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?
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.
So why do you think NPs want to have independent practice right?
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.
I work in a variety of settings providing anesthesia, and I work with all of the aforementioned type of providers in the hospital and 2 of the 3 in outpatient surgery centers.
The real issue here is when nurses decide to use the title doctor. It seems to aggravate some physicians to no end. It has nothing to do with safety or confusing patients. It has to do with egos. It took me 8.5 years of formal schooling to earn my Doctorate and if I want to use it in the clinical setting I don't believe there should be a barrier to me using that title as long it is put in context (i.e. Dr. x nurse anesthetist).
I have worked residents and medical students for a number of years, and most residents that I have worked never bother to inform the patient that they are residents. I have also seen a number of medical students lead patients to believe that they are physicians.
Dental and medical school are only alike in the first 2 years, and after that they are vastly different schools.
There is absolutely no reason that NPs cannot function independently. Physicians assume they should be in charge of everything, but there is no benefit to physicians to be in charge of NPs or other APNs. There is not one scientific study that shows a benefit to physicians leading APNs.
I always wondered what class or formal education/training do physicians think they received that makes them capable supervisors. Physicians are often the worst supervisors, because often they automatically assume everyone that is not a physician should do whatever they want/say and physicians often assume they are often right when they are not.
I would argue in the academic setting I 100% agree with you. Anyone who has a doctorate has earned the right to be called Dr So and so. However, in healthcare this can be confusing and it isn't appropriate. For the average patient, doctor = physician. When a close family friend was hospitalized he did not insist on being called Dr despite his PhD in economics. But this was his choice. For APNs, since they are healthcare workers, referring to yourself as doctor with patients and other healthcare workers is misleading. If APNs want a title to acknowledge their work and higher learning, I think it's completely justified but it should not be doctor in the clinical setting. Blame the patients and society.
You are right in that it is very confusing for the public, and advanced healthcare providers of all backgrounds too. I would argue, physicians who do not have a doctorate should no longer entitle themselves as "Dr. So-and-so, but rather as "Physician So-an-so".
Perhaps not now, but down the pipe, this titling of advanced healthcare providers will need to be sorted out. How can the public know when we ourselves are uncertain.
Just a thought...
BM and BMS get the title "Physician"
ARNP get the title "Nurse Practitioner"
Medical Doctorate (physician) keeps the title "Doctor"
Nursing Doctorate gets the title "Advanced Practitioner"
Anyone without a medical doctorate gets the title "Doctor of So-an-So"
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.
The NP should step aside? And let the physician do the job?? Why on earth would this take place when the NP is more than qualified??? Please tell me you are not a nurse. Please.
NPs are just as competent as Physicians. Docs are feeling threatened where there is truly no need. They don't want people to confuse and NP for an MD, but the fact is that NPs are proud to be NP and I've never met one that has said to me that they were a doctor- even though that is exactly what they are. We really have to get over this hump. No one should be saying that one is better than the other, and neither should one be saying that they're not equal. Doctors collaborate with one another on their own, why would an NP not collaborate with a Physician if the need was present?
Your license and credibility are on the line. You're going to give the best care you possibly can- whether you went to school for twelve years or eight. Seriously, stop fighting against common sense.
Now I do feel than an NP straight from school should probably have supervision for some length of time, maybe a couple of years. That just makes plain sense to me. Med Students do the same thing. There's nothing wrong with that. You learned it, now prove yourself in practice to make sure that you are competent on your own, but after that- Free Willy!!!
NPs are just as competent as Physicians. Docs are feeling threatened where there is truly no need. They don't want people to confuse and NP for an MD, but the fact is that NPs are proud to be NP and I've never met one that has said to me that they were a doctor- even though that is exactly what they are. We really have to get over this hump. No one should be saying that one is better than the other, and neither should one be saying that they're not equal. Doctors collaborate with one another on their own, why would an NP not collaborate with a Physician if the need was present?
Your license and credibility are on the line. You're going to give the best care you possibly can- whether you went to school for twelve years or eight. Seriously, stop fighting against common sense.
Now I do feel than an NP straight from school should probably have supervision for some length of time, maybe a couple of years. That just makes plain sense to me. Med Students do the same thing. There's nothing wrong with that. You learned it, now prove yourself in practice to make sure that you are competent on your own, but after that- Free Willy!!!
When I complete my BSN to DNP program I will have 1080 clinical hours from a 3 year program. Not all programs are the same. There are choices in providers so that those who only care to see physicians are able to do so. If however, you only care to see a physician then please do not complain if you are not able to be seen the same day that you call.
"In the face of physician opposition, Connecticut lawmakers have passed a bill allowing nurse practitioners (NPs) and other advanced practice registered nurses (APRNs) to work independently after a 3-year collaboration with a physician there.The Connecticut House okayed the measure 110 to 34 Monday after state Senate approval earlier in April..."
"In the piece, titled "Nurses Are Not Doctors," Dr. Jauhar pointed to a study published in Effective Clinical Practice in 1999 reporting that patients assigned to NPs underwent more diagnostic imaging than those under a physician's care (the difference was statistically significant, which was not the case for many other NP–physician comparisons)."
"Dr. Kopanos took issue with Dr. Jauhar's extrapolations from the 1999 article in Effective Clinical Practice. She noted a design limitation identified by the authors themselves: Diagnostic imaging for NP patients could have been ordered by physicians as well as NPs, yet the study did not break that out. She also surmised that NPs might have indeed ordered more diagnostic imaging because they more closely adhered to national screening guidelines for certain classes of patients than physicians."
Specializes in Pain, critical care, administration, med.
And nope, all the docs/residents I work with were trained here in the U.S. and have doctorates. Which is why they're called doctor.
Usually physicians have bachelor degrees. Some have masters and it's usually a MHA or MBA. Nurses have a higher level of academic education then most MD's
The attitude and behavior of some is enough to make me move my my providers to NPs. They may not want to see NPs...some of the comments there make me not want to see them.
I'm not worried about their opinion because again...just an opinion. The facts are the facts...they are backed by studies.
Gluteus
51 Posts
So why do you think NPs want to have independent practice right?