Doctoral-Trained Nurses

The number of doctoral-trained nurses has soared over the last decade. These nurses now run their own classrooms, laboratories, research journals, research grants, and licensing boards; generate knowledge parallel to that generated by medical doctors; earn substantial salaries; enjoy autonomy, status, and public re- spect similar to that of other professionals; and have the legal right to call them- selves doctors. Moreover, around half of the states allow them to prescribe at least some medications and to work essentially as primary care providers. This au- tonomy and status is justified by numerous research studies published in major medical journals that have found care provided by advanced practice nurses to be as good as or better than that provided by doctors.

Not surprisingly, however, the American Medical Association (AMA) is fighting against this trend and fighting to maintain its dominance. The case of nurse–midwifery illustrates these pressures. Nurse–midwives are registered nurses who additionally earn nationally accredited graduate degrees in midwifery. The earliest nurse–midwives, beginning in the 1920s, practiced primarily in poor or rural areas with few doctors and enjoyed considerable autonomy. Beginning in the 1960s, a growing number of nurse–midwives worked largely independent of doctors in homes and clinics, providing a true alternative to medicalized child- birth. These days, however, changes in insurance costs and regulations (supported by doctors) have made it virtually impossible for nurse–midwives to work inde- pendently. Almost all nurse–midwives now attend deliveries only in hospitals and only when doctors expect the delivery to be routine, uninteresting, and poorly paid. Yet research indicates that care by nurse–midwives (at home or in hospitals) is at least as safe as care by doctors in hospitals. In fact, Britain’s National Health Service declared in 2014 that it was safer for healthy women to deliver at home or in a birth center with a nurse–midwife than with a doctor in a hospital.

On the other hand, nurse–midwives have legal authority to practice and to write prescriptions in all 50 states. The majority of states require private health insurers to reimburse nurse–midwives for their services, and all states reim- burse midwives for serving Medicaid clients. In 2014, nurse–midwives attended 8% of all U.S. births.