Nurses are Not Doctors

Nurses General Nursing

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An article appeared today in the New York Times as a followup to a bill passed in New York granting nurse practitioners the right to provide primary care without the oversight of a physician. The authors of the bill state "mandatory collaboration with a physician no longer serves a clinical purpose and reduces much-needed access to primary care". The need for more primary care providers is due to the shortage of primary-care physicians, the aging boomer population, and the Affordable Care Act.

Although the president of the American Association of Nurse Practitioners feels that the current "hierarchical, physician-centric structure" is not necessary, many physicians disagree citing that the clinical importance of the physician's expertise is being underestimated and that the cost-effectiveness of nurse practitioners is being over-estimated.

Many physicians also feel that "nurse practitioners are worthy professionals and are absolutely essential to patient care. But they are not doctors."

What are your thoughts on this? Where do nurse practitioners fit into the healthcare hierarchy?

For the complete article go to Nurses are Not Doctors

Specializes in Pain, critical care, administration, med.

NPs will care for pAtients that MDs don't wAnt based on their insurance or lack of. There is no adversarial relationship to be made. This is a fact. I have a patient who needs to see a professional based upon needing an interventional procedure. No physician will see him because he has Medicaid. As a nurse and a NP all I know is he needs care. I care for him but frustrated I can't get him the care that he really needs. I have been a nurse for thirty years and worked with many residents and had to step in to ensure that the "resident" who is often left unattended or being mentored by someone with no more experience then themselves doesn't harm patients. Please don't patronize nurses we often save your butt and the patients.

I am not so sure why you are ignorant any only think you are right. I have done my research and fully aware of what the MD has.

First Wikipedia is Not a good source of information. My guess is your education did not teach you where to look for good reliable information.

Second- Mds do not receive a academic MD. Yes their title is MD but not in academic schooling. Their MD is derived from their clinical experience. It really doesn't matter but to you. I also was not talking about foreign schools. I can read and understand. I stAted a fact and you choose to see it your way. This is why nursing is the wAy it is. It doesn't really matter. This whole story started on a uneducated belief of a physician about NPs and it continues in this thread.

I'm not even sure what this means. What's an academic MD? What is academic schooling? How do you get an MD from clinical experience? I'm not trying to be patronizing I just really don't understand what you are trying to say.

personal attacks aren't necessary. I won't belittle your education if you won't belittle mine. I assure you my medical education was top notch.

i agree though, it doesn't really matter.

FNPs are taking jobs that most physicians do not want. FP is considered the easiest residency to get for that very reason. NPs are filling a gap that physicians have left undermanned for years.

I don't think anyone is denying that all healthcare providers should work together, but the difference in opinion is that NPs/APNs do not need laws forcing collaboration/supervision especially when it is most often not needed. Forced collaboration adds nothing to the care of a patient, increases bureaucracy, and often just builds animosity between different types of providers.

My personal opinion, I agree with a lot of what you said. I wouldn't say physicians don't want these jobs, the residencies for primary care fill 100% every year with 1000s of people who didn't match into a residency begging for anything. However, primary care is not a desirable field anymore among physicians. Many of my colleagues love it and are dedicated to going into it despite the lifestyle. Others can't afford to with the loan debt they have. Either way, even with every residency filled every year, unless we increase the number of primary care residencies we can't produce enough doctors to fill the demand. NPs are filling that gap, and many do it well. Where I live the average person can wait over a month to get a new patient visit. That's unacceptable. We need more providers and if NPs can help with that I'm all for it... But, in my opinion, if we want NPs to step up and help with this gap then we need to ensure that all NPs are meeting some minimum requirements that all providers should have to meet before providing care to patients. Let's not make it PCP licensing vs NP licensing. If you are doing the same job as a PCP, take the same exams to ensure everyone is up to snuff. I think most of the experienced NPs I've worked with would have no problem and would keep doing what they are doing. The others would have to admit there are some huge gaps in their education and it would also force NP schools to ensure their students can pass (or people wouldn't go). That's my perfect world.

Specializes in Anesthesia.
My personal opinion, I agree with a lot of what you said. I wouldn't say physicians don't want these jobs, the residencies for primary care fill 100% every year with 1000s of people who didn't match into a residency begging for anything. However, primary care is not a desirable field anymore among physicians. Many of my colleagues love it and are dedicated to going into it despite the lifestyle. Others can't afford to with the loan debt they have. Either way, even with every residency filled every year, unless we increase the number of primary care residencies we can't produce enough doctors to fill the demand. NPs are filling that gap, and many do it well. Where I live the average person can wait over a month to get a new patient visit. That's unacceptable. We need more providers and if NPs can help with that I'm all for it... But, in my opinion, if we want NPs to step up and help with this gap then we need to ensure that all NPs are meeting some minimum requirements that all providers should have to meet before providing care to patients. Let's not make it PCP licensing vs NP licensing. If you are doing the same job as a PCP, take the same exams to ensure everyone is up to snuff. I think most of the experienced NPs I've worked with would have no problem and would keep doing what they are doing. The others would have to admit there are some huge gaps in their education and it would also force NP schools to ensure their students can pass (or people wouldn't go). That's my perfect world.

Those exams do not ensure a better provider or even a quality provider it just tests what the medical licensing boards think you should know. NPs just like all APNs have a wealth of research showing they already provide quality care there isn't a need for another liscensing past what they already have that has already proven as effective tool.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Second- Mds do not receive a academic MD. Yes their title is MD but not in academic schooling. Their MD is derived from their clinical experience.

I don't understand what you're saying/why you're differentiating between a medical doctorate and "academic schooling". What definition of "academic schooling" are you using? And why do you think that a medical doctorate program does not qualify? It is schooling, at the doctorate level, in an academic setting. It still blows my mind that you would claim that most nurses have more "academic schooling" than MDs.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
NPs will care for pAtients that MDs don't wAnt based on their insurance or lack of. There is no adversarial relationship to be made. This is a fact. I have a patient who needs to see a professional based upon needing an interventional procedure. No physician will see him because he has Medicaid. As a nurse and a NP all I know is he needs care. I care for him but frustrated I can't get him the care that he really needs. I have been a nurse for thirty years and worked with many residents and had to step in to ensure that the "resident" who is often left unattended or being mentored by someone with no more experience then themselves doesn't harm patients. Please don't patronize nurses we often save your butt and the patients.

And I work with a whole hospital full of MDs who take care of Medicaid/Medicare patients. I think it's dangerous and unfair to make sweeping generalizations such as:

NPs will care for pAtients that MDs don't wAnt based on their insurance or lack of.
Specializes in Anesthesia.

Public hospitals most often do not have a choice of what type of patients/payers are admitted or seen. This is not true outside of hospitals in private practice where the amount of Medicaid and Medicare patients are limited to a certain total percentage of patients in order have more room for better reimbursement/private insurance patients.

U.S. trained physicians earn their degree academically and through clinical education similar to most U.S healthcare providers.

Specializes in Anesthesia, ICU, PCU.
My personal opinion, I agree with a lot of what you said. I wouldn't say physicians don't want these jobs, the residencies for primary care fill 100% every year with 1000s of people who didn't match into a residency begging for anything. However, primary care is not a desirable field anymore among physicians. Many of my colleagues love it and are dedicated to going into it despite the lifestyle. Others can't afford to with the loan debt they have. Either way, even with every residency filled every year, unless we increase the number of primary care residencies we can't produce enough doctors to fill the demand.

You wouldn't say physicians don't want the jobs, but then immediately afterwards claim that it's not a desirable field among physicians anymore. Did I misunderstand or did you contradict yourself? Primary care residencies fill up 100%, and thousands of physicians are left begging for anything. So what, the NPs who actually want to be primary care providers should bugger off so some resentful medical students get placed into their safety net residency? And why because they paid more for their education? This sounds like an internal problem within the medical community (putting out too many physicians for the positions available, or not training physicians to the standard required for placement) akin to the nursing community's problem of putting out too many graduate nurses for the positions available. If that is the case, perhaps the medical community should reconcile its own problems?

Obviously there is a problem in that state with access to primary care. Seems like they are hoping this will provide some solution to that problem. In many states, nurses do not need physician supervision, but they do need a plan for whom to refer out to due to their scope of practice. That said.....primary physicians refer out to specialists all the time too.

Specializes in Adult Internal Medicine.

According to the National Resident Matching Program data only 95.8% of Family Medicine residencies (which is actually up from 2004 when only 78.8% filled). Only 45.2% of those residencies were filled with US seniors. Over half the residencies were filled with foreign physicians, which to my knowledge, they use as a quick residency to practice.

Specializes in Anesthesia.
http://www.nrmp.org/wp-content/uploads/2013/08/resultsanddata2013.pdf It would also seem that although the FP residencies are mostly filled these positions are not 100% filled.
According to the National Resident Matching Program data only 95.8% of Family Medicine residencies (which is actually up from 2004 when only 78.8% filled). Only 45.2% of those residencies were filled with US seniors. Over half the residencies were filled with foreign physicians, which to my knowledge, they use as a quick residency to practice.

They may not fill initially, but they 100% fill by the time residency starts July 1.

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