Help! ideas on getting along with a MD who dislikes NPs - page 2

greetings fellow nurse practitioners! I am in my first job as an NP and liking it for the most part, I am the only mid-level there except for a locum who occasionally works there. my mentors... Read More

  1. by   traumaRUs
    Be very careful. This is a litigation experience just waiting to happen!

    From all that you've written about this practice, I would get out before you get a call to give a deposition due to a lawsuit.
  2. by   strelitzia
    For what its worth, here is some insight from the other side of the fence.

    I have a close childhood friend who is a newly minted int. med. MD and she and I have discussed this NP/PA/MD issue a lot, as she went the MD route and I went the nursing one.

    From her perspective:
    Like most MD's she bust her gut and jumped through ridiculous hoops just to get admitted into med school. Once in, she was blindsided by the absurdly excessive study load and tuition akin to taking on the mortgage of a fancy house. She said many of them felt stunned by what they'd got themselves into, but couldn't drop out as they are so deep in debt which becomes immediately payable if they stop studying. By this point they need the future salary of an MD to be able to pay back their loans, leaving them in effect, trapped into medicine, even though many by this point are disillusioned with it as a career, having not fully appreciated the stress, tremendous responsibility, and burden of being constantly available to your work/patients. By the time they finish residency, some of them are so scarred they believe they have PTSD. They've been pushed to the limit, and some of them become extremely resentful and bitter towards NP's and PA's who they see doing essentially the same work as they do, but with a far easier path to that point, and far less debt incurred getting there.

    I am not excusing your colleague's attitude, as I believe it is unprofessional, unfair and hurtful to you. It is also potentially dangerous for you if she is in a position to check your charts, for she could make life very hard for you by being spitefully critical of your work, and make you look bad to your bosses on purpose.

    If it were me, I would ask to speak with her privately. I would tell her how much you respect the path she took, but explain plainly that you are a trained professional as well, and as such you would like to be respected for your own caring and commitment to your patient's well-being. I would be quite frank as to how her comments make you feel, and ask if she be willing to share your commitment to making a cordial, collegial working relationship in your office.

    If she persists with the snide comments, then put your man pants on and as hard as it is, go and talk with your boss about it. I believe he will respect you more if you have tried to address the matter with the offending MD first. This is how I was taught to handle 'lateral violence', as they call it now I guess. Your boss will be able to be sympathetic to her position while at the same time insisting that she adjust to the reality that mid-levels are a fact of life now and she just has to learn to work with them graciously, no matter what her personal opinions are. She is going to be working with mid-levels for the rest of her professional career, she has to learn to get along with them.

    In reality, this puts a lot of pressure on you to make no mistakes at all, and be doublely professional (for both of you) which is a high hurdle to scale day in and day out as a relatively new NP. Only you can tell whether it is worth it to you in the end. Hopefully if you speak plainly as to how her comments feel to you, she will leave you alone and start being more professional herself. She will HAVE to, if your boss requests it.

    Good luck! Have faith in yourself!!
  3. by   pedspnp
    Thanks I have faith in myself, this md is known for being difficult and providers have left because of him along with nursing staff. Why they keep him I don't know if it is because he brings alot of $$. He is nice one minute then nasty the next. I guess my only option is to sit down with him with administration and have a chat
  4. by   nurseethics
    I have been an RN for 35 years and an NP for only one....from your noted behaviors from the MD...you will never have a professional relationship with this MD.

    This is about safe patient care and credibility. Cut your losses and get out. Nursing has always taken the high road, let him have his trash behaviors...walk away knowing you can rise above that, others know.
  5. by   pedspnp
    The draw back is I love my pt's I work rural health where I am really needed and I took a NHSC loan repayment and to not fulfill the contract is 7100.00 a month for however many months left
  6. by   nomadcrna
    We are NOT mid-levels. Expunge that word from your vocabulary.

    I'd confront her the next time it happens.


    The American Academy of Nurse Practitioners (AANP) opposes use of terms such as
    "mid-level provider" and "physician extender" in reference to nurse practitioners (NPs) individually
    or to an aggregate inclusive of NPs. NPs are licensed independent practitioners. AANP
    encourages employers, policy-makers, healthcare professionals, and other parties to refer to NPs
    by their title. When referring to groups that include NPs, examples of appropriate terms include:
    independently licensed providers, primary care providers, healthcare professionals, and clinicians.
    Terms such as "midlevel provider" and "physician extender" are inappropriate references
    to NPs. These terms originated in bureaucracies and/or medical organizations; they are
    not interchangeable with use of the NP title. They call into question the legitimacy of NPs
    to function as independently licensed practitioners, according to their established scopes
    of practice. These terms further confuse the healthcare consumers and the general public,
    as they are vague and are inaccurately used to refer to a wide range of professions.
    The term "midlevel provider" (mid-level provider, mid level provider, MLP) implies that the care
    rendered by NPs is "less than" some other (unstated) higher standard. In fact, the standard of
    care for patients treated by an NP is the same as that provided by a physician or other healthcare
    provider, in the same type of setting. NPs are independently licensed practitioners who provide
    high quality and cost-effective care equivalent to that of physicians.1,2 The role was not
    developed and has not been demonstrated to provide only "mid-level" care.
    The term "physician extender" (physician-extender) originated in medicine and implies that the NP
    role evolved to serve an extension of physicians' care. Instead, the NP role evolved in the mid-
    1960's in response to the recognition that nurses with advanced education and training were fully
    capable of providing primary care and significantly enhancing access to high quality and costeffective
    health care. While primary care remains the main focus of NP practice, the role has
    evolved over almost 45 years to include specialty and acute-care NP functions. NPs are
    independently licensed and their scope of practice is not designed to be dependent on or an
    extension of care rendered by a physician.
    In addition to the terms cited above, other terms that should be avoided in reference to NPs
    include "limited license providers", "non-physician providers", and "allied health providers". These
    terms are all vague and are not descriptive of NPs. The term "limited license provider" lacks
    meaning, in that all independently licensed providers practice within the scope of practice defined
    by their regulatory bodies. "Non physician provider" is a term that lacks any specificity by
    aggregately including all healthcare providers who are not licensed as an MD or DO; this term
    could refer to nursing assistants, physical therapy aides, and any member of the healthcare team
    other than a physician. The term "allied health provider" refers to a category that excludes both
    medicine and nursing and, therefore, is not relevant to the NP role.
    1. AANP (2007). Nurse practitioner cost-effectiveness. Austin, TX: AANP.
    2. AANP (2007). Quality of nurse practitioner practice. Austin, TX: AANP.
    For more information, visit www.aanp.org
    Use of Terms Such as Mid-Level
    Provider and Physician Extender
    American Academy of Nurse Practitioners, 2009
    Revised 2010
  7. by   dissent
    Re: PedsPNP's predicament-
    I wouldn't even bring into account training or the path he/she took. Even if you were the janitor, his/her kind of behavior is completely inappropriate. I think bringing into account he/she's a doctor is irrelevant and for some reason weakens your position.

    Re: the term midlevel-
    I realize some think this term has a derogatory tone but quite frankly it is accurate. An NP/PA has more training than a floor nurse (BSN/ADN) but less training than a physician. Thus they are between the two. So it's just semantics and fighting it makes you seem pretentious and self important when you don't have the training to claim equivalence. Not saying this to start a war.
  8. by   nomadcrna
    The credentialing organizations disagree with you.
    As they state, we do not give a different level of care and we are judged ON THE SAME LEVEL as the MDs care.
  9. by   dissent
    What is true and what some quasi-political agency says is the truth are 2 very different things.
  10. by   nomadcrna
    LOL, our certifying organization? I think they carry quite a bit of weight.
    Are you a NP? If you are an NP, maybe think about supporting the AANP.
    It is a shame we have to fight our own as we struggle to enhance our profession.
  11. by   bsnanat2
    feeling a little self important nomadcrna?
    the np role did develop as a response to a shortage of primary care physicians in certain rural areas. the success of the np position should not embolden np's to step outside of their training. mid-level provider is an accurate term because np's can successfully care for medical needs of 'mid-level' complexity. to think that an np is the same as a physician is delusional and will eventually prove dangerous. np's that present the arguments that you did are the reasons physicians will continue to fight np's instead of embracing them. np's are a different animal, not an equal animal to the physician. a good np knows how to care for their patient and when to make a referral to a physician. recognition is one thing, equality to a physician is quite another. the care provided is the same or better than physicians, but the level of complexity that can be adequately cared for is about 'mid-level' to that of a physician. the physicians will let you have your cake when you stop trying to take theirs. keep striving for recognition as an equal and you may get the outrageous malpractice insurance and lawsuits that go along with it. that for sure will end the np field. np's are too important to let that happen. stay in your lane or go to med school. a pickup truck can haul some of the same things that a tractor trailer can, but try to use a pickup as a semi and see how long it lasts. np’s like you are dangerous and will eventually get in over your head. what’s that? hasn’t happened yet? it probably has but you’re too delusional to know it.
  12. by   bsnanat2
    duplicate post
    Last edit by bsnanat2 on May 17, '11 : Reason: duplicate post
  13. by   nomadcrna
    LOL, You still did not answer my question, are you an NP?
    Its a shame you have to become personal. That is usually the answer when you really don't have an argument.
    Are you even a nurse?
    On the mid-level side, if NP give "mid-level" care, why are we judged at the same level of care as physicians?
    Why do the major credentialing organizations feel as I do?
    I've been doing this a long time. I do provide care at the same level and my treatment of patients is judged at the same level as my physician counterparts. Whether I"m doing anesthesia or family practice or covering an ER in a rural town. If I make a mistake, the courts don't compare my care to other just other NPs, my care is compared to the standard of care, which includes physicians and NP providing that type of care. If I have an anesthesia mishap, I'm compared to the current practice standards, MDA and CRNA. The same goes for when I'm doing inpatient or ER medicine.
    So you can take it personally since the facts do not support you.
    I see that you are a BSN student. Maybe you should get some experience, become a RN then NP and walk the walk a bit before you open your mouth. At least get your RN license then come back.

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