The world of healthcare has a big dividing line down the middle.
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- On one side, the world of doctors: As medical school and residency-trained experts, doctors drill down on disease or injury, bringing their technical training and skills to bear on treating and curing physical and biological problems
- On the other side, the world of nurses: Nursing involves a more holistic perspective on care and treatment of the patient as a whole person, giving careful attention to their environment, and their overall well-being first. Nurses treat the same diseases and injuries as doctors, but more often take into account factors that aren’t always strictly medical in nature – things like emotional states, behavioral issues, and family supports.
If you understand the difference between the nursing and the medical models, then you will grasp in an instant why there are two different terminal degrees and distinct practice roles in the world of healthcare.
The decision to pursue a Doctor of Nursing Practice vs MD, or medical doctorate, isn’t just a question of time, prestige, or money. It’s about what role you want to play in treating patients who need your help.
Defining the Difference Between MD vs DNP Degrees and Programs
To understand the difference between earning a DNP and earning an MD, it helps to first take a look at what each degree means in the medical world.
What is a DNP?
The Doctor of Nursing Practice degree is the highest-level practice-oriented degree you can earn in nursing. As a practice-focused doctorate, it’s ideal for advanced practice registered nurses (APRNs), and that’s primarily who it’s intended for – both BSN-prepared RNs looking to transition into one of the four APRN roles and existing APRNs looking to advance and further specialize.
For that reason, it’s always offered with two entry points:
- Post-bachelor’s BSN-to-DNP (for bachelor’s-prepared RNs looking to become APRNs)
- Post-masters MSN-to-DNP (for APRNs and other master’s-prepared nurses looking to advance their knowledge and become more specialized)
Although only a master’s degree is currently required in most roles for APRN licensing, DNPs have gone the extra mile, developing in-depth knowledge and expertise in their focus area to hone nursing skills at the highest level.
The DNP was established in the early 2000s as a hands-on, action-oriented alternative to the PhD. Instead of a research or teaching focus, DNP degrees teach diagnosis and treatment skills in one of four recognized APRN practice areas (Nurse Midwife, Nurse Anesthetist, Clinical Nurse Specialist, Nurse Practitioner) as well as generalist tracks and systems-focused tracks in administration.
Of course, just like the master’s programs designed to prepare NPs and Clinical Nurse Specialists (CNS), DNP tracks for these roles also offer a population focus, one of six different types of patients and settings that a nurse practitioner or CNS will work with:
- Family/Individuals of all ages
- Adult/Gerontology (acute or primary care)
- Women’s Health/Gender-related
- Neonatal
- Pediatrics (acute or primary care)
- Psychiatric/Mental Health
Is a DNP a Doctor?
If you want to watch someone in healthcare struggle to answer a simple question, just ask them “Are nurses with doctorates called doctors?”
The answer is “sometimes”, but it’s tough to explain why. After all, the degree is a doctoral degree. It’s not uncommon for doctoral graduates in other fields, such as education or veterinary medicine, to be called doctor.
But in healthcare, we like to be very precise. Although many nurses who have earned a DNP feel they have earned the right to hold a title consistent with the type of degree they have worked so hard for, everyone recognizes that in common use, “doctor” always means a medical doctor.
In some states, it’s illegal for anyone other than an MD to describe themselves as a doctor. In others, it’s permitted in social or academic settings, but not clinically.
What is an MD?
The MD, or Doctor of Medicine degree, is the level of education required to be licensed as a medical doctor. They have been around for far longer than the DNP, with the first medical degrees issued circa 1000 AD in Italy.
MD programs last four years. They are distinguished by a strong focus on chemistry, biology, physiology, and anatomy. Medical students get the broad spectrum of healthcare fields in their basic education. They’ll go through rotations in everything from dermatology to emergency medicine to get exposure to and experience in a wide range of medical practices.
While DNPs will have already worked with patients in their population focus and practice area before ever enrolling, most medical students won’t pick a specialty until their third year of medical school. MDs can concentrate in any kind of medicine, with dozens of specialties to choose from—everything that a DNP can focus in and more.
The MD model of understanding disease and injury is systems-based. The MD degree is similarly focused on developing an understanding of those basic biological and physiological systems.
MD vs DNP Paths to Licensing and Advancement Are Different
The paths to becoming an APRN vs an MD have a clear difference in terms of meeting minimum education requirements. That’s because there is a road to APRN licensure that requires only a Master of Science in Nursing in most practice areas – in fact, that’s the road much more frequently traveled. On the other hand, an MD is the only way to get a license to practice medicine.
Nurse Anesthetists are soon to be the exception to the rule about meeting minimum APRN licensure requirements with an MSN. The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) and its program accreditation division, COA, both support an ongoing initiative to make the DNP the standard requirement for CRNA licensure by 2025, just as anesthetists all require an MD.
Because many APRNs have only a master’s, those holding a DNP are often tracked for management and leadership roles. Although they hold the same legal authorities, their additional expertise makes them the best choice for more advanced positions right after graduation.
Doctors, on the other hand, have to continue to climb the ladder and make more focused strides toward management if that’s what they choose to do. MDs aren’t typically tracked for managerial and leadership roles in the same way DNP-prepared nurses are.
For nearly 20 years, there has been a push in the field of advanced practice registered nursing to make the DNP the entry-level degree for all APRNs – it’s been a talking point since the American Association of Colleges of Nursing (AACN) originally published its DNP position paper in 2004. The impact of that proposed transition is yet to be seen. Though it’s unclear if that will ever occur, it is still a part of the conversation among APRN certifying bodies and other stakeholders.
The licensing process for doctors is lengthier, requiring them to take several steps of the standardized United States Medical Licensing Exam (USMLE) at different stages in their educational process. DNPs must pass only the required APRN certification exam after graduation.
It’s somewhat more common for nurses to earn a DNP with the goal of taking on leadership roles. In fact, some DNP degrees have executive leadership tracks that prepare graduates for those roles, not APRN licensing.
While some people do graduate from medical school and pursue research or other roles, it’s less common to do so and there are no special options for that path.
MD vs DNP Educational Approach and Requirements
MD vs DNP education differences attract the most attention when comparing the two roles. Most of the training covers the same ground:
- Basic chemistry, biology, and anatomy
- Differential diagnostics
- Evidence-based practice and research training
- Advanced physiology and pathophysiology
- Advanced pharmacology
- Treatment models
The major difference is, once again, the emphasis on different models of how to approach patient care.
But there are also concrete differences between medical school requirements and DNP program requirements.
DNP vs MD Program Requirements for Admissions
Getting into medical school is intentionally difficult. A limited number of slots for training translates into stringent med school requirements for enrollment. The ferocious competition leads to a lot of sleepless nights trying to figure out how to impress different med school admissions committees. Passing the all-important MCAT, or Medical College Admission Test, leads to late-night cram sessions and expensive tutoring.
Certain undergraduate coursework prerequisites must be filled to meet most med school requirements. There is often debate over whether a premed bachelor’s or a stringent science undergrad program like biology or chemistry is better.
Different entry-points make DNP program requirements more varied. Because post-master’s DNP programs cater only to nurses already holding an MSN, they may require that applicants already have an APRN license. A certain number of clinical hours of practice may also be required. For post-bachelor’s DNP programs aimed at BSNs, there are fewer restrictions.
You can see our Frequently Asked Questions about Doctorate in Nursing Practice Programs for more details.
Post-Degree Education Requirements for DNPs vs MDs
Another major difference in DNP vs MD training is what happens after the degree and applicable certification and licensure is earned.
DNPs can go directly into practice. Prior experience in nursing is common among DNP graduates, with most coming into these programs after years on the clinic floor. Though a total of 1,000 clinical hours are typically required for graduating with a DNP (including the 500 gained in a previous MSN program), the APRN positions DNPs come into after they graduate do not typically require any additional formal supervised experience.
In medicine, however, residency programs are a major part of post-degree education. After graduation, doctors are expected to apply to a residency program in their specialization and put in another three to four years of supervised practice before becoming board-certified. Even for those who do not specialize, a one-year internship is required before taking the USMLE Step 3 exam required for licensure.
There is some movement in the APRN world to develop a stronger residency model. You can already find APRN residencies and fellowships that offer similar supervised training. They typically only last for a year, however.
How Long It Takes to Earn an MD vs DNP
Both prospective MDs and DNPs are expected to come to the table with a bachelor’s degree before applying to their doctoral program. MDs may have majored in pre-med, but it’s not a requirement. DNPs often hold a BSN, or even an MSN if they have already become APRNs.
Coming in with only a bachelor’s degree, the DNP will take about three years to complete. Nurses who have already earned an MSN, however, can expect to earn a DNP with only two additional years of training.
In total, a DNP will take from 7 to 8 years of college education before becoming eligible for licensure.
For an MD degree, almost all candidates will apply directly to medical school after earning their baccalaureate. Med school is an additional four years of study. Residency training requires another three to four years for most programs.
In total, an MD will take between 9 and 13 years of college and post-graduate education before becoming eligible for licensure.
Many MDs also become board-certified in their specialty area. This can require additional years of supervised practice, running into tens of thousands of clock hours.
Counting the Hours in School and Residency Helps Set DNPs and MDs Apart
In debates over expertise and appropriate practice authority, much is made of the extensive number of hours of training required of medical doctors to become both licensed and board certified in a specialization compared to APRNs.
But this is often only half the story. Many nurses only come to the DNP after years of practice as registered nurses. In many cases, they will have accrued tens of thousands of hours more patient contact time before they even apply to a DNP program. That blows the average medical student’s real-world experience out of the water, even counting residency and fellowship training.
Of course, there’s no requirement for DNP students to have had a lengthy prior career as an RN first, although this often the case, and RN licensure is expected in most cases. So it’s impossible to say that every DNP has equal or greater hands-on experience to every MD.
But, it’s also too simplistic to argue that DNPs somehow all have less experience than MDs when they become licensed. Sometimes that simply isn’t the case.
Cost Difference in MD vs DNP Training
Another big difference in MD vs DNP paths is the cost of the degree. It can be the defining reason you pick one over the other, in fact.
The Association of American Medical Colleges estimates that for 2020, the average medical student will graduate with more than $200,000 in loan debt.
Although the American Association of Colleges of Nursing doesn’t maintain similar statistics for DNP programs, a quick review of institutions online and other published estimates show total program costs ranging from $70,000 to just over $100,000 depending on the school and the type of degree (BSN-DNP or MSN-DNP).
All in all, it’s likely that you will pay twice as much for an MD as you would for a DNP degree.
DNP vs MD Scope of Practice Remains a Subject of Debate
The single largest subject of debate over MD vs DNP is in the appropriate scope of practice for each role.
MDs have the authority to practice to the full scope of their training in every state. As long as they comply with legal regulation and ethical considerations, they’re allowed to treat any patient and perform any procedure.
As APRNs, DNP practice authority is complicated, to say the least. Each state has different restrictions:
- In a growing number of states, DNPs can prescribe medication of any type independently on their own authority.
- In others, a DNP may need a collaborative practice agreement with a licensed MD, and even then may only prescribe certain medications with certain limits.
One thing that is universally true is that DNPs have less autonomous practice authority than MDs in every state. Though that doesn’t necessarily place restrictions on what most APRNs do in the course of a normal day, in many cases, it means that even with a DNP, nurses are less often able to diagnose and treat complex or advanced injuries or disease.
The Fight Over Defining the Scope of Practice for APRNs Has Been Long and Hard Fought
And that fight isn’t over yet.
The COVID-19 pandemic stretched the healthcare workforce to the limits. Hospitals and health regulators pretty quickly reversed many of the limits on practice authority when doctors were in short supply. According to the American Association of Medical Colleges, there will be a critical short-fall in the number of MDs in the United States by 2034, just in time for the tsunami of health issues associated with Baby Boomers that’s expected to crest over the system.
With the increased demands this will be placing on an already overburdened healthcare system, it’s very likely that the level of practice authority and autonomy granted to DNP-prepared APRNs will become a bigger and bigger part of the conversation in the years ahead.
Doctor of Nursing Practice vs MD Practice and Work Environment
Because of the restrictions on their practice authority, DNPs in certain settings have far less autonomy than MDs. Particularly in organizations where both APRNs and doctors are employed, the APRNs will frequently find themselves lower down the ranks than doctors.
MDs can work toward any specialization and take jobs in larger healthcare organizations or set out on their own in private practice.
On the other hand, the status of the DNP at the top of the APRN education ladder means that DNPs are more likely to have managerial or leadership authority as part of their jobs.
DNPs also may practice in certain settings that allow considerable autonomy. Just like MDs, they can open their own practice, or work in a group practice.
In terms of hours and professional commitments, there’s not much difference between DNP and MD graduates. Depending on their specialty and practice environment, they will have similar demands on their time, and have remarkably similar workdays. Paperwork, patient visits, treatment coordination, and interacting with other providers will be very similar for both.
DNP vs MD Salary Differences and Career Outlook
Either way you go, the outlook is booming for advanced healthcare practitioners in the United States over the next decade. According to the Bureau of Labor Statistics, the outlook for all healthcare industry positions is set to increase by 12 percent between 2020 and 2030.
The salaries for MDs vs DNPs, of course, are weighted toward the doctors. BLS data for 2021 for physicians and surgeons bumps right up against the very top of the scale, with salaries of more than $208,000 per year.
For DNPs, it’s more difficult to evaluate the likely salary. BLS only tracks data for particular job roles, in this case, nurse practitioners. But since NPs can be qualified with an MSN as well as a DNP, the actual salary for DNPs is submerged in the data.
You can get a good idea, however, by taking a look at the top range of salaries for NPs. With the highest qualifications in the field, it makes sense that DNPs would command the top rates. And according to BLS, for the top ten percent of NPs as of 2021, that salary was over $200,540 per year.
For job growth, on the other hand, DNPs have a clear advantage. BLS forecasts that the number of jobs for Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners will explode at a 45 percent growth rate during the ten-year period leading up to 2030.
By comparison, the number of physician and surgeon jobs shows only a 3 percent growth rate. But family practitioner MDs, those most directly comparable to FNPs, are set for a growth rate of 5 percent.
How To Decide Between a DNP and MD Degree
With all that information, how do you decide between a DNP vs MD?
You might find some overwhelming obstacle in the differences we just covered. Maybe med schools is just financially out of reach. Maybe the thought of committing more than a decade of study to an MD is just too big a time commitment.
But in the end, for most people, it comes back to the nursing versus the medical model. Are you fascinated by the mechanisms of disease and the process of applying your medical training to a cure? Or are you primarily interested in the big picture, and finding the right combination of treatments and accommodations to suit each individual?
Many healthcare workers know from the start which style of treatment they are more comfortable with. You will probably find yourself drawn more toward nursing or more toward medicine. That alone can decide whether an MD or a DNP is the better degree to pursue.
If you find that a DNP is the better choice for you, we can help you learn how to become a Doctor of Nursing Practice.
2021 US Bureau of Labor Statistics figures for Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners and Physicians and Surgeons reflect national data not school-specific information. Conditions in your area may vary. Data accessed in May 2022.