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Friday, October 3, 2014

Ebola in Texas

A man sickened with Ebola in Texas has already made international news and the implications of case have multiple implications not only in healthcare, but in society and politics as well.

The first and most important thing is that Texas grossly underfunds public health in the state.  Under funding public health care means that citizens are at higher risk for falling victim to an epidemic disease like Ebola because there are insufficient resources (including training for the emergency room hospital workers to be able to recognize the disease's symptoms) to respond to the epidemic early and contain it.

Texas Republicans have cut back public health funding, undoubtedly because they see it as big government, to the point where the state with one of the fastest growing populations in the country ranks 34th nationally, according to a 2013 report by the Robert Wood Johnson Foundation. This is not new news. Texas gubernatorial candidate Wendy Davis gets the gift of a new talking point in an already tight election race.

When it comes to public health, government is the appropriate institution to respond to these kinds of crises. What most people don't know is that public health response to disease came from the business sector in the 1600s as global trade began to expand.  A ship that arrived into a port carrying diseases could quickly devastate a major trading center and hurt a country economically.  Business demanded better regulations around screening ships to protect their profits.

The sadder implications of the case in Texas is the likely social response.  Undoubtedly due to an already hostile culture toward outsiders in the state, we will likely see increased attacks on individuals perceived to carry the disease --most likely immigrant Africans since the man came from Liberia.  We don't actually know if he is Liberian, and that's important to remember.  He could easily be an aid worker or other professional based in Liberia who was home visiting family members.

Nationally I suspect we will start to see travel moratoriums put in place for countries where the disease has been detected.  This has big economic implications for these countries, many of which already struggle economically.  Their health systems were already made vulnerable enough by economic policies advocated by conservative political groups which advocate underfunding of healthcare systems in favor of private sector responses.  In a case like Ebola, you can't wait to have a bidding war among private healthcare providers to respond to an epidemic. Health systems around the world need to be appropriately funded so that workers have the resources, protection, and support they need to respond quickly and effectively to public health crises like Ebola. Without it, we are all at risk.

Thursday, September 25, 2014

PhD or DNP?

I've been thinking about this topic for a long time.  It's one where I get the most questions from students about which doctoral degree to do in their future career path.

The short answer comes with questions: What do you want to do with your doctoral degree?  Do you want to design and conduct research?  Do you want to focus on applying and testing evidence in clinical practice?  Your answer to that question will determine your educational program choice.

Let's start with why you would choose a PhD. Around the world, everyone knows what a PhD is as a degree.  Doesn't matter where you got it from, with a PhD after your name people will recognize you spent a lot of time in school and must have passed some higher standard of educational preparation.  Outside the United States, except for maybe Canada, no one knows what a DNP degree is or what you can do with it.  It will take decades before that happens.  If you think you want a career with an internationally recognized credential, then you should choose a PhD.

Another reason to choose a PhD is because you want intensive preparation in how to design and conduct research or policy analyses.  You see problems with patient care stemming from different sources and you want to know how to fix them through data analysis, intervention design, or rigorous translation studies. A PhD will prepare you to do that and over your career, you will see a difference made in many lives.

A DNP program that promises to train you in research in 3 years or less is selling you a bag of goods. A DNP program should prepare you to critically evaluate and synthesize research evidence so you can translate that into organizational quality improvement, leadership initiatives, and evidence-based policies.

Another factor to consider about the DNP is that it is a degree that is still figuring out what it wants to be.  Starting in 2015, it will become a standard degree preparation program for nurse practitioners.  This came about because people recognized NPs took a lot of credits, enough to qualify for a clinical doctorate degree.  In the case of some curricula, they also wanted to offer more clinical training time. There is no consensus on whether or not a DNP will be required for nursing education, administration, or informatics.  Those, for now, will remain two year masters degrees.

The DNP is also a solution for the faculty shortage (though vociferously denied by some that it is that) since most people seeking DNP degrees are people who really like clinical practice and want to keep a hand in it.  The DNP allows practitioners who want to teach and practice to do that more easily than a PhD degree does.

So this is my two cents on the subject. When choosing a doctoral program, choose the one that fits your career goals best.  Both are significant time and resource commitments so choosing the right program early will save you a lot of hassle in the long run.