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

[westcoastgirl]

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 are several experienced MDs who have been good teachers to me. It is actually the lone new graduate MD who has been less than professional on several occasions to me as well as others at the clinic.

She has been frustrated by other things at the workplace and so I've just steered clear of her. However recently she told me to my face that if things were up to her to decide I would just be seeing otitis media and URI patients.

I have always stayed professional in spite of whatever she does and I even go out of my way to be nice to her. It's hard not the take the latest comment personally. Now it's affecting the way I feel about going in to work, I feel like I'm a convenient scapegoat for her. The experienced MDs review my charts and have been satisfied with my work so far. Fortunately they are the decision makers about what sort of patients I see.

I don't want to bring this up to the medical director, I'm too new to be making waves and everyone else is a MD anyway. Any advice?

[pedspnp]

i know this is a old thread but wanted to comment on what i consider a hostile work enviroment, the md in the office who is not my supervising md has lied about me, has lied to me about what a parent said about me. Has told the nurse that a referral i have made is not neccessary, has told them labs i ordered were not needed. Last week he removed a lab report then told management he knew nothing about the lab report I complained to management, they came and talked to him and i thought that was the end of it, well he started back up last week, I am seriously calling them tomorrow once i get into work and telling them that I feel this is a hostile enviroment and what are they going to do to fix it.

[traumaRUs, MSN, APRN]

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.

[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!!

[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

[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.

[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

[nomadcrna, DNP, CRNA, NP]

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 http://www.aanp.org

Use of Terms Such as Mid-Level

Provider and Physician Extender

© American Academy of Nurse Practitioners, 2009

Revised 2010

[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.

[nomadcrna, DNP, CRNA, NP]

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.

[dissent]

What is true and what some quasi-political agency says is the truth are 2 very different things.

[nomadcrna, DNP, CRNA, NP]

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.

[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.