nurse practitioner career question

  1. Hi everyone, I'm typing here to ask you guys some questions about the career nurse practitioners, and if you could shed some light on the career as a NP it would be so helpful. Thank you for taking the time to read my post.

    I've read articles online about the career as an NP, as well as watched video's on the career of NP's as well, but I'm still confused of the whole job as a nurse practitioner.
    My questions are:

    1.) If a nurse practitioner who works in a clinic (not their own) or a hospital with doctors, would they be doing the same work as a regular physican? So for example, an adult/family nurse practitioner, would they do the same work as a family/internal medicine doctor? Or a pediatric nurse practitioner, would they be doing the same work as a pediatrician? By same work I mean-making sure they have their routine checkup, or diagnose them with any illness they may come in with, or give refill/start prescription. Or would the NP's be considered the same role as a PA (except for prescription) and assist the doctor in what they need help with. (So pretty much following doctors orders) (I used the example of a clinic that is not owned, because I would like to work in a health system clinic or a hospital)

    2.) If the nurse practitioner isn't unsure about a diagnosis, or they're not sure with something, do the NP's go to the physicians to have their questions/doubts answered? Is that kind of where, what separates the NP's and the MD's? That the NP's just like a PA can ask the doctor questions anytime they are not sure, and the MD would be the one to answer it?

    I guess I'm just confused on if NP's and the family/internal/pediatrics MD are doing the same work and getting paid less, would it be better to go be an MD instead of a NP? (I know training time is longer for an MD, but I would consider it)

    Any advice would be appreciated, and once again, thank you for taking the time to read my post.
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  2. 6 Comments

  3. by   juan de la cruz
    Quote from blessed1234
    1.) If a nurse practitioner who works in a clinic (not their own) or a hospital with doctors, would they be doing the same work as a regular physican? So for example, an adult/family nurse practitioner, would they do the same work as a family/internal medicine doctor? Or a pediatric nurse practitioner, would they be doing the same work as a pediatrician? By same work I mean-making sure they have their routine checkup, or diagnose them with any illness they may come in with, or give refill/start prescription. Or would the NP's be considered the same role as a PA (except for prescription) and assist the doctor in what they need help with. (So pretty much following doctors orders) (I used the example of a clinic that is not owned, because I would like to work in a health system clinic or a hospital)
    Nurse Practitioners can perform patient examination, order tests, interpret exam and diagnostic tests, diagnose, treat including prescribe in all 50 states. This is the same role physicians perform before NP's were around. The conditions wherein these NP roles can be performed depend on the state nursing practice act that govern Nurse Practitioners in the 50 states. In some states, NP's must work under supervision of a physician. Majority of laws do not specify degree of supervision - in some cases, physician presence is not required to supervise. Some states call supervision under a different name - "collaboration", which is a friendlier term. There are about 1/3 of states where NP's are completely independent from physician involvement.

    In many cases, NP's (and even PA's) do not assist physicians in any setting. They actually see their own patients on their own time and perform the roles mentioned above with no direct physician oversight. In some cases, NP's (and PA's) are part of a provider team if you will, where the NP initially sees the patient, discusses the care with the team (usually a physician as the head) and plan patient management based on the team's decision. This is a more common model in hospitals and high-acuity situations. There are NP's and PA's who assist surgeons in the OR - this is probably the only example where NP's and PA's assist physicians.

    Quote from blessed1234
    2.) If the nurse practitioner isn't unsure about a diagnosis, or they're not sure with something, do the NP's go to the physicians to have their questions/doubts answered? Is that kind of where, what separates the NP's and the MD's? That the NP's just like a PA can ask the doctor questions anytime they are not sure, and the MD would be the one to answer it?
    NP's consult other NP's, PA's, and physicians for anything related to patient management that they need a higher level of expertise to resolve. This does not "separate" NP's from physicians or even PA's because all providers (including physicians) rely on consultation to another provider with more expertise on a particular patient condition or a disease that they have very limited knowledge of. Many times, providers also consult other professionals in the health care arena including Pharmacists, Dietitians, Social Workers, Physical and Occupational Therapists, and Speech and Language Pathologists.

    Quote from blessed1234
    I guess I'm just confused on if NP's and the family/internal/pediatrics MD are doing the same work and getting paid less, would it be better to go be an MD instead of a NP? (I know training time is longer for an MD, but I would consider it)
    The difference in reimbursement (or pay) was historically a selling point for NP's. This was a marketing ploy to boost the market value of NP's as cost-effective providers. In this age of disparate insurance reimbursement for similar work performed by both physicians and NP's, there is a movement towards asserting the right to equal pay for equal work. We shall see where that goes.

    You seem new to this whole concept. Are you considering a career as a provider? The argument against pursuing a career as a physician versus a Nurse Practitioner has been the fact that medical school takes a longer route of training requiring a huge debt burden in terms of school loans. However, it does seem as though some NP programs have become just as expensive. You may need to do more research on your own. Looking through this forum is a good start.
  4. by   PMFB-RN
    Quote from juan de la cruz
    The argument against pursuing a career as a physician versus a Nurse Practitioner has been the fact that medical school takes a longer route of training requiring a huge debt burden in terms of school loans. However, it does seem as though some NP programs have become just as expensive. You may need to do more research on your own. Looking through this forum is a good start.
    *** Do you think that argument needs to be re-thought now that NP & MD are pretty much the same in terms of time commitment (4 years under grad, 3 year professional degree) and getting closer in cost?
  5. by   juan de la cruz
    Quote from PMFB-RN
    *** Do you think that argument needs to be re-thought now that NP & MD are pretty much the same in terms of time commitment (4 years under grad, 3 year professional degree) and getting closer in cost?
    I think the time commitment is not the same still. Even in primary care, NP's still have less total years of training (even in the case of an NP with DNP) compared to physicians. However, I think in some ways NP school have become so expensive that the return of investment in terms of salary potential may now appear less appealing as it did in the past. If you look through these forums, there are still posts from NP's in areas of the country whose salaries are very similar to staff RN pay.

    Personally, I still reap in the benefits of having chosen NP over being a physician in my field. I work with residents and fellows who are in post-graduate year 6 or 7 and are still not finished in their training. You would think that at some point they would have to start making a real living to pay off their loans.
  6. by   blessed1234
    Thank you so much for taking the time to explain and answer my questions!
  7. by   PMFB-RN
    Quote from juan de la cruz
    I think the time commitment is not the same still. Even in primary care, NP's still have less total years of training (even in the case of an NP with DNP) compared to physicians. However, I think in some ways NP school have become so expensive that the return of investment in terms of salary potential may now appear less appealing as it did in the past. If you look through these forums, there are still posts from NP's in areas of the country whose salaries are very similar to staff RN pay.

    Personally, I still reap in the benefits of having chosen NP over being a physician in my field. I work with residents and fellows who are in post-graduate year 6 or 7 and are still not finished in their training. You would think that at some point they would have to start making a real living to pay off their loans.
    *** They may not be the say but they are much closer than they have ever been. With the advent of the (typically) 3 year DNP and fairly new three year medical schools you are pretty much looking at the same number of years of schooling. The same number of years of barrowing money to survive. Residents may not make much but at least they can stop barrowing money for living expenses.
    Your comments R/T cost of NP vs NP salary are spot on.
    A couple years ago I attended an information meeting about the MSN FNP program at a private Catholic College. The question was asked if there were plans to ever go to a DNP. The presenter was adamant that they would NOT go the DNP model under any circumstances. Her point was that their NP program was supposed to produce competent providers at a minimum of cost with the hope they would practice in medically underserved areas after graduation.
    She was so adamant about it she said that if DNP ever became a requirement they would drop NP education altogether and look into a PA program. I thought she made a great point.
  8. by   BlueDevil,DNP
    PMFB- I think your point has some merit if the learner is beginning from scratch and intending to proceed straight through. That isn't true for all of us, obviously. For many candidates, NP school represents a reentry into nursing education; exiting and reentry along the way, perhaps at multiple points (CNA, LPN, ADN, BSN, MSN, NP, DNP) makes a lot more sense for some people. This is not as easily achieved in the medical pathway. Food for thought.

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