In Support of Independent NP Practice

[Corey Narry]

Resources from Bridging the Provider Gap:

From the National Governors Association: http://www.nga.org/cms/home/news-room/news-releases/page_2012/col2-content/nurse-practitioners-have-potenti.html

- looks like state governors are in favor of practice independence for NP's

AANP Map of Practice Environments Across States, 2013

Citizens Advocacy Center: Reforming Scope of Practice, A White Paper

[Susie2310]

You can disagree, refuse to see anyone but a MD for you and your family, and be an active advocate against NP practice based on your "experiences".

In the end, policy will be made on hard data of satisfaction, cost, and outcomes. If you are such a vehement advocate against NP autonomy, haven't you dug up some data to support your position?

Data to support my position that physicians are trained in medicine and are uniquely qualified by their training to practice medicine? Nurse practitioners do not provide the same quality of medical care at the level physicians do because they are not trained as physicians. Do you ask "Where is the data to support that legal assistants cannot practice law just as well as lawyers do? After all, legal assistants can be very knowledgeable and can provide quite a range of legal services much more cheaply than a lawyer. When I need legal work done I go to a lawyer because I want the expertise of a lawyer, and I pay a lawyer's fee, not a legal assistant's fee. When I or my family go to the doctor we want the expertise of a physician, and we are billed a physician's fee.

[myelin]

Data to support my position that physicians are trained in medicine and are uniquely qualified by their training to practice medicine, and that nurse practitioners are not qualified to practice medicine? Do you ask "Where is the data to support that legal assistants cannot practice law just as well as lawyers do? After all, legal assistants can be very knowledgeable and can provide quite a range of legal services much more cheaply than a lawyer. When I need legal work done I go to a lawyer because I want the expertise of a lawyer, and I pay a lawyer's fee, not a legal assistant's fee. When I or my family go to the doctor we want the expertise of a physician, and we understand we are being billed a physician's fee.

This is such a poorly formed argument I don't know where to begin. Your comparison makes no sense, because the relation between a legal assistant and a lawyer is not at all analogous to the relation between a NP and a physician. The point is that there is plenty of data demonstrating that NPs have great outcomes and you have no data to support your anecdotal experiences. If you don't want to see a NP, then don't. Nobody is holding a gun to your head. Also, your rant against NPs (while entertaining) has little to do with the topic at hand, and is serving to distract and derail the thread.

[SycamoreGuy]

It is however an interesting comparison. In California paralegals can sit for the bar after so many years of training (or atleast they used to be able to). Why is that not the case in other states? Because lawyers don't want people encroaching on their turf. What profession do most politicians come from? That's right, lawyers.

[Susie2310]

This is such a poorly formed argument I don't know where to begin. Your comparison makes no sense, because the relation between a legal assistant and a lawyer is not at all analogous to the relation between a NP and a physician. The point is that there is plenty of data demonstrating that NPs have great outcomes and you have no data to support your anecdotal experiences. If you don't want to see a NP, then don't. Nobody is holding a gun to your head. Also, your rant against NPs (while entertaining) has little to do with the topic at hand, and is serving to distract and derail the thread.

There is a big difference between the training and experience of a physician and that of a nurse practitioner. The great outcomes I have read about in studies nurse practitioners referred me to have relied on a lot of qualitative data, i.e. patient satisfaction questionnaires. Also the studies had several limitations. I am stating my point of view against independent NP practice: That does not make my point of view a rant. Please read the terms of service; you will find I am permitted to respectfully disagree with you or any one else.

[Guest343211]

You can disagree, refuse to see anyone but a MD for you and your family, and be an active advocate against NP practice based on your "experiences".

In the end, policy will be made on hard data of satisfaction, cost, and outcomes. If you are such a vehement advocate against NP autonomy, haven't you dug up some data to support your position?

Policy will be made based on political agendas. . .and how data is spun to fit the agendas. You just can't compare most NPs clinicals to the residencies programs of most physicians. It's not just the fact that they get more in-depth knowledge in medical school. It's the whole investment in terms of residencies and fellowships. Until Nursing gets programs that are equivalent, I'm with Susie. I mean, it is what it is. This topic has been argued to death, and in the end, the political powers that be will make the policies, as I have said, will be based with whomever they lobby and the particular political agendas. It will be about money, but in the end, the NPs will be miserable too, b/c they will be doing a ton more work and be poorly compensated as well.

[Guest343211]

But I don't want to practice SERIOUS medicine...so boring.

Both my parents had complex comorbid conditions. Both loved their PAs and NPs more than their physicians. Dad's still trucking but mom passed on. I also went to an Urgent care after two visits to a physician for a rash. The NP gave me a new cream and knocked it out, yea!

Listen I have been helped tremendously my an incredible RN/doctor of naturopathy. She has some great stuff going on, and when her patients follow the guidelines, they see remarkable improvement in their health and wellbeing. Nonetheless, if for example, I had head trauma, I would not go to her for that. If I still need mitral value surgery or strong cardiac management, I'm going to see reputable physicians in these areas, period.

Part of the trouble is the way in which one can go to become an NP. Yes, you have some incredible NPs that already came into with very strong acute and or critical care experience, and they are remakable. But today the schools just want to churn these people out for profit, and they let nurses with little to no strong clinical experience into many programs. And then the whole process, again, should be run more like physician residencies. Sure, maybe not as much or to the same degree. But I have encountered more uninsightful and subpar practitioners compared with insightful, and excellent practitioners. You aren't going to find a lot of data either way, b/c strong comparitive analyses have not been done. A few suggestive studies here or there. Certainly not anything of RCT level research. So, it will come down to experience and opinion, period.

Now, while I have met my share of buffons in medicine, truthfully, percentage wise at least, yes, in MY experience, they (less than safe and effective buffons in medicine) have been quite rare. Most have been good to excellent in clinical insightfulness, thoroughness, and approach to care. I will make the exception that I am referring to mostly those physicians with whom I have interacted in critical and acute care specifically. They are also smart enough to know what they should refer out. Again, a wise person knows their limits. At the same time, they are not completely uninformed and can follow-up quite well with folks that have had to be sent out to various specialists.

Getting to what's real here, this cannot be argued in the sense of anything objectively measureable. Perhaps, at the most, some very limited research perspectives that can be argued with exceptions and caveats. It will come down to politics and opinions.

Medicine education is superior in terms of strength in sciences, depth of understanding, vetting and testing processes, length of training, and really the incredibly MAJOR pain in the butt process from start to finish. Someone decided that in order to practice medicine and deal with the complexities of the human body--and human life, a lot more time, intensity, precepting, mentoring, evaluating, and verifying needed to be put in place in medical education and training. Because such processes are so time-consuming and expensive, and b/c they render the physician in her/his particular field a higher level of responsibility and accountability--while taking a major investment in terms of his/her whole life, it has, at least in prior days--and still somewhat today, commanded/commands high incomes. The LONG and ARDUOUS process of becoming a physician, along with the level of accountability, justifies the incomes--in general.

Now, we are in a situation where we will be scrambling to make government approach to healthcare somehow financially feasible. That means more midlevel care providers. It's economics $$$. This is a big part of the political agenda.

When the burdens of running independent practices become as overwhelming for midlevels as for physicians, it will not be as enticing for many NPs.

Yes, that's my perspective and opinion. I am sorry if it is troubling, but so much of what is going on in the real world is quite troubling. Look at what happened in Boston for heaven's sake.

[myelin]

There is a big difference between the training and experience of a physician and that of a nurse practitioner. The great outcomes I have read about in studies nurse practitioners referred me to have relied on a lot of qualitative data, i.e. patient satisfaction questionnaires. Also the studies had several limitations. I am stating my point of view against independent NP practice: That does not make my point of view a rant. Please read the terms of service; you will find I am permitted to respectfully disagree with you or any one else.

No one is saying you're not allowed to disagree, so I don't know why you keep trying to tell people to read the terms of service. Please point out the specific limitations with the studies (ps. all studies have limitations) that render all of them inaccurate, in your estimation. What flaws in methodology and data analysis, in particular, are you worried about? Patient satisfaction surveys are just one method that has been used to measure outcomes data. And it's true, survey data isn't the greatest, but it certainly isn't the worst and it's used all the time in many fields (including medicine). If survey data automatically means that we can't trust the findings then I guess the entire field of nutrition science is over.

I'm not sure anyone is arguing that a NP and a MD have the same training, so I'm not sure why you keep trying to make that point over and over. The point is that there is no data to support NP supervision, ie: there is no data showing that patient outcomes are superior when NPs are supervised. So why require supervision?

[BlueDevil,DNP, DNP, RN]

NPs have had completely autonomous practice in a variety of practice environments in my state for a few decades. We are doing fine, and so are the patients, lol. There is plenty of data here to prove that NPs practice safely and quite on par with our physician colleagues. In fact, the outcomes are indistinguishable. The only way to tell the data sets apart is by patient satisfaction, which is higher for the NP group. Come and get it. The state BOM here supports independent NP practice, and the physicians here would all disagree with Susie and Sam, after having had the bird's eye view of the situation.

Independent NP practice is safe, works, and is inevitable. We are at the tipping point, and I don't think anyone's unfounded prejudices or anecdotal stories are going to stop NP independent practice nationwide. It's coming, and like dominoes all the states will fall into line one by one.

[Susie2310]

NPs have had completely autonomous practice in a variety of practice environments in my state for a few decades. We are doing fine, and so are the patients, lol. There is plenty of data here to prove that NPs practice safely and quite on par with our physician colleagues. In fact, the outcomes are indistinguishable. The only way to tell the data sets apart is by patient satisfaction, which is higher for the NP group. Come and get it. The state BOM here supports independent NP practice, and the physicians here would all disagree with Susie and Sam, after having had the bird's eye view of the situation.

Independent NP practice is safe, works, and is inevitable. We are at the tipping point, and I don't think anyone's unfounded prejudices or anecdotal stories are going to stop NP independent practice nationwide. It's coming, and like dominoes all the states will fall into line one by one.

BlueDevil, nurse practitioner training is not comparable to physician training. Please direct me to the data you say proves that nurse practitioners practice safely and on a par with physicians; presumably the data is available on the internet.

[BrandonLPN, LPN]

I find it amusing that some of people who claim NPs are indistinguishable from physicians are the same people who poo-poo the role of LPNs and ADNs in favor of the BSN. It can't be denied there is some hypocrisy and irony there.

Does more education make one a better health care provider or doesn't it??

If one says a NP education is "good enough", doesn't it seem odd when the same person turns around and says a ADN isn't because "more education is always better."?

[BostonFNP, APRN]

Data to support my position that physicians are trained in medicine and are uniquely qualified by their training to practice medicine?

I think you are the only person arguing this rather trivial point. MDs are educated in a medical model and licensed to practice medicine. NPs are educated under a nursing model and licensed to practice advanced practice nursing, a scope that overlaps significantly with the scope of medicine. To the general public, there is not much of a difference in whether someone is practicing medicine or advance practice nursing, their provider is their provider.

Nurse practitioners do not provide the same quality of medical care at the level physicians do because they are not trained as physicians.

Show me the data to support this statement. In fact, the data shows there is no distinguishable diference between NP and MD provided care in terms of outcomes. See me previous statement, if you want to engage in a discussion that is larger than your sample size of 1, do your research.

The great outcomes I have read about in studies nurse practitioners referred me to have relied on a lot of qualitative data, i.e. patient satisfaction questionnaires. Also the studies had several limitations.

Isn't their some irony in this statement? You are saying that the studies on NP outcomes are "qualitative" (when in fact most are not) while vehemently arguing against NP autonomy based on your anecdotal personal experience with no data to support your position. Again, lets see the "real" studies showing significant difference between NP and MD provided care.

[BostonFNP, APRN]

I think it is important to highlight that, for me, NP autonomous practice has nothing to do with practicing in isolation. In fact, I think NPs are the best interdisciplinary providers, which might account for their outcomes. No one should practice in a vacuum. NPs will always need other NPs and MDs to collaborate with. I personally feel that patients do best when co-managed by a NP and a MD.

Independent practice for me is about NPs being allowed to practice to their full scope and be paid for it. It would prevent NP-owned practices from paying a MD $50-75k a year to review charts for an hour a month.