Women's Health vs Family NP

Jory, MSN, APRN, CNM · Jun 7, 2013

Babies are delivered all over the country by family practice physicians. Even c-sections are done by FPs. Everything does not center around urban utopia.
Again, no offense intended but you are showing that you really don't understand advanced practice.

No hospital around here would let a general practice physician perform a c-section. If a woman comes in that has been seeing a GP for prenatal care, typically the general surgeon will do the c-section of needed. I have NEVER seen a GP do surgery on anything. They are not trained surgeons.

You apparently do not understand the concept between "generalist" and "specialist" and somehow, under the mindset that the knowledge and training is the same.

Amazing.

I have seen first hand, the damage a generalist will do when trying to perform care when the patient should have been referred to a specialist.

allnurses Guide · Jun 7, 2013

What I was told is that for example, it is entirely appropriate for an FNP to do a basic pap on a patient, even a colposcopy if necessary, however, it would not be appropriate, let's say, for an FNP to monitor a patient throughout a pregnancy.
Most people that are going for their FNP plan to work in a specialty versus general primary care...so if it were me, that would be an important aspect to find out.

Jory, appreciate your enthusiasm, but you are spreading misconceptions. You are speaking to issues that are above your education and experience level, and sadly, you were led astray by other individuals.

As for the first statement, it is entirely acceptable for an FNP to follow a woman through her entire pregnancy, in fact her entire lifespan. FNPs are educated on prenatal care and lactation, and the national board exams test the FNP on these subjects, providing verification of competence in these arenas for entry to practice.

As for your second statement, also false. The majority of FNPs work in primary not speciality care.

Enthusiasm is a great thing, but if it gets you over your head, it can become problematic.

nomadcrna, DNP, CRNA, NP · Jun 7, 2013

Your limited experience is really showing.

Just because you have not seen it, does not make it fact.

Below is what is called evidence based medicine. You will become proficient in EBM if you further your education. The reason i seem offended is that I'm tired of non-APN coming in here and giving their "opinion" or what "they heard".

BTW, it is individual states that dictate how we practice.

So what do you say now? So who does not understand what various specialties do?

Family Practice IS a specialty.

Some other surgeries that I have personally done anesthesia for(by family practice) include c-sections, hemorrhoids, appendectomy, vasectomy, tubal ligation, circumcisions.

I bet you will really foam at the mouth when I tell you that there are FNPs that do colonoscopies! Oh my

I even do minor surgical procedures as a FNP.

Outcomes of cesarean sections p... [J Am Board Fam Pract. 1995 Mar-Apr] - PubMed - NCBI

Cesarean Delivery in Family Medicine (Position Paper) -- AAFP Policies -- AAFP

J Am Board Fam Pract. 1995 Mar-Apr;8(2):81-90.

Outcomes of cesarean sections performed by family physicians and the training they received: a 15-year retrospective study.

Deutchman M, Connor P, Gobbo R, FitzSimmons R.

Source

Department of Family Medicine, University of Tennessee, Memphis, USA.

Abstract

BACKGROUND:

Family physicians are the major or sole providers of Cesarean section services in many communities. Approximately 2800 family physicians provide Cesarean section services in communities of all sizes across the country.

METHODS:

The outcomes of all Cesarean sections performed at two rural hospitals during a 10- to 15-year period were examined and compared with standard quality-outcome criteria published in the medical literature. Outcome criteria included rates of various surgical complications, use of blood transfusion, infant Apgar scores, and length of postoperative hospital stay. Other descriptive data were examined including patient demographics, operating time, anesthesia type, and choice of incision. Statistical analysis consisted of chi-squares, odds ratios, and stepwise multiple regression.

RESULTS:

Five hundred sixty-three Cesarean sections were performed by 12 residency-trained family physicians, 68 by general practitioners, 70 by general surgeons, and 9 by obstetrician-gynecologists. Family physicians met or surpassed the referenced standards in all measures examined. The number of Cesarean sections each physician performed while in residency training was also examined. The average number of in-training Cesarean sections was 46, ranging from 25 to 100.

CONCLUSIONS:

The results of this study support the ability of family physicians to provide Cesarean section services based on a wide range of training backgrounds and variable numbers of procedures done in training.

OVERVIEW AND PURPOSE

Obstetric care for patients is an integral part of many family physicians’ scope of practice and remains an important component of family medicine residency training.^1,2 An American Academy of Family Physicians (AAFP)/American College of Obstetricians and Gynecologists (ACOG) Joint Statement asserts that access to high-quality maternity care is an important public health concern in the United States.³ A cooperative and collaborative relationship among obstetricians, family physicians, and nurse midwives is essential for provision of high-quality care for pregnant women. The most important objective must be the highest standard of care regardless of specialty.

Family physicians provide substantial perinatal care in this country, especially to rural and underserved populations, delivering 100% of the babies in some geographic areas. Obstetric services provided by family physicians have declined in the past decade, with only 23% providing deliveries and fewer than 10% providing prenatal visits.^4,5 The Future of Family Medicine Project first outlined the broad spectrum of services that family physicians will be expected to provide to renew the specialty and meet the needs of patients and society.⁶ Comprehensive accessible care is further described in the more recent Patient-Centered Medical Home (PCMH) model promoted by the AAFP and other organizations.⁷ Operative deliveries and other advanced perinatal services are ideally suited for this model of comprehensive care, which involves extended or more advanced services.

Several factors contribute to current and future demand for routine and advanced maternity care services by family physicians. To provide the appropriate access to care that all women deserve,²the following must be considered: Rural areas rely on comprehensive perinatal care provided by family physicians, including cesarean delivery.^8,9 A high percentage of family physicians in rural areas provide obstetric care (e.g., 46% in the West North Central United States).⁵

The cost of medical malpractice insurance has continued to increase and remains a major factor in obstetrician/gynecologist’s career dissatisfaction.¹⁰
Obstetricians increasingly are choosing subspecialty careers, dropping obstetrics from their practices, retiring early, or practicing in areas that are already well served.^11-13
Cesarean delivery rates in this country are at an all time high of more than 31.1% of all deliveries, having risen 50% over the past decade.^14,15

Cesarean delivery is one of the most common surgical procedures. According to the CDC approximately 1.3 million cesarean deliveries are performed in the United States annually. Despite the use of risk assessment systems and protocols, the need for cesarean delivery can arise suddenly and unpredictably during the course of labor. An essential component of modern perinatal care is the prompt availability of surgical intervention without the need to transport the patient.

Provision of cesarean delivery by well trained family physicians augments services available to women, in some places providing additional options for care, and in other places providing a service that would not otherwise be available. Regardless of specialty, there should be shared common standards of perinatal care. Quality patient care requires that all physicians practice within their ability as determined by training, experience, and current competence.³Given that many family physicians currently perform cesarean deliveries and many continue to be trained for this service, it is important that there be a common understanding of the place for cesarean delivery as part of a family physician’s scope of practice and as part of the health care delivery system.

This document should serve as a resource for family physicians who are training for and planning to include cesarean delivery in their practice. It also will assist hospital and health plan credentialing committee members and administrators, obstetricians, midwives, nurses, and other clinical staff to understand the role of family physicians in providing cesarean delivery in their practice of medicine.

SECTION II - SCOPE OF PRACTICE FOR FAMILY PHYSICIANS

Family medicine is a specialty based on comprehensive care encompassing a breadth of medical services. Family physicians practice among diverse populations and in geographically varied, often remote, settings. Family physicians choose their personal scope of practice based on their experiences in training, practice interests, and the needs of their practice populations. Broadly speaking, the following indicate the extent to which cesarean delivery is within the current scope of family medicine practice:

A joint AAFP/ACOG statement recommended core educational guidelines, and a joint statement on hospital privileges affirms that surgical delivery is within the scope of family practice.^1,3
About 4.3% of active AAFP members, or 4,000 family physicians, perform cesarean delivery. In predominantly rural areas, such as the West North Central region of the United States, an average of 15.3% of family physicians perform cesarean deliveries.¹⁶
Among family medicine residencies, 55% provide cesarean delivery training.¹⁷
Nationally, about 25 family medicine fellowships in obstetrics exist, many of which specifically seek to train family physicians to perform cesarean delivery independently.¹⁸
More than 2,000 U.S. family physicians have hospital privileges to perform cesarean delivery.¹⁹

Published data document that cesarean delivery care provided by family physicians in active practice or in training can meet or exceed national standards for maternal and infant outcomes.^19-21 In addition, there is some evidence that women who receive their perinatal care from family physicians have lower cesarean delivery rates than patients cared for by obstetrician/gynecologists.^21,22 This is important for social and financial reasons and because surgical delivery carries a significantly increased risk of maternal morbidity and mortality over lady partsl delivery. There is much written on the indications for cesarean delivery, but the indications most commonly given are listed in the Appendix, Table 1.^15,19,53

No hospital around here would let a general practice physician perform a c-section. If a woman comes in that has been seeing a GP for prenatal care, typically the general surgeon will do the c-section of needed. I have NEVER seen a GP do surgery on anything. They are not trained surgeons.
You apparently do not understand the concept between "generalist" and "specialist" and somehow, under the mindset that the knowledge and training is the same.
Amazing.
I have seen first hand, the damage a generalist will do when trying to perform care when the patient should have been referred to a specialist.

britpanda · Jun 7, 2013

Pull up an WHNP program at any graduate school and then an FNP program. WHNP would be a one-year program if one semester of women's health is all that was needed.
Functioning similarly is not the same as being trained identically for the patient population you serve.
Who would you go to for the delivery of your baby? A general practice physician or a ob/gyn?

I purposefully didn't speak as to their training, only that in our office the two providers function in similar roles. Since we are reproductive endocrinology and GYN, we don't deliver babies. Perhaps it might be an idea to read someone's post thoroughly before trying to belittle their comments when they're just trying to give someone some information about one real-life situation. Geesh.

IrishIzCPNP, MSN, RN, APRN, NP · Jun 8, 2013

Just because somebody CAN do something doesn't mean they SHOULD do it.

allnurses Guide · Jun 8, 2013

Just because somebody CAN do something doesn't mean they SHOULD do it.

Should do what?

nomadcrna, DNP, CRNA, NP · Jun 8, 2013

Ok, post some evidenced based medicine that says that they should not do "it". Once again, you should educate yourself on what evidenced based medicine is. We base our whole practice on it. If the evidence did not say we were safe doing "it", do you really think we would currently be doing "it".

So, please enlighten us on what you don't think someone should be doing. Provide evidence on why they should NOT be doing it.

Just because somebody CAN do something doesn't mean they SHOULD do it.

IrishIzCPNP, MSN, RN, APRN, NP · Jun 8, 2013

Ok, post some evidenced based medicine that says that they should not do "it". Once again, you should educate yourself on what evidenced based medicine is. We base our whole practice on it. If the evidence did not say we were safe doing "it", do you really think we would currently be doing "it".
So, please enlighten us on what you don't think someone should be doing. Provide evidence on why they should NOT be doing it.

Honestly...ebm is great but there's something to be said for life experience too. For example...I'm an L&D RN and the family docs who do OB make me want to run away screaming. They can do it...they shouldn't. It's a nightmare and their patients are paying the price.

You are hung up on ebm. I get ebm. I'm in grad school...totally get ebm. There not enough evidence out there to make me comfortable with family practice doc doing OB.

IrishIzCPNP, MSN, RN, APRN, NP · Jun 8, 2013

Ok, post some evidenced based medicine that says that they should not do "it". Once again, you should educate yourself on what evidenced based medicine is. We base our whole practice on it. If the evidence did not say we were safe doing "it", do you really think we would currently be doing "it".
So, please enlighten us on what you don't think someone should be doing. Provide evidence on why they should NOT be doing it.

And if you are so aware about evidence you would know that something from 1995 isn't very impressive.

allnurses Guide · Jun 8, 2013

And if you are so aware about evidence you would know that something from 1995 isn't very impressive.

So how do you feel about this, just published two months ago.

Neggers, Y., & Crowe, K. (2013). Low Birth Weight Outcomes: Why Better in Cuba Than Alabama?. The Journal of the American Board of Family Medicine,26(2), 187-195.

IrishIzCPNP, MSN, RN, APRN, NP · Jun 8, 2013

So how do you feel about this, just published two months ago.
Neggers, Y., & Crowe, K. (2013). Low Birth Weight Outcomes: Why Better in Cuba Than Alabama?. The Journal of the American Board of Family Medicine,26(2), 187-195.

What does comparing Cuba to America have to do with anything? Nothing. Two different societies, medical training, culture, expectations....

allnurses Guide · Jun 8, 2013

What does comparing Cuba to America have to do with anything? Nothing. Two different societies, medical training, culture, expectations....

It's a system where the majority of OB cases are managed by primary care providers......