Just because someone is able to complete NP school and then pass boards does not make them independent thinkers. I have found many NPs that are VERY confident in their patient care and then I have known many who unfortunately for our profession...are just glorified nurses with advanced degrees. When I first started practicing in my community, I had to deal with physician ignorance. Most had NPs working FOR them, but were not seeing patients truly independently. As I continued growing my patient base, these physicians began to see me as an integral part of the health care community and IF I referred a patient to a specialist, they knew I had done everything I could for that patient but they needed more. My referrals...cardiologists for stents, caths, bypass...etc.; orthopedists for replacements; surgeons for surgery; oncologist for cancer. I have yet to refer a patient to an endocrinologist or pulmonologist.