American Academy of Family Physicians thoughts on NPs

Advanced Practice Columnist / Guide · Aug 17, 2012

To me, this is a very divisive document with inaccuracies and incorrect information. I am surprised that a professional organization such as the American Academy of Family Physicians would put their official stamp on such a document. Where are the references for those claims? who proofread this document for pete's sake?

"Nurse practitioners can come to their certiﬁcation from various routes. They can complete an associate’s degree program or nursing diploma program and go directly into a master’s degree program or they can complete their Bachelor of Science degree in nursing"

...I can't believe someone didn't proofread this. What a poorly written, convoluted and misleading statement.

"According to the 2002 survey conducted by the American Association of Critical-Care Nurses Task Force on the Professional Clinical Doctorate, practice-focused nursing doctoral programs share core content areas and competencies"

...come on! get the acronyms right. There are 2 AACN's in Nursing. In this case the correct reference is the American Association of Colleges of Nursing, not the American Association of Critical Care Nurses which have absolutely nothing to do with the DNP. Their involvement in NP matters is limited to certification of Adult ACNP's who do not compete with Family Physicians.

"NP Clinical Training: 2,800 – 5,350 hours. Total of six weeks for master’s degree and 12 weeks for doctor of nursing practice"

...those numbers are just bizarre and begs for actual sources of where those data came from.

chuckster, ADN, BSN, RN, EMT-B · Aug 17, 2012

So this was posted on another message board. I want to get your thoughts on this
Read thru this leaflet published by AAFP, 2008....look at what they list as the educational training for NPs and other comments. I'm insulted. Someone needs to have a chat with the folks at the American Academy of Family Physicians.....

http://www.aafp.org/online/etc/medialib/aafp_org/documents/press/nurse-practicioners/np-training.Par.0001.File.tmp/NP_Info_FP-NPTraining-Compare-4pgs.pdf . . .

After reading the leaflet, all I can say is "Wow!" This document filled with so much incorrect information, distortions and half-truths that it is actually dangerous to distribute to the public. Hopefully one of the professional nursing organizations will contact AAFP and get them to correct the document before it does too much damage.

SHGR, MSN, RN, CNS · Aug 17, 2012

I read a lot of what the AAFP puts out, since they are the official organization for Family Medicine docs. Their tone is definitely not pro-nursing in any way- they do not see nursing as partners with medicine. This saddens me, and I have read this specific document and was likewise disappointed. Since their literature often talks about being patient-centered and team-oriented, you would think this would not be the case.

Our particular clinic's philosophy seems to be that NP and PA are okay as long as they bring in revenue and don't cause trouble.

norlns24 · Aug 17, 2012

Should this surprise anyone? NPs are a threat to their hegemony. NPs have taken over many roles in health care once solely filled by physicians, and have affected the salary dynamics of the profession. AAFP is a physicians' lobbying organization and its primary goal and purpose is to promote the profession and protect it from external threats. This is what lobbyists do. As the number of NPs grow and as cost pressures continue to bear down on health care, expect more such press releases and calls for changes in NP standards and licensure.

Advanced Practice Columnist / Guide · Aug 17, 2012

Should this surprise anyone? NPs are a threat to their hegemony. NPs have taken over many roles in health care once solely filled by physicians, and have affected the salary dynamics of the profession. AAFP is a physicians' lobbying organization and its primary goal and purpose is to promote the profession and protect it from external threats. This is what lobbyists do. As the number of NPs grow and as cost pressures continue to bear down on health care, expect more such press releases and calls for changes in NP standards and licensure.

Oh I agree, I wasn't surprised that the AAFP would make an effort to establish their dominance in the family practice turf in the face of FNP competition. What surprised me was how poorly written and inaccurate the document was. Physicians have a strong argument when it comes to length and depth of training...that's a given. But to not even have the facts straight is quite embarrassing for a professional organization in AAFP's stature.

CRF250Xpert · Aug 17, 2012

It doesn't benefit the AAFP in any way to give NPs any credit. They own the PAs, so why would they condone or applaud NPs when we don't answer to them? I recently began working with two new Family Practice MDs who never worked with an NP in training. I asked if they knew anything about NPs and both said "no". After a few weeks, both spontaneously have mentioned things like, "wow, I am really impressed with your depth of knowledge", etc. I can only wonder about how little they think we know about medicine. It's the "nurse" part in NP that trips them up. If we could only change our title after grad school we'd carry alot more clout.

netglow, ASN, RN · Aug 18, 2012

Nobody cares about patients and safety, that is a ruse. Hospitals are cutting back. They will cut back no matter what. If the economy vastly improves they will cut back. It's all about the money and making more of it and keeping it. Some MDs feel some kind of threat but they don't know what to do about it as they are always just a bit lacking in "game".

Cluelessness is why they sold themselves out and joined the big corporate networks and are just regular employees like us in my metro area. Almost nobody is independent. I'm just waiting for clear evidence of a freeze of sorts in MD hiring, and a build up of NP/PA because of the ability to pay them less. I see this also in the big medical groups (some of which are very large groups owned by MDs)... admin might be MDs, but you see, when it comes to money - eventually they are gonna see it and want it all too. I have seen some evidence in one large system in my area. Lots of former specialty supervisory roles going to NPs, not MDs so much anymore. Some MD blogs lamenting specialists just out of fellowship unable to get jobs.

The game changes so easily.

whatdoIdonow? · Aug 18, 2012

When I call for a sick appointment with my doctor, and the receptionist tells me the only appointment available is with the NP, I feel like I am being take advantage of. The education of the NP is nowhere near that of the MD. And, the price of the appointment isn't being reduced related to the decreased amount of education of the NP. I wait to see the doctor on the off chance my condition will require that added expertise of an MD education. Sure, there are bad doctors, but the facts are the NP doesn't have the same credentials. Additionally, doesn't the NP have to operate under the license of an MD inorder to be able to write Rx's and can only write certain types of Rx's?I guess that means there are checks and balances on the NP, but that's only because of their reduced education. And why pay for the middle man when I can get the main man for the same price? I bring all this up because I'm an RN looking into my next step in education- MSN to teach, NP to go into clinical practice. When I looked into the curriculum of the PA's, it was much more science based than either. I am more comfortable seeing a PA than an NP for my medical concerns because of this education gap. So, I see the point of the article in question.

NPinWCH · Aug 18, 2012

When I call for a sick appointment with my doctor, and the receptionist tells me the only appointment available is with the NP, I feel like I am being take advantage of. The education of the NP is nowhere near that of the MD. And, the price of the appointment isn't being reduced related to the decreased amount of education of the NP. I wait to see the doctor on the off chance my condition will require that added expertise of an MD education. Sure, there are bad doctors, but the facts are the NP doesn't have the same credentials. Additionally, doesn't the NP have to operate under the license of an MD inorder to be able to write Rx's and can only write certain types of Rx's?I guess that means there are checks and balances on the NP, but that's only because of their reduced education. And why pay for the middle man when I can get the main man for the same price? I bring all this up because I'm an RN looking into my next step in education- MSN to teach, NP to go into clinical practice. When I looked into the curriculum of the PA's, it was much more science based than either. I am more comfortable seeing a PA than an NP for my medical concerns because of this education gap. So, I see the point of the article in question.

First, your assumptions are probably incorrect. If you are calling to see the NP for an acute issue, you'd be fine seeing the NP. I'm sure they could diagnose and treat you just fine. I see acute and chronic issues daily, from colds, pinkeye, bronchitis to pneumonia. I have had patients complain of gastro symptoms with dehydration and dx acute renal failure, seen pts post fall with dizziness and worked them up and dx anything from benign positional vertigo to concussion to TIA/stroke, and chest pain that has been anything from heartburn, rib fx to MI. I see chronic patients from childhood to 100 years old with anything from ADHD, constipation to chronic renal failure/COPD/CHF/HTN/DM. I manage all their meds and consults and lab tests. I do exactly what my MD colleagues do. I work the same job and I am held to the exact same standards they are. My point is, an NP has seen it in family practice and can dx it.

I don't know what state you practice in, but in many states NPs actually have more independent practice than PAs. As an NP in Ohio I can have my own practice, sure I need to have an MD/DO collaborator, but I can hire him and he can be on my payroll. I work under my own license and I can write just about all rx that an MD can. The exceptions in my case at this point now would be certain cancer meds, inpatient IV meds, certain psych meds and certain hormones such as growth hormone. Some I cannot write, some need to be MD/DO initiated and some I only need to discuss/consult with my MD/DO either in person, email or over the phone before starting a patient on before writing the rx.

PAs in many states have much more restrictions to their practice (they cannot practice independently), which they are rightfully working to change. They seem to have more freedom, but that is because they have for the most part remained good little soldiers and stay obedient to their MD masters.

You have the option to see the MD or NP, you are correct, but you may be doing yourself a disservice by waiting to see the MD. Sure, the cost isn't any different, but you may find the level of service is much better...

Jory, MSN, APRN, CNM · Aug 18, 2012

When I call for a sick appointment with my doctor, and the receptionist tells me the only appointment available is with the NP, I feel like I am being take advantage of. The education of the NP is nowhere near that of the MD. And, the price of the appointment isn't being reduced related to the decreased amount of education of the NP. I wait to see the doctor on the off chance my condition will require that added expertise of an MD education. Sure, there are bad doctors, but the facts are the NP doesn't have the same credentials. Additionally, doesn't the NP have to operate under the license of an MD inorder to be able to write Rx's and can only write certain types of Rx's?I guess that means there are checks and balances on the NP, but that's only because of their reduced education. And why pay for the middle man when I can get the main man for the same price? I bring all this up because I'm an RN looking into my next step in education- MSN to teach, NP to go into clinical practice. When I looked into the curriculum of the PA's, it was much more science based than either. I am more comfortable seeing a PA than an NP for my medical concerns because of this education gap. So, I see the point of the article in question.

Here is the different between a good NP and a bad NP:

A good NP can recognize the signs/symptoms of a disease or condition they are not qualified to treat and refer you appropriately.

A bad NP will have a "know it all" attitude and try to keep the patient in-house, rather than refer them out.

Wow...that sounds like a whole lot like what some doctors do.

It also makes a big difference on what that NP did before they became an NP. I'll trust an NP's opinion that was a cardiac nurse for several years before she became an FNP before I'll listen to ONE THING a general practice physician says that just did one or two cardiac rotations and during that time, 90% of his job rested around probably asking the nurses what so-and-so doctor normally did....if, for example, I had to see my primary care physician in order to get a referal to a cardiologist.

Here is another fact for you: PA's are NEVER allowed to practice independently in any state, while NP's are in many states.

There was also an article posted on here awhile back that stated statistically, ACNP's diagnosed disorders more accurately in an emergency room setting than the ER doc.

Maybe it's because nurses have spent far more time with patients vs a 10 minute fly by.

whatdoIdonow? · Aug 18, 2012

Thanks for the additional info. I don't mean this as an attack on the NP as a person. My problem is with the significantly fewer years of training between the MD and the NP. Can't dispute that, and, I personally can't get around it...I feel safer with the MD.