Should NPs become COMPLETELY independent?

[BS, NP]

wow....there are some well-informed folks on here.....yeah...no one should be downplaying another profession......that doesn't help.....I think it is truly a semantic debate here....be it DOCTOR is a professional title but we all know a euphymysm for a medical caregiver.......who here has not been called 'doc' by your patients???...but....who should be called physicians?? some seem to think we should.....well, if we're arguing for rights as advanced practice nurses why would we WANT to be called a physician....we have to be careful what we are asking for here....it is becoming a slippery slope.....we may lose the support of those who are well established and on our sides....we are NOT physicians....some NPs argue that doctors of chiropractic and optometry carry the title physician while they don't fully care for the entire patient in the same medical manner.........let the non allopathic and osteopathic practitioners of optometry and chiropractic have the title I suppose....traditionally they always have.....fighting for the same or similar RIGHTS is a different story....

I've been giving it alot of thought and really trying to see the big picture......people are getting so hung up on titles and credentials and wording and program curricula......arguing who's better a PA...an NP.....a physician...??? I used to have the theory that if you took an NP, a PA and a physician right out of school.....I think the physician is hands down more prepared, more skilled, more educated.......but, 10 years 15 years down the road....how much does experience and insight and continued learning and study develop each practitioner? could the PA end up being the brightest and most informed and best medical decision maker...?? yes, I think so....could it be the physician, the NP? sure.....doesn't it depend on all kinds of factors that take priority after education? drive? ability to integrate knowledge and medical literature? experiential and acuity exposure in practice? etc...etc.....

I think the definition on this site sums it up well........ A Nurse Practitioner (NP) is a registered nurse with advanced academic and clinical experience in diagnosing and managing most common acute and chronic illnesses either independently or in collaboration with a physician.

we just want to do what we are doing and be who we are and be rightfully recognized and legitimized for it, no???

no we don't have the same training as physicians.....could we safely take on the primary care needs of the population.......sure.....I think we could..........aren't we pretty much doing that now.....as it is....???? won't we still call on our physician and NP and PA colleagues for insight and expertise and experience when ours falls short.....???? yes...I think we will.......

I guess I kind of enjoy basically being independent and still legal having an attachment to a physician who in many cases knows more than I do......

I guess I don't need to be able to say I'M INDEPENDENT to boost my ego.......while some seem to have that need.....

I've heard some folks make a few decent arguments as to why dissolve of collaborative practice agreements is a good and/or founded thing......such as: a rightful move based on our experience and quality and scope of practice; would free up care for those who have independent clinics should something happen to their physician supervisor (death or move or stop practicing)

I guess the facts are coming in and I'm still on the fence......

can anyone else offer other reasons for why this move is so necessary or deserved....???? thanks........

[dgenthusiast]

Simple answer to the question of whether NPs should become completely independent: No. But that's not how politics works. I believe there are a number of states that already allow independent practice though, from what I understand, from the population of NPs, it's very few that practice independently without any physician oversight (correct me if I'm wrong about that).

[Spacklehead, MSN, NP]

What I find interesting is that many docs don't want NPs to be independent. They would rather have the NP collaborate with or be supervised by another doc. This all kind of surprises me because if I was a physician, I'd be more than happy to have NPs be independent - that way they can pay the higher insurance premiums like docs do and I wouldn't have to worry about being dragged into a lawsuit if the NP I collaborate with/supervise makes a mistake. It would be on the NP at that point to prove that they could provide competent care as PCPs. Therefore, I would think it would be in the docs' best interests to support NP independence, right? Kind of makes one wonder why they don't support NP independence then.......???

That being said, I am completely and utterly happy to collaborate with my docs. I like that I have them as someone to bounce ideas/questions off of when I am unsure of something. I have no problem with having to collaborate with a doc.

[wowza]

What I find interesting is that many docs don't want NPs to be independent. They would rather have the NP collaborate with or be supervised by another doc. This all kind of surprises me because if I was a physician, I'd be more than happy to have NPs be independent - that way they can pay the higher insurance premiums like docs do and I wouldn't have to worry about being dragged into a lawsuit if the NP I collaborate with/supervise makes a mistake. It would be on the NP at that point to prove that they could provide competent care as PCPs. Therefore, I would think it would be in the docs' best interests to support NP independence, right? Kind of makes one wonder why they don't support NP independence then.......???

That being said, I am completely and utterly happy to collaborate with my docs. I like that I have them as someone to bounce ideas/questions off of when I am unsure of something. I have no problem with having to collaborate with a doc.

This doesn't make sense. Most docs are against it because they don't think NPs have enough education. Instead of granting NPs independence and letting them loose on the population before there is appropriate data, shouldn't we show they can provide equivalent care? We wouldn't start prescribing a new class of hypertension med without any data to back it up. So, IMO before NPs become independent they should have to prove they can provide equivalent care to PCPs (and we are talking multicentered, over at a minimum 5-10 years). There is inadequate, incredibly biased data out there currently. Until it is shown that NPs, despite 1/10th the education of a physician, can provide equivalent care, NPs should not be independent. But clearly the politicians know a lot more...

[Spacklehead, MSN, NP]

Funny that it doesn't make any sense - as an OB/GYN said something very similar to me the other day while we were discussing NP independence. He stated he was all for it also (especially for midwives), for very similar reasons as I mentioned above.

[Spacklehead, MSN, NP]

Oh, and I think it makes perfect sense. As a doc - would you want someone who you think doesn't have enough education to safely take care of patients to collaborate with you? I sure wouldn't, and I'm sure the docs who do hire NPs strongly believe that they have the education to take care of those patients competently.

[Sugah Britches]

I think it is truly a semantic debate here....be it DOCTOR is a professional title but we all know a euphymysm for a medical caregiver.......who here has not been called 'doc' by your patients???...but....who should be called physicians?? some seem to think we should.....well, if we're arguing for rights as advanced practice nurses why would we WANT to be called a physician....we have to be careful what we are asking for here....it is becoming a slippery slope.....we may lose the support of those who are well established and on our sides....we are NOT physicians....some NPs argue that doctors of chiropractic and optometry carry the title physician while they don't fully care for the entire patient in the same medical manner.........let the non allopathic and osteopathic practitioners of optometry and chiropractic have the title I suppose....traditionally they always have.....fighting for the same or similar RIGHTS is a different story....

Yes it is semantics but it is in the semantics that confusion and misunderstanding occurs.... A physician is a Doctor of Medicine...

Can a nurse be a physician? NO.. not unless they attend and graduate medical school

Can a nurse be a Doctor? Yes.. The field of medicine does not solely own the distinction of Doctor... I know numerous PhDs and Doctorates that would be offended at the notion a physician is the only one worthy of being called Dr.

I know that it sounds petty but clarity is necessary for effective collaboration and communication.

[dgenthusiast]

no we don't have the same training as physicians.....could we safely take on the primary care needs of the population.......sure.....I think we could..........aren't we pretty much doing that now.....as it is....???? won't we still call on our physician and NP and PA colleagues for insight and expertise and experience when ours falls short.....???? yes...I think we will.....

The problem is though, just because you think you could safely provide primary care doesn't necessarily mean you actually can. Like wowza mentioned, there are no well-done long term studies looking at this data (and these types of studies are essential in the field of primary care where it's usually chronic long-term conditions that are managed and performing a 6-month study, for example, is almost as useless as doing no study at all). There just isn't any valid data suggesting that NPs/DNPs provide care equivalent to that provided by a board-certified attending. Evidence-based decisions don't usually occur in politics though.

[wowza]

Oh, and I think it makes perfect sense. As a doc - would you want someone who you think doesn't have enough education to safely take care of patients to collaborate with you? I sure wouldn't, and I'm sure the docs who do hire NPs strongly believe that they have the education to take care of those patients competently.

Unless the NP presented each case to me (just like residents have to present to an attending in clinic), I wouldn't want a collaborative agreement. I think those collaborative agreements where 5 or 10% of charts are reviewed are worthless. Reviewing a chart is kinda worthless in and of itself. Most charts say very little and without eye-balling the patient when you have issues, what's the point? It's a personal preference but I wouldn't want a collaborative agreement.

Can a nurse be a Doctor? Yes.. The field of medicine does not solely own the distinction of Doctor... I know numerous PhDs and Doctorates that would be offended at the notion a physician is the only one worthy of being called Dr.

I know that it sounds petty but clarity is necessary for effective collaboration and communication.

No self respecting PhD would ever go into a hospital and claim they are a doctor. The title Dr in a clinical setting should only be reserved for physicians.

[Sugah Britches]

No self respecting PhD would ever go into a hospital and claim they are a doctor.

Well, they would never claim to be a physician. But you are right. The problem lies in the general populations perception, in the language of most laypersons ( in the US) Physician and Doctor are synonymous. With the introduction of the Doctorate degree in other fields of health care it is obvious that a distinction is necessary.

I firmly believe that if a person has invested the time and effort to obtain a doctorate degree then they are entitled. I don't think that anyone with a DNP , PharmD or DPT wish to portray themselves to be anything other than their said profession. Where the battle line is drawn is when some Physicans' purport that the MD is the only one that should be able to use the title, it often comes across as a position that a medical degree is the only REAL doctorate degree and that all others are just an attempt by those of lesser intelligence (can't get into med school) to deceive the patient population and put them at risk. It is insulting and naturally puts others on the defense.

Addendum: I AM NOT IMPLYING THAT YOU HAVE MADE THIS INSINUATION OR DEGRADED THE ACADEMIC ACHIEVEMENTS OF OTHERS!

[elkpark]

I think those collaborative agreements where 5 or 10% of charts are reviewed are worthless. Reviewing a chart is kinda worthless in and of itself. Most charts say very little and without eye-balling the patient when you have issues, what's the point?

I completely agree with you, but would submit that the existence of these "collaborative agreement" requirements with such limited requirements about supervision is basically a covert acknowledgement of the ability of NPs in those states to practice independently -- the "collaborative agreement" is just the final "fig leaf" covering up the reality of, essentially, independent practice. I would guess that many of those states will eventually do away with the "collaborative agreement" requirement and just allow independent practice, which seems to be the general trend nationally. :)

[zenman]

No self respecting PhD would ever go into a hospital and claim they are a doctor. The title Dr in a clinical setting should only be reserved for physicians.

I've worked in rehab settings and the psychologists would always introduced themselves as, "I'm Dr. Smith, I'm a psychologist." They all seemed self-respecting, lol!