How is the NP role different from MD

Trauma Columnist · Jan 9, 2008

I'm an adult health CNS who practices as an APN in a nephrology practice. Yes, I do make dx, order tests, meds, interpret tests, etc.. Is that what an MD does? Yes. However, I'm not an MD and my education and training does not equal an MD. What I do is the nuts and bolts of the case. Yes, I can handle changing routine meds. However, I don't function as an MD. I practice in conjunction with an MD. If I have a question, I ask one of the physicians. However, I am expected to have a proposed plan of action prior to contacting them. So...to answer your question: my job is similar to a physician and my job is to extend the physician coverage, doing routine care that doesn't require a physician's skillset.

HOpe that helps. Do you have any idea where you want to work?

Advanced Practice Columnist / Guide · Jan 9, 2008

Hi,
I started my FNP program this year, part time and have not yet begun clinicals. But I'm already getting worried- it seems like NP's diagnose, treat and chart just like MD's do. They say NP's see mainly 'routine' illnesses but I'm quickly realizing it's not always that straightforward. The medical knowledge base is so vast, I'm not sure how we can be expected to function the way MD's do with only a fraction of the training. Can some practicing NP's out there tell me in what ways there job is like/unlike a full flegded MD?

Am I sensing a fear of being expected to know everything an MD does and not having the same amount of time devoted to learn the stuff? That's totally understandable. As an FNP you are already aware that your training is focused on primary care of patients of all ages. While a number of FNP's have set-up independent practice on their own, not all states allow for this kind of practice arrangement. It is actually a small percentage that do so and I'm sure these are seasoned NP's. You should rest assured that when you graduate as an FNP, you are not expected to be an expert off the bat. There is a steep learning curve for most NP's while transitioning into the role from being an RN. This is however easily achievable once you've landed a job and have been in the position for a while.

In regards to your question, I am never without a physician resource person as Acute Care NP. I believe that in the acute care setting, it is impossible for an NP to run the show on their own. In fact, even physicians never do so. True I get to play slueth sometimes and investigate vital signs, labs, diagnostic tests, and such in the hopes of figuring out what is wrong with a particular patient. But when things become not as straightforward as I initially thought, I always know that my collaborating physicians are there to offer their wisdom. And if they themselves couldn't figure out what's wrong, it never hurts to consult another specialty. Knowing your limitations and discussing it with your team is the key.

abcdefg · Jan 10, 2008

Yes, that's exactly right Pinoy- I'm concerned that I'll be expected to function on my own, doing everything the MD does and only consulting with questions when strange things arise. It's reassuring to hear that I won't be totally on my own and that it will be OK to ask questions.

amzyRN · Feb 6, 2008

It seems like even MDs aren't completely on their own either. They consult other practitioners also and make collaborative decisions and it also seems to me that NPs are specializing, more so than doctors. Also, maybe NP training can be so efficient that the NP can do just a good of a job as an MD within their expertise. The anatomy, physiology, pharmacology seems to be taught a little different via nursing school versus medical school, but does looking as in depth into that make a better practitioner?

n_g · Feb 6, 2008

When it's my life on the line, heck yeah.

platon20 · Feb 6, 2008

It seems like even MDs aren't completely on their own either. They consult other practitioners also and make collaborative decisions

A pediatrician rarely consults other pediatricians about their patients. Now of course they refer out to subspecialists, but thats different than an NP role in which they have backup by a person working in the same specialty.

and it also seems to me that NPs are specializing, more so than doctors.

Thats not true. Doctors are much more subspecialized than NPs on average. All of the national leaders in various diseases are MDs. Just about all the ground breaking research on new treatments is being done by MDs and PhDs.

Also, maybe NP training can be so efficient that the NP can do just a good of a job as an MD within their expertise.

The role of an NP is not exactly the same as the MD though.

The anatomy, physiology, pharmacology seems to be taught a little different via nursing school versus medical school, but does looking as in depth into that make a better practitioner?

For bread and butter routine stuff? No. But the answer is absolutely YES for weird diseases or for research. All the world famous leaders in various medical specialties are either MDs or PhDs and they spend a lot of time learning the minutiae, so it does make a difference.

amzyRN · Feb 6, 2008

A pediatrician rarely consults other pediatricians about their patients. Now of course they refer out to subspecialists, but thats different than an NP role in which they have backup by a person working in the same specialty.
Thats not true. Doctors are much more subspecialized than NPs on average. All of the national leaders in various diseases are MDs. Just about all the ground breaking research on new treatments is being done by MDs and PhDs.
The role of an NP is not exactly the same as the MD though.
For bread and butter routine stuff? No. But the answer is absolutely YES for weird diseases or for research. All the world famous leaders in various medical specialties are either MDs or PhDs and they spend a lot of time learning the minutiae, so it does make a difference.

Is there evidence about the weird diseases or for research, i.e. that NPs are deficient in recognizing them, or collaborating with physicians who may be able to assist in those cases? So far I've heard of none, so far that is just supposition. It seems like no one wants to address the faults in medical training and address the possibility that NP training can possible yield an equivalent clinician that can spot a strange disease and refer/collaborate to help. I believe that NPs can spot these diseases and refer and treat/prescribe for the common ones. MD curriculum seems and I haven't asked one of my friends who just got into UCLA medschool about the curriculum and if he feels that going into such depth will be retained or will make his mind superior to a PA or an NP w/r/t a certain scope of knowledge. I mean I was a molecular biology major and I studied in depth about how vesicles bud from cell membranes and it's an intensely complicated process, but knowing that didn't help my understanding of general concepts in anatomy and pharmacology, for example and it didn't mean that someone else that lacked that background could not do just as good as me in the context of pharmacology. I believe that reductionism and it's educational model may not yield the a better clinician than a non reductionist educational model, such as NP programs. There's no proof either way, so now all we have is out opinions and I think if you personally feel like you would like to delve more indepth with medical science, apply to med school. We should study what we love and if you want to know who each protein turns and the electrons that cause that and the mathematical equations that describe that, med school may be for you and I'm not even sure to the degree of depth that they go. They might not go into the math so much. But anyway, from what I got from the tone of this thread were people that lacked confidence in their skills and if that's so and if med school would give that confidence, then choose that path instead of knocking NP training. Not to offend, if I got it wrong and no offense in my argument either.

j

n_g · Feb 7, 2008

What if NP's trained by reading textbooks only and never saw patients while in school? How competent do you think that NP would be? Not very. Would a car mechanic be any good at fixing your car if he only read textbooks? I don't think so either.

You can't learn this stuff by reading a textbook only. You need hands-on learning. You read, a preceptor points it out to you in a live patient, you see for yourself, then you read some more. Physicians do much more of this stuff and see weirder things because their training is so much longer. Their differential is much longer.

Why don't you try to learn how to play a musical instrument by reading about it only and then pick up the instrument for the first time in front of Carnegie Hall.

amzyRN · Feb 7, 2008

But an NP can gain the skills by seeing patients and they will improve as time goes on, just like MDs will, by practicing. They do similar things from slightly different perspectives, the MD has a broader scope, more training (more textbook learning also), but I think the end product is the same in their shared scope. Two different ways to get to a similar place. And PAs have shorter training also, but I don't hear the angst about them not being prepared to do similar things doctors do. And if we are going to try to see things objectively we must have proof of some of the claims here have been, that NPs are unprepared and scared to take on what MDs do. People just don't want to accept that some people can do what others do in half the amount of time. Maybe it shouldn't take 7 years to become a doctor, maybe med school should be revised, but in the mean time people will become PAs and NPs in half the time and do some of what doctors do with half the debt and so what.

n_g · Feb 7, 2008

While the NP is working, there will be no preceptor to point out things to him/her. Oh look, here's this or that. Oh look, this lab value with this symptom means we need to include this in our differential. Oh look, you should have asked these questions. Oh look, this is a better treatment plan. Etc. You are on your own and it really is very difficult to learn this stuff from a textbook without having someone experienced guiding you and just as importantly having the live patient with the actual disease in front of you. Sometimes the disease presents atypically or out of a list of 50 signs and symptoms only 2-3 things actually stand out. You cannot condense those two aspects into the existing NP curriculum or even in the DNP because the clinical hours are just too short. NP's will have 1000 clinical hours by the time they graduate while even a medical school graduate will have about 5000 hours and yet they aren't ready for prime time. They will accumulate another 10000 hours or more during residency. The nursing leaders have forced the DNP on us without addressing the deficiencies in the training. It's ivory tower thinking and for those of us in the trenches we're mere pawns. They've sent us to war without proper training and equipment.

platon20 · Feb 7, 2008

but in the mean time people will become PAs and NPs in half the time and do some of what doctors do with half the debt and so what.

And doctors will continue to earn double what NPs and PAs make. Even with an extra 100k in debt, 160k/yr vs 80k/yr is a no-brainer, the doc comes out way ahead in the end.