Do NP's work under MD's?

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I always thought that NP's could practice alone.......they dont need a doc to supervise them, but PA's do. Is this true??? Can NP's practice alone?

I agree sistermike. I don't understand why NPs are so hipped on not wanting to "work under the doctor." It would make them more marketable if they are willing to work in a more collaborative way instead of independent, and it would give the patient the best outcome.

Great post!

I, personally, wish we'd all get over the semantics and terminology: working under a physician; supervising phsician; collaborative physician.

When a mid-level provider works among physicians, who wouldn't fully utilize their extensive training, expertise, and knowledge to the fullest degree? It is beyond my understanding that all mid-level practitioners don't view collaborating with physicians (and/or collegues), as a really good thing, which only helps to provide care--perhaps to a fuller/better degree--for the patient.

A later post in this thread comments on why he/she would not want to be a PA b/c of apparently some kind of significance. Let me make it clear: In so many cases, and all the one's I've worked in, PAs and NPs work essentially the same. The NPs need collaborative activity and PAs need a supervising physician, (SP). Let me tell you that the PA/SP relationships I've ever seen, is nothing different than 2 practitioners collaborating about a patient. Some grossly misunderstand the term SP and think that everything needs to be run past that SP. All PAs I know work autonomously and run either questions by, or review some cases by, and other like collaborating when they think it's appropriate and know their limitations. The PAs I know are not viwed by their patients as "the doctor's assistant" as a poster on this thread has mentioned.

To be honest, when I'm seeing a physician and he/she tells me that they want to talk with their partner too about something, I certainly am glad that they're open to other's medical collaboration. It also shows a level of humility that I certainly appreciate in ANY medical provider, be it, NP, PA, MD, DO, etc...

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Great post!

I, personally, wish we'd all get over the semantics and terminology: working under a physician; supervising phsician; collaborative physician.

When a mid-level provider works among physicians, who wouldn't fully utilize their extensive training, expertise, and knowledge to the fullest degree? It is beyond my understanding that all mid-level practitioners don't view collaborating with physicians (and/or collegues), as a really good thing, which only helps to provide care--perhaps to a fuller/better degree--for the patient.

A later post in this thread comments on why he/she would not want to be a PA b/c of apparently some kind of significance. Let me make it clear: In so many cases, and all the one's I've worked in, PAs and NPs work essentially the same. The NPs need collaborative activity and PAs need a supervising physician, (SP). Let me tell you that the PA/SP relationships I've ever seen, is nothing different than 2 practitioners collaborating about a patient. Some grossly misunderstand the term SP and think that everything needs to be run past that SP. All PAs I know work autonomously and run either questions by, or review some cases by, and other like collaborating when they think it's appropriate and know their limitations. The PAs I know are not viwed by their patients as "the doctor's assistant" as a poster on this thread has mentioned.

To be honest, when I'm seeing a physician and he/she tells me that they want to talk with their partner too about something, I certainly am glad that they're open to other's medical collaboration. It also shows a level of humility that I certainly appreciate in ANY medical provider, be it, NP, PA, MD, DO, etc...

Great post! Amen to that. I too am wondering about the hang up many NPs have about working independently, where in the same sentence they are saying "I'm not a substitute for MD/DO". But that's axactly how it's comming across for many of the docs out there. I'm also puzzled about the whole "independent practice" economic aspect. Couls some of you, independently working NPs, enlighten me on how patients choose to see you over the physician (if there is one around). Of course I'm talking about solo NP practice. I really want to know. I understand that you could work with a physician group, but then there would not be any difference between NP/PA in such a set up. And the issue of colaboration vs suprvision becomes irrelavent,IMHO.

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Specializes in Med/Surg, Geriatrics.
Couls some of you, independently working NPs, enlighten me on how patients choose to see you over the physician (if there is one around). Of course I'm talking about solo NP practice. I really want to know. I understand that you could work with a physician group, but then there would not be any difference between NP/PA in such a set up. And the issue of colaboration vs suprvision becomes irrelavent,IMHO.

I'm not a NP but I can tell you that there are people in this world who prefer to see an advanced practice nurse over a physician. *gasp!!!* Yes, it's true. When I had my first child I chose a CNM to deliver her and it was the right decision. A few months ago I was watching a program in which a woman was giving birth to her third child with a midwife and she stated that the first child was delivered by a physician and the second child was delivered by midwife and the difference was so amazing that for her third, there was no choice for her. I read an article in the Atlanta paper about a NP who had her own practice (although she collaborated with a physician as required by law) and several of her patients were interviewed who stated that they preferred her. Oh and here's another article from the WSJ about Columbia Advanced Practice Nurse Associates, the first NP practice in the USA to win admitting privileges to a hospital and to get full reimbursement from insurance companies:

http://webreprints.djreprints.com/1092601143383.html

William Spears started out using Capna occasionally for flu shots at times when his investment-management business demanded that he spend time in New York, away from his home in Connecticut. On one such visit, he recalls the nurse saying, " 'While you're here, why don't I take your blood pressure?"

When it turned out to be high, she wouldn't let him leave until he booked another appointment. On the follow-up visit, the nurse prescribed medication and sent him to a cardiologist.

"It's the thoroughness and the time they spend that makes the difference," he says. Mr. Spears has been a patient at Capna for five years, and says he schedules checkups twice as often as he did with previous primary-care providers.

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Again, let's please end the battle, shall we? Some people would rather see a physician; some people would rather see an NP; some people would rather see their PA.

I'd hope we, as adults, can reason in our minds enough to understand that we shouldn't ever generalize or make blanket statements; certainly not all people, all of the time, would rather see any one type of provider. Some wouldn't want anything less than a physician, while some would love the care they get from their NP and would be happy to not change that, while still others love and would prefer to see their PA.

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I'm not a NP but I can tell you that there are people in this world who prefer to see an advanced practice nurse over a physician. *gasp!!!* Yes, it's true. When I had my first child I chose a CNM to deliver her and it was the right decision. A few months ago I was watching a program in which a woman was giving birth to her third child with a midwife and she stated that the first child was delivered by a physician and the second child was delivered by midwife and the difference was so amazing that for her third, there was no choice for her. I read an article in the Atlanta paper about a NP who had her own practice (although she collaborated with a physician as required by law) and several of her patients were interviewed who stated that they preferred her. Oh and here's another article from the WSJ about Columbia Advanced Practice Nurse Associates, the first NP practice in the USA to win admitting privileges to a hospital and to get full reimbursement from insurance companies:

http://webreprints.djreprints.com/1092601143383.html

Hi SharonH, RN!

I'm sure there are NPs out there in private practice, but mostly in the rural area. I'm from NY and certainly know about Capna. Most of the NPs there are doctorate prepared faculty members from the Columbia. I'm sure it serves political needs as well. But there are not too many other NPs in NY who are in their solo practice. I don't think it's possible from the business perspective. General public is not quite ready to see something other than MD/DO for their medical provider. Anyway, just an observation for this regional area.

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Specializes in ER, critical care.
General public is not quite ready to see something other than MD/DO for their medical provider.

There are 2 NP owned clinics in the small city where I work. Both run at full capacity 5 days a week.

In addition, it is routine for patients who I have cared for in the ER to ask if it would be possible to see me in my office. I don't happen to have an office and at this point don't really want an office, I am pretty happy where I am.

The general public is perhaps more willing to see someone other than the MD/DO as their health care provider than you are ready to admit.

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Specializes in Acute Care Psych, DNP Student.
I'm not a NP but I can tell you that there are people in this world who prefer to see an advanced practice nurse over a physician. *gasp!!!* Yes, it's true.

I'm one of these people. My primary healthcare provider is a NP. I choose her rather than an MD (I had seen MD's all my life) because she listens to me, focuses on prevention, and doesn't have a massive ego. She also talks with me about my care rather than giving me doctor's orders if you know what I mean. Love the NP's. I see another NP at a Planned Parenthood for my yearly gyn stuff rather than a GYN MD too. It is so refreshing to see a healthcare provider (APRN) and be treated with respect and as the owner of my own body.

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Specializes in Acute Care Psych, DNP Student.

I didn't mean to stereotype and make irresponsible generalizations such as MD=ego trip, NP=perfection.

That's not what I meant. I've seen great MD's and I saw an incompetant snot of an NP once. That said, overall I feel much better seeing APRN's. There just tends to be an autonomous, egalitarian feel to the care with a focus on prevention.

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There are 2 NP owned clinics in the small city where I work. Both run at full capacity 5 days a week.

In addition, it is routine for patients who I have cared for in the ER to ask if it would be possible to see me in my office. I don't happen to have an office and at this point don't really want an office, I am pretty happy where I am.

The general public is perhaps more willing to see someone other than the MD/DO as their health care provider than you are ready to admit.

Hey ERNP!

I hope you don't view my comments as a negative. I'm actually looking for this positive reassurance that yes...it can be done. I've been struggling with the career choice of NP vs MD for a long, long time. I'm an RN x 16 yrs, so I'm certainly no RN/NP basher. But I was a medical student also,albeit for 2 short semesters. While in med school I've met NPs,PAs, even CRNAs and many other allied health folks, who were just like me ...simply not happy with their professional role, and yes, their status.But may be not to continue a very long, and very,very expansive medical education was a blessing for me too. I'm also a licensed Acupuncturist who wanted to have an integrative medicine practice, with the right to diagnose and to prescribe an Rx , if necessary. It would be a lot more difficult for an NP in NYC to have that level of the independence (esp financial) than a small town NP. But I'm glad that many NPs out there have found their niche.

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Specializes in ER, critical care.
Hey ERNP!

I hope you don't view my comments as a negative. I'm actually looking for this positive reassurance that yes...it can be done.

I did think you were sounding a little negative and if that was not your intention, I apologize for my error of interpretation.

Let me assure you, it can be done. It is a lot of work on the business end (my primary Achilles heel), but it can be done. If I hadn't seen it, I might not have believed it myself.

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Hello! I live right near you-in Worcester. Are you an NP or a student NP? I just started the MSN program at UMASS-Worc. I'm taking an elective class now and will be full time in the fall. Just wanted to say hello. :)

-Christine

Hello,

Good luck at UMASS-Worc. I just graduated with MSN. Studying for my test (end of June). I am SOOO nervous.

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Specializes in Nephrology, Cardiology, ER, ICU.

I just finished a post-MSN adult health clinical nurse specialist. In IL, NPs and CNS's have the same scope of practice and same need for a collaborative agreement. I just got a great job with a large group of 10 nephrologists, 5 PAs and 3 NPs (I'll be the first CNS). In IL, the Medicaid reimbursement is 85% of the MD rate for care. I will be doing chronic dialysis care. I am looking forward to it.

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