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?
OK, so residents are not physicians. Thank you clearing that up for me.
That is a rather curious thing to ask. I don't know of ANYONE who thinks NP = physician. I certainly know better. I don't know anyone who thinks the training recieved in an NP program is comparable to a residency trained physician.
I have read most of this discussion and haven't seen anyone state that NP training is the same as medical training.
I guess I have no idea why you would ask this question. Especialy why you would ask me.
I didn't know U of P even had an NP program.
In nursing we have two levels of nurses, RNs and LPNs. I am an RN but I realize that one doesn't have to have full RN training to preform many nursing tasks.
I was using U of phoenix as example... After seeing many NP curricula of various universities in my state and including the one that I got my BSN from, all I can say is that there is no way I would let a NP be my practitioner if is not something obvious ( flu, sore throat etc..). That is me! If other people will let them be their 'physician', I am ok with that.
I think they both could provide equal care in the FP setting. What is important for any type of healthcare provider to know is when to consult.
I have seen both physicians and nurses make mistakes, and most often physicians make mistakes because they think they know too much and are egotistical in thinking they are right. Nurses IMHO seem to make mistakes mostly because they are too dogmatic in their approaches.
You are being 'philosophical' here, but all I am looking for is a 'Yes or No' answer...
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Oh really, nobody?
Yes, nobody, at least not me or any discussion I have read so far.
If your residents leave their residency early, they can't not be physicians. What about this is hard for you to connect to what you said? I was actually trying to make your argument concise and coherent for you
Wha? Who said anything about residents leaving their residency early? I asked if my residents are physicians. The answer I got is that they are not.
Wow, thanks for summing up your arguments about NP independence so eloquently.
Another impressive rebuttal.
I will leave this place with quite an impression. Oh, and since you failed to seek out this scientific evidence that you're so hypocritically demanding of, you've wrongly assumed that I'm a physician.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I was using U of phoenix as example... After seeing many NP curricula of various universities in my state and including the one that I got my BSN from, all I can say is that there is no way I would let a NP be my practitioner if is not something obvious ( flu, sore throat etc..). That is me! If other people will let them be their 'physician', I am ok with that.
I guess my perspective is different. I have recieved very top notch emergency care from providers who never set foot in a college. I am talking about 18-D special forces medics who took care of me all the times I was wounded while in the army.
I also observed these same guys treat various farm animals and preform dentristry.
I am far less impressed with academic degrees and much more impressed with level of skill, regaurdless of how they came to have their
I will leave this place with quite an impression. Oh, and since you failed to seek out this scientific evidence that you're so hypocritically demanding of, you've wrongly assumed that I'm a physician.
Try. Harder.
The ball is in your court to provide scientific evidence to support your view against NP independence. I have already provided meta-analyses, literature reviews, and RCTs. Where you have provided absolutely no scientific evidence to support your views.
My profession and education is posted so if you are not a med student/resident and/or physician then what exactly is your education that makes you so sure that NP education is too inferior to practice independently despite multitude of studies that state otherwise.
I will leave this place with quite an impression. Oh, and since you failed to seek out this scientific evidence that you're so hypocritically demanding of, you've wrongly assumed that I'm a physician.
Try. Harder.
I assumed you were a pre-med student. Most of the physicians that I know come across as being much better educated. Of course, I work with some good ones. Good enough they don't need to feel threatened by uppity NPs.
I've been quietly following this thread, I think it's hilarious to see the SDN trolls (who are most Likely pre-med) try and argue things they have a very limited understanding of.
They are quite happy to have NPs practice under a physicians supervision but have no clue about what that supervision actual entails.
Then there is the other troll that obviously doesn't know what a dual MD-PhD is since they tried to explain the difference between the two degrees... Duh!!! I think out of all the professions, nurses are most aware of the difference between professional and research degrees.
Wow lots of false assumptions being made here. Let's just simmer down and not resort to personal attacks. It completely negates any intelligent thing you try to say.
1. I don't think anyone that's in touch with reality can compare the training to become a physician (medical school + residency) and the training to become an APN. It's night and day. If you want to just focus on med school vs NP school, the curriculum and clinical hours and overall focus are very different. It doesn't matter how long each school is. You could do an NP program over 5 years, you are still learning the same material. It's about content. I don't think anyone can make a legitimate argument that the content of what you learn as a physician greatly exceeds what you learn as a NP. Let's not be offended by it. It's just reality. Whether that matters is what we are debating.
2. Nursing curriculum has an incredibly different focus than medical training. We have completely different yet complementary jobs. I can't do my job well without you guys, and vice versa. That said, if you look at the focus of nursing curriculum and their exams it's hard to instill confidence in the medical community. It takes more than just hanging around in the hospital to learn how to think like a doctor, learn to diagnose. You don't have to go to medical school to learn how to dx and tx but you have to prove that NPs across the board are learning to do that. Without a standardized curriculum and quality control, APNs won't have a leg to stand on. You shouldn't be able to go online and learn how to be a provider. That's just scary! Plus if someone has years and years of nursing experience I think it's great but as many nurses have stated nursing =/= doctor. Much of that experience will help, but not all of it. It's a completely different world, different focus. It's not that nurses aren't capable of it, it's that they aren't properly trained. I'm sure I'm smart enough to be a nurse, but I'd suck at it without someone teaching me how. Eventually I'd probably get the hang of it, but I'd never be as good as you all because I never took the time to learn it the right way. And who suffers while I'm figuring it out? My colleagues and my patients.
3. Many nurses here have clearly stated that nurses are not doctors, APNs have no intention of trying to be doctors... But yet you are arguing for independent practice to do exactly the same job as a primary care doctor. Yes, you can refer to specialists if it is out of your league, but 1) this is exactly the same thing PCPs do and 2) you don't know what you don't know and 3) increase costs since, as a few studies have shown, your scope is more limited and will need to refer more. If nurses want to fill the gap by working as doctors rather than with doctors, they need to prove their competence just like doctors do. Some people are talking about step exams but those are exams are the minimum you have to do to become licensed and practice. If you truly want to prove not just competence but excellence, become board certified. Some here are saying well passing those exams don't improve patient outcomes! No such exam exists. Exams prove competence. If you want to provide care with no supervision in the US, whether doctor or APN, you need to show sufficient evidence that you have the competence to diagnose and treat like a physician. Nursing exams have a completely different focus so you can't use them to show competence at doing the same work as a physician. Let's stop trying to say it's the same job, many smart people here have admitted it's exactly the same job. Healthcare is a very protected industry, you have tremendous power over someone's life. Physician curriculum has been so highly regulated and controlled because it's acknowledged that this is a serious job with serious consequences if you are not up to snuff. Same work, prove same competence. I think many ANPs, if they study, will have no problem. But many more will not and this will show the variety in NP education and preparedness BEFORE we unleash them on patients.
talk to to any nurse or APN who has made the switch to MD and they will tell you it's night and day.
Gluteus
51 Posts
I was using U of phoenix as example... After seeing many NP curricula of various universities in my state and including the one that I got my BSN from, all I can say is that there is no way I would let a NP be my practitioner if is not something obvious ( flu, sore throat etc..). That is me! If other people will let them be their 'physician', I am ok with that.