Physician Hostility

Why are so many physicians threatened and hostile toward NPs? What are the strategies in dealing with these types of professionals,and in what ways can we make it easier to practice together?

For one thing you can tell your state nursing boards to quit encroaching on the scope of MD work.

Its no wonder MDs are mad. With the stroke of a pen and nothing more, nursing boards are directly competing against them.

NPs would be spitting mad if there was a bill in the state legislature to give PAs independent practice rights. Everybody tries to protect their turf, including MDs, PAs, and NPs.

Why are so many physicians threatened and hostile toward NPs? What are the strategies in dealing with these types of professionals,and in what ways can we make it easier to practice together?

Hi Blake.

I'm fortunate that i've had minimal if any hostility. I also first worked as a house officer role so I was working to 'help' house docs manage their patients off hours. This made the docs more familiar with me as a person and a practitioner. I have made it a point now in private practice to consult subspecialities and always note in my progress note "so and so help appreciated ". If i see the doc in person i will also thank them. We have a 'doctors' lounge and i will swing by on my way in and out and converse with whoever is there. If i send one of my patients to a doc as an outpatient i will always write an introductory letter before hand and send my latest exam. What has been nice is that now some docs will write for me specifically for a consult. Now, there is one doc who would always change whatever antibiotic i ordered when i covered him and i think overall he is just inept and threatened. He treats the staff nurses like idiots they outshine him daily. The payback?? If someone is looking for a new PCP I will never recommend him.

Why are so many physicians threatened and hostile toward NPs? What are the strategies in dealing with these types of professionals,and in what ways can we make it easier to practice together?

I am an RN (prospective NP) working in a University hospital where the doctor NP relationship works very well. I guess much of the MD to NP relationship is based on over all setting. At an academic teaching center, the is no competition for the almighty $$$... maybe that's why they no one fights here.

The reason that physicians are hostile toward NP's is that NP's attempt to seek more autonomy when their training does not prepare them to be solo providers. The pathophysiologic knowledge necessary to be a medical provider is simply well above that taught in any NP program. At least in PA school they teach the basics of the medical model, and they humbly agree that they need supervision to provide the best care. NP's will slowly alienate all state medical boards to the point that the they will push them to urge legislators to repeal the current nursing practice acts. NP's should simply learn that they serve an important role, but one that should be supervised. NP's will only cut off their own tails if they continue to seek autonomy.

Simple jealousy and competition.

Hap, and PAC does that mean that if NP programs added another thirty hours or so in additional classes such as gross anatomy, and advanced, advanced (since many already have advanced patho) pathophysiology that you would be satisfied and agree to more NP autonomy? Don't get me wrong, I do NOT blaim you for opposing the expansion of NP autonomy, just be honest and "keep it real". Every profession seeks to protect, and at the same time expand it's "turf". It is intrinsic in our economic system from accountants and appraisers to zoologists and zoo-keepers. At the same time almost none of these groups will admit their true motivations (and yes this probably includes NP's from time to time also). M.D's will wage a legislative, and PR war with NP's. Sometimes they will win, and sometimes they will lose (other times it will be a stalemate). NP's can appeal to HMO's, insurance companies, government, and hospitals that they are safe, and COST EFFECTIVE (in a setting of health care inflation that runs double to triple the rate of overall inflation in the overall economy). On the other hand M.D's can appeal to tradition, and the great trust that the public tends to place in them (as well as rely upon long established political contacts, and considerable economic firepower). It will be an interesting contest, but don't pretend it is something other than what it actually is, a battle rooted in our economic history and intrinsic to our economic system.

MDs and PAs...sorry to tell you this but every study I've seen show that NPs provide care as safe and more cost-effective as MDs. Deal with it!

which studies are those???

I work in a teaching hospital.

I have not experienced doctor hostility just because I am a NP. The hematology physicians I work with created the NP position ...it was THEIR idea to hire a NP...and I believe it is working out well. Doctors in other specialties have been courteous and professional when I send patients for consult. Any negative vibes that I have had, have come from staff nurses, notably the ones who have been practicing 20+years.

A commentary from one of my colleagues written when we were in NP school and had to f/u and analyse current healthcare events:

"CNN.com dated January 5, 2000, written by CNN's Rhonda Rowland.

The article entitled: Study: Nurse Practitioners equal to doctors in some cases: was taken from a study published in the first week of January, 2000 in the Journal of the American Medical Association or JAMA for short. The study was done and involved 1,316 patients who visited a hospital emergency/urgent care within the Columbia Presbyterian system. Of these people, 510 were assigned to doctors and 806 were assigned to NP's. Most of the people involved in the study were Hispanic women in their 40's. The study spanned over a six month period. It was found that the patients in both groups were equally as satisfied with their care.

I felt this study and article were of great significance to the continuing advancement of ANP's. First of all, it went on to educate the public about what Nurse Practitioners do. Second, it validated the 65,000 nurse practitioners working in the U.S. regarding their role in the current healthcare system. The article also addressed similar findings among over 100 other studies suggesting the same thing; that patients are satisfied with the care NP's give; that NP's tend to spend more time with their patients; that the two groups had similar rates of referrals to other healthcare practitioners; and that NP's patients "fared as well medically". "

It would be interesting to see a study that examined patient outcomes as defined by morbidity and mortality among patients admitted to acute care facilities with similar diagnoses over a wide geographic area treated by M.D's, N.P's and P.A. respectively. The ideal way to conduct such as study would be to have an independent organization (at least in theory) such as the GAO or surgeon general, conduct such an analysis. Another option might be to bring leading nursing and physician organizations (or at least their publications) together to decide upon study parameters. Of course no amount of research would change the conflicts inherent between these interest groups in the forseeable future. Here's the thing if NP's can prove that they are even in the same BALLPARK in safety as M.D's then they can make a persuasive economic argument for increasing their usage in the current environment of medical hyper-inflation. At the very least this might produce a counter-trend among physicians to bring back G.P's (which are viewed by other M.D.'s about like witch doctors) and halt the ever increasing trend towards medical specialization. Keep in mind that for YEARS the AMA attempted to marginalize D.O's. with varying degrees of success (both from a PR and legislative perspective). When they decided that they couldn't "beat" them, they basically incorporated them into the ranks of physicians.