting her bachelor's in nursing there in 2006 and working for three years in hospital and outpatient settings in the Washington, D.C., area.
"I like classroom interaction, but I've been pretty impressed with how they try to facilitate online learning," she says. "We end up having good discussions even though nobody can see each other." Bruner chose the family nurse practitioner track because she prefers an outpatient setting to acute care and hopes to work with all types of patients.
Since doctoral degrees won't be expected of nurses in her field until at least 2015, Bruner could have exited the three-year doctoral program with a master's degree after five semesters rather than continuing for the additional three, leaving the decision about getting a D.N.P. until later.
But "I have a long career ahead of me," she says. "I wanted to be prepared. I didn't want to go back to school when I was older and ready to start a family." And she thinks there's no doubt that a more demanding role is the future of nursing.
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