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?
Why are podiatrists separate? That's always seemed weird to me.
Because their training is foot specific, they don't learn EKG interpretation or neurotransmitter action or COPD management because you don't need to know it to treat tinea or plantar fasciatis.
Specializes in Nurse Leader specializing in Labor & Delivery.
It seems so silly that we're having this argument. The research shows that NPs are as effective as MDs in primary care. I don't get why people, especially nurses, are arguing this point.
It seems so silly that we're having this argument. The research shows that NPs are as effective as MDs in primary care. I don't get why people, especially nurses, are arguing this point.
My thought exactly. Why would someone belonging to a profession argue with a legislation that would unanimously advance said profession? Anecdotal experience? Natural resistance to change? Dare I say... old school nurse mentality where the nurse is just the physicians helper? And the opinions persist despite available research suggesting otherwise.
I think it is fair enough for NPs to perform primary care when the physician is not around. Would you let the patient wait for the doctor when you can do it yourself? With enough knowledge, NPs can do it. However, if there is a physician, NPs should not take their place. NPs should step aside and let the physician do the job.
Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
I think it is fair enough for NPs to perform primary care when the physician is not around. Would you let the patient wait for the doctor when you can do it yourself? With enough knowledge, NPs can do it. However, if there is a physician, NPs should not take their place. NPs should step aside and let the physician do the job.
Why are NPs perfect if the MD isn't there but not perfect if the MD is there? How does that make sense? Why should an NP "step aside" from doing something she is qualified to do for an MD? Do we not want to hurt the MDs feelings?
The good news...all these unsupported opinions, in the end, don't mean much. Sure it would be nice if people were truly educated on the topic, aware of the studies and stepped away from their antiquated opinion based on nothing but anecdote...but if that won't happen. We can be thankful for the studies supporting independent practice for NPs which are being used to promote the profession.
Specializes in Oncology; medical specialty website.
My thought exactly. Why would someone belonging to a profession argue with a legislation that would unanimously advance said profession? Anecdotal experience? Natural resistance to change? Dare I say... old school nurse mentality where the nurse is just the physicians helper? And the opinions persist despite available research suggesting otherwise.
You know, I posted my thoughts without insulting you. I would request that you allow me to do the same. If you disagree, fine, but there's no reason to throw around insults like "old school nurse mentality where the nurse is just the physician's helper." Such is not the case.
Specializes in Nurse Leader specializing in Labor & Delivery.
TU didn't accuse you of that, s/he simply wondered out loud if that is part of the reasoning behind the resistance. If the shoe doesn't fit, don't try to cram it on your foot.
And yes, there are still some old school nurses who believe that the nurse is the doctor's helper. That's not an insult, that's a fact.
Okay....Then what do you call a Podiatrist, a Dentist, and a Psychologist (with a doctorate in Psychology) in the hospital? That would be Doctor and not a one of them are physicians.
When you introduce yourself to a patient do you always tell the patient that you are a resident in your x year of training? Do most residents ever tell their patients that their residents/interns?
Physicians have been confusing patients for decades longer than any other health profession, and continue to do so on a daily basis.
There is nothing wrong with a nurse who has earned their Doctorate to introduce himself or herself as Doctorate X your nurse. It often opens the door up to doing some explaining, but when has patient education been a bad thing.
Healthcare is always changing. Patients and society views are going to be forced to change with the changes in healthcare even if that means bruising a few physician egos along the way.
In my hospital, none of those fields practice on inpatient. If a patient needs to see a dentist they go to a dentist office, also dentistry school is very similar to medical school. If they need to see a psychologist they go to a psychologist's practice. We don't have podiatry, but in other places I hear it is the same. It's either a consult or they are referred to a podiatrist. I just think to introduce yourself as Dr. Smith without any context (which I've seen) is misleading to a patient in a hospital/clinical setting until the average lay person catches up that doctor =/= physician.
With regards to physicians confusing patients I don't really understand. A resident is still a physician, they have an MD/DO. They are just in training. When I meet a patient I introduce myself as Dr. MD2B, I'm the resident taking care of you. Dr. White is the attending, he's leading the team taking care of you. The problem is the average lay person has no clue what a resident, intern, attending is. My non-medicine friends have no clue what I'm talking about if I say 3rd year this, resident that. I don't think a resident introducing themself as a doctor is disingenuous because they are, they have an MD degree. A medical student can not and should not.
I also see a lot of discussion on this forum talking about NPs and residents and how they know more than the residents and the medical students. I'd like to say I 100% agree. From my own personal experience the NPs I work with could wipe the floor with me, not to mention the ICU nurses. They save my butt all the time... but this is not a fair comparison. The correct comparison is the nursing student and the medical student, not the nurse and a student. Some nurses and NPs have years and years of clinical experience while a medical student is still learning. Residents are physicians in training, they can not practice independently and they are also learning from attendings and NPs. I don't think you do justice to your argument comparing yourself to students and trainees. NPs should compare themselves to PCPs since that is the niche they feel that they can occupy.
In this meta-analysis, all of the NP's were working with a physician, the patients were overwhelmingly urban and of a minority status, and the measurements were heavily weighted to SUBJECTIVE patient self-reports of well being.
Focused on neonatal ICU's, and delivery results of CNM's. Clearly, the NICU's have supervising medical directors (no NP autonomy in this setting.) CNM's, while technically NP's, serve a healthy and self-selected population....and pregnancy is not a disease.
from the article: "NP's managing relatively simple ailements without the supervision of a doctor may also allow doctors to work on cases where advanced training has a larger marginal impact on patient health." ie.....NP's handle the routine so that doc's can manage the "zebras".
The point has NEVER been about the value of NP's in collaborative settings; it is the issue of independant practice. NP's (and PA's, for the same reasons) are not trained or educated enough to practice alone, without the resource of a supervising physician and the ability to reach out for support. They may make patients (or the patient's parent) FEEL that they are healthier and happier, and in most cases, that is great. BUT far too many mass-produced NP's attempt to play above their own league, and that can be dangerous.
I think if everyone was to be completely honest the real crux of the independent practice issue is money. If the MD/DOs lose the ability to supervise the NP/PAs then it's a big hit to the wallet.
The biggest joke is the collaborating docs that do a "chart review" for NP clinics once a quarter where they flip through 3-4 charts in an hour and collect their $15k.
It seems so silly that we're having this argument. The research shows that NPs are as effective as MDs in primary care. I don't get why people, especially nurses, are arguing this point.
I may have somewhat agreed until I read the recent debate on here- beside nursing vs. non bedside nursing NP's: the thought that NP's do not need to practice at the bedside first, as they do not function in the role of a nurse, they function more as a provider.
Maybe I am old school as well. As someone else stated, I see an NP for non urgent issues, or when i'm certain of the diagnosis. Something I'm uncertain of, i want to see my physician.
blondy2061h, MSN, RN
1 Article; 4,094 Posts
Because their training is foot specific, they don't learn EKG interpretation or neurotransmitter action or COPD management because you don't need to know it to treat tinea or plantar fasciatis.